Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly

Diffuse aspiration bronchiolitis (DAB) is a new term that we proposed to define a clinical entity that is characterized by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles. In the present study, a total of 4,880 consecutive autopsies were reviewed and we found 31 patients with DAB (0.64%). To investigate the clinicopathologic features of DAB, the 23 patients with DAB (age, 81.2 +/- 6.2 years [mean +/- SD]), from whom clinical information was available, had their features compared to those of 40 randomly selected patients with aspiration pneumonia (age, 81.9 +/- 8.3 years [mean +/- SD]). Oropharyngeal dysphagia was observed in half of the patients with DAB, and two thirds of patients with DAB were bedridden. The onset of DAB was more insidious than aspiration pneumonia, and in half of the patients with DAB episodes of aspiration were unrecognized. Neurologic disorders (52.2%) and dementia (47.8%) were common associated diseases. Most patients with DAB showed signs of bronchorrhea, bronchospasm, and dyspnea. The macroscopic appearance of the cut surface of DAB lung showed diffusely scattered miliary yellowish nodules that resembled those of diffuse panbronchiolitis (DPB). Histologic findings of DAB were characterized by localization of chronic mural inflammation with foreign body reaction in bronchioles. Recurrence of small amounts of aspiration might play a role in the pathogenesis of DAB. In view of possible therapeutic intervention, we emphasized the importance of recognizing this entity and differentiating DAB from pulmonary diseases associated with bronchospasm in the elderly, in particular, late-onset asthma and DPB.

[Pharmacokinetic and clinical evaluation of azithromycin in pediatric infections]

Azithromycin (AZM) was studied for its concentrations in plasma and urine, efficacy and safety. 1. Plasma and urine samples were collected from one patient diagnosed as having Mycoplasma pneumonia for drug level determination. The drug was given once daily at 9.7 mg/kg body weight for three days. The drug concentrations in plasma was 0.149 microgram/ml in 12 hours after the start of the treatment, and 0.095 microgram/ml at the point of 24 hours after the end of the treatment. Urinary recovery rate up to 72 hours post-dosing was 6.39%. 2. The effectiveness of AZM was assessed in 19 patients with following diagnoses: pharyngitis in two patients, bronchitis in four, pneumonia in seven and Mycoplasma pneumonia in six. The drug was rated "excellent" in 11, "good" in seven, "poor" in one, resulting in an efficacy rate of 94.7%. 3. AZM eradicated two strains of Streptococcus pyogenes and Streptococcus pneumoniae identified in patients. 4. The AZM MIC's were 0.39 microgram/ml against Staphylococcus aureus, 0.20 microgram/ml against S. pneumoniae, < or = 0.0008 microgram/ml against Mycoplasma pneumoniae. 5. One patient complained of mild diarrhea, while another showed a slight increase in eosinophils, suggesting an abnormal laboratory change. In conclusion, AZM was found useful in treatment of pediatric infections.

Insulin-like growth factor I (IGF-I) delays the onset of diabetes in non-obese diabetic (NOD) mice

It has been shown that prophylactic exogenous insulin treatment prevents the development of insulin-dependent diabetes mellitus (IDDM) in animal models and humans. In this study, we examined whether the development of diabetes and insulitis in female non-obese diabetic (NOD) mice could be affected by prophylactic administration of insulin-like growth factor I (IGF-I), which shares structural homology with insulin and has insulin-like metabolic effects. Two experiments which differed in duration and dosage of IGF-I treatment were carried out. In the first experiment, animals were treated from 4 to 9 weeks of age with IGF-I (17.9 nmol/day at 4-5 weeks of age and 35.9 nmol/day at 6-9 weeks of age) and observed up to 34 weeks of age. In the second experiment, the animals were treated from 4 to 34 weeks of age with IGF-I (1.79 nmol/day at 4-5 weeks of age, 3.59 nmol/day at 6-9 weeks of age, and 5.38 nmol/day at 10-34 weeks of age). The former treatment could significantly delay the onset of diabetes (P < 0.05) and decrease the insulitis score at 10 weeks of age (P < 0.01). On the other hand, the latter treatment did not affect the incidence of diabetes, the age at onset or the insulitis score. Our results suggest that the IGF-I treatment at the early age may provide protection against autoimmune beta-cell destruction in NOD mice.

Effect of growth hormone (GH) therapy on parathyroid hormone metabolism in a girl with GH deficient short stature and chronic renal failure

During GH treatment of a 14 year-old girl with chronic renal failure and short stature, she developed hyperparathyroidism which was successfully treated by the oral agent 26,27-F6-1, 25-dihydroxyvitamin D3 (26,27-F6-1,25(OH)2vit D3). It is hypothesized that the elevation of serum PTH level was induced either by the rise in phosphorus levels induced by GH or by a direct stimulatory effect of IGF-I on PTH production. This seems to be the first report of this kind.

Possible distinct pathogenesis in low responder myasthenia gravis: association of soluble interleukin-2 receptor with acetylcholine receptor antibody titre or abnormal thymus

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Inhibition by triptoquinone-A of LPS- and IL-1 beta-primed induction of NO synthase in rat thoracic aorta

We investigated the effect of triptoquinone-A (TQA), an active principal of Triptergium wilfordii, on the induction of nitric oxide synthase (NOS) promoted by endotoxin (LPS) and interleukin-1 beta (IL-1 beta). Prophylactic application of TQA selectively prevented LPS-primed initiation of L-arginine (Arg)-induced relaxation, and cGMP formation of rat thoracic aorta, and LPS-stimulated nitrite production by cultured aortic smooth muscle cells, which appear to be mediated by NOS expressed by LPS in vascular smooth muscle. TQA also prevented IL-1 beta-triggered initiation of Arg-induced relaxation and nitrite accumulation. These results suggest that TQA prevents LPS-or IL-1 beta-promoted induction of NOS in vascular smooth muscle, thus inhibiting development of Arg-induced vasorelaxation.

Detection of human T lymphotropic virus type I proviral DNA in patients with diffuse panbronchiolitis

In Japan a number of reported cases of diffuse panbronchiolitis (DPB) have been associated with human T lymphotropic virus type I (HTLV-I) infection. In this study the hypothesis that HTLV-I proviral DNA may be prevalent in DPB was examined using polymerase chain reaction (PCR) for the region of env or the two-step PCR for the pX region of this virus. The presence of HTLV-I proviral DNA was studied in the peripheral blood mononuclear cells (PBMC) obtained from 10 patients with DPB. The presence of proviral DNA in PBMC in 12 patients with chronic obstructive pulmonary disease (COPD), eight patients with idiopathic interstitial pneumonia (IIP), four patients disease were also studied as relevant controls. The lung tissue obtained from 11 patients with DPB, 12 patients with diffuse aspiration bronchiolitis (DAB) at autopsy, and the surgical lung samples obtained from 12 patients with bronchogenic cancer were also studied. Peripheral blood mononuclear cells obtained from one DPB patient and one bronchogenic carcinoma patient were positive for the HTLV-I pX region. The presence of the pX region was also found in the lung tissue of three DPB patients (27.3%) and one DAB patient (8.3%). None of other subjects were positive for HTLV-I proviral DNA, In conclusion, HTLV-I is not the causative virus in the pathogenesis of COPD, IIP, bronchiectasis and bronchogenic carcinoma. There is a likelihood that HTLV-I infection is associated with some cases of DPB; however this association needs further verification.

Sex reversal in a child with duplication of sex reversing locus on the short arm of the X chromosome (Xp)

We report a child with a female phenotype possessing a karyotype of 46,XY,13p+. The child had female external genitalia, and manifested severe mental retardation, pulmonary atresia and multiple congenital abnormalities. Laparoscopy revealed the presence of streak gonads and Müllerian structures. Histological examination of the gonads showed ovarian-like stroma with immature seminiferous tubules. Chromosome and gene analyses demonstrated Xp11.23 (or 11.3)-pter duplication and an intact sex determinating factor of Y (SRY). The findings of this case suggest that duplication of Xp causes sex reversal in the presence of SRY.

Change of immunological parameters in the clinical course of a myasthenia gravis patient with chronic graft-versus-host disease

The change in immunological parameters was studied during the clinical course of a myasthenia gravis (MG) patient with chronic graft-versus-host disease (GVHD), which developed after bone marrow transplantation from an HLA-identical donor. Anti-acetylcholine receptor antibody gradually decreased in the patient treated with immunosuppressive agents, but was not detected in the donor. Lymphocyte numbers were low just before the onset of MG, increased abruptly within several days and then gradually decreased with treatment. The percentage of CD3+ and CD19+ lymphocytes was higher at onset than before, the percentage of CD4+ cells was higher at onset and gradually decreased with treatment, while CD8+ cells showed the lowest level just before onset and gradually increased during the clinical course. CD4+/CD45RA- cells also showed the highest levels at onset and a gradual decrease with treatment. Cellular, as well as humoral immune responses, might be associated with the pathogenesis of MG with chronic GVHD.

Inhibition by SK&F96365 of NO-mediated relaxation induced by Ca2(+) -ATPase inhibitors in rat thoracic aorta

1. We investigated the effect of SK&F96365, a putative inhibitor of receptor-operated Ca2+ entry, on the endothelium-dependent, NO-mediated relaxation and cyclic GMP formation induced by Ca2(+)-ATPase inhibitors in rat thoracic aorta. 2. SK&F96365 inhibited cyclopiazonic acid or thapsigargin-induced relaxation and cyclic GMP formation mediated by a constitutive NO synthase, which is known to be activated by the Ca2+ that enters into the endothelial cells via plasma membrane Ca2+ channels subsequent to depletion of stored Ca2+ by Ca2(+)-ATPase inhibitors. 3. SK&F96365 also inhibited relaxation and cyclic GMP formation induced by acetylcholine, without affecting those induced by nitroprusside and A23187. 4. Ni2+ attenuated relaxation and cyclic GMP formation induced by cyclopiazonic acid and acetylcholine. 5. In contrast, the voltage-dependent Ca2+ channel blocker, nifedipine, did not affect the relaxation caused by Ca2(+)-ATPase inhibitors. 6. These results suggest that endothelium-dependent, NO-mediated relaxation of the arteries induced by Ca2(+)-ATPase inhibitors is triggered by the Ca2+ that enters into endothelial cells via receptor-operated channels (SK&F96365-sensitive channels) subsequent to depletion of stored Ca2+ as a result of inhibition of the Ca2(+)-ATPase (Ca2+ pump) of the stores.

The influence of blood gas changes on hyperthermia-induced seizures in developing rats

Fever induces seizures in infants with febrile convulsions or epilepsy. Hyperpnea induced by fever may contribute to the induction of these seizures. In order to examine this possibility, we evaluated the effect of changes in arterial blood gas tension on hyperthermia-induced seizures in developing rats. Electrical seizure discharges were induced by application of infra-red rays on the skull of rats under mechanical ventilation with different respiratory conditions. There was positive correlation between pCO(2) and the seizure threshold (ST) defined as a latency from the start of hyperthermia to the occurrence of seizures: ST (seconds, s) = 2.36 pCO(2) + 0.05 (R(2) = 0.80, P < 0.001). Seizure duration (SD) was longer at lower pCO(2) level: 18 (6-33) (median, range) s at pCO(2) ranging from 23 to 26 mmHg vs. 0 (0-7) s at pCO(2) ranging from 35 to 57 mmHg (P < 0.01). Hypoxia significantly increased ST: 84 (61-100) s at P0(2) ranging from 53 to 76 mmHg vs. 60 (51-72) s at P0(2) ranging from 87 to 131 mmHg (P < 0.01). Hyperoxia prolonged SD: 27 (10-30) s at P02 ranging from 100 to 170 mmHg vs. 9 (0-23) at P0(2) ranging from 53 to 93 mmHg (P < 0.02). Hypocarbia caused by fever-induced hyperpnea probably contributes to the generation of fever-induced seizures.

[Developmental studies on the petrous part of the human temporal bone--special references to the morphogenesis of the facial nerve canal]

Development and formation of the petrous bone was examined in total of 343 Japanese skulls. The materials used consisted of 310 skulls of Japanese fetuses ranging from the fourth to tenth month, 19 skulls of Japanese juveniles from the third month to 7 years of age, and 20 temporal bones obtained from 14 adult cadavers. A total of six group of ossification centers appear in the petrous part during 5th fetal month, and they form the petrous bone at 6th fetal month. The firstly-appeared ossification center is just above the round window, and the second is on the ampulla of anterior semicircular canal. Other ossifications are observed between the cochlea and semicircular canals, on the brim of internal acoustic porus, on the superior surface of the petrous apex, and on the summit of posterior semicircular canal. The ossification of the facial canal starts at 6th fetal month, though the geniculate part and tympanic part do not complete until one year old after birth. Even in adults, the facial canal dehiscence are found at more than 10% of cases, mainly locating in the tympanic part. On the basis of these results, formation of the petrous bone including facial canal and other bony structures was discussed from the viewpoints of the ossification and pre- and postnatal middle ear development.

Expression of immunoreactive activin A protein in remodeling lesions associated with interstitial pulmonary fibrosis

The expression of activin A, one of the transforming growth factor-beta supergene family, was studied in various pulmonary conditions associated with interstitial pulmonary fibrosis (3 cases with diffuse alveolar damage, 6 cases with idiopathic pulmonary fibrosis, and 1 case with pulmonary fibrosis associated with rheumatoid arthritis) using immunohistochemical techniques on paraffin-embedded sections. Controls consisted of 10 cases with normal pulmonary parenchyma, and 2 cases with primary pulmonary hypertension and 1 case with secondary pulmonary hypertension were also studied. The lung specimens from normal parenchyma weakly expressed immunoreactive activin A on the bronchiolar epithelium. In marked contrast, all of the specimens from cases with diffuse alveolar damage and interstitial pulmonary fibrosis demonstrated strong expression of activin A on metaplastic epithelium, hyperplastic smooth muscle cells, desquamated cells, and alveolar macrophages. Pulmonary arteries from patients with primary or secondary pulmonary hypertension showed abundant immunoreactive activin A on smooth muscle cells. These findings suggest a potential role for this growth factor, activin A, in the pathogenesis of pulmonary tissue remodeling associated with interstitial pulmonary fibrosis.

Hypereosinophilic syndrome with generalized myasthenia gravis

A patient with hypereosinophilic syndrome simultaneously had generalized myasthenia gravis. Ultrastructural and functional studies demonstrated an increase of the activated hypodense eosinophils. The eosinophilic cationic protein level in plasma and whole blood paralleled the severity of congestive heart failure. A high level of interleukin-5 was detected in both serum and in conditioned medium of T cells by interleukin-2 stimulation before therapy. The findings indicate that both diseases may be associated with a common T-cell abnormality.

The physicochemical and biopharmaceutical properties of fragmented keratin as a new drug carrier

Two types of fragmented keratin were prepared from buffalo horn and hoof using savinase and Na2S, and their physicochemical and biopharmaceutical properties were examined in mice. The number-average molecular weight of enzymatically fragmented keratin (E-FK), chemically fragmented keratin (C-FK), and fragmented gelatin (FG) were 8000, 33,000, and 6600, respectively. The systematic acute toxicity of FKs was significantly low. Moreover, the immunogenicity of FKs was significantly lower than that of superoxide dismutase. FKs and FG were partially hydrolyzed by trypsin. FKs were digested easily by alpha-chymotrypsin, but FG underwent less hydrolysis under the same conditions. FKs were bound to plasma proteins, including albumin, and also to some proteins in liver and kidney homogenates. In plasma, E-FK was hydrolyzed slowly, but in liver and kidney homogenates it showed slightly faster hydrolysis. In contrast, FG was not hydrolyzed in any of the media used here. After intravenous administration of FKs and FG to mice, these molecules were rapidly eliminated from the plasma. E-FK and C-FK were taken up into the kidneys (CLuptake, kidney; 10,400, 11,600 microliters/h/g), and then gradually excreted in urine. FG was excreted rapidly into urine (CLurine; 6360 microliters/h). Interestingly, C-FK was also taken up into the liver (CLliver; 4820 microliters/h). These results indicated that fragmented keratins are biodegradable materials and might be used as new types of liver- and kidney-specific targeting carriers.

Induction of DNA polymerase beta and gamma in the lungs of age-related oxygen tolerant rats

To clarify a mechanism for oxygen tolerance in young rats, 3 and 8 week-old rats were exposed to 100% oxygen. All 8 week-old (8W) rats died between 48 and 72h, whereas most 3 week-old (3W) rats survived for more than 72 h under hyperoxia. It was assumed that this difference is attributable to oxygen tolerance in 3W rats compared with 8W rats. To clarify this difference, we measured the change in the activity of DNA polymerase, which is related to the final step of DNA repair. DNA polymerase activity in crude lung extracts from 3W rats increased up to 72 h after oxygen exposure. On the other hand, the activity in 8W rats was decreased at 24 h and 48 h. The activity of DNA polymerase beta, which is related to nuclear DNA (nDNA) repair, was approximately seven times higher in 3W rats than in 8W rats. DNA polymerase beta activities in 3W rats decreased up to 48 h with oxygen exposure, but recovered to pre-exposure levels by 72 h. Moreover, an induction of DNA polymerase gamma, which is related to mitochondrial DNA (mtDNA) replication and/or repair, was observed only in 3W rat lungs after 24 h of oxygen exposure. From these results, we conclude that the induction of DNA polymerase beta and DNA polymerase gamma in lung tissue plays a key role in oxygen tolerance in very young rats.

[Clinical significance of levels of lung surfactant protein A in serum, in various lung diseases]

To assess the utility of measuring lung surfactant protein A (SP-A) in serum, a newly developed SP-A kit (Teijin TDR-30) was used at four facilities to measure serum SP-A levels in patients with various lung diseases. Serum SP-A levels in healthy volunteers were 24.6 +/- 9.6 ng/ml (mean +/- SD). serum SP-A levels did not differ significantly between different age groups (thirties through seventies). A cut-off level of 43.8 ng/ml was calculated, based on the values of the healthy volunteers. The serum SP-A levels in patients with idiopathic interstitial pneumonia (IIP: 67.9 +/- 42.5 ng/ml), pulmonary alveolar proteinosis (PAP: 7.0 +/- 45.7 ng/ml), and collagen disease with interstitial pneumonia (CDIP: 55.3 +/- 37.9 ng/ml) were significantly higher than those in healthy volunteers. When calculated with the cut-off value stated above, the positive rate of diagnosis for IIP was 71.4%. SP-A levels correlated closely with the clinical course; SP-A levels rose significantly during exacerbations of IIP. Measurement of SP-A in serum is useful for the diagnosis of IIP, PAP, and CDIP, and for monitoring exacerbations of IIP.

Effect of cyclosporin A on human bone marrow granulocyte-macrophage progenitors with anti-cancer agents

Cyclosporin A (CyA) overcomes P-glycoprotein (P-gp) associated multidrug resistance (MDR). P-gp expression is frequently observed among, not only various cancer cells, but also several normal tissues including bone marrow progenitor cells. These findings lead us to examine whether CyA enhances the myelotoxicity of anti-cancer agents. Bone marrow mononuclear cells were incubated with anti-cancer agents (vincristine, VCR; doxorubicin, ADM; etoposide, VP-16; cytarabine, Ara-C; methotrexate, MTX) and a concentration of CyA (0.5, 5.0 micrograms/mL). The methylcellulose assay for granulocyte-macrophage progenitors (CFU-GM) was conducted using the post-treated cells. There was no significant toxicity for marrow CFU-GM formation after 72 h incubation with CyA (84-108% of control). The inhibitory concentration that reduced colonies by 50% (IC50) was 12 nmol/L for VCR, 6 nmol/L for ADM, 220 nmol/L for VP-16, 15 nmol/L for Ara-C and 35 nmol/L for MTX, respectively. For VCR, ADM and VP-16, the number of CFU-GM was unchanged with the addition of CyA at 0.5 microgram/mL concentration. In contrast at 5 micrograms/mL CyA, the number of CFU-GM (% of control) was reduced significantly (P < 0.05 or P < 0.01). With MTX and Ara-C, the number of CFU-GM was unchanged after addition of CyA, even at 5 micrograms/mL concentration. We conclude CyA may therefore enhance cytotoxic drug sensitivity in MDR tumor cells at a clinically achievable concentration (0.5 microgram/mL) without marrow toxicity.

Long-term change of anti-acetylcholine receptor antibody in patients with myasthenia gravis after thymectomy

Anti-acetylcholine receptor antibody (AChR Ab) plays an important role in the pathogenesis of myasthenia gravis (MG). We investigated the change of anti-AChR Ab titer after thymectomy of 10 MG patients including five patients whose age at onset was younger than 16 years. Anti-AChR Ab titer was increased in four of six patients with remission and three of four patients without remission. Change of anti-AChR Ab titer in individual patients showed an increase occurred 1-4 years after thymectomy. It is likely that thymectomy influences immune response and induces autoreactive lymphocytes and autoantibodies.

A morphologic study of lung secretory leukoprotease inhibitor in pneumonia

The present study was undertaken to determine the localization of cells laden with secretory leukoprotease inhibitor (SLPI) in bronchial/bronchiolar epithelium (B/Br-E) by histochemical techniques to see whether SLPI production occurs in conjunction with pathologic bronchopneumonia. Ten lung were obtained at autopsy from patients between 63 and 100 yr of age, including six with pathologic pneumonia and four without pneumonia. SLPI-laden cells in the B/Br-E corresponded mostly to goblet cells with apparent hyperplasia. A morphometric study performed on the B/Br-E indicated that the percentage of SLPI-laden cells was significantly correlated with the percentage of mucus-containing cells (r = 0.72, p < 0.001). This trend was similar in the bronchi (r = 0.60, p < 0.05) and in the bronchioles (r = 0.90, p < 0.01). The increased percentage of mucus and SLPI-laden cells in the B/Br-E was closely correlated with acute inflammatory changes in the adjacent alveoli, particularly in bronchi rather than in bronchioles. From these observations we conclude that the number of SLPI-laden cells in the airways increases in correlation with goblet cell hyperplasia. In addition, these morphologic changes are associated with the existence of acute inflammatory cell infiltration in the alveolar area.