[A case of pedunculated intrathoracic chest wall type lipoma]

The case was a 52-year-old female. Though the abnormal shadow on the chest X ray film was pointed out in 1990, she had been observed as a benign intrathoracic tumor for one year and four months. But she was admitted to our hospital for further evaluation because the mass shadow enlarged subsequently. The mass shadow was suspected as intrathoracic lipoma by the CT and MRI. However, because the shadow enlarged and its inner part was not single density that was equal to subcutaneous adipose tissues, left thoracotomy was performed. The tumor was pedunculated from the fatty tissue of the fifth intercostal space near the tubercle of rib. It was easily resectable, encapsulated and measured 6.0 x 3.5 x 2.5 cm in size. It was histologically diagnosed as benign lipoma. Preoperative diagnosis of the present tumor became possible to a certain extent by means of CT and MRI. However, in view of imperfect differentiation between lipoma and liposarcoma, the surgical treatment should be considered.

[Thoracoscopic surgery for benign esophageal diseases]

The thoracoscopic surgery for two benign esophageal diseases, esophageal leiomyoma and esophageal diverticulum, were successfully performed. Case 1 was a 37-year-old female with esophageal leiomyoma that was located at 30 cm from the incisor of the left anterior esophagus. The tumor was enucleated under the thoracoscopy, combined mini-thoracotomy for 3 cm in length. It was useful enough to rotate the left side to the right with two slings traction for better visualization of lesion site. After resection, the proper muscle layer of the esophagus was closed. Case 2 was a 70-year-old male, who complained of dysphagia because of esophageal diverticulum. It was 8 cm in size and located at 28 cm from the incisor of the right wall of the esophagus. It was also resected under the thoracoscopy, combined mini-thoracotomy for 3 cm in length. Intraluminal esophagoscope was useful to dissect safely and confirm the intralumen of the diverticulum. Its neck was divided parallel to the longitudinal axis of the esophagus by two endo-staplers. And then, the muscle layer was closed. It was suggested that esophageal leiomyoma and esophageal diverticulum were suitable for thoracoscopic surgery.

[Three cases of thymic hyperplasia associated with hyperthyroidism]

We encountered three cases of thymic hyperplasia associated with hyperthyroidism. Case 1 was in a 35-year-old woman; a chest CT scan showed an anterior mediastinal mass and right-sided pleural effusion, which suggested the presence of a thymoma Case 2 was in a 21-year-old man who complained of palpebral ptosis and also had myasthenia gravis (Osserman type I). Case 3 was in a 47-year-old woman; a chest CT scan showed thymic hyperplasia and mediastinal lymphadenopathy. In all cases, anti-thyroid medication was given first, because of the associations with hyperthyroidism. Moreover, in cases 1 and 2 no tumor was found, and only hyperplasia was detected in the thymus, although both patients underwent extended thymectomy. Furthermore, surgery was not effective against the hyperthyroidism (anti-thyroid medication could not be withdrawn or reduced). In cases 2 and 3, thymic hyperplasia, as seen on chest CT scans, resolved as thyroid function was normalized by anti-thyroid medication. The pretracheal lymphadenopathy seen in case 3 also resolved. Thymic hyperplasia may have been a result, not a cause, of hyperthyroidism. When we encounter patients with thymic masses and hyperthyroidism, we should give anti-thyroid medication and observe the thymus for some time before resorting to surgery.

Polycaprolactone depolymerase produced by the bacterium Alcaligenes faecalis

Several microorganisms were isolated as bacteria degrading polycaprolactone (PCL), and one of them, a strain B273 identified as Alcaligenes faecalis, was selected. Because this strain produced only slight PCL depolymerase activity, the hyperproducing mutant, TS22, was isolated after UV irradiation. Synthesis of PCL depolymerase was derepressed, probably based on the altered regulation of metabolic pathways in strain TS22. The partially purified enzyme hydrolyzed p-nitrophenyl fatty acids and triglycerides other than PCL, but not poly(3-hydroxybutyrate), indicating that PCL depolymerase may be a kind of lipase.

Purification and properties of poly(3-hydroxybutyrate) depolymerase from the fungus Paecilomyces lilacinus D218

Poly(3-hydroxybutyrate) depolymerase was purified to homogeneity from the culture filtrate of Paecilomyces lilacinus D218 by column chromatography on CM-Toyopearl 650M and hydroxylapatite. The molecular weight of the enzyme was estimated to be 48,000 by SDS-PAGE. Maximal activity was observed near pH 7.0 and 45 degrees C. The Km and Vmax values for PHB were 0.13(mg/ml) and 3750 (U/mg protein), respectively. The enzyme hydrolyzed PHB and p-nitrophenyl fatty acids but not polycaprolactone and triglycerides.

[Evaluation of thoracoscopic surgery with mini-thoracotomy for primary lung cancer--as seen from the angle of lymph node dissection]

The extent of thoracoscopic surgery using a mini-thoracotomy for radical lung cancer surgery was investigated with regard to practical applicability. Thirteen patients with lung cancer underwent video-assisted lobectomy or segmentectomy and lymph node dissection through a 6-8 cm mini-thoracotomy. Eleven of thirteen cases were able to undergo video-assisted lobectomy and segmentectomy, but in one patient with strong adhesion and one patient who developed hemorrhage due to pulmonary arterial injury, thoracotomy was extended to 15-20 cm. Ten patients with lung cancer who underwent lobectomy under standard thoracotomy, underwent lymph node dissection under simulated 6-8 cm mini-thoracotomy. These ten cases and five cases who underwent lymph node dissection under 6-8 cm mini-thoracotomy were then switched over to standard thoracotomy to examine the possibility of residual lymph nodes. On the right-side, R2 lymph node dissection was practical, but on the left-side, #3, 3p, 4, 7 lymph node dissections were insufficient or impractical in some cases. The above results suggested that right-sided lobectomy is practical for radical thoracoscopic surgery with a mini-thoracotomy is practical for up to stage II. However, on the left side, the procedure should be confined to stage I.

Synthesis of monoesters of pyrroloquinoline quinone and imidazopyrroloquinoline, and radical scavenging activities using electron spin resonance in vitro and pharmacological activity in vivo

Monoesters with the ester groups at C-2 of pyrroloquinoline quinone (PQQ) and C-9 of imidazopyrroloquinoline (IPQ) were synthesized, and radical scavenging activities of coenzyme PQQ, IPQ compounds synthesized from PQQ and various amino acids, and monoesters of PQQ and IPQ were studied in vitro and in vivo. PQQ and PQQ monoesters had strong radical scavenging activity using ESR in in vitro experiments. The IC50 value for superoxide (O2-) was from 1 to 6 x 10(-8) M and that for the hydroxy radical (.OH) was from 4 to 6 x 10(-5) M. IPQ compounds and IPQ monoesters also showed radical scavenging activity. These compounds prevented injury during in vivo experiments, such as hydrocortisone-induced cataracts, endotoxin shock and CCl4-induced liver injury (isolated hepatocytes and rats). Especially, the monoesters of PQQ and IPQ prevented liver injury in rats equally by oral or intraperitoneal administration. These results suggest that PQQ functions as a radical scavenging factor in addition to being a cofactor of quinoprotein enzymes, and monoesters with the ester groups at C-2 of PQQ and C-9 of IPQ are developed as treatment or preventive medicine for disease caused by radical compounds on the basis of strong radical scavenging activities, absorbability into cells, toxicity, safety and chemical stability.

Synthesis and aldose reductase-inhibitory activity of imidazopyrroloquinoline esters

Derivatives of imidazopyrroloquinoline (IPQ) and its esters were synthesized. Some of these compounds potently inhibited aldose reductases of rabbit lens and dog kidney, as well as the human recombinant enzyme, though the coenzyme pyrroloquinoline quinone (PQQ) was a relatively poor inhibitor. The IPQ esters with a methyl substituent at the C-3 carboxyl group were less potent inhibitors than the analogs without esterification at this position. An IPQ ester with the free carboxyl group at C-3 inhibited sorbitol accumulation in rat red blood cells.

Serial changes in the prevalence of islet cell antibodies and islet cell antibody titer in children with IDDM of abrupt or slow onset

OBJECTIVE

To elucidate the significance of clinical and immunogenic heterogeneity in Japanese children with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Serial changes in the prevalence of islet cell antibodies (ICAs) and in ICA titer were monitored for 10 years after diagnosis in 34 IDDM children, 17 with abrupt onset and 17 with slow onset, whose durations of disease were > 5 years.

RESULTS

In slow-onset IDDM children, enough beta-cell function was maintained in the early phase of the disease within 2 years after diagnosis. There was a high prevalence of ICAs in children with both forms of IDDM at the time of diagnosis (abrupt onset 94%; slow onset 82%). However, the decline in the frequency of ICAs in slow-onset IDDM seemed less marked than in abrupt-onset IDDM after a duration of > or = 1 year (47 vs. 82%, 1-3 years; 24 vs. 47%, 3-5 years; 24 vs. 47%, 5-7 years; 18 vs. 53%, 7-10 years, P < 0.05). In terms of changes in ICA titer, abrupt-onset IDDM children initially had high ICA levels of 160-320 Juvenile Diabetes Foundation units (JDF U), but these titers decreased rapidly after the 1st year. On the other hand, slow-onset IDDM children tended to continue to be ICA+ for a relatively long period with low titers of 20-40 JDF U. Among 12 children who remained ICA+ for > 5 years, slow onset was noted in 67% while abrupt onset was seen in only 33%.

CONCLUSIONS

From these results, we speculated that changes in ICA titer reflect the slow autoimmune destruction of pancreatic beta-cells. It may be probable that immunogenic factors as well as environmental factors could affect the clinical features in the early phase of IDDM in children.

Characterization of imidazopyrroloquinoline compounds synthesized from coenzyme PQQ and various amino acids

Imidazopyrroloquinoline (IPQ) compounds synthesized from coenzyme PQQ (pyrroloquinoline quinone) and various kinds of amino acids were characterized. IPQ was synthesized from coenzyme PQQ and one of three amino acids (glycine, L-tryptophan and L-tyrosine). Two kinds of IPQ compound were formed from coenzyme PQQ and L-serine. At higher pH, IPQ was synthesized, at lower pH hydroxy-methyl-IPQ was synthesized. IPQ with R of amino acids represented by R-CH(NH2)-COOH was synthesized from coenzyme PQQ and other amino acids. IPQ compounds do not act as cofactor of glucose dehydrogenase. Molar absorption coefficients of IPQ are 31,400 M-1 cm-1 at 251 nm, 30,700 M-1 cm-1 at 276 nm, and 20,700 M-1 cm-1 at 423 nm at pH 7.0 and room temperature.

Synthesis of esters of coenzyme PQQ and IPQ, and stimulation of nerve growth factor production

Esters of pyrroloquinoline quinone (PQQ), a cofactor of microbial quinoprotein enzyme, and imidazopyrroloquinoline (IPQ, from PQQ and glycine) were synthesized, and their chemical stability, toxicity to L-M cells and nerve growth factor (NGF) inducing activity in L-M cells were studied. PQQ esters were found to be potent enhancers of NGF production, but IPQ esters had only marginal effects on NGF production. The monoester of PQQ with a methoxycarbonyl group at C-2 of PQQ is a most effective compound because of its NGF inducing activity, limited toxicity, safety and chemical stability. These results suggest that PQQ-2-esters could be developed as a curative or preventive drug for retrograde neural diseases in the central and perpheral nervous system.

Association of polymorphism in the interferon gamma gene with IDDM

Cytokines may play important roles in the pathogenesis of insulin-dependent diabetes mellitus (IDDM). We analysed a dinucleotide repeat polymorphism within the first intron of the interferon gamma (IFN-gamma) gene in Japanese diabetic patients (175 IDDM and 145 non-insulin-dependent diabetes mellitus) and 267 control subjects. A significant difference was observed in the global allele distribution of the polymorphism between the IDDM and control groups (p = 0.039). The difference from the control group was more evident in the patients whose insulin therapy started within 1 year from onset (p = 0.006) or in the young-onset (< 10 years) patients (p = 0.0006). The alleles "3" and "6" were increased in the IDDM patients, and a significant increase in the frequency of the "3/6" genotype was observed in the IDDM patient group (9.1%, RR 2.9, p = 0.010), in the patients with initial insulin therapy less than 1 year from onset (10.6%, RR 3.4, p = 0.004), or in the young-onset patients (16.7%, RR 5.7, p = 0.0003) in comparison to the control subjects (3.4%). There was a tendency towards frequent occurrence of clinical characteristics which reflect young or abrupt onset of diabetes or both, and depletion of insulin secretion capacity in the patients with "3/6" or "6/6" in comparison to the patients with other genotypes. These results suggest that the IFN-gamma gene region may contribute to the pathogenesis of IDDM and could be a genetic marker for IDDM.

Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in Japanese children

The overall annual IDDM incidence rates by area in Japan for 1985-1989 for children 0-14 years of age at diagnosis were from 1.65 to 2.07 per 100,000. The incidence in males and females did not show any temporal trends during the period between 1980 and 1989. The prevalence of IDDM was about 1 per 10,000. The clinical features at diagnosis among Japanese IDDM children identified during the 2-year period between 1979 and 1980 were as follows. Fourteen percent of the cases were in coma and 12% of the cases were asymptomatic at diagnosis. There is a suggestion that slow onset IDDM is often seen in Japan. In these children, the decline of serum CPR levels and the prevalence of ICA (islet cell antibodies) over the course of diabetes was slower than in those with an abrupt onset classical IDDM. During the period from 1975 through 1990 the incidence rates of NIDDM in school children showed as much as an approximate 1.5-fold increase along with a similar increase in the prevalence of obesity. About eighty percent of these NIDDM children were obese. A predominance of female children developing diabetes was seen in both type of diabetes, IDDM and NIDDM, in Japan. Non-obese type NIDDM in children was more common in females than in males. It is interesting to note that the mean height of Japanese children with IDDM was not different from the national average, but children with NIDDM were significantly taller than the national average.

Enzyme immunoassay for erythrocyte aldose reductase

This two-site immunoassay measures erythrocyte aldose reductase by using monoclonal and polyclonal antibodies to recombinant human enzyme. Total incubation time is 2.5 h, and the limit of detection is &lt; 0.05 microgram/L. Analytical recovery tested with blood samples from healthy and diabetic individuals was 101-106%. Average CVs within and between assays were 3.7% and 4.8%, respectively. The enzyme content determined by this system correlated well with the activity of aldose reductase isolated from the same erythrocyte preparations. The amount of erythrocyte aldose reductase per milligram of hemoglobin was higher in women than in men (P &lt; 0.001), but no significant correlation was observed between the amount of enzyme and the age of the individuals. This assay method should provide useful clinical information to optimize administration of aldose reductase inhibitors for effective prevention and treatment of diabetic complications.

Enzyme immunoassay for erythrocyte aldose reductase

This two-site immunoassay measures erythrocyte aldose reductase by using monoclonal and polyclonal antibodies to recombinant human enzyme. Total incubation time is 2.5 h, and the limit of detection is < 0.05 microgram/L. Analytical recovery tested with blood samples from healthy and diabetic individuals was 101-106%. Average CVs within and between assays were 3.7% and 4.8%, respectively. The enzyme content determined by this system correlated well with the activity of aldose reductase isolated from the same erythrocyte preparations. The amount of erythrocyte aldose reductase per milligram of hemoglobin was higher in women than in men (P < 0.001), but no significant correlation was observed between the amount of enzyme and the age of the individuals. This assay method should provide useful clinical information to optimize administration of aldose reductase inhibitors for effective prevention and treatment of diabetic complications.

The protective effect of pyrroloquinoline quinone and its derivatives against carbon tetrachloride-induced liver injury of rats

Pyrroloquinoline quinone (PQQ) and its derivative, oxazo pyrroloquinoline (OPQ-G), protected rats from experimental liver injury induced by carbon tetrachloride (CCl4) in vivo. This effect was observed after an intraperitoneal injection of 5 mg/kg PQQ or OPQ-G, which was given twice, 10 min and 1 h before CCl4 administration. Pyrroloquinoline quinone protected primary cultured rat hepatocytes from CCl4 toxicity in vitro. This protection was most effective at a concentration of 3 mumol/L PQQ. Pyrroloquinoline quinone derivatives (oxazo pyrroloquinoline, methyl-thioethyl oxazo pyrroloquinoline and PQQ-allylester) also protected the hepatocytes from CCl4 toxicity. Pyrroloquinoline quinone and its derivatives inhibited the lucigenin-enhanced chemiluminescence from isolated hepatocytes initiated by CCl4. These results suggest that eliminating free radicals is one of the protective mechanisms of PQQ and its derivatives against CCl4-induced liver injury.

Stimulation of nerve growth factor production by pyrroloquinoline quinone and its derivatives in vitro and in vivo

Pyrroloquinoline quinone (PQQ), which is a cofactor of microbial quinoprotein enzymes, was found to be a potent enhancer of nerve growth factor (NGF) production in vitro. One of PQQ derivatives, oxazopyrroloquinoline trimethylester, had little activity in vitro, but increased the NGF content in rat brain in vivo.

Recombinant human granulocyte colony-stimulating factor therapy for cyclic neutropenia associated with common variable immunodeficiency

A 14 year old boy with common variable immunodeficiency (CVID) had regularly recurring episodes of severe infections independently of the serum gamma-globulin level. Serial blood counts revealed that this patient also had cyclic neutropenia. Recently, recombinant human granulocyte colony-stimulating factor (rhG-CSF) was reported to be an effective treatment for this disease. We tried rhG-CSF therapy for this patient and a prompt increase in the neutrophil count was noted. However, the cyclic alterations and duration of the nadir of the neutrophil count were not altered, which suggested that rhG-CSF has a variable efficacy in at least some patients with cyclic neutropenia.

Trace levels of pyrroloquinoline quinone in human and rat samples detected by gas chromatography/mass spectrometry

A detailed procedure for the assay of free pyrroloquinoline quinone (PQQ) in human and rat samples by gas chromatography/mass spectrometry (GC/MS) has been established with stable-isotopic PQQ as internal standard. PQQ was extracted from the samples, after addition of the internal standard, with butanol under acid conditions and with Sep-Pak C18 cartridges. After derivatization of PQQ with phenyltrimethylammonium hydroxide, molecular peaks at m/z 448 and 462 were used for detection of PQQ and [U-13C]PQQ by selected ion monitoring, respectively. Trace amounts of free PQQ were detected in eight organs, plasma and urine of the human, and in three organs of the rat. The PQQ level was highest in the human spleen (5.9 +/- 3.4 ng/g tissue, followed by the pancreas and lung, and it was below detection limits for human brain and heart. Trace levels of PQQ were also found in rat small intestine, liver and testis. Our data are far below those measured by the redox cycling method of Gallop's group for human plasma, adrenal and urine.

Failure to verify the presence of pyrroloquinoline quinone (PQQ) in bovine plasma amine oxidase by gas chromatography/mass spectrometry

The presence of covalently bound pyrroloquinoline quinone (PQQ) in bovine plasma amine oxidase (BPAO) was examined by the use of gas chromatography/mass spectrometry. The enzyme was subjected to proteolysis with proteinase in the presence of [U-13C]PQQ as an internal standard. After isolation and derivatization of PQQ with phenyltrimethylammonium hydroxide, molecular peaks at m/z 448 and 462 were used for detection of PQQ and [U-13C]PQQ, respectively, by selected ion monitoring (SIM). In the SIM profile, although the sample extract obtained from BPAO treated with proteinase clearly showed the peak at m/z 462 for the internal standard, there were no peaks detectable at m/z 448, showing the absence of PQQ in the proteolysis digest of BPAO. Thus, our results do not support the claim that BPAO contains covalently bound PQQ in its structure.

Paracoccus aminophilus sp. nov. and Paracoccus aminovorans sp. nov., which utilize N,N-dimethylformamide

Two methylamine- and N,N-dimethylformamide-utilizing Paracoccus spp. are described. These bacteria are gram-negative, nonsporeforming, nonmotile, coccoid or short rod-shaped organisms. Their DNA base composition is 62 to 68 mol% G + C. Their cellular fatty acids include large amounts of C18:1 acid. Their major hydroxy acids are 3-OH C10:0 and 3-OH C14:0 acids. The major ubiquinone is Q-10. These bacteria are distinguished from Paracoccus denitrificans and Paracoccus alcaliphilus by physiological characteristics and by DNA-DNA-homology. Paracoccus aminophilus sp. nov. and Paracoccus aminovorans sp. nov. are proposed. The type strain of P. aminophilus is DM-15 (= JCM 7686), and the type strain of P. aminovorans is DM-82 (= JCM 7685). Paracoccus halodenitrificans is distinguished from other Paracoccus species on the basis of cellular fatty acid composition, hydroxy fatty acid composition, and DNA-DNA homology. It may not be a valid member of the genus Paracoccus.

Extractions of pyrroloquinoline quinone from crude biological samples

The best conditions for extractions of free pyrroloquinoline quinone (PQQ) from crude biological samples were investigated with various organic solvents and Sep-Pak C18 cartridges. PQQ was measured with use of its native fluorescence in aqueous solution. PQQ was well extracted into n-butanol under acid conditions, and addition of NaCl did not improve the solvent extraction. PQQ, which had been extracted into n-butanol, could be re-extracted into an aqueous phase by addition of either n-heptane or pyridine, or combination of them. PQQ, which had been adsorbed to Sep-Pak C18 cartridges, could be eluted with a mixture of pyridine and water with very excellent recovery. The recovery of 1 micrograms PQQ, which had been added to 1 g human liver, brain and 1 ml plasma and had undergone the n-butanol and the Sep-Pak extractions, was 50, 75 and 105%, respectively. From the blank fluorescence, endogenous levels of free PQQ in human liver, brain and plasma were found not greater than 0.41, 0.08 and 0.13 micrograms/g or ml, respectively, if present.

Initial signs and diagnosis of diabetes--special considerations of Oriental patients

Hyperglycemia and other metabolic derangements resulting from absolute or functional deficiency of insulin are accompanied by typical signs and symptoms of diabetes. The clinical signs and the findings of hyperglycemia over 200 mg/dl should establish a diagnosis of diabetes mellitus. An oral glucose tolerance test (O-GTT) is rarely necessary for diagnosis of diabetes in a child. A small proportion of children, however, present less severe symptoms, and may require an O-GTT. Approximately 14% of IDDM children were in coma at diagnosis in Tokyo, and 11 onset deaths (0.94%) were observed among the 1172 newly diagnosed IDDM cases in Japan. A significant decline in the onset mortality, however, has been observed in the past 20 years in Japan in association with the improvement of early management of childhood diabetes. The clinical distinction of IDDM from NIDDM is often difficult in diabetic children of Oriental origin without obesity. Japanese IDDM can be divided into two forms, abrupt and slow onset forms, but they may be essentially the same disease. There was no difference in the frequency of being tested positive for circulating ICA between the two groups of the patients. But a difference in the frequency of HLA DR4 and DRW9 was noticed between the two groups. Clinical features of 107 children with NIDDM were studied and about 75% of these cases were obese. All of them can be detected by routine urinalysis for glucose. Diet and exercise therapy in most of the newly diagnosed patients resulted in remission but some of them may require insulin or an oral hypoglycemic agent to get better glycemic control.

Type 1 (insulin-dependent) diabetes in Japanese children is not a uniform disease

The initial course of Type 1 (insulin-dependent) diabetes mellitus was studied in two groups of Japanese children, i.e. 21 patients with abrupt onset (Group A) and 19 patients detected by urine glucose screening at school with minimal or no symptoms (Group B). There was no statistical difference in mean age at diagnosis between Group A and B (11 +/- 3 years vs 11 +/- 3 years). Group A patients revealed a rapid deterioration of pancreatic B-cell function, but there was evident recovery of the B-cell function from 3 to 9 months following initial treatment. The B-cell capacity in Group B was self maintained until 24 months after diagnosis. Thereafter, even these patients exhibited a progressive decline in the B-cell function. The two groups had a similar incidence of islet cell antibodies at diagnosis (58% vs 69%). However, human leukocyte antigen studies revealed that patients in Group A had a significantly higher prevalence of DR4 and DRW9 than those in Group B (p less than 0.01). These results suggest that in Japanese children there are two forms of diabetes, an abrupt and a slow onset form, which are clinically different and which also seemed to be genetically independent types, or possibly the same disease diagnosed at different stages.