Inhibitory effect of a single local probucol administration on neointimal formation in balloon-injured rat carotid artery

The aim of this study was to determine whether a single local probucol administration could suppress neointimal formation in balloon-injured rat carotid artery. Rats were divided into four groups; (i) rats receiving no probucol (control group); (ii) rats receiving topical application of 50 mg probucol at the time of ballooning (p-top group); (iii) rats fed chow containing 1% probucol (p-fed group; (iv) rats receiving both topical application of 50 mg probucol and chow containing 1% probucol (p-top/fed group). Although serum total cholesterol levels did not significantly differ between the control and the p-top groups at two weeks after balloon injury, the p-top group had a smaller intimal/medial ratio or intimal area than the control group (0.97 +/- 0.11 vs. 0.53 +/- 0.08 or 0.15 +/- 0.02 mm2 vs. 0.08 +/- 0.02 mm2 respectively, P < 0.01). Neointimal formation was suppressed to a similar extent in the p-fed group, in which serum total cholesterol level was approximately 40% lower than that in the control group. Thus, a single local delivery of probucol can suppress neointimal formation in balloon-injured rat carotid artery without altering serum lipid level.

Malignant hemangioendothelioma of the aorta

We present a rare case of aortic malignant hemangioendothelioma with a mural growth pattern in which the endothelial nature was confirmed by immunohistochemical demonstration of Factor VIII-related antigen. Aortic sarcomas and malignant hemangioendotheliomas in the literature are reviewed.

Hepatitis C virus genotypes and development of hepatocellular carcinoma

BACKGROUND

Among several genotypes of hepatitis C virus (HCV), genotypes 1b (or II) and 2a (or III) are predominant in Japan. Although it has been shown that the efficacy of interferon treatment of patients with chronic hepatitis C varies with the HCV genotype, the relationship between HCV genotype and the development of hepatocellular carcinoma (HCC) has not been well described.

METHODS

The genotypes and serum levels were determined for HCV-RNA in 72 patients with HCC and 131 patients without HCC, all of whom were positive for second-generation HCV antibody and HCV-RNA. In addition, clinical data from 34 patients with HCC who each had a history of blood transfusion were analyzed.

RESULTS

Fifty-seven (79.2%) of 72 patients with HCC had genotype 1b HCV, whereas 101 (77.1%) of 131 patients without HCC had genotype 1b, indicating that there was no significant difference in the prevalence of genotype 1b HCV between the patients with and without HCC. Furthermore, comparison of patients with HCC with genotype 1b HCV with those with genotype 2a who had a history of blood transfusion did not differ significantly in the number of years from blood transfusion to diagnosis of HCC. Levels of HCV-RNA were not significantly different among patients with liver diseases of various stages.

CONCLUSIONS

Hepatocellular carcinoma develops in patients with either genotype 2a HCV or genotype 1b HCV. A difference in genotype is not likely to be responsible for the difference in development of HCC.

Carboplatin-based combination chemotherapy for testicular cancer: relationship among administration dose of carboplatin, renal function and myelosuppression

Carboplatin (CBDCA), a derivative of cis-diamminedichloroplatinum, has low renal and neural toxicity. The dose-limiting factor of this agent is myelosuppression. We experienced various degrees of myelosuppression, when the dose of CBDCA was determined by the body surface area (BSA) in CBDCA-based combination chemotherapy for testicular cancer. Calvert demonstrated that the dose of CBDCA administered should be adjusted by renal function, because CBDCA was excreted through the glomerulus. We report the relationship among 3 factors; the administration dose of CBDCA, renal function and the degree of myelosuppression. We treated 6 patients with testicular cancer. A total of 22 courses of CBDCA-based combination chemotherapy was performed. The area under the curve (AUC) was calculated by the following formula, which was demonstrated in Calvert's study. CBDCA dose = AUC x (GFR + 25), GFR; glomerular filtration rate. The degree of myelosuppression was examined. All chemotherapy courses were divided into 2 and 3 groups according to BSA and AUC, respectively. WBC and Plt reduction rates and nadir counts were significantly correlated with AUC, and showed no significant relationship to the dose determined by BSA. This study revealed that the degree of myelosuppression was closely related with AUC, which reflects the renal function.

Effects of long-term omeprazole treatment on adult rat gastric mucosa--enhancement of the epithelial cell proliferation and suppression of its differentiation

Effects of long-term omeprazole treatment on the process of epithelial cell proliferation and differentiation in the adult rat gastric mucosa were investigated. Animals were treated with omeprazole (25 mg/kg body weight/day) for 28 days to induce anacidity in the stomach. The treatment induced a marked decrease in the number of chief cells in the gastric mucosa and at the same time an increase in that of immature pepsinogen-producing cells expressing class III mucin. This was accompanied by a decrease to 60% and 10% of the control values in the mucosal levels of pepsinogen and its mRNA, respectively. Moreover, the expression of cathepsin E in surface mucous cells was reduced. Cell proliferation studies revealed that the rate of bromodeoxyuridine-labeled cells was increased by omeprazole. The above-described changes were reversed by cessation of the treatment and they were not caused by the omeprazole-treatment at a dose which does not induce anacidity in the stomach. These results suggest that long-term omeprazole treatment reversibly increases the epithelial cell proliferation and suppresses its differentiation in the adult rate gastric mucosa probably by altering the acidic environment specific for the stomach.

[Greenfield filter placement following successful cardiopulmonary resuscitation in a patient with sudden death due to pulmonary embolization]

A 54-year-old man was admitted as an emergency following an episode of syncope and severe dyspnea. The clinical presentation and laboratory data strongly suggested pulmonary embolism, so intravenous thrombolytic therapy was performed. Immediately following the initiation of thrombolytic therapy, the patient experienced cardiopulmonary arrest, but he was successfully resuscitated. Ascending venography of the left lower limb demonstrated a large intraluminal thrombus which was apparently floating between the femoral vein and inferior vena cava. In addition to the anticoagulation therapy, a Greenfield filter was implaced intravenously to prevent recurrent embolization.

Renocolic fistula caused by xanthogranulomatous pyelonephritis

A 68-year-old female was diagnosed with a renocolic fistula, associated with left chronic pyelonephritis due to a ureter stone. Nephrectomy and repair of the fistula were performed. Histopathological examination revealed xanthogranulomatous pyelonephritis.

The novel variants of mb-1 and B29 transcripts generated by alternative mRNA splicing

The Ig-alpha/Ig-beta heterodimers encoded by mb-1 and B29 genes, respectively, are crucial for the constitution of the B-cell receptor (BCR). We report here novel variants of mb-1 and B29 transcripts produced by alternative mRNA splicing. The proteins encoded by these variants are predicted to conserve transmembrane and cytoplasmic portions of Ig-alpha and Ig-beta but lack a part of the extracellular portions containing cysteine residues which are required for intramolecular and intermolecular S-S bonds. Transfection studies revealed that the variant mb-1 and B29 did not contribute to the BCR expression on cell surfaces. Although peripheral B cells contain small amounts of the variant mb-1 and B29 transcripts, treatment with an anti-IgM antibody, LPS or IL-4 induces a significant increase in amounts of the variant transcripts. These observations suggest that B-cell activation induces alternative splicing of mb-1 and B29 transcripts which encode proteins unable to constitute the BCR.

Histological and immunohistochemical changes after transurethral balloon laser hyperthermia in the canine prostate

Transurethral balloon laser hyperthermia (TUBAL-H) for the prostate was performed in a canine model. Eleven normal and hyperplastic prostates were heated at between 40 to 45 degrees C for 30 min. Compared to the pretreatment weight, the prostatic weight significantly increased immediately after treatment and significantly decreased at 4 weeks later, but was not significantly different after 8 weeks. Histologically, shedding of epithelial cells was observed immediately after treatment, although, coagulonecrotic tissue was not seen. After 8 weeks, atrophic changes of epithelial cells were observed at the inner portion of the prostate. By immunohistochemical analysis, epithelial cells expressing apoptosis related antigen (Ley) were observed at the inner portion of the prostate from immediately after treatment until 4 weeks later. The atrophic epithelia and the expression of apoptosis in the prostate gland were pathological changes induced by TUBAL-H. From the present data, it is suggested that TUBAL-H combined with radiation or administration of anti-cancer drugs may be effective for prostate cancer.

Neuroendocrine tumors of the liver and pancreas associated with elevated serum prostatic acid phosphatase

A 58-year-old man was revealed to have multiple liver tumors with elevated prostatic acid phosphatase (PAP) during a medical examination. The tumors were of neuroendocrine nature, but no abnormal findings were obtained in other organs in which neuroendocrine tumors develop frequently. Repeated transarterial embolization was partially effective. However, the tumors became resistant to the therapy three years later, continued growing and ruptured. Autopsy disclosed neuroendocrine tumors in the pancreas, which were immunohistologically positive for PAP. Neuroendocrine tumors of the pancreas and liver producing PAP are rare; this case is reported with a review of literature.

[Age-related changes in amplitude ratio, duration ratio and area ratio in nerve conduction studies]

We investigated the effect of aging on nerve conduction parameters in 184 subjects (aged 10-75 years) without any history or signs of peripheral neuropathy, in order to clarify the diagnostic parameters of demyelinating neuropathies in the aged. The CMAP amplitude ratio (proximal CMAP/distal CMAP), duration ratio and area ratio remained unchanged throughout the second to eighth decades. The lower limits of normal CMAP amplitude ratio (mean -3SD) were 0.79 (median nerve), 0.74 (ulnar nerve), 0.59 (peroneal nerve), and 0.48 (tibial nerve). The upper limits of normal CMAP duration ratio (mean 11+ 3SD) were 1.22 (median nerve), 1.19 (ulnar nerve), 1.35 (peroneal nerve), and 1.32 (tibial nerve). The lower limits of normal CMAP area ratio (mean -3SD) were 0.84 (median nerve), 0.78 (ulnar nerve), 0.61 (peroneal nerve), and 0.62 (tibial nerve). There were no age-related changes in amplitude ratio or duration ratio of SNAP, although the standard deviations increased with age. Since the amplitude ratio, duration ratio and area ratio are simple and age-independent, they can provide useful and reliable information for routine nerve conduction studies for aged patients with demyelinating neuropathies.

[A case of portal-systemic encephalopathy with slowly progressive, non-flapping tremor]

A 52-year-old man has slowly developed a non-flapping tremor during 30 years. He also had suffered from poor concentration for two years. He had, however, no history of episodic disturbance of consciousness. He had no other neurological symptoms except for tremor and hyperreflexia. The tremor was postural and intentional, and extremely increased at the end point. The factor of intentional tremor and hyperkinesia volitionnelle seems to be present in the tremor. Laboratory examination disclosed a hyperammonemia, reduction in Fisher ratio, and poor excretion of ICG. Selective abdominal angiography visualized a large shunt vessel between the left gastric vein and the left renal vein. The normal liver scintigram with 99mTc excluded the dysfunction of liver, and we conclude that the shunt vessel might be congenital. Tremor markedly improved after normalizing blood ammonia level by resection of the shunt vessel. The present case suggests that tremor, even without episodic disturbance of consciousness, could be based on the portal-systemic encephalopathy.

Clinical efficacy of fluvastatin for hyperlipidemia in Japanese patients

The objective of the study was to evaluate the efficacy and safety of fluvastatin in patients with hypercholesterolemia, including heterozygous familial hypercholesterolemia, in a 1-year study (a 12-week open assessment, followed by 40 weeks of active treatment). Of the 337 patients enrolled in the study, the effects of fluvastatin were analyzed in 296 patients at baseline and at 12 weeks. Of these, 265 were receiving 20 mg/day fluvastatin at week 12 and in 20 patients the dose had been increased to 30 mg/day; 11 patients violated the dosing protocol. A total of 229 patients continued into the 40-week, long-term phase, and 212 patients were analyzed at baseline and after 24 and 52 weeks. At the end of treatment, 153 evaluable patients were still taking 20 mg/day fluvastatin, 1 was taking 10 mg/day, and 48 patients were taking 30 mg/day, and 10 were taking 40 mg/day. In the 20 mg/day fluvastatin group, low density lipoprotein cholesterol (LDL-C) levels decreased by 24.1% at week 12 and by 29.3% at week 52. In those patients requiring the higher doses, the corresponding reductions in LDL-C were 20.2% (week 12) and 26.7% (week 52). Total cholesterol was also reduced at week 12 by 17.0% (20 mg/day) and 15.7% (20-30 mg/day), and at week 52 by 20.4% (< or = 20 mg/day) and 19.2% (> or = 30 mg/day). Throughout the study, fluvastatin was generally well tolerated and no serious clinical adverse events were observed. In conclusion, long-term treatment of hypercholesterolemia with fluvastatin at dosages of 20-40 mg daily can be considered both safe and effective.

Involvement of rho in GTP gamma S-induced enhancement of phosphorylation of 20 kDa myosin light chain in vascular smooth muscle cells: inhibition of phosphatase activity

In beta-escin-permeabilized cultured pig aortic smooth muscle cells GTP gamma S dose-dependently enhances Ca(2+)-induced, wortmannin-sensitive phosphorylation of 20 kDa myosin light chain (MLC20). GTP gamma S does not potentiate thiophosphorylation of MLC20, but does inhibit its dephosphorylation. Pretreatment with C. botulinum exotoxin C3, which specifically ADP-ribosylates and inactivates the rho family of the small molecular weight G proteins, completely abolishes the effects of GTP gamma S. These results indicate that rho is involved in the GTP gamma S-induced enhancement of Ca(2+)-dependent MLC20 phosphorylation in aortic smooth muscle cells, and strongly suggest that this effect of rho is due to inhibition of protein phosphatase activity toward MLC20.

Somatostatinoma of the pancreas associated with von Hippel-Lindau disease

A 39-year-old man was admitted because of lumbago, vomiting and massive gastrointestinal bleeding. Oliguria developed a few days later, which was followed by hyperkalemia and cardiac arrest. Autopsy disclosed multiple renal cell carcinomas with diffuse metastasis to the liver, adrenal gland, psoas muscle and vertebrae. In addition, a somatostatinoma was found in the pancreas. From these findings and past history of cerebellar hemangioblastoma and spinal hemangioma he was diagnosed to have von Hippel-Lindau disease. Von Hippel-Lindau disease with islet cell tumor is very rare and is reported here with a review of literature.

A possible role of vitamin D receptors in regulating vitamin D activation in the kidney

The vitamin D endocrine system is regulated reciprocally by renal 25-hydroxyvitamin D3 1 alpha- and 24-hydroxylases. Previously, we reported that renal proximal convoluted tubules, the major site of 1 alpha, 25-dihydroxyvitamin D3 production, have vitamin D receptors. In the presence of vitamin D receptors, renal proximal convoluted tubules cannot maintain the state of enhanced production of 1 alpha, 25-dihydroxyvitamin D3. To clarify this discrepancy, we proposed a working hypothesis for the reciprocal control of renal 25-hydroxyvitamin D3 1 alpha- and 24-hydroxylase activities. In rat models of enhanced renal production of 1 alpha, 25-dihydroxyvitamin D3, expression of vitamin D receptors and 25-hydroxyvitamin D3 24-hydroxylase mRNAs was strikingly suppressed in renal proximal convoluted tubules but not in the cortical collecting ducts. In vitamin D-deficient rats with up-regulated renal 25-hydroxyvitamin D3 1 alpha-hydroxylase activity, expression of vitamin D receptor mRNA in renal proximal convoluted tubules was also down-regulated, indicating that the down-regulation of vitamin D receptor mRNA is not the result of the enhanced production of 1 alpha, 25-dihydroxyvitamin D3. In Japanese quail models with up-regulated renal 25-hydroxyvitamin D3 1 alpha-hydroxylase activity by sex steroids, expression of vitamin D receptor mRNA was also down-regulated in the kidney but not in the duodenum. These results suggest that the down-regulation of vitamin D receptors plays a critical role in production of 1 alpha, 25-dihydroxyvitamin D3 in renal proximal convoluted tubules.

Prostanoid secretion by rat hepatic sinusoidal endothelial cells and its regulation by exogenous adenosine triphosphate

We investigated the secretory profiles of prostanoids in two types of nonparenchymal cell from the rat liver, sinusoidal endothelial cells and Kupffer cells, in primary culture both under basal conditions and after stimulation with adenine nucleotides. Prostaglandin (PG) E2 was the main prostanoid secreted by both types of hepatic nonparenchymal cell in the basal and adenosine triphosphate (ATP)-stimulated states. Time- and concentration-dependent effects of ATP-mediated PGE2 secretion were noted in sinusoidal endothelial cells, whereas the profile of the relative potencies of individual nucleotides was consistent with the presence of P2y and P1 purinergic receptors. In Kupffer cells, the regulation of prostanoid secretion by adenine nucleotides was essentially the same as that in sinusoidal endothelial cells except that adenosine did not stimulate prostanoid secretion and that prostanoid secretion differed somewhat; Kupffer cells secreted relatively more PGF2 alpha and less 6-keto-PGF1 alpha than sinusoidal endothelial cells in the presence of ATP, suggesting the presence of only P2y receptors. In summary, PGE2 is the main prostanoid secreted by hepatic nonparenchymal cells and its secretion may be stimulated by adenine nucleotides and adenosine.

Occurrence of antibody against rat hepatic sinusoidal endothelial cells in sera of patients with autoimmune hepatitis

To determine whether an antibody against hepatic sinusoidal endothelial cells was present in sera of patients with autoimmune hepatitis (AIH) type 1, we measured the serum IgG bound to the glutaraldehyde-fixed cultured rat sinusoidal endothelial cells by enzyme-linked immunosorbent assay. IgG bound to the cells was detected significantly more in patients with autoimmune hepatitis type 1 (97.1%) than in those with primary biliary cirrhosis (13.0%), chronic hepatitis C (5.9%) or B (7.9%), or healthy controls (0%). IgG-F(ab')2 fragments from autoimmune hepatitis patients also bound to the cells, and this binding was observed after absorption of the fragments with rat hepatoma cells, but not after absorption with bovine carotid endothelial cells. Culture of sinusoidal endothelial cells in the presence of IgG from AIH patients significantly reduced the number of viable attached cells. In conclusion, anti-sinusoidal endothelial cell antibody occurred in the sera from patients with autoimmune hepatitis type 1.

Effect of CCK-B/gastrin receptor antagonist on pepsinogen-producing cells during omeprazole treatment

The present study investigated the effect of long-term treatment with omeprazole on pepsinogen-producing cells and examined whether the selective CCK-B/gastrin receptor antagonist was able to prevent the omeprazole-induced changes, if occurred, in rat stomach. Rats were treated with omeprazole and/or the CCK-B/gastrin receptor antagonist for 28 days. As a result, omeprazole markedly reduced mucosal pepsinogen activity and its mRNA concentration in rat stomach. Morphologically, in fundic glands omeprazole drastically decreased the proportion of mature chief cells and reciprocally increased that of immature chief cells which were positive for class III mucin. These effects of omeprazole were attenuated by an addition of the CCK-B/gastrin receptor antagonist. Our results suggest that omeprazole retards the differentiation of chief cells in fundic mucosa probably through hypergastrinemia in adult rat.

Takayasu's arteritis in prepulseless stage manifesting lymph node swelling and hepatosplenomegaly

A 17-year-old male had fever of unknown origin (FUO) for 3 months with positive c-reactive protein, lymph node swelling, and hepatosplenomegaly. Biopsy specimens of the liver and lymph node disclosed nonspecific inflammation. Lymph node swelling and hepatosplenomegaly subsided gradually, while vascular murmur and pulselessness appeared. Computerized tomography and magnetic resonance imaging showed thickened arterial wall, while angiography disclosed arterial narrowing. From these findings he was diagnosed to have Takayasu's arteritis. The therapy with prednisolone was effective. Takayasu's arteritis is rarely manifested by hepatosplenomegaly and lymphadenopathy in its prepulseless stage.

Changes in prostatic thickness and the location of ejaculatory ducts in autopsy prostates

OBJECTIVE

To measure prostatic thickness and the depth of ejaculatory ducts from the urethral surface to prevent ejaculatory duct damage during transurethral balloon laser thermotherapy.

MATERIALS AND METHODS

In 47 prostates obtained at autopsy, the prostatic thickness and the depth of ejaculatory ducts from the urethral surface were measured in eight directions from the centre of the urethra.

RESULTS

The depth of ejaculatory ducts was approximately 6 mm from the urethral surface regardless of prostatic weight. Increase in prostatic weight was associated with increase in the thickness in all directions except the posterior one; the thickness ranged from 9 to 20 mm. The posterior thickness at the level of the transition zone was 10 mm regardless of prostatic weight.

CONCLUSION

When benign prostatic hypertrophy is treated transurethrally, using laser or microwave equipment, care should be taken to avoid heating the posterior region of the prostate.

C1q-binding immunoglobulin G in MRL/l mice consists of immune complexes containing antibodies to DNA

Previous studies have shown that the majority of C1q-binding IgG in patients with systemic lupus erythematosus (SLE) is composed of autoantibodies to the collagen-like region of C1q. Mice of the MRL/l strain are considered as a murine model of human SLE and possess autoantibodies to nuclear antigens as well as IgM and IgG rheumatoid factors (RF). This study was undertaken to characterize the C1q-binding IgG in MRL/l mice. In contrast to human SLE, C1q-binding IgG in MRL/l mice showed immunochemical characteristics of immune complexes rather than those of autoantibodies to C1q. Namely, C1q-binding IgG in MRL/l mice was large-sized upon HPLC gel filtration and abolished by digestion with pepsin or by high salt concentration, and bound to the globular region of C1q. The C1q-binding activity in MRL/l mice was absorbed by double-stranded DNA- or single-stranded DNA-cellulose. The medium-sized immune complexes containing RF have been well documented in MRL/l mice. In this study, however, mouse IgG-Sepharose failed to absorb fully C1q-binding IgG. We conclude that the majority of C1q-binding IgG in MRL/l mice consists of large-sized immune complexes containing antibodies to DNA.

[Clinical analysis of ureteral injuries]

Six cases of ureteral injuries were analyzed. Two cases were male and 4 cases were female. The right side was affected in 1 case and the left in 5 cases. The affected portion was the uretero-pelvic junction in 1 case and lower iliac vessels in the other cases. Five cases were iatrogenic injuries in surgical or gynecological pelvic operation, and the other was due to blunt trauma. Intraoperative diagnosis was made in 4 cases. Drain leakage led to diagnosis in one case and pyelonephritis in another. Ureteroureterostomy was performed in 2 cases, pyeloureterostomy in 1 case, ureteroneocystostomy with psoas hitch in 1 case, Boari bladder flap in 1 case and simple suture in 1 case. 4-0 or 5-0 Dexon with an atraumatic needle was used for all anastomoses. Except for case 1, who died of the recurrence of carcinosarcoma, renal functions were preserved in all patients during the follow-up period ranging from 5 months to 7 years 8 months.