[Ocular murine cytomegalovirus infection in immunocompromised hosts]

Cytomegalovirus (CMV) chorioretinitis is one of the commonest complications in immunocompromised hosts. However, the entire scope of ocular involvement during generalized CMV infection in immunocompromised hosts is yet to be elucidated. Balb/c nude mice were inoculated intraperitoneally with Smith strain of salivary gland passaged murine cytomegalovirus. Eight days after infection, they were sacrificed and the pathological features of virus spread were studied by immunofluorescence method. Subconjunctival tissues, corneal stroma, outer ocular muscles and occasional choroidal tissue are the site of positive fluorescence in the eye. At the same time, viral antigens were detected in the various organs such as spleen, liver, salivary glands, etc. Balb/c nude mice were injected intraperitoneally with silica three days and one day prior to virus infection to suppress their macrophages. The localization of viral antigens in the silica-treated mice was similar to that in untreated mice. When the peripheral blood obtained from the nude mice infected for 8 days was titrated for the virus, cell-free virus and blood-cell-associated virus was detected. These results indicated that cell-free virus is the major source of its spread.

Specific detection of positive and negative stranded hepatitis C viral RNA using chemical RNA modification

Since hepatitis C virus (HCV), a major causative agent of posttransfusional non-A, non-B hepatitis, is a positive stranded RNA virus, it is supposed to replicate via a negative RNA strand. Although strand specific reverse transcription-polymerase chain reaction (RT-PCR) method was recently developed to detect each strand of HCV RNA, the specificity of the strategy has remained to be determined. In this study, using in vitro transcribed positive and negative stranded HCV RNAs mixed with hepatic cellular RNA from normal liver, we found that this strategy did not distinguish between the two RNA strands, but that chemical modification of RNA samples at the 3' end followed by strand specific RT-PCR made specific detection possible. Liver tissues, sera and peripheral blood mononuclear cells (PBMC) from ten patients with chronic HCV infection were analyzed with the novel strategy of RT-PCR combined with RNA modification. Positive and negative strands of HCV RNA were detected in liver tissues of ten (100%) and nine (90%) cases, respectively. Negative RNA strand was detected also in sera of five cases (50%), positive strand being detected in nine cases (90%). In PBMC, positive strand of HCV RNA was detected in eight cases (80%), whereas negative strand in only one case (10%), suggesting that HCV has much less cellular tropism to PBMC than to hepatocytes.

Comparative study of CA242 and CA19-9 for the diagnosis of pancreatic cancer

A comparative study of a new tumour marker, CA242, and CA19-9 was conducted with special reference to their diagnostic usefulness in pancreatic cancer. CA242 showed sensitivity similar to that of CA19-9 for overall cases and early cases (stage I tumour) of pancreatic cancer. For other malignancies, the positive rates of CA242 were lower than those of CA19-9 except for colorectal cancer. An important characteristics of CA242 was that it was only slightly and infrequently elevated in the sera of patients with benign diseases such as chronic pancreatitis, chronic hepatitis and liver cirrhosis. This characteristic was more apparent in the patients with benign obstructive jaundice, indicating that the serum level of this marker was scarcely affected by cholestasis. Using cut-off levels corresponding to a 90% specificity, the clinical results obtained with CA242 in the diagnosis of pancreatic cancer were similar to those obtained with CA19-9, except that CA19-9 was falsely negative in some patients with early-stage pancreatic cancer. These findings suggest the usefulness of this marker for screening pancreatic cancer in patients on their first hospital visit. However, CA242 was found to be influenced by the Lewis blood group system. This unfavourable result is attributed to the C241 catcher antibody of this assay system, which has almost the same epitope specificity as the C50 and the NS19-9 monoclonal antibodies. In conclusion, CA242 is superior to CA19-9 in diagnosing pancreatic cancer by virtue of its higher specificity.

Traction apophysitis of the medial malleolus

We report the cases of three children with chronic injuries of the medial tibial malleolus caused by traction injuries during sport. All three had the triad of swelling of the medial malleolus, tenderness over its anterior part, and pain on forced valgus movement of the foot. Radiographs showed bilateral accessory ossification centres and MRI demonstrated partial avulsion or avulsion fracture of the apophyseal cartilage and fragmentation of the accessory centres. A review of 134 young basketball players showed that 25% had tenderness of the anterior medial malleolus. This high rate indicates that traction apophysitis of the medial malleolus is not uncommon in children as a sports-related disorder.

[Analysis of methods of administration on local arterial infusion chemotherapy for severe advanced hepatocellular carcinoma]

Between 1986 and 1994, hepatic local arterial infusion chemotherapy with implanted reservoir was performed for 51 patients with hepatocellular carcinoma (HCC) who were not indicated for surgery, PEIT and/or TAE because of the advanced stage of tumors and impaired liver function. We compared direct effects, survival rates, and rates of outpatients by dividing these 51 patients into 3 groups according to the methods of administration--repeated one-shot arterial infusion group, continuous arterial infusion group and intermittent high-dose arterial infusion group. There were no significant differences among these three groups in terms of background factors. The continuous infusion group had significantly better survival rates than the repeated one-shot infusion group, and the survival rate of the intermittent high-dose infusion group was similar to that of the continuous infusion group, although there were no significant differences in effectiveness among the three groups. Patients in the continuous infusion group and intermittent high-dose infusion group could receive almost all of their treatment as outpatients. Furthermore, more patients in the intermittent high-dose infusion group could receive whole treatment without hospitalization than patients in the continuous infusion group. Because intermittent high-dose arterial infusion of 5-FU showed about the same survival rate as continuous arterial infusion and because it can maintain high quality of life, it is suggested to be a standard method for local arterial infusion of 5-FU for severe advanced HCC.

[Determining the most effective therapeutic method as a primary treatment for squamous cell carcinoma of the oropharynx]

Fifty-nine patients with squamous cell carcinoma of the oropharynx, treated between 1978 and 1991 at Aichi Cancer Center, were used for this study. The purpose of this study is to investigate the possibilities and limitations of conservative therapy, as well as surgical problems and the future direction of combined therapy. We divided the patients into two groups receiving primary treatment; those treated conservatively mainly by radiation (42 patients) and those treated mainly by surgery with radical resection (17 patients). We then used several factors to compare the 5-year survival rates between these groups and to evaluate any differences observed. The results were as follows; in T3/T4 grades, ulcerated and invasive tumors and highly differentiated types, the improved prognosis in surgical groups was statistically significant. Whether cervical metastasis was positive or not had no effect on the survival rate of either group. Furthermore, with lateral wall type, both groups had good prognoses. These data suggest that therapy should not be selected on the basis of stage or positive cervical metastasis, but by T factor, location, tumor type (expansive or invasive) and histologic differentiation. At present, we consider these factors to be key elements influencing the possibilities and limitations of conservative therapy for oropharyngeal squamous cell carcinoma.

Left ventricular motion after bypass operation for coronary artery disease with collaterals

Left ventricular ejection changes obtained from left ventricle roentgenograms were analyzed before and after coronary artery bypass grafting in 22 consecutive patients with chronic obstructive left anterior descending coronary artery disease receiving collaterals before surgical revascularization. The collateral vessels all disappeared after surgical revascularization. After operation, ejection changes of anterobasal, anterolateral and apical walls supplied by the left anterior descending coronary artery improved from 43.6% +/- 9.7% to 48.5% +/- 8.6% (p < 0.05), from 35.2% +/- 10.9% to 39.4% +/- 9.5% (p < 0.05), and from 46.0% +/- 10.6% to 50.0% +/- 8.7% (p < 0.05), respectively. The improvement in left ventricular wall motion did not appear to be related to the extent of preoperative collateralization. Thus, left ventricular wall motion was impaired in the area supplied by collaterals and was improved by myocardial revascularization. These results suggest that coronary blood flow, even through well-developed collaterals, may not be sufficient, which may produce chronic active ischemia and impaired left ventricular wall motion.

Acteoside, a component of Stachys sieboldii MIQ, may be a promising antinephritic agent (2): Effect of acteoside on leukocyte accumulation in the glomeruli of nephritic rats

We investigated the effect of acteoside in comparison with that of cyclosporin A on leukocyte accumulation in the glomeruli of rats with crescentic-type anti-glomerular basement membrane (GBM) nephritis. Acteoside given p.o. at a dose of 30 mg/kg once a day for 15 consecutive days after treatment with anti-GBM serum markedly suppressed the urinary protein as well as glomerular histological changes. Acteoside given p.o. for 5 or 15 consecutive days markedly suppressed the accumulation of total leukocytes, ED-1-positive cells (monocytes/macrophages), CD4-positive cells, CD8-positive cells, interleukin-2-receptor-positive cells (activated T cells) and Ia-positive cells in the glomeruli. These effects of cyclosporin A (20 mg/kg/day, p.o.) were also as potent as those of acteoside (30 mg/kg/day, p.o.). Cyclosporin A also strongly suppressed the elevation of plasma antibody level against rabbit gamma-globulin. However, in this dose, acteoside did not significantly suppress the antibody formation. It can be concluded from these results that acetoside may exert its antinephritic action by suppressing the accumulation of leukocytes in the glomeruli.

Association between anthropometric measures and spinal bone mineral density

RATIONALE AND OBJECTIVES

The relationship of vertebral bone mineral density (BMD) to various anthropometric factors, including body weight and height, vertebral volume, and muscle area was examined. The sex- and menopause-related differences in these relationships also were studied.

METHODS

Both cortical and trabecular BMD were measured using quantitative computed tomography (QCT). Integral BMD was measured using dual x-ray absorptiometry (DXA) in 74 men and in 96 premenopausal and 155 postmenopausal women. The psoas muscle area was measured using CT images. Vertebral volume was determined using CT images and CT topography.

RESULTS

Bone mineral density had the strongest relationship with age in postmenopausal women. Trabecular BMD was correlated with muscle area and vertebral volume in premenopausal women, but not in postmenopausal women. The correlation of trabecular BMD with various anthropometric factors in men was stronger than that in women. Dual x-ray absorptiometry-BMD was found to be more affected by bone volume than was QCT-BMD.

CONCLUSIONS

The association of anthropometric factors with BMD differs in men and women, as well as in premenopausal and postmenopausal women.

Traction apophysitis of the medial malleolus

We report the cases of three children with chronic injuries of the medial tibial malleolus caused by traction injuries during sport. All three had the triad of swelling of the medial malleolus, tenderness over its anterior part, and pain on forced valgus movement of the foot. Radiographs showed bilateral accessory ossification centres and MRI demonstrated partial avulsion or avulsion fracture of the apophyseal cartilage and fragmentation of the accessory centres. A review of 134 young basketball players showed that 25% had tenderness of the anterior medial malleolus. This high rate indicates that traction apophysitis of the medial malleolus is not uncommon in children as a sports-related disorder.

Induction of c-fos and c-myc oncogene expression in the pyloric mucosa of rat stomach by N-methyl-N'-nitro-N-nitrosoguanidine and taurocholate

The induction of c-fos and c-myc expression in the pyloric mucosa of 8-week-old F344 male rats after oral administration of the glandular stomach carcinogen, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), or the tumor-promoter, taurocholate, was examined by Northern blotting. MNNG at doses of 5-50 mg/kg body weight dose-dependently induced transient increase of up to 30-fold c-fos expression with a maximum after 30 min, and of 8-fold c-myc expression with a maximum after 3 h. It also induced up to 3-fold increase in S-phase cells in the proliferation zone of the pyloric mucosa after 16 h. Similar effects were observed with sodium taurocholate at doses of 200-800 mg/kg body weight. These results suggest that c-fos and c-myc oncogenes play a role in stomach carcinogenesis.

Estimation of pS2 protein level in human body fluids by a sensitive two-site enzyme immunoassay

A sensitive two-site enzyme immunoassay (EIA) system was established for human pS2 protein, a small estrogen-inducible secretory protein of unknown function originally identified in MCF-7 human breast cancer cells. Our EIA system is based on the sandwiching of antigen between anti-recombinant (r) pS2 antibody IgG coated on a polystyrene plate and biotinylated anti-rpS2 antibody IgG. The amount of pS2 protein was quantified by measurement of the bound enzyme activity of subsequently added streptavidin-linked beta-D-galactosidase (beta-D-galactosidase, EC 3.2.1.23). pS2 protein purified from MCF-7 culture supernatants was detectable at a concentration as low as 3 pg/ml (corresponding to 60 fg/well). This EIA system revealed that the amount of pS2-like immunoreactivity (LI) in human urine was 13.6 ng/mg creatinine (median, n = 416) and that there was no correlation between the pS2-LI concentration in urine and sex or aging. pS2-LI levels in plasma and sera of the normal subjects were 392 pg/ml (median, n = 14) and 494 pg/ml (median, n = 12), respectively. The serum level of the patients with breast cancer (528 pg/ml; median, n = 67) was not statistically different from that of normal subjects, although high levels of pS2 protein in breast cancer tissues had been reported.

Corneal endothelial cell loss following phacoemulsification using the Small-Port Phaco

We studied the extent of corneal endothelial injury after phacoemulsification using the Small-Port Phaco (SPP), a new phacoemulsification instrument that allows linear aspiration during phacoemulsification. Of 72 eyes undergoing phacoemulsification, the SPP was used in 33 (group 1) and a standard phacoemulsification instrument in 39 (group 2). Endothelial cell density was examined by specular microscopy preoperatively and at 1 and 3 months after surgery, and the percentage of endothelial cell loss was evaluated. Operative factors influencing endothelial injury such as the duration of ultrasound emission, the ultrasound power expended, and the amount of irrigating solution used also were measured. The percentages of endothelial cell loss at both 1 and 3 months were significantly less (P < .05) in group 1 than in group 2 (in group 1, 4.3 +/- 3.4% at 1 month, and 5.6 +/- 3.8% at 3 months; in group 2, 6.9 +/- 4.6%, and 8.3 +/- 5.4%, respectively). The duration of emission was shorter and the ultrasound power discharged was smaller in the SPP cases. Since the total ultrasound energy emitted in the SPP cases was less than that in the standard-instrument cases, we conclude that the reduced corneal endothelial damage observed in group 1 was directly related to the smaller total ultrasound power expended in these cases.

Aortic walls in atherosclerotic rabbits--mechanical study

Mechanical properties of the descending thoracic aortae harvested from endothelial cell-denuded and/or cholesterol diet-fed rabbits were studied primarily with their pressure-diameter relationships. Male Japanese white rabbits having 3.1 to 3.5 kg initial body weight were divided into 4 groups. The rabbits in Groups A and C were fed a regular chow, while those in Groups B and D were given 1 percent cholesterol diet; the luminal surfaces of the descending thoracic aortae in the rabbits of Groups C and D were injured by drawing catheter-tip balloons. These animals were sacrificed after keeping for 4, 8, 16 or 32 weeks and, then, their descending thoracic aortae were excised for the studies of pressure-diameter relationships. Stiffness parameter (beta") and incremental elastic modulus (H theta theta were used to quantitatively represent the structural stiffness of the aortic wall and the elastic modulus of the wall material, respectively. Denudation of endothelial cells thickened the aortic walls in Group C, but induced no significant changes in beta" and H theta theta. Shape of the pressure-diameter curve changed gradually with time in Group D, and beta", H theta theta, and thickness to wall radius ratio increased significantly, while those in Group B showed no significant changes with a few exceptions. Averaged percent fraction of the luminal surface area stained with Sudan IV (As) was around 50 percent in Group B and 100 percent in Group D at 32 weeks. Even if As is over 80 percent in Group D, 50 percent (7/14) of the walls gave significantly higher beta"- and H theta theta-values at 100 mm Hg than the others. Significantly increased calcification and intimal hyperplasia were observed in the walls with high beta"- and H theta theta-values.

Mechanical and dimensional adaptation of rat aorta to hypertension

To investigate mechanisms of the mechanical adaptation of soft biological tissues to load, effects of hypertension on the mechanical properties and wall dimensions of thoracic aortas were studied in rats. Goldblatt hypertension was induced in male Wistar rats aged 8 to 9 weeks by constricting their left renal arteries. Two, 4, 8, or 16 weeks after the operation, thoracic aortas were excised and used to determine static pressure-diameter relations and wall dimensions. Wall thickness correlated significantly with the systolic blood pressure before sacrifice, Psys, at each period. The aortic hoop stress became almost constant at all Psys 2 weeks after the operation. On the other hand, the stress calculated for 100 and 200 mmHg correlated negatively with Psys. The incremental elastic modulus of the wall at Psys had a significant correlation with Psys having a positive slope at each period, although the correlation disappeared at 16 weeks after the operation. These results imply that: 1) thickness of the aortic wall increases very rapidly in response to hypertension; 2) wall stress developed by the in-situ blood pressure is kept constant at a normal level irrespective of hypertension; 3) elastic modulus of the wall of the hypertensive rats at the in-situ blood pressure becomes equal to the normal value after relatively long period of time; 4) in response to the alteration of the applied force, dimensional change appears much earlier than the change in the elastic properties.

Vertebral measurements for assessment of osteoporosis

We measured the vertebral heights and spinal bone mineral density (BMD) of healthy women, and morphometrically evaluated the physiological features of the vertebrae to investigate the relationship of BMD to types of spinal deformity as well as the radiographic detection rate for decreased vertebral bone density. Vertebral BMD was measured from L1 to L4 using dual X-ray absorptiometry and from L1 to L3 using quantitative computed tomography in 245 healthy women ranging in age from 22 to 81 years. The vertebral heights, anterior (Ha), middle (Hm), and posterior (Hp), were measured from T12 through L5, and the Ha/Hp and Hm/Hp ratios were calculated. Although the age-related reduction of vertebral height was not as marked as that of BMD, the vertebral heights, especially the Ha and Hm from T12 to L5 vertebrae, and the Ha/Hp and Hm/Hp from T12 to L3, significantly decreased with age. The presence of a wedge-shaped deformity was strongly related to cortical BMD, and biconcave deformity to trabecular BMD. Although investigation of the sensitivity and specificity of several criteria revealed that vertebra-specific dimension criteria are useful in the detection of decreased bone density, the detection of decreased BMD using vertebral measurements is considered to be limited.

[The pulmonary air meniscus sign in a case of sclerosing hemangioma]

A 57-year-old woman was admitted to our hospital because of a slowly growing pulmonary tumor with a 34 year history. Chest roentgenogram on admission showed a 42 mm sharply demarcated solitary tumor in the left upper lobe. Chest CT revealed a slit-like pulmonary air meniscus. Left upper lobectomy was performed. A specimen from the resected lung histologically showed solid, papillary and hemorrhagic patterns, and the diagnosis of pulmonary sclerosing hemangioma was therefore made. Pulmonary air meniscus sign in pulmonary sclerosing hemangioma is rare. We think one possible mechanism in the production of an air meniscus sign in sclerosing hemangioma is bleeding in communication with a bronchus.

HTLV-II non-integrated malignant lymphoma induction in Japanese white rabbits following intravenous inoculation of HTLV-II-infected simian leukocyte cell line (Si-IIA)

Lymphoma induction in rabbits by an unknown factor derived from an HTLV-II-producing simian (Cynomolgus) leukocyte cell line (Si-IIA) is reported. Thirteen of 17 male Japanese white rabbits (76%) inoculated intravenously with Si-IIA cells developed malignant lymphoma including Hodgkin-like lymphoma between 62 and 167 days after inoculation. Histologically, there was extensive diffuse or nodular infiltration of either large cell type or mixed type lymphoma cells in many organs, frequently involving the spleen, liver, lymph nodes and kidneys, and less frequently the thymus, bone marrow, lungs, heart, skin and gastrointestinal tract. Hodgkin-like lymphoma was also observed in two rabbits. Chromosomal analysis of five cell lines established from tumor-bearing rabbits revealed the male rabbit karyotype. The immunophenotype of these tumor cells was usually T-cell (CD5+ or -, RT1+, RT2+ or -, CD45+, CD4-, RABELA- and MHC class II-DQ+) except for Hodgkin-like lymphoma cells which expressed only CD45. However, integration of the HTLV-II provirus genome could not be demonstrated in the tumor tissues or any of the rabbit cell lines by polymerase chain reaction or Southern blot analysis. Moreover, no lymphoma was induced by inoculation of HTLV-IIC, MOT (other HTLV-II-producing human cell lines) or TALL-1 (control). Two of four rabbits injected with cell-free pellets from Si-IIA cultures died of malignant lymphoma (15-20 days). Five irradiated rabbit cell lines were inoculated but only one (Ra-SLN) induced lymphoma in 1 of 3 rabbits at 27 days. Neither Herpesvirus saimiri nor Herpesvirus ateles (simian oncogenic viruses) was detected in Si-IIA cells by immunofluorescence testing. These data suggest that the high rate of lymphoma induction in rabbits may be caused not by only HTLV-II or well known simian oncogenic viruses, but rather by an unknown passenger agent derived from Si-IIA or HTLV-IIA, with which Si-IIA was established.