Morphology of the dorsal lingual papillae in the lesser mouse deer, Tragulus javanicus

The dorsal lingual papillae of the lesser mouse deer were studied morphologically using light and scanning electron microscopy. Four types of papillae, filiform, fungiform, vallate and foliate, were observed. Filiform papillae consisted of larger main papillae with smaller secondary papillae on their anterolateral aspects. Secondary papillae were well distributed over the anterior two-thirds of the tongue, but were very rare or absent in the posterior third. Fungiform papillae were distributed among the filiform papillae, being larger and more abundant on the tip of the tongue. Vallate papillae were round-flat or long-flat, surrounded by a prominent circular groove and a thin annular pad. An important finding was the presence of distinct and prominent foliate papillae on the posterolateral sides of the tongue. Keratinisation of the covering stratified squamous epithelium was relatively weak. Taste buds were observed in the epithelium of the fungiform, vallate and foliate papillae. The lingual papillae of the lesser mouse deer showed some characteristics that differed from those reported for domestic ruminants. These may be related to the feeding habits and the type of food eaten by this species.

[Chronic necrotizing pulmonary aspergillosis in a patient with chronic pulmonary emphysema]

A 67-year-old man with pulmonary emphysema was admitted to the hospital because of left back pain. Chest roentgenography revealed an infiltrate in the left upper lobe, with cavitation, Mycetoma-like shadows were seen in the cavities about 3 weeks later, and a test for the precipitating antibody to Aspergillus fumigatus was positive. Chronic necrotizing pulmonary aspergillosis (CNPA) was diagnosed, and fluconazole was given. A chest roentgenogram taken 4 weeks later showed resolution of both the mycetoma-like shadows and much of the infiltrate. Systemic immunosuppression was highly unlikely: the patient had not been undergoing corticosteroid therapy, and had no predisposing conditions, such as a chronic debilitating illness or diabetes mellitus. In that sense, this case is similar to another reported recently, in which CNPA was associated with chronic obstructive pulmonary disease in an immunocompentent patient.

The effects of lipo-prostaglandin E1 on axial pattern flaps in rabbits

The effects of lipo-prostaglandin E1 (lipo-PGE1), lipid microspheres containing PGE1, on axial pattern flaps were examined using 12 x 20 cm axial pattern flaps based on the right superficial inferior epigastric vessels on the abdomens of rabbits. The surviving area of the skin flap in the lipo-PGE1 group (0.197 +/- 14.1 cm2; n = 10) was significantly increased (p < 0.02) compared with the saline control group (110.4 +/- 5.5 cm2; n = 10). Changes in pedicle blood flow after lipo-PGE1 administration were determined using an ultrasonic pulsed Doppler flowmeter (n = 5). Blood flow in the artery was increased immediately after administration, and it was maintained for 40 minutes. The surface blood flow at the caudal end of the flap on the nonpedicle side, where it was poor, was measured using laserflowgraphy. Blood flow in the skin flap surface was improved 5 to 15 minutes after lipo-PGE1 administration, and it was maintained for as long as 60 minutes. Venous occlusion of the skin flap was also improved (n = 3). In conclusion, lipo-PGE1 increased the blood flow in the axial pattern flaps, resulting in significant enlargement of the surviving skin flap area.

False-positive inferior petrosal sinus sampling in the diagnosis of Cushing's disease. Report of two cases

Inferior petrosal sinus sampling (IPSS) for adrenocorticotropic hormone (ACTH) levels in patients with Cushing's syndrome has become a useful method to distinguish ACTH-secreting pituitary tumors (Cushing's disease) from other causes of the syndrome, principally ectopic adrenocorticotropin secretion by an occult tumor. Although the test is generally regarded as highly specific, the authors recently encountered two patients whose IPSS measurements were false-positive for Cushing's disease. The results of IPSS suggested a pituitary origin of ACTH secretion in both patients, but transsphenoidal surgery failed to disclose a pituitary adenoma or to improve postoperative plasma cortisol levels. Both patients subsequently were found to have an ACTH-secreting carcinoid tumor of the lung. The false-positive IPSS studies were due to periodic hormonogenesis. The patients must be hypercortisolemic at the time IPSS is performed for the study to be valid.

Plasma concentration of human adrenomedullin in patients on hemodialysis

To investigate a possible pathophysiological role of human adrenomedullin (AM), we measured the plasma concentration of immunoreactive-AM (ir-AM) in 38 patients with end-stage renal disease (ESRD) on hemodialysis (HD) and 38 healthy subjects (age and sex matched). In addition, plasma ir-AM was characterized by a reverse-phase high performance liquid chromatography. The mean value (+/- SEM) of plasma AM in the patients before HD (10.1 +/- 0.67 fmol/ml) was markedly higher than that in the control group (2.9 +/- 0.13 fmol/ml, p < 0.001), but plasma AM levels were not altered by HD. There was a significant correlation between plasma AM levels and mean blood pressure (MBP) in a group of subjects including both patients before HD and healthy subjects (p < 0.01). In chromatographic study, the major peak of ir-AM in the plasma from patients on HD, as well as healthy subjects, emerged at an elution time identical to that of synthetic AM, indicating that the active form of AM was present in the circulating blood. The secretion of AM seemed to be increased in response to the conditions elicited by ESRD such as hypervolemia and/or hypertension, and reduced renal excretion of the peptide may also contribute to its high plasma level.

Effect of an angiotensin II receptor antagonist, TCV-116, on neointimal formation following balloon injury in the SHR carotid artery

1. In the present study, we examined the effect of a novel angiotensin II type I receptor antagonist, TCV-116, on carotid neointimal formation after balloon injury in SHR and WKY rats. 2. Oral administration of TCV-116 at a dose of 10 mg/kg per day reduced not only systolic blood pressure but also neointimal formation after carotid balloon injury. TCV-116 also suppressed cardiac hypertrophy. An angiotensin-converting enzyme inhibitor, lisinopril (20 mg/kg per day), had a similar effect to that of TCV-116. 3. In the WKY experiment, both TCV-116 and lisinopril suppressed neointimal formation as well as systolic blood pressure, but did not suppress cardiac hypertrophy. 4. Although SHR showed markedly enhanced neointimal formation after balloon injury compared with age-matched WKY rat, both TCV-116 and lisinopril showed similar suppressive effects on neointimal formation in both SHR and WKY rats. 5. These results confirm the important role of angiotensin II in neointimal formation following balloon injury. Further studies are needed to clarify the mechanism of the difference between SHR and WKY rats in the response of vascular smooth muscle cells.

Localization of Fas antigen mRNA induced in postischemic murine forebrain by in situ hybridization

The expression of mRNA for the Fas antigen, a membrane-associated protein mediating apoptosis, was localized by in situ hybridization histochemistry in murine brains following 30 min of global cerebral ischemia. Six hours following the ischemia, many labeled cells were detected anew throughout the brain. The hybridization was seen in the small neural cells and in the cells along the walls of the ventricles and vessels, and became undetectable 24 h following the ischemia. These results suggest that the Fas antigen is expressed in the neuron, glia and periventricular cells of the post-ischemic brain.

Random amplified polymorphic DNA analysis of clinically and environmentally isolated Cryptococcus neoformans in Nagasaki

We examined clinical (pulmonary cryptococcosis and cryptococcal meningitis) and environmental (pigeon excreta) isolates of Cryptococcus neoformans var. neoformans (serotype A) in the southern Japanese prefecture of Nagasaki. The random amplified polymorphic DNA profiles obtained by using three primers revealed six patterns among 21 clinical isolates and three patterns among 8 environmental isolates. Pattern I was the most common (18 of 29 isolates) and was found among isolates obtained throughout the entire Nagasaki Prefecture. Patterns I, III, and IV were found among both clinical and environmental isolates. Patterns I and IV had a characteristic distribution, and in particular, pattern IV was isolated exclusively (five of six isolates) from isolates from Nagasaki City. Two environmental isolates from two locations associated strongly with two patients revealed identical random amplified polymorphic DNA patterns (patterns I and IV) for isolates from each patient. Our results suggest that clinical and environmental isolates belong to the same pool of C. neoformans isolates and that these isolates have certain geographic locations, although the number of isolated strains was limited.

[Marked bone marrow necrosis preceding acute monoblastic leukemia]

Bone marrow necrosis is rarely diagnosed during life but is more often seen at autopsy by accident. The prognosis of patients with bone marrow necrosis secondary to neoplastic disease is extremely poor. We described a 53-year-old man with bone marrow necrosis preceding acute monoblastic leukemia. He was admitted in June, 1994, for continuous back pain and marked elevation of serum lactate dehydrogenase. After admission, a hematologic examination showed progressive pancytopenia in peripheral blood and bone marrow necrosis. He was diagnosed as AML (M5) from the sudden appearance of leukemic blasts in the peripheral blood two months later. Induction therapy was immediately administered according to JALSG-92 protocol. The patient suffered from tumor lysis syndrome after chemotherapy, but complete remission was achieved by dialysis.

Binding of human IgM from a rheumatoid factor to IgG of 12 animal species

The binding of IgM from a rheumatoid factor (RF-IgM) to IgG from 12 animal species was analyzed by an ELISA system. The RF-IgM bound various animal IgG with dissimilar affinities. The binding of RF-IgM to animal IgG was inhibited by addition of protein A, which binds some animal IgG by recognizing the junctional site on CH2-CH3 domains in the Fc region. As previously reported, no significant correlation was observed between the binding of RF-IgM to IgG and the content of galactose-free oligosaccharides, which is increased in IgG of rheumatoid arthritis patients or autoimmune mice. We suggest that the crucial epitope of IgG for RF-IgM binding is not the oligosaccharide structure generated specifically in IgG of autoimmune diseases but that RF-IgM may recognize a certain protein conformation of a region in IgG near the binding site of protein A.

Lack of interleukin-2 (IL-2) expression and selective expression of IL-10 mRNA in human renal cell carcinoma

Freshly isolated tumor-infiltrating lymphocytes (TIL) are often functionally deficient. Since one of the key functional parameters of an immune response is the local production of cytokines, we studied the expression of cytokine genes in freshly isolated renal cancer tissue. Using a PCR-assisted mRNA amplification assay, the constitutive expression of mRNA for 10 different cytokines was assessed in renal cancer tissue. We compared the cytokine mRNA expression in freshly isolated samples of renal carcinomas, renal cancer cell lines established from the tumor samples, peripheral blood mononuclear cells (PBMC) and non-tumor kidney tissue isolated from the same patients. IL-10 mRNA expression was detected only in tumor samples, while renal cancer lines, PBMC and non-tumorous kidney tissues were devoid of this cytokine. One-third of the tumor samples but none of the normal kidney samples also expressed G-CSF mRNA. IL-6, TNF-alpha and IFN-gamma mRNA were expressed non-selectively in tumors, PBMC and normal rental tissue. Expression of IL-2, IL-3 and IL-4 mRNA was not detected in any of the tissues analyzed. Established renal cancer lines exhibited expression of IL-1 alpha, IL-6, TNF-alpha and GM-CSF. Culture of tumor-derived T cells with anti-CD3 monoclonal antibody (MAb) resulted in expression of IL-2, IL-3 and IL-4 mRNA. In contrast, none of these cytokines was detected in culture with recombinant human IL-2 alone. Since IL-10 is known to suppress antigen presentation, these findings have important implications for the possible in vivo role of IL-10 as a suppressor of local anti-tumor response.

An anatomic study for the rectus abdominis myocutaneous flap combined with a vascularized rib

The anatomy of the vascular connections between the eighth intercostal vessels and the deep epigastric vessels was studied in a series of 20 dissections in 10 preserved cadavers to develop the rectus abdominis myocutaneous flap combined with a vascularized rib. The distance between the point where the eighth intercostal vessels attached to the costal margin and the xiphoid process and the arcuate line, which become a good guide for design of the flap, was measured. The average length of the vascular pedicle of a vascularized rib was over 10 cm. Possible clinical uses of this compound flap for reconstruction of a composite maxillary or mandibular defect are described.

Anti-peptide antibodies to the P4502D subfamily in rat, dog and man

1. In order to obtain specific antibodies of the P4502D subfamily, we generated two anti-peptide antibodies against synthetic peptides, DPAQPPRD (peptide A) and DPTQPPRH (peptide B). The sequence of peptide A occurs in rat P4502D2, P4502D4 and human P4502D6, whereas the sequence of peptide B occurs in the dog P4502D subfamily. These sequences are closely related to an epitope of liver/kidney microsomal autoimmune hepatitis. 2. In immunoblotting studies, the anti-peptide antibody against peptide A recognized a 49-KDa protein in microsomes derived from human lymphoblasts expressing P4502D6 and rat liver. It showed no crossreactivity with microsomes from dog liver. In contrast, the anti-peptide antibody against peptide B recognized a 49-KDa protein only in microsomes of dog liver. These indicate that each anti-peptide antibody has the specificity for the respective sequences of the members of P4502D subfamily, with the species investigated herein. 3. In immunoinhibition studies, the anti-peptide antibodies against peptide B inhibited bunitrolol 4-hydroxylation and propranolol 4,5-hydroxylation, which are mediated by the dog P4502D subfamily. These data suggest that the anti-peptide antibodies against peptide B bind to the native and denatured forms of the P4502D subfamily. 4. The present study has demonstrated that the anti-peptide antibodies against this region are useful for studying the members of the P4502D subfamily.

Purification and characterization of a dog cytochrome P450 isozyme belonging to the CYP2D subfamily and development of its antipeptide antibody

Species differences in the metabolism of bunitrolol (BTL) and propranolol (PL) in liver microsomes from rats and dogs were investigated. Hepatic microsomes from dogs lacked the ability to catalyze PL 7-hydroxylation, which is mediated by the CYP2D subfamily in rats. This suggested that dogs might lack the CYP2D subfamily; however, the antibody against cytochrome P450 (P450) BTL (CYP2D2) recognized a protein of approximately 49 kDa in hepatic microsomes from dogs, indicative of the presence of the CYP2D subfamily in dogs. The P450 purified from dog hepatic microsomes was designated P450 Canis familiaris (CF)1. It cross-reacted with the antibody against P450 BTL. The apparent molecular weight of the purified P450 CF1 was estimated to be 49 kDa. Its N-terminal amino acid sequence resembled the sequences of the members of the rat CYP2D subfamily and was the same as the sequences of the dog CYP2D subfamily, as deduced from the cDNA, except for the lack of four residues at the N-terminal. P450 CF1 could mediate metabolism of BTL and PL. P450 CF1, however, could not mediate PL 7-hydroxylation, which is almost exclusively mediated by CYP2D in rats. These findings indicate that P450 CF1 belongs to the CYP2D subfamily and that it differs functionally from the rat CYP2D subfamily. An antipeptide antibody against the synthetic peptide (DPTQPPRH), the sequence of which occurs in dog CYP2D at position 266-273 (S. Kirita et al., unpublished data), inhibited BTL 4-hydroxylase activity by 71% in dog hepatic microsomes at the substrate concentration of 0.01 M. This is further evidence that the CYP2D subfamily, in particular P450 CF1, is largely responsible for the oxidation of beta-blockers in dog hepatic microsomes.

Hepatic sinusoidal endothelial cells can store and metabolize serum immunoglobulin

Sinusoidal inclusion-containing endothelial cells in the liver were investigated with particular interest in their capacity of metabolizing immunoglobulin. Formalin-fixed deparaffinized liver specimens were used for immunohistochemistry, and pronase digestion was proved to be effective for antigen retrieval of immunoglobulin. The inclusions in sinusoidal endothelial cells were strongly immunostained with anti-immunoglobulin (Ig)G, IgA, and IgM antibodies in predigested sections. The complements were not identified immunohistochemically in the inclusions even after pronase treatment. Two women with autoimmune liver disease, who initially represented high levels of serum gamma globulin and abundant inclusion-containing endothelial cells, were studied. The subsequent biopsy after effective corticosteroid therapy demonstrated significant histological improvement as well as the disappearance of inclusion-containing endothelial cells (ICECs). During and after treatment, their serum gamma globulin levels were drastically reduced. In conclusion, the hepatic sinusoidal endothelial cells can take up serum immunoglobulin, probably through a receptor-mediated pathway, and its excessive storage results in the formation of cytoplasmic inclusions that are easily recognized by a light microscope. The stored immunoglobulin may be degraded in the cytoplasm, and the inclusions would disappear in association with the reduction of sinusoidal gamma globulin content. In other words, the intralobular density of inclusion-containing endothelial cells is a morphological predictor for the serum gamma globulin level.

[Detection of Helicobacter pylori by culture and the 13C-urea breath test using an automated breath 13C analyzer]

Up to now, the diagnosis of H. pylori infection has been made by the breath test using 13C-urea. In this study, 13C-urea breath samples were tested in 34 patients (peptic ulcer scar 17, chronic gastritis 17 cases) with an automated breath 13C analyzer (ABCA. Europa Scientific, Crewe, UK) and compared with the results of endoscopical diagnosis for H. pylori infection. Endoscopic and 13C-urea breath test (13C-UBT) were performed before eradicative medication. We described a modified protocol for the growth grade of H. pylori colonies in microbiology (H. pylori score), and for the delta 13C area under curve (AUC; permil*hr) obtained from each sample of expired breath. There was a significant correlation between delta 13C-AUC and the delta 13C level of each sample, but the correlation coefficient obtained at 10min (R2 = 0.582) was lower than that obtained at the other four time points (20min; 0.891, 30min; 0.949, 40min; 0.946, 50min; 0.946, 60min; 0.820). The delta 13C-AUC well correlated with H. pylori score (p < 0.01), none of 26 H. pylori positive patients detected by culture was 13C-UBT negative (delta 13C-AUC < 8.2 permil*hr in mean + 2SD of H. pylori negative group). In conclusion, 13C-UBT using ABCA has high sensitivity and specificity, and it provides a non-invasive method for the detection of H. pylori urease activity.

Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate

During the authors' initial 4-year experience with radiosurgery using the Leksell cobalt-60 gamma unit, they treated 121 patients with cerebral arteriovenous malformations (AVMs). The radiosurgical dose to the margin of the nidus was 20 Gy for lesions less than 2.0 cm in diameter (volume < or = 4.2 cm3); 18 Gy for malformations 2.1 to 3.0 cm in diameter (volume 4.2-14.1 cm3); and 16 Gy for malformations greater than 3.0 cm (volume > 14.1 cm3). Fifty-one patients underwent follow-up angiography between 1 and 3 years after treatment, and complete obliteration of the nidus was confirmed in 38 (74.5%) of these patients. Thirty-two (74.4%) of 43 AVMs with volumes of 10 cm3 or less and six (75%) of eight larger AVMs (volume 11-30 cm3) showed complete obliteration. Analysis of the time course of AVM nidus shrinkage and obliteration showed that most of the radiosurgically induced effect had occurred by 36 months after treatment. Retrospective analysis of the dose plans for 10 AVMs that were not obliterated by 36 months after gamma knife radiosurgery at the authors' institution (eight cases) or elsewhere (two cases) revealed that six AVMs had not been covered completely by the prescribed isodose. Six (5%) of the 121 patients developed neurological deficits as a direct result of radiosurgical treatment. The authors infer from these data that malformations up to 30 cm3 in volume (approximately 4.0 cm in average diameter) can be treated effectively with an acceptably low complication rate using a radiosurgical dose of 16 Gy to the margin of the nidus. The obliteration rate for the larger malformations that were treated with a dose of 16 to 18 Gy appears to be similar to that for smaller ones treated with 18 to 20 Gy. As more experience accrues using radiosurgery to treat AVMs, patient selection criteria and the variables associated with successful obliteration of the nidus should become more clearly defined.

Expanded cavum septi pellucidi and cavum vergae associated with behavioral symptoms relieved by a stereotactic procedure: case report

CASE REPORT

A 6-year-old boy had symptoms such as unstable gait, behavioral symptoms, and irregular appetite, evacuation, and sleep. Giant cavum septi pellucidi and cavum vergae of 3 x 3 x 5 cm were revealed by computed tomography (CT) and magnetic resonance imaging (MRI). After stereotactic cyst-peritoneal shunting, regression of the cavities was revealed by CT and MRI, in association with marked improvement in the above-described symptoms. In the corpus callosum particularly, which had been preoperatively revealed on sagittal MRI sections to be extended circumferentially as a result of compression by a cyst; the compression was relieved postoperatively, and compression of the pericallosal brain tissue was also relieved.

CONCLUSIONS

Compression of the brain tissue around the cyst (limbic system, etc.) was considered the most important cause of the behavioral symptoms in this patient.