Differential effects of isoflurane and halothane on the induction of heat shock proteins

Isoflurane is considered to be a less hepatotoxic volatile anesthetic than halothane since it not only undergoes quantitatively much less metabolism to form toxic reactive intermediates, but also preserves better hepatic blood flow. However, the biochemical basis for the reduced hepatotoxicity has not been elucidated. In this study, we examined the induction of two heat shock proteins, heat shock protein 70 (HSP70) and heme oxygenase-1 (HO-1), in the livers of rats pretreated with or without phenobarbital, followed by exposure to isoflurane or halothane under hypoxic conditions. In the phenobarbital-pretreated rats, the maximal induction of HSP70 was observed by halothane-hypoxia treatment, followed by a half-maximal induction by isoflurane-hypoxia treatment, and less than 30% induction by hypoxia treatment alone. Serum alanine aminotransferase (ALT) activity, an indicator of hepatic dysfunction, which correlated well with the extent of centrilobular necrosis, showed similar changes with increases in HSP70 mRNA. In contrast, HO-1 mRNA was induced only by treatment with halothane-hypoxia. In addition, changes in the expression of HSP70 and HO-1 mRNAs were correlated with their protein expression in the liver. In non-pretreated rats, neither isoflurane-hypoxia exposure nor halothane-hypoxia exposure caused apparent hepatic injury. There was also no induction of HSP70 or HO-1 mRNA by these treatments in non-pretreated animals. These findings demonstrate that there is a significant difference in hepatic injury, and in the induction of HO-1 and HSP70 between halothane-hypoxia and isoflurane-hypoxia treatments. Isoflurane is known to be safer than halothane, which may, in part, be accounted for by the generation of less oxidative stress in the presence of isoflurane, as assessed by reduced induction of heat shock proteins compared with halothane treatment.

[Lung cancer metastasis to the gingiva]

A 70-year-old man was referred to our hospital complaining of left gingival tumors with bleeding, halitosis and impediments to eating and speaking. Tumors were also found in both lungs, the stomach, the intestines and the right adrenal gland. Biopsies of the gingiva and the stomach pointed to undifferentiated carcinoma. Although the patient was treated with carboplatin plus 5-fluorouracil, the gingival tumors did not change in size. Subsequently, the gingival tumors were irradiated with a total dose of 39 Gy, and disappeared completely. The patient died 78 days later of hemorrhage of the digestive tract. Postmortem examination revealed that the primary tumor was in the left lung. Nineteen cases of lung cancer metastatic to the gingiva have been reported. The prognosis in all was very poor, and the QOL was compromised. However, several cases have improved with therapy to the gingiva. We believe that initial therapy should be directed at metastatic gingival tumors of the lung.

Expression of type I, type II, and type X collagen genes during altered endochondral ossification in the femoral epiphysis of osteosclerotic (oc/oc) mice

The osteosclerotic (oc/oc) mouse, a genetically distinct murine mutation that has a functional defect in its osteoclasts, also has rickets and shows an altered endochondral ossification in the epiphyseal growth plate. The disorder is morphologically characterized by an abnormal extension of hypertrophic cartilage at 10 days after birth, which is later (21 days after birth) incorporated into the metaphyseal woven bone without breakdown of the cartilage matrix following vascular invasion of chondrocyte lacunae. In situ hybridization revealed that the extending hypertrophic chondrocytes expressed type I and type II collagen mRNA, as well as that of type X collagen and that the osteoblasts in the metaphysis expressed type II and type X collagen mRNA, in addition to type I collagen mRNA. The topographic distribution of the signals suggests a possible co-expression of each collagen gene in the individual cells. Immunohistochemically, an overlapping deposition of type I, type II, and type X collagen was observed in both the extending cartilage and metaphyseal bony trabeculae. Such aberrant gene expression and synthesis of collagen indicate that pathologic ossification takes place in the epiphyseal/metaphyseal junction of oc/oc mouse femur in different way than in normal endochondral ossification. This abnormality is probably not due to a developmental disorder in the epiphyseal plate but to the failure in conversion of cartilage into bone, since the epiphyseal plate otherwise appeared normal, showing orderly stratified zones with a proper expression of cartilage-specific genes.

Tissue-specific gene expression of heme oxygenase-1 (HO-1) and non-specific delta-aminolevulinate synthase (ALAS-N) in a rat model of septic multiple organ dysfunction syndrome

Reactive oxygen species are thought to be involved in the pathogenesis of septic multiple organ dysfunction syndrome (MODS). It has been reported that heme oxygenase-1 (HO-1) (EC 1.14.99.3) is induced in septic animal models and is thought to confer protection against oxidative tissue injury. In this study, we examined changes in gene expression of HO-1 and non-specific delta-aminolevulinate synthase (ALAS-N) (EC 2.3.1.37), the rate-limiting enzymes in heme catabolism and heme synthesis, respectively, after intraperitoneal administration of bacterial lipopolysaccharide (LPS) to rats. LPS treatment caused the elevation of body temperature, increases in white blood cell counts, and marked elevation of serum interleukin-6 levels associated with liver, lung, and kidney injuries, characteristic of septic MODS. LPS administration significantly induced HO-1 mRNA, protein, and enzyme activity in the liver, lung, and kidney. In contrast, ALAS-N mRNA was decreased rapidly in the liver, followed by an oscillating recovery pattern. Induction of hepatic HO-1 mRNA and rapid suppression of ALAS-N mRNA were likely the result of a rapid increase in hepatic free heme concentration as judged by the increase in heme saturation of tryptophan pyrrolase. In contrast to that in the liver, the ALAS-N mRNA level in the lung and kidney was increased significantly after LPS administration, suggesting a novel mechanism of ALAS-N regulation in these tissues. These findings suggest that HO-1 and ALAS-N mRNA are regulated in a tissue-specific manner in a rat model of septic MODS.

Differential induction of brain heme oxygenase-1 and heat shock protein 70 mRNA in sepsis

We examined gene expression of heat shock protein 70 (HSP70) and heme oxygenase-1 (HO-1), which is the rate limiting enzyme in heme catabolism and is also known as heat shock protein 32 (HSP32), in the rat brain using a sepsis model induced by bacterial lipopolysaccharide (LPS). Intraperitoneal injection of LPS (10 mg/kg) to rats caused the elevation of body temperature and white blood cell (WBC) counts as well as marked elevation of serum interleukin-6 (IL-6) level, showing the typical pathological characteristics of sepsis. In this model, HO-1 mRNA increased at 6 h after LPS administration and continued to rise until 30 h. In contrast, HSP70 mRNA increased only between 3 h and 6 h after LPS administration, returning completely to the control level by 12 h. HO-1 mRNA was expressed predominantly in the cortex and the medulla oblongata, while HSP70 mRNA was expressed mainly in the striatum. HO-1 and HSP70 mRNA levels thus showed distinctive time courses and tissue distribution in the brain, suggesting that gene expression of these heat shock proteins (HSPs) is separately regulated.

Prevention of halothane-induced hepatotoxicity by hemin pretreatment: protective role of heme oxygenase-1 induction

Reductive metabolism of halothane in phenobarbital-pretreated rats is known to increase free radical formation that results in hepatotoxicity. It also is associated with a marked induction of microsomal heme oxygenase-1 (HO-1), suggesting that there is an alteration in heme metabolism. In this study, we examined heme metabolism in rats pretreated with phenobarbital, followed by exposure to halothane-hypoxia. In this model, there was a significant decrease in microsomal cytochrome P450 content in the liver, followed by a rapid increase in free heme concentration and a decrease in the level of mRNA for the nonspecific delta-aminolevulinate synthase. A transient but dramatic induction of HO-1 mRNA and a prolonged induction of heat shock protein 70 mRNA also occurred. The HO-1 protein was detected principally in the hepatocytes around the central vein. Serum alanine transaminase (ALT) activity, an indicator of hepatic dysfunction, increased continuously throughout the experiment. Hemin pretreatment induced hepatic HO-1 with abrogation of the halothane-induced hepatotoxicity in this model, as judged by ALT activity and normal histology. Our findings in this study thus indicate that halothane-induced hepatotoxicity is due not only to its reductive metabolite formation, but also to an increase in hepatic free heme concentration, which is a potent prooxidant; HO-1 induction is an important protective response against such changes. This is also the first study to demonstrate that hemin pretreatment, which induces HO-1 prior to exposure to halothane, effectively prevents halothane-induced hepatotoxicity.

Protective effect of heme oxygenase induction in ischemic acute renal failure

OBJECTIVE

To examine the role of heme oxygenase-1 (HO-1) induction in the recovery of renal function in rats with ischemic acute renal failure.

DESIGN

Randomized, masked, controlled animal study.

SETTING

University-based animal research facility.

SUBJECTS

Sprague-Dawley male rats, weighing 200-250 g.

INTERVENTIONS

Anesthetized rats were subjected to bilateral flank incisions, and the right kidney was removed. Renal ischemia was performed by left renal microvascular clamping, followed by reflow of the blood.

MEASUREMENTS AND MAIN RESULTS

Ischemia of the kidney in the uninephrectomized rat significantly induced HO-1 messenger RNA, protein, and enzyme activity, reaching a maximum at 6 hrs, which was mediated in part through an increase in microsomal heme concentration. Heat shock protein 70 was induced extremely rapidly, reaching a maximum at 1 hr, suggesting that HO-1 and heat shock protein 70 gene expression are regulated separately. Inhibition of HO activity by tin mesoporphyrin, which resulted in an increase in microsomal heme concentration, significantly exacerbated renal function, as judged by the sustained increase in serum creatinine concentration and extensive tubular epithelial cell injuries. In contrast, animals that did not receive tin mesoporphyrin showed normal creatinine concentration and microsomal heme concentration 24 hrs after reperfusion, as well as restoration of abnormal renal histology.

CONCLUSION

These findings indicate that the expression of HO-1 in the ischemic kidney may be critical in the recovery of renal cell function in this animal model. These findings also suggest that H0-1 induction may play an important role in conferring protection on renal cells from oxidative damage caused by heme.

[Heat shock response in a rat model of septic multiple organ dysfunction syndrome]

Severe sepsis is known to result in multiple organ dysfunction syndrome (MODS), which is thought to be mediated by oxidative stress, as a result of excessive systemic inflammation. Heme Oxygenase-1 (HO-1), the rate limiting enzyme in heme catabolism, is also known as HSP32. HO-1 is induced not only by its substrate heme but also by oxidative stress. We investigated gene expression of HO-1 and physiological significance of HO-1 induction in a rat model of septic MODS induced by intraperitoneal injection of bacterial lipopolysaccharide (LPS). Following administration of LPS, HO-1 mRNA was significantly induced in the liver, lung and kidney in an organ-specific manner. Hepatic HO-1 induction appears to be mediated by an increase in hepatic free heme concentration. Inhibition of HO activity by tin mesoporphyrin significantly exacerbated lung injury. These results suggest that HO-1 induction may play an important role in conferring protection on cells from oxidative damage not only by catalyzing heme, a pro-oxidant, but also by producing bilirubin, an anti-oxidant. Furthermore, HO-1 mRNA is induced markedly in the buffy coat of the blood at 3 h after LPS administration, coinciding with the increase in serum IL-6 level, suggesting that HO-1 may be one of the key markers of septic MODS.

Membrane topology of Alzheimer's disease-related presenilin 1. Evidence for the existence of a molecular species with a seven membrane-spanning and one membrane-embedded structure

A significant member of early-onset familial type of Alzheimer's disease cases has been shown to be caused by dominant mutations in either of the two genes encoding presenilin 1 (PS1) and presenilin 2 (PS2). These two proteins are highly homologous to each other and have been reported to be mainly localized to the membranes of intracellular compartments such as the endoplasmic reticulum. Information about the membrane topological structures of these proteins is indispensable for understanding their physiological and pathological roles. Although several models have been proposed previously, their precise membrane topologies remain unknown. In this study, we examined this issue in detail by expressing a series of C-terminally deleted PS1 mutants fused to the hydrophilic portion of Escherichia coli leader peptidase in vitro using a reticulocyte lysate in the presence of microsomal membranes. Our results predict that PS1 exists mainly in a seven membrane-spanning structure with its C-terminal end exposed to the luminal space. This was also confirmed by expressing these fusion proteins in cultured cells. We further showed that a ninth hydrophobic segment is tightly bound to the membrane without spanning it. Based on the above observations, we propose a novel "seven membrane-spanning and one membrane-embedded" topological model for presenilins.

[Pranlukast allows reduction of inhaled steroid dose without deterioration in lung function in adult asthmatics]

We undertook a community based case-control study to measure the effect of pranlukast on the reduction of inhaled steroid in adult asthmatics. Forty-one adults completed a run-in period of 4 weeks on 800 microgram of beclomethasone dipropionate (BDP) documenting twice daily peak expiratory flow (PEF) and symptom score and therapeutic score on a standard diary. Forced expiratory volume in one second (FEV1.0), V50, V25 was measured once during the run-in period. Patients were then randomized to receive either pranlukast with 400 microgram of BDP or 400 microgram alone for 8 weeks. There was no difference in the symptom score and therapeutic between the two groups at any time point. However, morning and evening % PEF run-in expressed as a % of the PEF average during the run-in period was significantly lower at 8 weeks in the groups without pranlukast. There were subjects in the group without pranlukast (35.3%) compared to those with (20.8%) who had a 10% or more reduction in % PEF from the run-in period. The patients with an FEV1.0 < 80% predicted who were randomized to the control group were more likely (5 of 7) to have a fall in % PEF run-in and those randomized to received pranlukast were less likely to have a fall in % PEF run-in though this was not significant (2 of 6). In this study, pranlukast has demonstrated steroid sparing effect. Severe asthmatics (FEV1.0 < 80%) who deteriorate after reduction of inhaled steroid may benefit most from pranlukast. Larger studies are now required to explore this important effect.

Clinical manifestation and survival of patients with idiopathic bilateral atrial dilatation

We studied the histories of eight patients who lacked clear evidence of cardiac abnormalities other than marked bilateral atrial dilatation and atrial fibrillation, which have rarely been discussed in the literature. From the time of their first visit to our hospital, the patients' chest radiographs and electrocardiograms showed markedly enlarged cardiac silhouettes and atrial fibrillation, respectively. Each patient's echocardiogram showed a marked bilateral atrial dilatation with almost normal wall motion of both ventricles. In one patient, inflammatory change was demonstrated by cardiac catheterization and endomyocardial biopsy from the right ventricle. Seven of our eight cases were elderly women. Over a long period after the diagnosis of cardiomegaly or arrhythmia, diuretics or digitalis offered good results in the treatment of edema and congestion in these patients. In view of the clinical courses included in the present study, we conclude that this disorder has a good prognosis.

Patent ductus arteriosus and neonatal death in prostaglandin receptor EP4-deficient mice

The physiological role of the prostaglandin E2 receptor EP4 subtype was investigated by generation of EP4-deficient-mice by gene targeting. Loss of the EP4 receptor was not lethal in utero, but most EP4 (-/-) neonates became pale and lethargic approximately 24 h after birth and died within 72 h. Less than 5% of the EP4 (-/-) mice survived and grew normally more than a year. Histological examination revealed that the ductus arteriosus in dead neonates remained open, while it was partially closed in the survivors. In situ hybridization study showed that EP4 mRNA was strongly expressed in the ductus. These results suggest that neonatal death is at least partly due to patent ductus arteriosus and that the EP4 receptor plays a role in regulation of the patency of this vessel. They also indicate that normal function of the EP4 receptor is essential in neonatal adaptation of the circulatory system.

Multiple regression analysis of airway responsiveness in adult asthmatic patients

The aim of this study was to determine which background variables exert the most influence on airway responsiveness in adult asthmatic patients. The relationships between airway response and background variables were investigated by multiple linear and logistic regression analysis in 97 asthmatic patients. Airway responsiveness was measured by the oscillation technique during methacholine inhalation challenge. The regression analyses revealed that modified Aas score "one of asthma severity score", was the major factor contributing to airway hyperreactivity. We conclude that the number of attacks during a previous year is the most important background factor related to airway hyperresponsiveness on a clinical basis.

[A case of idiopathic interstitial pneumonia with marked increase of CA19-9 in serum and BALF]

A 84-year-old man was admitted with dyspnea. Chest X-ray and CT showed honeycombing in the dorso-basal segments of the lung bilaterally. Idiopathic interstitial pneumonia (IIP: chronic, typical type) was diagnosed in accordance with the clinical criteria proposed by the Japanese Ministry of Health and Welfare. An extensive examination revealed no malignancy. However, the CA 19-9 level in bronchoalveolar lavage fluid (BALF) was very high (5,700 U/ml). An immunohistochemical test of lung tissue obtained by transbronchial lung biopsy was positive for CA 19-9 in bronchiolar epithelial and goblet cells. This case suggests that CA 19-9 is occasionally produced on a large scale in the lung of patients with IIP.

Eosinophilic myocarditis associated with toxicodermia caused by phenobarbital

We report on a 37-year-old man with congestive heart failure caused by eosinophilic myocarditis associated with toxicodermia. He developed many annular skin eruptions and peripheral eosinophilia due to reactions against phenobarbital. Right ventricular endomyocardial biopsy revealed extensive infiltration of eosinophils in the myocardium. A drug lymphocyte-stimulating test (DLST) for phenobarbital was positive. His symptoms, cardiomegaly, and cardiac function were improved by discontinuing phenobarbital followed by oral administration of prednisolone. We conclude that this eosinophilic myocarditis must have been induced by an allergic reaction to phenobarbital and that long-term eosinophilia contributed to the myocardial injury.

Characterization of the mouse prostaglandin F receptor gene: a transgenic mouse study of a regulatory region that controls its expression in the stomach and kidney but not in the ovary

BACKGROUND

The actions of prostaglandin F2alpha are mediated by a cell-surface receptor (FP), but little is known about the regulation of FP gene expression. To clarify the mechanisms underlying tissue specific transcription of the mouse FP gene, we isolated and characterized mouse genomic DNA clones encoding FP.

RESULTS

Structural analysis revealed that the mouse FP gene is composed of three exons and two introns, and spans more than 11 kilobases. By primer extension and PCR analyses, the major transcription start site was identified as a cytosine nucleotide, but additional sites of transcription initiation were found in the ovary. There was no apparent difference in the FP gene transcription initiation site between the ovary, kidney and stomach. Sequence analysis of the putative promoter region showed only two potential SP-1 binding sites, but no other typical well-known consensus sequences. We generated transgenic mice with the potential promoter region of the FP gene connected to the lacZ reporter gene. Northern blot analysis showed that the pattern of expression of the transgene corresponded to that of FP expression, except in the ovary. Upon analysis by in situ hybridization, the lacZ gene transcripts were found to be expressed in the fundic glands in the stomach, and the cortical tubules in the kidney, in which endogenous FP transcripts were also expressed. On the contrary, expression of lacZ transcripts was not detected in the corpora lutea, where the highest expression of FP mRNA was observed.

CONCLUSIONS

These studies suggest that a separate control mechanism exists for FP expression in the ovary, distinct from the expression in the stomach and kidney.

Altered pain perception and inflammatory response in mice lacking prostacyclin receptor

Prostanoids are a group of bioactive lipids working as local mediators and include D, E, F and I types of prostaglandins (PGs) and thromboxanes. Prostacyclin (PGI2) acts on platelets and blood vessels to inhibit platelet aggregation and to cause vasodilatation, and is thought to be important for vascular homeostasis. Aspirin-like drugs, including indomethacin, which inhibit prostanoid biosynthesis, suppress fever, inflammatory swelling and pain, and interfere with female reproduction, suggesting that prostanoids are involved in these processes, although it is not clear which prostanoid is the endogenous mediator of a particular process. Prostanoids act on seven-transmembrane-domain receptors which are selective for each type. Here we disrupt the gene for the prostacyclin receptor in mice by using homologous recombination. The receptor-deficient mice are viable, reproductive and normotensive. However, their susceptibility to thrombosis is increased, and their inflammatory and pain responses are reduced to the levels observed in indomethacin-treated wild-type mice. Our results establish that prostacyclin is an antithrombotic agent in vivo and provide evidence for its role as a mediator of inflammation and pain.

Failure of parturition in mice lacking the prostaglandin F receptor

Mice lacking the gene encoding the receptor for prostaglandin F2alpha (FP) developed normally but were unable to deliver normal fetuses at term. Although these FP-deficient mice showed no abnormality in the estrous cycle, ovulation, fertilization, or implantation, they did not respond to exogenous oxytocin because of the lack of induction of oxytocin receptor (a proposed triggering event in parturition), and they did not show the normal decline of serum progesterone concentrations that precedes parturition. Ovariectomy at day 19 of pregnancy restored induction of the oxytocin receptor and permitted successful delivery in the FP-deficient mice. These results indicate that parturition is initiated when prostaglandin F2alpha interacts with FP in ovarian luteal cells of the pregnant mice to induce luteolysis.

Restoration of disturbed tooth eruption in osteopetrotic (op/op) mice by injection of macrophage colony-stimulating factor

Osteopetrotic (op/op) mice show severe osteosclerosis caused by an inherited deficiency of osteoclast and resultant failure of tooth eruption, which can be cured by the injection of macrophage colony-stimulating factor (M-CSF). The present study revealed that consecutive injections of M-CSF in these mutant mice brought about a recovery of bone resorption resulting in the resumption of growth of tooth root and periodontal ligament. Bone resorption at the inner surface of bony crypts was noted on the 5th day after the start of M-CSF injections. This activity was reduced with the progress of root and periodontal ligament formation, being confined to the basal and crestal portion of bony crypts by the 15th day of the experiment. Second molars emerged into the oral cavity on the 15th day, but no eruption of first molars was observed until the 20th day. Throughout the experiment, first molars exhibited appreciable root deformity, which was less severe in second molars. Delayed eruption of first molars was thought to be related to the severity of the disturbance of root formation.

Association of expression of mRNA encoding the PGF2 alpha receptor with luteal cell apoptosis in ovaries of pseudopregnant mice

The relationship between the expression of mRNA encoding the prostaglandin F2 alpha (PGF2 alpha) receptor and luteal cell apoptosis as determined by oligonucleosome formation was determined in mouse corpora lutea on days 2 (early phase), 6 (mid-phase), and 11 and 13 (late phase) of pseudopregnancy. No signals for mRNA encoding the PGF2 alpha receptor were detected in the ovary as shown by RNA blot analysis of pregnant mares' serum gonadotrophin (PMSG)-treated mice. The expression of the mRNA that could be detected in the corpora lutea on day 2 after hCG treatment was low, but it was increased on day 6 and reached a plateau on days 11 and 13. On days 11 and 13, in situ hybridization signals for mRNA encoding the PGF2 alpha receptor were localized to large luteal cells of the corpora lutea, especially the cells in the superficial layer. However, ethidium bromide staining revealed marked oligonucleosome formation in the corpora lutea on days 11 and 13. Similarly, positive signals of in situ nick-DNA-end labelling were also detected in the corpora lutea on days 11 and 13. Analysis of the adjacent sections of the corpora lutea on day 13 showed that both signals for DNA strand breaks and mRNA encoding the PGF2 alpha receptor were co-expressed in the corpus luteum. These results suggest that apoptosis during structural luteolysis closely associates with the increased expression of mRNA encoding the PGF2 alpha receptor in luteal cells of pseudopregnant mice.

Oral mucosal lesions in experimental graft-versus-host disease: morphological and immunohistochemical characterization of infiltrating cells

To facilitate recognition of the oral mucosal lesion that develops in rats with graft-versus-host disease (GVHD) induced by injecting spleen cells of parental strain rats (Brown Norway) into non-irradiated (Brown Norway x Lewis) F1 hybrid rats, we followed the development of the tongue lesion histologically and immunohistochemically. This assessment revealed an increase in the number of MHC class II+ cells with dendritic shape in the lamina propria to be the earliest stage of the tongue lesions in GVHD rats. The subsequent mononuclear cell infiltration with epithelial cell destruction, characteristic of GVHD, consisted of CD8+ cells and macrophages. Our findings seem to indicate that MHC class II+ cells with dendritic shape may provide antigen presentation in the induction of local immunological responses, including tissue destruction, by CD8+ cells and macrophages in the tongue of GVHD rats.

Histopathologic observation of seven removed endosseous dental implants

Seven failed endosseous dental implants that were removed from humans were examined histologically. Results suggest that the hollow-basket portion or the vent should be located as far from the gingiva as possible, and that an adequate healing period is needed for implant placement following tooth extraction. In addition, findings also suggest that the hollow-basket implant is not suitable for a healing socket, that periodic inspection is necessary for two-stage implants to evaluate adaptation of the embedded junction between the abutment and implant in the gingiva, and that there is risk of coating separation from hydroxyapatite-coated implants and possibilities of coating resorption.

Mononuclear cell thyroiditis in rats with graft-versus-host disease

Rats with graft-versus-host disease (GVHD), induced by injecting spleen cells of parental strain rats (Brown Norway) into non-irradiated (Brown Norway x Lewis) F1 hybrid rats, develop thyroiditis. This is characterized by mononuclear cell infiltration with destruction of the epithelium and a significant reduction in serum thyroid hormone levels. Immunohistochemically, the mononuclear cells consisted mainly of CD8-positive cells and macrophages. These findings provide evidence that the thyroid gland can now be enumerated as one of the target organs during GVHD. The CD8-positive cells may serve as important effector cells in lesion development, either by direct cytotoxicity or by supporting the cytotoxic potential of macrophages.

[Long-term results of endourological treatment of urinary calculi: multivariate analyses of the risk factors related to recurrence or re-growth]

To evaluate the risk factors related to the long-term outcome of endourologic treatment of urinary calculi, data from the rates of recurrence or re-growth in 145 patients with 167 renal units who were observed for more than 3 months at the Hiroshima University Hospital, were reviewed. The factors included in the present analysis were age, previous stone, location, number, size and composition of stone and procedures of treatment. Of 167 renal units, the overall recurrence and re-growth rates were 17% and 10%, respectively. The earliest recurrence and re-growth appeared at 3 months after the treatment, and 71% of recurrence and 81% of re-growth occurred within 2 years. In 9 out of 20 renal units (45%) with unsuccessful treatment, residual stones enlarged during the follow-up. Stone located in renal calyx and pelvis, previous stone, multiple stones, size of stone more than 20 mm, stone composed of calcium oxalate and/or calcium phosphate and struvite stone were likely to be risk factors. However, on the univariate analysis there were no significance of difference among these variables. On the results of analysis by Cox's proportional hazards model, characteristics such as stone located in renal calyx and pelvis, size of stone more than 20 mm (p < 0.01), treatment with percutaneous nephrolithotripsy (PNL), previous stone, size of stone between 10 mm and 20 mm, and multiple stones (p < 0.05), were significantly related to either recurrence or re-growth of stone.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term results of endourologic treatment of urinary calculi: investigation of risk factors for recurrence or regrowth

To evaluate the risk factors related to the long-term outcome of endourologic treatment of urinary calculi, we examined rates of recurrence and regrowth in 167 renal units. The following risk factors were examined: age; previous stone; location, number, size, and composition of stone; and procedures. In our study sample, the overall recurrence and regrowth rates were 17% and 10%, respectively. The earliest recurrence and regrowth appeared at 3 months after treatment, and 71% occurred within 2 years. In 22% of renal units that were estimated to be stone-free, stones appeared later, and 45% of inadequately fragmented stones enlarged. Stones located in a renal calix and pelvis, multiple stones, large stones (more than 20 mm), stones composed of calcium oxalate or calcium phosphate or both, and struvite stones were likely to be risk factors, but there were no significant differences statistically. Although the possibility of several risk factors was suggested in our study, thorough fragmentation of stones and complete removal of fragments, combined with extracorporeal shock wave lithotripsy or chemolysis if needed, is ultimately responsible for successful treatment of urinary calculi.

[A clinical study on upper urinary tract calculi treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy, with regard to bacteriuria before ESWL treatment]

To study a clinical problem in urolithiasis complicated with bacteriuria treated by extracorporeal shock wave lithotripsy (ESWL), we studied relationships between the frequency of bacteriuria and some clinical factors such as sex, location of, size of and composition of calculi in patients with upper urinary tract calculi. We also evaluated whether bacteriuria caused fever elevation after ESWL monotherapy. Six hundred seventy patients with upper urinary tract calculi, 440 renal calculi and 230 ureteral calculi, were subjected to the present study. The results were summarized as follows: 1) Bacteriuria was found in 40 of 440 patients with renal calculi (9%) and 12 of 230 patients with ureteral calculi (5%). 2) The frequency of bacteriuria was significantly higher in female (11%) than in male (6%) (p < 0.05). 3) Ten strains of Pseudomonas aeruginosa, 7 of Escherichia coli and 6 of Proteus mirabilis were isolated in patients with bacteriuria. 4) On the location of renal calculi in patients with bacteriuria, 37 out of 40 patients (93%) were found in R2. In contrast, bacteriuria was the most frequently found in DS 6 (19%), whereas the positive rates were about 10% in DS 3 (7%), DS 4 (*7%) and DS 5 (9%). The presence of bacteriuria was not related to the location of calculi or the size of calculi in patients with ureteral calculi. 5) Most of the calculi with bacteriuria were composed of magnesium ammonium phosphate or the mixture of calcium phosphate and carbonate with or without oxalate. 6) Patients with bacteriuria had a significantly higher rate of fever elevation after ESWL than those without bacteriuria (p < 0.01).

Transient recruitment of osteoclasts and expression of their function in osteopetrotic (op/op) mice by a single injection of macrophage colony-stimulating factor

Severe deficiency of osteoclasts in op/op mice, caused by the absence of functional macrophage colony-stimulating factor (M-CSF), is cured by daily injections of purified recombinant human M-CSF (rhM-CSF). In this study, we found that a single injection of 5 micrograms rhM-CSF is enough for recruitment of osteoclasts in mutant mice. Osteoclast number increased during the period between 2 and 4 days after the single rhM-CSF injection. When YM175, a new derivative of bisphosphonate, was administered to the mice 4 days after rhM-CSF injection or later, osteoclasts disappeared by 3 days after YM175 administration. However, a significant number of osteoclasts were detected even at 3 days after YM175 administration when YM175 was administered 3 days after rhM-CSF injection or earlier. These results indicate that YM175 is cytotoxic only to functioning osteoclasts and that recruitment of osteoclasts is finished 4 days after a single rhM-CSF injection. The osteoclasts actively resorbed bone trabeculae for a prolonged period, demonstrating that M-CSF is not requisite for the functioning of mature osteoclasts.

[Changes in rabbit lens epithelial cells after intravitreal silicone oil injection]

Using adult albino rabbits, the clinical course of lens opacity and morphological changes of lens epithelial cells were observed from 2 weeks to 3 months after intravitreal silicone oil injection. Simple vitrectomy was performed in both rabbit eyes. One eye with silicone oil injection served as an experimental eye, while another control eye did not receive any injection. Seven examined eyes showed early posterior subcapsular lens opacity from one month after silicone oil injection by slit-lamp microscopy. Small intracellular vacuoles near to the interdigitation of the lens epithelial cells were observed in the 7 eyes from 2 weeks after the procedure by transmission electron microscopy. These changes were not observed in 7 control eyes. As a result, it is surmised that cataract formation after intravitreal silicone oil injection may be associated with morphological changes of the lens epithelial cells.

Interference with interparietal growth in the human skull by the tectum synoticum posterior

The tectum synoticum posterior, which is one of the 3 skull roof elements of the chondrocranium, interferes with the growth of the human interparietal bone, thus giving rise to lateral incisures in the bone. Our observations on the developmental fate of the incisures strongly suggest that the sutura mendosa is the remnant of these incisures.

Multiloculated renal cell carcinoma

Multiloculated renal cell carcinoma and multilocular renal cyst with renal cell carcinoma are uncommon diseases. We report on 2 cases of multiloculated renal cell carcinoma. To our knowledge 16 cases of multiloculated renal cell carcinoma and multilocular renal cyst with renal cell carcinoma have been previously described in detail. The authors review the literature and discuss the aetiology and diagnosis of the disease.

Essential role of macrophage colony-stimulating factor in the osteoclast differentiation supported by stromal cells

Severe deficiency of osteoclasts, monocytes, and peritoneal macrophages in osteopetrotic (op/op) mutant mice is caused by the absence of functional macrophage colony-stimulating factor (M-CSF). To clarify the role of M-CSF in the osteoclast differentiation, we established a clonal stromal cell line OP6L7 capable of supporting hemopoiesis from newborn op/op mouse calvaria. Although very few macrophages appeared in the cocultures of bone marrow cells and OP6L7 cells, a 50-fold larger number of macrophages was detected in the day 7 cocultures when purified recombinant human M-CSF (rhM-CSF) was exogenously supplied. Tartrate-resistant acid phosphatase (TRACP; a marker enzyme of osteoclasts)-positive cells appeared only when bone marrow cells were cultured in contact with OP6L7 cells and both rhM-CSF and 1 alpha, 25 (OH)2D3 were added. The TRACP-positive cells became multinucleated with increasing time in culture and expressed the c-fms/M-CSF receptor. These results indicate that both contact with stromal cells and M-CSF are requisite for osteoclast differentiation under physiological conditions.

Congenital osteoclast deficiency in osteopetrotic (op/op) mice is cured by injections of macrophage colony-stimulating factor

Osteopetrotic (op/op) mice have a severe deficiency of osteoclasts, monocytes, and peritoneal macrophages because of a defect in the production of functional macrophage colony-stimulating factor (M-CSF) resulting from a mutation within the M-CSF gene. In this study, we examined whether daily 5-microgram injections of purified recombinant human M-CSF (rhM-CSF) for 14 d would cure these deficiencies in the mutant mice. Monocytes in the peripheral blood of the op/op mice were significantly increased in number after subcutaneous injections of the factor two or three times a day. In contrast, osteopetrosis in the long bones of op/op mice was completely cured by only one injection of rhM-CSF per day. Bone trabeculae in the diaphyses were removed. Many osteoclasts were detected on the surface of bone trabeculae in the metaphyses. Although development of tooth germs of uninjected op/op mice was impaired, rhM-CSF injection restored the development of molar tooth germs and led to tooth eruption as a consequence of the recovery of bone-resorbing activity. These results demonstrate that M-CSF is one of the factors responsible for the differentiation of osteoclasts and monocyte/macrophages under physiological conditions.

Possible involvement of bone cells in a new cementum formation

Cells from the gingival lamina propria, bone-derived granular tissues and periodontal ligament (PDL) were isolated after periodontal surgery and subsequently cultured in vitro. The resulting cells were defined as gingival cells, bone cells and PDL cells, respectively. Under a phase contrast microscope, the cultured cells exhibited a spindle and/or a polyhedral shape. On the basis of their appearance under an electron microscope, spindle-shaped cells and polyhedral-shaped cells were identified as fibroblasts and osteoblasts, respectively. Bone cells, a homogeneous population of osteoblasts, had a more rapid growth ability than PDL cells, which were a heterogeneous population of fibroblasts and osteoblasts. Of particular interest was that only bone cells produced bone matrix in the multilayers in vitro. These results support the hypothesis that the phenotype expressed by cells from the alveolar bone establishes a new concept for progenitor cells in the formation of cementum.

[Long-term follow-up results of TUL (transurethral ureterolithotripsy)]

We experienced 112 cases of urolithiasis treated with transurethral ureterolithotripsy (TUL) between December, 1985 and September, 1988. We analyzed 35 patients treated with TUL and who had come to our hospital to be examined by cystography, renal ultrasonography, plain X-ray, and urinalysis more than 3 months later. The follow-up term ranged from 3 to 30 months after TUL. The patients were treated using a 12Fr Stortz rigid lithotripter or flexible uretero-fiberscope with electrohydraulic lithotripter. Urinalysis, kidney-ureter-bladder X-ray (KUB), ultra-sonography and cystogram were the main disciplines for follow-up. Urinalysis revealed 4 cases of hematuria, 3 cases of hematopyuria and 2 cases of pyuria. KUB showed no newly formed stones, but 2 cases of ureteral stones had moved from the kidneys. Renal ultrasonography demonstrated no hydronephrosis of operated side, except for 1 case of mild hydronephrosis, who had had severe hydronephrosis preoperatively. We searched for vesicoureteral reflux (VUR) in 34 of the long-term follow-up patients after TUL, but no VUR was seen on their cystograms. No significant late complications of TUL were observed. No harmful effects of ureteral dilation during transureteral operation were found even in long-term follow-up patients.

[Estimation of passive smoking during pregnancy by cotinine measurement and its effect on fetal growth]

Maternal cigarette smoking has been associated with some complications of pregnancy, including low birth weight and increased morbidity. Recently, it has been reported that maternal passive smoking also affects the fetal environment and causes fetal growth disturbance. In this study, we aimed to investigate the effects of maternal passive smoking on pregnant women and their fetuses by measuring cotinine concentrations in maternal urine and umbilical cord blood. The results were as follows: 1) Among 259 pregnant women, 17 cases (6.6%) were active smokers. The women who were not aware of passive smoking at all, were only 39 cases (15.1%). More than 80% of the pregnant women smoked either passively or actively each day. 2) Cotinine concentrations in both maternal urine and umbilical cord blood increased with the increase in passive smoking. Those in maternal serum, however, did not correlate with the increase in passive smoking. 3) The relative birth weight (R.B.W.) of the newborn infants delivered by the mothers whose cotinine concentration was more than 9.0ng/ml (This value represented the mean +1.5SD of the cotinine concentration in the urine from the mother who did not passively or actively smoke) was significantly lower than that of the mothers whose cotinine concentration was less than 9.0ng/ml. It is concluded that the measurement of the cotinine concentration in maternal urine or umbilical cord blood is very useful in estimating the effects of passive smoking on pregnant women. And passive smoking as well as active smoking also has a harmful effect on the fetal growth mechanism.

[Circulating forms of insulin-like growth factor-I(IGF-I)/somatomedin C (SMC) in fetal life: relationship between changes in its binding proteins and growth delay during intrauterine and post-natal periods]

IGF-I/SMC shows mitogenic activities in a wide variety of cell types and stimulates cell growth in vitro and in vivo. Unlike most other peptide hormones, IGF-I/SMC circulates in the plasma as macromolecular complexes with specific plasma binding proteins, approximate molecular weight of 150K and 40K daltons. In order to elucidate the roles of IGF-I/SMC for fetal and postnatal development, the levels of plasma IGF-I/SMC, distribution of circulating IGF-I/SMC on its binding proteins, and profiles of unsaturated somatomedin binding proteins (USBP) were estimated in newborns and a growth-retarded infant (leprechaunism). The concentrations of IGF-I/SMC in cord plasma increased gradually after the 28th week of gestation and reached 37.3 +/- 14.6 ng/ml (Mean +/- S.D.) in full term infants. Although the levels of IGF-I/SMC in cord plasma were significantly lower than those in non-pregnant women (188 +/- 58), they showed a positive correlation with birth weight and relative birth weight (R.B.W.: percentage comparison to the average birth weight of normal infants in the same gestational week). In adult plasma, immunoreactive IGF-I/SMC was eluted predominantly in 150K dalton region (73.5%) and to a lesser extent (26.5%) in 40K dalton, and two apparent peaks of USBP could also be determined in both 150K and 40K dalton regions. On the other hand, in fetal plasma 84.4% of immunoreactive IGF-I/SMC was eluted in 40K region on the 20th week, but on the 26th week, 71.6% of IGF-I/SMC was eluted in 150K region and after the 35th week, more than 70% of IGF-I/SMC was determined in 150K region as observed in adult plasma. However, 150K.USBP could not be detected in cord plasma obtained from appropriate-for-date(AFD) infants until after the 35th week of gestation. Additionally, a positive correlation was demonstrated between 150K.USBP/40K.USBP ratio and birth weight. Some cases of small-for-date(SFD) infants whose IGF-I/SMC circulated mainly as 150K complex could catch up on their growth early in postnatal life. However, in the SFD newborns, if either 150K.USBP or 150Kcomplex of IGF-I/SMC could not be detected, their growth spurt was remarkably delayed until a year after birth. Furthermore, the similar disorders of IGF-I/SMC distribution and its USBP profile were also observed in the case of leprechaunism, who showed severe intrauterine and postnatal growth retardation.(ABSTRACT TRUNCATED AT 400 WORDS)

[A case of leprechaunism with disorders of insulin-like growth factor-I(IGF-I)/somatomedin C(SMC) binding protein and its receptor]

Leprechaunism is a rare genetic disorder characterized by physical abnormalities, intrauterine and postnatal growth retardation, poorly developed subcutaneous fat and muscle at birth, and early death. This patient, who was a 1.5 year-old female with typical clinical features of leprechaunism, had relatively high levels of plasma GH and IGF-I/SMC but no glucose intolerance or insulin resistance. Studies were undertaken to elucidate (1) the differences among some kinds of methods for IGF-I/SMC measurement, (2) the distribution patterns of IGF-I/SMC between two kinds of its binding protein (SMBP) in plasma, and (3) the dynamics of IGF-I/SMC receptor in her erythrocytes and liver microsomal membranes. The results were as follows: (1) The level of IGF-I/SMC measured by Nichols radioimmunoassay kit was 1.33U/ml, which was higher than that of infants the same age. Conversely, it was lower than that of the control which was measured by radioimmunoassay using recombinant IGF-I/SMC after acid-ethanol or Seppak C18 extraction. (2) By Sephadex G150 gel-chromatography, immunoreactive IGF-I/SMC was eluted predominantly in 150K region, and two apparent peaks of unsaturated somatomedin binding protein (USBP) were determined in a neonatal infant (appropriate to date), a normal adult and an infant of the same age as this patient. On the other hand, immunoreactive IGF-I/SMC was located only in the fractions corresponding to 40K region, and only one peak of USBP could be estimated in the region of 40K dalton. (3) The IGF-I/SMC receptor in the patient's erythrocytes possessed significantly lower binding affinity but higher binding capacity in comparison with that of the normal neonate and adult. In addition, the receptor in liver microsomal membranes obtained from this patient at autopsy also indicated lower affinity but higher capacity than that of fetuses at more than 19 weeks of gestation. This was coincident to that of fetuses less than 19 weeks of gestation. These results suggested that this patient resembled the intrauterine fetus before midgestation not only in the co-relationship among GH, IGF-I/SMC and its binding proteins, but also in the characteristics of its receptor. The severe growth retardation existing in this patient may be, at least partly, due to the abnormality and/or immaturity of IGF-I/SMC function. It is speculated that leprechaunism could be classified in relation to fetal growth mechanism by aspects of biological functions of IGF-I/SMC during development.

An ultrastructural study of human epithelial rests of Malassez maintained in a differentiated state in vitro

Healthy human periodontal ligaments (PDL), obtained from the extracted teeth (premolars and third molars), were cultivated for 1-35 days, using a multi-purposes culture chamber (MPCC) equipped with various transparent membranes. The resting state of the epithelial rests of Malassez (ERM), similar to their in vivo counterparts, appeared as small islands or strands with scant cytoplasm containing poorly developed organelles. This state was most effectively maintained in MPCC with a cellophane sheet. MPCC with a Sartorius membrane filter permitted proliferation and emigration of ERM. Proliferating ERM were characterized by more profiles of rough endoplasmic reticulum and free ribosomes, new formation of actin-containing microfilaments, less prominent tonofilaments and desmosomes and loss of gap junctions. Most of these ultrastructural changes are manifested in epithelial cells during wound healing. The emigrating ERM from PDL explants, as well as occasional proliferating ERM within explants, consisted of two cell types--outer basal-like cells, as described above, and inner tonofilament-rich prickle-like cells, suggesting a propensity for differentiation of ERM. The results show the possibility of controlling the growth and differentiation of ERM through the MPCC culture environment.

Ultrastructure of fibroblasts in cyclosporin A-induced gingival hyperplasia

Specimens from 2 cases of gingival hyperplasia resulting from the treatment with the immunosuppressant cyclosporin A (CSGH) and 4 cases of inflamed gingiva (non-CSGH) were examined by electron microscopy with particular interest in the fibroblasts. In general, the fibroblasts in CSGH revealed the ultrastructural characteristics of active protein synthesis and secretion and less cytotoxic or degenerative changes. Some fibroblasts in the CSGH (23.8%) displayed cytological modifications comparable to so-called myofibroblasts, i.e., microfilament bands with semi-periodic dense nodes, nuclear indentations, and basal-lamina associated, cell-to-stromal junctions. Conversely, 5.9% of the fibroblasts in the non-CSGH showed these modifications. The modified fibroblasts were found most predominantly in the transitional area between inflamed and fibrous connective tissues. From these findings, it is suggested that the myofibroblastic modification in CSGH is regarded as a common morphological sign in actively proliferating fibrous tissue and may participate in the host-tissue response to the plaque-associated irritants.

Ultrastructural and morphometric analyses of human cementoblasts and periodontal fibroblasts

In order to elucidate the cytological characteristics of human cementoblasts which distinguish them from periodontal fibroblasts, the periodontal ligament and gingival connective tissue attached to 37 extracted teeth from 27 patients (ages 10-67) were analyzed by electron microscopy coupled with a morphometric procedure. The cementoblasts largely consisted of either immature or resting types of collagen-producing cells (CPC), both of which were poor in the rough endoplasmic reticulum and Golgi complex; these organelles were well-developed in the relatively less common active cementoblasts. The cementoblasts consistently revealed a higher mean-volume-density per tissue unit than the fibroblasts and sometimes were grouped into clusters with the formation of junctional apparatuses. The relative volume of glycogen particles per cytoplasm was significantly higher in the cementoblasts, whereas the rough endoplasmic reticulum was higher in the fibroblasts. From the present study, it is suggested that the cementoblasts are functionally less active CPC than the periodontal fibroblasts.

[Combined administration of human chorionic gonadotropin and human menopausal gonadotropin in idiopathic male infertility]

Clinical experiences of HCG-HMG therapy for 56 cases of idiopathic male infertility were studied. Serum levels of LH, FSH and testosterone were measured before therapy. Sperm density improved in 25% of all cases. In the low FSH group, sperm density showed a high rate of improvement. The basal FSH was the best indicator to predict the prognosis of fertility. Additional measurements of LH and FSH response to GnRH gave further information on the prospect of fertility.

Microfilaments in human cementoblasts and periodontal fibroblasts

An electron microscopic survey was carried out on the human periodontal ligament (PDL), including a part of the gingival connective tissue attached to extracted tooth roots (11 functioning premolars and 6 nonfunctioning third molars) in order to examine the characteristics of microfilaments (6 nm) in cementoblasts and PDL fibroblasts. Microfilaments which were grouped in bundles with semiperiodic dense nodes or in meshworks just beneath the cell membrane were seen predominantly in the cells characterized by their ultrastructurally immature appearance. These microfilaments were more commonly observed in third molar PDL than in premolar PDL and, in general, more conspicuous in cementoblasts than in fibroblasts. The significance of microfilaments in human PDL is discussed, particularly in relation to cell differentiation and morphogenesis.