Low ocean-floor rises regulate subpolar sea surface temperature by forming baroclinic jets

Sea surface temperature (SST) fronts in mid- to high-latitude oceans have significant impacts on extratropical atmospheric circulations and climate. In the western subarctic Pacific, sharp SST fronts form between the cold subarctic water and the recently found quasi-stationary jets that advect warm waters originating in the Kuroshio northeastward. Here we present a new mechanism of the jet formation paying attention to the propagation of baroclinic Rossby waves that is deflected by eddy-driven barotropic flows over bottom rises, although their height is low (~500 m) compared with the depth of the North Pacific Ocean (~6000 m). Steered by the barotropic flows, Rossby waves bring a thicker upper layer from the subtropical gyre and a thinner upper layer from the subarctic gyre, thereby creating a thickness jump, hence a surface jet, where they converge. This study reveals an overlooked role of low-rise bottom topography in regulating SST anomalies in subpolar oceans.

Sea surface temperature fronts in mid-and-high latitudes give significant impacts on atmospheric circulations and climate. Here, the authors uncover a new mechanism on the sea surface front genesis in the subpolar oceans in which small-amplitude bottom topography is surprisingly effective.

Mucocutaneous inflammation in the Ikaros Family Zinc Finger 1-keratin 5-specific transgenic mice

BACKGROUND

Our genomewide association study documented an association between cold medicine-related Stevens-Johnson syndrome/toxic epidermal necrolysis (CM-SJS/TEN) and Ikaros Family Zinc Finger 1 (IKZF1). Few studies examined biological and pathological functions of IKZF1 in mucosal immunity. We hypothesized that IKZF1 contributes to the mucocutaneous inflammation.

METHODS

Human skin and conjunctival tissues were obtained for immunohistological studies. Primary human conjunctival epithelial cells (PHCjECs) and adult human epidermal keratinocytes (HEKa) also used for gene expression analysis. We also generated K5-Ikzf1-EGFP transgenic mice (Ikzf1 Tg) by introducing the Ik1 isoform into cells expressing keratin 5, which is expressed in epithelial tissues such as the epidermis and conjunctiva, and then examined them histologically and investigated gene expression of the epidermis. Moreover, Ikzf1 Tg were induced allergic contact dermatitis.

RESULTS

We found that human epidermis and conjunctival epithelium expressed IKZF1, and in PHCjECs and HEKa, the expression of IKZF1 mRNA was upregulated by stimulation with polyI:C, a TLR3 ligand. In Ikzf1 Tg, we observed dermatitis and mucosal inflammation including the ocular surface. In contact dermatitis model, inflammatory infiltrates in the skin of Ikzf1 Tg were significantly increased compared with wild type. Microarray analysis showed that Lcn2, Adh7, Epgn, Ifi202b, Cdo1, Gpr37, Duoxa1, Tnfrsf4, and Enpp5 genes were significantly upregulated in the epidermis of Ikzf1 Tg compared with wild type.

CONCLUSION

Our findings support the hypothesis that Ikaros might participate in mucocutaneous inflammation.

Diagnostic usefulness of FDG-PET/CT in advanced malignant lymphoma of the uterus: report of two cases

Summary Malignant lymphoma of the uterus is difficult to diagnose because of its rarity and nonspecific symptoms. However, recently, 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become an important non-invasive diagnostic tool for the management of lymphoma patients. The authors report two cases of malignant lymphoma of the uterus, in which FDG-PET/CT was useful for diagnosis. Examination using ultrasonography or magnetic resonance imaging (MRI) demonstrated a normal-sized uterus and normal endometrium, but FDG-PET/CT showed FDG accumulation in the uterine body in both cases. Endometrial biopsy revealed diffuse large B-cell lymphoma, and chemotherapy with rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) was initiated immediately. Primary malignant lymphoma of the female genitalia is reported to be rare. The present authors' experience with FDG-PET/CT suggests that malignant lymphoma of the female genitalia (including metastasis) may not be as rare as previously reported. Uterine malignant lymphoma may be overlooked by the examination of ultrasound, CT, or MRI.

Variability of parvovirus B19 genotype 2 in plasma products with different compositions in the inactivation sensitivity by liquid-heating

BACKGROUND AND OBJECTIVES

Our previous report showed that parvovirus B19 genotype 1 in different solutions derived from plasma preparations showed different heat-sensitivity patterns during liquid-heating. In this study, we similarly examined B19 genotype 2.

MATERIALS AND METHODS

Two plasma samples one containing B19 genotype 1 and the other genotype 2 DNA were used. Four process samples collected immediately before the heat treatment step in the manufacture of albumin, immunoglobulin, haptoglobin and antithrombin preparations were spiked with B19 and subsequently treated at 60°C for 10 h. A low pH immunoglobulin solution was also spiked with B19 and treated at room temperature for 14 days. Infectivity was then measured.

RESULTS

B19 genotype 2, similar to genotype 1, showed three patterns of inactivation: (i) a rapid inactivation in the albumin and immunoglobulin preparations, (ii) a slow inactivation in the haptoglobin preparation and (iii) only limited inactivation in the antithrombin preparation. Its sensitivity in the low pH immunoglobulin solutions also resembled that of genotype 1.

CONCLUSION

Both genotypes 1 and 2 of B19 varied in sensitivity to liquid-heating and low pH among different plasma preparations.

Extent of hepatitis E virus elimination is affected by stabilizers present in plasma products and pore size of nanofilters

BACKGROUND AND OBJECTIVE

To investigate the physico-chemical properties of hepatitis E virus (HEV) with regard to inactivation/removal, we have studied four isolates with respect to sensitivity to heat during liquid/dry-heating as well as removal by nanofiltration.

MATERIALS AND METHODS

Hepatitis E virus in an albumin solution or phosphate-buffered saline (PBS) was liquid-heated at 60 degrees C for a preset time. HEV in a freeze-dried fibrinogen containing stabilizers was also dry-heated at 60 or 80 degrees C for a preset time. In addition, to clarify the removal of HEV, the purified virus in PBS was filtered using several types of virus-removal filter (nanofilters) that have different pore sizes. HEV infectivity or genome equivalents before and after the treatments were assayed by a semiquantitative cell-based infectivity assay or quantitative polymerase chain reaction assay, respectively.

RESULTS

Hepatitis E virus isolates in albumin solutions were inactivated slowly at 60 degrees C for 5 h and the resultant log reduction factor (LRF) was from 1.0 to > or = 2.2, whereas the virus in PBS was inactivated quickly to below the detection limit and the LRF was > or = 2.4 to > or = 3.7. The virus in a freeze dried fibrinogen containing trisodium citrate dihydrate and l-arginine hydrochloride as stabilizers was inactivated slowly and the LRF was 2.0 and 3.0, respectively, of the 72 h at 60 degrees C, but inactivated to below the detection limit within 24 h at 80 degrees C with an LRF of > or = 4.0. The virus in PBS was also confirmed as to be approximately 35 nm in diameter by nanofiltration. These results are useful for evaluating viral safety against HEV contamination in blood products.

CONCLUSION

The sensitivity of HEV to heat was shown to vary greatly depending on the heating conditions. On the other hand, the HEV particles were completely removed using 20-nm nanofilters. However, each inactivation/removal step should be carefully evaluated with respect to the HEV inactivation/removal capacity, which may be influenced by processing conditions such as the stabilizers used for blood products.

Preventive therapy for non-steroidal anti-inflammatory drug-induced ulcers in Japanese patients with rheumatoid arthritis: the current situation and a prospective controlled-study of the preventive effects of lansoprazole or famotidine

BACKGROUND

There is a lack of evidence for the efficacy of preventive medications for peptic ulcers (PUs) among long-term users of non-steroidal anti-inflammatory drugs (NSAIDs) in Japan.

AIM

To estimate the preventive effect by normal dose, not high-dose histamine-H2 receptor antagonists (H2RA) for NSAID-induced ulcers.

METHODS

We designed two different studies to assess the efficacy of anti-ulcer agents in rheumatoid arthritis (RA) in patients treated over a long term with NSAIDs. An investigative survey divided patients into those not taking anti-ulcer agents (non-medication group); those taking mucosal protective agents (mucosal protectant group), H2RA (H2RA group), proton pump inhibitors (PPI group), or a prostaglandin E1 analog (PG) (PG group). The second study compared prospectively the preventive effects of either famotidine 20 mg bd (famotidine group) or lansoprazole 15 mg daily (lansoprazole group) in patients with PU scars.

RESULTS

The prevalence of PU in the H2RA group was significantly lower compared to the mucosal protectant group (P < 0.05), and the mucosal protectant group was not significantly different to the non-medication group. The prospective study revealed that the PU onset rate of the famotidine group was 8% (1/13), and lansoprazole group was 15% (2/13), indicating no significant differences between the two.

CONCLUSIONS

In Japan, normal-dose H2RA is expected to be a new PU preventive treatment strategy in patients requiring long-term NSAID therapy.

Implications of corpus gastritis, atrophy and cyclooxygenase in the development of gastric erosions after curing Helicobacter pylori infection

BACKGROUND

Helicobacter pylori eradication decreases recurrence of peptic ulcers with marked improvement in histological inflammation, but gastric mucosal injuries may be developed even after eradication.

PURPOSE

To investigate the mechanisms responsible for the development of gastric erosions after eradication, we analysed the relationship between clinicopathological risk factors and the occurrence of gastric erosion after curing H. pylori infection.

PATIENTS

Sixty patients underwent endoscopy before, and 3, 6 and 12 months after the completion of H. pylori eradication.

METHODS

Risk factors associated with the development of gastric erosions after eradication were assessed by multivariate analysis, and cyclooxygenase-1 and -2 immunoreactivity was histologically examined in the gastric mucosa before and after eradication.

RESULTS

The cumulative prevalence of gastric erosions after H. pylori eradication was 38.3% within 1 year. Using multivariate analysis, corpus gastritis scores (inflammation score+activity score), corpus atrophy scores and an age of more than 50 years were found to be independent factors associated with the development of gastric erosion after eradication with odds ratios of 7.39, 0.13 and 5.00, respectively. Cyclooxygenase-2 immunoreactivity of the corpus was decreased for the non-erosion group after eradication, but not for the erosion group.

CONCLUSIONS

Severe gastritis or less severe atrophy in oxyntic glands but not in pyloric glands before eradication may be involved in the development of gastric erosions after curing H. pylori infection.

Monocyte chemoattractant protein 1 (MCP-1) released from Helicobacter pylori stimulated gastric epithelial cells induces cyclooxygenase 2 expression and activation in T cells

BACKGROUND

and aims: To clarify the interaction between gastric epithelial and mucosal T cells, we examined the role of cytokines released from epithelial cells in response to Helicobacter pylori water extract protein (HPWEP) in regulating T cell cyclooxygenase 2 (COX-2) expression and activation.

METHODS

Media from MKN-28 cells incubated with HPWEP for 48 hours were added to Jurkat T cells and human peripheral T cells. C-C and CXC chemokine concentrations in MKN-28 cell media, and COX-2 expression, interferon gamma (IFN-gamma), and interleukin (IL)-4 secretions in T cells were determined by western blot analysis and ELISA methods. Distributions of COX-2 positive T cells and monocyte chemoattractant protein 1 (MCP-1) in tissue specimens with H pylori associated gastritis were determined as single or double labelling by immunohistochemistry.

RESULTS

MCP-1, IL-7, IL-8, and RANTES were detected in media from MKN-28 cells incubated with HPWEP. Media as a whole, and MCP-1 alone, stimulated COX-2 expression and peripheral T cell proliferation. Anti-MCP-1 antibody inhibited media stimulated COX-2 mRNA expression in Jurkat T cells. Media stimulated IFN-gamma but not IL-4 secretion from peripheral T cells, while MCP-1 stimulated IL-4 but not IFN-gamma secretion. Both stimulated cytokine release, and peripheral T cell proliferation was partially inhibited by NS-398, a specific COX-2 inhibitor. In mucosa with gastritis, COX-2 was expressed in T cells and MCP-1 was localised mainly in epithelial and mononuclear cells. MCP-1 levels and the intensity of COX-2 expression in tissue samples were closely related.

CONCLUSIONS

Cytokines such as MCP-1, released from gastric epithelial cells in response to HPWEP, seem to modulate T cell immune responses, at least in part via COX-2 expression.

Interphase detection of t(4;14)(p16.3;q32.3) by in situ hybridization and FGFR3 overexpression in plasma cell malignancies

The immunoglobulin (Ig) genes are frequently involved in chromosomal rearrangements with a wide variety of partner loci in multiple myeloma (MM). However, several partner chromosomes have not been detected by conventional cytogenetic methods; for example, 4p16.3 (FGFR3), 6p25.3 (IRF4), and 16q23 (c-maf). To clarify the incidence of t(4;14)(p16.3;q32.3) in primary tumors of MM and to evaluate possible correlations with specific manifestations of the disease, G-banding, double-color fluorescence in situ hybridization (DC-FISH), and/or reverse-transcriptase polymerase chain reaction (RT-PCR) were performed on 40 patients with MM-two with plasmacytoma (PCM) and three with plasma cell leukemia (PCL). All patients were studied by DC-FISH; 40 were studied by G-banding and 36 were studied by RT-PCR. The FISH probes consisted of a cosmid pC385.12 containing the FGFR3 gene, a YAC Y6 containing VH, and a phage Iggamma1-10 containing the gamma1 constant region (Cgamma). We identified eight patients with either FGFR3/Cgamma fusion or FGFR3 overexpression: six patients with both FGFR3/Cgamma fusion and FGFR3 overexpression, one patient with FGFR3/Cgamma, and one with FGFR3 overexpression. FGFR3/Cgamma fusion was demonstrated at a frequency of 19% to 38% on interphase nuclei in seven of the 45 patients. Lytic bone lesions were found to be associated with FGFR3 overexpression. Interphase FISH with FGFR3 and Cgamma probes combined with RT-PCR proved to be an effective tool for detection of this fully cryptic translocation, thus facilitating the characterization of clinical features of MM patients with t(4;14).

CD38-mediated signaling events in murine pro-B cells expressing human CD38 with or without its cytoplasmic domain

To elucidate the signaling mechanism of CD38 (a transmembrane molecule highly expressed in immature hemopoietic cells), we transfected Ba/F3 murine pro-B cells with a cDNA encoding human CD38. CD38 ligation with anti-CD38 Abs caused rapid, transient, dose-dependent tyrosine phosphorylation of several proteins, including the tyrosine kinase TEC and the adaptor molecule CBL, and association of tyrosine-phosphorylated proteins with phosphatidylinositol 3-kinase p85. Exposure to anti-CD38 Abs or their F(ab')2 and Fab also induced tight aggregation of CD38-transfected Ba/F3 cells, which appeared to be Ca2+ and Mg2+ independent and did not involved LFA-1. Aggregation was abrogated by addition of the tyrosine kinase inhibitor herbimycin A and was delayed by the phosphatidylinositol 3-kinase inhibitor wortmannin, suggesting a link between biochemical events and cellular effects induced by CD38. Cell aggregation was accompanied by a decrease in cell recovery. After 3 days of culture on bone marrow-derived stroma, the mean (+/-SD) cell recovery in the presence of anti-CD38 (T16) was 10.5 +/- 9.2% (n = 7) of that in parallel cultures with an isotype-matched nonreactive Ab. Finally, CD38 ligation in Ba/F3 cells expressing a mutant human CD38 lacking the cytoplasmic domain induced tyrosine phosphorylation with intensity and kinetics similar to those seen with the entire protein. It also induced cell aggregation and decreased cell recovery. We conclude that CD38 triggers remarkably similar signaling pathways in human and murine immature B cells. This signaling is independent of the CD38 cytoplasmic domain, suggesting the existence of accessory transmembrane molecules associated with CD38.

Transoral joint release of the dislocated atlantoaxial joints combined with posterior reduction and fusion for a late infantile atlantoaxial rotatory fixation. A case report

STUDY DESIGN

A case of a late infantile atlantoaxial rotatory fixation is reported for which transoral anterior release was performed.

OBJECTIVES

To report a patient who underwent transoral anterior release of the dislocated atlantoaxial joint for a case of late infantile atlantoaxial rotatory fixation and quadriparesis.

SUMMARY OF BACKGROUND DATA

Infantile atlantoaxial rotatory fixation is diagnosed easily by using recently developed imaging techniques such as computed tomography, magnetic resonance imaging, and three-dimensional computed tomography. Nevertheless, patients in whom the condition has been overlooked still are encountered, and the reduction in these patients becomes impossible by traction or by simple posterior open reduction. Few reports on the management of type II-IV chronic atlantoaxial rotatory fixation in which an anterior surgery was performed exist in the literature, and no report exists in which atlantoaxial joint release on the both sides was attained.

METHODS

A 9-year-old girl had a type III atlantoaxial rotatory fixation and quadriparesis. She received direct skull traction and repeated manual reduction while she was awake or under general anesthesia. Neither reduction nor movement was obtained, according to the radiographs. Therefore, it was necessary to perform open reduction posteriorly and transorally to release the fixed and contracted joints between C1 and C2.

RESULTS

After the anterior release of the joints, there was an inherent force preventing a complete rotational reduction. However, after a successful posterior reduction and fusion, and for more than 4 years after surgery, neither rotatory displacement nor neurologic deterioration was noted.

CONCLUSIONS

The authors suggest that careful transoral anterior release of the atlantoaxial joint permits successful reduction in a case of chronic fixed atlantoaxial rotatory fixation combined with cord compression.

Genotype configuration in a case of primary gastric lymphoma with T-cell phenotype

T-cell malignant lymphoma of the gastrointestinal tract is rare. The genotype of gastric T-cell lymphoma remains unclear. The aim of this study was to elucidate the pathogenesis of a case of primary gastric T-cell lymphoma by using cytogenetics and molecular biology. Gastric biopsy specimens and lymphoma cells in the ascites were examined by immunocytology, cytogenetic analysis, and Southern blot analysis. The histological diagnosis of the gastric lymphoma was diffuse large cell type. T-cell markers were positive in immunocytochemistry of the gastric lymphoma cells and in FACS analysis of lymphoma cells in the ascites. All lymphoma cells in the ascites had complex abnormal karyotypes containing t(8;14)(q24;q32). Southern blot analysis revealed rearrangement of the IgH and C-MYC genes of the lymphoma cells in both the stomach and the ascites, but no comigration of the C-MYC with the JH locus could be detected. The TCR-beta and -gamma genes were in their germ-line configurations. In this patient, although the phenotype was T-cell lymphoma, the karyotype t(8;14)(q24;q32) and genotype had the characteristics of B-cell lymphoma. The unique B-cell genotype configuration and the C-MYC activation suggested that the cellular origin of this rare case of malignant lymphoma with a T-cell phenotype was quite immature lymphocytes.

Prevalence and growth characteristics of malignant stem cells in B-lineage acute lymphoblastic leukemia

We used a stroma-supported culture method to study the prevalence and growth characteristics of malignant stem cells in acute lymphoblastic leukemia (ALL). In 51 of 108 B-lineage ALL samples, bone marrow-derived stroma not only inhibited apoptosis of ALL cells but also supported their proliferation in serum-free medium. When single leukemic cells were placed in the stroma-coated wells of microtiter plates, the percentage of wells with leukemic cell growth after 2 to 5 months of culture ranged from 6% to 20% (median, 15%; 5 experiments). The immunophenotypes and genetic features of cells recovered from these cultures were identical to those noted before culture. All cells maintained their stroma dependency and self-renewal capacity. Leukemic clones derived from single cells contained approximately 10(3) to 10(6) cells after 1 month of culture; other clones became detectable only after prolonged culture. Cell growth in stroma-coated wells correlated with the number of initially seeded cells (1 or 10; r = .87). However, the observed percentages of positive wells seeded with 10 cells always exceeded values predicted from results with single-cell-initiated cultures (P < .003 by paired t-test), suggesting stimulation of leukemic cell growth by paracrine factors. In conclusion, the proportion of ALL cells with clonogenic potential may be considerably higher than previously thought.

Clinical significance of thallium-201 and gallium-67 scintigraphy in pulmonary tuberculosis

One hundred and thirty-nine patients with pulmonary tuberculosis were evaluated by means of gallium-67 and thallium-201 scintigraphy. The disease was clinically active in 83 and inactive in 56. The uptake ratio between the lesion and the contralateral normal lung field was calculated. The ratio determined by 67Ga scintigraphy was expressed as GR, and that determined by 201T1 scintigraphy (early or delayed) as ER or DR. The 201T1 retention index (RI) was calculated using the following equation: RI = DR - ER/ER x 100. The sensitivity, specificity and accuracy of 201T1 scintigraphy with respect to the activity of pulmonary tuberculosis were better than those of 67Ga scintigraphy (the figures for 201T1 scintigraphy were 88.0%, 82.1% and 85.6%, respectively, and those for 67Ga scintigraphy, 83.1%, 60.7% and 74.1%). We found a significant correlation between GR and ER, but there was no significant correlation between RI and ER. When the relationships between ER, C-reactive protein and 1-h erythrocyte sedimentation rate were examined among patients with abnormal uptake, no significant relationships were noted. In the 27 patients who could be followed up, GR and ER decreased with duration of the therapy, indicating a decrease in disease activity which was consistent with clinical findings. The RI was significantly higher in the early stages of therapy than in the later stages (P < 0.01), suggesting a temporary delay in 201T1 washout in the early stages. The washout seemed to be promoted by the effects of the therapy. Overall, it is concluded that 201T1 scintigraphy is more useful and more suitable than 67Ga scintigraphy for the evaluation of disease activity and therapeutic effects in patients with pulmonary tuberculosis.

Human B-cell progenitors and bone marrow microenvironment

Apoptosis of normal and leukemic immature B-cells in vitro is suppressed by contact with bone marrow-derived stromal layers. In stroma-supported cultures of immature B-cells, we found that ligation of CD38, a type II transmembrane protein, inhibited the cell growth and induced apoptosis. CD38 ligation also induced tyrosine phosphorylation and activation of intracellular substrates, including syk, phospholipase C-gamma, c-cbl, and phosphatidylinositol 3-kinase (PI 3-K). Wortmannin and LY294002, two potent inhibitors of PI 3K, rescued immature B cells from CD38-mediated growth suppression. In vitro culture of leukemic lymphoblasts may have potentially important clinical application. First, stroma-supported cultures of acute lymphoblastic leukemia (ALL) cells can determine the growth potential of leukemic cells. In a series of 70 children enrolled in a single program of chemotherapy, cell growth on stroma was a powerful and independent prognostic indicator. Second, a culture system capable of maintaining the majority of ALL blast cells at high levels of viability is also ideally suited for testing antileukemic drugs. Promising results were obtained with 2-chloro-deoxyadenosine and interleukin-4, leading to clinical trials of these two compounds in children with refractory ALL. In addition, we compared the direct antileukemic activities of dexamethasone and prednisolone and found that dexamethasone is five to six times more cytotoxic (on a molar basis) than prednisolone, in agreement with the anti-inflammatory activities of these drugs. This finding may serve to guide the selection of dexamethasone dosage in the treatment of ALL.

[Three-dimensional CT angiography of the portal vein using multiple threshold display]

To evaluate the usefulness of three-dimensional (3D) CT angiography of the portal vein obtained by using a multiple threshold display, 3D reconstructions were performed in 15 patients. The CT scanner employed was the Toshiba Xvigor. A volume of 150 ml of lopamidol 300 mg1/ml was administered at 3.3 ml/sec intravenously. Portal venous phase helical scanning was initiated 80 seconds after the start of the injection. Helical CT data were acquired using up to 25 continuous 1.0-sec rotations during a single breath-hold with an X-ray beam width of 7 mm and a couchtop movement speed of 7 mm/sec. Axial images were reconstructed at a section interval of 3 mm. Both the shaded surface display (SSD) and multiple threshold display (MTD) were generated by using Xtension with Sparc20. MTD was performed as follows. First, voxels, with higher CT values than that of liver parenchyma, were selected. Then, selected voxels were divided into eight parts, which were each assigned gradations of white to grey. The highest part of selected voxels, with higher CT values than that of the second branch of the portal vein, were set to white and a transparency of 0%. The other seven parts were each assigned transparencies of more than 0%. MTD images were compared with SSD in 15 cases by two radiologists. MTD images were superior to SSD images in quality, because MTD diminished surrounding artifacts due to liver parenchyma and enabled small vessels to be depicted clearly. Based on the above results, it was considered that MTD was a useful method for 3D CT angiography using enhanced helical CT.

[Three-phase dynamic helical CT for hepatocellular carcinoma: optimal scanning protocol]

To assess the optimal scanning protocol for three-phase dynamic helical CT, 20 patients were examined according to the following 4 methods (5 cases each) : (1) 100 ml Iopamidol (300 mgI/ml), at a rate of 2 ml/sec ; (2) 120 ml,3 ml/sec, (3) 150 ml, 3 ml/sec ; (4) biphasic method, initial 100 ml, 3.3 ml/sec ; remaining 50 ml, 1.6 ml/sec. Assessment of the time-density curve of the aorta, and the liver parenchyma, indicated that protocol (4) was superior to the others. Using protocol (4), 32 patients (62 nodules) with hepatocellular carcinoma underwent three-phase scanning, consisting of early, late, and delayed phases. Out of 61 nodules, 43 nodules were detected as high density areas in the early phase, 7 nodules as low density areas only in the late phase, and 3 nodules as low density areas only in the delayed phase. Compared with MRI, three-phase dynamic helical CT demonstrated numerous nodules, especially those less than 10 mm in diameter, and, therefore, was useful for the detection of hepatocellular carcinoma.

CD38-mediated growth suppression of B-cell progenitors requires activation of phosphatidylinositol 3-kinase and involves its association with the protein product of the c-cbl proto-oncogene

The signalling pathways that arrest the cell cycle and trigger cell death are only partially known. Dimerization of CD38, a 45-kD transmembrane type II glycoprotein highly expressed in immature B cells, inhibits cell growth and causes apoptosis in normal and leukemic B-cell progenitors, but the molecular mechanisms underlying these cellular responses are unknown. In the present study, we found that CD38 ligation in the immature B-cell lines 380, REH, and RS4;11 caused rapid tyrosine phosphorylation of the protein product of the proto-oncogene c-cbl. Dimerization of CD38 was accompanied by the association of cbl with the p85 subunit of phosphatidylinositol 3-kinase (Pl 3-K), resulting in markedly increased Pl 3-K activity in antiphosphotyrosine and anti-cbl immunoprecipitates. Wortmannin and LY294002, two potent inhibitors of Pl 3-K, rescued immature B cells from CD38-mediated growth suppression. This effect was observed not only in model B-cell lines, but also in cultures of leukemic lymphoblasts from patients, and in normal bone marrow B-cell progenitors as well. Concentrations of inhibitors that reversed cellular responses to CD38 significantly decreased Pl 3-K activity. By contrast, rapamycin, a p70 S6-kinase inhibitor, did not rescue immature B cells from CD38-mediated suppression. These results suggest that Pl 3-K activity is essential for CD38-mediated inhibition of lymphopoiesis and that cbl and Pl 3-K are regulatory molecules whose activation can result in suppression of cell proliferation and apoptosis in immature lymphoid cells.

[Two cases of breast cancer detected by 99mTc-tetrofosmin myocardial scintigraphy]

Breast cancer ranks the second position among the cancer of women in Japan. We report two cases of breast cancer detected by 99mTc-tetrofosmin. First case was 51 years old female with breast cancer (invasive papillotubular carcinoma) and dextrocardia. She received 99mTc-tetrofosmin myocardial scintigraphy to evaluate dextrocardia and suspicious coronary artery disease. A planar image of 99mTc-tetrofosmin myocardial scintigraphy showed myocardium at the right side, gall bladder at the left lower side and abnormal uptake on the left chest wall. Transaxial images of 99mTc-tetrofosmin myocardial SPECT showed myocardium at the right side and abnormal uptake on the left chest wall. Second case was 78 years old female with breast cancer (intracystic papillary carcinoma) and arrhythmia. 99mTc-tetrofosmin myocardial scintigraphy was performed to evaluate arrhythmia and suspicious coronary artery disease. A planar image of 99mTc-tetrofosmin myocardial scintigraphy shows hot nodule at the lateral side of the myocardium. Transaxial images of 99mTc-tetrofosmin myocardial SPECT showed abnormal uptake at the left lateral side on the chest wall. Both cases appeared illed foci as abnormal uptake with 99mTc-tetrofosmin scintigraphy, although histological diagnosis was different. We conclude that 99mTc-tetrofosmin scintigraphy is helpful for evaluating breast cancer.

CD38 signal transduction in human B cell precursors. Rapid induction of tyrosine phosphorylation, activation of syk tyrosine kinase, and phosphorylation of phospholipase C-gamma and phosphatidylinositol 3-kinase

Ligation of CD38 inhibits proliferation and induces apoptosis of human immature B cells, but the molecular mechanisms underlying this function are unknown. We found that CD38 dimerization with the specific mAbs T16 and IB4 induces rapid and transient tyrosine phosphorylation of several intracellular proteins in the immature B cell lines RS4;11, REH, 380, Nalm6, and OP-1. This effect could be markedly reduced by incubating cells with the tyrosine kinase inhibitors genistein, staurosporine, and herbimycin A. CD38 dimerization induced tyrosine phosphorylation of the protein kinase syk and increased syk kinase activity. CD38 dimerization also induced tyrosine phosphorylation of phospholipase C-gamma and of the p85 subunit of phosphatidylinositol 3-kinase (PI 3-K). The latter was accompanied by a distinct increase in PI 3-kinase activity in the immunoprecipitates obtained with an anti-phosphotyrosine Ab. In contrast to the signaling triggered by surface Ig engagement in B lymphocytes, CD38 ligation did not appear to induce tyrosine phosphorylation of the src-like protein tyrosine kinases lyn, fyn, and btk, or of vav- and ras-GTPase-activating protein, nor did it induce detectable changes in cytosolic CA2+ concentrations. CD38 signaling also differed from cytokine-induced signaling in that it did not cause tyrosine phosphorylation of Jak1 and Jak2. Finally, CD38 ligation did not inhibit IL-3-induced tyrosine phosphorylation of Jak2. These results identify CD38 as a cell surface receptor with signal transduction properties activated by dimerization. Induction of signal transduction by CD38 ligation implies the existence of a yet unidentified natural ligand of CD38.

CD38 signal transduction in human B cell precursors. Rapid induction of tyrosine phosphorylation, activation of syk tyrosine kinase, and phosphorylation of phospholipase C-gamma and phosphatidylinositol 3-kinase

Ligation of CD38 inhibits proliferation and induces apoptosis of human immature B cells, but the molecular mechanisms underlying this function are unknown. We found that CD38 dimerization with the specific mAbs T16 and IB4 induces rapid and transient tyrosine phosphorylation of several intracellular proteins in the immature B cell lines RS4;11, REH, 380, Nalm6, and OP-1. This effect could be markedly reduced by incubating cells with the tyrosine kinase inhibitors genistein, staurosporine, and herbimycin A. CD38 dimerization induced tyrosine phosphorylation of the protein kinase syk and increased syk kinase activity. CD38 dimerization also induced tyrosine phosphorylation of phospholipase C-gamma and of the p85 subunit of phosphatidylinositol 3-kinase (PI 3-K). The latter was accompanied by a distinct increase in PI 3-kinase activity in the immunoprecipitates obtained with an anti-phosphotyrosine Ab. In contrast to the signaling triggered by surface Ig engagement in B lymphocytes, CD38 ligation did not appear to induce tyrosine phosphorylation of the src-like protein tyrosine kinases lyn, fyn, and btk, or of vav- and ras-GTPase-activating protein, nor did it induce detectable changes in cytosolic CA2+ concentrations. CD38 signaling also differed from cytokine-induced signaling in that it did not cause tyrosine phosphorylation of Jak1 and Jak2. Finally, CD38 ligation did not inhibit IL-3-induced tyrosine phosphorylation of Jak2. These results identify CD38 as a cell surface receptor with signal transduction properties activated by dimerization. Induction of signal transduction by CD38 ligation implies the existence of a yet unidentified natural ligand of CD38.

[Clinical usefulness of dipyridamole loading 99mTc-tetrofosmin myocardial scintigraphy]

This study performed to establish the most suitable method in one-day protocol and to evaluate clinical usefulness of 99mTc-tetrofosmin myocardial scintigraphy after dipyridamole infusion. Image quality and liver overlapping of the myocardial SPECT were evaluated in 107 patients with old myocardial infarction (42 cases), angina pectoris (53 cases) and others (12 cases). Left ventricular wall motion and coronary artery stenosis were compared to myocardial uptake score in 55 patients who received cardiac catheterization. The suitable image quality was acquired in early SPECT images using 259 MBq of 99mTc-tetrofosmin. The overlapping between inferior wall and liver uptake was able to minimize over 45 minutes interval from injection of 99mTc-tetrofosmin to data acquisition. The segments of normal wall motion had no perfusion defect of the myocardial SPECT in all cases (100% (148/148)). The segments of abnormal wall motion had decreased myocardial uptake of the myocardial SPECT (77% (24/31)). The agreement between coronary artery stenosis and decreased myocardial uptake was 96% (24/25) in right coronary artery, 87% (26/30) in left anterior descending coronary artery and 83% (19/23) in left circumflex coronary artery. These data suggests that image quality of dipyridamole loading 99mTc-tetrofosmin myocardial scintigraphy. Myocardial perfusion in the 99mTc-tetrofosmin myocardial scintigraphy is good correlation to both left ventricular wall motion and coronary artery stenosis.

Characterization of a 14q+ marker chromosome in philadelphia chromosome positive acute lymphoblastic leukemia by DNA analysis and fluorescence in situ hybridization

We report a case of precursor-B acute lymphoblastic leukemia (ALL) with the Philadelphia chromosome (Ph) and a 14q+ chromosome whose additional material was a part of the long arm of der(9)t(9;22). A minor population carrying the standard Ph translocation without the 14q+ was also observed at the first presentation. The translocation of the BCR gene from chromosome 22 to the subtelomeric region of the 14q+ was confirmed by fluorescence in situ hybridization (FISH) using a yeast artificial chromosome (YAC) clone containing the BCR gene. The breakpoint of chromosome 14 could not be determined exactly but probably was at 14q24 or 14q32 by conventional chromosome analysis. Nevertheless, FISH using a YAC clone containing the human immunoglobulin heavy chain (IgH) gene locus, Southern blot, and pulsed-field gel electrophoresis (PFGE) analyses with IgJH probe, and loss of heterozygosity analysis at the alpha 1-antitrypsin (AT) gene locus showed lack of involvement of the IgH gene in the 14q+ and more centromeric breakage than the alpha 1-AT locus at 14q32.1. Thus, the formation of the 14q+ seemed to be a secondary genetic event after the Ph translocation and presumably played a minor role in the pathogenesis of B-cell malignancy in this case.

[Assessment of myocardial contraction and relaxation with 99mTc-tetrofosmin multi-gated myocardial SPECT]

Myocardial relaxation at the diastolic phase was not evaluated by multi-gated myocardial SPECT, although myocardial contraction at the systolic phase was studied by percent wall thickening and Bull's eye methods. We make out a myocardial volume curve and report to evaluate the myocardial relaxation using multi-gated myocardial SPECT. The study population consisted of 3 normal human subjects (3 male, 32-37 years old), 10 idiopathic cardiomyopathy, 10 coronary artery disease and 1 hypertensive heart disease combined with aortic regurgitation. All cases were injected 555 MBq of 99mTc-tetrofosmin (Amersham Healthcare Corporation) intravenously at rest. A triple detector gamma-camera (GCA-9300A, Toshiba Medical, Japan) and a data processing computer (GMS-5500A, Toshiba Medical, Japan) were used in this study. A cardiac cycle (R-R interval) was divided by 16 frames (50-80 msec per 1 frame). Eight myocardial volume curves were calculated at the anterior wall, apex and inferior wall of the vertical long axis view and were calculated at the septal wall, apex and lateral wall of the horizontal long axis view, respectively. The patterns of the myocardial volume curves were classified into 5 patterns (Normal pattern (N), Delayed Contraction pattern (DC), Delayed Relaxation pattern (DR), Mixed pattern (M) and Normal pattern with Decreased amplitude (ND)). Myocardial uptake was evaluated visually of grading into severe hypertrophy (5), hypertrophy (4), normal (3), mild hypoperfusion (2), hypoperfusion (1) and perfusion defect (0). We compared patterns of the myocardial volume curves to myocardial uptake in the same segments. It was possible to detect myocardial edge of the total 16 frames with 50-60% threshold in the normal volunteer and in patients with hypertrophic cardiomyopathy and to make a myocardial volume curve. The region of the severe myocardial perfusion defect could be detected with 20% threshold in patients with old myocardial infarction. In comparison with myocardial volume curves and myocardial uptake, 74.6% in the N pattern had a normal uptake (3), 66.7% in the ND pattern had a normal uptake (3), 61.5% in the DC pattern had a hypoperfusion segment (0, 1 or fill-in to normal uptake), 44.4% in the DR pattern had a hypertrophic segment (4, 5 or fill-in to increased uptake). The pattern of myocardial volume curve indicates myocardial contractility and relaxation in each myocardial segment.

[A comparison among 123I-IMP SPECT, EEG and MRI in patients with temporal lobe epilepsy]

N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT), electroencephalography (EEG), and magnetic resonance imaging (MRI) were performed in 19 patients with temporal lobe epilepsy during interictal stage. MRI demonstrated abnormal signal in mesial temporal lobe (hippocampus) in 10 of 19 patients and 123I-IMP SPECT showed a hypoperfusion area in 15 of 19 patients. When compared with EEG and MRI data, disagreement of the affected area was observed in 3 cases. In comparison of EEG and 123I-IMP SPECT data, disagreement of the affected area was observed in 6 cases. Although there were no disagreement in comparison of MRI and 123I-IMP SPECT. We made a reprojection data parallel to the hippocampus in 123I-IMP SPECT. These data demonstrated obviously a hypoperfusion area around the hippocampus. In cases within one month from seizure attack, wide hypoperfusion area was showed on 123I-IMP SPECT in comparison of abnormal signal area on MRI. It could be considered that a reprojection data parallel to the hippocampus was useful to know extent of hypoperfusion area in temporal lobe epilepsy.

p53 gene mutations and loss of a chromosome 17p in Philadelphia chromosome (Ph1)-positive acute leukemia

We screened 23 cases of Philadelphia chromosome (Ph1)-positive acute leukemia (Ph1AL) for loss of a chromosome 17p and mutations in exons 2 to 11 of the p53 gene by single-strand conformation polymorphism (SSCP) analysis and DNA sequencing. Loss of a distal part of chromosome 17p including loss of a whole chromosome 17 emerged in three cases, among which two were Ph1-positive acute lymphoblastic leukemia (Ph1ALL) with point mutations within the highly conserved region of the p53 gene. Another case of Ph1-positive acute myelogenous leukemia (Ph1AML) also exhibited a p53 point mutation in company with loss of normal p53 allele, although showing normal chromosome 17 homologues. We also performed Southern blot hybridization analysis to examine p53 gene rearrangements in 13 cases of Ph1AL. We found a rearrangement in one case of Ph1ALL and a loss of heterozygosity (LOH) at the p53 locus without any rearrangement in another Ph1ALL. Both cases showed no abnormality within the entire coding region by SSCP analysis. Thus, p53 gene alterations were commonly involved in Ph1AL with loss of a 17p (two point mutations in three cases), while rarely in cases with normal chromosome 17s (one point mutation in 20 cases and one rearrangement in 13 cases). Rare p53 gene alterations in Ph1AL may therefore be related to low incidence of loss of a chromosome 17p.

[A basic study of multi-gated single photon emission computed tomography with thallium-201]

A Multi-gated SPECT was acquired commonly in 64 x 64 matrix and 8 frames per cardiac cycle (64 x 64/8F). But it was not established that 64 x 64 matrix and 8 frames per cardiac cycle were the most suitable in multi-gated SPECT. Five normal volunteers were examined multi-gated 201Tl SPECT with 5 acquisition modes of 128 x 128 matrix/16 frames, 128 x 128/8F, 64 x 64/32F, 64 x 64/8F using multi-detector SPECT system (GCA-9300). And we calculated percent wall thickening (%WT) [%WT = (ES counts - ED counts)/ED counts] in 9 cases with 64 x 64/8F. The images quality of both 128 x 128/16F and 128 x 128/8F was not clear in compared with images of both 64 x 64/16F and 64 x 64/8F, because the end-diastolic phase of 128 x 128/16F images showed a decreased uptake of 201Tl in the antero-apical region. Although 64 x 64 (8) images had only 8 frames per cardiac cycle, we could observe systolic and diastolic phase and we could calculate %WT. The %WT (M +/- SD) of horizontal long axis images were 48 +/- 15 (sept. basal), 48 +/- 19 (sept. apical), 65 +/- 29 (apex), 49 +/- 22 (lat. apical) and 40 +/- 15 (lat. basal).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical effects of a combination treatment with cefodizime and minocycline for infections in patients complicated with hematological disorders]

We evaluated clinical effects and toxicities of a combination in treatment with cefodizime (CDZM) and minocycline (MINO) for infections complicated with hematological disorders in 67 patients. Fifty-nine patients were evaluable, including 32 with acute leukemia, 15 with malignant lymphoma, and 12 with other hematological disorders. Clinical efficacies were excellent in 17 cases, good in 24 cases, fair in 2 cases, and poor in 16 cases. The efficacy rate was 69.5% (41 cases/59 cases). This treatment was also effective in 8 of 12 cases in which granulocyte counts were less than 500/microliter through the course of administration. No subjective side effects were observed. Abnormal values in laboratory tests were noted in 5 cases. Mild elevations of GOT, GPT, Al-P and bilirubin were observed, but none was serious. Thus, the combination of CDZM and MINO is an effective and safe regimen for the treatment of infections in patients complicated with hematological disorders.

[512 x 2048 matrix whole body scintigraphy with laser imaging system]

Although we could acquire a detailed 512 x 2048 matrix whole body scintigraphy, the 512 x 2048 matrix whole body scintigraphy was divided to the upper and lower half of the body, because a many of CRT system displayed only 1024 x 1024 matrix with non interlace mode. We made 12 dots of normal vertical image distance to 0 dot with laser imaging system (Li-10 Konica medical inc.), and we printed these divided whole body images in the four partition of the film. The lead bar phantom (interval from 6 mm to 3 mm) filled with 99mTcO4- was studied by both 512 x 2048 matrix whole body scanning mode and 256 x 1024 whole body scanning mode in the basic study. And the distance between the lead bar phantom and the gamma camera was changed from 10 mm to 100 mm. We studied 41 patients with metastatic bone tumor (14 breast cancer, 7 lung cancer, 7 prostate cancer, 5 others, 6 unknown origin) clinically. However the 512 x 2048 matrix whole body scan was better quality of images than 256 x 1024 matrix whole body scan at 100 mm distance in the basic study. The abnormal uptake of metastatic sites was shown equally in both 512 x 2048 and 256 x 1024 matrix whole body scintigraphy. The 512 x 2048 matrix whole body scan was better quality of images than 256 x 1024 matrix whole body scan in 26 out of 41 patients, equal in 10 out of 41 patients and worse in 3 out of 41 patients. The matrix size of 512 x 2048 matrix whole body scintigraphy (0.98 mm2) was smaller than that of 256 x 1024 matrix whole body scintigraphy (1.95 mm2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of 99mTc-HM-PAO thigh accumulation in patients with cerebro-vascular disease]

99mTc-HM-PAO cerebral SPECT and whole body scintigraphy (WBS) were performed in 5 patients without cerebro-vascular disease (CVD) (Group 1), 31 patients with CVD but not hemiparesis (Group 2) and 18 patients with CVD and hemiparesis (Group 3). Four ROIs were drawn manually around the whole body (WB), brain (Br), right and left thigh (Th). We calculated some ratios: the total counts in the brain over the total counts in the whole body (Br/WB), the total counts in the thigh over the total counts in the whole body (Th/WB) and the mean counts in the thigh over the mean counts in the brain (Th/Br). The Br/WB was 6.9 +/- 1.8%, rt-Th/WB was 4.9 +/- 2.1%, lt-Th/WB was 5.1 +/- 1.3% and Th/Br was 0.46 +/- 0.17 in group 1. Whole body scintigraphies in group 1 revealed clear and similar images between right and left thigh. The Br/WB was 6.7 +/- 1.4%, Th/WB of paretic side was 4.6 +/- 1.0%, Th/WB of non-paretic side was 5.8 +/- 1.2% and Th/Br was 0.47 +/- 0.18 in group 3. The Th/WB in non paretic side was significantly higher than that in paretic side (p < 0.01). The thigh images in group 3 revealed clearly different between paretic and non-paretic thigh. In conclusion we could acquire the clear thigh images with 99mTc-HM-PAO. It was possible that we evaluated not only cerebral perfusion but also muscle atrophy and/or perfusion in patients with CVD using 99mTC-HM-PAO.

[Clinical efficacy of 99mTc-tetrofosmin myocardial scintigraphy--comparison to 201Tl myocardial scintigraphy]

99mTc-tetrofosmin is a lipophilic, cationic diphosphine which has been developed for myocardial imaging. We examined 9 patients with ischemic heart disease including 3 angina pectoris (AP), 4 old myocardial infarction (OMI), 1 AP with OMI and 1 syndrome X. One patient was examined before and after operation. 370 MBq of 99mTc-tetrofosmin was injected during exercise and 740 MBq at rest. And 74 MBq of 201Tl myocardial exercise and redistribution scintigraphy was also performed to compare with 99mTc-tetrofosmin myocardial scintigraphy. SPECT, multiple gated SPECT and anterior planar images were obtained in all cases. We calculated percent wall thickening (%WT) using multiple gated SPECT images. There was a decreased lung uptake in 99mTc-tetrofosmin planar images compared to 201Tl myocardial scintigraphy. Liver and Biliary system uptake in 99mTc-tetrofosmin images was decreased with intake of milk. Segmental comparison of SPECT images showed an agreement in 9/10 of the segment between 201Tl and 99mTc-tetrofosmin. We could obtain excellent quality of multiple gated SPECT images in all patients. We could calculate percent wall thickening (%WT) in all patients. We conclude that 99mTc-tetrofosmin myocardial scintigraphy should provide usefulness for detection of ischemic myocardium as same as 201Tl myocardial scintigraphy, although the biologic characteristics of two agents were different. These data and excellent quality of multiple gated SPECT images suggest that 99mTc-tetrofosmin is a new 99mTc agent for evaluation of patients with ischemic heart disease.

Alterations of the p53 gene in Philadelphia chromosome-positive leukemia including chronic myelogenous leukemia and acute leukemia

We analyzed the structural alteration of the p53 gene, by Southern blotting with conventional and/or pulsed-field gel electrophoresis, in patients with Philadelphia chromosome-positive leukemia (chronic myelogenous leukemia; CML, 34 cases and acute leukemia; AL, 5 cases). We found an alteration of the p53 gene in one of 5 AL patients. Loss of heterozygosity was detected in two CML patients with i(17q) chromosome, but we could find no other alterations in the remaining CML patients.

Absence in Ph-negative, M-BCR rearrangement-positive chronic myelogenous leukemia of linkage between 5' ABL and 3' M-BCR sequences in Philadelphia translocation

The Philadelphia (Ph) chromosome can be detected in the vast majority of patients with chronic myelogenous leukemia (CML). We performed a long-range analysis of chromosomal translocation junction by pulsed-field gel electrophoresis (PFGE) techniques, to examine whether molecular evidence of a reciprocal Ph translocation exists in Ph-positive CML as well as Ph-negative, M-BCR rearrangement-positive CML. The rearrangement within M-BCR and ABL was detected in all patients including nine Ph-positive CML, and three Ph-negative CML. The rearranged 3'-abl fragments showed comigration with rearranged 5'-bcr fragment in rare-cutting restriction enzyme digests in all patients with Ph-positive CML. Thus, the physical linkage of the 3' part of ABL to the 5' side of M-BCR on 22q-chromosome was shown. The same linkage was also demonstrated in all three patients with Ph-negative CML. Meanwhile, the rearranged 3'-bcr fragments showed comigration with rearranged pHabl5' (or T39-1-2) fragments in all patients with Ph-positive CML, indicating the linkage of the 5' end of ABL to the 3' part of M-BCR on 9q+ chromosome. However, this linkage was absent in two Ph-negative CML patients who could be studied. The results suggest that a genomic insertion of 3' ABL into M-BCR in Ph-negative CML occurs by a single cytogenetic event rather than a two-translocation mechanism.

[Clinical evaluation of ceftazidime monotherapy for infections complicated with hematological disorders]

Fifty patients with infections associated with hematological disorders were treated with ceftazidime (CAZ). Among them 44 cases were evaluable, including 21 with acute leukemia, 17 with malignant lymphoma, and 6 with other hematological disorders. Excellent responses were observed in 15 patients (34.1%) and good responses in 15 (34.1%), with an overall efficacy rate of 68.2%. The efficacy rate among sepsis and suspected sepsis cases was 67.6%. This treatment was also effective in 7 of 10 cases in which neutrophil counts were less than 500/mm3 through the course of administration. Laboratory abnormalities included mild eosinophilia in 1 case, slight elevation of GOT in 1 case and slight elevation of GPT in 1 case. These results suggest that CAZ is an effective and safe antibiotics for the treatment of infections in patients with hematological disorders.

[Clinical evaluation of a combination treatment with cefminox and fosfomycin for infections complicated in patients with hematological disorders]

We evaluated clinical effects and toxicities of a combination treatment with cefminox (CMNX) and fosfomycin (FOM) for infections complicated with hematological disorders in 56 patients. Among those, 52 patients including 22 with malignant lymphoma, 19 with acute leukemia, and 11 with other hematological disorders were evaluable. Excellent and good responses were obtained in 33 (63.5%) of the 52 patients. This treatment was also effective in 5 of 9 cases in which granulocyte counts were less than 500/mm3 through the course of administration. Side effects were observed in only one patient. Mild nausea occurred but was not serious. These results indicate that the combination of CMNX and FOM is an effective and safe regimen for the treatment of infections complicated in patients with hematological disorders.

[Clinical evaluation of imipenem/cilastatin sodium as a second line regimen in severe infections associated with hematologic disorders]

Imipenem/cilastatin sodium (IPM/CS), which has a broad spectrum of activity against both Gram-positive and -negative bacteria including methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, was used as the second choice for severe infections associated with hematological disorders. Sixty-five patients were treated with IPM/CS. Among them, 53 patients were evaluable for the clinical efficacy. Twelve patients were not evaluable due to the following reasons: 5 patients were treated with combinations of other regimens such as cefzonam, cefmenoxime, ciprofloxacin or gamma-globulin, 5 were patients to whom IPM/CS was administered as the first choice, and the remaining 2 patients were thought to be suffering not from febrile infections but from febrile tumor. Excellent responses were observed in 10 (18.9%) patients and good responses in 23 (43.4%) patients, with an overall rate of efficacy of 62.3%. The efficacy in septic patients was 75% (3/4), and that in patients whose peripheral granulocytes were continuously below 100/microliter was also 75% (6/8). Two patients who suffered from tumor fever and 5 patients who had received no chemotherapy before IPM/CS administration were included in the final evaluation of side effects. Side effects were observed in 16 patients (16/60, 26.7%). In a 61 years, female patient, a skin eruption was found 4 days after IPM/CS therapy was started. In 15 patients, mild gastrointestinal symptoms such as nausea and vomiting were identified within a few days after IPM/CS treatment was started. Abnormal laboratory data such as eosinophilia, liver dysfunction or renal dysfunction were also identified in 4 patients (4/60, 6.7%). Degrees of these abnormalities were very slight, however, and the continuation of treatment was not disturbed. These results indicated that IPM/CS was an effective second line regimen of chemotherapy for the treatment of severe infections in patients with hematological disorders.

Acute erythroleukemia with t(3;5) accompanied by hepatocellular carcinoma

A female patient in whom acute nonlymphocytic leukemia (ANLL, FAB-M6) developed during treatment of hepatocellular carcinoma (HCC) is described. Two years after partial hepatectomy and subsequent chemotherapy, leukemia developed following a 2 month preleukemic stage. Chromosomal analysis revealed an abnormal karyotype, 46,XX,-5, + der(5)t(3;5)(q25;q31). The balanced translocation t(3;5) has been observed in all types of ANLL and MDS except for ANLL M3 subtype. We summarize patients with ANLL M6 and t(3;5).

[Cytogenetic and molecular aspects of Ph-positive leukemia]

Cytogenetic and molecular aspects of Ph-positive leukemia are described in comparison with those of Ph-positive CML. Chromosomal characteristics of Ph+AL are; 1) mixture of a normal karyotype at diagnosis, 2) frequent combination with +Ph, +21, +6, +8, or -7, 3) recovery of a normal karyotype at remission. Additional chromosome changes at myeloid blast crisis (BC) of CML are characterized by +Ph, i(17q), +8, or +19. Meanwhile, lymphoid BC exhibits +Ph, +21, but not i(17q) or +19. There seems no cytogenetic difference between Ph+AL and lymphoid BC of CML, but i(17q) may be specific for CML BC. Eight patients with Ph+AL were studied with pulsed-field gel electrophoresis (PFGE) to examine the break site within ABL and BCR genes. One case had a M-BCR rearrangement and the remainder a rearrangement upstream of M-BCR. Minor-BCR rearrangement occurs seldom in CML but is detected in approximately a half of the reported cases of Ph+AL. ABL was rearranged within 1st or 2nd intron in all 8 cases. ABL breakpoints appear randomly distributed between exons 1b and 2 in both Ph+AL and CML.

Missing Y chromosome in Ph1-negative chronic myeloid leukemia with bcr rearrangement. Evidence for a bcr-abl recombination on chromosome 22 by in situ hybridization

In a case of Philadelphia chromosome (Ph1)-negative chronic myeloid leukemia (CML) without the Y chromosome, we investigated the differences, at the molecular level, from Ph1-positive CML. Using Southern blot analysis and in situ hybridization studies, we could demonstrate a rearrangement within the breakpoint cluster region (bcr), and the location of a bcr-abl fusion gene on chromosome 22. To our knowledge, this is the first case of Ph1-negative CML with a loss of the Y chromosome in which the molecular abnormalities are shown to be identical with those in Ph1-positive CML.

Reciprocal t(14;19)(q32.3;q13.1) in a patient with B-cell lymphoma

A patient with B-cell lymphoma with a chromosome rearrangement of t(14;19)(q32.3;q13.1) is reported. This patient had leukemic features and an aggressive clinical course. The histopathologic diagnosis was malignant lymphoma, small noncleaved cell. Chromosome analysis of the cells from a cervical lymph node and peripheral blood showed a reciprocal translocation between chromosome 14 with a break at band q32.3 and chromosome 19 with a break at band q13.1, to which the bcl-3 gene has been mapped. Monoclonal rearrangement of the JH gene was detected by Southern blot analysis. However, we could not detect rearrangement of the bcl-3 gene. This case also had a t(2;8)(q13;q24.1), but the c-myc gene remained in its germline. This is the first case with the reciprocal t(14;19) and 8q24 chromosomal breakpoint in a B-cell lymphoid malignancy.

[Clinical evaluation of cefuzonam of severe infections in leukemia and related disorders]

Cefuzonam (CZON) which has a broad spectrum on both Gram-negative and Gram-positive bacteria including methicillin-resistant Staphylococcus aureus was evaluated in severe infections associated with hematological disorders. Sixty five patients were treated with CZON. Among them, 56 patients were evaluable for effectiveness. Nine patients were not evaluable because 3 patients were treated with combination of other antibiotics such as ceftizoxime, norfloxacin, ofloxacin, 1 patient was subjected to additional therapy of G-CSF and gamma-globulin, 4 were the patients with other disease than hematologic disorder (3 malignant mesotheliomas, 1 ovarian cancer), and the remaining one was prophylactically treated. Excellent responses were observed in 21 (37.5%) patients, good responses in 11 (19.6%) patients, with an overall efficacy rate of 57.1%. The efficacy rate in septic patients was 80% (4/5), and that in patient whose peripheral granulocytes were continuously below 100/microliters was 60% (3/5). Three patients who suffered from malignant mesothelioma, one patient who suffered from ovarian cancer, one patient who was treated prophylactically were included in the final evaluation of side effects. Side effects were observed in 2 patients (2/61, 3.3%). In a patient of 7 years, mild liver disfunction (GOT/GPT, 46/55) was found in 10 days after CZON treatment was started. In a patient of 65 years, mild appetite loss was identified in 2 days after CZON administration was begun. The liver disfunction was improved soon after the cessation of the treatment. The mild appetite loss disappeared while the treatment was continued. These results showed that CZON was an effective and safe antibiotic for the treatment of severe infections in patients with hematological disorders.

Lack of involvement of the G-CSF gene by chromosomal translocation t(15;17) in acute promyelocytic leukemia

Using a human G-CSF cDNA as a probe, we analyzed the t(15;17) breakpoint by Southern blot analysis with conventional and/or pulsed-field gel electrophoresis in 12 patients with acute promyelocytic leukemia. The results did not show the rearrangement, deletion, or restriction fragment length polymorphism within the gene and in the surrounding sequences.

[A case report of an acute myelogenous leukemia (FAB M1) with Klinefelter's syndrome]

Reported is the second documented case in Japan of acute leukemia with Klinefelter's syndrome. The patient, a 52-year-old male, was admitted to hospital on July 9, 1983, after complaining of a fever and general malaise. The hematological examinations revealed a WBC count of 14,300/cmm with 32% being leukemic cells. Bone marrow aspiration disclosed a nucleated cell count of 687,000/cmm with 41.6% being leukemic cells consisting of myeloblasts. The endocrinic laboratory data showed a high level of urine gonadotropin and chromosomal studies revealed a 47,XXY karyotype. A diagnosis of acute myelogenous leukemia (M1) with Klinefelter's syndrome thus was derived from these findings.

Actions of human interleukin-4/B-cell stimulatory factor-1 on proliferation and differentiation of enriched hematopoietic progenitor cells in culture

We studied the effects of recombinant human interleukin-4 (IL-4) on colony formation by enriched hematopoietic progenitors. IL-4 alone did not support colony formation at all. When IL-4 was combined with granulocyte colony-stimulating factor (G-CSF), the number of pure neutrophil colonies increased three times over that supported by G-CSF alone. IL-4 added 5 days after the addition of G-CSF failed to exert this synergistic effect, indicating that IL-4 acts on the early stage of proliferation. The mapping experiments (sequential observation of colony formation) have clearly shown that IL-4 did not initiate progenitor cell proliferation. Based on these data, IL-4 may possess a direct action on progenitor cells; however, it can only act as a costimulant with G-CSF. In contrast, IL-4 had possible inhibitory effects on macrophage colony formation supported by interleukin-3 (IL-3) and macrophage colony-stimulating factor (M-CSF). In other words, IL-4 may induce progenitor cells to become sensitive to G-CSF and thereby induce neutrophil differentiation. Delayed addition experiments demonstrated that human IL-4, unlike murine IL-4, could support neither proliferation nor survival of erythroid burst or mixed colony forming cells. Neutrophil colony forming cells only survived and recovered after addition of G-CSF and erythropoietin on day 5 of incubation. On the other hand, IL-3 supported neutrophil, erythroid burst, and mixed colony forming cells as reported previously (Sonoda et al, Proc Natl Acad Sci USA, 85:4360, 1988). These results led us to propose that IL-4 possibly acts with more mature progenitor cells than those of IL-3 or granulocyte-macrophage (GM)-CSF.

The unbalanced 1;7 translocation in de novo myelodysplastic syndrome and its clinical implication

In our chromosome study of 97 patients with myelodysplastic syndrome (MDS), six showed an unbalanced translocation between chromosomes 1 and 7 [-7, +der(1)t(1;7)(p11;p11)]. All of them had morphologic myelodysplasia in trilineage of bone marrow cells, and cytopenia was the major finding in the peripheral blood. All six patients had symptoms of infection at the time of diagnosis, and five showed immunologic abnormalities (polyclonal hypergammaglobulinemia in four and increased marrow plasma cells in three). None of the patients survived more than 11 months after the diagnosis; the median survival time was 4 months. Both of the two patients whose karyotypes were reexamined in the course of their disease showed karyotypic evolution accompanying the coincidental leukemic transformation. Six patients with MDS who had the same chromosome abnormality [t(1;7)] are described and their characteristic clinical features are presented.

Chromosomal abnormalities define clonal proliferation in CD3- large granular lymphocyte leukemia

Six patients with lymphoproliferative disorder of large granular lymphocytes (LDGL) were studied for chromosomal abnormalities. When the patients were divided into two groups depending on the expression of a mature antigen of T cell lineage, CD3, two with CD3+ phenotype had a stable disease, whereas three of the four patients with CD3- phenotype had marked hepatosplenomegaly and a highly aggressive disease. Chromosomal abnormalities were detected in four of six patients, indicating a clonal proliferation of large granular lymphocytes in individual patients. In particular, chromosomal abnormalities were found in three of the four patients with CD3- LDGL, all of which had a germ-line configuration of the T cell receptor beta-chain gene. Thus, the chromosomal abnormalities provide definitive evidence for the clonal origin of the expanded cells in the CD3- LDGL.

Long arm deletion of chromosome 7 unrelated to original karyotype in recurrent t(8;21) acute myeloblastic leukemia

We describe a chromosomal abnormality, 7q-, unrelated to the original karyotype in a patient with recurrent t(8;21) acute myeloblastic leukemia. The 7q-, del(7)(q22q34), was seen in otherwise karyotypically normal cells. Cyclophosphamide was administered for 5 months during the maintenance therapy. Our observations indicate that unrelated karyotypes, besides karyotypic evolution, may be implicated in tumor cell heterogeneity and may support the previous documentation of a possibly causal relationship between chemotherapy and development of 7q-. A larger study will be required to elucidate the biologic significance, if any, of the unrelated karyotypes.

[Clinical evaluation of a combination treatment with cefbuperazone and amikacin in infections complicating with hematological disorders]

The efficacy and the safety of a combination regimen using cefbuperazone (CBPZ) and amikacin (AMK) were evaluated in severe infections in patients with hematological diseases. Twenty two patients were subjected to this combination therapy; among these, 18 patients were evaluable for the effectiveness. They included 9 cases of leukemia, 5 cases of malignant lymphoma, 2 cases of aplastic anemia, and 2 cases of angio-immunoblastic lymphadenopathy with dysproteinemia. Excellent responses were obtained in 5 patients and good responses in 5 patients, with a total effectiveness of 55.6%. Efficacy rates for individual types of infections were; 2/2 in sepsis, 6/14, or 42.9% in suspected sepsis, 1/1 in urinary tract infection, and and 1/1 in upper respiratory infection. The combination treatment was also effective in 4 of 6 cases in which neutrophil counts were less than 500/mm3 prior to therapy. Side effects were observed in only one patient. Mild proteinuria occurred in a 80-year-old male in 6 days after the regimen was started, but was not serious. These results indicate that a combination of CBPZ and AMK is safe and effective for the treatment of infections even in patients with compromised immunodefenses.

Distribution of breakpoint within the breakpoint cluster region (bcr) in chronic myelogenous leukemia with a complex Philadelphia chromosome translocation

We analyzed, by Southern blot hybridization, the site of breakpoint within the breakpoint cluster region (bcr) in six patients with a complex Philadelphia chromosome (Ph) translocation and in 23 unselected patients with a standard Ph. The breakpoint was found within the 5.8 kb bcr in all 29 patients. When the bcr was subdivided into four parts, fragments I-IV, based on the restriction enzyme sites, among the six patients with a complex Ph, two had a breakpoint at fragment I, three at fragment II, and one at fragment III. This distribution of breakpoints in patients with a complex Ph did not differ significantly from that in patients with a standard Ph. A deletion of an allele within the bcr was found in three patients (50%) with a complex Ph and in three (13%) with a standard Ph. The internal bcr deletion may be more common in patients with a complex Ph.

Clinical and cytogenetic features in six patients with chronic myelogenous leukemia and a complex Philadelphia translocation

Six patients with chronic myelogenous leukemia and a complex Philadelphia (Ph1) translocation are described. The complex Ph1 translocations were a three-way translocation in five patients and a five-way translocation in one. Additional chromosomal aberrations were detected in four of five patients when the blastic crisis supervened. The median survival time was 42 months. The remaining patient died of acute myocardial infarction 23.5 months after the diagnosis of CML was made. There seems no difference between these six patients and those with the standard Ph1 with respect to clinical, hematologic and cytogenetic findings.