[Survival rate of patients with diabetic retinopathy after vitreous surgery]

We studied various factors affecting the survival rate after vitreous surgery in 140 patients with diabetic retinopathy, who had undergone vitreous surgery between 1982 and 1990, according to the life-table theory and Cox proportional hazards model. The 5-year survival rate was 95.8%. The most common cause of death was cerebro-cardiovascular disease in 75.0%. The ratio of the observed number of deaths (O) to the expected ones (E), the O/E ratio, was significantly higher in patients who had undergone surgery between 55 and 69 years of age. The O/E ratio was significantly higher in both cardiovascular disease and cerebrovascular disease groups. Factors associated with a lower survival rate included age at operation, history of nephropathy, and neuropathy.

Pathology of livers infected with "silent" hepatitis B virus mutant

We have discovered that non-A, non-B, non-C, non-D, non-E (so-called type F) acute and chronic hepatitis is caused by a hepatitis B virus (HBV) variant with mutations in the X open reading frame. This silent HBV mutant does not induce immunoserological markers. In the present investigation we attempted to elucidate the putative mechanism of hepatocellular necrosis and expression patterns of hepatitis B surface antigen (HBsAg) and core antigen (HBcAg) in biopsied liver tissue. The subjects consisted of 14 patients with acute hepatitis, 11 with chronic hepatitis and eight with liver cirrhosis, all of whom had been previously diagnosed as having so-called hepatitis F. Nine of the 14, 10 of the 11 and all eight, respectively, of the above patients exhibited significant positive immunostaining for HBsAg within their hepatocellular cytoplasm, diffusely or focally. HBcAg stained in a few hepatocellular nuclei in 24.2% of the patients. Histological features were characterized by necroinflammation, indicating immune-mediated hepatocellular necrosis. Despite the serological-marker negativity, the results of immunostaining for HBsAg and HBcAg support replication and expression of HBV DNA, though weak.

Bradykinin and Met-T-kinin-Leu stimulated PGE2 production by rat macrophage and fibroblast

T-kininogen degradation and kinin release were observed in rat macrophages cultured under acidic conditions. Bradykinin and Met-T-kinin-Leu (a kinin precursor) stimulated PGE2 production by macrophages and fibroblasts but had no effect on O2- production. PGE2 production by macrophages stimulated with 10 microM bradykinin increased by approximately 148% compared to non-stimulated macrophages (0.47 +/- 0.13 vs 0.31 +/- 0.16 ng 10(6) cells-1 30 min-1), and increased by 161% in stimulated as opposed to non-stimulated fibroblasts (0.50 +/- 0.07 vs 0.31 +/- 0.05 ng 10(5) cells-1 30 min-1). No O2- production was detectable in fibroblasts despite stimulation with PMA, A23187, bradykinin, and Met-T-kinin-Leu. O2- production by macrophages was 4.2 +/- 0.3 and 3.0 +/- 0.2 nmol 10(6) cells-1 min-1 after stimulation with PMA and A23187, respectively, but no O2- production was observed after stimulation with bradykinin or Met-T-kinin-Leu. These data suggest that bradykinin and the kinin precursor are implicated in granulomatous tissue formation and wound healing through arachidonic acid and its metabolites but not through O2-.

Enhancement of the anti-tumor activity of recombinant interleukin-2 (rIL-2) by immunocomplexing with an F(ab')2 fragment of murine monoclonal antibody against rIL-2

We have investigated the biological properties of an immune complex composed of recombinant interleukin-2 (rIL-2) and an F(ab')2 fragment of a monoclonal antibody against rIL-2 in mice for the induction of killer cells and anti-tumor activity, as well as the pharmacokinetic properties of the immune complex injected subcutaneously into mice. The immune complex demonstrated sustained serum rIL-2 levels, with a 2.4-times longer "mean-residence-time" than free rIL-2. A more significant portion of rIL-2 was detected in lymph nodes after the subcutaneous injection of the immune complex than with rIL-2 alone. Splenic lymphocytes from mice given the immune complex showed higher killer cell activity against YAC-1 and P815 cells than those from mice given rIL-2 alone. The immune complex also exerted a more significant anti-tumor effect in a dose-dependent manner in Meth-A fibrosarcoma-bearing mice than dit rIL-2 alone.

Mass screening for hepatocellular carcinoma: experience in Hokkaido, Japan

Mass screening for liver cancer based mainly on abdominal ultrasound was begun in major cities of Hokkaido, Japan, in November 1981, to enable early detection and treatment of hepatocellular carcinoma (HCC). Serum alpha-fetoprotein levels were also measured to minimize false negative studies. Examinees included those who sought liver disease screening as well as high risk individuals: hepatitis B surface antigen carriers and those with a past or current liver disease, history of blood transfusion, family history of liver cancer, and more recently those with positive anti-hepatitis C antibodies. The examination was carried out on each Saturday and Sunday as one round, and by February 1992 48 rounds had been performed. A total of 8090 individuals were investigated, and HCC was detected in 91 with a detection rate of 1.12%. This rate was 1.6% among 5684 individuals who were selected for high risk. Cumulative rates of survival among these patients were 79.0% at 1 year, 43.8% at 3 years, 19.3% at 5 years and 15.4% at 7 years. These survival rates were comparable with those for the patients with HCC diagnosed during follow-up of chronic liver disease and treated at our hospital. The cost for detecting one HCC patient in this programme was 2,660,000 yen (approximately US$25,000), which was less than those for some other types of cancer in a similar setting. Considering the high detection rate in this programme, we feel that similar programmes should be encouraged and supported.

Increased heart rate and blood pressure response, and occurrence of arrhythmias in elderly swimmers

Changes in the heart rate (HR) and blood pressure, and the occurrence of arrhythmias after swimming were examined in 52 members of swimming classes aged 40 to 76 years. After swimming 25 m twice at a usual intensity, HR increased markedly in the subjects to 87 +/- 11% of predicted maximal HR, while the rate of perceived exertion was modest. The systolic blood pressure (SBP) also increased significantly, and SBP of 200 mmHg or higher was exclusively observed in subjects 60 years or older. After entering the pool, immersing the face and swimming, 28 subjects (54%) developed various arrhythmias. Premature ventricular contraction (PVC) was provoked or aggravated by swimming in 19 subjects. The incidence of PVC provocation or aggravation increased as SBP at rest or age increased. Swimming causes marked rise in HR and SBP in elderly subjects, and frequently provokes or aggravates PVC in older subjects and/or in subjects with higher SBP at rest.

"Silent" hepatitis B virus mutants are responsible for non-A, non-B, non-C, non-D, non-E hepatitis

Since the recent introduction of diagnostic kits for hepatitis C and E, some cases of non-A, non-B, non-C, non-D, non-E hepatitis (so-called hepatitis F) have been revealed. We attempted to demonstrate that so-called hepatitis F is caused by hepatitis B virus (HBV) variants. Polymerase chain reaction (PCR) was used to amplify serum HBV DNAs from 20 patients with acute hepatitis and 20 patients with chronic hepatitis who had been diagnosed as having so-called hepatitis F on the basis of conventional serological markers. The PCR technique successfully amplified HBV DNAs in 18 (90%) cases of acute hepatitis and 17 (85%) cases of chronic hepatitis. Sequencing of HBV DNAs of six patients (acute 3, chronic 3) revealed equally a T-to-C mutation of DR2 and an 8-nucleotide deletion of the 3'-terminus of the X gene coding region, giving rise to the generation of a C-terminally truncated X protein and probable damage to the enhancer II/core promoter elements. These mutations of the X gene coding region may lead to suppression of replication and expression of HBV DNAs. Thus virtually all cases of so-called hepatitis F appear to be caused by "silent" HBV mutants, at least in Japan.

Augmentation in cytotoxicity of lymphnode lymphocytes by OK-432

It has been demonstrated that natural killer (NK) cell activity of lymphnode lymphocytes (LNL) is very low and hardly augmented by interferon. In this study, OK-432 was injected into the gastric cancer mass through endoscopy one week before the operation, through which NK activity of LNL was significantly increased. A single cell assay could divide the OK-432-injected patients into two groups; responder and non-responder. In responders, the increased activity induced by OK-432 was found also in the distal lymphnodes.

[Resuscitation from experimentally induced hemorrhagic shock with hypertonic saline (effects on thoracic duct lymph flow and tissue oxygen tension)]

We compared the effect of hypertonic salt solution (7.2%, HS) with that of normal saline (NS) and lactated Ringer's solution (LR) for the treatment of hemorrhagic shock. We monitored hemodynamic parameters, thoracic duct lymph flow, and tissue oxygen tension over 3 hours after hemorrhage. Twenty-seven anesthetized mongrel dogs (0.5% halothane) were bled to an aortic pressure of 60 mmHg for 90 min following 40 mmHg for 30 min and then they were resuscitated with each solution. In NS group, the volume transfused was twice the bled volume, and in other two groups, each solution was transfused providing equal amounts of sodium as NS group. We found that hemodynamics were restored in HS group as well as in other two groups. On the other hand, thoracic duct lymph flow and tissue oxygen tension of renal cortex and liver increased significantly over other two groups. We conclude that small volume resuscitation with 7.2% NaCl may be effective in the initial treatment of hemorrhagic shock from the view of tissue circulation in vital organs.

[A successful mitral valve replacement for infective endocarditis with mitral valve aneurysm]

We reported a rare case of mitral valve aneurysm. The patient was a 67-year-old woman with regurgitation of mitral and aortic valve due to infective endocarditis. Preoperative two-dimensional echocardiogram revealed a aneurysmal change and prolapsing on anterior mitral leaflet. Left ventriculogram showed mitral regurgitation of Sellers IV. She underwent mitral valve replacement with 27 mm Carbo Medicus prosthesis successfully. There was a perforated valvular aneurysm (21 x 15 x 11 mm) and inflammatory cleft on anterior mitral leaflet at histopathological findings. The pathogenesis of mitral valve aneurysm was generally infective endocarditis and rarely congenital anomaly, syphylis, Aortitis syndrome, or Marfan syndrome. Mitral valve replacement was a procedure of choice for mitral valve aneurysm, which is especially large, perforated and severely inflammatory one.

Enhancement of anti-tumor activity of recombinant interleukin-2 (rIL-2) by immunocomplexing with a monoclonal antibody against rIL-2

We have investigated biological properties of an immune complex of recombinant interleukin-2 (rIL-2) and a monoclonal antibody against rIL-2 in mice for induction of killer cells and for anti-tumor activity. We have also examined the clearance of subcutaneously-injected immune complex in mice and compared it with that of rIL-2 alone. Plasma rIL-2 levels were sustained longer in mice given the immune complex than in mice given rIL-2 alone at a dose of 10 micrograms/mouse, and they were detectable even at 24 hours after the administration of the immune complex, while they fell to undetectable levels by 6 hours after the administration of rIL-2 alone. A more significant portion of rIL-2 was detected in lymph nodes after subcutaneous injection of the immune complex than that of rIL-2 alone. Splenic lymphocytes from mice given the immune complex demonstrated a higher killer cell activity against YAC-1 cells than those from mice given rIL-2 alone. The immune complex also exerted more significant anti-tumor effect in a dose-dependent manner in Meth-A fibrosarcoma-bearing mice than rIL-2 alone. Our results indicate that immunocomplexing of rIL-2 with an antibody against rIL-2 provides a useful tool as the drug delivery system for cancer therapy using rIL-2.

Transforming growth factor beta 1-induced cellular heterogeneity in the periosteum of rat parietal bones

We examined the osteogenesis process in transforming growth factor beta 1 (TGF-beta 1)-treated neonatal and adult rats, aiming to investigate the age difference in the effect of TGF-beta 1 on mesenchymal cell differentiation. Recombinant human (rh) TGF-beta 1 (20 and 200 ng) was injected onto the outer periostea of the right side of the parietal bone of each rat once a day for 1-12 days starting at the age of either 1 day or 12 weeks. On the day after the final injection, the calvaria was excised and evaluated histologically. In the neonates, the 12-day treatment with rhTGF-beta 1 increased the number of osteoprogenitor cells, resulting in intramembranous ossification. In the adult rats, rhTGF-beta 1 induced differentiation of chondrocytes. Cartilage masses were surrounded by mesenchymal cells, which would differentiate into chondrocytes. The cartilage matrix was partially calcified, with chondrocytes buried therein. In the calcified matrix, marrow cavities containing some multinuclear osteoclasts were formed. These findings indicate that rhTGF-beta 1 stimulated the differentiation of mesenchymal cells into chondrocytes and produced the cartilaginous matrix. rhTGF-beta 1 induced intramembranous ossification of the parietal bone in neonatal rats, and it induced enchondral ossification in adults. This result suggests that the different responses of mesenchymal cells in the periosteum to rhTGF-beta 1 may depend on the age of the animals used: namely, they may reflect the respective osteogenic stages of modeling and remodeling.

[Transcranial magnetic stimulation of the facial nerve--identification of the actual excitation site in the cat]

The site where transcranial magnetic stimulation excites the facial nerve was studied in 6 cats. Transcranial magnetic stimulation of the facial nerve was recorded from the left mentalis muscle. A figure-of-eight shaped magnetic coil was used, and coil induction direction had more influence on the facial nerve evoked compound muscle action potentials (CMAPs) than the coil position. No change could be detected in the CMAPs before and after craniotomy, after cerebellar lobectomy and after exposure of the facial nerve in the facial canal. The facial nerve was stimulated electrically at the porus, meatal portion, geniculum and horizontal portion. The latencies of the CMAPs for each portion were measured and compared with the magnetic response, which was coincidental with that of the meatal portion. The facial nerve was then transected distally from the porus, and CMAPs following magnetic stimulation were recorded at each step. The CMAPs disappeared when the nerve was transected at the fundus. The results of both approaches in this study led to the conclusion that transcranial magnetic stimulation excites the facial nerve at the meatal portion.

Usefulness of resting thallium-201 delayed imaging for detecting myocardial viability in patients with previous myocardial infarction

To test the feasibility of resting thallium-201 (201Tl) initial and delayed scintigraphy for detecting the area of viable myocardium, we performed single photon emission computed tomography (SPECT) in 57 patients with previous myocardial infarction (MI). All had received coronary arteriography (CAG) and left ventriculography (LVG). Initial and delayed myocardial imagings were carried out 10 min and 2 hours, respectively, after the injection of 201Tl at rest. Redistribution was judged by visual interpretation and/or the circumferential profile curve, and found in the infarcted or its adjacent area in 40 of the 57 cases (70.2%). A negative washout (net increase of 201Tl uptake in delayed image) was detected in 17 of these 40 cases. In 10 of the 57 patients, both exercise and rest-injected 201Tl myocardial images were obtained at exercise and rest, and compared visually. The areas of abnormal perfusion were smaller in the resting delayed images than those seen after exercise in 9 of the 10 cases, and were equal in one case. Thus, resting 201Tl delayed myocardial scintigraphy appears to reduce the underestimation of the size of the viable myocardium by the usual 201Tl images obtained after exercise or by single initial images obtained at rest in patients with previous MI.

The usefulness of Avitene for the control of oozing in laparoscopic cholecystectomy

An efficient method for the laparoscopic application of Avitene is presented herein. During laparoscopic operation, we cannot staunch bleeding points directly. Given such circumstances, the spray application of Avitene is a very effective method of hemostasis that should make laparoscopic operations even safer.

Prognostic significance of posturally induced crackles. Long-term follow-up of patients after recovery from acute myocardial infarction

We found that on pulmonary auscultation, fine crackles could be induced by changing the posture from sitting to supine and/or from supine to supine with passive leg elevation in patients without obvious congestive heart failure. We named these crackles "posturally induced crackles (PIC)." To investigate the relationship between PIC and long-term prognosis after myocardial infarction, we followed up 262 patients who recovered from acute myocardial infarction for a mean period of six years. Cardiac death occurred in three of 78 PIC-negative patients and in 28 of 143 PIC-positive patients. PIC-negative patients had a significantly better long-term prognosis than PIC-positive patients according to the Kaplan-Meier survival curves for cardiac death (p < 0.01). In a multilogistic model based on 70 appropriate cases, PIC was the third most important prognosticator after recovery from myocardial infarction and the number of diseased coronary vessels and the pulmonary capillary wedge pressure ranked first and second, respectively.

Extravascular lung water measured with 99mTc-RBC and 99mTc-DTPA is increased in left-sided heart failure

Extravascular lung water (EVLW) was quantitatively measured in 81 patients consisting of 10 subjects with normal cardiac function and 71 patients with left-sided heart diseases, using 99mTc-RBC as a non-diffusible indicator and 99mTc-DTPA as a diffusible indicator in the equilibrium phase. EVLW averaged 3.0 +/- 1.4 (ml/kg, mean +/- SD) in subjects with normal cardiac function (n = 10), 4.3 +/- 1.7 in New York Heart Association functional class I patients (n = 30), 4.8 +/- 2.4 in NYHA functional class II patients (n = 33) and 9.4 +/- 5.4 in NYHA functional class III (n = 8) patients. EVLW was greater in NYHA class III than in normal controls or NYHA classes I or II (p < 0.01). Lung thermal volume (LTV) was also measured in 31 of the 81 patients using a double indicator dilution technique with sodium and heat. LTV averaged 6.0 +/- 1.2 (ml/kg) in normal subjects (n = 4), 8.6 +/- 2.0 in NYHA functional class I patients (n = 11), 9.7 +/- 3.0 in NYHA functional class II patients (n = 13), and 15.9 +/- 8.2 in NYHA functional class III patients (n = 3). The correlation between EVLW and LTV was significant (EVLW = 0.79 x LTV - 72.8, r = 0.80, p < 0.01). There were significant differences in EVLW/LTV ratio between NYHA class III (0.93 +/- 0.16) and NYHA class I (0.62 +/- 0.22). Thus, it was shown that EVLW was increased in left-sided heart failure and that LTV overestimated the EVLW.

Thallium-201 myocardial SPECT findings at rest in sarcoidosis

In 41 patients with sarcoidosis (diagnosed according to criteria recommended by the Committee on Diffuse Pulmonary Disease, Ministry of Health and Welfare, Japan 1988), thallium-201 (201Tl) myocardial SPECT was performed to investigate: (1) the ability of 201Tl SPECT to detect cardiac involvement of sarcoidosis with images recorded at rest and 2 hours later, and (2) the relationships between 201Tl myocardial SPECT findings and the activity of sarcoidosis or endomyocardial biopsy findings. As to the abnormal findings in 201Tl myocardial SPECT, (1) a low density area was seen in 13 of 41 cases (31.7%) and non-uniform uptake was found in 17 cases (41.5%), (2) the mean washout ratio (n = 39) was 16.5 +/- 7.4%, which is significantly (p < 0.05) lower than that found in normal subjects, 23.9 +/- 7.5% (n = 10). Of the 19 patients judged visually to be normal, 5 patients had a reduced mean washout ratio less than 12%. Thus, the incidence of abnormal findings including all types of abnormality, on 201Tl myocardial SPECT in sarcoidosis was 63.4% (26/41 cases). In studying the relationship between 201Tl myocardial SPECT findings and the activity of sarcoidosis (as measured by the serum ACE (angiotensin converting enzyme) or lysozyme level, or the presence of more than 30% symphocyte fraction in BALF (broncho-alveolar lavage fluid)), 20 (80%) of 25 cases with 201Tl abnormality were judged to be active sarcoidosis, while only 6 (37.5%) of 16 cases with normal findings on 201TI SPECT were judged to be active.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemodynamics and respiratory function in heart failure]

We discussed the pathophysiology of left-sided heart failure with special reference to the pulmonary "venous" system and further discussed the relationship between the capacitance of the pulmonary "venous" system and the pulmonary function. The slope of the pressure-volume line (compliance) in the pulmonary "venous" system was flat in NYHA class II and III patients as compared to class I. Elevated pulmonary "venous" pressure leads to a decrease in the compliance of the pulmonary "venous" system and consequently to a decrease in the static pulmonary compliance and this causes a respiratory dysfunction and an increase in the ventilation-perfusion imbalance. These changes may finally lead to an increase in the work of breathing, resulting in clinical symptoms such as dyspnea.

Morphological study of recombinant human transforming growth factor beta 1-induced intramembranous ossification in neonatal rat parietal bone

Recombinant human transforming growth factor beta 1 (rhu TGF beta 1) was injected singly or repeatedly for 3-12 days into the periosteum of the right side parietal bone of neonatal rats under the period of bone growth, and the time course of histological changes of the bone was observed by light and electron microscopy and by enzyme histochemistry. The repeated injections of rhu TGF beta 1 at 200 ng/day increased the thickness of the bone tissue on the treated side, which was about twice the nontreated side value after 12-day injections. On the dermal side, preosteoblasts in the periosteum increased in an early stage of treatment, and thereafter, differentiation into osteoblasts, increase of bone matrix, bone marrow cavity formation, and increase of osteoclasts within the bone marrow cavities were observed. Activation of osteoblasts on the dura mater side was also seen. The single injection of rhu TGF beta 1 at 200 ng resulted only in increased osteoprogenitor cell layers and bone matrix formation in an early stage, and the thickness of the osteoprogenitor cell layers and bone tissue at 12 days after single injection was comparable to the values on the nontreated side. At 1 microgram, however, the osteoblasts were activated, and the osteoprogenitor cell layers and bone matrix formation were markedly increased. At 12 days, the bone tissue thickness on the treated side was about twice the nontreated side value, as in the repeated treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of liver regeneration in mice following extended hepatectomy by transfusion of lymphokine activated killer cells

Lymphokine activated killer (LAK) cells can destroy not only tumor cells but also syngeneic liver cells. In this study, the effects of passive transfer of LAK cells on liver regeneration were examined by the 3H-thymidine uptake and bromodeoxyuridine (BrdU) labeling methods after resection of 70% of the volume of the liver. LAK cells were infused 12h after hepatectomy and the effects on regeneration of liver cells were examined 36 h later. The transfusion of LAK cells induced significant inhibition of liver regeneration at a dose of 5-10 x 10(7) cells. Neuraminidase treatment of lymphocytes is desirable to enhance the selective entrapment of LAK cells into the liver. When LAK cells were treated with neuraminidase (0.5 units/ml), and transfused into hepatectomized mice, more potent suppression of liver regeneration was induced in comparison with the same dose of LAK cells. The intraperitoneal injection of recombinant interleukin 2 (rIL-2) after partial hepatectomy also inhibited the regeneration of remnant liver. From these results, lymphocytes such as LAK cells appear to regulate liver regeneration.

[The influence of pulmonary "venous" compliance on the static pulmonary compliance: a study of patients with left-sided heart disease with normal respiratory function]

In heart diseases, such as mitral stenosis and angina pectoris, the static pulmonary compliance has been reported to be decreased. By definition, the pulmonary "venous" system consists of the pulmonary veins and the left atrium. It plays an important role as the reservoir for the left ventricle. In this laboratory, the pulmonary "venous" compliance (Cp"v") has been evaluated as delta V/delta P of a short segment of the P"V" volume-pressure curve. To evaluate the influence of Cp"v" on the static pulmonary compliance and to speculate about the mechanisms of the reduction in static pulmonary compliance in left-sided heart disease, hemodynamic data and static pulmonary compliance (Cst) were measured in 27 patients with left-sided heart disease. Cst was measured with esophageal balloon technique in a sitting position. The static volume-pressure curve was fitted by a sigmoid model: V = Vm/(1 + e(A-P)/kappa), where kappa is a shape constant and an index of the lung stiffness. The pulmonary blood volume (PBV) was estimated with our own method, using radionuclide (RN) angiocardiography. The mean pulmonary artery wedge pressures (PAW) were measured using a floating catheter. Cp"v" was calculated as the delta V/delta P from the increment of pulmonary "venous" volume (delta V) and that of PAW (delta P) that occurred during passive elevation of the legs. Pulmonary arterial compliance (Cpa) was obtained from an analysis of the diastolic decline in pulmonary arterial pressure wave forms.(ABSTRACT TRUNCATED AT 250 WORDS)