Absence of association between human spumaretrovirus and Graves' disease

Graves' disease (GD) is an autoimmune thyroid disease. The etiology of GD is still not clear. Both genetic and environmental factors, such as infectious agents, are believed to be involved in its pathogenesis. Recent findings suggest a role for human spumaretrovirus (HSRV) in the pathogenesis of GD. To test this hypothesis, we looked for the HSRV gag region sequence in DNA extracted from the peripheral blood leukocytes and thyroid tissue of patients with GD, and controls. Genomic DNA was subjected to a highly sensitive nested polymerase chain reaction, followed by dot-blot hybridization with an internal probe. HSRV gag region DNA fragments were detected in the peripheral blood leukocytes of patients with GD and controls to a similar extent; 5.3% (2/38) of Caucasian patients with GD, 4.7% (2/43) of Caucasian controls, 4.7% (2/43) of African-American patients with GD, and 6.5% of (3/46) African-American controls. Similar values were obtained for the samples of thyroid tissues; 5.5% (1/18) of Caucasian patients with GD and 5.0% (1/20) of controls. The differences in all these comparisons were not statistically significant. These results do not support a role for HSRV in the pathogenesis of GD.

[Calcium metabolism in porcine liver transplantation]

The influence of warm ischemia on calcium metabolism in liver transplantation (LTX) was investigated using temporary portal vein arterialization (PA) technique. Group I pigs were added no warm ischemia (n = 6). In group II, donors were killed by KCl, and the livers were left in situ for 60 min (n = 6). After anastomosing the suprahepatic vena cava, revascularization was carried out employing PA. Initial reperfused blood was collected through the infrahepatic vena cava. All pigs survived more than 4 days in group I, whereas all died within 2 days in group II. In group II, Ca2+ levels of initial reperfused blood were significantly lower than those of arterial blood. Ca2+ levels of initial reperfused blood in group II were significantly lower than those in group I. Within 90 min after revascularization, biliary output and biliary calcium content and excretion in group I recovered to 30%, 100% and 40% of normal, respectively, but in group II only 2 animals could excrete bile. In conclusion, in the liver with 60 min warm ischemia, Ca2+ influx occurred immediately after revascularization followed by decreased calcium excretion in bile, which suggested that accumulation of calcium might be one of the causes of warm ischemic injury.

[Intratumoral LPD deposition within hepatocellular carcinoma without arterial tumor staining]

The dissociation of intratumoral LPD deposition and arterial tumor staining was investigated in 20 cases of hepatocellular carcinoma (HCC) without arterial tumor staining. The intratumoral deposition of LPD injected from the hepatic artery was observed in nine cases of HCC and coincided with the decrease in tumor vascular bed evaluated by photomicroscopic study and arterial portography. LPD deposition was not observed within the 11 other tumors, which were diagnosed as well differentiated HCC. Infusion angiographic CT revealed that the arterial and portal vascular beds were separated from each other. Therefore, arterial tumor staining was insufficient for accurate evaluation of the tumor vascular bed. The vascular bed in cancerous and noncancerous tissue was accurately evaluated by the addition of the contrast enhancements from the hepatic artery and the portal vein.

[Ultrasonography for traction injuries of the brachial plexus]

Results of preoperative ultrasonography (US) were compared with the subsequently offered operative findings retrospectively on 35 ventral rami of the cervical nerves (11 C5, 11 C6 and 13 C7) in 12 patients injured in motorcycle accidents in order to examine the usefulness of US in the diagnosis of nerve injury. The findings of a US-scanned ramus consisted of shape, internal echo pattern, regularity of border, and ratio of the diameter of an injured nerve to that of the corresponding nerve on the intact side (I/C). An intact ventral ramus was shown as a hypoechoic tubular structure with many parallel fine linear internal echoes, a regular border, and I/C ranging from 1.0 to 1.2. Categories such as I/C and shape improved the accuracy of differential diagnosis of severe nerve injuries. Avulsion of the ganglion was observed as a winding or tadpole-shaped remarkably enlarged (2.3 < or = I/C < or = 5.0) mass lesion, intraforaminal lesion as a thick (1.5 < or = I/C < or = 3.2) structure with an irregular shape and border close to the transverse process, and pseudocontinuity as irregular internal echoes. It was difficult to discriminate a lesion with continuity and localized scar formation around the nerve from normal fasciculi. These results strongly suggest that the application of improved US diagnosis to cervical nerve injury should make it much easier to select the best treatment for the patient, in that we can detect preoperatively those injuries to which nerve transplantation is not applicable.

[A synchronous double cancer of esophagus and stomach treated with 5-fluorouracil and consecutive low-dose cisplatin]

We report a case of double cancer of esophagus and stomach treated with 5-fluorouracil and consecutive low-dose cisplatin. The patient was a 58-year-old man with liver cirrhosis. Using upper gastrointestinal fiberscopy, a superficial depressed lesion (O-IIc) in the middle thoracic part of the esophagus and Borrmann 2 type lesion in the fundus of the stomach were also detected. Microscopic examination of the biopsy specimen revealed moderately differentiated squamous cell carcinoma and adenocarcinoma. But laparotomy could not be done due to impaired liver function (KICG 0.051, ICGR15 45.2%). The patient was treated for 28 days with continuous 24 hour infusion 5-FU, 250 mg/body/day plus low dose CD-DP, 10 mg/body daily by bolus infusion d1-5, 8-12, 15-19, 22-26. One month after the chemotherapy, both the gastric cancer and the esophageal cancer were remarkably reduced (diagnosis: PR), and showed no malignancy in the histology. There was no change in the histological findings of the esophageal lesion at 31 months after the chemotherapy. This therapy is effective for patients with gastric cancer and esophageal cancer.

Role of retinoic acid in mouse neural crest cell development in vitro

This study examines the role of retinoic acid (RA) in mouse neural crest cell development in culture. We have compared the effects of RA on the developmental behavior of mouse neural crest cells from different axial levels, that is the mesencephalic (cranial) and sympathoadrenal (trunk) levels by colony assay using antibodies against cell-type-specific markers. In control cultures in the absence of RA, the efficiency of colony formation by cranial neural crest cells was considerably lower than in colony cultures of trunk neural crest cells. Pulse-labelling experiments using 5-bromo-2'-deoxyuridine (BrdU) showed that the proportion of neural crest cells that incorporated BrdU was significantly smaller in day 5 cultures of cranial neural crest cells in the absence of RA compared to cultures from the trunk level. However, BrdU-incorporation matched the labelling observed in trunk crest cell cultures when RA was added to the culture medium. The efficiency of colony formation and the proportion of BrdU-incorporated cells in trunk crest cell cultures was similar in the presence and absence of RA. The results suggest that in the early stages of in vitro development, RA has a larger impact on proliferation and/or survival of cranial neural crest cells than of trunk neural crest cells. Moreover, the data indicate that RA significantly affects melanogenesis and the differentiation of serotonergic neurons in mouse neural crest cell cultures from both axial levels. Whereas melanogenesis was suppressed by RA treatment, serotonergic neurogenesis was promoted. Double-labelling experiments with antibodies against BrdU and serotonin (5-HT) indicated that RA selectively promoted proliferation of these neurons at a later stage of in vitro development. Furthermore, RA acted upon both committed cells and multipotent cells, Based on the results, we conclude that RA plays multiple critical roles in mouse neural crest cell development.

Comparative characterization of release factor RF-3 genes of Escherichia coli, Salmonella typhimurium, and Dichelobacter nodosus

The termination of protein synthesis in bacteria requires two codon-specific release factors, RF-1 and RF-2. A gene for a third factor, RF-3, that stimulates the RF-1 and RF-2 activities has been isolated from the gram-negative bacteria Escherichia coli and Dichelobacter nodosus. In this work, we isolated the RF-3 gene from Salmonella typhimurium and compared the three encoded RF-3 proteins by immunoblotting and intergeneric complementation and suppression. A murine polyclonal antibody against E. coli RF-3 reacted with both S. typhimurium and D. nodosus RF-3 proteins. The heterologous RF-3 genes complemented a null RF-3 mutation of E. coli regardless of having different sequence identities at the protein level. Additionally, multicopy expression of either of these RF-3 genes suppressed temperature-sensitive RF-2 mutations of E. coli and S. typhimurium by restoring adequate peptide chain release. These findings strongly suggest that the RF-3 proteins of these gram-negative bacteria share common structural and functional domains necessary for RF-3 activity and support the notion that RF-3 interacts functionally and/or physically with RF-2 during translation termination.

Risk assessment of adverse pulmonary effects induced by adrenaline beta-receptor antagonists and rational drug dosage regimen based on receptor occupancy

To clarify the beta-1 selectivity of beta-adrenergic receptor blocking agents (beta-blocking agents) after typical oral doses, the relationships between the effects on exercise heart rate or FEV1 and beta-1 or beta-2 receptor occupancies (phi 1, phi 2) of seven beta-blocking agents, acebutolol, atenolol, metoprolol, oxprenolol, timolol, propranolol, and pindolol were analyzed retrospectively. Nonlinear relationships between the pharmacologic effect and phi 1 and between the pulmonary adverse effect and phi 2 were obtained. Based on these findings, a new index of cardiovascular selectivity is proposed, given by the ratio of beta-1 receptor occupancy to beta-2 receptor occupancy (phi 1/phi 2). Using this new index, there was a little difference in beta-1 selectivity between acebutolol and pindolol (3.1:1.0), in contrast to a marked difference in beta-1 selectivity (320:1) as a conventional index between these two drugs. This finding indicates that even beta-1 selective drugs must be administered carefully to patients with pulmonary disease. Furthermore, the relationship between the pharmacologic or pulmonary effects and phi 1 or phi 2 has been analyzed quantitatively with a ternary complex model and used to develop rational dosage regimens for beta-1 selective beta-blocking agents, such as atenolol, to obtain the desired pharmacologic effects with minimum adverse pulmonary effects.

Familial non-multiple endocrine neoplasia medullary thyroid carcinoma: report of a case confirming a new clinical entity in Japan

Most hereditary medullary thyroid carcinomas (MTC) occur in association with multiple endocrine neoplasia (MEN) type 2 syndromes. Since Farndon et al. reported two kindreds, that is collections of relatives, with familial non-MEN MTC in 1986, only five kindreds with this disorder have been reported in the English literature. In this paper, we describe a rare Japanese kindred with familial non-MEN MTC, confirming the existence of this distinct clinical entity in Japan. A 42-year-old woman underwent a left hemithyroidectomy with modified neck dissection (MND) under a diagnosis of sporadic MTC at 28 years of age. She developed lymph node metastasis in the right neck region 7 years after the initial surgery, and underwent MND and right hemithyroidectomy. Although no findings of MTC were histologically confirmed in the resected right thyroid lobe, C-cell hyperplasia was observed. Hereditary MTC was strongly suspected, but we could not confirm specific manifestations associated with MEN type 2 in any family members. However, 7 years later, a paternal aunt and cousin were diagnosed with MTC. Other family members were evaluated by ultrasonography and calcium-pentagastrin provocation testing, and three additional patients with MTC across two generations were found. None of these patients had any extrathyroidal manifestations associated with MEN type 2, and the entity of familial non-MEN MTC was confirmed.

Replacement of the DR alpha chain with the E alpha chain enhances presentation of Mycoplasma arthritidis superantigen by the human class II DR molecule

Mycoplasma arthritidis mitogen (MAM) is produced by an organism which can cause chronic proliferative arthritis in rodents. MAM possesses a typical superantigenic activity; it has the ability to activate a large panel of T cells which express specific V beta segments of the T-cell receptor. The presentation of MAM to T cells by antigen-presenting cells is mediated primarily through its binding to the major histocompatibility complex (MHC) class II E alpha chain in mice and the DR alpha chain in humans. However, MAM is much less active for human peripheral blood lymphocytes than for mouse splenocytes. It was suggested that a difference in MAM binding affinity between human and mouse class II molecules may account for their different MAM activities. To examine this possibility, we generated a panel of B-cell transfectants whose DR molecule is composed of either the DR alpha or the E alpha chain paired with a DR3 beta chain. The ability of these transfectants to present MAM to human peripheral T cells was analyzed. Our data show that transfectants expressing E alpha DR beta chimeric molecules have higher MAM-presenting activity than transfectants expressing wild-type DR alpha DR beta molecules, while the latter have higher activity in stimulating DR3-alloreactive T cells. Since both types of transfectants present MAM to T cells expressing the same T-cell receptor V beta gene families, the higher MAM-presenting activity of the E alpha transfectant is not due to its ability to interact with a different set of T cells. Furthermore, both the E alpha 1 and E alpha 2 domains contribute to this increased affinity for MAM binding. Taken together, our data suggest that there may be multiple MAM binding sites on the E alpha and DR alpha chains and residues unique to the E alpha chain may provide additional affinity for MAM.

Histamine H1 receptor occupancy in human brains after single oral doses of histamine H1 antagonists measured by positron emission tomography

1. Histamine H1 receptor occupancy in the human brain was measured in 20 healthy young men by positron emission tomography (PET) using [11C]-doxepin. 2. (+)-Chlorpheniramine, a selective and classical antihistamine, occupied 76.8 +/- 4.2% of the averaged values of available histamine H1 receptors in the frontal cortex after its administration in a single oral dose of 2 mg. Intravenous administration of 5 mg (+)-chlorpheniramine almost completely abolished the binding of [11C]-doxepin to H1 receptors (H1 receptor occupancy: 98.2 +/- 1.2%). 3. Terfenadine, a nonsedative antihistamine, occupied 17.2 +/- 14.2% of the available H1 receptors in the human frontal cortex after its administration in a single oral dose of 60 mg. 4. There was no correlation between H1 receptor occupancy by terfenadine and the plasma concentration of the active acid metabolite of terfenadine in each subject. 5. PET data on human brain were essentially compatible with those on H1 receptor occupancy in guinea-pig brain determined by in vivo binding techniques, although for the same H1 receptor occupancy the dose was less in human subjects than in guinea-pigs. 6. The PET studies demonstrated the usefulness of measuring H1 receptor occupancy with classical and second-generation antihistamines in human brain to estimate their unwanted side effects such as sedation and drowsiness quantitatively.

Imidapril hydrochloride in essential hypertension: a double-blind comparative study using enalapril maleate as a control

OBJECTIVE

To assess the value of using imidapril hydrochloride (ACE/TA-6366), a long-acting angiotensin converting enzyme (ACE) inhibitor developed in Japan, to treat patients with essential hypertension.

PATIENTS AND METHODS

A double-blind, comparative, phase III study was carried out using enalapril maleate as a control, with a 4-week observation period and a 12-week treatment period. Both drugs were started at a dose of 5 mg once a day, increasing to 10 mg in patients whose antihypertensive response was insufficient after 4 weeks. The study included 231 outpatients aged 30-74 years; of these, 108 in the imidapril group and 115 in the enalapril group were assessed. There were no differences in background factors between groups.

RESULTS

An adequate antihypertensive effect was observed in 71.3% (77/108) in the imidapril group in in 66.1% (76/115) in the enalapril group, with no significant difference between groups. The pulse rate was unchanged in both groups. The drug had no adverse effects in 86.1% (93/108) of the imidapril group and 79.1% (91/115) of the enalapril group, with no significant difference between groups. Adverse drug effects were observed din 5.6% (6/108) of the imidapril group and 12.2% (14/115) of the enalapril group. Cough was the most frequent side effect, reported in 0.9% (1/108) of the imidapril group and 7.0% (8/115) of the enalapril group. Other side effects were reported in 4.6% (5/108) of the imidapril group and 5.2% (6/115) of the enalapril group. Abnormal laboratory values were observed in 3.7% (4/108) of the imidapril group and 0.9% (1/115) of the enalapril group.

CONCLUSIONS

Imidapril showed excellent clinical efficacy and safety compared to enalapril. The low incidence of cough is of particular interest.

Rarity of oncogenic mutations in the thyrotropin receptor of autonomously functioning thyroid nodules in Japan

Constitutively activating mutations have recently been identified in the thyrotropin receptor (TSHR) of hyperfunctioning thyroid adenomas and familial hyperthyroidism. In the present study, we evaluated the frequency of constitutively activating TSHR mutations in a large series of autonomously functioning thyroid nodules (AFTNs) in Japan. Forty-five AFTNs (38 solitary hyperfunctioning thyroid adenomas and 7 toxic multinodular goiters) were analyzed. Genomic DNA was extracted from paraffin-embedded tissue sections, from which DNA fragments encoding the mutational hot spots of the receptor (the third cytoplasmic loop and the sixth transmembrane segment) were amplified by polymerase chain reaction. In the single-stranded conformation polymorphism (SSCP) analysis, only one hyperfunctioning adenoma (no. 21) displayed a migration abnormality. In sequence analysis, an unusual mutation of alternate three-base deletions at nucleotides 1953-1957 (AAA GAT ACC to AAG TCC), resulting in one amino acid deletion (Asp at 619) and one conservative amino acid substitution (Thr to Ser at 620), was identified in tumor DNA but not in leukocyte DNA of no. 21. Further, the normal sequence in these regions was confirmed in 10 randomly selected samples with normal migrating patterns in SSCP analysis. The functional property of the mutant with delta 619 and T620S (designated TSHR delta 619) was then evaluated with in vitro mutagenesis and transfection studies. Unexpectedly, however, there were no significant differences in TSH binding affinity, and basal and TSH-stimulated levels of cAMP and inositol 1,4,5-triphosphate between the TSHR delta 619 and the wt-TSHR. In conclusion, the incidence of the constitutively activating TSHR mutations in AFTNs appears to be low in Japan. The oncogenic potential of a novel somatic mutant TSHR delta 619 identified in a hyperfunctioning adenoma in this study is at present uncertain because of its intact function.

A case of the incomplete double aortic arch diagnosed in adulthood by MR imaging

Double aortic arch is a rare vascular anomaly, particularly in adults. Most of patients were infants or children. In this report we describe a case of the incomplete double aortic arch in a 55 years old woman complaining of esophageal symptoms was found by esophagography and examined by MR imaging. This anomaly had double aortic arch with partial atresia of the left arch. The right common carotid artery (RCCA) and the right subclavian artery (RSA) arose from the large right aortic arch (RAA). The left common carotid artery (LCCA) and subclavian artery (LSA) arose from the left aortic arch (LAA). Aortic diverticulum was detected at the interior site of the descending aorta connected with the left subclavian artery (LSA). The mediastinal organs were surrounded by the vascular ring (RAA, LAA, LSA and aortic diverticulum).

[Treatment of solid tumor by a small amount of direct current]

Solid tumor treatment was given in our animal laboratory to determine the mechanism of tumor disappearance by direct electric current, and clinical trials were done on 9 far advanced recurrent rectal cancers. Solid tumors of Yoshida sarcoma in Donryu rat were treated by 1 mA of constant direct current for 1 hour a day, for 4 days. The tumors disappeared in 13/16 within 21 days. Positive results of DNA Nick-end labeling and ladder patterns in the gel electrophoresis of DNA were observed in the regressing tumor specimen. It is considered that apoptosis is the one of the mechanisms of a disappearing tumor. As for the clinical trial concern, in 9 cases of rectal cancer, one CR and 5 PR were seen.

[Relationship between sleep stage and blood pressure variability during apnea in patients with sleep apnea syndrome]

A marked transient increase in blood pressure can occur at the end of each apneic period in patients with sleep apnea syndrome (SAS) and SAS may be a risk factor for cerebrovascular disease. To estimate blood pressure variability during apnea arterial blood pressure was directly and continuously recorded, and the transient increase in blood pressure in each sleep stage was assessed. Polysomnography was done in 5 men with SAS: arterial blood pressure, oxygen saturation, and respiratory curves were recorded. The maximum arterial blood pressure during the apneic period was compared with that at the end of apnea. The transient increase in blood pressure was 32.2 +/- 5.8 mmHg (mean +/- S.E.) for systolic pressure and 18.2 +/- 2.1 mmHg for diastolic pressure. During REM sleep, the values were 38.8 +/- 6.6 mmHg for systolic pressure and 23.4 +/- 2.2 mmHg for diastolic pressure. The increase in arterial blood pressure was significantly higher during REM sleep than during N-REM sleep (p < 0.05). This wide variation in blood pressure suggests that SAS is a risk factor for cerebrovascular disease, and that SAS may promote essential hypertension.

[123I-metaiodobenzylguanidine myocardial scintigraphy in a case of pheochromocytoma before and after resection of it]

A 55-year-old man with pheochromocytoma was examined by 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy before and after resection of the tumor. MIBG images showed decreased uptake in infero-posterior wall before operation. The heart to upper mediastinum uptake ratio was low at the delayed anterior planar image, and mean MIBG clearance from the left ventricle was increased. These abnormal scintigraphic findings improved after resection of the tumor. We thought that these abnormal MIBG findings were not due to abnormal cardiac sympathetic nerve function, because ECG, chest X-ray, UCG and 201Tl myocardial scintigram did not reveal any abnormality. It may be presumed that these abnormal MIBG findings were caused by high plasma catecholamines concentration. The mechanism of abnormal MIBG findings of the heart remains uncertain in various heart diseases. MIBG findings in this case with pheochromocytoma before and after resection may contribute to interpretation of the kinetics of MIBG in heart.

[Intra-arterial infusion chemotherapy for advanced liver metastases from lung cancer via implantable vascular access: report of six cases]

Six patients with advanced liver metastases judged as a survival limiting factor from lung cancer were treated with intra-arterial infusion chemotherapy employing totally implantable vascular access. The treatment regimen included 5-FU/CDDP/EPIR/MMC/etoposide in various combinations and this therapy was repeated as long as possible. There were no serious side-effects or complications, such as bone marrow suppression or gastrointestinal symptoms. The therapy could be continued for a mean duration of 7.2 months (ranging from 2 to 13 months). Cause of death was due to extra-hepatic lesion in all 5 patients. The direct effect on liver metastases reviewed on CT scan was 83.3% (CR: 1, PR: 4, NC: 1), and the median survival period was 108 days (for small-cell group: 92 days; for non-small-cell group: 407 days). We conclude that this therapy is useful in the treatment of liver metastases from lung cancer because of its limited toxicity and high direct effect.

Frequency of mutations of insulin receptor gene in Japanese patients with NIDDM

To examine the prevalence of abnormalities in the insulin receptor structure gene in Japanese with non-insulin-dependent diabetes mellitus (NIDDM), a population of 51 patients with NIDDM was screened for mutations in this gene. Patient genomic DNAs of both alleles corresponding to 22 exons of the gene were amplified by polymerase chain reaction (PCR). The PCR products on pUC19 were sequenced. Three patients with heterozygous missense mutation Thr831-->Ala831 in exon 13 and one patient with heterozygous missense mutation Tyr1334-->Cys1334 in exon 22 of the beta-subunits were identified. Linkage analysis of one of the families plus statistical studies showed that the mutation Thr831-->Ala831 is possibly responsible for the onset of NIDDM. In COS cells transiently expressing both mutant receptor cDNAs and a cDNA of a M(r) 85,000 regulatory subunit of phosphatidylinositol 3-kinase (PI 3-kinase), the mutation Tyr1334-->Cys1334 impaired binding of the receptor with the M(r) 85,000 subunit of PI 3-kinase, but linkage analysis of the family showed that the mutation did not cosegregate with NIDDM in the pedigree. Therefore, one missense mutation (Thr831-->Ala831) in the insulin receptor, as found in three patients, is possibly involved in the etiology of a subset of the 51 NIDDM patients.

Changes in glycoconjugates revealed by lectin staining and stage-specific embryonic antigen-1 immunostaining in hamster submandibular glands during the postnatal period

Lectin binding and stage-specific embryonic antigen-1 (SSEA-1) immunoreactivity were studied in the developing submandibular glands of young Syrian golden hamsters (Mesocricetus auratus) from postnatal day 1 (the day of birth) to day 28. The submandibular glands were fixed in a solution containing 6% mercuric chloride, 1% sodium acetate, and 0.1% glutaraldehyde (HgCl2-G) or 4% paraformaldehyde (4P), and embedded in paraffin. Sections from HgCl2-G fixation were stained with three lectin-peroxidase conjugates: peanut agglutinin (PNA), Ulex europeus I agglutinin (UEA I), and wheat germ agglutinin (WGA). Sections from the 4P-fixed tissues were immunostained with monoclonal antibodies against SSEA-1, sialyl SSEA-1 and fucosyl SSEA-1. On the day of birth, the terminal unit of the submandibular gland was composed of fetal type secretory cells and proacinar cells. The secretory cells were PNA, UEA I, and WGA positive. The number of secretory terminal tubule cells decreased rapidly, and lectin-positive secretory cells were replaced by adult secretory cells that did not show PNA or UEA I stainings but were weakly positive for WGA. Fetal secretory cells were positively immunostained for SSEA-1 and sialyl SSEA-1, and immature ductal cells were stained for fucosyl SSEA-1. The positive stainings disappeared with regression of the fetal epithelial cells. Hence, modulation of glycoconjugate expression in the submandibular glands, which reflects changes in secretory cells from the fetal type to adult type during postnatal development, is revealed by lectin staining and immunostaining for SSEA-1 and related antigens.

Acute renal failure associated with Candida albicans infection

A 16-year-old male with a long history of steroid-responsive nephrotic syndrome developed fever, abdominal pain, thrombocytopenia and acute renal failure. The clinical course and renal histology were similar to, but not typical of, haemolytic uremic syndrome. Positive cultures (throat, oesophagus, stool), an elevation in serum levels of specific antibody and fungal polysaccharide (1,3) beta-D-glucan and response to the antifungal therapy indicated an association between this syndrome and infection with Candida albicans.

Pathogenesis of adenocarcinoma induced by gastrojejunostomy in Wistar rats: role of duodenogastric reflux

The pathogenetic effect of duodenogastric reflux of the development of gastric stump carcinoma was studied experimentally. In this animal model, 95 male Wistar rats were subjected to a specially designed gastrojejunostomy to divert the duodenal contents into the resected stomach through the afferent and efferent loop. The rats were fed normally without any carcinogen administration. The incidence of adenocarcinomas around the anastomosis of afferent loop was 0% at 10 weeks, 18.8% at 20 weeks and 34.4% at 40 weeks, so the incidence was apt to rise in parallel with passing of the weeks. At 40 weeks, the rats had a significantly higher incidence of adenocarcinoma in the gastric mucosa around the afferent loop than around the efferent loop (P < 0.05). Of particular interest is that invasive growth of the cancerous tissue into the liver was observed in one animal. Polypoid lesions called 'atypical hyperplasia' in the present study were similar to gastritis cystica polyposa of humans. The development of adenocarcinoma was found to be intimately connected with atypical hyperplasia, which might be promoted by repeated destruction and regeneration by duodenogastric reflux. These results suggest that the direct contact of the duodenal juice with the gastric mucosa induces carcinoma in the anastomotic lesion. From the clinical perspective, our findings suggest that a surgical technique that minimizes the duodenogastric reflux should be chosen.