[Recurrent bronchogenic cyst--a case report]

Mediastinal bronchogenic cyst is a benign tumor and occupied about 5% of mediastinal tumor in Japan. As a benign tumor, recurrence of bronchogenic cyst is very rare, and we found only 2 cases were reported. We experienced a recurrent bronchogenic cyst found 14 years after first operation. The patient was 56-year-old male, and admitted to our hospital for further evaluation of his abnormal shadow on chest roentogenogram. He had no symptoms. He was operated an bronchogenic cyst for 14 years ago. Chest X-ray, CT, and MRI demonstrated a paratracheal cystic mass which was suspected of a recurrent bronchogenic cyst. An operation was done, and the tumor was resected. A histopathological study showed that the tumor had thin wall and had a ciliated epithelium, then it was diagnosed bronchogenic cyst. The most likely explanation for the recurrence in our patient is an incomplete resection during the initial operation. It is though that only a very small amount of epithelial tissue need remain for recurrence. For prevention of recurrence, complete resection of cyst is necessary, and long-term follow-up is indicated to detect recurrence.

Monocyte chemoattractant protein 1 inhibits growth of rat vascular smooth muscle cells

The early atherosclerotic lesion is characterized by the migration of inflammatory cells, including monocytes, which may serve as a source of cytokines such as monocyte chemoattractant protein 1 (MCP-1), a homologue of mouse JE. We investigated the effect of MCP-1 on the growth of vascular smooth muscle cells (VSMC) isolated from rat aortae. In Northern blot analysis, MCP-1/JE transcripts were not observed in unstimulated VSMC, but its expression was clearly observed by exposure to lipopolysaccharide (1 micrograms/ml) for 6 h. Human recombinant MCP-1 inhibited the uptake of [3H]thymidine by VSMC cultured in 0.5% fetal bovine serum (FBS) containing Dulbecco's modified Eagle's medium (DMEM) in a dose-dependent manner. The inhibitory effect of MCP-1 on the growth of VSMC was also confirmed by a change in cell counts. The antiproliferative effect of MCP-1 was significantly blocked in the presence of an anti-MCP-1 antibody. MCP-1-induced inhibition of [3H]thymidine uptake was not affected in the presence of indomethacin (1 micrograms/ml) or NG-monomethyl-L-arginine (0.1 mM), and MCP-1 showed no effect on 6-ketoprostaglandin F1 alpha, guanosine 3',5'-cyclic monophosphate, and adenosine 3',5'-cyclic monophosphate syntheses in VSMC. These results indicate that MCP-1 inhibits the proliferation of VSMC in vitro and that its effect is independent of prostaglandin or nitric oxide generation.

[The effect of an endothelin receptor antagonist, 97-139, on intraocular pressure in rabbits]

We studied intraocular pressure (IOP) response to an intravitreal injection of 10(-5)M (20 microliters) endothelin-1 (ET-1) in unanesthetized rabbits, and found a transient IOP rise followed by a prolonged IOP reduction. ET-1 (10(-6)M) caused a sustained IOP reduction without an initial IOP rise. The ETA receptor selective antagonist, 97-139 (10(-2)M, 20 microliters), had no effect when used alone; however, when used in combination with ET-1 (10(-5)M), 97-139 (10(-2)M) significantly blocked the ocular hypotensive response to ET-1. 97-139 (10(-3)M), when used with 10(-6)M ET-1, also suppressed the IOP reduction induced by ET-1. Aqueous prostaglandin (PG) E2, determined by radioimmunoassay, was significantly elevated following intravitreal injection of ET-1 (10(-5)M). Prior injection of 97-139 (10(-2)M) significantly suppressed the elevation of aqueous PGE2 concentration caused by ET-1 (10(-5)M). These results suggest that both the IOP response and the elevation of aqueous PGE2 following ET-1 injection are at least partially mediated by ETA receptor.

A novel method to chemically immobilize antibody on nylon and its application to the rapid and differential detection of two Vibrio parahaemolyticus toxins in a modified enzyme-linked immunosorbent assay

A new method of chemically immobilizing antibody on nylon was developed. The method consists of serial treatments with HCl, polyethylene imine, and maleic anhydride methylvinyl ether copolymer, which resulted in the stable immobilization of sufficient amounts of antibodies on nylon. This principle was used to differentially detect two immunologically related but nonidentical hemolysins (thermostable direct hemolysin [TDH] and TDH-related hemolysin [TRH]) of Vibrio parahaemolyticus in a modified enzyme-linked immunosorbent assay with antibodies immobilized on nylon slips (NSIT). The results (dark purple color on nylon slips) were easily evaluated by the naked eye. The results with NSIT were compatible with those obtained by using DNA probes or a conventional bacterial culture test, not only with cultured specimens but also with clinical specimens (diarrheal stool samples). Furthermore, the NSIT differentially detected TDH and TRH in a single test. The antibody immobilization method developed here is applicable to various immunological detection methods and may improve their sensitivity and specificity.

[Major symptoms of multiple myeloma and their management--neurologic disorders]

The incidence of neurologic complications in multiple myeloma has been reported as high as 10 to 40% of the patients and neurologic symptoms are sometimes recognized as first manifestation of the disease. Neurologic lesions in multiple myeloma are classified as follows. 1. cerebral disorders (due to intracranial lesion, or renal insufficiency, hypercalcemia, anemia without intracranial lesion), 2. cranial nerve and intracranial involvement, 3. spinal cord or cauda equina compression, 4. radiculopathy (involvement of a nerve root). 5. peripheral neuropathy, Incidence, symptoms, and management of each disorder are reviewed with presenting case reports of the patients with multiple myeloma cases who showed neurologic disorders in our institution.

Evaluation of two assay kits for thermostable direct hemolysin (TDH) as an indicator of TDH-related hemolysin (TRH) produced by Vibrio parahaemolyticus

Reversed passive latex agglutination (RPLA) or enzyme-linked immunosorbent assay kits with beads (Bead-ELISA) are commercially available in Japan to detect the thermostable direct hemolysin (TDH) produced by Vibrio parahaemolyticus isolates. We evaluated whether these kits can be used to assay the pathogenic toxin, TDH-related hemolysin (TRH), produced by some so-called Kanagawa phenomenon-negative V. parahaemolyticus strains isolated from patients with diarrhea. Our results showed that the two kits, RPLA and Bead-ELISA, can detect TRH, although they were originally developed for detection of TDH. This may be due to the use of polyclonal anti-TDH antisera that cross react with TRH. Although the sensitivity for TDH detection by RPLA and Bead-ELISA differed tenfold, that for TRH detection was essentially equal. The minimum concentration of TRH required for detection by the two assay kits was about 10 ng/ml.

Leukomyelopathy in ataxic calves

Seventy-three fattening calves ranging from 6 to 15 months old on a farm were affected by ataxia over a period of four months. About 10 ataxic animals recovered after the administration of various kinds of vitamins and needle puncture therapy. The principal lesions in 14 ataxic animals examined were characterized by bilateral vacuolation with axonal degeneration confined to the spinal white matter. Ultrastructurally, the vacuoles were present in the periaxonal areas and bounded by dissociated myelin lamellae. No pathogen was isolated from the visceral organs of the animals. The serum copper remained within the normal range. Possible etiological factors remain unknown in the ataxic disease.

[A young woman with rheumatoid arthritis who rapidly developed secondary amyloidosis]

A 22-year-old woman, who had been diagnosed as having rheumatoid arthritis (RA) 2 years before, was admitted to our hospital complaining of watery diarrhea (several times/day). She had been treated with low dose prednisolone (PSL) and auranofin in out-patient clinic. On admission, laboratory data showed moderate proteinuria (0.3 g/day) and positive CRP (2.7 mg/dl). Although the activity of RA was controlled by the administration of low dose methotrexate (7.5 mg/week) in addition to PSL, watery diarrhea and proteinuria did not improve. The biopsy of the stomach, rectum and kidney revealed the deposition of AA type amyloid protein, resulting in the diagnosis of secondary amyloidosis. Secondary amyloidosis has been reported as one of the common complications in RA patients, especially in old patients with a long history of RA. To our knowledge, however, there have been few reported cases who developed secondary amyloidosis so early during the course of RA as our case. We should be careful for the development of secondary amyloidosis even in young RA patients with short history of RA, when the disease is active.

Suppression of mitogenic response of bovine peripheral blood lymphocytes by ketone bodies

Mitogenic response of peripheral blood lymphocytes from ketotic cows and effect of ketone bodies on lymphocyte blastogenesis were investigated. Glucose consumption index (GCI) values for phytohaemagglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM) in the ketotic cows were significantly lower than those in the healthy dry cows. A significant negative correlation was observed between the GCI values and serum concentrations of total ketone and beta-hydroxybutyric acid. When lymphocytes from healthy dry cows were preincubated in the medium with acetoacetic acid or beta-hydroxybutyric acid, the GCI values for PHA and PWM were significantly lower than those in the lymphocytes without ketone bodies. These findings indicate that increased serum concentrations of acetoacetic acid and beta-hydroxybutyric acid in ketotic cows suppress lymphocyte blastogenesis.

Neural mechanism of depressor responses of arterial pressure elicited by acupuncture-like stimulation to a hindlimb in anesthetized rats

The effects of acupuncture-like stimulation of a hindlimb on renal sympathetic nerve activity (RNA) as well as mean arterial blood pressure (MAP) were examined in anesthetized rats. An acupuncture needle (diameter of 160 microns) was inserted into the skin of a hindlimb and underlying muscles to a depth of 5 mm and was twisted at about 1 Hz. Under deep anesthetic condition, in about 70% of trials, acupuncture-like stimulation for 60 s induced a decrease in MAP which was accompanied by a decrease in RNA. Acupuncture-like stimulation applied to the muscles alone, but not to the skin alone, induced inhibition of RNA and MAP. Transection of sciatic and femoral nerves ipsilateral to the hindlimb stimulation completely abolished the responses of RNA and MAP. The hindlimb stimulation excited the femoral and common peroneal afferent nerves. In spinalized animals, the hindlimb stimulation did not produce any changes in RNA and MAP. The results indicate that the decrease in MAP induced by acupuncture-like stimulation of a hindlimb is a reflex response. The afferent pathway is composed of hindlimb muscle afferents while the efferent pathway is composed of sympathetic vasoconstrictors including the renal nerves. Endogenous opioids may not be involved in the present reflex, because an intravenous injection of naloxone, an antagonist of the opioid receptors, did not influence the reflex.

Synthesis and properties of oligo-omega-amino acids derivatives containing nucleosides

Nucleic acid analogs, that consist of oligo-omega-amino acids as main chains were synthesized. At first, hydroxyl group of deoxy and ribonucleic acid was converted into amino or carboxylic acid group. Then, amino acid derivatives containing aminonucleoside or nucleoside-5'-carboxylic acid at alpha-position were synthesized. Amino acids used in this paper were L-glutamic acid, L-2-amino adipic acid (L-homo glutamic acid), L-ornithine, and L-lysine. These amino acid derivatives containing nucleoside were oligomerized by activated ester methods and Merrifield's solid phase synthesis. The properties of these analogs were studied and compared with oligo-alpha-amino acid derivatives containing nucleoside at omega-position.

[Morphological change and reversibility of major pelvic ganglion neurons using rat model of partial urethral ligation]

We made partial urethral ligation in female Wistar rats to evaluate the morphological change and the reversibility of the major pelvic ganglion (MPG) neurons before and after partial urethral ligation. Thirty rats were divided into 4 groups; normal control group (N = 3), ligation group (N = 9), release of ligation group (N = 9), and sham-operated group (N = 9). WGA-HRP (horseradish peroxidase with lectin wheat germ agglutinin) was injected into the right side of the bladder 4 days before the MPG neurons were removed. MPG was examined by the axonal tracer method. Rats with partial urethral ligation for 1 week exhibited a significant increase in the size (419.1 +/- 146.0 microns2) of the mean area of MPG neurons as compared to the normal controls (318.0 +/- 118.6 microns2), but they showed a steady decrease in size (304.2 +/- 118.6 microns2) similar to that in the sham-operated group (310.2 +/- 116.3 microns2) 3 weeks after the removal of the ligation. The rats with partial urethral ligation for 7 weeks and 11 weeks also exhibited a significant increase in the mean area (7w; 484.1 +/- 192.6 microns2, 11w; 549.4 +/- 181.3 microns2), but they did not show complete recovery (7w; 383.3 +/- 159.6 microns2, 11w; 549.6 +/- 279.5 microns2) as compared to the sham-operated group (7w; 324.4 +/- 124.9 microns2, 11w; 345.9 +/- 121.7 microns2) after removal of ligation. Only the 1-week ligation group showed recovery in neuronal size. These findings imply that the neuronal hypertrophy might become irreversible when the period of partial urethral ligation persisted beyond 7 weeks.

Stress fractures of the medial malleolus: a case report

The findings for stress fracture of the medial malleolus in two patients are presented. In case 1, a 54-year-old woman complained of gradual onset of pain over the medial malleolus after prolonged walking. Magnetic resonance imaging was useful in the early detection of the stress fracture of the medial malleolus. In case 2, a 16-year-old male developed stress fracture of the medial malleolus during repetitive Kendo fencing activity. Good clinical results were obtained with nonsurgical therapy.

Acute interstitial nephritis and uveitis with bone marrow granulomas and anti-neutrophil cytoplasmic antibodies

Acute interstitial nephritis (AIN) and uveitis of unknown etiology developed in a 15-year-old girl. Symptoms and urinary abnormalities improved spontaneously but moderate renal dysfunction and anterior uveitis persisted. A repeat biopsy performed 2 years later showed focal tubulointerstitial changes, while bone marrow examination revealed granulomas. Simultaneously, antineutrophil cytoplasmic antibodies (ANCA) were detected, and decreases in T cell population and lymphocyte function were found. These immunological abnormalities normalized in parallel with clinical improvement with corticosteroid therapy, strongly suggesting that in some patients autoimmune disorders contribute to the pathogenesis of the disease.

[An epidemiological study of stroke in a geriatric community--with special reference meteorological factors]

The incidence of cerebrovascular event during a period of 3 years in the geriatric society in Japan was examined along with the alternating pattern of cerebrovascular accidents in relation to aging and seasonal factors. The population of Tsuwano town was approximately 7000. The percentage of aged people over 65-year-old reached 23.1% in the 1990 national census. All cerebrovascular accident patients in our hospital and two outpatients clinic in this city were registered during the period from April, 1990 to March, 1993. The number of patients in the period was 95 cases, of which 19 were classified as transient ischemic attack (TIA), 30 as cerebral thrombosis, 16 as cerebral embolism, 10 as cerebral hemorrhage, 7 as subarachnoid hemorrhage, and 13 as unclassified cerebral infarction. The frequency of each type except TIA was 39.5% cerebral thrombosis, 21.1% cerebral embolism, 13.2% cerebral hemorrhage, and 9.2% subarachnoid hemorrhage. In all cases, hypertension was observed in 62.1%, and past history of cerebrovascular accident was observed in 29.5%. The cerebral embolism group was older than the other groups and one-half of this group had atrial fibrillation. Peak incidence differed by type of illness, TIA and cerebral embolism occurred uniformly throughout the year, but subarachnoid hemorrhage and cerebral thrombosis in the spring. The relationship of cerebrovascular accident to crisis, especially potentiation by cerebral thrombosis was evaluated in light of climatic factors.

Defective T cells from gld mice play a pivotal role in development of Thy-1.2+B220+ cells and autoimmunity

The gld mouse represents a fascinating animal model of autoimmune disease, which is characterized by massive development of Thy-1.2+B220+ CD4-CD8- cells. These cells thus have double positive markers for T and B cells, but are double negative for CD4 and CD8 markers and are thus designated DN cells in the present context. An additional important feature in gld mice is a defect in expression of Fas ligand. To investigate the regulatory role of bone marrow-derived cells for the development of these DN cells and of gld autoimmunity, we constructed chimeric mice transplanted with fetal liver cells or fetal thymus from gld mice into nonirradiated severe combined immunodeficient (SCID) mice. These chimeric mice regenerated, developed both these DN cells and the gld autoimmune syndrome and also generalized lymphoproliferative disorders. However, when fetal liver cells from both gld and non-gld mice (C57BL/10 Thy-1.1 mice) were co-transplanted into SCID mice, the development of DN cells was apparently inhibited. Further, this inhibition was also seen in SCID mice that had been grafted with both gld and non-gld fetal thymus revealing the pivotal role played by T cells in development of DN cells. When B cells purified from non-gld (C3H+/+) mice were transplanted into SCID mice grafted with gld fetal thymus, the development of DN cells was not inhibited. Taken together, these findings indicate that T cells from non-gld mice inhibit the expression of gld features, e.g., lymphoproliferation, immune-based nephritic disease, and autoantibody production. These findings also suggest that the Fas ligand is selectively expressed on T cells.

Defective T cells from gld mice play a pivotal role in development of Thy-1.2+B220+ cells and autoimmunity

The gld mouse represents a fascinating animal model of autoimmune disease, which is characterized by massive development of Thy-1.2+B220+ CD4-CD8- cells. These cells thus have double positive markers for T and B cells, but are double negative for CD4 and CD8 markers and are thus designated DN cells in the present context. An additional important feature in gld mice is a defect in expression of Fas ligand. To investigate the regulatory role of bone marrow-derived cells for the development of these DN cells and of gld autoimmunity, we constructed chimeric mice transplanted with fetal liver cells or fetal thymus from gld mice into nonirradiated severe combined immunodeficient (SCID) mice. These chimeric mice regenerated, developed both these DN cells and the gld autoimmune syndrome and also generalized lymphoproliferative disorders. However, when fetal liver cells from both gld and non-gld mice (C57BL/10 Thy-1.1 mice) were co-transplanted into SCID mice, the development of DN cells was apparently inhibited. Further, this inhibition was also seen in SCID mice that had been grafted with both gld and non-gld fetal thymus revealing the pivotal role played by T cells in development of DN cells. When B cells purified from non-gld (C3H+/+) mice were transplanted into SCID mice grafted with gld fetal thymus, the development of DN cells was not inhibited. Taken together, these findings indicate that T cells from non-gld mice inhibit the expression of gld features, e.g., lymphoproliferation, immune-based nephritic disease, and autoantibody production. These findings also suggest that the Fas ligand is selectively expressed on T cells.