Dual-tracer autoradiography with thallium-201 and iodine-125-metaiodobenzylguanidine in experimental myocardial infarction of rat

Dual-isotope scintigraphic studies with 201Tl and radioiodinated metaiodobenzylguanidine (MIBG) suggest that acute myocardial infarction causes extensive regional myocardial denervation beyond the infarcted area. We therefore investigated the histopathological and biochemical significance of the discrepancy between 201Tl and 125I-MIBG distribution determined by dual-tracer autoradiography in experimental myocardial infarction.

METHODS

Left coronary arteries of 12 male Wistar rats were ligated for 30 min followed by reperfusion. Dual-tracer autoradiography of infarcted heart sections was performed with 201Tl and [125I]MIBG 4 hr or 2 days after coronary reperfusion, followed by immunohistochemical staining with myoglobin monoclonal antibody to determine the area of myocardial infarction. Ultrastructural alterations and myocardial norepinephrine (NE) content in the region determined by dual-tracer autoradiography and myglobin immunostaining were studied.

RESULTS

Thirty-minute coronary ligation with 4-hr reperfusion produced myocardial infarction associated with discrepant region in the peri-infarcted myocardium characterized by decreased [125I]MIBG uptake and normal 201Tl distribution (discrepant region), as determined by dual-tracer autoradiography. In the discrepant region, which disappeared after 2 days, the nerve terminals showed loss of granular cores, with normal structures between normal myocytes. The mean myocardial NE level in the discrepant region was significantly lower than that in the nonischemic region (255.2 +/- 85.9 versus 549.5 +/- 82.5 ng/mg).

CONCLUSION

The uptake discrepancy of 201Tl and [125I]MIBG observed in the infarcted heart represents a transient functional denervation of the regional cardiac sympathetic nerve terminals in the noninfarcted myocardium.

Serial changes of plasma plasminogen activator inhibitor activity in acute myocardial infarction: difference between thrombolytic therapy and direct coronary angioplasty

The fibrinolytic system is impaired in patients with acute myocardial infarction (AMI). The primary regulatory element of fibrinolytic activity is plasminogen activator inhibitor (PAI). There are no reports, however, on the serial changes of PAI activity after thrombolysis or coronary angioplasty in patients with AMI undergoing emergency coronary angiography. This study was designed to examine the difference in the change of fibrinolytic activity between patients with AMI who underwent thrombolytic therapy with recombinant tissue-plasminogen activator (rTPA) and those who underwent direct percutaneous coronary angioplasty (PTCA). We measured the serial changes of PAI activity and tissue plasminogen activator (TPA) antigen after rTPA therapy or direct PTCA. Twenty-two patients received emergency coronary angiography and were treated with rTPA intravenously. Twenty patients underwent direct PTCA. Plasma PAI activity levels were increased on admission and further increased within 24 hours in patients treated with rTPA and in those treated with direct PTCA. In the thrombolysis group, there were two peaks in plasma PAI activity levels (IU/ml) at 4 hours (27.0 +/- 2.9) and at 16 hours (25.6 +/- 2.5) after the initiation of rTPA infusion. However, in the direct PTCA group, there was one peak of PAI activity (IU/ml) at 16 hours (23.9 +/- 2.7) after the initiation of direct PTCA. In conclusion, the PAI activity has two peaks in the thrombolysis group and one peak in the direct PTCA group.

Effect of the initial bolus volume of recombinant tissue-type plasminogen activator on coronary recanalization and infarct size in Japanese acute myocardial infarction patients. Kumamoto University Myocardial Infarction Study (KUMIS) Group

Coronary recanalization rate and infarct size were compared between 2 different methods of intravenously administering recombinant tissue-type plasminogen activator (rt-PA) 41.4 mg; 1) an initial bolus dose of 30% followed by infusion of the remainder over 60 min (30% group), and an initial bolus dose of 10% followed by infusion of the remainder over 60 min (10% group). Thirty min after beginning rt-PA infusion, the coronary recanalization rate was higher in the 30% group than in the 10% group (82.9% (34/41) vs 53.7% (22/41), p < 0.01). The peak creatine kinase and peak creatine kinase-MB levels were lower in the 30% group than in the 10% group. We conclude that a higher initial bolus dose of rt-PA gives a higher rate of recanalization of the infarct-related artery at the very early phase, and probably leads to a smaller infarct size.

[Identification and analysis of immune cells infiltrating into the glomerulus and interstitium in lupus nephritis]

This study was performed to investigate the role of cell-mediated immunity in lupus nephritis (LN). Frozen sections from 38 patients with LN were examined by indirect immunoalkaline-phosphatase labeling using monoclonal antibodies to identify the immune cells infiltrating into the interstitium and glomerulus. 14 patients showed minor glomerular abnormality (MGA), 9 had mesangial LN (MesLN), 12 had diffuse proliferative LN (DPLN) and 3 had membranous LN (MLN). Monocyte/macrophage and helper/inducer T cells infiltrated in the interstitium predominantly, but intraglomerular infiltration of these cells was rare. Monocyte/macrophage and suppressor/cytotoxic T cell levels were significantly higher (p < 0.05) in the interstitium in DPLN patients and monocyte/macrophage level was significantly higher (p < 0.05) in MesLN patients than in MGA patients. In the interstitium, serum creatinine level was highly correlated with infiltrations of suppressor/cytotoxic T cell, monocyte/macrophage (p < 0.01), pan T cell and total leucocyte (p < 0.05). Clinical activity score was correlated with suppressor/cytotoxic T cell (p < 0.001), monocyte/macrophage and pan T cell (p < 0.01). These results suggest that suppressor/cytotoxic T cell and and monocyte/macrophage may play an important role in the progression of lupus nephritis.

Donor card registration system in Japan: an obstacle to procuring kidneys for transplantation

Donor cards are a simple and effective way to give a consent to organ donation in cases of unexpected death. In Japan the prevalence of donor cards is low (0.4%) compared to the United States (24.6%), although about 50% of Japanese people are reported to be willing to donate their organs after death, a figure equivalent to the United States. We hypothesized that the donor card registration system can explain the low prevalence, and an introduction of a free delivery system will increase the prevalence. From April 1992 to April 1993, 402 high school students and 3391 workers in the Tokyo metropolitan area were requested to answer questionnaires; all the questionnaires were returned. Few respondents (15.5%) knew the way in which to be registered as a donor card holder. If donor cards were delivered freely and registration to carry a donor card was not required, 48.8% replied that they would be willing to carry donor cards. The most commonly cited reason for not carrying a donor card was 'I had no opportunity to get a donor card'. This study indicates that the introduction of free delivery of donor cards will increase the prevalence dramatically if a sufficient number of opportunities are offered. We recommend that a free delivery system should be introduced in order to increase the prevalence and secure the will of the deceased rather than the will of the family.

[A case of primary pulmonary B cell lymphoma confirmed by gene analysis]

A 76-year-old man visited our clinic with chest radiographic evidence of a coin lesion in the right middle lung. Chest CT demonstrated an infiltrative shadow mainly in the S4 segment. Lymphoproliferative disorders were suggested by transbronchial lung biopsy. Middle lobectomy was performed. Pathological study showed massive proliferation of mature lymphocytes. Immunoperoxidase studies could not demonstrate a neoplastic monoclonal process. Pseudolymphoma was diagnosed. High molecular weight DNAs were extracted from frozen specimens. Whether genes of immunoglobulins and T-cell receptors were rearranged was investigated using DNA probes against JH and TCR beta-1 receptor gene. One rearranged band was found in the JH chain. No rearranged band appeared in TCR beta-1 chain. B cell lymphoma was diagnosed instead of pseudolymphoma.

[Stimulatory effects of a streptococcal protein, preabsorbing antigen (PA-Ag), on human lymphocytes]

The possible role of a streptococcal protein, preabsorbing antigen (PA-Ag), in human cellular immunity was examined by a lymphocyte stimulation test. Lymphocytes were obtained from 12 healthy adult donors who had no history of acute poststreptococcal glomerulonephritis nor of other renal diseases, and from the blood of 4 umbilical cords. In addition to PA-Ag, pre-purified material from ruptured cell supernatant (RCS) was also tested for lymphocyte stimulation, and their time-response relationships were compared to those with stimulation by phytohemagglutinin (PHA), a nonspecific mitogen. Results showed that the lymphocytes of the 12 adult donors proliferated in a dose-dependent manner in response to PA-Ag or RCS stimulation. In the response to these proteins, the peak responsiveness of lymphocyte proliferation was characteristically seen between the 5th and 7th days of cultivation, while it was seen between the 3rd and 5th days in PHA stimulation. Surprisingly, lymphocytes derived from umbilical cord bloods also significantly proliferated in the presence of PA-Ag. These results indicate that PA-Ag stimulates human lymphocytes to proliferate in a different manner than when stimulated by PHA, and the induction of the stimulatory effects is not dependent on antigen-specific response, since it does not require pre-sensitization of the host.

Plasma lipoprotein (a) levels and fibrinolytic activity in acute myocardial infarction

To evaluate the effects of lipoprotein (a) [Lp (a)] on the fibrinolytic system in patients with acute myocardial infarction (AMI) who underwent thrombolytic therapy with recombinant tissue-type plasminogen activator, we examined serial changes in plasma levels of Lp (a), plasminogen activator inhibitor (PAI) activity, alpha 2-plasmin inhibitor-plasmin complex (PIC) and thrombin antithrombin III complex (TAT) in venous plasma samples from 25 patients with AMI for 3 weeks. Plasma Lp (a) levels were significantly increased 5, 7, and 14 days after admission and tended to decrease by the 21st day. On the other hand, the ratio of PIC/TAT was significantly increased on the 7th day and remained high for 3 weeks (p < 0.01), while plasma PAI activity was significantly decreased on the 5th day after admission (p < 0.01). Thus, plasma fibrinolytic function is impaired in the early phase after AMI, and gradually improves over the course of 3 weeks. The increase in plasma Lp (a) levels is, therefore, not accompanied by a significant decrease in plasma fibrinolytic function in patients with AMI.

[A case report of light and heavy chain deposition disease (IgG2 lambda)]

A 73-year-old male was admitted to the renal division of our hospital because of hypertension, proteinuria and bilateral pretibial edema. Eight years previously, he was diagnosed as being afflicted with interstitial pneumonia on the basis of a chest X-ray examination. Laboratory tests conducted during the current admission showed normocytic normochromic anemia, renal dysfunction and mild proteinuria. Total IgG was normal, but a high proportion of IgG2 was observed. M-protein in the serum was positive for both IgG lambda and Bence Jones protein (lambda type). A bone marrow biopsy showed the proportion of plasma cells to be 10.6%, but atypical cells were not found. We diagnosed the patient's condition as plasma cell dyscrasia. Light microscopy examination of a renal biopsy specimen showed moderate mesangial proliferation with a deposition of PAS-positive and Congo red negative materials in the mesangial area: nodular gomerulonephritis was seen in some glomeruli. Immunofluorescence revealed IgG and lambda light chains, strong linear staining along the glomerular basement membrane and tubular basement membrane and positivity in the mesangial area. Results of staining for IgA, IgM, fibrinogen and C3 were weakly positive in the mesangium area, while those for C4, Clq and free kappa were negative. Positive staining of IgG2 was seen by immunoperoxidase study, but the tissue was negative for IgG1, IgG3, IgG4. Electron microscopy demonstrated a dense granular deposition in the mesangial, subendothelial and peritubular area and a microfibrillar structure in the mesangial area. The diameter of the microfibrillar structure was 14 nm on the average.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemolytic uremic syndrome without hemolytic anemia: a case report

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Most cases of HUS are caused by E. coli O157:H7 verotoxin. In the case reported here, diarrhea continued for twenty days after an E. coli 0157:H7 infection and was followed by acute renal failure and thrombocytopenia. Examination of percutaneous renal biopsy tissue showed typical HUS findings, e.g., mesangiolysis in glomeruli and thickening of capillary walls with prominent double outlines, but there was no indication of hemolytic anemia. LDH and haptoglobin, indications of hemolytic anemia, were in the normal range throughout the patient's clinical course. The patient's red blood cells had P1 antigen, which reportedly provides protection by adsorption of toxin into the red blood cells thereby preventing or limiting toxic damage to other organs. Therefore, we assumed that because of the expression of P1 antigen in this patient, the kidneys were not severely damaged and microangiopathic hemolytic anemia was thereby avoided.

Primary mesenteric tumor of adult T-cell leukemia/lymphoma: report of a case

A rare case of primary mesenteric tumor of adult T-cell leukemia/lymphoma (ATLL) is reported. A 64-year-old man was admitted to our hospital after the diagnosis of a palpable ileocecal tumor. Although the serologic test for human T-cell lymphotrophic virus type I (HTLV-I) antibody was positive, neither ATLL cells in the peripheral blood nor systemic lymphadenopathy were observed. At laparotomy, the tumor was histopathologically revealed to be ATLL, and was also found to be restricted to the mesentery. An immunohistochemical examination of the tumor tissue using a specific monoclonal antibody was positive for CD2 and CD4, and negative for CD8. Proviral genome integration in the tumor cells was found by Southern blotting using a 32P-labeled HTLV-I probe with EcoRI and PstI digestion. Combination chemotherapy including cyclophosphamide, Adriamycin, vincristine, and prednisolone was begun postoperatively, but the patient did not respond to therapy. Up to now, only two cases of ATLL originating primarily in the abdominal cavity have been reported. These cases all demonstrate the need to consider the possibility of a primary ATLL mesenteric tumor without leukemic manifestation in the peripheral blood.

Effects of KB-5492, a new anti-ulcer agent with a selective affinity for the sigma-receptor, on aspirin-induced disruption of the rat gastric mucosal barrier

The effect of KB-5492, a new anti-ulcer agent with a selective affinity for the sigma-receptor, on aspirin-induced disruption of the gastric mucosal barrier was studied in rats. Intragastric instillation of aspirin at 200 mg/kg rapidly decreased the gastric transmucosal potential difference (PD) in anesthetized rats. The PD recovered gradually following the removal of aspirin from the instillation solution. Aspirin, administered orally at 200 mg/kg, also reduced the amount of gastric covering mucus and induced a decrease in gastric H+ concentration and an increase in gastric Na+ concentration in pylorus-ligated rats. KB-5492, administered intraduodenally at 200 mg/kg, significantly prevented the aspirin-induced decrease in PD and accelerated the recovery of PD. In addition, KB-5492 at 200 mg/kg significantly prevented the reduction of gastric covering mucus, the decrease in gastric H+ concentration and the increase in gastric Na+ concentration induced by aspirin. These effects were similar to those of 0.01 mg/kg of 16,16-dimethyl prostaglandin E2 (dmPGE2). Teprenone at 200 mg/kg did not show any effect except for the inhibitory effects on the changes in gastric H+ and Na+ concentration. In the histological study, marked reduction of PAS-positive epithelial mucus and the exfoliation of surface epithelial cells were observed in the gastric mucosa exposed to aspirin. KB-5492 and dmPGE2 almost completely prevented the former, whereas both drugs prevented the latter incompletely. These findings indicate that KB-5492 protects the gastric mucosal barrier against the disruption by aspirin, which may be mainly exerted by retention of the gastric covering mucus.

Effects of KB-5492, a new anti-ulcer agent, on ethanol- and acidified aspirin-induced gastric mucosal damage in vivo and in vitro

The effects of KB-5492, a new anti-ulcer agent with selective affinity for the sigma receptor, on ethanol- and acidified aspirin-induced gastric mucosal damage were studied in vivo and in vitro and compared with those of 16,16-dimethyl prostaglandin E2 (dmPGE2). In the in vivo study, KB-5492 (200 mg/kg, p.o.) as well as dmPGE2 (0.01 mg/kg, p.o.) significantly prevented the acute macroscopic lesions in rat gastric mucosa induced by oral administration of either absolute ethanol or 80 mM aspirin in 150 mM HCl. The light microscopic examination revealed that KB-5492 almost completely prevented the deep mucosal lesions induced by these necrotizing agents. KB-5492 also prevented the exfoliation of surface epithelial cells, but its preventive effect was incomplete. In the in vitro study, gastric epithelial cells, isolated from the rat stomach, were cultured for 6 days until they reached confluency. Subsequently, 51Cr was incorporated into the cells. Both 10 mM aspirin (at pH 5.0) and 12.5% ethanol (at pH 7.4) induced damage to the cells and markedly increased 51Cr release from the cells. KB-5492 at 0.3 and 1 mM and dmPGE2 at 0.3 and 1 microM significantly, but not completely, prevented both the aspirin- and ethanol-induced increases in 51Cr release from the cells. These findings indicate that KB-5492 as well as dmPGE2 may exert a direct but limited protective effect on the surface epithelial cells in vivo.

Inhibitory effect of beta-carotene and astaxanthin on photosensitized oxidation of phospholipid bilayers

Large unilamellar liposomes comprising of egg yolk phosphatidylcholine (PC) was exposed to photoirradiation in the presence of methylene blue (water-soluble photosensitizer) or 12-(1-pyrene)dodecanoic acid (P-12, lipid-soluble photosensitizer) to estimate the inhibitory effect of beta-carotene and astaxanthin on photosensitized oxidation of phospholipid bilayers. Without sensitizers, astaxanthin decreased much slower than beta-carotene and other hydrocarbon carotenoids (lycopene, alpha-carotene). Astaxanthin lasted longer than beta-carotene even in the presence of methylene blue or P-12. Decrease of astaxanthin was also much slower than that of beta-carotene when egg yolk PC was replaced by dimyristoyl PC. However, inhibitory effect of astaxanthin was lower than beta-carotene in the case of P-12 sensitized photooxidation. These results suggest that effectiveness of carotenoids as antioxidants on photosensitized oxidation (Type II) in phospholipid bilayers depends on the site of singlet oxygen to be generated, as well as their stability on photoirradiation.

ANCA associated vasculitis allergica cutis (VAC) and mild proliferative necrotizing glomerulonephritis

We report here the case of a 69-year-old male with vasculitis allergica cutis (VAC) accompanied by a nephrotic syndrome associated with serum perinuclear-staining anti-neutrophil cytoplasmic antibody (P-ANCA). Renal biopsy specimens showed mild proliferative glomerulonephritis with crescentic and necrotizing lesion in the glomeruli, while lesional skin biopsy specimens showed leukocytoclastic vasculitis in the deep dermis. Pauci-immune deposits were evident (deposits of immunoglobulins and complements were absent) by immunofluorescence microscopy in both tissues. The appearance of weakly positive P-ANCA associated with skin lesions and renal dysfunction occurred twice in this patient. Following corticosteroid administration, renal dysfunction was remarkably diminished and proteinuria decreased. P-ANCA titer were decreased, reaching the normal level. ANCA associated glomerulonephritis complicated by VAC has not been reported previously. In the present case, the vasculitis cutis and glomerulonephritis is assumed to be associated with the appearance of weakly positive P-ANCA.

Expression of group-II phospholipase A2 in malignant and non-malignant human gastric mucosa

The expression of Group-II phospholipase A2 (M-PLA2) was analysed immunohistochemically in malignant, non-malignant (including atrophic, hyperplastic, pseudopyloric metaplastic and intestinal metaplastic) and normal human gastric mucosae. M-PLA2 was consistently detected in the stem cell lineage, pseudopyloric metaplasia and the generative cells of hyperplastic foveolar epithelium and intestinal metaplasia (IM). In IM, the appearance of M-PLA2 was found to be closely related to the degree of development of the brush borders on columnar cells and was especially prominent at dense brush borders. Paneth cells of IM, particularly their secretory products, were strongly immunoreactive for M-PLA2. In gastric cancer, the expression of M-PLA2 was detected exclusively in cancer cells with a low grade of differentiation, and seemed to be intensified in the invading zone of the tumour. These observations suggest that the expression of M-PLA2 is associated with the proliferative kinetics and regeneration of human gastric mucosa, and may indicate a physiological relationship between its expression and metaplasia of small intestinal type. Moreover, the appearance of M-PLA2 may be related to the invasive ability of gastric cancer.

A case of Sjögren's syndrome complicating immune-mediated aplastic anaemia

A 78-year-old Japanese woman with Sjögren's syndrome complicating immune-mediated aplastic anaemia is described. A diagnosis of aplastic anaemia was made from severe pancytopenia with hypoplastic marrow. Laboratory studies suggested an association of bone marrow suppressive T-lymphocytes with the pathogenesis of aplastic anaemia. Following the administration of mepithiostan and prednisolone, pancytopenia improved gradually. Two years after the onset of aplastic anaemia, Raynaud's phenomenon developed and examinations revealed the existence of keratoconjunctivitis sicca and anti-SSA/Ro and anti-SSB/La antibodies.

Effects of aspirin DL-lysine on thrombin generation in unstable angina pectoris

To evaluate the effects of aspirin on thrombin generation in patients with unstable angina, plasma levels of thrombin-antithrombin III complex (TAT) as a new marker of thrombin generation and of 11-dehydro-thromboxane B2 (11-dehydro-TXB2) as an indicator of platelet activation were measured in 18 patients with unstable angina, including 8 patients with prolonged rest angina (> 15 minutes). Aspirin DL-lysine (900 mg) was administered intravenously to 9 of the 18 patients (aspirin group); the other 9 were not given aspirin during the first 24 hours of hospitalization (non-aspirin group). Clinical characteristics, angiographic features and medications other than aspirin were similar between the 2 groups. Levels of plasma TAT and 11-dehydro-TXB2 were significantly higher (p < 0.05) in patients with prolonged rest angina than in those without the condition (n = 10). In 5 patients with prolonged rest angina who received aspirin, plasma TAT levels (ng/ml) were significantly decreased (4.52 +/- 1.18 at baseline, 2.50 +/- 0.65 at 1 hour and 2.16 +/- 0.42 at 24 hours after aspirin administration, p < 0.01) with a significant decrease in plasma 11-dehydro-TXB2 levels. However, the reduction in TAT after aspirin administration was slight in patients without prolonged rest angina (n = 4). In contrast, levels of plasma TAT and 11-dehydro-TXB2 in the non-aspirin group remained unchanged during the study period. These results suggest that aspirin rapidly reduces thrombin generation through inhibition of platelet activity in patients with unstable angina with prolonged rest angina.

[The effectiveness of preservation of hepatic arterial blood flow by modified Appleby procedure with reconstruction of the hepatic artery--serial changes in postoperative liver function]

We investigated whether modified Appleby procedure with reconstruction of the hepatic artery can avoid complications due to a decrease in heptic arterial flow which has been comprehended in conventional Appleby's operation. The postoperative liver function of 17 patients undergoing modified Appleby's procedure was compared with that of 16 patients undergoing total gastrectomy and distal pancreato-splenectomy (control group). (1) Anticoagulant therapy was not required during and after operation. The common hepatic arterial flow after vascular anastomosis was 396 +/- 101 ml/min. Postoperative celiac arteriography revealed good patency of anastomosis. (2) There were no significant differences between the modified Appleby group and the control group in any of the blood levels of GOT, GPT total bilirubin and alkaline phosphatase at any point until the fourth postoperative week. In none of the patients in the modified Appleby group, the blood levels of GOT and GPT exceeded 250 IU/l. (3) In the modified Appleby group, ICG-R15 was 4 +/- 1% before operation and 6 +/- 3% at the first postoperative month. These results suggested that modified Appleby procedure enabled us to perform resection according to Appleby's operation safely, without need for preoperative or intraoperative examination about the retrograde blood flow mediated by the gastrodudenal artery.

Serial changes in renal function during laparoscopic cholecystectomy

Intraoperative serial changes in systemic hemodynamic parameters and in the results of renal function tests were studied in 7 patients who underwent laparoscopic cholecystectomy (LAP) in which intra-abdominal pressure was maintained at 12 mm Hg, and in 7 patients who underwent minilaparotomy cholecystectomy (MINI). No significant changes were observed in the parameters in the MINI group during the operation. However, urine output, effective renal plasma flow and glomerular filtration rate in the LAP group were decreased 60 min after initiation of pneumoperitoneum.