Allergic rhinitis in laboratory workers caused by occupational exposure to guinea pigs: an immunological and clinical study

Occupational exposure in laboratory workers to various animals can result in clinically significant respiratory allergies. We used clinical and immunological methods to study five laboratory workers who exhibited symptoms of nasal allergy upon occupational exposure to guinea pigs. As compared with a control group of ten nonallergic laboratory workers, the symptomatic workers generally had positive skin test reactions for allergens derived from the urine, saliva, and pelts of the guinea pigs. The study group with symptoms also showed high serum levels of specific IgE and demonstrated an immediate, positive reaction to nasal provocation testing with urine-derived antigen. However, specific IgG values in the sera of these patients did not differ significantly from control values. Overall results indicated that a type 1 allergy was involved.

Protein kinase C-independent activation of Raf-1 and mitogen-activated protein kinase by leukotriene B4 in guinea pig eosinophils

Leukotriene B4 (LTB4) and phorbol 12-myristate 13-acetate (PMA) were found to activate serine/threonine kinase c-Raf-1 (Raf-1) and mitogen-activated protein (MAP) kinase in guinea pig eosinophils. Raf-1 was activated by both compounds in a time- and dose-dependent fashion, and the activation by each paralleled that of MAP kinase. The LTB4 receptor antagonist ONO-4057 prevented the LTB4-induced activation of Raf-1 and MAP kinase, but had no effect on the PMA-induced activation of these kinases. The protein kinase C (PKC) inhibitors, (+/-)1-O-hexadecyl-2-O-methylglycerol (AMG-C16) and bisindolylmaleimide (GF 109203X), suppressed the PMA-induced activation of Raf-1 and MAP kinase, but not the LTB4-induced activation of both kinases. Our findings suggest that the activation of Raf-1 and MAP kinase by LTB4 involves a PKC-independent pathway.

[The characteristic feature of myocardial imaging with 123I-labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid in hypertrophic cardiomyopathy with asymmetric septal hypertrophy]

The aim of this study was to elucidate the characteristic feature of myocardial imaging with 123I-labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid (BMIPP) in the patients with hypertrophic cardiomyopathy (HCM). In 26 patients with asymmetric septal hypertrophy (ASH), the imaging data were acquired for 15 minutes after the injection of 123I-BMIPP by the emission computed tomography (ECT). ECT image was divided into 17 segments to score the severity of the defect in each segment using a 5-point grading system from score 3 to score -1; score 3 = severely decreased tracer uptake, score 2 = moderately decreased tracer uptake, score 1 = mildly decreased tracer uptake, score 0 = normal and score -1 = increased tracer uptake. Reduced uptake (Defect Score > or = 2) was frequently observed in septal portion of anterior wall (65%), septal portion of posterior wall (62%) and apical wall (73%). Defect score was higher in septal portion of anterior wall (p < 0.001), septal portion of posterior wall (p < 0.01) and apical wall (p < 0.01) than in the ventricular septum. This result indicates that in hearts with ASH, 123I-BMIPP image reveals severely impaired fatty acid metabolism in these regions. With the reference of the previous report about histologic features in necropsy hearts with HCM, myocardial fatty acid metabolic disorder shown by reduced 123I-BMIPP uptake is closely related to the histological abnormalities in hearts with HCM.

Retroauricular subcutaneous Dacron tunnel for extracranial-intracranial autologous vein bypass graft. Technical note

✓ The authors describe the application of a Dacron tube as a retroauricular subcutaneous tunnel in extracranial-intracranial autologous vein bypass graft.

Characteristics of human hepatocellular carcinoma cell lines (Hep-KANO) derived from a non-hepatitic, non-cirrhotic hepatitis B virus carrier

We have established two cell lines of hepatocellular carcinoma [Hep-KANO, clone 1 (CL-1) and clone 2 (CL-2)] from tissue obtained at autopsy of a hepatitis B virus (HBV) carrier without histological signs of hepatitis or liver cirrhosis. These cell lines differed considerably from each other in morphology, proliferation pattern, alpha-fetoprotein secretion, albumin synthesis, cytokine secretion, modal chromosome number and transplantability to nude mice. Histologic examinations also revealed differences between them. Amplification of N-myc, L-myc, H-ras, K-ras, N-ras, c-erb-B and c-erb-B-2 and rearrangement of p53 were not found in either of the cell lines. However, CL-1 and CL-2 showed an identical HBV-DNA integration pattern. A 4-fold amplification of c-myc was observed in CL-1, but not in CL-2. Hep-KANO cell lines, CL-1 and CL-2 may be useful in clarifying the question of whether hepatocarcinogenesis is directly caused by HBV infection.

Cavernous sinus cavernoma treated with radiation therapy--case report

A 71-year-old female presented with a syncopal attack. She underwent surgery for what appeared to be a meningioma. However, a small incision in the dura mater caused severe bleeding. Histological examination of the biopsy specimen showed sinus cavernoma with an incomplete pseudocapsule. The dura mater encapsulated the cavernous sinus cavernoma, explaining the severe bleeding from the dural incision. She was treated with Linac irradiation (40 Gy) which resulted in a decrease in tumor size. Radiation therapy is indicated for the treatment of cavernous sinus cavernoma, especially if associated with severe intraoperative bleeding.

Primary pineal melanoma with long-term survival: case report

A rare case of primary pineal melanoma is reported. The patient was a 53-year-old woman who complained of a severe headache. Computed tomography and magnetic resonance images revealed obstructive hydrocephalus caused by a mass lesion in the pineal region. A biopsy was performed through an occipital transtentorial approach. A black pigmented solitary tumor was seen without leptomeningeal dissemination. Histologic examination revealed melanoma. Chemotherapy consisting of dacarbazine, ACNU, vincristine, and interferon was used. Follow-up imaging studies showed dramatic reduction of the tumor without recurrence for 4 years. This report demonstrates that a solitary primary intracranial melanoma without leptomeningeal dissemination and with rare mitoses may yield a good result with chemotherapy.

Acute brain swelling in cerebral embolization model of rats. II: Biochemical study

To investigate the mechanism of acute brain swelling after cerebral embolism in rats, the authors evaluated the regional changes in tissue pH, ATP, blood-brain barrier function, and water content. The deep cerebrum--thalamus, hypothalamus, and hippocampus--had alkaline change in tissue pH accompanied with the disruption of the blood-brain barrier, decrease of ATP, and increase of water content. The cortex and the caudate putamen, on the other hand, did not show edema though acidic change and ATP decrease were seen. These results suggest that an early vasogenic edema in the deep cerebrum is a main factor for evolving acute brain swelling in this embolization model of rats.

[Near infrared spectrophotometric monitoring for cerebral ischemia during the occlusion of the internal carotid artery at CEA]

Near infrared spectrophotometry provides noninvasively real-time information on cerebral oxygenation and cerebral blood volume. Using this method of spectrophotometry we investigated the adequacy of collateral circulation during cross-clamping of the internal carotid artery in patients who underwent carotid endarterectomy. In 15 patients, oxy-hemoglobin, deoxyhemoglobin and total hemoglobin were monitored continuously by near infrared spectrophotometry at the ipsilateral frontal area on the operated side. Changes in these parameters following temporary cross-clamping of the internal carotid artery were evaluated. The stump pressure of the internal carotid artery was measured in every patient. Only the maximum decrease in oxy-hemoglobin during cross-clamping of the internal carotid artery correlated significantly with the stump pressure of the internal carotid artery. Changes in oxy-hemoglobin during cross-clamping of the internal carotid artery demonstrated three patterns; no change or minimally decreased (4 patients), decrease with recovery (4 patients), and decrease without recovery (7 patients). The stump pressure of the internal carotid artery in patients who had no recovery of their decreased oxy-Hb was significantly lower than that in any other pattern (p < 0.01, Mann-Whitney U analysis). Patients who experience decrease in oxy-Hb without recovery following cross-clamping of their internal carotid artery may have poor collateral circulation and therefore may develop cerebral ischemia.

[A case of idiopathic hypoparathyroidism associated with primary hypothyroidism and diabetes mellitus]

A 50-year-old man was admitted to our hospital for the evaluation of hypocalcemia and the treatment of diabetes mellitus. Seven months before admission, he sometimes felt thirst and polyuria, and 4 months before admission, he went to a doctor to check his blood glucose and was diagnosed as having diabetes mellitus which had suddenly developed. At that time he was treated with sulfonylurea, but his diabetic control was very poor. At the time of admission to our hospital, the patient's serum calcium (Ca) level was 5.7 mg/dl, phosphorus (P) 5.0 mg/dl, and fasting blood glucose 308 mg/dl, but urinary ketone bodies were not detected. High sensitive assay of parathyroid hormone (HS-PTH), intact PTH and C-terminus PTH concentrations were under the level of detection. TSH level was slightly high (6.1 mu U/ml) with positive antimicrosomal and antithyroglobulin antibodies but thyroid hormone levels were within normal limits. TRH test showed over-response of TSH. Based on Ellsworth-Howard test, we made the diagnosis of idiopathic hypoparathyroidism associated with primary hypothyroidism and diabetes mellitus. He was treated with insulin twice a day and reached good control, and he was also administered 1 alpha-OH-D3 and calcium lactate resulting in an increase of serum Ca level after 2 weeks. These findings suggest that this case may be a polyglandular autoimmune (PGA) syndrome type 1 reported by Neufeld, which is very rare in Japan. The type of diabetes mellitus of this case is controversial. It is, however, necessary to pay attention to the decrease of the patient's insulin-secreting activity because autoimmune disorders are accompanied by this case.

Expression and characterization of a fusion protein between the catalytic domain of poly(ADP-ribose) polymerase and the DNA binding domain of the glucocorticoid receptor

A fusion protein comprising the DNA-binding region of the glucocorticoid receptor and the catalytic domain of poly(ADP-ribose) polymerase was constructed. This chimeric protein was expressed both in E. coli and in eukaryotic cells and was recognized by antibodies to both polymerase and the glucocorticoid receptor. Similar to polymerase, the chimera produced bona fide poly (ADP-ribose) polymers covalently bound to protein and was inhibited by 3-aminobenzamide. Like the authentic glucocorticoid receptor, the fusion protein formed a stable complex with DNA containing the glucocorticoid response element. In mammalian cells, the fusion protein significantly and specifically inhibited the ability of the glucocorticoid receptor to stimulate a reporter construct. These results indicate that polymerase activity can be targeted to specific DNA sequences and modulate gene expression.

[Myocardial ischemia and abnormality of cardiac sympathetic nervous function in apical hypertrophic cardiomyopathy]

Exercise 201Tl myocardial scintigraphy of patients with apical hypertrophic cardiomyopathy (AH) often shows transient perfusion defect in the apex. Catecholamine may be related to the pathogenesis of AH, but this is not certain. The relationship between hypertrophy, myocardial ischemia, and cardiac sympathetic nervous function were investigated by comparing 123I-MIBG myocardial SPECT with exercise 201Tl myocardial SPECT especially at the apex which is the hypertrophic region. Seventeen patients with AH, mean age of 53 +/- 11 years old, underwent 123I-MIBG myocardial SPECT and exercise 201Tl myocardial SPECT on separate days. Decreased tracer uptake regions and the severity and extent of the defect were evaluated visually and compared. Myocardial clearance of 123I-MIBG in apical, midventricular, and basal regions was calculated from the bull's eye display. 123I-MIBG SPECT showed a decreased uptake or defect in the apex of all patients. 201Tl SPECT showed a reversible perfusion defect in the apex of 10 patients, an irreversible perfusion defect in the apex in 3, and normal perfusion in 4. Comparing decreased uptake on the exercise 201Tl myocardial image and 123I-MIBG 4-hour delayed image, the severity of the defect was: MIBG > Tl in 12 patients (71%), MIBG = Tl in 5 (29%), and the extent of the defect was: MIBG > Tl in 11 (65%), MIBG = Tl in 6 (35%). Mean clearance of 123I-MIBG in the apical and midventricular regions was significantly higher than that in the basal region (apical 46.2 +/- 7.1%, midventricular 44.4 +/- 7.8%, basal 38.7 +/- 7.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of Matas test by CBF studies, angiographic cross-filling and stump pressure in CEA patients]

Temporary and/or permanent occlusion of carotid artery is one of the most important strategy in the surgical treatment for cervical vascular and paraclinoid lesions. Cerebral ischemia produced by this procedure should be preoperatively grasped for the safety of the surgeries. Matas test has been widely applied to estimate the collateral blood flow at the main artery occlusion by observing only clinical features. In this study, we measured CBF and common carotid artery stump pressure (CCA stump P) in contrast to angiographic cross-filling in 43 carotid endarterectomy (CEA) patients to quantitatively evaluate Matas test. The patients were manually occluded the CCA on the affected side and clinically observed for at least 10 minutes. CCA stump P and cross-filling were evaluated in all patients and CBF measurements were carried out in the patients who clinically tolerated Matas test. CBF studies were performed by single photon emission CT with Xe-133 inhalation method and CBF values were obtained in the middle cerebral artery territory before and during Matas test. CCA stump P was measured during carotid angiography by manual occlusion of the proximal site of the CCA. Cross-filling was evaluated with the contralateral carotid angiography during the manual occlusion of the affected CCA. CBF changes in Matas test were classified into the following four patterns; bilateral mild decreases in CBF, unilateral severe decrease in CBF, unilateral mild decrease in CBF and no decrease in CBF. The frequency of bilateral mild decreases in CBF, unilateral severe decrease in CBF, unilateral mild decrease in CBF and no decrease in CBF were 8, 10, 14, 7 of 43 patients, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute brain swelling in cerebral embolization model of rats. I: Epidural pressure monitoring

The authors measured epidural pressure of rats using a microballoon to monitor brain swelling after cerebral embolism. Rats with embolization of the major cerebral artery frequently demonstrated acute brain swelling. Within 5 hours of embolization, the increase in epidural pressure was 29.7 +/- 20.3 mm Hg (mean +/- SD), ranging from 3 to 68 mm Hg. The increase in epidural pressure tended to reach a near-maximal value within 30 minutes of embolization and thereafter stayed at that point until the end of the experiment. These results suggest that measuring epidural pressure can quantitatively assess acute brain swelling in rats.

[Ruptured distal anterior cerebral artery aneurysms presenting with acute subdural hematoma: report of two cases]

Two cases of ruptured distal anterior cerebral-artery aneurysms presenting with acute subdural hematoma are reported. Case 1 was a 55-year-old male, who showed abrupt disturbance of consciousness. An emergency CT revealed acute subdural hematoma at the right parietal convexity and interhemispheric fissure with moderate midline shift. There was no evidence of subarachnoid hemorrhage. Right carotid angiography showed an aneurysm at the right distal anterior cerebral artery. An emergency external decompression was performed and the aneurysm was clipped successfully through the interhemispheric fissure. In the operative field, subarachnoid hemorrhage could not been seen, and the patient had uneventful recovery. Case 2 was a 66-year-old female, who complained of severe headache. She deteriorated rapidly and become comatous with development of anisocoria. An emergency CT revealed acute subdural hematoma on the bilateral parietal convexities and interhemispheric fissure with severe midline shift. There was no evidence of subarachnoid hemorrhage. Carotid angiography showed right distal anterior cerebral artery aneurysm. An emergency external decompression was performed, then the aneurysm was clipped successfully. She recovered with disorientation and hemiparesis. Ruptured distal anterior cerebral artery aneurysms presenting with acute subdural hematoma without subarachnoid hemorrhage are rare. It is suggested that CT scans and history of patients are most important but an emergency angiography was prerequisite for correct diagnosis. Surgical treatment should be the best management in such cases.

[Effect of epinephrine added to spinal anesthesia with lidocaine and tetracaine]

The effect of epinephrine added to the solution of lidocaine and tetracaine for spinal anesthesia was investigated in patients undergoing elective surgery of lower extremities. Thirty patients received 3ml of 2% lidocaine and 0.4% tetracaine and 30 patients received the solution with 0.1 mg of epinephrine added. A lumbar puncture was performed at the L2-3 interspace, using a midline approach with a 25-gauge spinal needle. Mean highest level of pinprick analgesia was Th6.1 without epinephrine and Th4.4 with epinephrine, and mean time for regression to Th10 was 2.3 hours without epinephrine and 3.6 hours with epinephrine. Progression of analgesia level was significantly faster and prolongation of duration was significant greater after adding epinephrine. No severe complications were found in any patients. We concluded that adding 0.1 mg of epinephrine to 3 ml of 2% lidocaine and 0.4% tetracaine could produce clinically useful prolongation of spinal analgesia.

Effects of hexoses and their derivatives on glucagon secretion from isolated perfused rat pancreas

Although it has been firmly established that D-glucose inhibits glucagon secretion from pancreatic A cells, the regulatory mechanism of glucagon secretion by D-glucose has not been elucidated. To study this regulatory mechanism by D-glucose, the effects of hexoses and their derivatives on glucagon secretion from the A cells of isolated perfused rat pancreas were investigated. When these cells were perfused with D-glucose, D-fructose, D-sorbitol, D-galactose, 2-deoxy-D-glucose, D-gluconic acid sodium salt and D-glucosamine HCl salt, glucagon secretion was significantly inhibited. None of the hexoses or their derivatives tested were found to stimulate glucagon secretion. The effects of these sugars on glucagon secretion were independent of their metabolism in the cells. From the findings that the sugars both metabolized and unmetabolized in the cells demonstrated comparable inhibition of glucagon secretion from the isolated perfused rat pancreas, it is speculated that the recognition system for these sugars may be probably present on the A cell membrane and responsible for mediating these inhibitory effects of glucagon secretion.

[Evaluation of angiographic delayed vasospasm due to ruptured aneurysm in comparison with cerebral circulation time measured by IA-DSA]

Delayed vasospasm due to ruptured aneurysm has been basically evaluated by angiographic changes in contrast to clinical features such as delayed ischemic neurological deficits (DIND). However, the discrepancies between angiographic and clinical findings have been pointed out. In this study, angiographic changes and cerebral circulation time in ruptured aneurysms were simultaneously investigated with IA-DSA. Thirty-two patients, who had ruptured aneurysms at the anterior circle of Willis and neck clippings at the acute stage, were investigated. Carotid angiogram was performed with IA-DSA on the 7-13th day after the attack. Angiographic changes were evaluated by Fischer's classification and circulation time was calculated in the following way. A time-density curve was obtained at the two ROI's; the C3-C4 portion and the rolandic vein. Circulation time was defined by the difference between the time showing peak optical density at the carotid and the venous portion. The control value of this circulation time obtained from 20 cases with non-rupture aneurysm and epilepsy was 3.4 sec (53 year old) on the average. X-ray CT scan examination was performed at the same time and clinical features were observed everyday. Angiographically, 3 cases were free from vasospasm, 18 cases were found to present slight to moderate vasospasm, and 11 cases showed severe vasospasm. Circulation time in patients with no spasm was 3.6 seconds, in patients with slight to moderate vasospasm it was 4.3 seconds and in patients with severe vasospasm it was 6.8 seconds. Ten patients showing cerebral infarction on CT scans demonstrated significantly long circulation time, 7.0 second on the average.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinicopathoradiological studies in 15 cases of megadolichobasilar anomaly]

We clinicopathoradiologically assessed 15 angiographically diagnosed megadolichobasilar anomalies. Nine of the patients were male and 6 were female; their average age was 61 years. Eleven patients presented with cerebral ischemic attacks, other two complained of trigeminal neuralgia and the remaining two suffered severe headaches. Twelve of the patients had severe hypertension. Vertebral angiography revealed marked elongation of the basilar artery with severe tortuousity and dilatation. The average distance from the dorsum sellae to the basilar artery bifurcation on the lateral view was 24.7 mm, and the average maximum diameter of the basilar artery was 8.6 mm. Aneurysmal dilatation of the basilar artery was also observed in four cases. In 14 of the 15 patients CT scans revealed characteristic findings, such as tubular high density mass with evident contrast enhancement extending from the ventral medulla to the interpeduncular cistern. The outcome was extremely poor, with five deaths and four patients with severe dementia. In the two autopsy cases, enlarged internal lumens could be observed despite severe atheroscrelotic changes, such as intimal thickening by atheromas.

Correlation between clotting and collagen metabolism markers in rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disease caused essentially by an immune-mediated mechanism. However, abnormalities of the clotting system have also been incriminated as having an important role in the pathogenesis of this disease. This study aims at assessing the clotting system and collagen metabolism alterations and the relationship between perturbances of the hemostatic pathway and the destructive and fibroproliferative processes in patients with rheumatoid arthritis. The coagulation system was evaluated by measuring thrombin-antithrombin III complex (TAT), prothrombin time (PT), activated partial thromboplastin time (APTT), and antithrombin III (AT-III). The fibrinolysis system was assessed by measuring fibrin degradation products (FDP), fibrinogen (FBG), alpha 2-antiplasmin (alpha 2-PI), D-dimer (DD) and plasmin-alpha 2-antiplasmin complex (PAP). As markers of collagen metabolism, the type III procollagen peptide (PIIIP) and the 7S domain of type IV collagen (7S-collagen) were determined. Blood concentrations of DD, PAP, TAT, PIIIP, and 7S-collagen were significantly higher in rheumatoid arthritis patients compared to controls. Serum levels of PIIIP were significantly correlated with PT, APTT, AT-III, FDP, and DD. 7S-collagen levels were inversely related to AT-III and FBG values. This study demonstrated the occurrence of a subclinical intravascular coagulation in rheumatoid arthritis and suggested the important role of blood coagulation in the alteration of the extracellular matrix metabolism in this disease.

A case of allergic liver injury induced by tegafur

A 51-year-old woman constitutionally susceptible to allergy presented with acute allergic liver injury. She was taking tegafur for treatment of carcinoma of the uterus. The acute liver injury appeared 3 weeks after the first drug administration. She had marked elevation of glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT), moderate jaundice, and eosinophilia. The virus markers revealed hepatitis B surface antigen (HBsAg) (-) antibody to hepatitis B surface antigen (HBsAb) (+), and immunoglobulin M HA antibody (IgM HA Ab) (-). The laparoscopic and histologic findings were compatible with drug-induced liver injury. Further, the results of the lymphocyte stimulation test (LST) and challenge test by tegafur were positive. From the above findings, the liver injury was diagnosed to be an allergic reaction induced by tegafur. The hepatic function returned to normal about 20 days after tegafur administration was suspended. Allergic liver injury induced by tegafur is very rare. We report the case with a short review of the literature.