CT appearance of interstitial pulmonary emphysema

Interstitial pulmonary emphysema (IPE) is the initial manifestation of ventilator-induced barotrauma. We report two patients in whom computed tomography was useful in showing IPE.

A-72363 A-1, A-2 and C, novel heparanase inhibitors from Streptomyces nobilis SANK 60192. I. Taxonomy of producing organism, fermentation, isolation and structure elucidation

Novel heparanse inhibitors, A72363 A-1, A-2, and C, were isolated from the culture filtrate of Streptomyces nobilis SANK 60192 by column chromatography on various resinous adsorbents, followed by preparative anion exchange HPLC. Spectroscopic studies revealed that they are diastereomers of siastatin B, a neuraminidase inhibitor.

[Radiologic-pathologic correlation between tumor edge and surrounding inherent structures in peripheral lung cancer]

PURPOSE

To evaluate the radiologic-pathologic relationship between the tumor edge of peripheral lung cancers and surrounding normal structures.

MATERIALS AND METHODS

Tissue samples from 16 lung cancers with diameters less than 2 cm were examined: 7 adenocarcinomas, 5 squamous cell carcinomas, 2 small cell carcinomas, 1 large cell carcinoma, and 1 that had metastasized to the lung. Inflation-fixed lung specimens containing tumor tissue were sliced to a thickness of 2 mm: The tumor edge of each section was traced under a stereomicroscope and its relationship to marginal structure, including bronchi, pulmonary arteries, and pulmonary veins containing interlobular septa, was analyzed. The tumor edge and marginal structures were classified into four types: Type 1, clear margin formed by marginal structures; Type 2, tumor involving the marginal structures; Types 3 and 4, marginal structures penetrating the tumor with and without a notch, respectively.

RESULTS

Type 1 was found in 23 of 47 pulmonary arteries (49%), 23 of 49 bronchi (47%), and 12 of 31 pulmonary veins or interlobular septa (39%). Type 2 was found in 11% (14/127), Type 3 in 15% (19/127) and Type 4 in 28% (36/127) of marginal structures. Type 1 was common in all histological types of carcinomas studied.

CONCLUSION

In small peripheral lung cancers, the tumor edge sometimes has a clear margin formed by surrounding structures such as interlobular septa. This can make it difficult to differentiate benign from malignant lesions.

A-72363 A-1, A-2, and C, novel heparanase inhibitors from Streptomyces nobilis SANK 60192, II. Biological activities

Inhibitory activities of A-72363 A-1, A-2 and C, the diastereomers of a neuraminidase inhibitor siastatin B, against various glycosidases were tested in comparison to siastatin B. Despite these compounds differing only in their configuration, each compound showed strikingly different specificities towards the various glycosidases tested. A-72363 C inhibited bovine liver beta-glucuronidase and tumor cell heparanase with IC50 values of 1.6 microM and 12 microM, respectively.

Subchronic toxicity of 3-phenylamino alanine, an impurity in L-tryptophan reported to be associated with eosinophilia-myalgia syndrome

Consumption of certain product lots of L-tryptophan (LT) has been reported to be epidemiologically associated with an outbreak of eosinophilia-myalgia syndrome (EMS) in the United States. Since the production lots were found to contain 3-phenylamino alanine (PAA) as an impurity, its effects were studied by administering the substance orally by gavage to 5-week-old Sprague-Dawley rats. Groups of animals were given PAA for 13 consecutive weeks at dose levels of 1, 10 and 100 mg/kg per day. The animals were killed at 4 or 8 weeks. Hematological and blood biochemical tests were performed and detailed histopathological observations were made. No significant abnormalities were observed in the test animals and in particular no EMS-like conditions. A brief summary of other animal studies using several species of rats and mice performed in our laboratory since 1989 on various LT related substances is also presented. No EMS-like effects were observed in these studies.

[Comparison of 99mTc-technegas scintigraphy and high resolution CT in pulmonary emphysema]

This study was undertaken to assess the usefulness of technetium-99m technegas scintigraphy axial images (technegas) compared with high resolution CT (HRCT) in 12 patients with pulmonary emphysema. All patients were male adult and heavy smokers and their mean age was 65. All patients inhaled 505 MBq technegas in several tidal volume breaths in the supine position without breath holding. SPECT imaging was performed by a Picker model Prism 2000. HRCT was performed after technegas. The technegas images showed different degree of changes from areas of heterogeneity to hot spots or defects. In emphysema, HRCT images showed low attenuation areas varying in size and number. In 4 of 12 patients, the degree of abnormal findings on technegas increased according to the degree of abnormal findings on HRCT. In the remaining 8 patients, however, more detailed findings were shown by technegas than by HRCT. There was no patients in which HRCT showed a greater changes than on technegas. HRCT can demonstrate low attenuation areas, even less than 5 mm in diameter. Moreover previous reports showed that aerosol inhalation would also demonstrate the airway disease. Assessment of the degree of involvement revealed by both methods indicated the superiority of technegas over HRCT. We conclude that technegas can represent the ventilation involvement easily more than HRCT in pulmonary emphysema.

Suppression of interleukin-1 alpha production by protein kinase C activators in human vascular endothelial cells

In human umbilical endothelial cells, treatment with tumor necrosis factor (TNF)-alpha stimulated the production of cell-associated interleukin (IL)-1 alpha. Combined treatment of human umbilical endothelial cells with TNF-alpha and the protein kinase C (PKC) activator 12-O-tetradecanoylphorbol 13-acetate (TPA) suppressed the TNF-alpha-induced production of IL-1 alpha. However, concentrations of 6-keto-prostaglandin F1 alpha in the conditioned medium were increased to a greater extent by combined treatment with TNF-alpha and TPA than by single treatment with TNF-alpha or TPA. Pretreatment with TPA for 15 min was enough to suppress the TNF-alpha-induced IL-1 alpha production. Pretreatment for 15 min with other PKC activators such as aplysiatoxin or teleocidin, also inhibited the TNF-alpha-induced IL-1 alpha production. Stimulation of cell-associated IL-1 alpha production by IL-1 beta or lipopolysaccharide was also inhibited by pretreatment with the PKC activator TPA, aplysiatoxin or teleocidin. However, treatment with the protein kinase inhibitor 1-(5-isoquinoline-sulphonyl)-2- methylpiperazine dihydrochloride (H-7) did not block the inhibitory effect of TPA, aplysiatoxin or teleocidin on the cell-associated IL-1 alpha production stimulated by TNF-alpha, IL-1 beta or lipopolysaccharide, although the PKC activator-induced stimulation of 6-keto-prostaglandin F1 alpha production was counteracted by H-7 treatment. The present work indicates that the production of cell-associated IL-1 alpha stimulated by TNF-alpha, IL-1 beta or lipopolysaccharide is inhibited by treatment with TPA, aplysiatoxin or teleocidin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Left ventricular systolic and diastolic function after mitral valve replacement with preservation of posterior chordae tendineae]

Left ventricular function was compared in 14 patients who underwent mitral valve replacement with preservation of the posterior leaflet, chordae tendineae and papillary muscle (preserved group) and 14 patients who underwent conventional mitral valve replacement (non-preserved group). 99mTc radionuclide ventriculography was performed before surgery and one month after surgery. The early diastolic filling rate, an indicator of the efficiency of diastolic function, was measured. The patients in the non-preserved group showed an anteroseptal ejection fraction of 28 +/- 10% before surgery and 32 +/- 10% after surgery, an apical ejection fraction (71 +/- 10% vs 73 +/- 16%), and an inferolateral ejection fraction (56 +/- 16% vs 53 +/- 16%). The global ejection fraction tended to decrease from 56 +/- 9% to 52 +/- 10%. The patients in the preserved group showed an anteroseptal ejection fraction of 37 +/- 13% before surgery and 43 +/- 19% after surgery, an apical ejection fraction (74 +/- 20% vs 77 +/- 17%) and an inferolateral ejection fraction (53 +/- 11% vs 68 +/- 16%). The global ejection fraction, reflecting improvement in the inferolateral ejection fraction, tended to increase from 53 +/- 11% to 58 +/- 11%. The early diastolic filling rate for the preserved group was 1.73 +/- 0.43 before surgery and 1.05 +/- 0.61 after surgery, while that for the nonpreserved group was 1.59 +/- 0.24 vs 0.97 +/- 0.48. Although the early diastolic filling rate normalized in both groups, there was no significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypersensitivity pneumonitis in a pearl nucleus worker

A 37-year-old woman had worked for 4 years in a shell-processing factory where considerable airborne dust was produced cutting and polishing fresh water shells into pearl nuclei. She had a dry cough and dyspnea. Transbronchial lung biopsy showed noncaseating granulomas and cellular intraalveolar infiltrates. High-resolution lung computed tomography (HRCT) showed diffuse small nodules and ground-glass opacities. Hypersensitivity pneumonitis caused by shell dust should be considered in the appropriate clinical setting in a patient with the appropriate radiographic abnormalities.

Bronchial and vascular supply in azygos lobe of inflated fixed lung: a case study

Azygos lobe is a comparatively rare anomaly of the lung, and its radiologic features are well known. However, reports concerning its bronchial and vascular supply are few. The authors describe the bronchial and vascular supply of an azygos lobe in the autopsied right lung of a 43-year-old man. In the inflated fixed lung, the azygos lobe was supplied by the bronchi of the apical sub-subsegmental branch of B1b (B1bi) and B1a (B1ai) accompanied by the accompanied by the pulmonary artery of the same sub-subsegments (A1bi, A1ai). The lateral sub-subsegmental branches of B1aii and B1bii accompanied by the pulmonary artery did not supply the azygos lobe. The azygos lobe was supplied by V1a. V2 but not V1b.

Does preconditioning affect recovery in stunned myocardium?

In this study, to determine whether preconditioning enhances the process of recovery from post-ischemic dysfunction, ultrasonic crystals were placed in 8 open-chest dogs to measure regional myocardial wall thickening in the ischemic area. A carotid-circumflex coronary artery bypass was created with an electromagnetic flow probe and a fixed stenosis was produced. Ventricular pacing was performed for 15 minutes at a rate of 190-220 bpm. After a 15 minutes rest period, a second pacing was performed in a similar manner. After cessation of the first pacing, circumflex wall thickening remained reduced significantly. Three minutes after cessation of the second pacing, circumflex thickening decreased further. After 15 minutes, wall thickening improved to the value recorded before the second pacing. The degree of improvement from 3 minutes to 15 minutes after the second pacing was greater than that after the first pacing. Thus, preceding demand ischemia modifies the rate of functional recovery from the next post-ischemic dysfunction, indicating that preconditioning of the ischemic myocardium enhances recovery from stunning.

[anorexia nervosa; an association with certain types of soft tissue emphysema]

A 17-year-old female with anorexia nervosa developed pneumomediastinum, subcutaneous emphysema, retroperitoneal emphysema, interstitial pulmonary emphysema and epidural emphysema (epidural emphysema; air between the dura mater and the vertebral arch). She had no history of bronchial asthma. The mechanism was presumed to be weakness of the alveolar wall due to malnutrition, leading to rupture of alveoli, followed by air entering the interstitium and dissecting along perivascular sheaths (interstitial pulmonary emphysema) into the mediastinum. A further increase in mediastinal pressure may bring about opening of the fascial planes along great vessels and allow air to penetrate into subcutaneous tissues and the spinal canal. These types of emphysema have been reported in bronchial asthma cases and in those on positive pressure breathing. To our knowledge, there are no previous reports of anorexia nervosa associated with these phenomena.

In vitro effects of OK-432 on irradiated mouse bone marrow cells

PURPOSE

In vitro effects of OK-432 on irradiated mouse bone marrow cells are examined.

METHODS AND MATERIALS

Bone marrow cells of BDF1 mouse (1 x 10(6) cells/ml) were incubated with alpha medium, 2% fetal calf serum and OK-432 in a CO2 incubator at 37 degrees C for 24, 48 and 72 h, respectively. After centrifugation, each supernatant was collected and used for conditioned medium in CFU-GM assay: Changes in CFU-GM as a function of incubation time and OK-432 dose was examined; changes of CFU-GM according to various doses of OK-432 were examined in two mouse strains, BDF1 and BALB/c mouse; changes in protective effect of OK-432 in terms of CFU-GM as a function of administration timing of OK-432 in relation to irradiation. As a radiation source, 137Cs at a dose rate of 500 cGy/min was used.

RESULTS

The CFU-GM decreased with the incubation time when OK-432 was not administered, while it significantly increased with incubation time when OK-432 was added at 0.5 and 1.0 KE/ml at 48-72 h of incubation. The former showed marked increase at 48-72 h of incubation. CFU-GM of BDF1 mouse was always higher than that of BALB/c mouse for any dose of OK-432. CFU-GM per femur according to the timing of administration of OK-432 from 24 h before to 24 h after irradiation showed 10299 +/- 2300 (24 h before), 10783 +/- 2463 (3 h before), 10045 +/- 1501 (immediately after), 8504 +/- 1188 (3 h after), 4898 +/- 1212 (6 h after), 1214 +/- 736 (12 h after) and 181 +/- 113 (24 h after irradiation), respectively.

CONCLUSION

OK-432 stimulates cultured mouse bone marrow cells to produce GM-CSF in vitro by direct contact action. This direct stimulating action of OK-432 on GM-CSF production of bone marrow cells can be kept from 24 h before to at least 3 h after irradiation.

An alpha-fetoprotein producing pancreatic cystadenocarcinoma

An autopsy case of an 83-year-old Japanese woman with pancreatic cancer with significantly elevated serum alpha-fetoprotein levels is reported. The pancreatic tumor was a mucinous cystadenocarcinoma with multiple metastasis to the liver. The immunohistochemistry for alpha-fetoprotein revealed positive reactivity in the cytoplasm of cancer cells in the primary and liver metastatic lesions. The current case is the first reported in which mucinous cystadenocarcinoma of the pancreas produced alpha-fetoprotein.

Slow relaxation process in the main transition of phosphatidylcholines studied with heat capacity spectroscopy. I. Multilamellar vesicles

Extremely slow relaxation processes have been examined near the main transition of multilamellar vesicle samples of dimyristoylphosphatidylcholine (DMPC) and dipalmitoylphosphatidylcholine (DPPC) with a heat capacity spectroscopic technique. The dynamic heat capacity showed a significant frequency dependence in the studied frequency region of 0.5 mHz to 50 mHz. The relaxation observed here has been analyzed with the Cole-Cole equation. The mean relaxation times were 120 s in DMPC, and 260 s in DPPC. The relaxation showed a polydispersive character. The parameter beta was around 0.5 in both DMPC and DPPC.

Assessment of left ventricular filling dynamics utilizing Doppler echocardiography in acute coronary syndrome

To evaluate prolonged diastolic dysfunction in acute coronary syndrome, mitral inflow velocities and left ventricular wall motion were examined with pulsed-wave Doppler and two-dimensional echocardiography in 14 patients with successful reperfusion, 8 patients without reperfusion after acute myocardial infarction, and in 10 patients with prolonged angina. Early peak flow velocity and the ratio of early to atrial peak flow velocity increased gradually both after the onset of acute myocardial infarction with reperfusion and cessation of angina pectoris. However, in acute myocardial infarction without reperfusion, early peak flow velocity and the ratio of early to atrial peak flow velocity decreased significantly. Atrial peak flow velocity remained unchanged in acute myocardial infarction with reperfusion, while it was decreased in angina pectoris on the seventh day. Regional systolic dysfunction abated gradually in acute myocardial infarction with successful reperfusion, and regional systolic dysfunction was not detected in angina pectoris on the third day. Thus, abnormalities in left ventricular early diastolic filling persisted for several days after reperfusion in acute myocardial infarction or cessation of angina. Left ventricular late filling remained unchanged in acute myocardial infarction, whereas, in angina pectoris, a compensatory increase in late filling diminished gradually with an increase in early filling. These results indicate that there are different types of recovery process after diastolic filling abnormalities in patients with acute coronary syndrome.

Improved method of preparation of inflated-fixed lung for radiologic-pathologic correlation

The technique of inflation and fixation of the lung with polyethylene glycol is useful for specimen radiography and radiologic-pathologic correlation, but it is limited by poor histologic staining of the fixed tissue. To improve staining we used formalin to distend and fix the lung before standard fixation with a polyethylene glycol mixture. In this preliminary study, canine and infant lungs, and lungs from three cases of lung cancer were examined. The modified technique provided high-quality staining and satisfactory specimen radiography in all cases except one of the lung cancers; in this case excessive shrinkage occurred and degraded radiographic quality. We conclude that the new method of preparation permits both specimen radiography and high quality staining of the fixed tissue.

Effect of human recombinant granulocyte colony-stimulating factor on induction of myeloid leukemias by X-irradiation in mice

Hematopoietic suppression is one of the serious problems induced by whole body irradiation. Granulocyte colony-stimulating factor (G-CSF) stimulates the progenitors of granulocytes and accelerates their recovery from bone marrow suppression induced by cytotoxic chemotherapy or radiation. On the other hand, G-CSF stimulates proliferation of myeloid leukemia cells as well as normal granulocytes in vitro. We designed a method to determine if G-CSF affects the incidence of myeloid leukemias induced by irradiation and the types of leukemias induced according to the French-American-British (FAB) classification in RFM/MsNrs mice. Administration of G-CSF (2 micrograms/d for 7 days) after a single 3-Gy irradiation significantly increased the number of peripheral blood neutrophils as compared with those in control mice. Even after discontinuation of G-CSF, both the total leukocyte and neutrophil counts increased to day 10, and their levels remained elevated until day 14. The incidence of myeloid leukemia in mice exposed to a single 3-Gy irradiation was 18.6% (38 of 204), and treatment with G-CSF did not increase the incidence (15.7% [32 of 204]). In the mice with radiation-induced leukemia, those receiving G-CSF had a mean survival time of 357 days, whereas those not receiving the factor survived for 349 days. There was no significant difference of survivals between the two groups. Most of the radiation-induced leukemias in the two groups were M1 or M2, according to the FAB classification; no characteristic difference was observed among the types of leukemias. Although G-CSF stimulated the leukemia cells in vitro, G-CSF administration after irradiation did not increase the occurrence of radiation-induced myeloid leukemias. Our results show that administration of G-CSF effectively accelerates neutrophil recovery from irradiation-induced hematopoietic injury and does not enhance the induction of myeloid leukemia in RFM/MsNrs mice by irradiation.

[Visual acuity testing of three-year-old children using Landolt ring and picture targets]

Visual acuity testing using Landolt ring and picture targets (silhouettes of butterfly, fish, bird and tulip), was performed on 184 three-year-old subjects who had received secondary ophthalmic examination at the age of 3 years and 1-3 months, and the results were evaluated. The examinations were feasible on 83.1% of the subjects for the picture test and 76.1% for the Landolt ring test; the picture test being significantly higher. However, when the level was set at 0.5, namely, 0.5 or more were judged as "passing" and less than 0.5 judged as "failing", the Landolt ring test showed a significantly higher rate than the picture test in the number "passing". Specificity and sensitivity were calculated with reference to the clinical findings. Results suggest that the Landolt ring test has a better validity than the picture test and the Landolt ring test could differentiate between good and poor vision. The silhouette of the bird was particularly poor. When using picture targets for testing, the necessity of proper selection of the kind of pictures used is indicated. In the case of use of the Landolt ring, reexamination at the age of 3 years and 6 months or later, or postponement of the examination until age 3 years and 6 months or later would appear to be beneficial for enhancing the feasibility of the test.

Case report: silent thyroiditis developed during alpha-interferon therapy

Alpha-interferon (IFN-alpha) was used for the treatment of chronic active hepatitis C in a 30-year-old woman who was euthyroid but had low titers of antithyroid antibodies before treatment. Two months after the initiation of IFN-alpha therapy she became thyrotoxic. She had nontender diffuse goiter. A laboratory examination revealed elevated levels of serum free thyroid hormones and a suppressed concentration of serum thyrotropin. Titers of antimicrosomal antibodies increased. The anti-thyrotropin receptor antibody was negative. A 99mTcO- scintigram of the thyroid showed reduced uptake. During the IFN therapy free thyroid-hormone levels started to decline. The IFN-alpha therapy was completed 1 month after the onset of thyrotoxicosis. Two months after the completion of the therapy the patient became euthyroid and 99mTcO- uptake was normalized. It is likely that preexisting chronic thyroiditis was exacerbated to cause silent thyroiditis during IFN-alpha therapy. None of the other 11 patients with chronic hepatitis C who had had no anti-thyroid antibodies and were treated with IFN-alpha showed anti-thyroid antibodies and thyroid dysfunction after the therapy. It is advisable to assess anti-thyroid antibodies and thyroid function in patients who are going to receive IFN-alpha treatment.

[Visual acuity testing of three- and four-year old nursery school and kindergarten children]

Visual acuity testing was conducted on 1,531 children in nursery schools and kindergartens in Chita district, for the purpose of determining the rate of successfully performing the test, as well as the visual acuity of those shown to be normal by various ophthalmologic examinations. The rate of successful performance of the visual acuity test increased monthly with increasing age, with maximum changes seen at 4-5 months after the third birthday. The rate of successful performance of the test at the third birthday was 73%, progressively increasing up to 95% in the successive 6 months. The rate at the fourth birthday became almost 100%. Average of visual acuity of 3.0-year old children was 0.55, and for 3.5-year olds was 0.82. The average visual acuity reached 0.88 at 4.0 years of age, and at 4.5 years of age became 0.97. In view of the results obtained, it is concluded that children who could not successfully perform a visual acuity test at 3.0-years of age should be tested again at 3.5-years of age. Preferably the vision screening should be performed during the period between 3.5- and 4.0-years of age, for reliability and efficiency. Accordingly, the screening standards should also be changed with consideration given to visual development of children of this age.

Association of IgG anti-GD1a antibody with severe Guillain-Barré syndrome

We earlier reported cases of 2 patients with severe acute Guillain-Barré syndrome (GBS) associated with high-IgG anti-GD1a antibody titer. We now have investigated the autoantibody against GD1a or GM1 in 37 GBS patients using the enzyme-linked immunosorbent assay and have found a statistically significant association between IgG anti-GD1a antibody and the severity of the disease (need of a respirator for more than 1 month and a poor functional prognosis 3 months after neurologic onset). An autopsy which showed severe GBS associated with IgG anti-GD1a antibody produced the following findings: (1) severe axonal degeneration and segmental demyelination of peripheral nerves; (2) lymphocytic infiltration; and (3) marked central chromatolysis of the lower motoneurons.