Assessment of tumour-infiltrating lymphocytes, regional lymph node lymphocytes and peripheral blood lymphocytes and their reaction to interferon-gamma in patients with renal carcinoma

The immunological distribution of tumour-infiltrating lymphocytes (TIL), regional lymph node lymphocytes (RLNL) and peripheral blood lymphocytes (PBL) was evaluated by means of immunohistochemical staining using monoclonal antibodies of each subset of lymphocytes (stored in frozen sections) in a series of 22 patients with renal carcinoma. The immunological effect of IFN (interferon)-gamma on these immunocompetent cells was also investigated. The effect of IFN-gamma on TIL was an increase in CD3 (pan-T cells), especially an increase in CD8 (cytotoxic/suppressor-T cells). When examining these cells according to stage and grade, a marked increase in CD3 was found in low stage and low grade patients. With regard to RLNL, there was a tendency towards a decrease in CD3 and an increase in CD20 (B-cells) following the administration of IFN-gamma. No specific effect on stage and grade was observed apart from a reduction in T cell subset ratios in high grade patients. With regard to PBL, no specific trend was noted except for an increase in CD16 (NK cells) when IFN-gamma was administered.

Lipid metabolism in acromegalic patients before and after selective pituitary adenomectomy

Lipid metabolism was studied in 16 acromegalic patients who all underwent transsphenoidal selective pituitary adenomectomy (SPA). Before the operation, their serum lipid levels correlated with none of the basal levels of serum growth hormone (GH), basal levels of plasma somatomedin-C (SM-C), fasting levels of plasma glucose (FPG), peak levels of plasma glucose (PGp) or basal and peak levels of serum immunoreactive insulin (IRIb and IRIp, resp.) in the oral glucose tolerance test (OGTT), and obesity indices. The serum GH levels as well as plasma SM-C levels in the group with decreased serum high density lipoprotein-cholesterol (HDL-C) differed greatly from those of the normal HDL-C group. However, there was no significant difference in either serum GH or plasma SM-C between groups with and without metabolic abnormality of any other lipid examined. After the operation, the basal levels of serum GH and plasma SM-C decreased significantly. In conjunction with these changes, PGp, serum IRIb, serum triglyceride (TG), non-esterified fatty acid (NEFA) and very low density lipoprotein (VLDL) decreased significantly. In contrast, serum HDL-C increased significantly. However, FPG, serum IRIp, obesity indices, serum total cholesterol (TC) and serum low density lipoprotein (LDL) showed no significant change. There were no significant differences in the levels of any serum lipid either before or after surgery among the diabetic, borderline and normal types defined by the preoperative OGTT patterns. Atherogenic indices (AIs) decreased significantly and returned to normal postoperatively. These results suggest that obesity or secondary diabetes is not a direct cause of hyperlipidemia in acromegaly. The prognosis of acromegaly is affected by arteriosclerotic complications. It is intriguing, therefore, that AIs were normalized by transsphenoidal SPA. Being rather a safe procedure, it can be performed without hesitation, aside from a conservative treatment.

Hypogonadism of male prolactinomas: relation to pulsatile secretion of LH

In order to investigate whether a hypothalamic disorder cause hypogonadism in male prolactinomas, LH pulsatile secretion was studied in 13 male patients. Serum PRL levels ranged from 186 to 45,000 ng ml-1 before treatment, and all the tumors were macroadenomas. Reduced LH secretion was revealed in 5 of 13 patients, and FSH was reduced in 1 of 13. Serum testosterone (T) levels were lower than the normal limit in all the patients. HCG tests in 3 patients showed good responses, but the peak values of T were lower than those of normal men. LH pulsatilities were examined in 5 hyperprolactinemic patients before treatment, in 4 hyperprolactinemic patients after operation, and in 8 normoprolactinemic patients after operation and/or bromocriptine treatment. There was no significant difference of the mean LH values, the frequencies of LH pulses, and amplitudes among the hyperprolactinemic patients before operation (n = 5), the normoprolactinemic patients after operation (n = 8), and normal men (n = 7). From these results, it was evident that the hypothalamus and pituitary function of male prolactinomas were well preserved, in spite of higher serum PRL levels and larger tumor size than those reported in females. It is suggested that the main cause of hypogonadism in these patients is due to testicular dysfunction resulting from excessive serum PRL.

Influence of differences in tumor vascularity upon the effects of hyperthermia

Utilizing two types of human renal carcinoma heterotransplanted in nude mice, we investigated the variations in hyperthermic effects (42.5 degrees C for 30 min) caused by differences in tumor type with special reference to variations in tumor vascularity. In the hypovascular JRC1 strain, sporadic vascular dilation was observed throughout the tumors after heating. Destruction of tumor cells was observed mainly in the region of dilation. In the hypervascular JRC11 strain, homogenous vascular dilation was observed immediately after heating, mainly at the periphery of tumors. There was a decrease in the viability of cells in the center of the tumor. Therefore, the hypervascular tumors showed greater destruction mainly at the center where blood circulation was reduced. The range of necrosis was also greatly affected by the extent of vascular dilation caused by heating in hypovascular tumors.

Dolichoectatic basilar artery treated by reducing hemodynamic stress--report of two cases

Two cases of dolichoectatic basilar artery with a mass effect to the brainstem structure were treated by reducing hemodynamic stress. In one case, angiograms showed the dolichoectatic basilar artery creating a turbulent flow in the vertebrobasilar junction, and unilateral vertebral artery clipping in addition to posterior fossa decompression was performed. The other case, a combination with bilateral internal carotid artery occlusion, underwent bilateral superficial temporal artery-middle cerebral artery anastomoses. The possible surgical treatments of dolichoectasia are discussed.

[In vivo anti-tumour efficacy of tumour necrosis factor and interferon- alpha, -gamma on human renal cell carcinoma heterotransplanted in nude mice]

Using human renal cell carcinoma heterotransplanted in nude mice (JRC 11: anaplastic and alveolar pattern, grade IV), the in vivo anti-tumour efficacy of tumour necrosis factor (rHu-TNF-alpha: PT-050) and IFN-alpha (nHu-IFN-alpha: HLBI), IFN-gamma (nHu-IFN-gamma: OH-6000) were investigated. The dose of TNF was 1,000, 3,000, 10,000 J.R.U. (i.p., every day), that of IFN-alpha was 1 x 10(4) and 1 x 10(5) I. U. (s.c., every day) and that of IFN-gamma was 1 x 10(4) and 1 x 10(5) I.U. (s.c., every day). Mono-therapy of TNF, IFN-alpha and IFN-gamma was not effective with regard to tumour regression rates, histological degeneration rates and survival time of the host mice. Combination therapy of TNF and IFN-alpha, IFN-gamma were also not effective with regard to tumour regression rates, but when considering histological change, sporadic disappearance of endothelium of intra-tumoural vasculature, flow of tumour cells clustered in intra-vascular cavity, and extra-vascular bleeding were observed. With special reference to survival of host mice, prominent prolongation of survival time in combination treatment, especially in TNF combination therapy groups with the dosage of 10,000 J.R.U. was observed. Therefore we concluded that there is no synergistic reaction in combination therapy of TNF and IFN against JRC 11 tumour. But combined activity of TNF and IFN on the vasculature of renal cell carcinoma (JRC 11) and the suppression of cachexia related condition were detected.

Serum hemolytic activity in dogs infected with Babesia gibsoni

The hemolytic activity in serum of Babesia gibsoni-infected dogs was examined. When the activity was assayed in a reaction system consisting of similar concentrations of the serum and canine red blood cells to those in blood, significant hemolysis was observed. The activity of the serum of B. gibsoni-infected dogs, either naturally or experimentally, was always higher than that of uninfected animals. Moreover, in the experimental infection with B. gibsoni, the change in serum hemolytic activity was parallel to those of anemia and parasitemia, whereas it was inversely parallel to that of the hematocrit value. The present study revealed the presence of a hemolytic factor(s) in the serum of B. gibsoni-infected dogs, suggesting that the progressive anemia was due to hemolysis by the factor(s).

Detection of the spatial distribution of late potentials by body surface mapping using forty-five unipolar, leads

For evaluating the spatial location of late potentials (LPs), the authors designed a new system for the body surface mapping of signal-averaged, filtered ECGs using forty-five thoracic unipolar leads (5 x 9 array). The signals from patients with old myocardial infarction (MI, N = 7) and arrhythmogenic right ventricular dysplasia (ARVD, N = 1) were amplified and passed through a bandpass (100-300 Hz) filter. The departure maps, LP isopotential maps, and LP30 area maps were generated and superimposed. The LP30 duration was determined as the section between the filtered QRS endpoints and points thirty milliseconds (ms) before. Isopotential maps of the LPs showed distinct positive and negative regions. In 7 cases with MI, the extreme was related to the zones indicated by the departure maps, and the LP30 area maps also corresponded to the departure areas. In 1 case of ARVD, endocardial fragmented activity directly recorded at the right ventricle closely corresponded with the region on the LP30 area map. In conclusion, body surface LP isopotential maps and LP30 area maps may provide useful information concerning the spatial distribution of endocardial fragmentation.

[Comparative study of the patients with renal cell carcinoma before and after 1980]

Patients with renal cell carcinoma treated at Jikei University and affiliated institutions were studied with regard to temporal differences. Our study population was divided into two groups: an earlier group comprising 169 patients treated between January 1957 and December 1979, and a later group comprising 165 cases treated between January 1980 and December 1984. The mean age in the earlier group was 56.2 years, while that in the later group was 60.4 years. Therefore, the patients in the earlier group were generally younger than those in the later group. Patients in the earlier group were more likely to present with urinary symptoms at the time of diagnosis. On the other hand, patients in the later group were more likely to present with extra-urinary symptoms or to be asymptomatic. The time period between the onset of symptoms and initial consultation with physician was longer (within one month) in the earlier group. Most patients in the later group underwent nephrectomy using the transperitoneal or thoracoabdominal approach. Few patients in the later group were treated with radiotherapy. As adjuvant chemotherapy, MFC (MMC, 5-FU and Ara-C) or MACV (methotrexate, actinomycin D, cyclophosphamide and vincristine) regimen were most commonly employed in the earlier group. FAV (5-FU, adriamycin and vinblastine) regimen or interferon therapy which was classified as biological response modifiers (BRM) were more commonly employed in the later group. More cases were diagnosed as stage II in the earlier group, and more cases were diagnosed as stage IV in the later group. No significant differences were observed between the earlier and later groups, with regard to 5- and 10-year survival rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal antibody against human enterokinase and immunohistochemical localization of the enzyme

A monoclonal antibody, hek-1, was raised against enterokinase or enteropeptidase that had previously been partially purified from human duodenal fluid. Hek-1 showed staining of two glycoprotein bands of relative molecular weights of 260,000 and 240,000 on immunoblot analysis of partially purified enterokinase and of ammonium sulfate fraction of duodenal fluid. An enzyme immunoassay for human enterokinase was developed, making use of hek-1. Sensitivity to enterokinase was 20 times higher than that of the conventional assay where BAPA was used as a substrate. The immunohistochemical study with hek-1 showed staining of the brush border membrane and some goblet cells of the duodenum and upper jejunum but no staining of the colon epithelium.

[67Ga-citrate scintigraphy in patients with fever of unknown origin]

67Ga scintigraphy was performed in 49 patients with fever of unknown origin (FUO). Positive findings were observed in 25 patients out of 49 (51%). Occult focal lesions were demonstrated in 4 patients and useful information for the diagnosis was provided in 4 patients. In short, the examination showed diagnostic usefulness in 8 (32%) out of positive cases. 67Ga scintigraphy may be recommended as a further examination for patients with strongly suspected focal lesion in FUO.

[A case of recessive dystrophic epidermolysis bullosa associated with dwarfism with special reference to pathophysiological role of growth hormone]

Epidermolysis bullosa is a group of disorders whose common primary feature is the formation of blisters following trivial trauma. Recessive dystrophic epidermolysis bullosa (RDEB), a subtype of epidermolysis bullosa, is frequently associated with growth retardation. This growth retardation has been reported to be caused by trophopathy following protein loss through skin lesions. Endocrine disorders as the cause of growth retardation in RDEB have not been clearly described. An 11-year-old female had a typical RDEB with dwarfism. Her height was 125 cm and weight was 21 kg, both of which were 2.5 SD below the average. The skin lesions were generalized and probably caused by undernourishment, infection, and blood loss through the skin. However, her serum albumin was at the lower normal limit, and the rapid turnover proteins were slightly decreased. Endocrinological examinations revealed that all the basal levels of pituitary, thyroid, and adrenal hormones were normal. Results of the exercise test, the insulin tolerance test, and the growth hormone-releasing factor test indicated the presence of hypothalamic disorder in secretion of growth hormone. This is the first report of RDEB in which hypothalamic disorder in growth hormone secretion was investigated. On the other hand, growth hormone is known to be involved in collagen metabolism, and a decrease in collagen fibrils and an increase in collagenase activities are found in the skin of RDEB. This implies that this hypothalamic disorder in growth hormone secretion may be involved in the pathophysiology of both dwarfism and the skin lesions in RDEB.

[A clinicopathological study of signet-ring cell carcinomas of the stomach]

Surgically resected signet-ring cell carcinomas of the stomach have been clinicopathologically investigated. Although this type of carcinoma was found to be widely spread in the propria mucosa, a deeper invasion beyond the submucosa appeared more slowly than in other types of carcinomas. For example, the larger the early carcinoma in which the invasion was restricted to within the submucosa, the greater the incidence of a signet-ring cell carcinoma increase, especially in cases involving the mucosa. The incidence of a nodal metastasis was found to be lower than in cases of a moderately and poorly-differentiated adenocarcinoma in the early stage. However, when the signet-ring cell carcinomas invaded beyond the submucosa, the tumor cells spread rapidly and widely in the wall with a subsequent abdominal implantation, causing ascites and peritonitis carcinomatosa. It seemed likely that this deep invasion was accelerated by cellular change, such as the enlargement of nucleus, cellular atypy, and a decreased mucin production. As signet-ring cell carcinoma arise from the neck of glands and infiltrate the propria mucosae under the superficial epithelium, diagnosis by the barium enema and an endoscopic examination is very difficult in the case of small-size lesions. In lesions greater than 1 cm in diameter, these carcinomas usually showed an erosive and/or ulcerated appearance.

[Diagnosis of paraaortic and pelvic lymph node metastasis by ultrasound guided percutaneous fine needle aspiration biopsy (FNAB)]

Ultrasonography (US) was performed in patients with gynecologic malignancies to detect paraaortic and pelvic lymphadenopathy. US of paraaortic lymph nodes was performed in 32 patients. Of the 32 patients 17 had lymphadenopathy, and ultrasound-guided percutaneous fine needle aspiration biopsies (FNAB) were therefore performed in 16 of these 17 cases. Of these 16 patients, 11 were positive and 5 were negative FNAB. US of pelvic lymph nodes was performed in 68 patients. Of the 68 patients 14 had lymphadenopathy, and FNAB were performed in 8 of these. All 14 of these FNABs were positive. There were no major complications from due to FNAB. It is therefore concluded that ultrasound-guided percutaneous FNAB is very useful in detecting metastatic lymph nodes of gynecologic malignancies.

Clinical evaluation of hypokalemia in anorexia nervosa

The serum and urinary levels of electrolytes were measured in 25 patients with anorexia nervosa admitted to this hospital. Seven (28%) of these patients vomited, usually surreptitiously. Hypokalemia was detected in 5 (20%) of these patients, all among those who vomited. The urinary chloride/sodium ratios were low in the patients who vomited, and did not overlap the values in patients who did not vomit, indicating that this ratio was a good indication of vomiting. These results suggested that stopping vomiting is most important for correcting hypokalemia.

Pubertal growth spurt induced by human chorionic gonadotropin in hypogonadotropic growth hormone-deficient children

Eight hypogonadotropic growth hormone-deficient children were treated with human chorionic gonadotropin (HCG) while they continued to receive a fixed dose of HGH for a one year period. They were observed for changes in somatomedin C (IGF-I) and height increase velocity. Mean somatomedin C was 0.79 +/- 0.30 U/ml in normal prepubertal children (N = 7) and 0.78 +/- 0.31 U/ml in prepubertal normal short children (N = 22). At pubertal stage 3, somatomedin C was 2.21 +/- 1.23 and 2.05 +/- 0.44 U/ml in normals (N = 5) and in normal short children (N = 7), respectively. When 3000-5000 units/week of HCG were given to each of the 8 hypogonadotropic growth hormone-deficient children who were receiving HGH at a mean dose of 0.33 +/- 0.05 IU/kg/week, testosterone increased from less than 0.3 ng/ml to more than 5 ng/ml at 6 months in 3 cases and at 12 months in 2 cases, while the testosterone concentration was less than 3.5 ng/ml in the remaining 3 cases. The rate of height increase rose significantly (p less than 0.001) from 5.2 +/- 1.0 to 9.3 +/- 1.4 cm/year mimicking the normal pubertal growth spurt. However, the mean somatomedin C concentration was 0.44 +/- 0.23 before therapy, 0.33 +/- 0.30 at 6 months and 0.31 +/- 0.14 U/ml at 12 months after the start of HCG therapy. It is concluded that the pubertal growth spurt induced by HCG in hypogonodotropic GH-deficient male children is not mediated by the increase in somatomedin C production.

[Chemosensitivity test utilizing in vivo-like growing of renal cell carcinoma]

Utilizing two different types of renal cell carcinoma (JRC 1; papillary pattern, grade III, JRC 11; anaplastic and alveolar pattern, grade IV) heterotransplanted in nude mice, studied: 1) chemosensitivity tests using an in vivo-like growing culture method (collagen gel-supported culture system) with 3H-thymidine up-take assay; 2) using H and E staining, serial change of each tumour in this culture system was examined during 7 days after culture start-up. The chemo-agent tested was natural human interferon-alpha (HLBI), and the doses were 10, 100, 1,000 I.U./ml. In JRC 1, significant responses to IFN (10, 100, 1,000 I.U.) were noted, but no dose dependency was observed. In contrast, in JRC 11, compared with control, a decrease of 3H-thymidine up take in each dose of IFN was observed, but no significant differences were observed between the tested groups and control. In the 3-day culture of JRC 1, the central portion contained fewer viable cells. In the 7-day, the majority of the viable cells were replaced throughout the tumour. In contrast, in the 3-day culture of JRC 11, a decrease of viability in the central portion was observed, and this tendency progressed during the period of culture. In the 7-day only two to three thin viable cell layers were observed around the cultured tumour. Consequently differences of growth features in this culture system can be seen between the different types of tumours. Thus, a more detailed examination is needed for the clinical application of this culture system.

Radioimmunoassay of human platelet-derived growth factor using monoclonal antibody toward a synthetic 73-97 fragment of its B-chain

A mouse monoclonal antibody toward a 73-97 fragment of human platelet-derived growth factor (hPDGF) B-chain was used to develop a radioimmunoassay (RIA) for serum hPDGF. By the single step procedure of the double antibody technique, the measurable range was 10-1,000 micrograms/l. The coefficients of variation within and between series were 10.2% and 12.1% respectively, and satisfactory dilution curves were obtained for sera from healthy subjects. The hPDGF levels in all plasma samples from 15 healthy subjects examined were below the detection limit (10 micrograms/l), whereas the mean hPDGF concentration (+/- SD) in serum samples of 60 healthy subjects was 31.9 +/- 20.4 micrograms/l. This value was significantly (p less than 0.01) higher than the mean for 21 patients with idiopathic thrombocytopenic purpura (12.6 +/- 4.5 micrograms/l). There was a significant positive (r = 0.481, p less than 0.01) but not a strong (r2 = 0.23) correlation between the peripheral blood platelet counts and serum hPDGF levels of all subjects. This RIA system should be useful clinically for measurement of serum hPDGF.

[Clinical evaluation of serum prostatic acid phosphatase assay based on the immunoenzymatic method (TZR-516)]

The usefulness of a newly developed prostatic acid phosphatase assay based on the immunoenzymatic method (PAP-IEA) was studied. Serum samples were obtained from 22 untreated prostatic carcinoma patients, 34 benign prostatic hyperplasia patients, 32 prostatic disease-free patients and 27 normal volunteers. Mean +/- S.D. of PAP-IEA in prostatic disease-free group and normal volunteer group was 0.46 +/- 0.27 ng/ml. So, the upper limit of PAP-IEA for clinical normal range was set to 1 ng/ml (= Mean + 2S.D.). Thus, the false positive rate of benign prostatic hyperplasia was estimated at 9% and false negative rate of untreated prostatic carcinoma at 27%. Meanwhile, PAP-IEA values measured in this study were correlated well to PAP-RIA values measured in the same samples (r = 0.994).