Apoptosis of a fibrosarcoma induced by protein-free culture involves DNA cleavage to large fragments but not internucleosomal fragmentation

A murine fibrosarcoma clone, Gc-4 SD, grows depending on fetal calf serum. In MTT assay, protein-free cultivation resulted in a reduction of the viable cell number time-dependently. Electron-microscopic and flow-cytometric analyses revealed that the reduction in growth was accompanied by the appearance of apoptotic cells. However, no internucleosomal fragmentation was observed even after SI-nuclease treatment. On the other hand, pulse field gel electrophoresis revealed that cleavage of DNA into high-molecular-weight fragments estimated as 50 to 150 kilobase pairs (kbp), with a peak of 100 kbp, was found in the serum-deprived cells. Large fragments disappeared from the DNA extracts when the smaller cells with high blue fluorescence with Hoechst 33342 were removed by flow cytometry, suggesting direct correlation between the large DNA fragmentation and apoptosis. The addition of aurintricarboxylic acid neither abolished the large DNA fragmentation nor inhibited the reduction in the number of viable cells. Both cycloheximide and actinomycin D enhanced the reduction in the number of viable cells as well as the large DNA fragmentation. These results suggest that apoptosis of a fibrosarcoma induced by protein-free culture involves a specific endogenous endonuclease, which may be distinct from and independent of the ATA-sensitive endonuclease producing internucleosomal DNA fragmentation.

Possible cardiac side effects of granisetron, an antiemetic agent, in patients with bone and soft-tissue sarcomas receiving cytotoxic chemotherapy

The cardiac effect of granisetron, a selective 5-hydroxytryptamine3 receptor antagonist, on 12 patients with bone and soft-tissue sarcomas treated by cytotoxic chemotherapy consisting of multiple courses was examined. Of the 12 patients, 4 showed significant electrocardiographical changes, including sinus bradycardia, integral change of P-waves, junctional escape beat, and atrioventricular (AV) block with Wenckebach phenomenon, indicating stimulatory regulation of the vagus nerve. These changes were observed in each patient after several courses of chemotherapy but not in the first course. There was no correlation between the electrocardiographical changes and the chemotherapeutic agents used or the type of tumor present. A patient with osteosarcoma showed persistent bradycardia in three courses, all protocols of which contained high-dose methotrexate. From these findings we conclude that the cardiac responses may be due to stimulated activity of the vagal efferent nerve, which is regulated reflexly by afferent nerve activity suppressed by granisetron. On the other hand, the antiemetic efficacy of granisetron was satisfactory. These results suggest that careful observation of the heart is necessary when granisetron is used, especially for chemotherapy consisting of repeated multiple courses.

[A case of thromboexclusion for thoracic descending aortic pseudoaneurysm with Behçet's disease]

A 59-year-old woman with Behçet's disease was admitted because of hemoptysis. She had undergone resection and patch closure of a thoracic descending aortic aneurysm 6 years before this current admission. The aortography after the first operation had shown a pseudoaneurysm at the operative site. In the current operation, we performed thromboexclusion with a temporary occlusion balloon in the distal thoracic descending aorta above Adamkiewicz. The post operative course was uneventful. Postoperative angiography demonstrated exclusion of the pseudoaneurysm and the patient was discharged without recurrent hemoptysis.

Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body weight but also to improve insulin sensitivity

OBJECTIVE

To evaluate the effects of walking combined with diet therapy (1,000-1,600 kcal/day) on insulin sensitivity in obese non-insulin-dependent diabetes mellitus (NIDDM) patients.

RESEARCH DESIGN AND METHODS

Subjects were divided into two groups: 10 patients were managed by diet alone (group D), and 14 patients were placed in the diet and exercise group (group DE). Group DE was instructed to walk at least 10,000 steps/day on a flat field as monitored by pedometer (19,200 +/- 2,100 steps/day), and group D was told to maintain a normal daily routine (4,500 +/- 290 steps/day). A glucose clamp procedure at an insulin infusion rate of 40 microU.min-2.min-1 was performed before and after the 6- to 8-week training program. Mean serum insulin concentrations ranged from 720 to 790 pmol/l.

RESULTS

While body weight (BW) in groups D and DE decreased significantly (P < 0.01) during the study, the amount of BW reduction in group DE was greater than that in group D (7.8 +/- 0.8 vs. 4.2 +/- 0.5 kg, P < 0.01). After training, glucose infusion rate (GIR) and metabolic clearance rate (MCR) in group D did not significantly increase; however, GIR and MCR increased significantly in group DE, from 17.21 +/- 1.11 to 26.09 +/- 1.11 mumol.kg-1.min-1 (P < 0.001) and from 3.0 +/- 0.3 to 5.3 +/- 0.4 ml.kg-1.min-1 (P < 0.001), respectively. The analysis of variance showed significant effects of exercise (time x exercise, P = 0.0005) for the improvement of MCR. Significant correlations were also observed between delta MCR and average steps per day (r = 0.7257, P < 0.005) in group DE.

CONCLUSIONS

Walking, which can be safely performed and easily incorporated into daily life, can be recommended as an adjunct therapy to diet treatment in obese NIDDM patients, not only for BW reduction, but also for improvement of insulin sensitivity.

Theoretical basis of paraneoplastic autoimmune disorders - (review)

The close correlation found between malignancies and autoimmune disorders suggests that a common pathogenetic mechanism plays a role in both disorders. Recent results obtained by analysis of V-H and V-L genes of autoreactive immunocytes reveal their oligo-clonality. They are essentially autoreactive with developmental antigens since these clones are prepared to recognize normal antigens without somatic mutations. Under the concept that immunity recognize developmental antigens as well as foreign antigens, it is conceivable that auto-reactivity is induced by an autonomy of immunocytes, when antigenic duality between self and non-self is an essential feature of immunity. In this process, autoimmunity due to malignancy is non-teleologic, since autoimmunity programmed a priori within immunocytes is expressed in an autonomic manner caused by cellular selfishness. On the other hand, paraneoplastic autoimmunity with non-immunocyte tumors suggests a mechanism differing from autonomic expansion of immunocytes. In order to explain this phenomenon, there are two possibilities: the first is that tumor cells secrete immune molecules including immunoglobulins and the second is that so-called antigen drive is related with curious MHC expression of tumor cells, with or without molecular mimicry due to somatic mutations. Both mechanisms are essentially non-teleological.

[Pseudoaneurysm of saphenous vein graft after CABG]

A 69-year-old man was admitted because of angina pectoris and thoracic descending aorta aneurysm. Staged operations were planned. First, he underwent CABG (coronary artery bypass grafting) with SVGs (saphenous vein grafts) to #4 PD, #7 and #12. Aprotinin was administrated to reduce blood loss. The routine postoperative graft angiography and enhanced CT showed a pseudoaneurysm in the SVG to #4 PD. We planned an elective operation of pseudoaneurysm repair and graft replacement of thoracic descending aorta. Also in this second operation, continuous infusion of aprotinin was started after the induction of anesthesia. About 30 minutes later, he suddenly fell in shock and cardiac arrest. Partial cardiopulmonary bypass was established and median sternotomy was performed. In the mediastinum, no bleeding was found. We found out a bleeding point of the SVG to #4 PD and a hemostatic clip on the right ventricule, and closed the bleeding point with suture. The cause of the pseudoaneurysm seemed to be defluxion of the hemostatic clip for a side brunch of the SVG. The cause of the preoperative shock may be an anaphylaxis to readministrated aprotinin.

Multiple neurilemmoma in both legs. A case report

A Japanese man, who was 61 years of age, presented with multiple neurilemmoma in both legs which had arisen from different levels of both sciatic nerves. There were no clinical findings relating to von Recklinghausen's disease in the patient or his siblings. Multiple neurilemmoma may be the result of embryonic metameric anomalies. The condition may be distinguished from von Recklinghausen's disease by the distribution of the lesions and genetic analysis.

Amino acid phosphatase activity of alkaline phosphatase. A possible role of protein phosphatase

Alkaline phosphatase (ALP) hydrolyzed phosvitin and amino acid phosphates demonstrating nonisotropy at different pH. Orthovanadate, a protein phosphatase inhibitor, more specifically inhibited the serine and tyrosine phosphatase activities of ALP than that of threonine phosphatase at concentrations > 0.1 mM or 0.01 mM, respectively. Calyculin A and okadaic acid at increased concentrations increased ALP amino acid phosphatase activity. Bisphosphonates, such as disodium-1-hydroxy-1-aminopropylidine-1,1-diphosphonate (APD) and ethane-1-hydroxy-1,1-diphosphonate (HEBP), at increased concentrations, inhibited ALP amino acid phosphatase activity. These results suggest that ALP may function as a protein phosphatase. In terms of protein kinase inhibitors, N-[2-(methylamino)ethyl]-5-isoquinolinesulfonamide, N-(6-aminoheyxl)-5-chloro-1-naphthalenesulfomide hydrochloride and 4',5,7-trihydroxyisoflavone had little effect on ALP amino acid phosphatase activity. Staurosporine slightly enhanced ALP serine and threonine phosphatase activities at a concentration of 0.1 mM. These results suggest that protein phosphatase activity does not depend on the protein kinase activity of ALP, since duality between the former and the latter is not supported. ALP may function less as a protein kinase than as a protein phosphatase. The coupling mechanism of phosphate dynamics may be regulated indirectly.

[Elderly non-hemophiliac patient with factor VIII inhibitor presenting various type hemorrhages]

A 81-year-old man who had been healthy without any history of abnormal bleeding, developed ecchymosis and hematuria in November, 1992 and was hospitalized in December, 1992. On admission, he developed widespread ecchymosis in his trunk and extremities, and subsequently ecchymosis of his cheek and neck, and also oral and pharyngeal hematoma. The laboratory data were as follows: whole blood clotting time, > 20 minutes; activated partial thromboplastin time (APTT), 108.6 seconds; Factor VIII activity, 4%. The level of Factor VIII inhibitor was high, 65.0 Bethesda Unit/ml. This inhibitor was a IgG type immunoglobulin, which had both kappa and lambda light chain. His serological and blood biochemical data of the blood were normal, and tests for autoantibodies were negative. The patient was treated with plasma exchange therapy, Prednisolone (PSL), Cyclophosphamide and Factor VIII concentrate. The hemorrhagic symptoms were improved, the inhibitor disappeared and the activity of Factor VIII returned to normal after one month. Follow-up was continued in the outpatient clinic for 5 months. After the dose of PSL was decreased, he developed bloody sputum and hematuria, and was readmitted in August, 1994. Factor VIII activity was 21% and the titer of Factor VIII inhibitor was 3.0 BU/ml. The hemorrhagic symptoms disappeared soon after increasing the dose of PSL, and the Factor VIII activity was normalized and the inhibitor could not be detected. These treatments appeared to offer effective control on severe hemorrhage in a patient with Factor VIII inhibitor.

[Bladder tumor associated with von Recklinghausen's neurofibromatosis: a case report]

A 47-year-old female was admitted to our hospital complaining of macrohematuria. The patient had a history of von Recklinghausen's disease. Her skin showed multiple cafe-au-lait spots and neurofibromatosis. Thorough examinations were done. Urine cytology was positive. Intravenous pyelography and cystography demonstrated an irregular wall of the bladder. A computerized tomographic scan demonstrated a 7 cm nodular mass. Cystoscopy revealed a papillary tumor on the right lateral and anterior wall of the bladder. She was diagnosed as having a bladder tumor in von Recklinghausen's neurofibromatosis. Total cystectomy was performed. Histopathological diagnosis was transitional cell carcinoma with squamous cell carcinoma (Grade III, pT3N2N0). Fifty three cases of von Recklinghausen's disease in the literature were accompanied with malignancy.

Calcium pyrophosphate dihydrate (CPPD) crystal dissolution by alkaline phosphatase: interaction of alkaline phosphatase on CPPD crystals

OBJECTIVE

As alkaline phosphatase (ALP) can dissolve calcium pyrophosphate dihydrate (CPPD) crystals, and as dissolution is facilitated when the enzyme is proximate to the crystals, we studied the mechanism of ALP interaction with CPPD crystals in vitro.

METHODS

ALP was incubated with CPPD crystals in an in vitro model system. Fluorescein isothiocyanate conjugated alkaline phosphatase (FITC-ALP), alkaline phosphatase product staining of calcium pyrophosphate dihydrate (CPPD) crystals and scanning electron microscopy were used to visualize ALP-CPPD crystal interactions.

RESULTS

ALP preferentially binds to the small end faces (optical 010 faces) of CPPD crystals. Etch pits indicative of dissolution were demonstrated coexistent with ALP crystal binding and ALP pyrophosphohydrolytic activity.

CONCLUSION

ALP binding to CPPD crystals is preferential for the smallest end faces (optical 010 faces). As ALP crystal binding is altered by ions but not by heat inactivation of ALP, ALP-CPPD crystal binding is considered a nonenzymatic mechanism distinct from ALP pyrophosphohydrolytic activity. Our study demonstrates that ALP binds and dissolves CPPD crystals in a stereoselective manner. This suggests that the CPPD crystal dissolution rate is limited by the availability of surface area on the crystal faces most susceptible to ALP binding.

Results of pneumoconiosis examination--different trends among industries

In this report we describe yearly changes in pneumoconiosis patients and pneumoconiosis progression in each industry in Japan, using statistics of Ministry of Labour based on the results of pneumoconiosis examinations performed at plants in accordance with the Pneumoconiosis Law. We found that the number of workers exposed to mineral dust decreased yearly. The number of subjects with positive findings, the number of new cases with pneumoconiosis, the ratio of positive findings, and the incidence rate of pneumoconiosis also decreased. In particular, the number of subjects with positive signs of pneumoconiosis clearly decreased. A similar tendency was seen in the number of cases including voluntary applications. Industry-wise, however, there was a large difference among the industries. The ratio of pneumoconiosis with complications, along with the progression ratio, decreased. Subjects with progressed pneumoconiosis decreased annually, exhibiting less-serious signs and symptoms. There have been reports with a different view about the general trend of pneumoconiosis. We examine and discuss the cause of discordance between the studies.

[Aortic valve replacement in patients older than 75 years of age]

From 1988 to 1992, 16 patients older than 75 years underwent AVR (14 cases) or AVR+MVR (two cases). All patients were followed up for an average of 2.4 years after the operation and follow-up totaled to 38 patient-years. There were no hospital death and one late death. The survival rate was 93.8% through 1 to 5 years and 15 patients are now in NYHA class I or II. The problems of AVR for elderly patients were calcification and small annulus. Decalcification using CUSA was effective technique and supraannular fixing of bioprosthetic valve avoided from aortic annular enlargement. The improved quality of life after AVR supports the aggressive surgery in elderly population.

[An outbreak of enteric adenovirus type 41 endemic in Fjieda, Japan]

To determine the incidence of enteric adenovirus, 447 stool specimens were collected between January 1991 to October 1992 from children with gastroenteritis at a clinic in Fujieda, Japan. Each specimen was tested for adenovirus group antigen and for specific enteric adenovirus types 40 and 41 (Ad40/41) by using monoclonal antibody enzyme immunoassays. Adenovirus was found in 10.7% (48 of 447) cases and 77.1% (37 of 48) of them were Ad40/41. There were two peaks of adenovirus infection May and November 1991. The virus was isolated with 293 cells from 48 of adenovirus positive specimens, and then was typed according to the SmaI cleavage pattern of the viral DNA and by neutralization with specific antisera. Ad41 was predominantly isolated in 64.6% (31 of 48), and Ad40 was in 10.4% (5 of 48). The remaining virus isolates were typed as Ad1, 2, 5, and 6. Ad41 was founded in 89.3% (25 of 28) from October 1991 to March 1992. Though Sma I and Hind III cleavage identified six Ad41 variants in the period, the variants identified from October 1991 to March 1992 were only two. The results indicated two variants of Ad41 strains caused an outbreak during the end of 1991 to early 1992 in Fujieda.

[Implications of alkaline phosphatase pyrophosphatase activity: intracellular functions of alkaline phosphatase]

We demonstrated that polyamines, such as spermine and spermidine, can enhance the pyrophosphatase (PPase) activity of alkaline phosphatase (ALP). Bisphosphonates such as disodium-1-hydroxy-1-aminopropylidine-1,1-diphosphonate (APD) and ethane-1-hydroxy-1,1'-diphosphonate (HEDP) inhibited ALP phosphate ester hydrolysis activity more than PPase activity at the same concentrations. This indicated that PPase activity of ALP was available in the presence of pyrophosphate analogues and possibly organic pyrophosphates as well. Vanadate and cadmium inhibited ALP and PPase activity more than ALP phosphate ester hydrolysis activity at the same concentrations. Calcium inhibited ALP PPase activity, though it did not inhibit ALP phosphate ester hydrolysis activity. At high concentrations, ascorbic acid slightly inhibited ALP PPase activity, though it did not inhibit ALP phosphate ester hydrolysis activity. ALP PPase activity appeared to have ubiquitous intracellular existence, broad substrate specificity and extensive interaction with calcium, vanadium and polyamines-substances which are important for cell metabolism and cell growth. These findings suggested that intracellular ALP modulated cell metabolism and cell growth by its PPase activity.

Focal obliteration of the descending aortic interface on normal frontal chest radiographs: correlation with CT findings

PURPOSE

To assess the frequency, location, correlation with age, and cause of partial obliteration of the descending aortic interface on normal frontal chest radiographs.

MATERIALS AND METHODS

Concurrent chest radiographs and computed tomographic (CT) scans of 1,500 patients in whom CT findings excluded a diagnosis of paraaortic pathologic processes were reviewed retrospectively.

RESULTS

Aortic interface obliteration was identified on 134 images (8.9%), which included 43 (2.9%) in the suprahilar and upper hilar portion, 56 (3.7%) in the lower hilar portion, and 46 (3.1%) in the cardiac portion of the interface. The causes were direct contact with or proximity to the aortic margin by pulmonary arteries at the suprahilar and upper hilar portion, superior segment vessels at the lower hilar portion, and various structures, including left inferior pulmonary vein, mediastinal fat, and left ventricle at the cardiac portion.

CONCLUSION

Partial aortic interface obliteration can be seen on normal frontal chest radiographs because of obstruction by small adjacent structures.

[Detection of group C rotavirus in the day care center]

Group C rotavirus was detected in stools of four patients from February to April, 1993. Of these patients, three were infants who were attendants of the day care center of the hospital. Although the route of viral infection has not been determined, the virus might have been spread within the center. Because the clinical symptoms of acute gastroenteritis caused by group C rotavirus were vomiting, serious anorexia and subsequent difficulty of oral intake of food, patients often required fluid administration therapy at the outpatient clinic. The symptoms continued 1 to 2 days. Diarrhea occurred 1.7 times daily for 1.2 days. Watery stool was found in 3 cases of patients, but no whitish stool was discovered. Vomiting developed 2.2 times daily for 1.2 days. These symptoms were less severe than those of gastroenteritis by group A rotaviral infection. The electrophoretic RNA pattern of group C rotavirus detected in the four cases were the same. However it was different from that of the virus strains previously isolated.

Triangular fibrocartilage in asymptomatic subjects: investigation of abnormal MR signal intensity

PURPOSE

To investigate the prevalence of abnormally high signal intensity of triangular fibrocartilage (TFC) tears on magnetic resonance (MR) images of asymptomatic subjects.

MATERIALS AND METHODS

MR images of one wrist in 70 asymptomatic volunteers (age range, 15-78 years) were evaluated for TFC high signal intensity. Findings at MR imaging and topographic parameters of each wrist studied were correlated with the subject's age. Any vertical or horizontal high-intensity slits that reached the joint surface or evidence of a perforation was considered abnormal.

RESULTS

Abnormally high TFC signal intensity was seen on images of 35 (50%) wrists. Further, a thin TFC was more often seen in subjects with positive variance, and positive ulnar variance and thin TFC were associated with high signal intensity. Age did not substantially affect the presence or absence of high signal intensity.

CONCLUSION

Since TFC high signal intensity was frequently detected in these asymptomatic wrists, MR imaging cannot reliably be used to detect clinically meaningful abnormalities.

Heterotopic expression of homeobox genes as a cause of organ specific metastasis

Organ- and tissue-specific metastases have been proposed as an alteration of invasion, translocation through vascular channels, lodgment, and local proliferation. However, experimental metastasis without tumor formation at the primary site can not be explained by these hypotheses. We hypothesize here that tumor cells heterotopically express homeobox genes as a marker of their location, and that they translocate elsewhere according to positional information encoded in these genes.

Hemodialysis for lithium intoxication: preliminary guidelines for emergency

In Japan, 9 cases of severe lithium intoxication have been treated by hemodialysis so far, and the usefulness and indications of this procedure are not yet understood fully. We have recently experienced a case of lithium intoxication treated by hemodialysis. Considering this case together with those reported previously, we have prepared some preliminary guidelines for the application of hemodialysis to patients with lithium intoxication. The blood concentration of lithium, renal function, the severity of consciousness disturbance and clinical symptoms such as somatic complications are, of course, important indices for the application of this therapy. We think that the signs of intoxication and the time interval between the onset and the beginning of treatment also serve as useful indices for application of hemodialysis.

[Effects of "low dose" aprotinin in open heart surgery and its plasma concentration]

To determine the effects of "low dose" aprotinin in open heart surgery, we administrated it in 109 cases of CABG or prosthetic valve replacement. Patients in Group A (Aprotinin) received continuous infusion of aprotinin at the rate of 6*10(5) KIU/hr from the induction of anesthesia to the start of ECC (extra corporeal circulation), and from the end of ECC to the end of blood stanching. They also received additional 5*10(5) KIU aprotinin in ECC prime volumes. 50 patients in Group C (Control) received neither aprotinin nor placebo. Bleeding after ECC (Group A: 315.7 +/- 203.1 ml, Group C: 484.3 +/- 598.5 ml p < 0.01), the first 6 hours drainage (Group A: 273.0 +/- 210.0 ml, Group C: 404.7 +/- 243.2 ml p < 0.01), the first 24 hours drainage (Group A: 510.2 +/- 248.0 ml, Group C: 721 +/- 317.7 ml p < 0.01) was significantly reduced in Group A. Amounts of homologous blood transfusion were significantly reduced in group A. (Group A: 4.7 +/- 5.3 units, Group C: 8.5 +/- 6.4 units p < 0.01). Among the patients with autologous blood transfusion, the rate of the patients without homologous transfusion was significantly higher in Group A (group A: 40/66 cases, Group C: 8/33 cases p < 0.01). The ECC time and the operation time was significantly shorter in Group A. There were 69 patients (Group A: 40, Group C: 29) whose ECC time was longer than 120 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Small bowel tumors: an analysis of tumor-like lesions, benign and malignant neoplasms

The clinical records of 72 patients with 73 small bowel tumors diagnosed over a period of 25 years were reviewed. The tumors consisted of 23 tumor-like lesions, 17 benign neoplasms and 33 malignant neoplasms, the mean size of which were 2.1 cm, 5.2 cm and 7.7 cm in diameter, respectively. The tumor-like lesions and benign neoplasms were found even in children, while the malignant neoplasms were observed in patients 43 years old or over. The most common tumor-like lesion was aberrant pancreatic tissue. The common benign neoplasms were leiomyoma, lipoma and adenoma. The malignant neoplasms consisted of adenocarcinoma, malignant lymphoma and leiomyosarcoma. Regardless of tumor type or tumor location, the lesions 4 cm or larger often caused abdominal symptoms. Most of the lesions less than 4 cm caused no symptoms, but the malignant lesions of this size in the ileum elicited abdominal symptoms in all patients. The presence of lesions was diagnosed preoperatively in 26.1% of patients with tumor-like lesions, 47.1% with benign neoplasms and 48.5% with malignant neoplasms. Resection was performed in all but one patient with tumor-like lesions and benign neoplasms. Among malignant lesions, the resectability rate was 80.0% for adenocarcinoma and 100% for both malignant lymphoma and leiomyosarcoma. However, the patients with malignant lesions showed a poor prognosis. In conclusion, it is important to recognize small bowel tumors--especially malignant lesions--as a rare but possible cause of abdominal symptoms and thereby to contribute to the early detection and successful management of small bowel tumors.

Effect of water fraction in selection of optimal TI value for STIR sequences

OBJECTIVE

This article describes the effect of the water fraction in the selection of the optimal TI value in a STIR sequence. This effect has been given little consideration in previous studies.

MATERIALS AND METHODS

Therefore, using both STIR combined with the Dixon method (opposed-phase STIR) and conventional STIR (in-phase STIR), we have investigated the effect of the water fraction in the selection of an optimal TI value for the STIR sequence.

RESULTS

Our findings have indicated that the water protons rather than the olefinic protons (-CH = CH-) play a major role in the opposed-phase effect in vivo.

CONCLUSION

Thus, it has been concluded that the most effective fat suppression can be achieved when the intravoxel phase cancellation effect between the water and lipid protons is maximal, rather than when the longitudinal magnetization of the lipid protons is minimal.

AIDS from an oncological viewpoint - paradoxical immunodeficiency by helper T-cell proliferation and senescence - review

Autoimmunity due to human immunodeficiency disease virus (HIV-1) infection may be explained by activation of the helper T cell. This phenomenon originates in the ontogenic duplicity of immunocytes recognizing self and nonself at the same time. This paradoxical behavior of the immune system is also observed in the senescence of individuals. The proliferative and functional 'stampede' of autoreactive helper T cells induced by HIV-1 may be considered as the progression of senescence or the acquisition of limited autonomy of immunity. According to this hypothesis, tumors except for T cell line tumors associated with HIV-1 infection can be explained by the secondary augmentation of other cell lines due to cytokines. It is suggestive that immunosuppressive agents with cytocidal effects on helper T cells improve acquired immunodeficiency due to HIV-1 and that these agents are effective in the treatment of malignancies associated with HIV-1 infection.

Spatial features of calcium transients during early and delayed afterdepolarizations

Although changes in intracellular Ca2+ concentration ([Ca2+]i) are spatially heterogeneous during spontaneous contraction in mammalian cardiac muscle, it has not yet been observed how [Ca2+]i changes spatially within cardiac myocytes during delayed (DADs) and early (EADs) afterdepolarizations. The aim of this study is to characterize the spatial features of the increase in [Ca2+]i during such afterdepolarizations and to understand the ionic mechanisms responsible for them. Myocytes were enzymatically isolated from guinea pig ventricles and loaded with fura 2-acetoxymethylester, the Ca2+ fluorescence indicator dye. Membrane potential was recorded with a conventional microelectrode technique, and spatiotemporal changes in fura 2 fluorescence and cell length were recorded using a digital television system. After superfusion with potassium-free Tyrode solution, DADs and EADs were induced. During DADs, fluorescence transients were heterogeneous within myocytes (n = 11). Furthermore, they often propagated within myocytes as if they were "waves." In contrast, during EADs, fluorescence transients showed no waves within myocytes but rather showed synchronous changes throughout the myocytes (n = 15). The results of this study suggest that the spatial features of the increase in [Ca2+]i differ between the DADs and EADs. We concluded from these differing features that the ionic mechanisms responsible for the two triggered activities are different.

Primary chondrosarcoma of the lung. A clinicopathologic study

BACKGROUND

Primary pulmonary chondrosarcoma is a rare neoplasm. A 73-year-old Japanese man had chondrosarcoma in the right lung. The tumor was considered to be of pulmonary origin because of the absence of extrapulmonary primary lesions for 2 years after lung resection.

METHODS

The histologic sections were stained with hematoxylin and eosin, conventional special staining, and immunohistochemical staining. The authors discussed the differential diagnosis and growth pattern, in addition to the histopathologic findings in the tumor cells. In a review of the literature, the authors compared the characteristics between the major bronchus (MB) and lung types.

RESULTS

Histopathologically, the tumor cells showed atypical cartilaginous differentiation without osteoid formation, benign or malignant-appearing epithelium, or sarcomatous components other than chondrosarcoma. The tumor showed expansive proliferation, invasion through the alveolar spaces, massive proliferation along the bronchial lumen, significant invasion into small vessels, and extrathoracic metastases. The review of the literature showed that the clinical period ending with surgical treatment was longer in the lung tumors than in the MB tumors.

CONCLUSIONS

Although MB tumors were reported to be discovered early, the invasion to major arteries or trachea often led to inoperability; however, lung tumors were considered to be resectable until they grew very large, even though the clinical period from onset to surgical treatment was longer in this type. Recent advancements in diagnostic and surgical techniques are expected to promote early discovery and improve prognosis whether the tumor occurs in the MB or lung.

The source of epifluorescence in isolated perfused heart loaded with fura 2-AM or indo 1-AM

The purpose of this study is to clarify the kinds of cells that fluoresce in isolated perfused heart intracoronarily loaded with fura 2-AM or indo 1-AM. The hearts from hamsters perfused by the Langendorff method were loaded with fura 2-AM or indo 1-AM intracoronarily. The epicardium was excited by ultraviolet light at a wavelength of 340 or 380 nm (fura 2) or 360 nm (indo 1). Epifluorescent images from arrested hearts prepared with St Thomas' cardioplegic solution were observed through an inverted microscope and taken by a still camera. Endothelial cells and pericytes of the capillaries showed intense fluorescence. In the intercapillary spaces, a less intense but still apparent fluorescence emitted by myocytes could also be detected. On the other hand, fluorescence from smooth muscle cells and fibroblasts could not be identified. Therefore, epifluorescence in the isolated perfused heart loaded with fura 2-AM or indo 1-AM was mainly generated within endothelial cells, pericytes, and myocytes. To evaluate calcium fluorescence in isolated hearts quantitatively, the fluorescence of endothelial cells and pericytes of the capillaries must be taken into consideration.

[Ankylosing spondylitis with acute anterior uveitis--correlation between HLA-B27 and clinical and radiologic findings]

Six cases of ankylosing spondylitis (AS) complicated with acute anterior uveitis (AAU) were reviewed. Clinical and radiologic findings of these cases were correlated with HLA-B27. All the patients were men; four of them were HLA-B27 positive, and two were B27 negative. The average age of onset was younger in B27+ patients than in B27- patients. Ophthalmologic study showed no definite difference in inflammatory change of AAU between B27+ patients and B27- patients. AAU in B27+ patients was completely cured in three months. A history of low back pain was more apparent in B27+ than in B27- patients. Three out of four B27+ patients showed complete bony ankylosis in sacroiliac joints, whereas no ankylosis was seen in B27- patients. CT scan was useful to demonstrate sacroilitis in cases with equivocal radiologic findings. Spondylitic changes were more extensive in B27+ than in B27- patients. The results support the concept that HLA-B27+ AS and B27- AS are different entities with similar phenotypic expression, and HLA-B27 is an arthritogenic gene in the Japanese population as well.

Expression of autocrine motility factor receptor in serum- and protein-independent fibrosarcoma cells: implications for autonomy in tumor-cell motility and metastasis

The motile response of serum-dependent (Gc-4 SD) and protein-independent (Gc-4 PF) murine fibrosarcoma cells to monoclonal antibody (MAb) that binds to gp78 a cell-surface receptor (M(r) 78,000) for an autocrine motility factor (AMF) was analyzed. The Gc-4 PF cells responded to the anti-gp78 by increased motility in vitro (3-fold) and increased lung colonization in vivo (8- to 20-fold), while the serum-dependent counterpart failed to respond to motile stimulation both in vitro and in vivo. Immuno-analysis of cell-surface expression and cell extracts revealed a smaller amount of gp78 in Gc-4 SD cells than in Gc-4 PF cells. Both cell lines secrete an equal amount of AMF to the culture media. Our results suggest that protein-free culture of Gc-4 PF cells is associated with high response to AMF and with high expression of its receptor, and that autonomous motile regulation may play a role in tumor dissemination.

Osteosarcoma with multiple skeletal metastases. A case of "nonstochastic" metastasis

Osteosarcoma of the thoracic spine developed in a 15-year-old Japanese boy. After his first admission with paralysis, multiple skeletal metastases were demonstrated in the absence of pulmonary metastasis. This rare condition may possibly be considered as a unicentric osteosarcoma with bone metastases, since there were no precursor lesions or history of exposure to radioactive materials or chemical agents. These multiple lesions may be an example of so-called "organ-specific metastasis," although this "nonstochastic" process is rare.

Effects of daily physical activity on insulin action in the elderly

The effects of daily physical activity on peripheral insulin action were investigated in aged individuals. Glucose infusion rates (GIR) during the euglycemic insulin clamp procedure in aged bedridden, aged controls, and aged athletes were compared with those in young controls and young athletes at insulin infusion rates of 40 and 400 mU.m-2.min-1 to estimate insulin action at physiological and maximal insulin concentrations, respectively. At both insulin infusion rates, GIR was significantly higher in aged athletes and significantly lower in aged bedridden subjects than in aged controls. Although there was no statistical difference in GIR at 400 mU.m-2 x min-1 between young athletes and young controls, GIR at 40 mU.m-2 x min-1 was higher in young athletes than in young controls. Comparison of the aged and young groups showed that although GIR at 400 mU.m-2 x min-1 was significantly lower in aged controls than in young controls, there was no significant difference between the aged athletes and the young athletes. We conclude that insulin responsiveness (insulin action at the postreceptor binding site) may decrease with the aging process and may be further affected by physical inactivity. Although physical training may improve insulin responsiveness in aged individuals up to levels similar to those in young athletes, physical training in young individuals may improve only insulin sensitivity.

[Serotypes and electropherotypes of group A human rotaviruses in patients with acute gastroenteritis in Saitama area, 1988-1991]

Serotypes and RNA electropherotypes of group A human rotaviruses were identified in stool samples from patients with acute gastroenteritis in Kasukabe Kosei Hospital, Saitama, Japan, during three rotavirus seasons from 1988 to 1991. Of the 665 stool samples from patients with acute gastroenteritis, 169 (25.4%) stool samples were positive for group A human rotaviruses. Of these 169 samples, 98 (58.0%) were serotype 1, 7 (4.1%) serotype 2, 14 (8.3%) serotype 3, 3 (1.8%) serotype 4 and 47 (27.8%) were untypable. Serotype 1 was predominant over all three rotavirus seasons. Serotype 2 was most prevalent in the second rotavirus season, serotype 3 in the third season. Serotype 4 was detected only the second rotavirus season. The ratio of subtype I to subtype II was 4.5:95.5. Among the 162 strains examined, 139 specimens were available to be electropherotyped. Fifteen different RNA electropherotypes were detected. Three to four different electropherotypes were more prevalent in each rotavirus season and the detection rate in each year was different within the same electropherotypes. The rotavirus strains of the same electropherotypes were observed with high prevalence for every rotavirus seasons. The same electropherotypes was found in human rotavirus strains of different serotypes that were appeared at different epidemic seasons.

Multivariate analysis of serum tumor markers for diagnosis of skeletal metastases

Serum tumor markers, including carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), cancer antigen 125 (CA 125), and tissue polypeptide antigen (TPA), were measured in 26 patients with skeletal metastases and 11 patients with primary malignant bone tumors. TPA, which was elevated in 16 patients (61.5%), was the most sensitive marker for detection of skeletal metastases. Combined measurement of these markers was useful in detecting skeletal metastases from primary lesions, although tumor markers had little organ specificity. In addition, skeletal metastases could be completely differentiated from primary lesions by the use of multivariate discriminant analysis of markers. The most and least powerful discriminating factors were AFP and CA 19-9, respectively. On multidimensional scaling, the distance between AFP and CEA was longest, with the other markers scattered between them. Expression of individual markers can not be linked to that of other markers.

Remodeling of large bone defects in the treatment of space-occupying lesions. Curettage without bone graft for treating benign bone tumors

Curettage without bone graft was performed in 17 patients with benign bone tumors and tumor-like lesions. New bone formation with uniformly increased radiodensity appeared in serial plain radiographs within 3 months after the operation. The average period before full weight could be borne on the lower extremities was 14 weeks. Computed tomography revealed that the central part of the bone lesions persisted without bone formation. The thickening of cortical bone was predominant. These data indicate that enough mechanical strength for daily activity will be recovered by bone within 4 months after curettage without any filler, although remodeling continues for over a year. It is suggested that bone graft and implantation of "biomaterials" are not necessary in patients, especially younger ones, with benign bone tumors or tumorous conditions.

Intoxication and injury

The relationship between alcohol use and injury severity was investigated in trauma patients admitted to a tertiary referral hospital during a 23-month period. Admission blood alcohol levels (BALs) were obtained on 427 trauma patients, who were stratified into three groups: those with no measurable blood alcohol, those within the legal limit of 100 mg/dL, and those over the legal limit or intoxicated. The no-alcohol group had significantly lower injury severity than the other two groups (p less than 0.001). Even when the BAL was well within the legal limit, injuries suffered by those in the alcohol-positive groups were more severe than those in the no-alcohol group. Confirmatory evidence of the effect of alcohol on injury severity was reflected by a 2.3% mortality in alcohol-negative patients compared with a 13.3% death rate in alcohol-positive patients (p less than 0.0001). To assess the potentially confounding effect of alcohol on injury scoring accuracy, we examined the change in Glasgow Coma Scale (GCS) scores following admission. No significant differences were found when admission GCS values were compared with GCS determinations made 24 hours following admission by separate observers. To correct for any potential bias as a tertiary referral center, repeat analysis with exclusion of transferred patients was done with essentially no change in results. Our data revealed a highly significant relationship between alcohol use, degree of injury, and resource consumption.

Clinical features of enteric adenovirus infection in infants

During the period December 1984 to October 1988, adenoviruses (Ads) were isolated on 119 occasions (1.6%) from stool samples of patients with gastroenteritis. By DNA restriction analysis, 85 enteric adenoviruses (EAds) were identified. Sixty-seven patients with these infections were studied, of whom 18 had Ad40, 30 had Ad41 and 19 had untyped Ad infections. The incidence of Ad infection was high in children between 6 and 11 months of age. The illness was characterized by watery diarrhea (whitish in one third of patients), continuing for a mean of 4.5 days, and vomiting, which occurred more often in patients with EAds than in other types of infection. Diarrhea, fever and vomiting were seen significantly more frequently in patients with Ad40 than in Ad41 infection. Diarrhea and vomiting were also seen significantly more frequently in patients with EAds than in Ads infection. Diarrhea, fever and vomiting were observed more frequently in patients with rotavirus than EAds infection.

[Clinical studies of cefdinir in pediatric infections]

Five percent fine granule preparation of cefdinir (CFDN, FK482) was administered to 30 patients with acute febrile respiratory tract infections (RTI) at 4.9-21.1 mg/kg/day divided into 3 portions. And 10% fine granule preparation of CFDN was also administered to 11 patients with acute febrile RTI and 1 patient with urinary tract infection at 10.0-20.0 mg/kg/day divided into 3 portions. Good clinical effects observed in 21 of 24 patients (87.5%) with acute pharyngitis, 12 of 13 patients (92.3%) with acute tonsillitis, 2 of 4 patients (50.0%) with pneumonia and a patient with urinary tract infection. From these patients, 34 causative organisms were isolated. Ten (83.3%) of 12 strains of Staphylococcus aureus, all 6 strains of Streptococcus pyogenes and 1 strain of Streptococcus pneumoniae, 6 (46.2%) of 13 strains of Haemophillus influenzae and 1 strain of Escherichia coli were eradicated from these patients. Among the patients with pneumonia, CFDN 20 mg/kg/day dose group showed better clinical responses and better bacteriological effects against H. influenzae among the patients given CFDN 20 mg/kg/day dose group than those given CFDN 5 mg/kg/day dose group. Side effects were noted in 2 cases, one case had soft stools and the other had diarrheas.

Symmetry of bone lesions in osteopoikilosis. Report of 4 cases

A sclerotomic symmetry in the bony lesions was clearly demonstrated in 4 patients with osteopoikilosis. Occurrence of the lesions was highest at the C6-7 and L3-4 levels.

[Roentgenographic and computed topographic observations on benign bone tumor and tumor-like lesions treated by simple curettage without bone grafting]

Curettage without bone graft was performed in fifteen patients with benign bone tumors and tumor-like lesions. We studied the bone formation after curettage by plain radiography and computed tomography for six or more months. Average period before full-weight-bearing in thirteen patients of the lower extremities was three and a half months. We found no pathological fractures after curettage in any of the patients. Increases in radiodensity and reconstruction of the bone were observed in serial plain radiographs within three months. Computed tomography revealed that the center of the lesions persisted without bone formation, although thickening of cortex bone was predominant. From the data obtained here, it appears that bone grafts may not be necessary in patients, especially in younger ones, with benign bone tumors and tumor-like lesions.

[Diagnosis of skeletal metastases by serum tumor markers]

Levels of serum tumor markers including CEA, AFP, CA 15-3, CA 19-9, CA 125 and TPA were measured in 26 patients with bone metastases and in 9 patients with primary bone tumors. TPA was the most sensitive marker to detect skeletal metastasis being elevated in 15 of the 22 patients (68.2%). High sensitivity was observed in CEA (46.1%), CA 15-3 (40%), and CA 125 (35%), and AFP showed relatively low sensitivity (4.3%). When elevation of TPA only or elevation of more than two tumor markers including TPA was used as a screening test for skeletal metastasis, over-all sensitivity, specificity, and accuracy were 73.1%, 88.9%, and 81% respectively. No definite correlation between the markers could be seen in this study. A combination of serum tumor markers was useful in the differential diagnosis of bone metastases from primary bone lesions. However, organ specificity of the markers were relatively low.

Epidemiology of enteric adenoviruses 40 and 41 in acute gastroenteritis in infants and young children in the Tokyo area

82/2,223 stool specimens, collected 1982-1988, from children with enteritis (3.7%) were found to contain adenoviruses; 17 adenovirus-positive samples were provided from other institutes. 89 adenoviruses were isolated in Graham 293 cells from these 99 specimens and were typed by DNA restriction enzyme analysis with Sma I. 37 strains were typed as adenovirus 40 (AD40), and 37 strains as adenovirus 41 (Ad41). Although most strains had the same DNA profiles, a few strains had 3 kinds of different electropherotypes generated by Sma I. Five strains were identified as adenovirus 31. The remaining 10 strains were adenovirus 1 (2 strains), adenovirus 2 (3 strains), adenovirus 3 (1 strain), adenovirus 5 (1 strain), and a non-classified adenovirus (3 strains). Ad40 and Ad41 infections were found throughout the year, but peaked between September and November. 80% of the children with adenovirus infections were less than or equal to 2 years of age. The highest incidence of diarrhea caused by Ad40 or Ad41 was in 6-11 months old children. 1982-1984, the rate of Ad40 infection was 91.7%, while the rate of Ad41 infection was only 8.3%. The prevalence of Ad40 infection gradually diminished from 1985. During 1987 and 1988 the reverse ratios, 20.6% and 79.4%, respectively, of Ad40 and Ad41 infections were observed. Thereafter, Ad41 infection became predominant.

Development and evaluation of the TD97 measles virus vaccine

The TD97 strain vaccine virus was prepared from the Tanabe strain measles virus by low-temperature passages in primary cell cultures and ultraviolet (UV) mutagenesis. The TD97 strain exhibited the following characteristics: highly temperature sensitive, neither multiplying nor forming any plaques at 40 degrees C in Vero cells; genetically stable, maintaining high temperature sensitivity after ten successive passages in CE cells at 30 degrees C or 35 degrees C; and M proteins of this virus about 1 KD slower in mobility in SDS-PAGE than that of the Tanabe strain. The TD97 strain was further confirmed to be attenuated by an inoculation test into primate brain. In field trials, 752 healthy children were inoculated with a live virus vaccine prepared with this strain, and the following results were obtained: the seroconversion rate was 97% (517/533), and the average HI antibody titer was 2(5.2). An antibody-increasing effect was also observed in children who were initially seropositive. In children who seroconverted, the rates of fever were 15.7% (55/351) for 37.5 degrees C or higher and 4.0% (14/351) for 39 degrees C or higher. The rash rate was 7.7% (27/351), and the incidence of local reaction was 5.4% (19/351). The TD97 strain is thus considered to be suitable in use for an attenuated measles vaccine.

[Left ventricular myxoma with mucocutaneous myxoid tumors--a case report]

A surgical treatment of left ventricular myxoma arising from the anterior wall of the left ventricle is reported. A 32 year old man with a history of transient syncopal attack had an echocardiographic diagnosis of left ventricular myxoma. He previously had had myxoid tumors excised from the nose and from the posterior part of the left thigh. Cardiac surgery was performed under extracorporeal circulation on December 20, 1989. A friable, gelatinous 5 cm long myxoma with a diameter of 3 cm was excised from the left ventricule. The postoperative course was uneventful. The clinical characteristics in all the reported cases of cardiac myxomas with associated myxoid tumors of the skin are reviewed. Cardiac myxomas in patients with mucocutaneous myxoid tumors have an atypical biological behavior with early development of myxomas, atypical location, multiple tumors and high rate of recurrent myxomas.

[Effect of aging and physical inactivity on glucose tolerance and insulin sensitivity]

It has been well documented that glucose intolerance is associated with aging, but it is not yet clear whether this phenomenon is due to the aging process itself or is secondary to the appearance of other age-related conditions among which physical inactivity is one of most important variables. To evaluate the effect of aging process and/or physical inactivity on insulin action, this study was undertaken using the euglycemic insulin clamp technique and the oral glucose tolerance test (OGTT). Subjects without diabetes mellitus and other serious diseases consisted of 14 non-obese aged individuals and 10 young controls (YC group), ranging in age from 63 to 85 yrs, and from 19 to 21 yrs, respectively. The aged individuals were further divided into two groups (one was termed as the AS group, in which 7 aged subjects had been confined to bed for at least 3 months and the other was termed as the AC group in which 7 aged controls kept their daily physical activity such as walking). The results of OGTT did not show any remarkable differences between AC and YC groups. In the AS group, however, glucose intolerance and low insulin response during OGTT were observed. In view of the tissue insulin action, MCR, which is thought as a reliable marker for tissue insulin action, evaluated by euglycemic insulin clamp was 5.31 +/- 0.68, 8.57 +/- 1.20, 9.60 +/- 0.35 ml/kg/min in the AS, AC and YC groups, respectively (AS less than AC, p less than 0.05, AS less than YC, p less than 0.01, AC less than YCM, N.S.).(ABSTRACT TRUNCATED AT 250 WORDS)

[Aneurysm of the diverticulum of the ductus arteriosus in the adult]

Aneurysm of the diverticulum of the ductus arteriosus is a rarely reported entry in adult. To our knowledge, only two previous patients underwent successful aneurysmectomy in Japan. Three new cases of aneurysm of the ductus arteriosus diverticulum in the adult, all diagnosed preoperatively and successfully repaired, are presented. All three patients are alive 17 to 44 months postoperatively. Our experience with these patients suggests several important features of these aneurysms: (1) CT scanning with contrast enhancement will almost invariably confirm the diagnosis of these aneurysms. (2) Exposure through a median sternotomy is generally good and carries less operative morbidity from rupture than a posterolateral thoracotomy. (3) Because of their critical location and the high incidence of rupture in reported cases, aneurysms producing symptoms, or those showing progressive enlargement should be surgically resected. (4) When a succular aneurysm of the aortic arch is demonstrated expanding toward the aortopulmonary window with adhesion to the pulmonary artery, the possibility of its origin from the ductus arteriosus must be investigated.

No correlation between tumor markers and prognosis under polygenic control systems

Tumor markers in serum should not be correlated with the prognosis of patients with malignant tumors, although the markers indicate the presence of tumors, since marker levels and prognosis are controlled independently by poly-genes. Furthermore, prognostic factors, including incidence of pulmonary metastasis, tumor growth rate, tumor drug sensitivity and host response, vary among patients. In general, tumor markers may be used to demonstrate response of tumor to treatments only when expression of the markers does not change in a time-dependent manner.