Pertussis immunization with acellular vaccines in Ghanaian children

In the present study, the persistence of antibodies to pertussis antigens was assessed in 51 Ghanaian children immunized with one of two acellular vaccines and one whole cell vaccine in early infancy. The effect of a booster dose 1 year after primary immunization was also examined. Antibody titres to pertussis toxin (PT) and filamentous haemagglutinin (FHA) were measured 1 month and 1 year after primary immunization and 1 month after the booster dose. Although geometric titres (GMTs) to FHA were significantly higher in the two types of acellular vaccinees in the whole cell vaccinees 1 month after primary immunization, GMTs to FHA and PT after 1 year were not significantly different in the three groups. Geometric mean titres to PT and FHA following the booster dose were significantly higher in the acellular vaccinees than in the whole cell vaccinees. Seropositivity rates to PT and FHA in the acellular vaccinees, which were more than 93.3% 1 month after primary immunization, ranged from 50.0 to 77.8% after 1 year. In conclusion, the acellular vaccines did not produce higher antibody levels than the whole cell vaccine 1 year after primary immunization. The booster dose was essential to maintaining sufficient seropositivity to pertussis antigens.

Subsequent epilepsy in very-low-birthweight infants: a long-term follow-up study from birth

We studied 197 survivors of 290 very-low-birthweight (VLBW, < 1,500 g) infants admitted to our neonatal intensive care unit from 1977 through 1982. The children were all followed until at least age 6 years (mean 10 years 6 months). Eight children (4.1%) had epilepsy: 5 had generalized, 2 had unilateral, and 1 had partial seizures. Two (1.0%) had active and poorly controlled epilepsy. Three had a history of epileptic seizures, but none for > or = 6 years, and 3 were no longer receiving antiepileptic drug (AED) treatment. Most (5 of 8) were severely multiply handicapped. As compared with VLBW children without epileptic seizures and neurodevelopmental abnormalities, VLBW children with epileptic seizures had a gestational age < 27 weeks, a weight < 1,000 g, severe perinatal complications as indicated by an Apgar score of < 4 at 5 min, and the need for long-term oxygen administration.

In vitro and in vivo effects of somatostatin on the growth of A431 cells

We previously reported that the octapeptide somatostatin (SS) analogue SMS 201-995 (SMS) unexpectedly stimulates the growth of A431 human epidermoid carcinoma cells in vitro. In the present study, we found that both SS-14 and SS-28 also stimulated the growth of A431 cells in vitro. The proliferative effect of SS-28 also stimulated the growth of A431 cells in vitro. The proliferative effect of SS-28 was greater than that of SS-14. In contrast, there was no difference in A431 cell tumor weight or area between the SMS-treated or untreated athymic, tumor-bearing mice. The serum epidermal growth factor (EGF) level of the SMS-treated mice was significantly lower than that of the untreated mice. Decreases in serum EGF may attenuate the proliferative effect of SMS in vivo.

Coexisting type III hyperlipoproteinemia and familial hypercholesterolemia: a case report

A 39-year-old man presented with type III hyperlipoproteinemia in association with heterozygous familial hypercholesterolemia (FH). He had extensive tuberous xanthomas over the knees and elbows and xanthomas in the Achilles tendons. He also had palmar xanthomas. He exhibited severe hypercholesterolemia and hypertriglyceridemia. This patient was heterozygous for FH, as evidenced by low low-density lipoprotein (LDL) receptor function on lymphocytes, and had type III hyperlipoproteinemia, as determined by apolipoprotein (apo) E phenotype 2/2 in isoelectric focusing of the E isoproteins and the presence of a broad beta band on electrophoresis. Because therapy consisting of diet restrictions and lipid-lowering agents such as clinofibrate and niceritrol did not decrease serum total cholesterol ([TC] 15.26 mmol/L) and triglyceride ([TG] 10.79 mmol/L) levels effectively, the patient underwent plasmapheresis once every 2 weeks using a dextran sulfate-cellulose column. Repeated plasmapheresis markedly reduced serum TC and TG and induced complete regression of the palmar xanthoma after 6 months. The severity of tuberous xanthomas on the knees and elbows was reduced after 2.5 years. After plasmapheresis, TC decreased to 1.94 mmol/L from 10.40 mmol/L and TG decreased to 0.33 mmol/L from 7.90 mmol/L. Plasmapheresis performed with a dextran sulfate-cellulose column was highly effective in removing the lipoprotein-remnant particles in this patient, leading to generalized improvement in the lipoprotein profile.

Effect of cholera toxin and pertussis toxin on the growth of A431 cells: kinetics of cyclic AMP and inositol trisphosphate in toxin-treated cells

Cholera toxin and pertussis toxin were inhibitory to the incorporation of thymidine into A431 cells in serum-free culture. Cholera toxin enhanced the growth inhibitory effect of epidermal growth factor (EGF) on A431 cells, whereas pertussis toxin attenuated the effect. Cholera toxin increased the concentration of intracellular cyclic AMP (cAMP) to three-times the initial concentration at 120 minutes and it increased the concentration of intracellular inositol trisphosphate (IP3) rapidly but transiently. Pertussis toxin reduced the concentration of IP3 both in EGF treated and untreated A431 cells at 10 minutes. cAMP was not involved in pertussis toxin-mediated effects. In conclusion, the intracellular cAMP and IP3 concentrations in CT-treated A431 cells are compatible with previous reports regarding the growth inhibitory effects on A431 cells. The inhibitory effect of PTX on the EGF-induced increase of intracellular IP3 is thought to be compatible with the finding that PTX attenuated the EGF-induced growth inhibition.

Comparative studies on bile flow and biliary lipid excretion after bile-acid loading in normal and partially hepatectomized rats

This study was performed to investigate sequential changes in bile secretion and biliary lipids after taurocholic acid (TCA) loading of regenerating rat liver. TCA was administered intravenously at stepwise-increasing doses to groups of non-operated control and partially hepatectomized rats, 24, 72 and 168 h after surgery. Bile flow, bile-acid output (BAO) and phospholipid output (PLO) (expressed per gram of liver) in partially hepatectomized rats increased more than in the controls. Using an isolated perfusion rat-liver system, TCA infusion was also carried out on groups of non-operated control and hepatectomized rats 72 h after operation. Again bile flow, BAO and PLO (expressed per gram of liver) were significantly higher in the partial hepatectomy case, mirroring the results obtained in vivo. When horseradish peroxidase (HRP) was pulse-loaded in isolated perfusion preparations, the second peak of biliary HRP secretion in hepatectomized rats was significantly higher than in controls. We conclude that increased bile-acid flow in partially hepatectomized rats is dependent upon acceleration of vesicular transport accompanying or following proliferation in regenerating livers.

Phytochrome, Gibberellins, and Hypocotyl Growth (A Study Using the Cucumber (Cucumis sativus L.) long hypocotyl Mutant)

The possible involvement of gibberellins (GAs) in the regulation of hypocotyl elongation by phytochrome was examined. Under white light the tall long hypocotyl (lh) cucumber (Cucumis sativus L.) mutant, deficient in a type B-like phytochrome, shows an increased "responsiveness" (defined as response capability) to applied GA4 (the main endogenous active GA) compared to the wild type. Supplementing far-red irradiation results in a similar increase in responsiveness in the wild type. Experiments involving application of the precursor GA9 and of an inhibitor of GA4 inactivation suggest that both the GA4 activation and inactivation steps are phytochrome independent. Endogenous GA levels of whole seedlings were analyzed by combined gas chromatography-mass spectrometry using deuterated internal standards. The levels of GA4 (and those of GA34, the inactivated GA4) were lower in the lh mutant under low-irradiance fluorescent light compared with the wild type, similar to wild type under higher irradiance light during the initial hypocotyl extension phase, and higher during the phase of sustained growth, in which extension involved an increase in the number of cells in the upper region. In all cases, growth of the lh mutant was more rapid than that of the wild type. It is proposed that GA4 and phytochrome control cell elongation primarily through separate mechanisms that interact at a step close to the terminal response.

Squamous cell carcinoma of the pancreas with massive invasion of the retroperitoneum

A 79-year-old woman with a rare form of pancreatic carcinoma with massive invasion of the retroperitoneum presented with upper abdominal pain and vomiting. Although examination (computed tomography, barium enema, upper gastrointestinal series) suggested peritonitis carcinomatosa due to pancreatic cancer, a primary lesion of the pancreas was not confirmed by endoscopic retrograde pancreatography. Autopsy ultimately revealed a small tumor (5 x 8 mm) of the uncinate process of the pancreas near the duodenum with peritonitis carcinomatosa. Microscopically, the tumor and its metastasis consisted of poorly differentiated squamous cell carcinoma without adenocarcinomatous change, a rare form of pancreatic tumor.

The mutant Eisai hyperbilirubinemic rat is resistant to bile acid-induced cholestasis and cytotoxicity

We investigated bile flow and biliary excretion of bile acids in the Eisai hyperbilirubinemic rat, a Sprague-Dawley mutant rat with conjugated hyperbilirubinemia, using both in vivo and in vitro models. In vivo bile flow was lower in Eisai hyperbilirubinemic rats than in the control rats before and after taurocholate was infused. After taurocholate was infused, bile acid output was similar in the Eisai hyperbilirubinemic rats and control rats. In the isolated perfused rat liver, biliary excretion of bile acids was higher in the Eisai hyperbilirubinemic rats than in the control rats after a high-dose infusion of taurocholate (0.33 mumol/min/gm liver). Infusion of taurochenodeoxycholate (0.22 mumol/min/gm liver) did not produce cholestasis and did not reduce the biliary excretion of bile acids in the Eisai hyperbilirubinemic rats. Taurochenodeoxycholate significantly increased the phospholipid/bile acid molar ratio and slightly reduced bile acid-induced alkaline phosphatase output into bile. The release of lactate dehydrogenase from the perfused liver 30 min after the start of the taurochenodeoxycholate infusion was 10 times lower in the Eisai hyperbilirubinemic rats than in the control rats (2.0 +/- 0.8 vs. 28.7 +/- 6.8 mU/min/gm liver). When the isolated perfused rat liver was infused with a 1-min pulse of horseradish peroxidase (25 mg), we observed an early and late peak of biliary excretion of horseradish peroxidase. The Eisai hyperbilirubinemic rats showed a significant increase in the late peak.(ABSTRACT TRUNCATED AT 250 WORDS)

The Arabidopsis GA1 locus encodes the cyclase ent-kaurene synthetase A of gibberellin biosynthesis

The first committed step in the gibberellin (GA) biosynthetic pathway is the conversion of geranylgeranyl pyrophosphate (GGPP) through copalyl pyrophosphate (CPP) to ent-kaurene catalyzed by ent-kaurene synthetases A and B. The ga1 mutants of Arabidopsis are gibberellin-responsive male-sterile dwarfs. Biochemical studies indicate that biosynthesis of GAs in the ga1 mutants is blocked prior to the synthesis of ent-kaurene. The GA1 locus was cloned previously using the technique of genomic subtraction. Here, we report the isolation of a nearly full-length GA1 cDNA clone from wild-type Arabidopsis. This cDNA clone encodes an active protein and is able to complement the dwarf phenotype in ga1-3 mutants by Agrobacterium-mediated transformation. In Escherichia coli cells that express both the Arabidopsis GA1 gene and the Erwinia uredovora gene encoding GGPP synthase, CPP was accumulated. This result indicates that the GA1 gene encodes the enzyme ent-kaurene synthetase A, which catalyzes the conversion of GGPP to CPP. Subcellular localization of the GA1 protein was studied using 35S-labeled GA1 protein and isolated pea chloroplasts. The results showed that the GA1 protein is imported into and processed in pea chloroplasts in vitro.

[Relation of electrocardiographic features and distribution of hypertrophy in hypertrophic non-obstructive cardiomyopathy during childhood]

The relationship between the electrocardiographic features and the distribution of ventricular hypertrophy in pediatric patients with hypertrophic non-obstructive cardiomyopathy (HNCM) aged from 6 to 16 years (mean 11.6 years) was studied during a period of 6 months to 10 years (mean 3.9 years). Hypertrophy in the three segments (anterior septum, lateral free wall, posterior free wall) of the left ventricle in 17 patients with HNCM was evaluated by two-dimensional echocardiography (short-axis cross section of the left ventricle) at the end-diastolic period. The 17 patients were divided into four groups according to the echocardiographic findings as follows: Group A: hypertrophy in the ventricular anterior septum with or without posterior septum (eight patients). Group B: hypertrophy in both the ventricular septum and lateral left ventricular free wall (three patients). Group C: hypertrophy in the lateral left ventricular free wall (three patients). Group D: hypertrophy in the posterior left ventricular free wall with or without posterior septum (three patients). The incidence of electrocardiographic abnormalities in each group was analyzed using serial standard 12-lead electrocardiography. Electrocardiographic abnormalities and the distribution of the ventricular hypertrophy were related as follows: Lateral free wall: increased SV1 + RV6 (p < 0.05), ST-T change in leads V5.6 (p < 0.01). Posterior free wall: ST-T change in leads II.aVF (p < 0.05). Electrocardiographic abnormalities in HNCM patients in the hypertrophy were: Group A: abnormal Q waves in leads II.III.aVF (75%) and V5.6 (50%), high voltage R waves in leads II.III.aVF (25%) and V1 (38%), low voltage R waves in leads V2.3 (13%) and V5.6 (38%), and ST-T changes in leads I.aVL (25%), II.aVF (13%) and V2-4 (50%). Group B: abnormal Q waves in leads II.III.aVF (33%), high voltage R wave in lead V1 (33%), increased SV1 + RV6 (67%), low voltage R waves in leads V2.3 (33%) and V5.6 (33%), and ST-T changes in leads I.aVL (33%), II.aVF (33%), V2-4 (67%) and V5.6 (67%). Group C: abnormal Q waves in leads I.aVL (33%) and V5.6 (33%), high voltage R waves in leads II.III.aVF (33%), V1 (67%) and V5.6 (33%), increased SV1 + RV6 (67%), low voltage R waves in leads V5.6 (33%) and ST-T changes in leads II.aVF (33%), V2-4 (33%) and V5.6 (67%).

A randomized controlled trial of two acellular pertussis-diphtheria-tetanus vaccines in primary immunization in Ghana: antibody responses and adverse reactions

Two acellular pertussis vaccines combined with diphtheria and tetanus toxoids (APDT vaccines) were compared with a whole cell PDT (WCPDT) vaccine in primary immunization in Ghana. One is a liquid vaccine which is used for general immunization in Japan and the other is a freeze-dried vaccine newly developed as a heat-stable vaccine. Eighty-nine infants were recruited in the study. Sixty-eight who completed three doses of the immunization were assessed for immunological responses. Twenty-one dropped out because of sickness or moving from the study area. A total of 242 vaccinations in 89 infants were followed up for adverse reactions. Geometric mean titres (GMTs) to filamentous haemagglutinin in the two APDT vaccinees were significantly higher than in the WCPDT recipients. GMTs to pertussis toxin, diphtheria and tetanus toxoids were not significantly different among the three groups. Seropositive rates to pertussis antigens, tetanus and diphtheria toxoids were 94.4 to 100% in the two APDT vaccines. Systemic reactions within 7 days of inoculation were similarly low in the three groups, but significantly fewer infants had local reactions after either of the two APDT vaccines than after the WCPDT vaccine.

Serum myeloperoxidase and serum cytokines in anti-myeloperoxidase antibody-associated glomerulonephritis

Anti-MPO antibodies, serum MPO and cytokines were examined in 106 patients with glomerulonephritis. Twenty-three patients had anti-MPO antibodies and crescent formation; 17 had crescentic glomerulonephritis (CRGN) and the remaining 6 had focal segmental necrosis with less than 50% crescent formation in the observed glomeruli. Pauci-immune CRGN accounted for 28 of 43 CRGN cases. Anti-MPO antibody titers were significantly higher in the cellular crescent stage and their titers correlated well with the number of crescents. Clinical observation revealed that 11 of 18 patients with anti-MPO antibody-associated CRGN had a respiratory tract infection prior to the onset of overt glomerulonephritis. Serum MPO was detected in 20 of 23 patients with anti-MPO antibodies and the amounts of MPO were especially high in the cellular crescent stage and correlated with anti-MPO antibodies. TNF-alpha and IL-6 were also detected in the sera in parallel with the anti-MPO antibody titers. These data suggest that anti-MPO antibodies, TNF-alpha and IL-6, induced by the infection, may activate neutrophils and MPO itself released from neutrophils, may play an important pathogenetic role in glomerular capillary necrosis leading to CRGN.

The C. elegans unc-18 gene encodes a protein expressed in motor neurons

The C. elegans unc-18 gene is required to maintain normal acetylcholine levels. We determined the complete structure of an unc-18 cDNA that encodes a protein of 591 highly charged and hydrophilic amino acids. The protein shows sequence similarity with elements of the secretory pathway in the yeast S. cerevisiae. Antibodies raised against a portion of the unc-18-encoded protein (UNC-18) detected a 68 kd soluble antigen on immunoblots and intensely stained all vertical cord motor neurons in situ. These findings suggest that UNC-18 participates in the axonal transport system and influences the acetylcholine flow in motor neurons.

Effects of dibutyryl cyclic AMP and papaverine on intrahepatocytic bile acid transport. Role of vesicle transport

The secondary messenger cyclic AMP plays an important role in regulating biliary excretory function by stimulating the transcytotic vesicle transport system, whereas papaverine exerts an inhibitory effect on this system. We therefore investigated their effects on bile acid-induced cytotoxicity and intrahepatocytic content of bile acid in primary cultured rat hepatocytes. Simultaneous addition of 1 mM dibutyryl cyclic AMP (DBcAMP), an analogue of cAMP, with 1 mM taurochenodeoxycholic acid (TCDCA) significantly decreased the release of lactate dehydrogenase (LDH) as compared with the case with 1 mM TCDCA alone (7.1 +/- 0.13% of total versus 10.7 +/- 0.3%). In contrast, 0.1 mM papaverine approximately doubled the amount of LDH (22.0 +/- 0.6% of total versus 10.7 +/- 0.3%; P < 0.01). The intracellular content of TCDCA 180 min after the administration of 1 mM TCDCA alone was 20.8 +/- 0.7 nmol/mg protein, that after simultaneous administration of 1 mM DBcAMP, 16.2 +/- 1.0 nmol/mg protein, and that after the simultaneous administration of 0.1 mM papaverine, 38.5 +/- 1.9 nmol/mg protein. A clear correlation between the release of LDH from hepatocytes and the intracellular content of TCDCA was thus observed. When given together with 1 mM taurocholic acid (TCA) or 1 mM tauroursodeoxycholic acid (TUDCA), papaverine exerted little effect on cytotoxicity or intrahepatocytic bile acid content. When cells were bathed in a medium free of bile acid after pretreatment with 1 mM TCDCA and 1 mM DBcAMP, additional exposure to DBcAMP for 30 min significantly stimulated reduction of intracellular TCDCA content (30.2 +/- 0.4% of total versus 44.0 +/- 1.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of somatostatin and its analogue on proliferation of human epidermoid carcinoma cells in vitro

Somatostatin (SS) and its analogue inhibit the growth of some human tumors in vivo. Surprisingly, we found that SS-14 and its analogue (SMS 201-995) exhibited unexpected proliferative effects on two lines of cells, A431 and KB human epidermoid carcinoma cells, in vitro. The level of intracellular cyclic AMP, an important second messenger that controls the growth of A431 cells, was unaffected in A431 cells by either SS-14 or SMS 201-995. In contrast, SS-14 (20 nM) and SMS 201-995 (10 nM) reduced the level of intracellular inositol 1,4,5-trisphosphate rapidly but transiently.

Transforming growth factor-alpha activity in effusions: comparison of radioimmunoassay and radioreceptorassay

Transforming growth factor-alpha (TGF-alpha) in pleural and peritoneal effusions was assayed by homologous radioimmunoassay (RIA) and radioreceptor assay (RRA) using human placental membrane. Effusions were obtained from 24 patients with and 17 patients without cancer. Most of the effusions were found to contain TGF-alpha by RIA and RRA, but immunoreactive epidermal growth factor (EGF) was not detected. Effusions were chromatographed on Bio-Gel P-60 with several peaks of TGF-alpha activity by both RIA and RRA. A discrepancy in the chromatographic pattern of TGF-alpha between RIA and RRa suggested the existence of EGF-like substances capable of binding to EGF receptors which lack immunoreactivity for EGF or TGF-alpha. The TGF-alpha concentration of the acetic acid-extracted malignant effusions assayed by RRA significantly exceeded the value obtained from benign effusions (17.0 +/- 8.7 vs. 9.2 +/- 6.3 ng/ml; mean +/- SD: p < 0.02). However, the concentrations obtained by RIA did not differ.

Effect of ascorbic acid on pituitary prolactin secretion in the non-ascorbate synthesizing Osteogenic Disorder Shionogi (ODS) rat

We examined the secretion of prolactin (PRL) in the hereditary scurvy-prone Osteogenic Disorder Shionogi (ODS) rat to investigate the role of ascorbic acid (AsA) in pituitary lactotroph and hypothalamic function. Plasma PRL concentrations of conscious AsA-deficient or control ODS rats were measured before and after the administration of metoclopramide (MCP), 5-hydroxy-L-tryptophan (5-HTP) or saline. The basal plasma PRL levels did not differ between the two groups. However, the AsA-deficient rats exhibited significantly larger changes in plasma prolactin concentration in response to MCP or 5-HTP than the control ODS rats. Thus, AsA deficiency enhanced the stimulated, but not the basal, secretion of PRL in ODS rats. Our findings suggest that AsA may have an inhibitory effect on PRL secretion.

Excretion of urinary epidermal growth factor in non-insulin dependent diabetes mellitus

Morning urine samples were assayed for human EGF (hEGF) in 137 non-insulin dependent diabetic patients with normal serum creatinine and beta 2-microglobulin levels. Serving as controls, 80 age- and sex-matched healthy subjects were also examined. A significant positive correlation between hEGF excretion and the level of hemoglobin A1C (HbA1c) was present in those patients with a HbA1c value exceeding 8% (r = 0.37; p = 0.003) but not in the overall patients. The urinary hEGF level did not correlate with the concentration of glucose in urine or plasma. The mean urinary hEGF level of diabetic patients was significantly lower than that of healthy subjects. The mean urinary hEGF level was significantly lower in the patients with a diabetic history that exceeded five years as compared with those with a history below five years. The mean urinary hEGF level was significantly lower in the patients with retinopathy vs. those without retinopathy. In the patients with HbA1c value below 8%, the mean urinary hEGF level was lower in the patients whose urinary albumin level exceeded 1.7 mg/mmol.creatinine as compared with those whose urinary albumin excretion was below 1.7 mg/mmol.creatinine. These findings suggest that urinary hEGF excretion may decrease with the progression of diabetic complications in the patients with well-controlled glycemia, and that inadequate glycemic control may lead to an increased excretion of urinary hEGF in the early disease stage.

Duodenal stromal tumor with neural differentiation

A 49-year-old woman was admitted to our hospital for detailed evaluation of an abdominal mass. Ultrasonography and computed tomography revealed two tumors, one a submucosal lesion of the duodenal second portion and the other a left adrenal tumor. Angiography showed that the tumors were hypervascular. Both tumors were removed surgically and examined histologically using hematoxylin-eosin staining. The duodenal tumor (10 x 6 x 5 cm) was initially diagnosed as a schwannoma, but immunohistochemical studies showed that it was S-100 protein negative and neuron-specific enolase positive. Therefore, this tumor was identified as a stromal tumor with neural differentiation. The left adrenal tumor was a nonfunctioning adenoma.

Transformation of coronary artery aneurysm to obstructive lesion and the role of collateral vessels in myocardial perfusion in patients with Kawasaki disease

OBJECTIVES

The aim of this study was to examine the transformation of coronary artery aneurysms to obstructive lesions and to assess the role of collateral vessels in patients with Kawasaki disease.

BACKGROUND

Coronary artery aneurysms, especially giant aneurysms, are known to become obstructive lesions in patients with Kawasaki disease. However, the process of transformation is not yet clear.

METHODS

Thirty patients (average age 9.9 years) with obstructive lesions secondary to Kawasaki disease underwent repeated coronary artery angiography and thallium myocardial scintigraphy over a mean period of 7.7 years after the acute onset of Kawasaki disease.

RESULTS

In the 27 patients who were enrolled in the acute phase of the disease because of coronary artery aneurysms, the later transformation to obstructive lesions was not significantly different between the 61 large and 6 medium-sized aneurysms. Obstructive transformation of aneurysms was more rapid in the right than in the left coronary artery (p < 0.001). From the last coronary angiogram obtained, the obstructive lesions were classified as localized stenosis > 90% in 10 vessels, occlusions in 6 vessels and segmental stenosis in 26 vessels. Both localized and segmental stenosis occurred significantly more often in the left anterior descending and the right coronary artery than in other vessels (p < 0.05). The incidence of collateral vessels was significantly correlated with a younger age at onset of Kawasaki disease, especially in patients with segmental stenosis (p < 0.001). Collateral vessels did not develop in the presence of localized stenosis regardless of the occurrence of myocardial ischemia. All occluded vessels had collateral development regardless of the presence of myocardial infarction.

CONCLUSIONS

The treatment of localized stenosis may play an important role in preventing myocardial infarction in the chronic phase of Kawasaki disease.

Increased content of epidermal growth factor in platelet lysates in non-insulin-dependent diabetes mellitus

We evaluated the content of EGF in platelet lysates obtained from 49 patients with non-insulin-dependent diabetes mellitus (NIDDM)(18 males, 31 females, age 58 +/- 13 years) and from 23 clinically healthy control subjects (11 males, 12 females, age 53 +/- 18 years). Platelets were collected from platelet-rich plasma and lysed. EGF was determined by radioimmunoassay. The immunoreactive EGF content in the platelet lysates in diabetic patients significantly exceeded that of control subjects (44.9 +/- 18.5 pg/mm3platelet vs. 34.2 +/- 7.8 pg/mm3platelet, mean +/- SD p < 0.008). In performing multiple regression analysis with ten clinical parameters, urinary albumin excretion (F = 16.1, r = 0.551, p < 0.001), duration of diabetes (F = 13.0, r = 0.511, p < 0.001) and the presence of diabetic proliferative retinopathy (F = 8.8, p < 0.01) were significantly associated with irEGF content in platelet lysates. These observations suggest that the amount of EGF in platelets may increase with the progression of diabetic complications. The mechanism for the increase of EGF in platelets remains to be clarified.

[Lymphoid infiltration of colon cancer and clinical significance of the skin test]

It was reported that lymphoid infiltration (LI) of colon cancer tended to be found more commonly in patients with colonic cancer in an early stage than in an advanced stage. This time, the correlation among LI of colon cancer, cell-mediated immunity and the cumulative 5-year survival rate was studied in 124 patients with resected colon cancer. The results were as follows: 1) The cumulative 5-year survival rate in patients with positive LI was higher than that in the patients with negative LI. 2) There was correlation between the degree of LI of the cancer and Su-PS skin reaction. 3) Postoperative cell-mediated immunity was reduced in the cases of poor prognosis. Therefore we insist on paying attention to immunochemotherapy for 24 months after surgery.

Thyroid storm associated with probable subclinical hypoadrenocorticism in an elderly woman

A 73-year-old woman was admitted to the hospital for severe persistent vomiting with fever, drowsiness, and weight loss. Elevated serum levels of thyroid hormones and the presence of a consciousness disorder with fever and vomiting led to the diagnosis of thyroid storm. A low normal concentration of serum cortisol, urinary 17-hydroxycorticosteroids and an elevated plasma level of corticotropin suggest that an inadequate adrenal reserve have been involved in the pathogenesis of the thyroid storm in this patient. She responded to the administration of intravenous methimazole and oral supersaturated potassium iodide solution.

Mutations in genes for acetylcholinesterase intensify lethality by acrylamide in Caenorhabditis elegans

Acrylamide inhibits growth and results in death in the nematode Caenorhabditis elegans. The lethargic effect is marked in the mutants defective in genes for acetylcholinesterase (AChE) and the effect is approximately parallel with the decrease in AChE activity by mutations. Although neither the activity nor the localization of the enzyme is affected by acrylamide, the acetylcholine level was significantly elevated.

[Early diagnosis and management against perioperative fungus infection]

Candida spp. is frequently detected from perioperative patients, especially from those requiring central venous catheter (CVC) management. CAND-TEC could detect the blood fungus infection easily and quickly. We analyzed 438 specimens from 57 patients requiring perioperative CVC management for more than three weeks, and investigated usefulness of CAND-TEC comparing with other serological methods. The dilution rate of CAND-TEC showed a positive correlation with amount of beta-D-glucan which was measured by Toxicolor test and Endotoxin-specific assay. It also showed a positive correlation with amount of D-arabinitol. When blood samples diluted more than four times were positive with CAND-TEC, the patients were considered to be infected, and accumulative infection rate was up to 84.2% three weeks after introduction of CVC management. CAND-TEC would be useful in detecting Candida infection compared with conventional methods, and the fungus infection was much more frequent incidence than ever expected. It is important to detect fungus infection early and respond immediately to avoid nosocomial infection.

[A case of microscopic polyarteritis nodosa associated with myeloperoxidase-antineutrophil cytoplasmic autoantibodies (MPO-ANCA)]

We report a case of microscopic polyarteritis nodosa associated with myeloperoxidase-antineutrophil cytoplasmic autoantibodies (MPO-ANCA). A 38 year-old female was admitted to our hospital, because of proteinuria, recurrent pyrexia, polyarthralgia, abdominal pain and purpura. She had a history of severe pulmonary hemorrhage and 4 kg weight loss for 8 months. On admission perinuclear ANCA without cytoplasmic ANCA was detected by indirect immunofluorescence assay and MPO-ANCA was detected by enzyme linked immunosorbent assay. But anti-nuclear antibodies, immune complexes and anti-glomerular basement membrane antibodies were not detected. Renal biopsy showed necrotizing crescentic glomerulonephritis without immune deposits. Skin biopsy revealed leukocytoclastic vasculitis. Diagnosis of microscopic polyarteritis nodosa was made by these clinical and histological evidence of vasculitis. As renal failure progressed after admission, corticosteroid and cyclophosphamide administration were started. Renal function and other symptoms improved paralleled with decreased MPO-ANCA titer to normal values. It is suggested that MPO-ANCA may be closely related to the pathogenesis of microscopic polyarteritis nodosa and it may be a good serological marker for diagnosis and disease activity of this disease.

The unc-18 Gene Encodes a Novel Protein Affecting the Kinetics of Acetylcholine Metabolism in the Nematode Caenorhabditis elegans

Genes affecting acetylcholine (ACh) levels without influencing choline acetyltransferase activity have been identified in Caenorhabditis elegans. We have examined one such gene, unc-18. We isolated a transposon-insertion allele for unc-18 and used it to clone a genomic region containing the unc-18 locus. The unc-18 location within this region was determined by rescuing the unc-18 mutant phenotype in a germ-line transformation experiment and identifying transcripts affected by four independent unc-18 mutations. A single-sized poly(A)+ RNA was synthesized from the gene. Expression of the transcript appears to be stage specific: The transcript is found in abundance at the early larval stage but in decreased amounts at the fourth larval and the adult stages. These results show that the unc-18 gene plays a role in development as well as in the kinetics of ACh metabolism.

A case of Goodpasture's syndrome associated with anti-myeloperoxidase antibodies

A case of Goodpasture's syndrome with anti-myeloperoxidase (MPO) antibodies is reported. Histological examination revealed crescentic glomerulonephritis and alveolar hemorrhage with linear deposition of IgG along the glomerular capillary walls and alveolar capillary walls by immunofluorescence microscopy. Not only anti-glomerular basement membrane (GBM) antibodies but also anti-MPO antibodies, an anti-neutrophil cytoplasmic antibody, were simultaneously detected in the serum. Although it is generally accepted that crescentic glomerulonephritis in Goodpasture's syndrome is mediated by anti-GBM antibodies, this case suggested that anti-MPO antibodies might also participate in the pathogenesis of crescentic glomerulonephritis and probably alveolar hemorrhage of Goodpasture's syndrome, especially with vasculitis.

[A case of anti-myeloperoxidase antibodies-associated idiopathic crescentic glomerulonephritis with pulmonary hemorrhage]

We report a case of idiopathic crescentic glomerulonephritis with pulmonary hemorrhage associated with anti-myeloperoxidase antibodies (anti-MPO ab). A 74 year-old female was admitted to our hospital because of rapidly progressive glomerulonephritic syndrome and dyspnea with bloody sputum. On admission anti-MPO ab, one of anti-neutrophil cytoplasmic antibodies, were detected but anti-GBM antibodies and immune complexes were not detected. Renal biopsy showed crescentic glomerulonephritis and lung biopsy showed massive alveolar hemorrhage. Both tissue had pauci-immune deposit by immunofluorescence microscopy. Hemodialysis and steroid administration were started. Pulmonary hemorrhage was improved remarkably, but renal failure progressed rapidly to end stage kidney, then hemodialysis was continued. Although subsequent 3 years uneventful maintenance hemodialysis had been performed, she admitted to our hospital again because of progressive dyspnea with hemoptysis after upper respiratory tract infection. On admission anti-MPO ab were detected again and steroid administration was started. Pulmonary hemorrhage was improved with decreased anti-MPO ab titer. While tapering the dosis of steroid, anti-MPO ab again increased and pulmonary hemorrhage recurred. Although pulse methylprednisolone therapy and plasma exchange were performed, respiratory failure progressed rapidly and she died of sepsis. Postmortem examination showed no evidence of systemic vasculitis. In this case, titer of anti-MPO ab was associated with not only idiopathic crescentic glomerulonephritis but also with pulmonary hemorrhage. We tried to detect enzymatically active MPO in serum. Titer of serum MPO was also associated with disease activity and anti-MPO ab. It is suggested that both anti-MPO ab and serum MPO are closely related to the pathogenesis of idiopathic crescentic glomerulonephritis and pulmonary hemorrhage.

[A case of graft-versus-host disease following irradiated fresh blood transfusion]

We reported a case of a fatal graft-versus-host disease (GVHD) which developed in a 65-year-old, male patient which was considered to have been induced by irradiated fresh blood donated by his son after a coronary bypass surgery. Fresh blood was obtained from his relatives, and a 15 Gy irradiation was performed before transfusion. The diagnosis of acute GVHD was made by clinical symptoms and histological examinations of the skin and the bone marrow. He died of sepsis on the 19th post-operative day. The HLA typing of the lymphocytes, revealed that the patient had A 2, A 24, Bw 52, Bw 62, Cw 4, DR 2, and his son had A 24, Bw 52, DR 2. A 24 and Bw 52 were homogeneous making his son histocompatible with one of the patient's haplotype. This might well be attributable to the occurrence of GVHD in this case, meaning that 15 Gy irradiation was not sufficient for the prevention of this disease.

Additional genes which result in an elevation of acetylcholine levels by mutations in Caenorhabditis elegans

Four mutant genes (unc-17, unc-18, unc-41 and unc-13) have been identified that result in abnormal accumulation of acetylcholine (ACh). We have now identified 3 more such genes (unc-63, unc-11 and unc-64). In addition to the abnormal accumulation of ACh, mutants in these 7 genes possess common phenotypes in locomotion, resistance to inhibitors of acetylcholinesterase (AChE) and in post-embryonic development. These results suggest that the 7 genes are involved in some related functions.

[The treatment of condyle neck fracture: statistics gathered by multi centric study and the related prognosis]

There are two different treatments for condyle neck fracture. One is non-surgical treatment involving intermaxillary fixation, and the other is radical surgical treatment through various techniques, but it is difficult to discuss the relative merits. The purpose of this report is to decide whether surgical treatment is necessary, by comparing the two types of treatment. In the period between April 1981 to December 1987, we treated 136 cases of condyle neck fracture at the Second Department of Oral and Maxillofacial Surgery School of Dentistry Aichigakuin University, and in 18 nearby hospitals. Of the 136 cases, 58 cases had fracture only at the condyle neck, while 78 cases had some concomittant fracture. As regards treatment, of the 136 cases, 49 (36%) were treated surgically, while 87 (64%) were treated non-surgically for condyle neck fracture. The surgically treated cases were divided into three groups: 24 cases were treated by pinning, 16 cases were treated by inter osseous wiring, and there were 9 other cases. In the treatment of concomittant fracture, 38 cases involved inter osseous wiring, 22 cases involved metal plate fixations, and there were 4 other cases. Non-surgical treatment accounted for 15 cases. The rate of surgical treatment for concomittant fracture was 82.1% of the cases treated. In surgically treated cases of condyle neck fracture, the mouth opening prognosis was generally poor. However, in these cases the deviation of mouth opening was generally better than in non-surgically treated cases. There were no differences in mastication, occlusion and pain in the TMJ region.

Coronary sinus blood flow and coronary haemodynamic function in children: measurement by the continuous thermodilution method with coronary sinus cannulation via the femoral vein

In 19 children with Kawasaki disease without any cardiac sequelae the coronary sinus was cannulated via the femoral vein with a specially designed flow catheter and coronary sinus blood flow was measured by the continuous thermodilution method. There was a statistically significant positive correlation between coronary sinus blood flow and age, body surface area, and left ventricular mass, but coronary sinus blood flow per left ventricular mass (100 g) was negatively correlated with age, body surface area, and left ventricular mass. Coronary vascular resistance was negatively correlated with age, body surface area, and left ventricular mass. Younger children require a much greater coronary blood flow per left ventricular mass and have a higher coronary vascular resistance than older children and adolescents. These results may indicate that coronary blood flow is less efficient in childhood than in adolescence or adulthood.

[Spinal epidural abscess as the cause of torticollis--diagnosis by magnetic resonance imaging]

Spinal epidural abscesses are rare, accounting for only 0.2-1.2 of every 10,000 hospital admissions. Because they often present with non-specific symptoms, they are frequently misdiagnosed. We present a case in which superconduction MRI was used to make the diagnosis and to follow the clinical course of a spinal epidural abscess. In December 1988, a 33-year-old male developed spiking fever and the sudden onset of torticollis. He had had a cerebral palsy from birth, with chronic tetraparesis and mental retardation. Isolation of staphylococcus aureus in urine and blood cultures confirmed the diagnosis of pyelonephritis and septicemia. A high fever persisted despite antibiotic therapy commenced immediately. A technetium 99 m scan showed a localized uptake of isotope in the cervical spine. An MRI examination performed in the following day under sedation showed a mass with the same signal intensity as muscle on T1-weighted images. It was located behind the vertebral bodies C1-Th1 compressing the spinal cord. In addition, a lesion with a decreased signal was also evident in the C5-C6 vertebral bodies. Because of torticollis, the patient was unable to keep his head still for a sufficient period of time, to obtain T2-weighted imaging. The MRI findings indicated the presence of a spinal epidural abscess and osteomyelitis. A second MRI done one month after admission showed a reduction in the size of the epidural mass, but further diminishing of the signal intensity of the vertebral lesion. One month later, the patient underwent the surgical removal of the pus and inflammatory soft tissue, and anterior fusion. The torticollis resolved following the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Transforming growth factor (TGF)-alpha in human milk

Transforming growth factor (TGF)-alpha and epidermal growth factor (EGF) were measured in human milk by means of homologous radioimmunoassay. As previously reported, EGF concentration in the colostrum was approximately 200 ng/ml and decreased to 50 ng/ml by day 7 postpartum. The value of immunoreactive (IR)-TGF-alpha was 2.2-7.2 ng/ml, much lower than that of EGF. In contrast to EGF, the concentration of IR-TGF-alpha was fairly stable during the 7 postpartum days. There was no relationship between the concentrations of IR-TGF-alpha and IR-EGF, suggesting that the regulatory mechanism in the release of the two growth factors is different. On gel-chromatography using a Sephadex G-50 column, IR-EGF appeared in the fraction corresponding to that of authentic human EGF, while 70%-80% of the IR-TGF-alpha was eluted as a species with a molecular weight greater than that of authentic human TGF-alpha. Although the physiological role of TGF-alpha in milk is not known, it is possible that it is involved in the development of the mammary gland and/or the growth of newborn infants.

Epidermal growth factor and transforming growth factor alpha induce ascitic fluid in mice

Recent studies have suggested that pleural or peritoneal effusion associated with metastatic tumors is induced by some mediators produced by the tumor cells. We studied the ability of well-characterized peptide growth factors to produce ascites in mice. Peritoneal administration of epidermal growth factor (EGF, 10 to 40 micrograms/mouse/wk) or transforming growth factor alpha (TGF-alpha, 10 to 40 micrograms/mouse/wk) via osmotic minipumps resulted in formation of bloody ascites. The amount of ascites produced was dependent on the dose of growth factors. Vehicle alone or insulin-like growth factor I (40 micrograms/mouse/wk) was without effect. Indomethacin, a blocker of prostaglandin synthesis, significantly reduced the ascites accumulation induced by EGF, suggesting that prostaglandins are involved in ascites formation induced by EGF. Dexamethasone was also effective in attenuating the effect of EGF. Thus, it is possible that peritoneal effusion associated with disseminated tumors is, at least in part, due to EGF-like materials (most likely TGF-alpha) produced by tumor cells. The mechanism by which these peptides induce bloody ascites is not known for certain, but it may be due to the reported activity for neovascularization or increased vascular permeability.

Amino acid sequence of a lectin from Japanese frog (Rana japonica) eggs

The complete amino acid sequence and the location of disulfide bonds of a lectin from Japanese frog (Rana japonica) eggs, which specifically agglutinates transformed cells, are presented. The sequence was determined by analysis of peptides generated by digestion of the S-carboxyamidomethylated protein with Achromobacter protease I, or chymotrypsin, and by chemical cleavage with BNPS-skatole or cyanogen bromide. The lectin is a single-chain protein consisting of 111 residues, with a pyroglutamyl residue at the amino terminus. Four disulfide bonds link half-cystinyl residue 19 to 72, 34 to 82, 52 to 97, and 94 to 111. The sequence and the location of the disulfide bonds are highly homologous to those of bull frog (Rana catesbeiana) egg S-lectin. They are also homologous to human angiogenin, a tumor angiogenesis factor, and a family of pancreatic ribonucleases.

[Pharmacokinetics and clinical evaluation of aztreonam in pediatric surgery]

Pharmacokinetic and clinical studies on aztreonam (AZT) in pediatric surgery were performed and results obtained are summarized below. 1. Plasma and urinary levels of AZT were measured in 6 neonate patients following drip-infusion for 1 hour of AZT (dose of AZT: 20 mg/kg). Plasma levels reached their peak (42.3-50.4 micrograms/ml) at the end of infusion or in 1 hour thereafter except in case 2. In case 2, plasma level reached its peak (36.6 micrograms/ml) at 2 hours after the end of infusion. Plasma levels of AZT decreased rapidly after reaching their peaks, and plasma half-lives (T 1/2) were 1.85-2.84 hours. Urinary recovery rates were 15.7-65.3%. 2. Bile levels of AZT were determined in 8 patients with biliary atresia following 1 hour drip-infusion of AZT (dose of AZT: 20 mg/kg for 4 patients, 40 mg/kg for the other 4 patients). In the 20 mg/kg group, peak levels of AZT in bile were noted 2 hours after the end of infusion, and they were 3.7-7.1 micrograms/ml. Recovery rates in bile in the first 6 hours after the end of infusion were 0.34-0.9%. In the 40 mg/kg group, peak levels of AZT in bile were found at 2 hours and 2-4 hours after the end of infusion, and they were 4.9-8.8 micrograms/ml. Recovery rates in bile in the first 6 hours after the end of infusion were 0.03-0.33%. 3. AZT and ampicillin were administered to 6 patients as prophylaxis against postoperative infections. Another patient with postoperative cholangitis was given AZT alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Insulin-like growth factor I and transforming growth factor alpha as autocrine growth factors in human pancreatic cancer cell growth

The roles of insulin-like growth factor I (IGF-I) and transforming growth factor alpha (TGF-alpha) as autocrine factors in the proliferation of MIA-PaCa 2 cells (human pancreatic cancer cells, PC cells) were investigated. Furthermore, the mechanism(s) of inhibition of PC cell growth by a phorbol ester in relation to these two kinds of growth factor was also studied. PC cells grew autonomously when Dulbecco's modified essential medium supplemented with 4% fetal calf serum was changed to serum-free medium (0.3% bovine serum albumin-Dulbecco's modified essential medium). In addition, serum-free conditioned medium from PC cells dialyzed against fresh Dulbecco's modified essential medium had a stimulatory action on the growth of the same kind of cells when compared with that induced by nonconditioned medium. These observations suggest that a factor(s) produced and released by PC cells stimulates their own growth. Analysis of conditioned medium from PC cells revealed the presence of immunoreactive (IR)-IGF-I and IR-TGF-alpha. The molecular size of IR-IGF-I was similar to that of authentic IGF-I. On the other hand, IR-TGF-alpha was present as multiple forms when analyzed using gel chromatography. Authentic IGF-I and TGF-alpha added to culture medium stimulated PC cell growth by 1.45- and 1.5-fold above control value, respectively. A monoclonal antibody to IGF-I receptor was able to inhibit PC cell growth. PC cell proliferation was markedly inhibited by 12-O-tetradecanoyl-13-acetate (greater than 0.16 nm), whereas cell growth of human fibroblasts was stimulated by it. 12-O-Tetradecanoyl-phorbol-13-acetate also reduced the binding of 125I-TGF-alpha, but not 125I-IGF-I, to PC cells. Decrease in TGF-alpha binding was mainly due to the reduced affinity of receptors to the ligand. These results suggest that IGF-I and TGF-alpha are involved in PC cell proliferation as autocrine factors. Further, the inhibition of PC cell growth by phorbol ester could be, at least partly, due to the decreased binding of TGF-alpha to the cells.

A case of total left anomalous pulmonary venous connection with intact atrial septum diagnosed by two-dimensional and Doppler echocardiography

Unilateral total anomalous pulmonary venous connection from a unilateral lung is extremely rare. A 6-year-old patient with anomalous pulmonary venous connection from the entire left lung to the left innominate vein, with an intact atrial septum, diagnosed by two-dimensional and Doppler echocardiography is reported. The combination of two-dimensional and Doppler echocardiography is very useful not only for anatomical diagnosis, but also for evaluation of its hemodynamics, despite the wide anatomical variability of the pulmonary venous connection. This is the first report of a case of left total anomalous pulmonary venous connection diagnosed noninvasively.

[Electrophysiologic effects of isoproterenol in children with Wolff-Parkinson-White syndrome]

12 children with the Wolff-Parkinson-White (WPW) syndrome underwent electrophysiologic study before and after the intravenous administration of isoproterenol. Effective refractory period of the accessory pathway and shortest paced cycle length with 1:1 atrioventricular (A-V) conduction via the accessory pathway were shortened after intravenous isoproterenol in all patients. Orthodromic reciprocating tachycardia was induced after isoproterenol in one patient who did not documented tachycardia attack or palpitation before. Anterograde A-V conduction via A-V node and retrograde V-A conduction via accessory pathway were enhanced. Thus, tachycardia cycle length was shortened. Potential high risk group patient who develop hazardous atrial fibrillation during exercise in the WPW syndrome may be selected by isoproterenol infusion.

Coronary sinus cannulation via the femoral vein

Cannulation of the coronary sinus has been usually accomplished by advancing a catheter through the brachial vein, subclavian vein, or internal jugular vein by venous cutdown or a sheath method. We here describe a technique for cannulation into the coronary sinus through the femoral vein by using a modified catheter. This catheter was easily inserted into the coronary sinus in all of 40 consecutive patients in whom it was attempted.

[Clinical and experimental studies on the etiology of congenital biliary dilatation (CBD)--with special reference to relationship between elastic fibers in the wall of the bile duct and type of CBD]

The purposes of this study are to clarify the correlation between the morphological differences in congenital biliary dilatation (CBD) and elastic fibers in the wall of the bile duct. Using forty-three patients with CBD and fifty-seven autopsy cases in which history of biliary disease had not demonstrated, histopathological studies have been performed. In addition, experimental models of anomalous choledocho-pancreatico ductal junction were created in twenty-two young sheep and nine neonatal lambs, and the differences in morphological change were studied in two groups. The results are as follows. 1) Elastic fibers were not seen in the wall of the common bile duct of neonate or infant. So it suggests that the ductal wall was extremely weak in this period and increased intraluminal pressure of the biliary system, induced by distal obstruction, caused the cystic dilatation easily. 2) Fusiform dilatation of the extrahepatic bile duct was produced in all experimental models. The reason why cystic dilatation was not caused in these models is that elastic fibers were abundant in just ductal wall of neonatal lambs. From these results, aging factors may play an important role in the formation of CBD.