The impact of external fixation on mortality in patients with an unstable pelvic ring fracture: a propensity-matched cohort study

AIM

There is not adequate evidence to establish whether external fixation (EF) of pelvic fractures leads to a reduced mortality. We used the Japan Trauma Data Bank database to identify isolated unstable pelvic ring fractures to exclude the possibility of blood loss from other injuries, and analyzed the effectiveness of EF on mortality in this group of patients.

PATIENTS AND METHODS

This was a registry-based comparison of 1163 patients who had been treated for an isolated unstable pelvic ring fracture with (386 patients) or without (777 patients) EF. An isolated pelvic ring fracture was defined by an Abbreviated Injury Score (AIS) for other injuries of < 3. An unstable pelvic ring fracture was defined as having an AIS ≥ 4. The primary outcome of this study was mortality. A subgroup analysis was carried out for patients who required blood transfusion within 24 hours of arrival in the Emergency Department and those who had massive blood loss (AIS code: 852610.5). Propensity-score matching was used to identify a cohort like the EF and non-EF groups.

RESULTS

With the use of propensity-score matching using the completed data, 346 patients were matched. When the propensity-score matching was adjusted, EF was associated with a significantly lower risk of death (p = 0.047). In the subgroup analysis of patients who needed blood transfusion within 24 hours and those who had massive blood loss, EF was associated with a significantly lower risk of death in patients who needed blood transfusion within 24 hours (p = 0.014) and in those with massive blood loss (p = 0.016).

CONCLUSION

The use of EF to treat unstable pelvic ring fractures was associated with a significantly lower risk of death, especially in patients with severe fractures. Cite this article: Bone Joint J 2018;100-B:233-41.

Clinical and Microangiographic Studies on Rupture of the E.P.L. Tendon after Distal Radial Fractures

The authors have treated 14 cases of spontaneous rupture of extensor pollicis longus tendon after fractures of the distal end of the radius, most of which were undisplaced or only slightly displaced. A microvascular study on five cadavers revealed that this tendon is subject to mechanical bending and attrition, has no mesotenon and has a poorly vascularised portion about 5 mm in length, which may be a cause of spontaneous rupture of the tendon.

Phosphoinositide-3 kinase-PKB/Akt pathway activation is involved in fibroblast Rat-1 transformation by human T-cell leukemia virus type I tax

Activated phosphoinositide 3-kinase (PI3K) and its downstream target Akt are essential for the fibroblast transformation induced by many viral products. Tax, encoded by human T-cell leukemia virus type I (HTLV-I), has been demonstrated to induce the transformation of rat fibroblast Rat-1 cell through NF-kappaB activation. By stable transfection of Rat-1 cells with expressing constructs of Tax and its mutant M47, which is defective in HTLV-I LTR transactivation, we selected their transformed clones, which have characteristics of NF-kappaB activation and colony formation beyond the cell monolayer (a malignant phenotype). However, these two characteristics in the transformed clones of Tax and M47 disappear after these cells have been treated with wortmannin, a specific inhibitor of PI3K. Further, increased activity of the PI3K/Akt is observed in the transformed clones of Tax and M47 as compared to the clones of empty vector Neo and the M148, which is defective in NF-kappaB activation and cell transformation. Increased activity of PI5K is present in the transformed clones of both Tax and M47 and in the M148 clone as compared to that in the Neo cell. It is known that the efficiency of Tax-induced cell transformation is not high; a minority of Tax-expressing clones show transformation, although the majority of Tax-expressing clones show activated NF-kappaB. A Tax-expressing, nontransformed clone after transfection with an active form of the catalytic subunit of PI3K, p110alpha, becomes transformed. Consistent with these results, a Tax highly-expressing human T-cell line MT2 exhibits both higher polyphosphoinositide turnover and higher activities of PI3K and PI5K than those of Jurkat or MT1 and HTLV-I-negative and a Tax-unexpressing cell line, respectively. These results demonstrate that the activation of the PI3K/Akt signaling pathway, excepting for the NF-kappaB, is also required for the cell transformation induced by Tax.

[Microcirculation in the periodontal tissues]

There is the microcirculation in the periodontal tissues with one characteristic vessel network with the periodontal membrane and the gingival. Two levels blood vessels network in the periodontal membrane surrounds the tooth root. The inner and outer marginal epithelium has two levels blood vessels network in the gingival, and the blood vessels network under the epithelium sends in a loop of capillary toward the epithelium. The blood vessels network of the periodontal tissues is subjugated to a injury of extraction of a tooth, orthodontic tooth movement and implant. And almost overcome it after the 30th day when received on injury.

Nerve distribution to the human knee joint: anatomical and immunohistochemical study

The nerve distribution to the knee joints was analyzed in 5 cadavers and 10 joint capsules specimens were resected during total knee arthroplasty. We found nerve fibers immunoreactive for anti-substance P antibody in the articular capsule. By confocal laser scanning microscopy, we evaluated the three-dimensional structures of the Ruffini's corpuscles and the free nerve endings, both of which were immunoreactive for anti-protein gene product 9.5.

Effects of YM358, an angiotensin II type 1 (AT1) receptor antagonist, and enalapril on blood pressure and vasoconstriction in two renal hypertension models

The effects of the angiotensin II type 1 receptor antagonist YM358 on blood pressure were compared to those of the angiotensin converting enzyme inhibitor enalapril in one-kidney, one-clip renal hypertensive rats (1K1C RHR), two-kidney, one-clip renal hypertensive rats (2K1C RHR) and normotensive rats (NTR). Additionally, the local drug actions in peripheral tissues were investigated using isolated mesenteric arteries from these rats. In 2K1C RHR, YM358 and enalapril produced a long-lasting hypotensive effect in a dose-dependent manner. In 1K1C RHR, YM358 (30 mg/kg) also produced an antihypertensive effect, whereas enalapril (30 mg/kg) had no effect. Administration of YM358, but not enalapril, to 1K1C RHR, 2K1C RHR and NTR did not affect heart rate. In isolated mesenteric arteries from 1K1C RHR and 2K1C RHR, angiotensin II (Ang II), angiotensin I (Ang I) and tetradecapeptide (TDP), a physiologically active renin substrate, produced concentration-dependent vasoconstriction. YM358 (10(-7) M) inhibited the vasoconstricting responses to Ang II, Ang I and TDP in isolated mesenteric arteries. In contrast, enalaprilat (10(-7) M), an active metabolite of enalapril, did not completely inhibit the response to Ang I and TDP. These results indicate that YM358 has higher efficacy than enalapril for the treatment of hypertension.

Inhibition of thrombin-induced neuronal cell death by recombinant thrombomodulin and E5510, a synthetic thrombin receptor signaling inhibitor

Thrombin, a serine protease generated by the activation of the blood coagulation cascade following vessel injury, converts fibrinogen to fibrin, activates platelets and several coagulation factors, and plays a pivotal role in thrombosis and haemostasis. Thrombin acts as a mitogen and apoptosis inducer in a dose-dependent fashion. We have previously shown that thrombin caused proliferation of vascular smooth muscle cells (VSMCs). Here, we show that a low concentration of thrombin caused proliferation of mouse neuroblastoma (Neuro-2a) and human neuroblastoma (NB-1) cells, while higher concentrations affected cell viability in a time-dependent manner. Similar effects were observed when thrombin receptor agonist peptide (SFLLRNPNDKYEPF, TRAP) was applied. The dying cells showed nuclear condensation and fragmentation, suggesting that cell death occurred by apoptosis. The extent to which thrombin induced cell death was significantly attenuated by recombinant thrombomodulin (rTM), or by a minimum functional domain of TM, termed E456. Furthermore, a synthetic compound that inhibits signaling from the thrombin receptor, 4-cyano-5,5-bis (4-methoxyphenyl)-4-pentanoic acid (E5510), and the antioxidant N-acetyl L-cysteine (NAC), efficiently prevented thrombin-induced Neuro-2a cell death. Thus, thrombin inhibitors and antioxidant appear to neutralize thrombin toxicity.

Cardiovascular and renal effects of conivaptan hydrochloride (YM087), a vasopressin V1A and V2 receptor antagonist, in dogs with pacing-induced congestive heart failure

The systemic hemodynamic and renal responses to conivaptan hydrochloride (YM087; 4'-(2-methyl-1,4,5,6-tetrahydroimidazo[4,5-d][1]benzoazepine -6-carbonyl)-2-phenylbenzanilide monohydrochloride), a vasopressin V1A and V2 receptor antagonist, were determined in pentobarbital-anesthetized dogs after 2 to 3 weeks of rapid right ventricular pacing. Congestive heart failure, characterized by decreases in first derivative of left ventricular pressure (left ventricular d P/dt(max)) and cardiac output, and increases in left ventricular end-diastolic pressure and total peripheral vascular resistance, was induced by chronic rapid right ventricular pacing at 260-280 beats/min. Intravenous administration of conivaptan (0.1 mg/kg) significantly increased left ventricular dP/dt(max) and cardiac output and significantly decreased left ventricular end-diastolic pressure and total peripheral vascular resistance. Conivaptan also increased urine flow and reduced urine osmolality by markedly increasing free water clearance. These results indicate that conivaptan produced hemodynamic improvement and marked aquaresis in dogs with congestive heart failure. Therefore, conivaptan may find clinical use in treating patients with congestive heart failure.

Sequential MR studies of cervical cord injury: correlation with neurological damage and clinical outcome

OBJECTIVE

To determine which images provide the most useful information and the best time to perform prognostic MRI.

DESIGN

The severity of neurological complications was assessed using the ASIA impairment scale. MRI was first performed within 48 h of injury, and was subsequently performed after 2-3 weeks, 3 months, 6 months, and 1 year.

SETTING

Inpatient SCI medicine unit.

SUBJECTS

Seventy-five patients with acute traumatic cervical spinal cord injury (9 women and 66 men) aged from 19-89 years (mean: 54.7 years).

RESULTS

Four characteristic patterns of signal changes were observed on MRI. These patterns correlated well with the severity of spinal cord damage and the clinical outcome.

CONCLUSION

T2-weighted images provided the most useful information, and the best times for prognostic imaging were at the time of injury and 2-3 weeks later.

Thrombin receptor mediated signals induce expressions of interleukin 6 and granulocyte colony stimulating factor via NF-kappa B activation in synovial fibroblasts

OBJECTIVE

To clarify the mechanism of thrombin receptor mediated signal transduction and the induction of cytokines by thrombin stimulation in rheumatoid synovial fibroblasts.

METHODS

Cytokines were measured by enzyme linked immunosorbent assay (ELISA) in the supernatants of cultured rheumatoid synovial fibroblasts stimulated by thrombin. To assess the mechanism of thrombin receptor mediated signal transduction in the rheumatoid synovial fibroblasts, electrophoretic mobility gel shift assay (EMSA), immunoglobulin kappa-chloramphenicol acetyltransferase (CAT) assay, and immunostaining for NF-kappa B subunit molecule was performed.

RESULTS

Thrombin stimulation activated the inducible transcription factor NF-kappa B, and then induced subsequent expressions of interleukin 6 (IL6) and granulocyte colony stimulating factor (G-CSF) in the cells.

CONCLUSION

Thrombin receptor mediated signal transduction could induce the expressions of IL6 and G-CSF, and increase inflammatory events in the cavum articulare via NF-kappa B activation.

Antihypertensive activity of a nonpeptide angiotensin II receptor antagonist, YM358, in rats and dogs

The antihypertensive activity of YM358, 2,7-diethyl-5-[[2'-(1 H-tetrazol-5-yl)biphenyl-4-yl]methyl]-5H-pyrazolo[1,5-b][1,2,4]tri azole potassium salt monohydrate, a new nonpeptide angiotensin II receptor antagonist, was characterized in rats and dogs. In conscious rats, YM358 after a single oral administration (1-30 mg/kg) lowered blood pressure. The rank order of hypotensive potency of YM358 in conscious rats was 2-kidney, 1-clip renal hypertensive rats > spontaneously hypertensive rats > normotensive rats on the basis of maximum hypotension. YM358 also caused decreases in blood pressure in 2-kidney, 1-clip renal hypertensive dogs and furosemide-treated dogs. Repeated administration of YM358 to 2-kidney, 1-clip renal hypertensive rats for 28 days produced a stable and long-lasting antihypertensive effect without influencing circadian blood pressure and heart rate rhythms. No reflex tachycardia was observed in any animals of either species treated with YM358. Therefore, the pharmacological profile of this compound indicates that YM358 has potential as a useful antihypertensive agent.

Pharmacological profile of YM358, a novel nonpeptide angiotensin AT1 receptor antagonist

The pharmacological profile of YM358, 2,7-diethyl-5-[[2'-(1 H-tetrazol-5-yl)biphenyl-4-yl]methyl]-5H-pyrazolo[1,5-b][1,2,4]tri azole potassium salt monohydrate, a novel non-peptide angiotensin AT1 receptor antagonist, was studied in vitro and in vivo. YM358 competed with [125I][Sar1, Ile8]angiotensin II for angiotensin AT1 receptors in rat liver membranes. YM358 displayed competitive kinetics and the pKi value was calculated as 8.79. In contrast, YM358 had little effect on the binding of [125I][Sar1, Ile8]angiotensin II to the angiotensin AT2 receptor in bovine cerebellum. In isolated rabbit aorta, YM358 produced a parallel rightward shift in the concentration-response curve for angiotensin II with a pA2 value of 8.82. YM358 had no effect on the contraction induced by KCl, norepinephrine, serotonin, histamine, prostaglandin F2alpha or endothelin-1 even at 10(-5) M. On the basis of pKi values in the binding assay and pA2 values in the isolated tissues, YM358 was approximately 3-10 times more potent than losartan in antagonizing angiotensin AT1 receptors. In pithed rats, intravenous administration of YM358 inhibited an increase in mean blood pressure induced by intravenous infusion of angiotensin II in a dose-dependent manner. In conscious normotensive rats, YM358 at 3-30 mg/kg p.o. inhibited the angiotensin II-induced pressor response in a dose-dependent manner. YM358 at 30 mg/kg caused maximum and complete inhibition 30 min after dosing, and inhibition lasted more than 24 h. These results demonstrate that YM358 is a potent, AT1-selective and competitive nonpeptide angiotensin receptor antagonist. Moreover, YM358 is both orally active and long-lasting. This pharmacological profile suggests that YM358 would be suitable for the treatment of cardiovascular disorders such as hypertension and chronic heart failure.

Ceramide-induced nuclear translocation of NF-kappa B is a potential mediator of the apoptotic response to TNF-alpha in murine clonal osteoblasts

Osteoblasts are affected by TNF-alpha overproduction by immune cells during inflammation. We demonstrate that apoptosis is induced in murine osteoblastic MC3T3-E1 cells by exceeding the concentrations 100 units/mL of TNF-alpha and 10 mumol/L of synthetic ceramide. The apoptotic signaling pathway activated by TNF-alpha was examined in MC3T3-E1 cells. Endogenous cellular ceramide concentrations increased within 3 min, and comparable peak levels were observed for 30 min after TNF-alpha treatment. Activation of nuclear factor-kappa B (NF-kappa B) was detected after TNF-alpha or synthetic ceramide stimulation. The concentration of NF-kappa B increased in the perinuclear region after 5 min of treatment and translocation into the nucleus was observed within 15 min of treatment. Degradation of I kappa B alpha/MAD-3 was observed after 60 min of ceramide treatment. These results indicate that nuclear translocation and activation of NF-kappa B through TNF-alpha generated ceramide may be one important apoptotic signaling pathway in MC3T3-E1 cells. The osteoblastic apoptosis triggered by TNF-alpha-generated ceramide may explain the inhibition of bone formation during severe bone inflammation.

Enhanced E-cadherin expression and increased calcium-dependent cell-cell adhesion in human T-cell leukemia virus type I Tax-expressing PC12 cells

Human T-cell leukemia virus type I (HTLV-I) Tax protein induces the expression of host cellular genes, some of which are crucial in cell proliferation and differentiation. We examined the mechanisms by which HTLV-I Tax protein induces phenotypic changes in PC12 cells. We demonstrated that the HTLV-I Tax gene induces epithelioid changes and increases cell-cell contact in PC12 cells. No change in the expression of the neural cell adhesion molecule was observed between HTLV-I Tax-expressing PC12 cells and PC12 cells transfected with a control plasmid. However, HTLV-I Tax-expressing PC12 cells demonstrated a marked change in the abundance and distribution of E-cadherin, which was concentrated at regions of cellular contact and accompanied by changes in calcium-dependent cell adhesion. Although E-cadherin is expressed at low levels in PC12 and PC12 transfected with a control plasmid cells, the steady state level of E-cadherin in tax-expressing PC12 cells increases significantly, apparently as a result of regulation at the transcriptional level. Diminished expression of Tax protein in Tax-expressing PC12 cells exposed to antisense oligonucleotides for the Tax gene suppresses E-cadherin expression and decreases cell-cell adhesion. These findings imply that HTLV-I Tax protein enhanced E-cadherin expression modulates calcium-dependent cell-cell adhesion mechanisms.

Induction of apoptosis in murine clonal osteoblasts expressed by human T-cell leukemia virus type I tax by NF-kappa B and TNF-alpha

We investigated the effects of various cytokines in the presence of human T-cell leukemia virus type I (HTLV-I) tax protein in murine clonal osteoblasts, MC3T3-E1 cells. Skeletal remodeling by osteoclasts and osteoblasts is coordinated by cytokines, which are activated by HTLV-I tax protein via nuclear factor-kappa B (NF-kappa B). MC3T3-E1 cells were cocultured with an irradiated HTLV-I-producing lymphocyte cell line, MT-2. After coculture, the tumor necrosis factor-alpha (TNF-alpha) level in the medium was markedly elevated during the 7 days of culture, and MC3T3-E1 cells underwent apoptotic cell death. Marked apoptosis was also observed in MC3T3-E1 cells treated with MT-2 culture medium and in HTLV-I tax-expressing MC3T3-E1 clones, which both expressed high levels of TNF-alpha. This apoptosis was prevented by treatment with neutralizing anti-TNF-alpha antibody (alpha TNF). HTLV-I tax protein and TNF-alpha induced activation of NF-kappa B in apoptotic MC3T3-E1 cells. Decreased NF-kappa B activation was observed in HTLV-I tax-expressing MC3T3-E1 cells treated with alpha TNF. Our results suggest that HTLV-I tax activated NF-kappa B and subsequently TNF-alpha, leading to apoptosis of osteoblasts.

Sequential MRI studies in patients with cervical cord injury but without bony injury

Sequential magnetic resonance imaging (MRI) of 23 patients who suffered cervical spinal cord injury without bony injury was performed prospectively. The major cord injury detected by MRI was at the C3-4 disc level in 16 patients (70%). Three patterns of signal changes were observed. Enhancement of the injured cord was observed on Gd-DTPA-enhanced MRI in 10 patients and the palsy of these patients was more severe than that of those without enhancement. Enhancement was recognized about 2 weeks earlier than the signal change (from isointense to low intensity) on T1-weighted images. This enhancement might represent necrosis, absorption, and reorganisation of the spinal cord, and appears to be a sign of a poor prognosis or an indication that damage is permanent. Another characteristic imaging finding was a vague high intensity signal in the dorsal column of the spinal cord extending rostrally from the main lesion, which appeared 2-3 months after injury and disappeared around 6 months. This finding represents Wallerian degeneration of the corticospinal tract in the cervical cord. Rigidity of the legs and sensory changes of the fingers became more prominent during this period.

Ultrastructure and x-ray microanalytical study of human pineal concretions

We examined human pineal concretions and found them to exhibit a multi-layered concentric structure consisting of irregularly spaced dense and sparse zones containing fine crystals. The hydroxyapatite crystallites were shown to be irregularly outlined plate forms (measuring 11-70 nm in their longest dimension and 2-10 nm in thickness). At the center of each crystallite a central dark line was observed by means of high resolution electron microscopy. The structure and size of the crystals were similar to those of dentin and bone. The ground surface of the concretions was observed metallurgically by means of an electron probe microanalyzer (EPMA). The surface zones of the concretions contained a higher concentration of zinc, which seems to play an important role during the mineralization process, whereas calcium and phosphorus exhibited higher concentrations at the center.

Nuclear proteins involved in cell division in the ciliate, Tetrahymena

For the purpose of clarifying the presence of nuclear proteins which may induce cell division, we conducted experiments using ciliate Tetrahymena which can be synchronized at the G2 phase in the cell cycle easily by periodic heat shock treatment (HST): We obtained proteins from the nuclei isolated from the cells grown at the early mid log-phase, at the G2 phase (60 min) and at the G1 phase (150 min), after HST. The proteins were studied by comparing the spots separated by isoelectric point, 10-20% gradient SDS two-dimensional electrophoresis. As a result, in comparison with the intranuclear protein at the log-phase, the proteins at the G2 phase showed a marked increase, but with no great change in the electrophoretic pattern. Meanwhile, the proteins at the G1 phase differed greatly from those at the G2 phase not only in the quantitative changes, but in the electrophoretic patterns. It is considered that the level of the accumulation of the nuclear proteins which should be closely involved in cell division must increase markedly at the G2 phase and decrease at the G1 phase. We confirmed the presence of four proteins: pI 5.8 MW 68 kDa, pI 6.1 MW 75 kDa, pI 8.6 MW 48 kDa and pI 6.6 MW 57 kDa, and then prepared monoclonal antibodies using these nuclear proteins as antigens. Among them, the antibody (IgM) against the pI 8.6 MW 48 kDa polypeptide (p48) was recognized the nuclei by indirect immunofluorescence in ancellular system at the S, G2 and the mid-M phases. However, nuclei at the late M and G1 phases were not stained.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of NF-kappa B activation in thrombin-induced human vascular smooth muscle cell proliferation

A thrombin receptor has been cloned and is thought to mediate a variety of thrombin-induced responses. However, the transcription factors important for postreceptor signaling have been little clarified. The post-receptor signals are mediated by several protein kinases responsible for NF-kappa B activation, and most thrombin-inducible genes have the kappa B sequence in the regulatory elements. The possibility that NF-kappa B may participate in thrombin signaling was therefore investigated in cultured human vascular smooth muscle cells (VSMCs). Thrombin receptor stimulation resulted in activation of NF-kappa B. Furthermore, treatment of cells with antisense p65 ODNs of NF-kappa B inhibited thrombin-stimulated growth of VSMC in vitro. Results indicate that the activation of NF-kappa B is involved in thrombin signaling and that this pathway causes the proliferation of VSMC induced by thrombin. Therapeutic potential of antisense NF-kappa B ODNs for the treatment with atherosclerosis and restenosis is also indicated.

A self-controllable mask with helmet to prevent self finger-mutilation in the Lesch-Nyhan syndrome

Self-mutilation is a characteristic symptom of Lesch-Nyhan syndrome. We report a newly developed orthosis for managing self-mutilation of the fingers through biting. The orthosis has a plastic mask attached to a helmet; the patient can manage the mask with one hand to stop biting fingers on the other hand. This is a report of a 6-year-old boy who was able to control finger biting by using the orthosis. Eighteen months later he has stopped biting his fingers and no longer wears the orthosis.

New cell line from hairy-cell leukaemia producing interleukin-6 after Epstein-Barr virus immortalization

A hairy-cell leukaemia (HCL) cell line, HCL-O, was established from the peripheral blood of a 62-year-old Japanese patient with a unique variant of HCL strongly expressing CD21, the receptor for the Epstein-Barr virus (EBV). The HCL-O cells expressed antigens similar and dissimilar to those expressed with the original hairy cells. The HCL-O cells were more mature than the original cells in their degree of B-cell differentiation, as indicated by a decrease of CD19 and surface immunoglobulin (sIg) expression together with the appearance of CD38 and cytoplasmic Ig (cIg). In addition, the cells expressed CD11c recognized by Leu-M5, a monoclonal antibody usually positive for HCL. Their karyotype and Ig gene rearrangement pattern were identical to those of the original cells. The EBV genome was detected in the HCL-O cells but not in the original cells. The HCL-O cells spontaneously produced a large quantity of interleukin-6 (IL-6) in the conditioned medium, whereas IL-6 serum level was not so high. These findings indicate that the HCL-O cell line is derived from the leukaemic hairy cells and possibly, in vitro EBV infection took place easily in the original hairy cells through their CD21, resulting in subsequent immortalization. IL-6 production by HCL-O cells may be induced or enhanced by EBV, and the secreted IL-6 might play a role in their own growth or differentiation.

HTLV-I associated and non-associated primary T-cell lymphoma of gastrointestinal tract

The gastrointestinal (GI) tract is the common extranodal site for non-Hodgkin's lymphoma (NHL), and primary lymphoma of GI tract are mostly of B-cell origin. We have treated 16 patients with primary lymphoma of GI tract between 1981 and 1991, of whom 10 (62%) were of B-cell origin, while 6 (38%) were of T-cell origin. The incidence of T-cell phenotype in our hospital was considered to be much higher than that of previous reports and these 6 patients with primary T-cell lymphoma of GI tract were carefully studied. The primary sites were stomach in 4, ileocecum in 1, and duodenum in 1 case. Their T-cell nature was confirmed by immunohistochemical methods. All were peripheral T-cell lymphomas; one was CD 3+ 4- 8- and the other 5 were CD 3+ 4+ 8-. The antibody against human T-cell leukemia virus type I (HTLV-I) was positive in 3 cases (HTLV-I associated), but negative in 3 (HTLV-I non-associated). The integration of HTLV-I proviral DNA in HTLV-I associated patients was demonstrated by Southern blot analysis after DNA amplification by means of polymerase chain reaction (PCR). The clinical features of the HTLV-I associated and HTLV-I non-associated primary T-cell lymphoma of the GI tract were quite different. HTLV-I associated patients showed leukemic manifestations and tumor involvement of the skin at a later stage of the disease. These observations indicated that HTLV-I can play an important role in the occurrence of primary T-cell lymphoma of GI tract.

Hyperkalaemia with renal tubular dysfunction by sulfamethoxazole-trimethoprim for Pneumocystis carinii pneumonia in patients with lymphoid malignancy

Hyperkalaemia with renal tubular dysfunction by oral therapy of sulfamethoxazole-trimethoprim (co-trimoxazole) is described in 2 elderly Japanese patients with lymphoid malignancy, who developed Pneumocystis carinii pneumonia and improved. A high dose of cotrimoxazole induced hyperkalaemia with the elevation of serum creatinine and blood urea, and increased urinary N-acetyl glucosaminase after several days of the drug administration in these patients; one patient became unconscious. Discontinuation of co-trimoxazole normalized serum potassium level and symptoms. A repeated low dose of the drug induced hyperkalaemia. Before the treatment of co-trixomazole, their serum levels of creatinine showed upper limits of normal ranges. In the present study, our cases suggested that patients receiving a high dose of co-trimoxazole should be evaluated for these potential complications during a course of treatment, particularly in elderly patients with preexisting renal dysfunction.

Fine structure of adrenergic nerve fibers in human periodontal ligament

The presence of adrenergic nerve fibers was demonstrated ultrastructurally in the human periodontal ligament obtained from extracted premolar teeth from 8 young patients. The nerve endings were located close to arterioles. The results suggest that they seem to control blood flow in the human periodontal ligament.

Coexistence of acute monoblastic leukemia and adult T-cell leukemia: possible association with HTLV-I infection in both cases?

A 64 year-old Japanese man who developed acute monoblastic leukemia during the course of adult T-cell leukemia/lymphoma (ATL) was studied. Leukemic cells in the peripheral blood and bone marrow were monoblasts positive for alpha-naphthol butyrate esterase (alpha-NBE) staining, CD11c and CD36 antigens, whereas tumor cells in the pleural effusion were ATL cells positive for CD2, CD4, CD25, CD29 and CD45RA antigens. These two malignant cells had different chromosomal abnormalities. Monoclonal integration of human T-cell leukemia virus type I (HTLV-I) proviral DNA and T-cell receptor C beta gene (TCR C beta) rearrangement were detected in the ATL cells, but not in the leukemic monoblasts. By polymerase chain reaction (PCR) in the peripheral blood mononuclear cells (CD11c+ 98%, CD2+ 4%, CD20+ 0%) not containing ATL cells, the presence of the gag region of HTLV-I was confirmed. These facts indicate that a double positive T cell (CD29+, CD45RA+) was possibly the target cell for HTLV-I infection and that HTLV-I was not directly related to the oncogenesis of the monocyte lineage in the present case, even if it did infect the monocytes. However, there is still an outside possibility that HTLV-I induced acute monoblastic leukemia indirectly.

[T-cell type non-Hodgkin's lymphoma associated with eosinophilia]

A 65-year-old man was admitted to our hospital in January 1990, because of weakness of upper limbs. On admission he was found to have generalized lymphadenopathy and leukocytosis. His WBC count was 40,900/microliters with 88% eosinophils. The bone marrow showed an increased number of eosinophils and their precursors but no other abnormalities. A diagnosis of non-Hodgkin's lymphoma (diffuse, medium sized cell type) was made by biopsy of his inguinal lymph node. The result of marker analysis was consistent with CD3+4+8-. The antibody to human T-lymphotropic virus type I was negative. A stomach biopsy revealed lymphoma cell infiltration. Extensive studies to identify the cause of the eosinophilia were undertaken, with consistently negative results. Combination chemotherapy was begun, and resulted in a dramatic resolution of the eosinophilia and the lymphadenopathy. The association of hypereosinophilia with non-Hodgkin's lymphoma is unusual. We report a patient with eosinophilia and non-Hodgkin's lymphoma, and discussed its possible etiology.

[Hairy cell leukemia expressing SIgM+, SIgG-, CD11b+ and CD21+ and accompanying lymphadenopathy without splenomegaly]

Hairy cell leukemia (HCL) expressing both surface monocytoid antigen and IgM (kappa) was reported. A 62-year-old male was admitted to our hospital in September 21, 1989 because of leukocytosis. Physical examinations showed axillary and inguinal lymphadenopathy but no hepato-splenomegaly. The leukocyte count was 12,600/microliters with 73% of abnormal cells like large lymphocytes which had abundant cytoplasm and hairy appearance under phase microscopy. They had ruffles with microvilli under electron microscope. Bone marrow puncture showed normocellular marrow with 71.2% of abnormal cells similar to the peripheral blood. Surface markers were CD11b+, CD21+, HLA-DR+, Tac- and IgM (kappa). They were positive for ++acid phosphatase staining, but negative for peroxidase and tartrate-resistant acid phosphatase staining. He was diagnosed as Japanese type HCL. HCL expressing both surface monocytoid antigen and IgM is rare and the clinical features of our case are compared with those reported in Japan.

[Phenytoin induced agranulocytosis: direct and T cell-mediated mechanisms]

A 57-year-old male was admitted to our hospital because of high fever and dyspnea. He had convulsive attacks after the operation for subarachnoid hemorrhage. He received an anticonvulsant, Hydantol F (Phenytoin + Phenobarbital), for 20 days before hospitalization. The white cell count on admission was 900/microliters without any neutrophils. Pseudomonas was demonstrated from blood cultures. After the anticonvulsant was discontinued and potent antibiotics were administered, his symptoms improved. Neutrophils appeared in the peripheral blood. We investigated the effect of phenytoin on the granuloid precursors using in vitro colony assay (CFU-C) after recovery from agranulocytosis. There was substantial decrease in CFU-C colony numbers when phenytoin or peripheral T-lymphocytes incubated with phenytoin was added in the culture. The addition of sera from acute phase did not affect the colony formation. These results suggested that direct toxic effect of the drug and cellular immunity played an important role in phenytoin induced agranulocytosis.

[A preliminary study on the morphological changes of the microvasculature following the peripheral nerve autografting]

The microvasculature of peripheral nerve following autografting was studied by scanning electron microscopy. The newly-formed capillaries was also examined by transmission electron microscopy. Capillaries of a fascicle were divided into an extrafascicular vascular plexus and an intrafascicular capillary bed; the former capillaries formed networks, while the latter capillaries ran longitudinally and formed slightly spiral curve. Normal intrafascicular capillaries had tight junctions, a continuous basement membrane and pericytes. On the suture line, capillaries of the graft and those of the host were connected by newly developed sinusoidal capillaries, which were formed at the extrafacicular region earlier than at the intrafascicular region. Newly developed sinusoidal capillaries were transformed into glomerulus-like capillaries and formed fine networks. These networks exhibited a normal capillary architecture after reconstruction. The endothelium of newly-formed capillaries showed a discontinuous basement membrane at the early stage of regeneration. An intrafascicular capillary bed was present in the middle part of the graft.

An experimental study of nerve regeneration through chemically treated allografts

We carried out experiments in rabbits to determine whether treating nerve transplants with gradually increasing concentrations of ethanol, ether and ficin would inhibit the graft-host immune reaction to the allograft. After treatment with ethanol, the basal laminar scaffold of the Schwann cell remained intact and there was satisfactory axonal regeneration. The results after additional treatment with ether or ficin did not achieve such good results. Preservation of the basal lamina is considered to be the essential factor in allowing neural regeneration in these circumstances.

Clinical and microangiographic studies on rupture of the E.P.L. tendon after distal radial fractures

The authors have treated 14 cases of spontaneous rupture of extensor pollicis longus tendon after fractures of the distal end of the radius, most of which were undisplaced or only slightly displaced. A microvascular study on five cadavers revealed that this tendon is subject to mechanical bending and attrition, has no mesotenon and has a poorly vascularised portion about 5 mm in length, which may be a cause of spontaneous rupture of the tendon.

[Clinical, cytogenetic and immunological studies of 2 cases with B-cell acute lymphocytic leukemia. Comparison between B-ALL and Burkitt's lymphoma reported in Japan]

Two patients with acute lymphocytic leukemia of B-cell phenotype (B-ALL) are described. They were 77-year-old female and 34-year-old male. One patient presented with marked splenomegaly, and the other with rupture of spleen on admission. Leukemic morphology revealed a typical L3 profile by FAB classification system in both cases. Immunologic analysis showed the presence of surface immunoglobulins in both cases, and one phenotype was IgM kappa, whereas the other was IgG kappa. Cytogenetic study revealed the typical translocations (8; 14) in both cases. Following chemotherapy, complete remission was achieved in one case, but the other died 36 days after admission. Including our two cases, we studied 12 cases of B-ALL and 77 cases of Burkitt's lymphoma reported in Japan, investigating the clinical prognosis as well as the biological features. We concluded that there are no significant difference of survival between B-ALL and Burkitt's lymphoma. We estimated it is due to oncogenesis from the same original cell in despite of the difference in main tumor site between two diseases.

[Acute myeloblastic leukemia associated with chronic thyroiditis]

A 57-year-old woman who suffered from acute myeloblastic leukemia during the course of chronic thyroiditis, is described. The patient was diagnosed as having chronic thyroiditis in 1984 when she was 53 year-old, and was treated with L-T4.Na. She admitted in July 1988 because of general fatigue, fever, cough and sore throat. On admission, hematological examination in the peripheral blood showed marked anemia and increased leukocytes with 20.5% leukemic cells positive for peroxidase staining. Bone marrow aspiration showed 38.8% leukemic cells. She was diagnosed acute myeloblastic leukemia. She reached complete remission after combination chemotherapy. The case of acute myeloblastic leukemia associated with chronic thyroiditis is rarely reported. We reviewed the literature and discussed acute myeloblastic leukemia associated with chronic thyroiditis including this case.

[Acute biphenotypic leukemia followed by two color flow cytometry]

In this paper is reported a case of acute biphenotypic leukemia who was treated by chemotherapy and pursued its effect by two color flow cytometry. A 33-year-old male patient was admitted due to fever and general fatigue and diagnosed as acute leukemia by hematological findings. Surface markers were investigated to find positive reaction of Leu 12 (CD19), J 5 (CD10), My 7 (CD13) and My 9 (CD33), in which Leu 12 and My 9 were simultaneously expressed on the same blast cells by two color flow cytometry. He was treated with daunorubicin, enocitabine, mercaptopurine, vincristine, and prednisolone to obtain partial remission. Then, he was administered L-asparaginase, doxorubicin, vincristine and prednisolone to reach complete remission. The effect of chemotherapy was investigated by not only bone marrow puncture, but also by two color flow cytometry. From the findings in this case, the two flow cytometry was proved to be a useful tool for not only diagnosis of acute mixed leukemia, aut also the judgement of the effect of treatment.

Cancer superimposed on adult T-cell leukemia

Forty-three patients with adult T-cell leukemia (ATL), admitted to the hospital from 1982 to 1987, were studied. Five of those were found to have additional cancer; two of the five had two additional kinds of cancers besides ATL. During the same period, in contrast, the authors encountered only three patients with some superimposed cancer among 155 cases of hematologic malignancies which had no association with human T-cell lymphotropic virus type I (HTLV-I). These facts strongly suggest that HTLV-I infection is not only associated with ATL, but it is likely to increase the incidence of other types of malignancy as well.

[von Recklinghausen's disease associated with malignant lymphoma]

A 59-year-old man was admitted to the Saga Medical School Hospital in November 1986 because of unconsciousness and lymph node swelling. He had café au leit spots and multiple neurofibromas since his thirties. The leukocyte count was increased. The level of serum LDH and Ca were extremely elevated. His bone marrow aspiration showed the invasion of lymphoma cells. Lymph node biopsy from his left neck and the study of surface markers were performed. And then, his illness was diagnosed as non-Hodgkin's lymphoma (diffuse, medium sized cell type, B cell type, stage IV B.) following von Recklinghausen's disease. After the admission, his general condition improved by chemotherapy, but he had a relapse 6 months later. And he died in November 1987. The case of von Recklinghausen's disease associated with malignant lymphoma in rarely reported. We reviewed the literature and discussed von Recklinghausen's disease associated with malignant lymphoma including this case.

Differences in prognostic factors between leukemia and lymphoma type of adult T-cell leukemia

Prognostic factors affecting the survival of adult T-cell leukemia (ATL) patients were analyzed in three groups: total cases, leukemia type cases, and lymphoma type cases. Factors found to be important overall, i.e. for total cases, were leukocyte count, ATL cell ratio in the peripheral blood, serum calcium levels and lactate dehydrogenase (LDH) level. Of those, LDH level proved not significant when evaluated separately for leukemia type or lymphoma type cases. Leukocyte count and ATL cell ratio were significant in leukemia type patients, whereas it was serum calcium level that was significant in lymphoma type; there were mutually exclusive sets of factors for the two groups. Thus, prognostic factors for ATL patients should be considered separately for each type of the disease.

Microvascularization of gingival wound healing using corrosion casts

The healing process in a wound induced by removal of 6 X 6 mm of gingiva and periosteum from the maxillary attached gingiva of 48 adult mongrel dogs was observed to investigate the potential blood supply for grafts placed on denuded bone. Three-dimensional observations were performed over 12 weeks by scanning electron microscopy (SEM) following the manufacture of corrosion capillary casts by acrylic resin injection. Revascularization in the gingival wound was mainly through formation of new capillaries from those existing below the surrounding epithelium with little new capillary formation from the Volkmann canals. Moreover, the periodontium contributed greatly to the vascularization, which was fastest from the gingival margin. Further, simplification of new capillary loops was also fastest from this direction. Regeneration of the periosteum and periosteal vascular plexus was slow, taking about twice the time of connective tissue and capillaries below the epithelium. The results indicated that blood supply to grafts on denuded bone in the early postgraft period would mainly be provided by capillaries below the epithelium surrounding the recipient bed.

Evaluation of sensibility after sensory reconstruction of the thumb

We have studied the restoration of sensation in 24 patients after operations involving the digital nerves of the thumb. These comprised 10 neurorrhaphies, two nerve graftings, five replantations, one toe-to-thumb transfer and six neurovascular island flaps. The average follow-up period was 46 months. Greater sensitivity was found in the moving two-point discrimination (2PD) test than in the static 2PD test. The results of the Semmes-Weinstein test showed good correlation with the static 2PD test. Porter's letter test showed correlations with both 2PD tests, and the pulp-writing test showed good correlation with the moving 2PD test. The neurorrhaphy cases had the best results using the static 2PD and Semmes-Weinstein test, and had good restoration of sensation; the replantation cases were next best. After neurovascular island flaps, patients exhibited hypersensitivity, double sensation and distorted images on the pulp-writing test. Using this same test the nerve grafting cases had distorted touch perception and perceived a straight line as a curve. The pulp-writing test, using moving touch, is one method of examining mechanoreceptors and shows to what extent the patient perceives what touches the finger pulp; it gives a better indication of higher functions than the 2PD test.

An investigation of the digital nerves of the thumb

With the use of a stereoscopic microscope, observations were made on the course of the proper digital nerve of the thumb on ten upper limbs in adult cadavers. By observation from the dorsal side after removal of the bone, it was possible to clearly see the ramification of the digital nerve from the subcutaneous tissue to the dermis. Ramification from the palm to the level of the interphalangeal joint was segmental. The digital nerve of the thumb trifurcates from the proximal site of the distal palmar thumb crease into the main, medial, and lateral branches. The main branch is thick and extends from the center of the pulp toward the fingertip. Ramification at the pulp of the thumb is of a radiating rather than segmental type, and its control can be considered as spotty or intermittent. Distribution of pacinian corpuscles is dense in the subcutaneous tissue of the distal palmar thumb crease. These observations are of clinical importance not only for avoidance of injury to the digital nerve in surgical procedures such as the incision and drainage for felon and the trigger thumb release but also for precise repair of the digital nerve in the reconstructive surgery of the thumb.

[Puncture technology and selective renal biopsy]

An experimental study of puncture technology for the kidney: We investigated the strength characteristics of tissues which are penetrated by the puncture needle for the kidney using a tension test. The tensile strength of the fascia, the muscle, the renal capsule, the renal parenchyma and the renal pelvis were 13.9, 1.1, 29.5, 0.5 and 21.4 kg/cm2, respectively. As the strengths differ, the needles for each tissue clearly need to be changed. Needle tip shape and needle material for kidney puncture were investigated by compression test, acryl resin injection into the renal vasculature, stereo-microscopy and scanning electron microscopy. These investigations revealed that the most suitable needle tip was a sharp cone shape, and material with a smooth surface and some flexibility such as Derlin seemed to be the most appropriate for the puncture needle for the kidney. Using the acryl resin injection method, stereo-microscopy and scanning electron microscopy, we studied the relative safety of single stage puncture and the repeated dilatation method to establish percutaneous nephrostomy. Single stage puncture seems to cause less damage to the kidney than the repeated dilatation method. Selective renal biopsy: A new puncture system using real-time ultrasound was developed at our clinic in 1978. The puncture procedure is monitored in 2 dimensional real-time images by a mechanical sector scanner equipped with an attachment for needle guidance. The application of the system to percutaneous renal biopsy is called "selective renal biopsy" because the specimen can be obtained selectively from any portion of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)