11Beta-hydroxysteroid dehydrogenase type 2 in human lung: possible regulator of mineralocorticoid action

11Beta-hydroxysteroid dehydrogenase type 2 (11betaHSD2) catalyzes the conversion of cortisol to biologically inactive cortisone and is thought to confer specificity on mineralocorticoid receptors (MR). Cortisol is a prerequisite for surfactant synthesis and fetal lung maturation. Recently, expression of 11betaHSD2 was demonstrated in human fetal lung, but its localization and possible biological roles remain unknown. Therefore, in this study, we examined immunohistochemical localization of 11betaHSD2, MR, and glucocorticoid receptor (GR) in nonpathological human lungs from fetus to adult (8 weeks gestation to 55 yr of age; n = 40) retrieved from pathology files. Both 11betaHSD2 and MR immunoreactivities were detected in airway epithelia, from bronchiole to trachea and in fetal and neonatal ciliated collecting duct cells of tracheal and bronchial glands, but were undetectable in alveoli. On the other hand, GR was detected in all cell types. These results indicate that 11betaHSD2 colocalizes with MR in human airway epithelia and suggest that 11betaHSD2 play an important role in pulmonary mineralocorticoid activity such as sodium and fluid transport.

A case of aldosterone-producing adenoma with severe postoperative hyperkalemia

It is known that some patients with primary aldosteronism show postoperative hyperkalemia, which is due to inability of the adrenal gland to secrete sufficient amounts of aldosterone. However, hyperkalemia is generally neither severe nor prolonged, in which replacement therapy with mineralocorticoid is seldom necessary. We report a case of a 46-year-old woman with an aldosterone-producing adenoma associated with severe postoperative hyperkalemia. After unilateral adrenalectomy, the patient showed episodes of severe hyperkalemia for four months, which required not only cation-exchange resin, but also mineralocorticoid replacement. Plasma aldosterone concentration (PAC) was low, although PAC was increased after rapid ACTH test. Histological examination indicated the presence of adrenocortical tumor and paradoxical hyperplasia of zona glomerulosa in the adjacent adrenal. Immunohistochemistry demonstrated that the enzymes involved in aldosterone synthesis, such as cholesterol side chain cleavage (P-450scc), 3beta-hydroxysteroid dehydrogenase (3beta-HSD), and 21-hydroxylase (P-450c21), or the enzyme involved in glucocorticoid synthesis, 11beta-hydroxylase (P-450c11beta), were expressed in the tumor, but they were completely absent in zona glomerulosa of the adjacent adrenal. These findings were consistent with the patterns of primary aldosteronism. Serum potassium level was gradually decreased with concomitant increase in PAC. These results suggest that severe postoperative hyperkalemia of the present case was attributable to severe suppression of aldosterone synthesis in the adjacent and contralateral adrenal, which resulted in slow recovery of aldosterone secretion. It is plausible that aldosterone synthesis of adjacent and contralateral adrenal glands is severely impaired in some cases with primary aldosteronism, as glucocorticoid synthesis in Cushing syndrome.

Fetal copper uptake and a homolog (Atp7b) of the Wilson's disease gene in rats

LEC rats are defective at the p-type copper transport ATPase gene (Atp7b) and exhibit excessive hepatic copper accumulation. However, copper concentration in fetal liver of LEC rats is lower than that of F344 normal rats. In this study, we made fetal backcrosses between LEC and F344 normal rats. At 19 days of gestation, hepatic copper concentrations of (LECXF344)F1XLEC and LECX(LECXF344)F1 fetuses were equivalent to those of F344 and LEC fetuses, respectively, irrespective of their Atp7b genotype. Furthermore, Atp7b expression was identified in the uterus and the maternal portion of placenta, but not in the fetal portion of placenta, in pregnant F344 rats. From these results, we speculate that the Atp7b product might contribute to a copper transport system from mother to fetus in the maternal portion, but not in the fetal portion of placenta.

Difficult tracheal intubation in patients with retinoblastoma caused by 13q deficiency

Anesthetic management of retinoblastoma patients is unremarkable in most cases. Patients are most often babies and laryngoscopic procedures for intubation are usually easy. However, we recently experienced two cases with retinoblastoma with whom tracheal intubation was accomplished with difficulty. We report the two cases with a review of all 5-year records of retinoblastoma (rbl) in our institution. The cases we experienced recently were all patients with rbl with deletion of the long arm of thirteenth chromosome (13q-). In the 5-year review, the incidence of the difficult intubation was significantly higher (P < 0.05) in rbl with 13q- (4/11) than in rbl without 13q- (0/147). In our experience macroglossia was noted for the difficulty in the intubation. We assume that some patients with rbl will be cases of difficult intubation even to cannot ventilate-cannot intubate level when the results of their chromosomal analysis show a deletion on the thirteenth chromosome.

Imaging of large early and early advanced hepatocellular carcinomas of more than 5 cm in diameter: report of two cases

In an attempt to clarify the imaging characteristics of large early and early advanced hepatocellular carcinoma (HCC), we present two such cases which were greater than 5 cm in diameter. One case had four early HCCs and the other had early advanced HCC which was followed for five years and nine months. Multiphasic CT, CT arteriography (CTA), CT arterial portography (CTAP), and MR imaging were performed. Early HCC was shown as a low density mass by multiphasic contrast CT, CTAP and as a hyperintense mass on a T1-weighted image (WI) and isointense on T2WI. Early advanced HCC was demonstrated as a hypodense mass with hyperenhancing interior nodules on CTA, and isodense with hypodense internal foci on CTAP. One follow-up case showed a multi-step progression from early to early advanced HCC, and finally to overtly advanced HCC. Despite the unusually large size of these two tumors, the findings of multiphasic CT, CTA, CTAP, and MR imaging were consistent with those seen in common-sized (less than 2 cm) early and early advanced HCCs. Multi-step progression of hepatocarcinogenesis was observed in one case.

A case of giant peritoneal loose bodies mimicking calcified leiomyoma originating from the rectum

Two giant peritoneal loose bodies were found in the pelvis in a 79-year-old man. These bodies were demonstrated by computed tomography and magnetic resonance imaging to be well circumscribed masses and to have marked calcification in their central portion. Preoperatively, these bodies had been diagnosed as a calcified leiomyoma originating from the rectum; however, surgery revealed these lesions to be detached appendices epiploica. Histological examination showed that these peritoneal loose bodies consisted of thin layers of eosinophilic substance and had no cellular component. Small peritoneal loose bodies are occasionally found during laparotomy, but such large ones measuring 6 cm are very rare. In our case, accurate diagnosis could not be obtained preoperatively, because these loose bodies mimicked calcified leiomyoma of the rectum.

Detection of Coxiella burnetii from dust in a barn housing dairy cattle

We attempted to detect Coxiella burnetii in dust samples collected from a barn housing dairy cattle by the polymerase chain reaction (PCR) method. Ten dust samples (five from ventilation fans and five from crossbeams) were collected from two areas in a barn on a farm near Sapporo, Hokkaido. C. burnetii was detected in 5 of the 10 dust samples. It was believed that aerial contamination by C. burnetii occurred in the barn.

Increased polyploidy, delayed mitosis and reduced protein phosphatase-1 activity associated with excess copper in the Long Evans Cinnamon rat

Until now, it is not known whether copper hepatotoxicity impairs mitosis. Enlarged hepatocytes with huge nuclei considered as polyploids are frequently observed in the Long Evans Cinnamon (LEC) rat which exhibits an abnormal accumulation of hepatic copper due to a defect in the gene homologous to human Wilson's disease gene responsible for intracellular copper delivery. This defect may lead to a abnormal mitotic progression in increased polyploidization and is associated with excessive hepatic copper. This study was designed to examine whether excess copper impairs mitotic progression and results in increased polyploidization using a model of LEC rat liver. Polyploidy was analyzed by flow cytometry. The rate of mitotic progression was investigated using the fraction of mitotic hepatocytes or a mitosis-specific phosphoprotein retained in regeneration. Nuclear protein phosphatase-1 (PP-1) activity essential to mitotic progression was measured. The effect of excess copper on incidence of polyploidy, the rate of mitotic progression and nuclear PP-1 activity was investigated using age- or copper overload-dependent changes in them in LEC rat, or genetic profile-dependent changes of them in backcrosses. LEC rat liver showed an increase of polyploidy, a delay of mitotic progression, and a reduction of nuclear PP-1 activity. These abnormal features concurred with increase of copper concentration accompanied by changes of age in LEC rats from 2 to 4 months of age, induced by dietary copper overload in LEC rat, or caused by single genetic defect in backcrosses. Excess copper impairs mitotic progression, resulting in increased polyploidization. Nuclear PP-1 activity is likely to be at least one of targets of copper hepatotoxicity leading to impairment of mitotic progression.

Decrease of nuclear protein phosphatase 1 activity and induction of mitotic arrest and apoptosis by a marine microalgal polysaccharide in human myeloid leukemia U937 cells

An extracellular polysaccharide, which we designate GA3P, produced from a marine microalga dinoflagellate Gymnodinium sp. A3, has been previously reported to induce apoptosis in lymphoid and myeloid cell lines. We found that the GA3P accumulates cells into the mitotic phase of the cell cycle and decreases nuclear protein phosphatase 1 (PP1) activity in a dose-dependent manner in myeloid leukemia U937 cells. Dose-dependent patterns in the decrease of nuclear PP1 activity and in the accumulation of cells into mitotic phase or apoptotic status by the GA3P were concordant with each other, indicating that the decrease of nuclear PP1 activity at least mediates some of the etiological steps in development of mitotic arrest and apoptosis induced by the GA3P. In addition, the GA3P repressed the expression of protein levels of the PP1 catalytic subunit isoform PP1 gamma 1 gamma 1. We thus suggest that the decrease of nuclear PP1 activity is due to down-regulation of the protein levels of the PP1 gamma 1.

Microinvasive breast carcinoma with extensive involvement of level III axillary lymph nodes: a case report

A 44-year-old woman presented with a right huge axillary mass. Both mammography and ultrasonography revealed a primary cancer of 2.8 cm maximum diameter in the right breast and metastases in the axillary lymph nodes, both being confirmed by aspiration cytology as ductal carcinoma. Right standard radical mastectomy with level III axillary lymph node dissection was carried out. Pathologically, the tumor was diagnosed as ductal carcinoma in situ with microinvasion (DCISM), histologic grade 3. The area of stromal invasion measured 1 mm at its widest point. Sixteen of the 17 resected axillary lymph nodes contained metastases, including six level III lymph nodes. Immunohistochemical studies of the tumor revealed overexpression of p53 protein, but not that of c-erbB-2 protein. The frequency of lymph node metastases from DCISM is reported to be very low. Therefore, the present case with extensive involvement of level III lymph nodes was unusual.

Localization of Ca(2+)-binding S100 proteins in epithelial tumours of the skin

The Ca(2+)-binding proteins S100A1, S100A2, S100A4, S100A6 and S100B were evaluated immunohistochemically in normal skin and skin appendage tumours. Epidermal basal cells, epithelial cells of sebaceous glands, hair follicle sheet epithelia and eccrine duct reacted strongly with an antiserum against human S100A2 but were nonreactive or weakly reactive to S100A1, S100A4, S100A6 and S100B. Varying types of skin appendage tumours and most peripheral cells in tumour nests of basal cell carcinoma and squamous cell carcinoma showed positive S100A2 immunoreactivity in neoplastic cells corresponding to basal cells but were nonreactive or faintly reactive for other S100 proteins. Langerhan's cells and melanocytes were labelled by S100B. Basophilic cells of calcifying epithelioma were occasionally stained with S100A2 antiserum. Eccrine poroma did not react with any S100 antiserum. Mixed tumours of the skin containing neoplastic myoepithelial cells stained strongly for S100A2 and S100B but only faintly for S100A1, S100A4, S100A6. This is the first report on selective evaluation of different S100 proteins in normal skin. These antibodies are valuable tools for better characterization of skin appendage tumours.

WA8242A1, A2 and B, novel secretory phospholipase A2 inhibitors produced by Streptomyces violaceusniger. II. Biological properties

WA8242A1, A2 and B, novel inhibitors of secretory phospholipase A2 (PLA2), were obtained from Streptomyces violaceusniger No. 8242. WA8242B inhibited secretory group I and II PLA2s in a dose-dependent manner. The mode of inhibition of group II PLA2 by WA8242B was in competitive fashion. WA8242B inhibited group II PLA2-induced Prostaglandin I2 (PGI2) production by human umbilical vein endothelial cells. Furthermore, WA8242B was effective in mouse zymosan writhing model.

Multitracer studies on the accumulation of radionuclides in mushrooms

We used the multitracer technique to study the transfer of several radionuclides to two mushroom species. Radionuclides accumulated in the fruiting bodies of the mushrooms in the order of 83Rb > 65Zn > 54Mn > 22Na > 75Se and 85Sr > 60Co > 88Y, 102Rh, 139Ce, 143.144Pm, 146.153Gd and 173Lu > 175Hf. The concentration ratio values for 83Rb, 65Zn and 54Mn in the fruiting bodies were more than 10, whereas those for 60Co, 88Y, 102Rh, 121mTe, 175Hf and the rare earth elements were less than 1. There were major differences in the accumulations of the alkali elements.

Daily intakes of 134Cs, 137Cs, 40K, 232Th, and 238U in Ukrainian adult males

Total diet samples were collected to estimate dietary intakes of several radionuclides for Ukrainian males by duplicate portion studies. The samples were collected in the Kiev, Rovno and Volynsky regions in autumn of 1994. Some foodstuffs, including milk and potato, were also collected in the same regions. Daily intakes of 232Th and 238U were estimated to be 2.0 mBq and 7.5 mBq per person, respectively. The estimated daily intake of 40K, 85 Bq per person, was equivalent to that of Reference Man (the intake of a West European and a North American). Daily intakes of 137Cs were found to be quite different between some regions. Daily intakes were 1.8 Bq per person in the Kiev region and 12 Bq per person in the Rovno and Volynsky regions. Daily intake of 134Cs was below 1 Bq per person.

Pheochromocytoma growing exophytically from the right adrenal gland and invaginating into the liver

A 5-cm pheochromocytoma located in segment 7 of the liver was found incidentally in a 45-year-old man with mild diabetes mellitus and hypertension, and resected. The tumor was demonstrated by computed tomography and magnetic resonance imaging to have completely invaginated itself into the liver and to be receiving blood from a dilated right hepatic artery alone. Surgery revealed the hepatic mass to be tightly adherent to the right adrenal gland. The histopathologic diagnosis was pheochromocytoma growing exophytically from the right adrenal gland. There was no association with multiple endocrine neoplasia type 1 and type 2. A postoperative 131I metaiodobenzylguanidine scan revealed no accumulation, and the patient is currently doing well without recurrence or hypertension one year after the operation. A pheochromocytoma deeply invaginating into the liver should be considered in the differential diagnosis of primary hypervascular hepatic tumors.

Hepatic tumor invasion of bile ducts: wedge-shaped sign on MR images

PURPOSE

To clarify the diagnostic importance of wedge-shaped areas of increased signal intensity that surround liver tumors on T1-weighted magnetic resonance (MR) images.

MATERIALS AND METHODS

In five patients with hepatic tumors, T1-weighted MR images that demonstrated wedge-shaped areas of increased signal intensity in the liver were reviewed; findings were compared with those at surgical and histologic examinations.

RESULTS

MR images showed localized intrahepatic bile duct dilatation lateral (three patients) and medial (two patients) to liver tumors within the wedge-shaped areas. At histopathologic examination, intraductal tumor growth was seen in local bile ducts in the same areas in five patients, and lipofuscin deposits were seen in the cytoplasm of atrophic hepatocytes in three patients.

CONCLUSION

On T1-weighted images, wedge-shaped areas of increased signal intensity associated with liver tumors indicate intraductal tumor extension in intrahepatic bile ducts. T1 shortening is possibly caused by lipofuscin deposits in atrophic hepatocytes.

Detection of Coxiella burnetii in cow's milk by PCR-enzyme-linked immunosorbent assay combined with a novel sample preparation method

The use of an adequate concentration of Triton X-100 enhanced immunomagnetic separation of Coxiella burnetii from milk. PCR-enzyme-linked immunosorbent assay (PCR-ELISA) could detect coxiellas more sensitively than could conventional PCR. PCR-ELISA is therefore thought to be suitable for the simultaneous assay of a large number of samples. However, the number of cows from which raw milk tested positive for coxiellas by PCR-ELISA was inconsistent with that found with the antibody to coxiella by indirect immunofluorescence assay. The inconsistency is thought to be associated with the differences in the infectious route, infectious dose, or the timing of yielding the antibody and the period of duration of the antibody.

Intersegmental attenuation difference on CT caused by partial Budd-Chiari syndrome secondary to hepatocellular carcinoma: report of two cases

For two patients with partial Budd-Chiari syndrome secondary to hepatocellular carcinoma, dynamic CT was evaluated. The obstructed hepatic veins were both the middle and left hepatic veins in Case 1 and the right hepatic vein in Case 2. The area affected by obstructed hepatic vein(s) was seen as low density on both unenhanced and contrast enhanced CT in Case 1 and as high density on enhanced CT in Case 2. The border of attenuation differences caused by the obstruction of the middle (Case 1) or right (Case 2) hepatic vein was intersegmental planes of the anterior segment of the right lobe, and that caused by the obstruction of the left hepatic vein was the intersegmental plane of the medial third of the left lateral segment. Once intersegmental attenuation difference is recognized on CT, partial Budd-Chiari syndrome should be considered.

Concentrations of 137Cs and 40K in edible mushrooms collected in Japan and radiation dose due to their consumption

To estimate radiocesium intake due to eating mushrooms, about 100 samples belonging to 11 species were analyzed to establish representative values for 137Cs and 40K in common edible mushrooms available in food markets. Concentration ranges were <0.047-39 Bq kg(-1) (wet wt) for 137Cs and 30-210 Bq kg(-1) (wet wt) for 40K. The median concentrations were 1.3 Bq kg(-1) (wet wt) for 137Cs and 97 Bq kg(-1) (wet wt) for 40K. The 137Cs concentrations in cultivated mushrooms were markedly lower than those in wild mushrooms. The annual intake of 137Cs per person through mushrooms was calculated (using analytical results and food consumption data in Japan) to be 6.0 Bq for 137Cs, which is about 32% of the total dietary intake of this nuclide. The effective dose equivalent of 137Cs through mushroom was estimated to be 7.7 x 10(-8) Sv (range estimated from the standard deviation: 3.0 x 10(-8) - 2.0 x 10(-7)).

[A coagulation of fibrinolytic study in children with nephrotic syndrome: evaluation of hypercoagulability by measuring with plasmin- alpha 2 plasmin inhibitor complex and FDP D-dimer]

Increased plasma plasmin-alpha 2 plasmin inhibitor complex (PIC) and FDP D-dimer (D-dimer) reflect in vivo activation of the coagulation and fibrinolytic systems. We measured plasma PIC, D-dimer and other coagulation and fibrinolytic parameters in 42 children with nephrotic syndrome. Higher levels of both plasma PIC (0.67 +/- 0.48 micrograms/ml, P < 0.01) and D-dimer (154 +/- 105 ng/ml, P < 0.001) were observed at the active stage of nephrotic syndrome, compared to the remission stage (0.43 +/- 0.18 micrograms/ml, 72 +/- 48 ng/ml, respectively). In addition, plasma D-dimer correlated significantly with serum albumin, urinary protein, plasma fibrinogen, aPTT, and plasma antithrombin III activity. Although no thromboembolic complication was diagnosed clinically in the study period, increased plasma PIC or D-dimer may reflect a hypercoagulable state or subclinical thrombosis in nephrotic syndrome.