Env-derived gp55 gene of Friend spleen focus-forming virus specifically induces neoplastic proliferation of erythroid progenitor cells

A group of retroviruses carrying truncated viral genes has recently been suggested as the cause of new patterns of diseases. One such virus is the replication defective component of the Friend murine leukemia virus (F-MuLV) complex, called Friend spleen focus forming virus (F-SFFV). This virus induces erythroblastosis, and a virion envelope-related glycoprotein, gp55, encoded by F-SFFV has been suggested as the pathogenic gene. The role of the gp55 gene is, however, yet unclear in the apparently multistep erythroleukemogenesis. By separately producing transgenic mice harboring the whole F-SFFV DNA, the gp55 gene alone under the control of the retroviral long terminal repeat (LTR) and the gp55 gene under the control of cytoplasmic beta actin transcriptional regulatory unit, we show here that the gp55 gene is capable of inducing neoplastic proliferation of erythroid progenitor cells specifically in the absence of helper virus and other F-SFFV sequences. Under the control of the viral LTR the gp55 expression was detected only in leukemic tissues, but under the control of cytoplasmic beta-actin regulatory sequences, the gp55 was also expressed in a variety of normal tissues including preleukemic normal spleens. The development of erythroleukemia was suppressed under the genetic background of C57B1/6 mouse (resistant to F-MuLV; Fv-2rr), and required additional events even under the background of DDD mouse (susceptible to F-MuLV; Fv-2ss). The p53 and Spi-1 genes were frequently aberrant in transplanted tumors and cell lines derived from them, but were not in primary leukemic spleens.

Surgical excision of familial cavernous angioma in the pontomedullary region--case report

The authors report on a surgical case of cavernous angioma in the pontomedullary region. A 60-year-old male exhibited a progressive neurological deficit consisting mainly of bulbar paresis and cerebellar signs, without ictal episodes, and computed tomographic scans showed growth of the lesion over 3 years. On preoperative assessment, a glial tumor was suspected to coexist with a cavernous angioma. The vascular malformation was totally excised successfully. This case also revealed an unusual familial occurrence.

[A study of developmental changes of Indian mandibles concerning development of weight, height, thickness and length of the mandible]

A total of 230 mandibles were classified into 7 groups 8 stages according to eruption phase, observing developmental changes from unerupted stage (Group A) to permanent dentition (Group G) 1. Development from Group A to deciduous dentition completion stage (Group C) was classified into 3 types. 1) Regarding height of mandibular ramus, height and weight of mandibular body, the increase from Group B where the deciduous central incisor erupts to Group C is greater that from Group A-B (type a). 2) As to coronoid process height, length of mandibular body, mandibular length and mandibular ramus width, equal increases were seen between Group A-B and B-C (type b). 3) Chin height and thickness of the mandibular body developed suddenly with the eruption of the deciduous central incisors. The increase is greater in Group A-B (type c). 2. They are classified according to size proportion in unerupted stage as compared to entire size. The classification are: 42%-33% (smaller), 50%-45% (medium), 70%-50% (bigger). 1) Type a is small at Group A and developed steadily after Group C. Development is greater, about 2.3-3 times. 3) Type b at Group A is larger than type a. It continuously developed after Group C. The developmental rate is about 2 times except the coronoid process height. 3) Type c is large at Group A. No development occurred after D1 stage when first molars erupt. Developmental rate is 1.4-1.85 times and smallest of the 3 types. 3. Developmental quantity: 1) Regarding total increase; The height of the mandibular ramus, the height of the mandibular ramus and coronoid process showed about 28-32 mm increase Group C accounted for 55%, Group C-D2 14%-17%, Group D2-G 30%-27% of the developmental increase. The mandibular ramus width showed increases of 14.43mm (74% at D1 stage) and subsequent increase was 7% between each group, showing equal increases. 2) Chin and mandibular ramus height showed increases of 14 mm. At Group C, development in chin height accounted for 67%. The mandibular body width increased 4.0mm-6.0mm at the foramen in m2/m2 and 6/6 portions. It reached 82%-100% in D1 stage. 3) An increase in mandibular body length and mandibular length was 50mm and 32mm, reaching 73% of the entire developmental amount by D1 stage.

Radioprotection of hematopoietic tissues in mice by indomethacin

We recently reported that indomethacin, an inhibitor of prostaglandin (PG) synthesis, increased the radioresponse of PG-producing murine tumors, but it protected the hematopoietic system from radiation damage [Furuta et al., Cancer Res. 48, 3008-3013 (1988)]. Here we have investigated possible mechanisms responsible for the radioprotective effect of indomethacin. In the exogenous spleen colony assay, bone marrow cells from indomethacin-treated mice showed a similar radioresponse to those from mice not treated with indomethacin, thus excluding true radioprotection as a mechanism. Also, neither the total number of bone marrow cells nor the number of stem cells in bone marrow were affected by the treatment with indomethacin. However, indomethacin induced significant splenomegaly, which was associated with an increased number of both nucleated cells and hematopoietic stem cells in the spleen. The latter was determined by the exogenous spleen colony assay. Thus indomethacin protected hematopoietic tissue indirectly through stimulation of hematopoietic cells in the spleen. When indomethacin was combined with WR-2721, which is a true radioprotector, we obtained a greater radioprotective effect than with either used alone according to the endogenous spleen colony assay.

Induction of a variety of tumors by c-erbB2 and clonal nature of lymphomas even with the mutated gene (Val659----Glu659)

The c-erbB2 gene is expressed uniquely in fetal epithelium in vivo and has been suggested to contribute to the development and/or progression of adenocarcinomas in man. In order to assess the oncogenicity of the c-erbB2 gene in vivo, normal c-erbB2 and mutant c-erbB2 encoding glutamic acid instead of valine at position 659 within the transmembrane domain were introduced into mice under the transcriptional regulatory unit of mouse mammary tumor virus long terminal repeat (MMTV-LTR) or immunoglobulin enhancer--SV40 early gene promoter (Ig/Tp). In transgenic mice with normal c-erbB2 under MMTV-LTR, not only adenocarcinomas but also a variety of tumors including B lymphomas were induced at relatively late onset. Induction of pre-B cell lymphomas with normal c-erbB2 was also observed using the Ig/Tp regulatory unit within 6-10 months in some members of one transgenic family among seven lines established. In contrast, with the mutant c-erbB2 under the Ig/Tp regulatory unit, the lymphoma was induced neonatally in all members of four transgenic families among ten lines obtained. However, the immunoglobulin heavy chain gene rearrangement pattern indicated that even with the mutant c-erbB2 the induced lymphomas were clonal.

[Detection of human papillomavirus genome in nasolaryngeal papillomas using digoxigenin labeled DNA probes]

It is being reported that human papillomavirus (HPV) has been implicated in the pathogenesis of various neoplastic lesions of the genital organs. To investigate the etiological role of HPV and its types in nasolaryngeal papillomas, we retrospectively analyzed HPV genomes by nucleic acid hybridization methods; for detecting DNA and mRNA, we employed the recently developed nonradioactive (digoxigenin labeled) DNA probes and compared the results by radioisotope methods. In total, 43 cases of papillomatous lesions were examined. They were verruca vulgaris of the nasal vestibule (Nr = 2), nasal inverted papilloma (IP, Nr = 26), and laryngeal papilloma (Nr = 15). HPV types examined were type 2, 6, 11, 16 and 18. Two cases of verruca vulgaris were shown to contain HPV-2 DNA and its mRNA by in situ hybridization. HPV-11 DNA was detected in 3 cases (12%) of nasal inverted papilloma whereas HPV-16 was detected in 1 case (4%); the latter case was associated with squamous cell carcinoma. These results suggest that HPV may be implicated in the development of IP, and HPV-16 may play an important role in the malignant transformation of IP. In the cases of multiple laryngeal papilloma (Nr = 8, one juvenile type and 7 adult type), either HPV-6 or HPV-11 was detected at the high rate (6/8, 75%). The presence of the HPV genomes provides strong evidence for the HPV etiology of these laryngeal papillomas. Whereas in the cases of adult single laryngeal papilloma (Nr = 7), HPV was not detected. Technically, the sensitivity of digoxigenin (DIG) labeled DNA probe was almost same as 35S labeled probe by dot blot hybridization, thus we applied DIG labeled probe to Southern blot hybridization with low background. By in situ hybridization using digoxigenin labeled probes, the rates of HPV detection were almost equal to those by 35S labeled probes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Appropriate lymph node dissection in thyroid adenocarcinoma]

Thirty-four patients underwent thyroid surgery for papillary and follicular adenocarcinomas in the period from 1985 to 1989. Fourteen patients were treated with local neck dissection and 20 patients, with modified or radical neck dissection. Cervical lymph node metastasis was found in 25 patients (74%). Our recent policy for lymph node dissection is as follows: When deep cervical lymph node metastasis is clinically demonstrated, radical or modified neck dissection is performed. In patients without clinically demonstrated metastasis, local neck dissection and sampling of the internal jugular chain are performed. When microscopic metastasis is found in frozen sections, modified neck dissection is added. Thus we could select patients for modified neck dissection and choose appropriate neck dissection for more complete cancer clearance without losing postoperative functions.

Onuf's motoneuron is resistant to poliovirus

Onuf's nucleus, located in the anterior horn of the sacral spinal cord, has been shown to innervate the striated muscles of the urethral and anal sphincters and is known to be well preserved in patients who have motoneuron disease. To answer the question whether the nucleus is also safe from motoneurotrophic virus infections, we examined the spinal cords of 3 individuals who had suffered severe poliomyelitis. In 2 of these which were acutely fatal cases, all motoneurons were damaged by neuronophagia, but Onuf's nucleus escaped the inflammatory degeneration. In a chronic case, neuronal loss in the anterior horn with replacement by gliosis was prominent below the thoracic cord down to the sacral cord, but Onuf's nucleus was well preserved. Thus, Onuf's nucleus appears to differ from other motoneurons with regard to susceptibility to poliovirus infection.

Thymic atrophy characteristic in transgenic mice that harbor pX genes of human T-cell leukemia virus type I

The human T-cell leukemia viruses (HTLV) are associated with T-cell malignancies in humans. The malignant transformation occurs after a long latency in some carriers, and its mechanism appears to be distinct from that of other classes of retroviruses which induce transformation through viral or cellular oncogenes. A widely postulated explanation is that the products of novel pX genes transactivate endogenous cellular genes which lead to tumor development in T cells. To directly examine the pathological effects of pX genes in vivo, we produced transgenic mice harboring the HTLV type I pX genes under several regulatory units: HTLV type I long terminal repeat, immunoglobulin enhancer-simian virus 40 promoter, and mouse mammary tumor virus long terminal repeat. Atrophy of the thymus was characteristic in these mice no matter which regulatory unit directed the expression of the genes.

Effect of chloride on blood pressure and sympathetic nervous system activity in deoxycorticosterone acetate-treated rats

The effect of selective chloride loading on blood pressure and sympathetic nervous system activity was studied in deoxycorticosterone acetate (DOCA)-treated rats. The rats fed a normal sodium-high chloride and fed a high sodium chloride diet had higher blood pressure and lower cardiac norepinephrine concentrations than those fed a normal sodium chloride diet. Furthermore, cardiac norepinephrine concentrations were significantly correlated with systolic blood pressure. These data suggest that selective chloride loading can raise blood pressure in DOCA-treated rats due to augmented sympathetic nervous system activity.

[The influence of the operating positions on the prepared abutment contour of full cast crowns. Unanatomical artificial teeth for fixed bridge]

With a view to research the effect of the crown form, we made the unanatomical artificial teeth and some doctors to do the abutment tooth preparation with full cast crowns for the maxillar left fixed prosthodontics three-unit bridge in random position. After that, following are the results of a study made on the influence to the prepared tooth form. The prepared teeth are the second premolar and the second molar (The "second premolar" is abbreviated to "5" and the "second molar" is abbreviated to "7"). 1. The reductions of occlusal surface was excessively larger at 5 and 7 buccal cusp regions, while it was excessively smaller at central groove area. 2. The reductions of axial surface and subgingival area were excessively smaller at 5 and 7. 3. As for the degree of axial taper, its was steeper toward the buccal and distal surfaces at 5 and 7. 4. As for the relative degree of axial taper, it get the largest in degree on both sides between 5 medial surface and 7 distal surface. The results of this experiment are similar to the results that used anatomical artificial teeth. These results are affected by the operating posture.

[Study on determination of the imaginary axis of the tooth crown. 1. Measuring procedure]

The state of inclination and the change under various conditions of the imaginary axis of the tooth crown of upper jaw and lower jaw right and left first molar can be determined by the measuring apparatus and method of this study. 2. The measurement error of this method was not more than 0.1 degree. This value was sufficient for the purpose of this study.

Complete Clq deficiency associated with IgG multiple myeloma

We report a case of IgG multiple myeloma with selective complete Clq deficiency. The patient was a 75-year-old Japanese woman who exhibited urticaria on the arm and an absence of serum hemolytic complement activity (CH50). Further studies revealed no vasculitis in the urticarial lesion but showed selective complete deficiency of Clq without low molecular weight Clq precipitin. Addition of highly purified Clq restored the CH50 level of the patient's serum to normal. It is suggested that this abnormality was a primary Clq deficiency. We discussed a relationship between the Clq deficiency and myeloma and reviewed the literature.

Effect of oral calcium on blood pressure response in salt-loaded borderline hypertensive patients

To clarify the mechanism of the antihypertensive effect of oral calcium loading, we studied the effect of low versus high calcium intake on salt-induced blood pressure elevations in patients with borderline hypertension. After a 7-day period of dietary salt restriction (50 meq/day), 27 patients were placed on a high salt (300 meq/day), low calcium (250 mg/day) diet for 7 days; 14 of these patients were given 2,160 mg/day of supplementary calcium (Ca group), and 13 patients were given placebo (non-Ca group). With a high salt intake, the percent increase in mean blood pressure was smaller in the Ca group than in the non-Ca group (+2.85 +/- 1.22% vs. +8.63 +/- 1.66%, respectively, p less than 0.01). The Ca group showed a smaller weight gain (p less than 0.05) and a greater urinary excretion of sodium (p less than 0.005) than the non-Ca group. In the Ca group, but not in the non-Ca group, high salt intake resulted in an increase in intraerythrocyte magnesium content (p less than 0.01), which was correlated inversely with the salt-induced changes in mean blood pressure (r = -0.54, p less than 0.05). While the increase in cellular magnesium was greater in the Ca group, the changes in red blood cell sodium and sodium/potassium ratio were not different between the two groups. The results suggest that oral calcium supplementation may prevent a rise in blood pressure in patients on a high salt, low calcium diet by attenuating the sodium retention.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of malignant gliomas with high-dose ACNU and autologous bone marrow transplantation]

Two patients with malignant gliomas located in the frontal lobe were treated by supraophthalmic intracarotid infusion of high-dose ACNU 15 mg/kg (ca. 600 mg/m2) combined with a total 60 Gy of irradiation after surgery. Irradiation therapy was started 13 days (case 1) and 10 days (case 2) after surgery, and single chemotherapy with ACNU 1,020 mg (case 1) and 1,100 mg (case 2) was performed when 36 Gy of whole brain irradiation was done. Chemotherapy was followed by autologous bone marrow transplantation containing 6.8 X 10(9) and 8.9 X 10(8) nucleated cells, respectively. Nadirs of white cell counts on 9 days in case 1 and 14 days in case 2 after chemotherapy were 280 cells and 240 cells/mm3, respectively, and the white cell counts less than 1,000/mm3 continued for 7 and 12 days, respectively. Local irradiation was started again when the number of white cells became more than 1,000/mm3 and 24 Gy was completed in each case. CT scanning carried out on discharge demonstrated no apparent abnormal high density area by contrast medium in both cases. These two patients did not show severe side effects at 10 months in case 1 and at 3 months in case 2 after high dose ACNU therapy, and remained progression-free at that time. Dose 15 mg/kg of ACNU may be the maximum tolerable dose patients can recover from severe myelosuppression, caused by high dose ACNU therapy combined with irradiation therapy, by marrow rescue.

The role of chloride in the sympathetic nervous system in DOCA-salt hypertension

Elevation in blood pressure in the deoxycorticosterone acetate (DOCA)-treated rat with a high-sodium, normal-chloride diet was less than that in the DOCA-salt rat not on such a diet. Compared with the DOCA-salt rat, there were greater sodium concentration in the carcass, and less norepinephrine turnover rates in the heart and the spleen than in the DOCA treated rat given a high sodium normal chloride diet. Extracellular fluid volumes were similar. These results suggest that not only water and sodium retention by sodium loading but also that activation in sympathetic nervous system by the combined effect of chloride and sodium are responsible for the development of DOCA-salt hypertension.

[Hypertrophic cardiomyopathy with left ventricular dilatation]

There is increasing interest in the notion that some patients with hypertrophic cardiomyopathy (HCM) progress to morphological and functional manifestations similar to those of dilated cardiomyopathy (DCM). From 165 consecutive patients with HCM, 20 patients with left ventricular dilatation (left ventricular end-diastolic diameter greater than or equal to 50 mm) were selected and designated as dilated HCM. The diagnosis of HCM was established in these patients either by detection of the classical form of HCM in family members, with 2-dimensional echocardiographic evidence of asymmetric septal hypertrophy (ASH; septal thickness greater than or equal to 15 mm and a ratio of septal to posterior wall thickness greater than or equal to 1.3); or by demonstrating myocardial fiber disarray in autopsy or biopsy samples. The clinical manifestations of these patients with dilated HCM were then compared with those of other forms of HCM without left ventricular dilatation; 1) 40 patients with hypertrophic obstructive cardiomyopathy (HOCM) who had resting intraventricular pressure gradients of 20 mmHg or more, 2) 80 patients with non-obstructive HCM, each of whom had ASH of the entire ventricular septum (typical ASH), and 3) 25 non-obstructive patients whose hypertrophy was localized to the apical region of the ventricular septum (apical ASH). Patients having apical hypertrophy with a spade-like configuration on the left ventriculogram were excluded from the study. Compared with HOCM and typical ASH groups, the patients with dilated HCM had family histories of significantly more frequent HCM and less frequent hypertension. The patients with dilated HCM also had significantly less fractional shortening (FS), decreased interventricular septal thickness, greater left ventricular end-diastolic pressure (LVEDP), and left ventricular dilatation. During the follow-up period (average: 3.5 years), seven patients (35%) with dilated HCM died; five from congestive heart failure (CHF), one suddenly, and one three days following mitral valve replacement. The other five patients had CHF at the time of their follow-up examination. The patients with apical ASH had clinical features similar to those of dilated HCM; a higher familial frequency, less marked septal hypertrophy, and higher LVEDP. They tended to develop left ventricular dilatation, associated with reduced fractional shortening, although left ventricular diameter at end-diastole did not exceed 50 mm. These findings suggested that dilated HCM is not a rare condition. It is observed in 12% of consecutive patients with HCM.(ABSTRACT TRUNCATED AT 400 WORDS)

Prostaglandin production by murine tumors as a predictor for therapeutic response to indomethacin

We investigated whether there is a relationship between the production of eicosanoids by murine solid tumors and their response to the prostaglandin H (PGH) synthase inhibitor indomethacin. Three sarcomas, designated FSA, NFSA, and SA-NH, and two carcinomas, designated MCA-K and HCA-I, syngeneic to C3Hf/Kam mice were used. In general, FSA and NFSA produced more PGH synthase products than lipoxygenase products, whereas HCA-I produced both types of metabolites in large quantities. All three tumors responded well to indomethacin treatment by slowing their growth. In contrast, MCA-K and SA-NH tumors produced insignificant quantities of PGH synthase products, but substantial amounts of lipoxygenase products. Their growth was not affected by treatment with indomethacin. Indomethacin did not influence tumor cell survival either in vitro or in vivo, but it reduced the proportion of S-phase cells in the tumors. The antitumor effect of indomethacin was not reduced by immunosuppression of the tumor host and was independent of tumor immunogenicity, implying that indomethacin acted through nonimmunological mechanisms. Thus, the effectiveness of indomethacin was directly related to the ability of tumors to produce PGs. Consequently, the eicosanoid profile of tumors could serve as a valuable way to select patients likely to respond to indomethacin and other PGH synthase inhibiting agents.

Increase in radioresponse of murine tumors by treatment with indomethacin

Indomethacin, an inhibitor of prostaglandin (PG) synthesis, was investigated for its ability to increase radioresponse of two fibrosarcomas, FSA and NFSA, in C3Hf/Kam mice. In addition, the effect of indomethacin on radioresponse of hematopoietic tissue, jejunum, hair follicles, and tissues involved in the development of radiation-induced leg contractures was determined. Indomethacin greatly increased radioresponse of 8-mm tumors, as assessed by both tumor growth delay and TCD50 assays. Enhancement factors for tumor growth delay and tumor radiocurability (TCD50) were 1.55 and 1.39, respectively, for FSA, and 1.4 and 1.26, respectively, for NFSA tumors. Of four normal tissues assessed, two (hair follicles and tissues responsible for development of leg contractures) showed no change in radioresponse after treatment with indomethacin, one (hematopoietic tissue) exhibited radioprotection, and one (jejunum) exhibited slight radiosensitization (enhancement factor, 1.12). Therefore, indomethacin significantly augmented tumor radiocurability but had minimal effect on radioresponse of some normal tissues.

Driven by the same Ig enhancer and SV40 T promoter ras induced lung adenomatous tumors, myc induced pre-B cell lymphomas and SV40 large T gene a variety of tumors in transgenic mice

Different types of tumors developed in transgenic mice following the introduction of the entire coding region of ras, myc or SV40 large T gene (T) linked to the same regulatory unit, consisting of a human immunoglobulin gene enhancer (Ig) and SV40 early gene promoter (Tp) with a 21-bp repeat. All the 12 transgenic mice harboring the intact T gene developed a variety of tumors including choroid plexus tumor, B cell lymphoma, histiocytic lymphoma, thymoma and others. This suggests that the Ig/Tp regulatory unit has transcriptional activity in these heterologous tissues. With this regulatory unit, myc gene induced solely pre-B cell lymphomas (five out of nine mice). Contrary to our expectation, however, the mutated ras gene induced lung adenomatous tumors in six out of eight transgenic mice over the 10-month observation period; the tumors are histologically comparable to adenocarcinomas in man. The tumors developed as early as 4 weeks after birth and the introduced ras gene was as efficiently expressed in both normal and neoplastic bronchioloalveolar epithelial cells as in normal lymphoid cells. An unidentified secondary event thus appears to be necessary for these ras-expressing cells to become neoplastic, as observed for myc (Leder et al., 1986). In a variety of tumors induced by Ig/Tp-T, on the other hand, T gene was expressed only in the tumor cells, but not in normal cells. Thus, derepression of T gene in normal cells appears to be closely related to their malignant change as observed in development of pancreatic acinar cell tumors by the T gene (Ornitz et al., 1985). These results suggest that ras and myc oncogenes penetrate differentially specific types of cells, while the SV40 T gene is tumorigenic in a variety of cell types.

[Comparative studies on the DNA content of human gastric cancer cells and its metastatic foci]

Comparative cellular DNA content measurements have been done on two sites differing from each other in their anatomical location, in 16 cases of gastric cancer by means of microphotometry. In addition, comparisons on the DNA stemline of the original gastric lesions and their metastatic lesions (8 cases of liver metastases and 9 cases of lymph node metastases) also were done. The main stemlines in four cases (25%) out of 16 gastric cancers exhibited different main DNA stemlines from the other sites in the same lesion, although in the other 12 cases examined, two sites showed the same DNA stemlines to each other. In almost all cases, the DNA stemlines of the metastatic foci were consistent with those of the original lesions. The lymph node metastases simulated the original lesions in its DNA stemlines (89%) more than did the cases of livermetastases (63%). In an exceptional case, the original lesion exhibited two definite stemlines (2C & 3.5C), but only one (2C) was recognizable in the metastatic focus of the liver. This difference indicates the probable role of "clonal selection" in a blood-borne metastasis.

The role of chloride on deoxycorticosterone acetate-salt hypertension

Selective sodium loading attenuated the development of hypertension in the deoxycorticosterone acetate (DOCA) treated rat. The DOCA treated rat fed a diet equimolar in sodium to a 7% sodium chloride diet and in chloride to a standard diet, differed in various parameters from the DOCA treated rat fed a 7% sodium chloride diet: it had higher sodium concentration in both erythrocytes and muscles, a higher erythrocyte ouabain sensitive 22Na efflux rate constant (Kos), and a lower norepinephrine turnover rate in the heart and the spleen. These results suggest that the suppressed sympathetic nervous system activity and the activated cell membrane sodium pump contribute in part to the mechanism for the suppression of the development of hypertension in the DOCA-selective sodium loaded rat.

Splenic arteriovenous fistula formation due to angiodysplasia in a splenic aneurysm of a patient with liver cirrhosis--a report of a case

A 53 year-old Japanese woman with liver cirrhosis manifested massive hematemesis due to ruptured esophageal varices. Celiac angiography demonstrated an aneurysm of the splenic hilus and arteriovenous fistula around the aneurysm. She underwent splenectomy, proximal gastrectomy, distal esophageal devascularization and pyloroplasty. Histological examination of the aneurysm revealed arterial dysplasia with a focal medial gap. Microscopic tissue clefts at the site of a medial gap were considered to be the source of the angiographic arteriovenous fistula.

[Hypertrophic cardiomyopathy manifesting different modes of illness: report of three cases]

Three cases of hypertrophic cardiomyopathy (HCM) which presented with different modes of appearance of left ventricular hypertrophy are reported. Case 1: A 24-year-old man had three relatives with HCM. At 13 years of age, he showed no electrocardiographic or echocardiographic abnormalities characteristic of HCM. During the ensuing 11 years, he developed asymmetric septal hypertrophy (ASH) and systolic anterior motion of the mitral valve (SAM), with right bundle branch block and T-wave inversion. Cardiac catheterization confirmed the diagnosis of hypertrophic obstructive cardiomyopathy by demonstrating an intraventricular pressure gradient of 25 mmHg. These observations indicate that this case developed abnormal hypertrophy during adolescence on the basis of genetic predisposition of an autosomal dominant trait. Case 2: A 51-year-old woman had three proven and three possibly affected relatives. At 35 years of age, she had a normal electrocardiogram, although the echocardiogram was not available. Now, 16 years later, she had developed ASH with abnormal Q-waves and was diagnosed as having non-obstructive HCM. These suggest that ASH can be manifested as late as during middle-age, even in those with genetic predisposition. Case 3: A 47-year-old woman was diagnosed as having hypertension and her blood pressure was 190/100 mmHg at 40 years of age, though she had no abnormal electrocardiographic findings and heart murmurs. Now, at 47 years of age, she had developed T-wave inversion, ASH, SAM, and an intraventricular pressure gradient of 50 mmHg. Thus, her ASH appeared during middle-age, and was probably provoked by hypertension, though a complete family survey could not be conducted. These three patients' findings indicate that there may be various modes of appearance of left ventricular hypertrophy in HCM. In the majority of patients with genetic predisposition, abnormal hypertrophy may develop during adolescence as in Case 1. In others, it may develop in middle-age, as it did in Case 2. The disease spectrum of HCM may additionally include those who develop abnormal hypertrophy during middle-age, following provocation by hypertension, as in Case 3.

Bilateral congenital posterolateral diaphragmatic hernia

The 11th recorded case of bilateral congenital posterolateral diaphragmatic hernia is here presented. Left-sided diaphragmatic hernia was corrected surgically, while the baby expired because of respiratory failure on the 31st operated day. Autopsy revealed that the baby had right posterolateral diaphragmatic defect with sac. From this experience, it might be said that at surgery for left-sided hernia, right diaphragm should be examined carefully.

Effect of 16,16-dimethyl prostaglandin E2 methyl ester on weanling rat skeleton: daily and systemic administration

The effects of 0, 0.3, 1.0, and 3.0 mg of 16,16-dimethyl prostaglandin E2 methyl ester (Di-M-PGE2) per kilogram per day administered subcutaneously for 21 days to fluorescent-labeled weanling rats were studied, by single-photon absorptiometric and static and dynamic histomorphometric techniques, to determine possible alterations in growth and mineralized tissue mass and their mechanisms of response. Specimens of femurs, proximal tibia, and tibial shaft were analyzed. Di-M-PGE2 caused a reduction in bone elongation and a dramatic accumulation in metaphyseal trabecular hard tissue mass. At high doses, the growth cartilage exhibited reduced thickness and degenerative cell size and cell production rate. The increased metaphyseal trabecular hard tissue mass was restricted to the secondary spongiosa region and was observed at all dose levels. The metaphysis was further characterized by an increase in bone and calcified cartilage cores, a marked elevation in osteoblast and osteoclast numbers, in osteoblast-to-osteoclast ratios, and in ratios of differentiated cells to osteoprogenitor cells. These findings were consistent with the interpretations that Di-M-PGE2 depressed bone elongation by delaying the division and maturation of growth plate chondrocytes; stimulated the differentiation of osteoblasts and osteoclasts, thus generating more differentiated bone cells but suppressing their activities; and increased metaphyseal trabecular hard tissue by creating an imbalance in osteoblasts over osteoclasts and suppressing hard tissue resorption.

Enhanced red cell sodium permeability in patients with borderline hypertension

Red cell membrane sodium permeability was studied in 41 untreated patients with essential hypertension (20 borderline hypertensives and 21 established hypertensives) and 21 age matched normotensive subjects by means of the measurement of unidirectional passive influx of 22Na+ into ouabain-treated erythrocytes. The mean value (+/- SD) of 22Na+ influx was greater in the hypertensives than in the normotensives (0.183 +/- 0.047 vs 0.152 +/- 0.047 mmol/l . cells/hr, respectively, p less than 0.02). Among the patients with essential hypertension, the borderline hypertensives demonstrated a higher 22Na+ influx than the established hypertensives (0.207 +/- 0.043 vs 0.160 +/- 0.038 mmol/l . cells/hr, respectively, p less than 0.001), and 22Na+ influx positively correlated with plasma renin activity (r = 0.44, p less than 0.005). In 16 of 20 borderline hypertensives, 5 year blood pressure changes were examined retrospectively, and a positive correlation was observed between mean blood pressure increase and 22Na+ influx value in these subjects (r = 0.64, p less than 0.01). These results suggest that passive sodium influx may be altered in the course of the development of hypertension in relation to the changes in blood pressure level and that enhanced sodium permeability may be a characteristic of the early stage of essential hypertension.

A circulating Na+-K+ATPase inhibitor, erythrocyte sodium transport and hypertension in patients with chronic renal failure

The level of circulating Na+-K+ATPase inhibitor (% inhibition), erythrocyte ouabain-sensitive 22Na+ efflux rate constant (Kos) and erythrocyte sodium content (RBC Na) were measured in 11 undialysed patients with chronic renal failure, 16 patients on chronic hemodialysis and 16 age-matched normotensive healthy controls. In uremics, % inhibition was significantly higher than that in the controls (p less than 0.001). There were significant correlations between % inhibition and both mean blood pressure (r = 0.74, p less than 0.001) and Kos (r = -0.47, p less than 0.005) for all the groups combined. Hypertensive uremics showed significantly higher % inhibition, lower Kos and higher RBC Na compared with normotensive ones. These data suggest that the elevated level of circulating Na+-K+ ATPase inhibitor may, at least in part, account for the pathogenesis of hypertension in patients with chronic renal failure.

[Hypertensive heart disease simulating dilated cardiomyopathy]

Echocardiography was performed for 246 patients with hypertension. Among the 246 patients, echocardiographic features simulating dilated cardiomyopathy (DCM) were observed in 12. These patients had past history of hypertension and prominent left ventricular dilatation with reduced left ventricular contractility, but no left ventricular wall thickening. To elucidate the mechanism producing DCM-like features in patients with hypertension, the clinical and echocardiographic findings of the 12 hypertensive patients (HT-DCM) were compared with those of 50 hypertensive patients without dilated left ventricles and of 31 patients with DCM. On admission, all patients with HT-DCM had congestive heart failure (CHF) without high blood pressure and their echocardiograms revealed the abnormal findings described above. There were no differences of the clinical and echocardiographic findings on admission between HT-DCM and DCM. Following medical treatment, relatively early improvement of CHF was noted in all patients with HT-DCM; the LV dimension decreased and diffuse wall motion abnormality improved steadily with gradual elevation of blood pressure during the follow-up periods. The LV function of most patients with HT-DCM improved markedly but never reached normal levels. There were no significant differences the right ventricular endomyocardial biopsy findings of between DCM and HT-DCM. It was suggested the DCM-like features in these cases are caused, not only by hypertension, but by other factors, as well.

Relationships between red cell cation contents and blood pressure level

Red cell sodium (R-Na), potassium (R-K) and sodium to potassium ratio (R-Na/K) were studied in 2,542 adults participating in periodic medical examinations. The mean values of R-Na and R-Na/K in untreated borderline (n = 406) and definite hypertensives (n = 485) were higher than those in normotensives (n = 1,651), but that of R-K was not different among the groups. The increased R-Na and R-Na/K in the hypertensives were observed only in those under 50 years, but not in those 50 years and over. In the normotensive subjects, age and sex affected the intraerythrocyte cation contents, but a positive family history of hypertension did not. Although a few characteristics correlated with both R-Na and mean blood pressure, and with both R-Na/K and mean blood pressure, multiple regression analyses revealed that R-Na and R-Na/K independently and significantly contributed to the variation in mean blood pressure. It was also indicated that these relations of R-Na and R-Na/K to mean blood pressure were significant in those under 50 years, but not in those 50 years and over. While several characteristics confound the relationships between red cell cation contents and blood pressure, these results suggest that the contributions of R-Na and R-Na/K to the mechanisms of human hypertension still persist in young to middle-aged people.