[A successful case of tricuspid valvulectomy for Ebstein's anomaly with severe tricuspid stenosis]

A 44-year-old male was admitted to our hospital complaining of general fatigue and dyspnea on exertion with congestive heart failure (NYHA IV). Cardiac catheterization and angiogram revealed Ebstein's anomaly with severe tricuspid stenosis and functioning small right ventricle. Because of tiny right ventricular chamber, the usual surgical treatment for Ebstein's anomaly i.e. tricuspid valve replacement or valvuloplasty were deemed to be inappropriate. Tricuspid valvulectomy was performed to relieve the inflow stenosis of the right ventricle and excellent symptomatic relief was achieved. It is very rare to seen an adult case of Ebstein's anomaly with severe tricuspid stenosis and functioning small right ventricle. Tricuspid valvulectomy may be justified to use in this rare condition.

Establishment of a sensitive radioimmunoassay for the detection of human IgE-binding factor (soluble CD23)

A monoclonal antibody (mAb) specific to low-affinity receptor for IgE (FceRII/CD23) was established by the fusion of spleen cells of BALB/c mice immunized with the FceRII+ human B lymphoblastoid cell line (RPMI 8866) with mouse myeloma P3U1. Four mAbs, 10/3 (IgG1), 11/4 (IgG1), 12/2 (IgG2b) and 15/6 (IgM), almost completely inhibited the IgE binding to FceRII+ cells but not to FceRII- cells. More directly, they were demonstrated to react only with 43-kD component/FceRII of the cell lysate of RPMI 8866 cells by sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot analysis. Since they have a different epitope specificity, a solid-phase radioimmunoassay (RIA) for the measurement of IgE-binding factor (IgE-BF) was established. It was found that the RIA with the use of 10/3 and 125I-labeled 11/4 or 12/2 gave good results in the detection of IgE-BF derived from B cells and monocytes as well as of T-cell-derived IgE-BF. More importantly, serum IgE-BF was also quantitatively measured by this RIA. Although increased serum levels of IgE-BF were observed in atopic patients, serum IgE-BF was decreased rather than increased in patients with very high serum IgE. This phenomenon may be explained by the decreased ability of the patients' B cells to spontaneously release IgE-BF in vitro.

Late radiation response of canine mediastinal tissues

The mediastinal tissues which included heart, lung, trachea and esophagus of 70 adult beagle dogs were irradiated to a range of total radiation doses between 24 and 68 Gy given in 2, 3 and 4 Gy fractions. The purpose of the study was the calculation of alpha/beta ratios for morphologic and functional changes of the mediastinal tissues. Functional assays including echocardiography, electrocardiography, right heart hemodynamics and cardiac output were performed. Histomorphometric analyses of all tissues included in the field were done 2 years after treatment. Euthanasia was performed on 7 of 70 dogs prior to 2 years due to congestive heart failure and seven other dogs had signs of heart failure 2 years after treatment. Heart failure was thought to be caused by either pericardial effusions or constrictive pericarditis in these dogs. Heart failure occurred at doses of 62 and 68 Gy given in 2 Gy fractions, 60 Gy given in 3 Gy fractions and 52 Gy given in 4 Gy fractions. The ED50 values for pericardial fibrosis for 2, 3 and 4 Gy fractions were 46.1, 43.9 and 26.6 Gy, respectively. An alpha/beta ratio of 2.5 Gy was calculated by direct quantal response analysis. Small foci of myocytolytic lesions were detected in 11 dogs. Calculated ED50 values for myocytolysis were 70.4 Gy given in 2 Gy fractions and 50.8 Gy given in 4 Gy fractions. The estimated alpha/beta ratio was 3.2 Gy. Heart rates determined from physical examination and frequency of S-T segment changes increased with increasing dose. No other dose related changes were found in any of the other functional parameters. Functional changes were detected in the 14 dogs with clinical signs of heart failure. Focal consolidation and subpleural fibrosis were present in the irradiated lung volume. These late changes had no detectable physiologic effect in these dogs because of the small volume of lung irradiated. The ED50 values for lung consolidation were 54.3, 45.8 and 26.6 Gy after 2, 3 or 4 Gy fractions, respectively. The estimated alpha/beta ratio was 3.4 Gy. No dose-related changes could be detected in the trachea or esophagus at 2 years after treatment. These results demonstrate that lung and pericardium are the most responsive tissues in the mediastinum within the first 2 years after treatment. Myocardial lesions were present with high ED50 values, but were not found to be functionally significant at 2 years after irradiation. Human clinical data indicate that longer observation periods are needed for development of these lesions.(ABSTRACT TRUNCATED AT 400 WORDS)

[The diagnostic value of a new whole blood histamine release test using paper disc-coupled antigens--results compared with intracutaneous test, RAST, and eye test]

We have developed a novel histamine release test (HR) using whole blood and antigen-coupled RAST paper discs, for the screening of allergens rather in a short time with a small amount of blood. Histamine was determined by a RIA kit. In order to evaluate the diagnostic value, the results of the test were compared with those of RAST, intracutaneous tests, and eye tests in 45 allergic patients. HR correlates better with RAST than intracutaneous test in almost all antigens. The closest positive correlation with the other tests was seen in mite allergen, followed by pollen, foods and mould spores in that order. When the HR was positive for house dust, 100% of the patients were also positive for the eye test, which is reported to closely correlate with bronchial provocation tests. HR seemed to be a useful test not only for the screening but also for the determination of pathogenic allergens.

Establishment of Epstein-Barr virus-negative diffuse large cell lymphoma cell line with an 8;22 chromosomal translocation

A new human B-cell lymphoma cell line was established from a pleural effusion of a patient with a diffuse large cell lymphoma which originated from an ileocecal tumor. The cell line, designated KAL-1, has been passaged 280 times over a period of 22 months. This cell line was successfully maintained in a chemically defined serum-free medium; its doubling time is approximately 24 h. Immunologically, the cells were demonstrated to express IgM lambda on the cell surface and to react with monoclonal antibodies to B-cell antigen including B1, B4, HLA-DR, and common acute lymphoblastic leukemic antigen but not with B2 and all the T-cell markers. Immunoglobulin gene analysis revealed rearrangements of both JH and C lambda. These data indicate that this cell line represents the B-cell lineage at the immature B-cell stage. This cell line was negative for Epstein-Barr virus nuclear antigen and had no detectable Epstein-Barr virus genome in cellular DNA. Chromosome analyses revealed that the cells carried an 8;22 chromosome translocation, reminiscent of variant type Burkitt's lymphoma. However, there was no histological evidence for Burkitt's lymphoma. Molecular studies showed that KAL-1 had deregulated high constitutive expression of c-myc. This cell line was demonstrated to be highly tumorigenic when injected into athymic nude mice. This tumor model should provide clues about the molecular mechanism involved in the pathogenesis of B-cell malignancy and appears to be a useful in vivo model for the study of molecular events during B-cell differentiation and therapeutic investigations.

Self-association of telomeric short oligodeoxyribonucleotides containing a dG cluster

Oligonucleotides containing a dG cluster, d(TmGnTm), are models of single-stranded parts of telomeric deoxyribonucleic acid and substitutes for poly(dG). Electrophoretic and spectroscopic analyses of the oligomers indicate that the oligomers can form two alternative structures, single- and quadruple-stranded helices, in solution at room temperature. The transformation of the single-strandef form into the quadruple-stranded form or vice versa is undetectable in 0.1 M NaCl at 4.3 x 10(-5) M strand concentration at room temperature. However, at a 50-fold higher strand concentration, the single-stranded oligomer is gradually converted into the quadruplex. An increase in ionic strength stabilizes the single-stranded structure, so it seems to inhibit the formation of the quadruplex. The quadruplex, [d(TTGGGGTT)]4, is resistant to denaturation in 7 M urea, in which the Watson-Crick type d(TTGGGGTT).d(AACCCCAA) duplex dissociates. An increase in the number of T residues facilitates the dissociation of the quadruplex by heating. Thus the number of T residues surrounding the dG cluster might control the rigidity of the quadruplex structure.

[An enzyme-linked immunosorbent assay (ELISA) for the quantitation of sugi pollen and Dermatophagoides mite allergens and its application for standardization of allergen extracts]

A simple enzyme-linked immunosorbent assay (ELISA) has been developed for the quantitation of the major allergens of sugi pollen, Cry j I and of Dermatophagoides mites, Der I (Der p I/Der f I) and Der II (Der p II/Der f II) for use in the in vitro standardization of allergen extracts. Polystyrene microplates coated with a IgG fraction of rabbit antiserum were incubated first with allergen extracts and then with biotinylated antiserum IgG. The bound allergen-biotinylated antibody complex was detected with commercially available streptavidin-enzyme conjugate followed by the addition of colorimetric substrate. The assay was very sensitive (-0.2 ng/ml) and reproducible (CV% = 1.9-13.8%). The ELISA was compared with the radioimmunoassay previously described, and the results showed a very good correlation between the assays (r = 0.967-0.990). The allergen content in three sugi pollen and three house dust extracts measured by the ELISA also demonstrated a good agreement with the relative potency of these extracts as determined by the intradermal skin test. These results indicate that the ELISA could be useful in the standardization of allergen extracts.

Enkephalinergic sympathetic and parasympathetic innervation of the rat submandibular and sublingual glands

Enkephalinergic innervation of the rat salivary glands was investigated by immunocytochemical techniques. Based upon immunostaining for enkephalin (ENK) and tyrosine hydroxylase (TH), 4 types of neurons could be distinguished in the submandibular ganglion: cells containing both ENK and TH (9% of all ganglion cells), cells containing only ENK (17%), cells containing only TH (4%) and cells lacking both ENK and TH (70%). Almost all of the ganglion neurons were also positive for AChE and so were most of the TH-positive cells. The ENK-positive fibers outnumbered the TH-positive fibers. Although TH-positive fibers displayed concurrent ENK immunoreactivity, fibers in the blood vessel walls were only immunoreactive for TH. Excision of the superior cervical ganglion resulted in a decrease of ENK fibers and the disappearance of most of the TH fibers from the submandibular gland. Most of the remaining ENK-positive fibers were immunonegative for TH, while the remaining TH-positive fibers were also positive for ENK. The salivary gland of the postnatal 8-week-old rats had a considerable number of ENK-positive neurons and fibers in the submandibular ganglion and acini.

[Evaluation of different treatments of Japanese bed quilts for reducing mite allergens]

We evaluated the effectiveness of different treatments of Japanese bedquilt (futon) in reducing mite allergens: vacuum-cleaning, beating plus vacuum-cleaning and washing of the whole futon in water. Before and after these treatments, small amounts of cotton were taken out of the futon and mite allergens were extracted from the cotton into water. The absolute contents of two kinds of major allergens of two Dermatophagoides species were immunochemically quantitated. We found that beating and vacuum-cleaning reduced the allergen contents by only about 40%, whereas washing reduced the allergens by more than 90%. Therefore, for reducing airborne mite allergens generated from futon, we think that washing the whole futon in water is the most effective method.

Enzymatic dispersion of mast cells from human sinus mucosa: characterization of histamine release and its comparison with chopped fragments of the tissue

Functional characteristics of mast cells in chopped fragments from sinus mucosa, which was dissected from patients with chronic sinusitis, were compared with those from dispersed cells prepared by enzymatic treatment. The results obtained in this study were the following. (1) Both chopped fragments and dispersed cells released histamine in a dose-dependent manner when incubated with anti-IgE. However, higher histamine release was always observed in dispersed cells. (2) Although no differences in the ability to reduce histamine release with salbutamol or forskolin could be observed between chopped fragments and dispersed cells, staurosporin and p-bromophenacyl bromide were more active on dispersed mast cells than chopped fragments. (3) Passive sensitization of dispersed cells with an allergic serum containing IgE to mite could be achieved only after elution of IgE on the cells with lactic acid.

[The effect of prostaglandin I2 on the postischemic recovery of the transplanted heart under deep hypothermia]

The effect of prostaglandin I2 (PGI2) on the postischemic recovery of the heart orthotopically transplanted under deep hypothermia was evaluated using puppies. Twenty-four pairs of dogs were divided into 4 groups according to the usage of PGI2 and preservation of the donor heart (in Euro-Collins' solution at 4 degrees C for 4 hours), namely Group I (non PGI2, no preservation), Group II (PGI2-treated, no preservation), Group III (non PGI2, 4 hours preservation), Group IV (PGI2-treated, 4 hours preservation). PGI2 was added into the donor's cardioplegic solution (500 ng/ml) and also was given intravenously to the recipient during cooling and rewarming periods (1 microgram/kg/min), and left ventricular pressure, max dp/dt, cardiac output were continuously monitored, and postmortem studies on myocardium were performed. Results were as follows: PGI2 yielded significantly better recovery of cardiac output and left ventricular pressure after transplanted of the heart, [Group I vs Group II (p less than 0.05), Group III vs Group IV (p less than 0.01)]. This effect was especially remarkable in the preserved heart groups. Microscopically, the contraction band formation in the myocardium was more prominent in Group III than in Group IV. It is concluded that PGI2 is of great use for the postischemic recovery of the transplanted heart not only by ameliorating the myocardial ischemic recovery of the transplanted heart, but also by reducing the afterload of the recipient during the recovery period from deep hypothermia.

Histamine release with a solid-phase-coupled allergen

Mite allergen was coupled to Sepharose, paper disk or microcrystalline cellulose, and the immobilized allergen was used for histamine release assay in human leukocytes. In terms of the spontaneous release and the reproducibility, the histamine release assay using immobilized allergen was comparable to that using soluble allergen. Histamine release increased progressively with the concentration of the immobilized allergen up to maximal release of histamine which persisted with further increase in immobilized allergen. Histamine release with soluble allergen decreased at higher concentrations of the allergen. The concentration of immobilized allergen required for maximal histamine release was the same as that with soluble allergen, but the maximal release with immobilized allergen was always about 20% lower than that with soluble allergen. Histamine release was not dependent on the density of allergen molecules on Sepharose beads. Although there was a significant correlation between histamine release obtained with a commercial disk, with a disk prepared in our laboratory, and with soluble allergen, the magnitude of the release by both assays using a paper disk was reduced significantly.

A case of occupational allergic bronchopulmonary aspergillosis unique to Japan

A 15-year-old female was diagnosed in 1980 as having allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus fumigatus based on Rosenberg and Patterson's criteria for the disease. The patient is the eldest daughter of a family of domestic brewers of soy sauce and bean paste in a small village, an occupation unique to Japan. The brewing process involved the use of Aspergillus oryzae as a fermenting agent. The patient had experienced episodic wheezing and pulmonary infiltrates during the same seasons in the previous three years, corresponding to the time of the highest A oryzae spore concentrations in the living area, suggesting high exposure to the Aspergillus spores in the aetiology of her exacerbations. She had a prominent family history of atopy and was demonstrated to be sensitive to a variety of aeroallergens in addition to A fumigatus. She was treated effectively by bronchial toiletting via broncho-fibrescope and theophylline medication until April 1981, when she moved to another city. During her life there, chest X-rays repeatedly showed abnormal shadows, and she was treated with inhalations of amphotericin B and bronchial toiletting several times at a hospital. She returned to her home town after seven years in April 1988 and visited the hospital to check her condition. Although she had been away from heavy exposure to A oryzae spores for seven years, precipitins to the culture medium of A oryzae were demonstrated to be far more prominent than those to A fumigatus antigen. Although her family had been exposed to A oryzae spores continuously, the patient was the only family member with ABPA due to A fumigatus and possibly due to A oryzae.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of pulmonary paraganglioma]

A pulmonary paraganglioma that was discovered incidentally as a solitary coin lesion on abdominal CT was successfully resected. Though this type of paraganglioma is extremely rare, it needs to be differentiated from certain other pulmonary neoplasms.

A comparison of swine abdominal temperature distribution after heating with BSD-1000, an annular phased array system (APAS), and Thermotron RF-8

External hyperthermia for deep-seated tumors is still a difficult problem. We compared the abdominal temperature distribution in a pig after heating with BSD-1000, an annular phased array system (APAS), and Thermotron RF-8. Thirty elastic tubes were inserted into the upper abdomen of the pig and a thermocouple was inserted into each of the tubes. After heating, these thermocouples were moved at 1-cm intervals and the three-dimensional temperature distribution was obtained. The temperature distribution after heating with APAS and Thermotron RF-8 was compared by using the distribution on the longitudinal center line of each sagittal plane at 1-cm intervals from the center. The temperature was much higher and its distribution more homogeneous with APAS than Thermotron RF-8.

Characterization and comparison of mitochondrial DNAs and rRNAs from Penicillium urticae and P. chrysogenum

Mitochondrial DNA (mt DNA) from a patulin producer, Penicillium urticae (synonym P. griseofulvum), was 27.8 kb +/- 0.6 kb in size by electron microscopy and 27.2 kb by agarose gel electrophoresis. Restriction endonuclease maps for nine restriction enzymes were constructed, and eleven fragments which covered the total range of the mt DNA were cloned into the Escherichia coli plasmid vector pUC19. Southern analysis of the native genomes of P. urticae and P. chrysogenum with six of the cloned fragments as probes indicated similar genome arrangements as well as similar restriction maps. Both the large and small rRNA genes of P. urticae and P. chrysogenum were located on these restriction maps using Southern hybridization, and the result also supported the similar arrangement. Agarose/formaldehyde gel electrophoresis indicated that the small rRNA was 1.5 kb in size in both species; but, surprisingly, the large rRNA was 4.2 kb in size for P. urticae and 3.5 kb for P. chrysogenum. These sizes were, respectively, 1.1 kb and 0.4 kb larger than those from the very closely related Aspergillus nidulans.

A case of postnephrectomy arteriovenous fistula

A rare case of a postnephrectomy arteriovenous fistula involving the major renal vessels is presented herein. This type of postnephrectomy arteriovenous fistula is very unusual; in fact, since first documented in 1934, only 65 cases have been reported in the world literature, including 2 cases from Japan. Even though postoperative arteriovenous fistulae are rare, one should bear this complication in mind when unknown causes of bruit or heart failure develop following surgery.

The causes and value of hyperphosphatemia in experimental strangulation obstruction

In model experiments with mongrel dogs, intestinal strangulation obstruction was induced by occluding the superior mesenteric veins, and a rise in the inorganic phosphate value of the blood was observed. The high inorganic phosphate values of the fluid exuding from the strangulated bowel suggest that intestinal factors associated with the strangulated bowel may be partly responsible for this elevated phosphatemia. However, hyperphosphatemia was also found in a model experiment in which the route through which the fluid was absorbed into the blood from the peritoneal cavity was interrupted by keeping the strangulated bowel in an intestinal bag. After this, in the model experiments in which a systemic blood pressure depression curve with a percentage reduction similar to that of the decreasing arterial blood pressure resulting from strangulation was produced (by exsanguination, and even by exsanguination with adequate perfusion of the gut), plasma inorganic phosphate values also increased. Therefore it is undeniable that systemic factors other than the above-mentioned local factors are related to the rise in plasma inorganic phosphate values in experimental strangulation obstruction. Because it is not possible to assert that phosphatemia is specific to intestinal strangulation, the importance of a rise in inorganic phosphate values in the early diagnosis of intestinal strangulation cannot be considered very great.

[The role of prostaglandin I2 in heart transplantation under deep hypothermia]

The role of Prostaglandin I2 (PGI2) on heart transplantation under deep hypothermia were investigated using 25 weighing an average of 5 kg. They were put to deep hypothermia by surface cooling with either anesthesia until rectal temperature reached 18 degrees C. Then the heart was arrested with cardioplegic solution, removed and re-transplanted. They were divided into 2 groups according to the usage of PGI2, i.e., non PGI2 group (n = 12) and PGI2-treated group (n = 13). In PGI2-treated group, PGI2 was administered intravenously 1 micrograms/kg/min during cooling and rewarming periods, and was added 500 ng/ml into cardioplegic solution. In the last 13 dogs (7 dogs in non PGI2 group and 6 dogs in PGI2 group) about which left ventricular functions were mainly examined, topical cooling of the myocardium was omitted. Results were as follows; compared with non PGI2 group, PGI2-treated group showed significantly higher cooling and rewarming rates, more rapid recovery of cardiac output after transplantation, and lower systemic vascular resistance throughout the experimental period. Left ventricular functions after resumption of heart beats were better in PGI2-treated group than in non PGI2 group. Microscopic examinations of the heart revealed that ischemic changes of myocardial cells were less prominent in PGI2-treated group than in non PGI2 group. It is concluded that PGI2 is useful additive for heart transplantation under deep hypothermia in that it could shorten operative time due to quicker control of the body temperature with rather stable haemodynamics and also it might protect myocardium during ischemia.

Quantitation of platelet-activating factor by high-performance liquid chromatography with fluorescent detection

Platelet-activating factors, 1-O-hexadecyl- and 1-O-octadecyl-2-acetyl-sn-glycero-3-phosphocholine (C16-AGEPC and C18AGEPC), were measured by reverse-phase high-performance liquid chromatography with fluorescent detection. C16AGEPC, C18AGEPC, and 1-O-hexadecyl-2-propionyl-sn-glycero-3-phosphocholine, which was suitable for use as an internal standard, were hydrolyzed with phospholipase C, and then the resulting hydrolyzed products were derivatized with 7-methoxycoumarin-3-carbonyl chloride or 7-methoxy-coumarin-4-acetic acid to form 7-methoxycoumarin ester derivatives which permit a fluorometric detection. The lower limit of detection of the derivatives was about 100 pg at a signal-to-noise ratio of 5:1. A commercial platelet-activating factor was demonstrated to contain C16AGEPC (70%) and C18AGEPC (12.8%) by the present method. The present method was also applicable to the measurement of acetyl-CoA:1-alkyl-2-lyso-sn-glycero-3-phosphocholine acetyltransferase activity in a lysate of human polymorphonuclear leukocytes.