[A case of traumatic priapism]

We report a case of high flow priapism secondary to arteriovenous fistula produced by perineal trauma in a 43-year-old patient. Diagnosis was based on the result of gasometry in cavernous blood and color doppler sonography. Superselective embolization of the deep artery of the penis was performed with good results. After 6 months of treatment, erection and sexual function were normal. Our case demonstrates that this procedure is a safe and effective therapy for high flow priapism.

Benign symmetrical lipomatosis of the hands

Benign symmetrical lipomatosis (BSL) is a disease characterized by massively symmetrical fat deposits predominantly in the neck and shoulder girdle area. The disease is frequently associated with alcoholism, hepatopathy, glucose intolerance, hyperuricemia, and malignant tumors. We describe a patient with BSL of the dorsal surfaces of both hands.

Augmentation of basal insulin release from rat islets by preexposure to a high concentration of glucose

We have found that preexposure to an elevated concentration of glucose reversibly induces an enhancement of basal insulin release from rat pancreatic islets dependent on glucose metabolism. This basal insulin release augmented by priming was not suppressed by reduction of the intracellular ATP or Ca(2+) concentration, because even in the absence of ATP at low Ca(2+), the augmentation was not abolished from primed electrically permeabilized islets. Moreover, it was not inhibited by an alpha-adrenergic antagonist, clonidine. A threshold level of GTP is required to induce these effects, because together with adenine, mycophenolic acid, a cytosolic GTP synthesis inhibitor, completely abolished the enhancement of basal insulin release due to the glucose-induced priming without affecting the glucose-induced increment in ATP content and ATP-to-ADP ratio. In addition, a GDP analog significantly suppressed the enhanced insulin release due to priming from permeabilized islets in the absence of ATP at low Ca(2+), suggesting that the GTP-sensitive site may play a role in the augmentation of basal insulin release due to the glucose-induced priming effect.

Melanotic neuroectodermal tumor of infancy in the mandible: report of a case

A case of melanotic neuroectodermal tumor of infancy occurring in the mandible is described. The patient was a 1-month-old boy with a rapidly growing tumor of the mandible. Computed tomography showed 2 well-defined osteolytic lesions in the right mandible. Histopathologic diagnosis of a biopsy specimen was melanotic neuroectodermal tumor of infancy. The tumor was excised with removal of the surrounding bone, but 1(1/2) months later it recurred, and segmental mandibulectomy and reconstruction of the defect with a titanium miniplate was performed. Retrospectively, evidence of recurrence was noted on computed tomography taken on the tenth postoperative day. The recurrence was caused by incomplete removal of the tumor. Histopathologically, the tumor cells of the recurrent lesion were dispersed extensively in the bone marrow, and bone remodeling was active. The surgical procedure may have stimulated tumor cell proliferation and reactive bone formation. The patient was followed for 2 years with no evidence of recurrence or metastasis.

Hyperreactivity of pseudoxanthoma elasticum-affected dermis to vitamin D3

A 68-year-old woman with pseudoxanthoma elasticum (PXE) was treated with oral vitamin D(3). After 2 weeks, new papules developed on the pre-existing plaques. Biopsy specimens of a fresh papule showed more abundant calcium deposition than before therapy. Electron microscopy revealed electron-lucent areas, which suggested unusual mineralization. From these findings, we propose that in patients with PXE, certain cutaneous tissues are highly sensitive to vitamin D(3), resulting in microdeposition of calcium salts.

[Pheochromocytoma of the urinary bladder: a case report]

A 49-year-old man was hospitalized with the chief complaint of coagulation in urine. The patient was not hypertensive. Cystoscopic examination showed a submucosal tumor in the left lateral wall of the bladder. A transurethral sonogram revealed a low echoic nodule. Transurethral resection of the tumor in the urinary bladder was performed. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. After operation, the patient's course was uneventful, and there has been no recurrence for one year after surgery. This patient is the 52nd patient with pheochromocytoma of the urinary bladder reported in the Japanese literature.

[Bacillus Calmette-Guerin intravesical instillation treatment for carcinoma in situ of the bladder. Gifu BCG Instillation Therapy Research Group]

We performed a retrospective long-term study to evaluate the efficacy of intravesical instillation of Tokyo 172 strain Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder. Between 1989 and 1998, 42 patients with CIS of bladder underwent intravesical instillation of BCG. In the follow-up period from 6 to 116 months (mean: 37.3 months), the efficacy rate of intravesical BCG instillation for CIS of the bladder was 81.0%. Two patients died from the bladder cancer. The non-recurrence rate in patients with grade 2 carcinoma (19 cases) was not significantly different from that in those with grade 3 carcinoma (23 cases). However, the recurrence rate in patients with secondary CIS (15 cases) was significantly higher than in those with primary CIS (27 cases). The recurrence of CIS was observed in 7 of 42 cases. In 6 of 7 patients, CIS recurred within one year after treatment. Total cystectomy was performed in 10 of 42 patients, and pathological findings of muscle layer invasion were detected in 8 patients. Although side effects occurred in 33 patients (77.5%), no clinically significant side effects were observed. Our results suggest that intravesical BCG therapy may be useful for the treatment of CIS of the bladder.

Distinctions between microglial cells and peripheral macrophages with regard to adhesive activities and morphology

Activated microglial cells and peripheral macrophages are hardly distinguishable from the viewpoints of morphology and function. There are various immunological markers common to both microglial cells and peripheral macrophages. In the present study, however, we found that microglial cells have distinct characters in terms of adhesion and morphology. By using a "rheoscope," that is an apparatus to rheologically measure the strength of cell adhesion to substrates, rat microglial cells were found to attach to polystyrene dishes much more weakly than alveolar and peritoneal macrophages. Interferon-gamma (IFNgamma) strengthened the adhesion of alveolar and peritoneal macrophages, whereas it weakened that of microglial cells. Morphological changes of microglial cells induced by IFNgamma were also different from those of peripheral macrophages. Furthermore, alveolar and peritoneal macrophages produced NO in response to IFNgamma, while microglial cells did not. When cultured on astrocyte-derived extracellular matrix (AsECM) in serum-free medium, only microglial cells extended multiple ramified processes. Conversely, alveolar and peritoneal macrophages on AsECM shrunk their ruffling membrane and rounded up. These distinctions between microglial cells and macrophages may reflect differences in cell lineages as well as environments in which individual cells reside.

Comparative study of assays for prostate-specific antigen molecular forms

BACKGROUND

The detection of prostate-specific antigen (PSA) molecular forms such as free PSA and PSA-ACT and the use of PSA molecular ratios, especially the percentage of free to total PSA, have been reported to improve the diagnostic accuracy of prostate cancer in the patients with slightly elevated serum PSA values. However, the correlation among the values of serum free PSA or PSA-ACT obtained in various assays remains unclear.

METHODS

Serum free PSA and PSA-ACT values were detected with the following assays: Hybritech, DPC, EIKEN, Abbott, Roche and Can-Ag for free PSA and Dainippon, Chugai, EIKEN and Bayer for PSA-ACT. The data obtained with each assay were compared with Hybritech (free PSA) and Dainippon (PSA-ACT) as standards.

RESULTS

The free PSA data obtained with the Hybritech, EIKEN, Abbott and Can-Ag kits were similar. The values obtained with the DPC and Roche kits showed a linear regression of y = ax + b with those obtained with the Hybritech, with a b value of zero and an a value of 1.20 and 1.57, respectively. The serum PSA-ACT values detected with the Dainippon and Chugai kits were identical. The equation for converting the data obtained with the EIKEN kits to the Dainippon value was 0.7636 x (EIKEN) + 0.1381.

CONCLUSIONS

Serum free PSA and PSA-ACT values obtained with various assays were not necessarily the same. Some kits for the assay of free PSA and PSA-ACT gave the same serum values. The free PSA values obtained with the other kits could be converted using appropriate equations. The gamma-Sm values showed wide variations and were not considered suitable as a measurement of free PSA.

[A case of spontaneous pyeloduodenal fistula]

A 61-year-old woman visited our hospital complaining of right flank pain and fever. The radiograph demonstrated multiple renal calculi. Radio renography showed no uptake in the right kidney. Therefore, we diagnosed her with pyonephrosis, and recommended open nephrectomy. However, she selected the conservative treatment with extra corporeal shockwave lithotripsy (ESWL). In spite of disappearance of multiple calculi, pyuria continued for 3 months after ESWL. Retrograde pyelography showed a fistula from the right pelvis into the duodenum. The patient was successfully treated by nephrectomy and duodeno-fistelectomy.

Nisoldipine improves the impaired erythrocyte deformability correlating with elevated intracellular free calcium-ion concentration and poor glycaemic control in NIDDM

AIMS

To explore the mechanisms underlying the impaired erythrocyte deformability (RBC-df) in diabetic patients, the relationship between erythrocyte intracellular free calcium-ion concentration ([Ca2+]i) and RBC-df, and the effects of Ca2+-channel blocker on [Ca2+]i and RBC-df were evaluated.

METHODS

Forty-eight patients with NIDDM and 24 control subjects were enrolled in this study. [Ca2+]i was determined using fura-2, and RBC-df by filtration method expressed as Deformability Index (DI). Erythrocytes were treated with nisoldipine to evaluate the effects of a Ca2+-channel blocker.

RESULTS

[Ca2+]i was significantly higher (82.6 (78.0-87.2) vs 76.6 (74.3-81.2) nmol lRBC-1, P<0.001), and DI was significantly lower (0. 14 (0.09-0.28) vs 0.22 (0.16-0.28), P<0.01) in NIDDM than in controls. There was a significant correlation between HbA1c and [Ca2+]i (r=0.38, P<0.01), between HbA1c and DI (r=-0.51, P<0.01), and between [Ca2+]i and DI (r=-0.42, P<0.01). Stepwise multiple regression analysis revealed HbA1c and [Ca2+]i as independent determinants for the impaired RBC-df. Nisoldipine treatment in vitro significantly decreased [Ca2+]i, and significantly improved RBC-df.

CONCLUSIONS

These data indicate that the impaired RBC-df in NIDDM may at least partly be attributed to the elevated [Ca2+]i and poor glycaemic control. In addition, favorable effects of a Ca2+-channel blocker on both [Ca2+]i and RBC-df have been demonstrated.

[A case of dermatomyositis associated with asymptomatic pneumomediastinum]

A 20-year-old woman initially presented with edematous erythema in the upper eyelids in December 1995. She was admitted to our department in January 1996 because of fever and multiple arthralgia. She was given a diagnosis of dermatomyositis (DM) on the basis of characteristic eruption, elevated serum level of creatine kinase, and increased inflammatory reaction. Chest computed tomography (CT) revealed faint interstitial changes in the left lower lung. The administration of corticosteroid caused improvement in the patient's condition and the interstitial lesion in the lung. Although she was asymptomatic, chest CT showed pneumomediastinum in the pretracheal space and concomitant pneumothorax around left bronchus. Those changes spontaneously disappeared 4 weeks later without treatment. The occurrence of pneumomediastinum in patients with DM has been well documented as an indicator of poor prognosis in the literature. It seems that a severe pulmonary disorder could secondary cause pneumomediastinum. In our case, however, the pneumomediastinum developed in spite of the low grade severity of the pulmonary lesion. This finding suggested that the pneumomediastinum may be associated with the development of DM itself.

Morphological changes of epithelial rests of Malassez in rat molars induced by local administration of N-methylnitrosourea

The objective was to examine the possibility that epithelial rests of Malassez can give origin to odontogenic tumours. A mixture of N-methylnitrosourea (MNU) and alginate impression material for dental use was injected onto the periosteum of the buccal side of the left mandible of 5-week-old, male Wistar rats (300 mg/kg body wt). The mixture was left at the site for several months. The rats were killed 1, 3, 5, and 8 months after the injection. After 5 and 8 months, the epithelial rests of Malassez in the cervical and bifurcational regions of the first, second, and third left mandibular molars were significantly enlarged and the alveolar bone around the lesion was resorbed by multinucleated cells in all rats. The epithelial masses were characterized by enamel organ-like structures, deposition of eosinophilic amorphous material, duct-like structures, and squamous metaplasia. In addition to these masses in the molar regions, odontogenic tumours were induced in the incisal region and carcinomas and sarcomas in the buccal region, knee, bladder, and skin. Local administration of a mixture of MNU and alginate impression material can induce odontogenic tumours from the epithelial rests of Malassez at high incidence.

[A case of polymyositis with anti-Jo-1 antibody preceded by BOOP]

A 56-year-old man experienced dyspnea since August 1995 and the chest X-ray film showed abnormal shadow. The diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP) was established based on the histological findings of transbronchial lung biopsy. The patient was treated with prednisolone and symptoms improved. Myalgia and muscle weakness developed associated with relapse of BOOP after withdrawal of prednisolone. Patient was admitted to our department on December 1995 for further examination. An increased level of serum CPK, histological findings of muscle biopsy consistent with myositis, and positive anti-Jo-1 antibody were identified. Those findings supported a diagnosis of polymyositis (PM), and BOOP was considered as a pulmonary complication of PM. Myositis and pulmonary lesion improved after second course of steroid therapy and patient was discharged on May 1996. Both chronic pulmonary fibrosis and acute progressive interstital pneumonia are well known as pulmonary lesion associated with PM. The former is frequently recognized in cases of PM with anti-Jo-1 antibody and the latter is often observed in cases without autoantibodies. The association of PM and BOOP, however, has rarely been reported. The findings that BOOP frequently preceded PM and anti-Jo-1 antibody was positive in half of the cases were observed in the literature.

Association of apolipoprotein allele epsilon 2 with psoriasis vulgaris in Japanese population

We studied phenotypic variations of apolipoprotein E (apoE) and the corresponding allele frequencies in 100 Japanese patients with psoriasis vulgaris (PV). The phenotypes of apoE were examined using analytical isoelectric focusing followed by immunoblotting with goat anti-apoE antibody and alkaline phosphatase-conjugated rabbit antigoat IgG. The phenotypic frequency of apoE3/2 in PV was significantly higher than in healthy controls, and this elevation was associated with an increased frequency of the epsilon 2 allele. Therefore, it is suggested that the apoE molecule plays an important role in the development of PV.

Establishment and characterization of a novel human cell line exhibiting both immunophenotypic markers of monocyte/macrophage and natural killer cell lineages from peripheral blood of a patient with atopic dermatitis

Large amounts of homogeneous cells are not always available for in vitro studies of inflammatory skin disorders. Here we demonstrate that a novel cell line, termed YAA, has been established from peripheral blood mononuclear cells, which were separated by the Ficoll method, of a patient with atopic dermatitis. YAA cells were grown in suspension culture. The cytochemical staining showed a positive reaction for alpha-naphthyl butyrate esterase, which was completely inhibited by sodium fluoride, but a negative result for periodic acid-Schiff, peroxidase and alkaline phosphatase. A large population of YAA cells exhibited phenotype of CD33 and CD56 but neither of CD2 nor CD3. The phorbol ester-stimulated YAA cells produced a considerable amount of tumor necrosis factor-alpha. These findings suggest that YAA might be a monocytoid line with an additional phenotype specific for natural killer cells.

[Two cases of recurrent, massive hemoptysis with contralateral, concurrent hemoptysis]

Bilateral, concurrent massive hemoptysis with respiratory failure is rare and difficult to manage. We encountered two patients with this condition. One was a 51-year-old woman and one was a 63-year-old woman. Both had inactive pulmonary tuberculosis and episodes of hemoptysis. Home oxygen therapy was prescribed to the former patient and bronchial artery embolization was done in the latter. The sites of initial bleeding were in the left basal segment and in the lingular segment. Bleeding was well controlled by endobronchial tamponade with a Fogarty balloon catheter in the left main bronchus, contralateral intubation, and systemic artery embolization. Use of water instead of air in the balloon was more effective in over the long term. Concurrent bleeding from the contralateral upper lobe bronchus was controlled by compression with a tracheal tube cuff at the bronchial orifice. Afterward, an infiltrative shadow was seen on the chest X-ray film and hemoptysis occurred in case 2 occurred in case 2. Treatment with erythromycin and antituberculosis drugs brought about improvement of chest X-ray findings and disappearance of the hemoptysis.

Production of amelogenin by enamel epithelium of Hertwig's root sheath

OBJECTIVE

To study the multiple potentials of differentiating odontogenic epithelial cells.

STUDY DESIGN

Bilateral first and second maxillary molars of 30 immature rats were perforated into the pulp chambers with a round bur. The pulps were observed histologically and immunohistochemically for amelogenin 3, 7, and 14 days after the perforation.

RESULTS

On day 7, the enamel epithelium of Hertwig's root sheath migrated and formed oval-shaped epithelial islands that resembled epithelial rests of Malassez. On day 14, the islands consisted of epithelial cells with large nuclei and cytoplasm partially surrounded by a subsequently formed osteodentin and cementum. Immunoreactivity for amelogenin was observed in the large epithelial cells and in the area between the cells as well as the calcified tissues. Some of the enamel epithelium resembling columnar ameloblasts of the enamel organ were also positive for amelogenin.

CONCLUSIONS

The enamel epithelium of Hertwig's root sheath appeared to differentiate into ameloblasts and produce amelogenin.

Putative linkage between HLA class I polymorphism and the susceptibility to malignant melanoma

Human leukocyte antigen (HLA) frequencies in 67 melanoma patients were compared to 120 controls in Japan. The frequency of HLA-B13 was increased in melanoma patients compared to controls and was particularly common in nodular melanoma HLA-B61 was decreased in melanoma patients. Almost 50% of acral lentiginous melanoma patients expressed HLA-B51 compared to 0% of nodular melanomas.

Immune response to Streptococcus pyogenes and the susceptibility to psoriasis

Monoclonal antibodies directed against type 12 Group A streptococcal cell wall antigens cross-react with nuclei and cytoplasm of cells from skin and synovium from controls, uninvolved skin of psoriatics and psoriatic plaques. Patients with psoriasis had high serum titres of antibody against the M12 (C-region) streptococcal antigen compared to controls. An abnormal immune response directed against a "self' antigen after initiation by Group A streptococcal infection may play an important role in the exacerbation or development of psoriasis.

Establishment and characterization of a novel human promonocytic cell line from peripheral blood of a patient with psoriasis

Human monocyte/macrophage lineages have unique phagocytic and immune-regulatory functions. We established a promonocytic cell line from the peripheral blood of a patient with psoriasis vulgaris. The newly established cells, termed YAP cells, grew in a suspension culture. In Wright-Giemsa-stained preparations, YAP cells were round or polygonal in shape. Transmission electron microscopy showed that the cells had clear nuclei with well-defined nucleoli. There were frequent mitochondria, a relatively abundant endoplasmic reticulum profile, free ribosomes and an occasional Golgi apparatus. Cytochemical studies showed a positive reaction for alpha-naphthyl butyrate esterase, which was completely inhibited by sodium fluoride, a diffuse positive reaction for periodic acid-Schiff, and a negative result for alkaline phosphatase and peroxidase. A large population of YAP cells reacted with the CD4, CD11b, CD25 and CD33 surface markers, but not with CD2, CD3, CD8 or CD19. We also found that YAP cells produced considerable amounts of TNF alpha, which was detected in the culture supernatant when the cells were treated with 1 ng/ml 12-O-tetradecanoylphorbol-13-acetate (TPA). Chromosome analyses showed that YAP cells contained a variety of marker chromosomes. It should be stressed that YAP cells were derived from a patient with a non-neoplastic disorder, whereas most monocytic cell lines previously reported are of malignant origin. This newly established cell line might be valuable for studying the pathogenesis of psoriasis, especially the role of monocytes/macrophages in the aetiology of the disease.