Parathyroid hormone-related protein is a possible autocrine growth inhibitor for lymphocytes

Adult T-cell leukemia (ATL)-related cells have the ability to produce a newly-isolated calcium-regulating protein, parathyroid hormone-related protein (PTHrP). The present study revealed that lectin-stimulated normal lymphocytes produce immunoreactive (IR)-PTHrP. When the T-cell-enriched fraction was purified from normal lymphocytes and then treated with lectin, a similar amount of IR-PTHrP was detected, suggesting that IR-PTHrP is an actual product of T-lymphocytes. A biologically active fragment of PTHrP, PTHrP(1-34), suppressed DNA synthesis in lectin-stimulated lymphocytes at concentrations greater than 50 pg/mL; the same concentration range of IR-PTHrP detected in the cultured media of lectin-stimulated lymphocytes. Therefore, it is reasonable to postulate that PTHrP is a cytokine inhibiting the cellular growth of normal lymphocytes.

Multiple meningiomas of the spinal canal and posterior fossa--case report

The majority of multiple meningiomas are associated with von Recklinghausen's disease, and those that are not, i.e., true multiple meningiomas, particularly with simultaneous development in the posterior fossa and spinal canal, are very rare. We recently encountered a case of true multiple meningiomas in which the lesions were found simultaneously in the left posterior fossa and the upper thoracic spinal canal. The spinal meningioma consisted mainly of meningotheliomatous components, and that in the posterior fossa of fibroblastic components. Both tumors were surgically removed. The cause of the multiplicity in cases of true multiple meningiomas is unknown. Incidental multiplicity is a consideration when the number of tumors is relatively small. Spinal meningiomas are often undetected in the absence of neurological symptoms. However, even if von Recklinghausen's disease is not present, and particularly when more than two meningiomas have been discovered, the patient must be carefully examined for other tumors.

Studies of protease inhibitors in the sera of patients with amyotrophic lateral sclerosis

Serum levels of 4 protease inhibitors, alpha-1-antitrypsin, C1-inactivator, alpha-2-macroglobulin and antithrombin-III were measured in 11 patients with amyotrophic lateral sclerosis (6 males and 5 females) and a control group without neurologic disease. Our results indicated no significant differences in the level of serum alpha-2-macroglobulin between the 2 groups. We found slight but significantly lower levels of serum antithrombin-III in ALS. The possibility of the participation of proteases or protease inhibitors in the pathogenesis of ALS is discussed.

Production of parathyroid hormone-related protein in adult T-cell leukemia cells

Human parathyroid hormone-related protein (PTHrP) mRNA was detected in peripheral leukemic cells obtained from adult T-cell leukemia (ATL) patients as well as in cultured human T-cell leukemia virus type I (HTLV-I)-infected T-cell lines. In contrast, PTHrP mRNA was not detected in other types of leukemic cells. Using radioimmunoassay, immunoreactive PTHrP was also detected in the spent media of HTLV-I-infected T-cell lines. These results suggest that PTHrP plays an important role in developing the hypercalcemia frequently observed in ATL patients.

Provocation of a paradoxical growth hormone response to corticotropin-releasing hormone by pretreatment with metoclopramide in patients with acromegaly and normal subjects

Two of 7 patients with acromegaly and one of 7 normal subjects exhibited a paradoxical rise in growth hormone (GH) to human corticotropin-releasing hormone (CRH) when pretreated with metoclopramide, although CRH alone did not induce an increase in GH. In one of these two patients with acromegaly, the GH increase to metoclopramide alone also reached the criteria of a paradoxical response. These two acromegalic patients showed a GH increase to metoclopramide pretreatment before and up to two months after surgery. In another acromegalic patient, whose GH level remained high 5 months after surgery, metoclopramide induced an increase in GH level, while in a patient who had an above-normal GH level 18 months after surgery, the resumption of physiological GH secretion after surgery was evidenced by a postoperative absence of a GH response to metoclopramide. It is suggested from these results that the GH response to metoclopramide and the metoclopramide-provoked GH response to CRH in patients with acromegaly result from the secretion of GH from nonadenomatous cells of the pituitary.

[Subrenal capsule assay (SRCA) using human lung cancer]

SRCA was performed using surgically removed fresh tissues in 26 cases of lung cancer. The histological examination of day 6 xenograft showed that only a few xenografts contained tumor cells because of the host cell infiltration and stroma. For the assay considered as evaluable, we defined that control mice needed to show delta tumor size larger than -0.5 OMU and histological presence of tumor cell more than 50% in the day 6 xenograft. The evaluable assay rate (EAR) was no more than 25% (4/16). By the pretreatment with X-ray irradiation of 3 Gy, host cell infiltration was significantly suppressed. With this procedure however, only 40% (4/10) of EAR was gained. The reason for this low EAR was due to the difficulty to obtain the specimens enriched with tumor cells because of stroma and necrotic tissue. Then we used specimen obtained from the human lung cancer line xenografted in nude mice, which resulted in a high EAR of 84% (16/19). We concluded that SRCA for fresh surgical materials was still difficult. However SRCA for lung cancer line was feasible, especially for in vivo preclinical chemosensitivity test for new agents and decision for new drug combination. SRCA as a disease oriented chemosensitivity test is expected to develop in the future.

[Clinical study of the delivery of very low birth weight infants in Iwate Prefecture]

Over the past 4 years, 119 very low birth weight infants (VLBWI, less than 1,500g) were delivered at Iwate Medical University. We analysed clinical background of mothers and prognosis of neonates. The objective of this study was to upgrade our perinatal care tailored to regional demand. The following results were obtained. 1. Maternal transport was necessary in 90.7% of the mothers. Preterm Premature Rupture of the Membranes (PPROM) was present in 38.8% of them. 2. The percentage of mothers with a cervical dilatation of more than 4cm was significantly higher in mothers without PPROM than in those with PPROM. 3. Delivery occurred within 24 hours in 86.8% of mothers without PPROM who had a cervical dilatation of more than 4cm. 4. The percentage of cesarean sections was 16.5%. 5. Death in the neonatal period occurred in 10.8% of VLBWI, 20% of extremely low birth weight infants (ELBWI, less than 1,000g), and 42.8% of infants weighing less than 750g. 6. There was no significant difference in the incidence of intraventricular hemorrhage (IVH) between infants with cephalic presentation and infants with breech presentation, or between infants delivered vaginally and infants delivered by cesarean section. The incidence of IVH was significantly higher in infants weighing less than 1,000g than in those weighing 1,000g or more. 7. The neonatal death nate and the incidence of IVH were significantly higher in infants weighing less than 750g than in those weighing 1,000g or more. 8. The incidences of pneumonia and sepsis were significantly higher in infants with PPROM than those without PPROM.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro degradation of amyloid material by four proteases in tissue of a patient with familial amyloidotic polyneuropathy

The effects of 4 proteolytic enzymes, alpha-chymotrypsin, bromeline, collagenase, and lysozyme on amyloid tissue sections from a patient with familial amyloidotic polyneuropathy (FAP) were evaluated. Degradation of amyloid fibrils was significant with alpha-chymotrypsin, moderate with bromeline and collagenase, and slight with lysozyme. All of these proteases except collagenase are used as oral mucolytics in humans. The possibility of their clinical usefulness in the treatment or prevention of the development of FAP is discussed.

Bleeding manifestations in 24 patients with familial amyloidotic polyneuropathy

Focal or generalized hemorrhage is a commonly encountered complication in patients with many kinds of amyloidosis. We studied 24 patients (18 males, 6 females) with familial amyloidotic polyneuropathy and found that five had experienced one or more bleeding episodes. In four of these five patients, bleeding occurred in the terminal stage. The incidence of hemorrhage in familial amyloidotic polyneuropathy is lower than that of other types of amyloidosis or that which has been reported in this disease. In our experience clotting abnormalities were rare; clotting factor deficiency appeared not to exist in familial amyloidotic polyneuropathy.

Studies of protease and protease inhibitors in familial amyloidotic polyneuropathy

Serum levels of 6 protease inhibitors, alpha 1-antitrypsin, Cl inactivator, alpha 2-macroglobulin, antithrombin-3, alpha 1-antichymotrypsin and inter-alpha-trypsin inhibitor were measured in patients with familial amyloidotic polyneuropathy (FAP) and a control group without neurologic disease. No significant differences were observed between the 2 groups. The proteolytic effect of brinase, an enzyme from Aspergillus oryzae, on amyloid tissue sections from patients with FAP was also evaluated. Amyloid fibrils were degraded by brinase, while the tissue structure remained fairly intact.

Detection of gastrin-releasing peptide mRNA in small cell lung carcinomas and medullary thyroid carcinomas using synthetic oligodeoxyribonucleotide probes

Human gastrin-releasing peptide (GRP) mRNA was detected in the tumor tissues of medullary thyroid carcinomas and small cell lung carcinomas using synthetic oligodeoxyribonucleotides as hybridization probes. The amount of GRP mRNA was estimated by radiodensitometric hybridization assay. A good correlation was found between the amount of GRP mRNA and the concentration of immunoreactive GRP in the tumor tissues.

Pituitary-adrenocortical response to metoclopramide in patients with acromegaly and prolactinoma: a clinical evaluation of catecholamine-mediated adrenocorticotropin secretion

We have demonstrated that metoclopramide stimulates cortisol secretion at least in part by a stress-mediated effect in normal men. To examine further the effect of the drug on the hypothalamo-pituitary adrenal system, we studied the cortisol response to 20 mg metoclopramide in patients with acromegaly, prolactinomas, and functional hyperprolactinemia and compared the results with the responses to insulin-induced hypoglycemia. In some patients, the effects of metoclopramide on CRH-induced ACTH and cortisol increase were studied to determine whether a change in dopaminergic (catecholaminergic) activity altered CRH stimulation of pituitary-adrenal function. No cortisol response to 20 mg metoclopramide occurred in 13 tests on 8 of 9 patients with prolactinoma or acromegaly with hyperprolactinemia, whereas both acromegalic patients without hyperprolactinemia had a response. All of the patients had a normal cortisol response to insulin-induced hypoglycemia. Pretreatment with metoclopramide enhanced the CRH-induced cortisol increase from 30-120 min after CRH in normal men, but only at 15 and 30 min in 5 agromegalic patients. The results suggest that metoclopramide acts in the hypothalamus to release ACTH through a dopamine antagonist-mediated (catecholaminergic) mechanism, and that metoclopramide may act additively with CRH to stimulate ACTH secretion in normal men. The absence of a metoclopramide-induced cortisol response in patients with acromegaly or prolactinomas and the absence of a normal cortisol response to metoclopramide-CRH in acromegalic patients could be due to endogenous catecholamine deficiency in these patients.

[Autologous bone marrow transplantation in osteosarcoma]

Four patients with osteosarcoma were treated with intensive chemotherapy and autologous bone marrow transplantation (ABMT). The patients received high-dose methotrexate (9-12 mg/m2) with citrovorum factor rescue, high-dose melphalan (60 mg/m2 X 3), actinomycin D (0.5 mg/m2 X 3), adriamycin (30 mg/m2 X 2) and high-dose cyclophosphamide (60 mg/kg X 2) during 4 weeks. Bone marrow was aspirated and cryopreserved before treatment and reinfused 48 hours after the completion of chemotherapy. Two of four patients had advanced osteosarcoma with multiple pulmonary metastasis, one of whom had responded well and achieved partial response while the other had shown no response, and both patients died of disease progression 4 and 11 months after ABMT, respectively. The other two patients who received this regimen at an earlier disease stage for prevention of pulmonary metastasis, are alive and well without any evidence of metastasis 31 and 18 months after ABMT, respectively. This regimen was tolerated well in all patients except for mild nausea and vomiting. No infectious episodes were observed during the period of aplasia which continued for 19 to 38 days after marrow infusion. These results suggest that this supralethal combination chemotherapy is safe and tolerable when used with ABMT and effective for patients with osteosarcoma, especially when applied in the non-metastatic phase.

Analysis of cell proteins in lymphoblasts of acute lymphocytic leukemia by two-dimensional gel electrophoresis

The two-dimensional gel electrophoresis (2-DE) method developed by O'Farrell was used to analyze the differences of major proteins between lymphoblasts from children with acute lymphocytic leukemia (ALL) at diagnosis (lymphoblasts, n = 6), normal lymphocytes (n = 6) and lymphocytes from children with ALL in complete remission (lymphocytes in CR, n = 12). Among all the spots, those which were deeply stained and large were termed 'major spots'. Their number was 118. Two spots (No. B1 and B2) were characteristic of lymphoblasts, three spots (No. N1-N3) were characteristic of normal lymphocytes. In lymphocytes in CR, the latter spots were not always detected, and furthermore, the former spots were detected in several gels. These findings may relate to the insufficient recovery of functions of lymphocytes in CR. Several spots (No. 6, 55 and 57) in lymphoblasts were remarkably larger than those in normal lymphocytes. Spot No. 67, an actin spot, in lymphoblasts was smaller than that in normal lymphocytes. Spots No. 6, 55 and 57 in lymphocytes in CR were relatively small in size.

[Studies on the transfer of cefotaxime into bone marrow blood]

Cefotaxime (CTX) was administered in a dose of 2 g to 20 adult patients prior to orthopaedic surgery. Samples of the bone marrow blood and the forearm venous blood were collected at 30, 60, 90 and 120 minutes after the CTX administration, and the concentration of the drug in each sample was determined. The results are described below. The mean concentration of CTX transferred into the bone marrow blood was 59.7, 28.9, 14.7 and 7.2 micrograms/ml at 30, 60, 90 and 120 minutes after the CTX administration, respectively. The mean concentration of CTX in the venous blood was 84.0, 39.1, 19.0 and 13.8 micrograms/ml at 30, 60, 90 and 120 minutes after the CTX administration, respectively. The mean ratio of the CTX concentration in the bone marrow blood to that in the venous blood was 73.9%, 71.0%, 75.1% and 51.6% at 30, 60, 90, 120 minutes after the CTX administration. From the above results, CTX is considered to be a useful antibiotic if it is administered prior to orthopaedic surgery to prevent infections.

An effective hospital-based pneumococcal immunization program

We studied a hospital-based pneumococcal immunization program. Ninety (66%) of 136 patients on the study unit (group 1) and 97 (80%) of 122 patients on the control unit (group 2) were candidates for pneumococcal vaccine based on age of 65 years or older or underlying medical condition, or both, and absence of prior vaccination. In group 1, an infection control nurse identified candidates at the time of discharge and offered vaccine. No intervention was made in group 2. Seventy (78%) of vaccine candidates in group 1 were vaccinated at the time of hospital discharge compared with none of 97 candidates in group 2 (P less than .001). A hospital-based program offering vaccine at the time of hospital discharge can significantly improve immunization rates and successfully immunize the majority of hospitalized individuals at high risk from pneumococcal infection.

Dramatic response to corticosteroid therapy of nephrotic syndrome associated with IgA nephropathy

We report a dramatic response of the nephrotic syndrome to prednisolone therapy (2 mg per kg per day) in a 6-year-old boy with IgA nephropathy. He had developed massive proteinuria (22.1 gm per day) and microscopic hematuria shortly after an episode of tonsillitis. Renal biopsy two months after onset showed mild mesangial hypercellularity with typical mesangial deposition of IgA. Corticosteroid therapy resulted in a sharp cessation of proteinuria and complete resolution of the urinary abnormalities. We suggest that massive proteinuria associated with IgA nephropathy may be responsive to corticosteroid therapy when there are minimal glomerular changes.

Pneumococcal vaccine in the hospital. Improved use and implications for high-risk patients

A randomized trial of a program to improve pneumococcal immunization was undertaken. Also studied were the prevalence of high-risk conditions for serious pneumococcal disease among hospital admissions and prior hospitalization of patients with pneumococcal bacteremia. During two successive winters, 56% of 1,062 medical patients were identified by admission diagnosis or age as having a high-risk condition. None had received prior vaccination. During the trial period, identifying candidates for vaccination increased immunization from two (2.1%) of 95 to ten (10.4%) of 96 in year 1 and from two (2.1%) of 96 to 19 (20%) of 95 in year 2. Among adults with pneumococcal bacteremia, 33 (54%) of 61, including 32 (64%) of 50 with high-risk conditions, had documentation of prior hospitalization within five years. A hospital-based program can increase pneumococcal immunization rates and would be directed at patients in whom serious pneumococcal disease is likely to develop.

[Evaluation of prognostic factors in hepatocellular carcinoma using multiple regression analysis]

We analysed the relationship between 19 prognostic factors and the life span of patients with hepatocellular carcinoma. Among 52 patients who had been admitted to the Gifu Prefectural Gifu Hospital, in 46 the pathological diagnosis was confirmed. We selected 9 of 19 variables by the stepwise forward regression method. These were Arels Classification, ascites, HBsAg, performance status, method of therapy, sex, GOT, albumin and bilirubin. Results of multiple regression analysis demonstrated that the presence of ascites is the most important factor; other significant factors are Ariel's Classification, performance status, positivity of HBsAg, method of therapy, and GOT. These parameters were paralleled with the survival curves, most of which had been categorized. Although intra-arterial infusion of ADM was considered the most favourable treatment method, the survival curves suggested that other methods were equally effective.

Prealbumin and immunoglobulin in serum and cerebrospinal fluid in familial amyloid polyneuropathy

Prealbumin, immunoglobulin G, A, and M concentrations in serum and cerebrospinal fluid from patients with familial amyloid polyneuropathy (Japanese type) were determined and compared with those of asymptomatic relatives or controls. Prealbumin concentrations were not significantly different between them. Using polyacrylamide disc-gel electrophoresis, no qualitative difference in the serum prealbumin was found between them. Among the serum immunoglobulins, only the immunoglobulin A concentration was significantly elevated in the patients as compared with asymptomatic relatives.

[Chemotherapy of hepatocellular carcinoma--with special reference to one-shot intra-arterial infusion of a high dose of adriamycin]

Twenty-two cases of non-operable hepatocellular carcinoma (HCC) were treated with three types of chemotherapy mainly with Adriamycin (ADM). In the group (A), one shot intraarterial infusion of 100 mg ADM into the hepatic artery (9 cases), group (B), one shot intraarterial infusion of 30 mg ADM (3 cases), and group (C), 20-60 mg of systemic administration of ADM (10 cases) were examined. The therapeutic effects and side effects were studied comparatively among these three groups. In terms of tumor regression, RR was 4 cases (44.4%), and MR was 4 (44.4%) in group (A), and PR was 1 (10%) in group (C). The average survival time was 8.3 months (5 cases are still alive) in group (A), 5.7 months in group (B), and 4.2 months in group (C), respectively As side effects, alopecia was found 100% in (A), 33% in (B); leukocytopenia was found 100% in (A), 33% in (B); but no serious complication due to leukocytopenia was observed in any of them. One shot of 100 mg of ADM intraarterial infusion therapy seemed to be superior in therapeutic effects against HCC over other therapies.

New fluorogenic peptide substrates for plasmin

Fluorogenic peptides, peptidyl-4-methylcoumaryl-7-amides (MCA), containing COOH-terminal lysine residues, were newly synthesized and tested as substrates for plasmin. Among six peptidyl-MCA's, Boc-Val-Leu-Lys-MCA and Boc-Glu-Lys-Lys-MCA were found to be useful for the specific and sensitive assay of plasmin. The Km values estimated from Line-weaver-Burk plots for these substrates using human and bovine plasmins were in the region of 10(-4) M. Boc-Glu-Lys-Lys-MCA was slightly hydrolyzed by bovine plasma kallikrein, and Boc-Val-Leu-Lys-MCA was slightly hydrolyzed by human and hog urinary kallikreins and hog pancreatic kallikrein. However, both of the fluorogenic peptides were essentially unaffected by urokinase, alpha-thrombin, Factor Xa, Factor IXa, Factor XIa, and Factor XIIa. It was confirmed that plasmin hydrolyzed Boc-Glu-Lys-Lys-MCA, cleaving the lysyl-MCA bond, but not the lysyl-lysyl bond. These fluorogenic peptides were resistant to human plasmin activated by streptokinase. Boc-Glu-Lys-Lys-MCA was not hydrolyzed by human plasmin or plasminogen in the presence of more than a 5-fold molar excess of streptokinase. The sensitivity of Boc-Val-Leu-Lys- of more than a 5-fold molar excess of streptokinase. The sensitivity of Boc-Val-Leu-Lys-MCA to human plasmin was also reduced, but plasmin retained 35% of the maximum activity even in the presence of a 20-fold molar excess of streptokinase. These results suggest that streptokinase-plasmin complex has essentially no activity towards Boc-Glu-Lys-Lys-MCA.

A new fluorogenic substrate method for the estimation of kallikrein in urine

Kallikrein in human urine was measured using a fluorogenic peptide substrate, proly-phenyl-alanyl-arginine-4-methylcoumaryl-7-amide (Pro-Phe-Arg-MCA). Using 20 microliters of normal urine, kallikrein activity was quantitatively assayed by incubation with a final concentration of 10(-4) M Pro-Phe-Arg-MCA at 37 degrees C for 90 min. The reaction was terminated by adding 50 units of Trasylolr or 20 microliters of 10% acetic acid. Using this method, kallikrein activity was measured in urine from normal subjects and patients with glomerulonephitis and Bartter's syndrome. These values were comparable with the values obtained by radioimmunoassay using bovine low-molecular-weight kininogen. When normal urine was applied to a column of arginine-Sepharose 4B, two activities, Pro-Phe-Arg-MCA hydrolyzing activity and kinin-releasing activity toward bovine low-molecular-weight kininogen, were eluted in the same fraction. These results indicate that the present method is useful for the estimation of kallikrein in urine, in terms of specificity, sensitivity, and simplicity.