In vitro analysis of extracellular matrix production by porcine glomerular mesangial and vascular smooth muscle cells

Proliferation potential and extracellular matrix production were compared in cultured porcine glomerular mesangial cells and arterial and venous smooth muscle cells. Mesangial and arterial smooth muscle cells proliferated more rapidly than venous smooth muscle cells. In immunofluorescence studies, mesangial and arterial smooth muscle cells stained strongly for collagen types I, III, and V; venous smooth muscles showed weaker staining for collagens III and V. Total collagen synthesis in cultured mesangial and arterial smooth muscle cells was lower than in venous smooth muscle cells. Electrophoretic analysis showed type I collagen predominated in all cell types, although levels were highest in mesangial and arterial smooth muscle cells. Collagen V (alpha 3) occurred only in venous smooth muscle cells. Mesangial and arterial smooth muscle cells showed cellbound fibronectin and laminin, which also were secreted into the medium. Venous smooth muscle cells secreted fibronectin, but all laminin was cell bound. The findings suggest a strong similarity between mesangial and arterial smooth muscle cells.

Cervical esophageal motility: evaluation with US in progressive systemic sclerosis

High-resolution ultrasound (US) showed that initial peristalsis propelled ingested soda smoothly and rapidly in 20 volunteers without symptoms who met both manometric and radionuclide esophageal scintigraphic (RES) criteria for normal motility. Twenty-eight patients with progressive systemic sclerosis were classified according to results of RES as follows: group 1, normal esophageal motility (three patients [11%]); group 2, hypomotility of the esophagus, excluding the cervical esophagus (18 patients [64%]); and group 3, hypomotility of the cervical esophagus (seven patients [25%]). In the seven patients of group 3, US demonstrated that an incomplete peristalsis sequence or a feeble peristalsis propelled the soda in a slow and/or to-and-fro motion with low velocities. In the other 21 patients (75%), the soda passed through the esophagus smoothly and rapidly. Retention of soda in the cervical esophagus was not limited to patients with hypomotility of the cervical esophagus. It is concluded that US is useful in evaluation of cervical esophageal motility.

Mitochondrial derangement: possible initiator of microalbuminuria in NIDDM

Morphometric analysis of 80 renal biopsy specimens from patients with non-insulin-dependent diabetes mellitus, who had been classified into four groups by grade of proteinuria and renal function, revealed mitochondrial enlargement in the proximal tubules, with cellular hypertrophy as an initial morphologic change in the microalbuminuria. This was followed by a thickening of the proximal tubular basement membrane and an increased interstitial volume, causing persistent overt proteinuria. Glomerular nodular and sclerotic lesions and severe tubulointerstitial damage became evident in the advanced stages. As an initial cause of microalbuminuria, the mitochondrial abnormality disturbed adenosine triphosphate (ATP) metabolism in proximal tubules, reducing active transport and causing urinary excretion of low-molecular-weight protein.

Perivascular innervation of the cerebral arteries in spontaneously hypertensive rats--an immunohistochemical study

Perivascular innervation in cerebral arteries of spontaneously hypertensive rats and of normotensive Wistar-Kyoto rats was studied. Adrenergic nerve fibers and neuropeptide Y-containing nerve fibers, indicative of vasoconstrictor nerves, were denser in all cerebral arteries of spontaneously hypertensive rats than those of Wistar-Kyoto rats. In contrast, cholinergic nerve fibers and vasoactive intestinal polypeptide, substance P-containing nerve fibers, indicative of vasodilator nerves, remained unchanged in all cerebral arteries of spontaneously hypertensive rats, as compared with findings in the Wistar-Kyoto rats. Thus, not only adrenergic nerve fibers but also neuropeptide Y-containing nerve fibers may play an important role in preventing the disruption of the blood-brain barrier and the development of hypertensive encephalopathy in spontaneously hypertensive rats.

Combination radiotherapy of urinary bladder carcinoma with chemohyperthermia

The combination therapy of urinary bladder cancer with radiation and hyperthermia with bleomycin was investigated. Immediately following daily external irradiation (40 Gy/4 weeks), patients were irrigated with a solution of warmed saline (intravesical temperature, 42-43 degrees C) containing 30 micrograms/ml bleomycin. Of a total of 56 patients, complete responses were observed in 25, and partial responses in 21. Among T2-T3 cases, an 84% response rate was noted in combination therapy, whereas a 56% response rate was observed after radiation alone (50-70 Gy). The side-effects of the combination therapy were limited to reversible bladder irritation, and bladder capacity could be maintained within normal limits. These results suggest that combination therapy represents an effective conservative therapy for the management of bladder cancer.

Neuropeptide Y- and vasoactive intestinal polypeptide-containing nerve fibers in the human cerebral arteries: characteristics of distribution

Perivascular innervation in cerebral arteries from 28 human fetuses at twelve to twenty-eight weeks' gestational age was studied histochemically. Neuropeptide Y (NPY)- and vasoactive intestinal polypeptide (VIP)- containing nerve fibers were densely distributed along with adrenergic and cholinergic nerve fibers in the major pial arteries at the base of the brain, an area that forms the circle of Willis, and in the lenticulostriate arteries. In contrast, distribution was sparse in the cortical circumflex branches of the middle cerebral artery, as compared with findings in the lenticulostriate artery of the same diameter. Densely distributed perivascular nerve fibers in the lenticulostriate arteries may play an important role in the pathogenesis of intracerebral hemorrhage.

[Nontraumatic hemorrhage in abdomen and retroperitoneum--CT, sonographic and clinical findings]

Sixteen patients with nontraumatic abdominal or retroperitoneal hemorrhage were examined with ultrasound (n = 16), and CT (n = 14). The lesions of the 10 patients with signs on the onset of hemorrhage were four rectus sheath hematomas, three renal subcapsular and perirenal hematomas, and subcapsular hematoma, pararenal hematoma, perirenal and parenal hematoma, on each. Fall in periphery blood hematocrit values within 24 hours after the onset was observed in only three patients. As the hematocrit value was increased, fluid area of hematoma was replaced by high density on CT and by hypoechoic area on ultrasound. The lesions of the remaining 6 patients were four renal subcapsular hematomas, one hepatic parenchymal and subcapsular hematoma, and one iliopsoas hematoma. CT is superior to ultrasound in evaluation of the nontraumatic hematomas. However, clinicians require to pay more attention to this disorder which occasionally mimick other disorders.

[Glomerular ultrastructures and prognosis of the patients with urinary abnormalities found by school screening program]

Detailed histopathological study were performed and compared with clinical features in 120 children with serial renal biopsies who were found by school screening program. 41 cases (34.2%) of IgA nephropathy (IgAN), 26 cases (21.7%) of thin membrane disease (TMD) and 22 cases (18.3%) of normal glomeruli [( Normal]) accounted for 74.2% of all biopsies. 81 cases (67.5%) were revealed to be minor glomerular abnormalities by light microscopy and which contained 26 cases (32.1%) of TMD, 22 cases (27.2%) of [Normal] and 19 cases (23.4%) of IgAN. The frequency and the severity of proteinuria was significantly higher in IgAN than in TMD and [Normal] (P less than 0.01, P less than 0.05). Hematuria was significantly greater in [Normal] than in IgAN. In the 71 follow-up cases, no patient went to renal insufficiency, moreover, urinary abnormalities had disappeared in 25.4% of the patients including IgAN, TMD, [Normal], nonIgA proliferative glomerulonephritis, incomplete foot process disease and MPGN. [Normal] consisted of stationary or exercised urinary abnormality.

Immunocytochemistry of intermediate filaments in cultured arterial smooth muscle cells: differences in desmin and vimentin expression related to cell of origin and/or plating time

The objective of this study was to determine whether intermediate filament expression, including desmin and vimentin, in cultured smooth muscle cells (SMCs) is related to cyto-differentiation or proliferation. Using antibodies to desmin and vimentin, we studied by immunoperoxidase technique the distribution of these proteins in subcultured SMCs derived from porcine aorta and coronary artery. In addition, the proliferative potentiality of the cells was estimated by the incorporation of [3H]thymidine into DNA. The frequency of desmin-positive cells in coronary arterial SMCs of 3 and 6 population doubling levels was significantly higher as compared to findings with the aortic SMCs and depended on the plating time. No difference was evident at the 12 population doubling level. In contrast, vimentin was present in the majority of both aortic and coronary arterial SMCs. With regard to the localization of vimentin, two cell types were observed, one had reaction products to vimentin in both perinuclear and cell-peripheral areas (type-I cell), the other only in the cell-peripheral region (type-II cell). The relative proportion of the type-I and -II cells varied with the period of culture. Most of the SMCs showed the type-I cell on the first day and the number of type-II cells was increased on the sixth day. Quiescent SMCs in serum-free media had the same percentage of desmin-positive cells and frequency distribution of type-I and -II cells as did the proliferating SMCs incubated in media containing 5% serum. These results suggest that intermediate filament expression, including desmin and vimentin in cultured SMCs, is related to cell origin and/or plating time, but not to the proliferating activity, per se.

[Mitochondrial enlargement of renal proximal tubulus as a cause of microalbuminuria in non-insulin dependent diabetics]

To clarify the ultrastructural changes of renal proximal tubulus in initial nephropathy having microalbuminuria, we observed 80 biopsies of non-insulin-dependent diabetics by light and electron microscopically morphometric analysis. The patients were divided into four groups; group I; no proteinuria (p.u.) & normal serum creatinine (Cr.); less than 1.5 mg/dl, group II; p.u. less than or equal to 0.5 g/day & normal Cr., group III; p.u. greater than 0.5 g/day & normal Cr., group IV; Cr. greater than 1.5 mg/dl. Age-matched 20 normal patients and 40 patients with IgA-nephropathy (20 cases with Cr. less than or equal to 1.5 mg/dl, 20 cases with Cr. greater than 1.5 mg/dl) were used as controls. In diabetics in Group I and II, significant changes were as follow. 1) general mitochondrial enlargement in size in proximal tubular cells, and significantly related to the level of fasting blood glucose, 2) enlargement of proximal tubular cells and their nuclei in size, 3) thickening of the proximal tubular basement membrane, and in group I, it indicated to get worse in future, 4) no relationship between the mitochondrial enlargement and other parenchymal parameters such as glomerular sclerotic change, interstitial fibrosis, luminar narrowing of arterioles and prognosis. Glomerular nodular-lesion, glomerular sclerotic change, and cortical tubulointerstitial fibrosis only appeared in the advanced stages; Group III and IV. We concluded that mitochondrial enlargement could be caused by the initially urinary excretion of low molecular proteins and microalbumin in diabetics, probably due to disturbances of ATP synthesis, reduction of active transport, and finally decreased of reabsorption in the proximal tubulus.

[Correlations among the renal parenchymal components and renal function with IgA-GN; age related changes]

To clarify and evaluate the changes by aging to renal parenchyma of IgA nephropathy with normal renal function (serum creatinine levels less than or equal to 1.5 mg/dl), we compared morphological findings and renal function in 100 adult patients with IgA nephropathy similarly distributed in each decade of age including over 60 y.o.. The following histological parameters were investigated; glomerular sclerotic index calculated a mean for total glomeruli, tubulointerstitial damage or interstitial volume measured by the point-counting method, luminal narrowing index by intimal thickening of arterioles determined morphometry. Tubulointerstitial damages were significantly correlated to aging with a direct linear worsening. Luminal narrowing of arterioles rapidly worsened with age after 40 y.o. who were frequently associated with chronic hypertension. The patients over 60 y.o. had a significant correlation between luminal narrowing of arterioles and glomerular sclerotic index, though those were statistically no related in patients less than 60 y.o.. Glomerular sclerotic index was significantly related with tubulointerstitial damage at all decades except for thirtieth decade. Serum creatinine level was well correlated with glomerular sclerotic index and tubulointerstitial damage, respectively; increase of those indices may indicate poor prognosis. We concluded that ischemic glomerular sclerosis by mean narrowing of afferent arterioles may appear after 60 y.o., probably due to insufficiency of autoregulation for glomerular circulation. Luminal narrowing of arterioles in patients less than 60 y.o. may not reflect to be a main cause for ischemic damage of glomerulus. Therefore it may not be a indicator for renal prognosis in patients with IgA nephropathy less than 60 y.o.

Effects of collagen matrix on proliferation and differentiation of vascular smooth muscle cells in vitro

In an attempt to better define the relationship between collagen matrices and vascular smooth muscle cells in vitro, proliferation of smooth muscle cells was observed in the early stages of culture. Cells spread on collagen gels had a longer doubling time and less incorporation of [3H]thymidine into DNA on the first day of culture than did cells grown on a plastic substrate. Cells on collagen gels were more elongated than were those on the plastic substrate and showed a "hills and valleys" arrangement from the first day in culture on the collagen type III gel. All cells were identified as smooth muscle having definite microfilaments, dense bodies, and pinocytotic vesicles. They had a distinct actin filament running from end to end when labeled with nitrobenzoxadiazole-phallacidin. Cells on the collagen gels had a larger number of actin filaments traveling parallel to the direction of the major axis of their cytoplasm than did those on the glass substrate. Therefore, cultured smooth muscle cells in the more physiological environment for cells in vitro, i.e., on collagen gels, show a suppression of cellular proliferation and an enhancement of differentiation in the early stages of culture. The effects of collagens on the differentiation of cells vary with the collagen phenotype.

High-renin malignant hypertension secondary to an aldosterone-producing adenoma

Malignant hypertension and high plasma renin activity was found in a 39-year-old woman with an aldosterone-producing adenoma. Only 3 similar cases have been previously reported, and all patients died before or after identification of the adenoma. The present paper documents the first reported case of a successfully managed high-renin malignant hypertension secondary to an aldosterone-producing adenoma. Regardless of its sporadic occurrence and common presence with low plasma renin activity, primary aldosteronism should be considered as a possible underlying cause of high-renin malignant hypertension.

Perivascular innervation of the mesenteric artery in spontaneously hypertensive rats

Perivascular innervation of the mesenteric arteries of 7-week-old and 6-month-old spontaneously hypertensive rats and normotensive Wistar-Kyoto rats was examined. The densities of neuropeptide Y-containing nerve fibers and adrenergic nerve fibers were increased in the distal regions of mesenteric arteries of spontaneously hypertensive rats as compared with findings in Wistar-Kyoto rats. However, the densities of cholinergic nerve fibers, vasoactive intestinal polypeptide-containing, and substance P-containing nerve fibers in the mesenteric arteries of the spontaneously hypertensive rats were unchanged in comparison with findings in the Wistar-Kyoto rats. Thus, not only adrenergic nerve fibers but also neuropeptide Y-containing nerve fibers may play an important role in the development and maintenance of hypertension in spontaneously hypertensive rats.

Disruption of the blood-brain barrier caused by nonionic contrast medium used for abdominal angiography: CT demonstration

We describe a case of disruption of the blood-brain barrier (BBB) by nonionic, low osmolality contrast medium after abdominal angiography. One plausible explanation of this event is that acute hypertension during angiography may have increased the BBB permeability, allowing the contrast medium to leak across it.

[High-resolution ultrasound of the thyroid in patients with Graves' disease]

The thyroid glands in 53 patients with Graves' disease were scanned with 10-MHz high-resolution ultrasound. Homogeneous echo pattern was noted in 21 patients (39.6%), and heterogeneous echo pattern was noted in 31 patients (60.4%). Each mean value of the serum triiodothyronine (T3), thyroxine (T4), and free thyroxine (Free T4) in patients with heterogeneous-echo thyroid was noted higher than that of the group with homogeneous-echo thyroid. (p less than 0.05) However, between the two groups, there is no significant difference in mean age and mean duration of treatment with antithyroid drugs. The heterogeneous echo pattern is strongly suggested to be correlated with the severity of hyperthyroidism.

A case of vesical varices as a complication of portal hypertension and manifested gross hematuria

We report a unique case of vesical varices in a patient who presented with an episode of serious gross hematuria. He also had cirrhosis of the liver and portal hypertension, and had undergone transection of the esophagus 10 years ago. A hemangiomatous mass was discovered on cystoscopic examination, and sonographic examination, computerized tomography and abdominal angiography revealed vesical varices. The genesis of vesical varices and possible treatment in this case are discussed.

"Osmiophilic elastolysis" of peripheral organ arteries in patients with Marfan's syndrome

Electron microscopic examinations were performed on systemic muscle-type arteries from two teen-age girls with Marfan's syndrome. In the peripheral organ arteries, the internal elastic lamella revealed a feature tentatively termed "osmiophilic elastolysis". The lytic changes appeared segmentally in the form of electron-dense fragments, and were partly absorbed. Regenerated elastin had a normal structure and surrounded the elastolytic lesions. The same changes were observed in the newly formed small areas of elastin in the thickened intima. The remaining elastic lamella in the affected region contained numerous fine electron-dense granules. Intercellular substances, including collagen fibrils and proteoglycan, other than elastic fibers, were increased secondarily in the elastolytic lesions without any evidence of ultrastructural abnormality. Medical smooth muscle cells making contact with the elastolytic lesions were necrosed and absorbed, and smooth muscle cells in a state of synthesis were increased in the adjacent areas. Abnormal elastogenesis, which showed no remarkable changes macroscopically or light microscopically, was systemic but segmental in the peripheral organ arteries, and regeneration of the structurally normal elastin was concurrent with elastolysis. These events were diagnostic for Marfan's syndrome, and cannot be explained by the conventional theory of elastogenetic enzymic deficiency.

Hypertension-related aggravation of Iga nephropathy: a statistical approach

To evaluate the influence of hypertension on human glomerulonephritis, 200 biopsies from 74 patients with Iga nephropathy were examined. Chosen for this study were 28 hypertensive patients and 46 normotensive subjects during an observation period of 3.84 +/- 2.17 years, which extended from the first to the last biopsy. In a comprehensive analysis, the following findings were observed: Glomerular sclerosis was analyzed semiquantitatively and estimated as "glomerular index" (GI). Interstitial volume (IV) was determined by the point-counting method. Mesangial electron dense deposits (MDD) and arteriolar hyaline change (HC) were also analyzed semiquantitatively. Arterial fibroelastic intimal thickening was analyzed morphometrically and estimated as the luminal "occlusive rate" (OR). These morphological parameters including their serial changes were compared between the hypertensives and the normotensives. The serial changes in GI and IV from the first to the last biopsy were significantly greater in the hypertensives than in the normotensives. Both OR and HC, including their serial changes, were significantly higher in the hypertensive subjects. In the study of MDD and its serial changes, no difference was apparent between the two groups. In the study of OR and HC, there was no correlation observed with GI. Our observations show that hypertension accelerates the progression of both glomerular and vascular sclerosis in case of human glomerulonephritis and suggests that this acceleration cannot only be explained by ischemia-related factors resulting from vascular sclerosis.

Apolipoproteins in human biopsied nephrotic kidneys

Using monospecific antibodies to purified human apolipoproteins, immunofluorescence microscopy of renal biopsies from 4 patients with nephrotic syndrome revealed apolipoprotein (apo) AI, apo CIII and apo B (LDL) in lysosomes of the proximal tubular cells. This supports the hypothesis that there is increased filtration of both high density lipoproteins (HDL) and low density lipoproteins (LDL) with partial reabsorption by the tubules, thus affecting the serum lipoprotein levels.