An autopsy case of B-cell lymphoma associated with macroglobulinemia (IgM-k)

While he was treated for macroglobulinemia showing symptoms, a 65-year-old man developed an enlargement of the left lateral cervical lymph node. Biopsy specimens of the cervical lymph node revealed large-cell non-Hodgkin's lymphoma. The lymphoma cells had rearrangement in the immunoglobulin heavy chain and kappa light chain genes. There was osteolysis involving right metatarsal bones. And, a tumor appeared on the upper hard palate in the terminal stage. Autopsy specimens showed infiltration of lymphoma cells into multiple organs. Production of monoclonal immunoglobulin M was detected only slightly and focally in the tumors. Plasmacytic differentiation as in Waldenström's macroglobulinemia was not seen in any organs except the tumor on the upper hard palate. From these findings, it is speculated that B-cell lymphoma might have developed in the course of macroglobulinemia.

Development of calcium phosphate based functional gradient bioceramics

A functional gradient bioceramic that can function gradually with respect to body tissue was studied by changing the composition of calcium phosphate gradually from the surface to the inside. Diamond powder was spread on the surface of compact hydroxyapatite (HA) powder and fired at 1280 degrees C under reduced pressure, followed by firing under atmospheric conditions. The sintered body thus prepared was dense and alpha-tricalcium phosphate (alpha-TCP: alpha-Ca3(PO4)2) was found on its surface. The content of alpha-TCP gradually decreased with increasing depth from the surface. In contrast, the content of HA increased with increasing depth from the surface. The gradient ratio of alpha-TCP and HA depends on the firing time for each condition, i.e. reduced or atmospheric pressure. The alpha-TCP formation was ascribed to the decomposition of HA due to the spontaneous combustion of diamond powder.

The dopaminergic system modulates the endogenous opioid system in guinea-pig isolated ileal longitudinal muscle

The effects of the dopamine antagonists haloperidol and sultopride were investigated on the twitch response, evoked by 0.1 Hz stimulation of guinea-pig isolated ileal longitudinal muscle, and on the inhibition of the twitch response induced by 10 Hz stimulation (post-tetanic twitch inhibition) and by application of opioids. Both haloperidol and sultopride concentration-dependently inhibited the twitch response, with threshold concentrations of 2 and 50 microM, respectively, and could also shift the concentration-response curve for ACh-contraction to the right in a non-competitive manner. Haloperidol (1 microM) and sultopride (20 microM) increased post-tetanic twitch inhibition and this could be prevented by naloxone (100 nM). Twitch inhibition induced by morphine and dynorphin 1-13 was not affected by haloperidol (1 microM) or sultopride (20 microM). Prazosin (1 microM) and yohimbine (2 microM) did not affect either the twitch response or the post-tetanic twitch inhibition. These results suggest that dopamine receptors are involved in the modulation of the ileal opioid system, in such a manner as to diminish the release of endogenous opioids by tetanic stimulation.

Non-decay type fast-setting calcium phosphate cement: composite with sodium alginate

Non-decay type fast-setting calcium phosphate cement (nd-FSCPC) was prepared by introducing sodium alginate (0-2.0 wt%) into the liquid phase of FSCPC. nd-FSCPC was stable even when the cement paste was immersed in distilled water immediately after mixing, whereas conventional FSCPC (c-FSCPC) decayed completely within 1 min upon immersion. The setting time of the cement, approximately 5 min, was not dependent on the presence of sodium alginate. In contrast, the introduction of sodium alginate into conventional CPC, i.e. CPC without neutral phosphate in the liquid phase, resulted in no setting when the amount of sodium alginate introduced was more than 1 wt%. Powder X-ray diffraction analysis revealed no significant difference for the conversion of cement to apatite for any concentrations of sodium alginate studied (0-2.0 wt%). The mechanical strength of the cement increased rapidly with the addition of sodium alginate up to 0.8 wt% when the cement paste was immersed and kept in distilled water at 37 degrees C, whereas further addition of sodium alginate decreased the mechanical strength. The results obtained in this investigation, taken together with sodium alginate's known excellent biocompatibility and absorption behaviour, indicate that the use of sodium alginate composite FSCPC as nd-FSCPC should be of value in orthodontics and oral and maxillofacial surgery where the cement is exposed to blood.

Rapid gastric emptying and pathological changes of vagus nerve in the spontaneously diabetic Chinese hamster

To estimate autonomic neuropathy in the spontaneously diabetic Chinese hamster, which is an established strain for the non-obese non-insulin-dependent diabetes mellitus model, gastric emptying and morphometric analysis of the vagus nerve were studied in 12-month-old spontaneously diabetic Chinese hamsters (duration of diabetes was 9 months). Gastric emptying was determined by the phenol red method. Vagus was obtained from just above the diaphragm. Morphometric analysis of myelinated fibers was performed light-microscopically using semi-thin sections and unmyelinated fibers were studied electron-microscopically using ultra-thin sections. Gastric emptying of spontaneously diabetic Chinese hamster was significantly increased compared with control (86.6 +/- 1.9 vs. 51.2 +/- 3.4, P < 0.01). Myelinated fibers of the spontaneously diabetic Chinese hamster were not different from control animals, while the size of unmyelinated fibers in the spontaneously diabetic Chinese hamster was significantly decreased. These data suggest that pathological changes in unmyelinated fibers, which consist mainly of afferent fibers, might play a role in gastric motor dysfunction in the spontaneously diabetic Chinese hamster.

[Postoperative interstitial pneumonia in primary lung cancer patients--its causes and management]

Eight patients who developed interstitial pneumonia after surgery for primary lung cancer were reviewed to investigate its causes and the key points in treatment. These patients accounted for 1.8% of 633 operated lung cancer patients at our institution over the last 9 years. Risk factors such as bilateral recurrent laryngeal nerve palsy, preoperative chemoradiotherapy, and extensive mediastinal involvement were present in all of them. Pneumonia developed on the nonoperated side in all patients between the 2nd and 45th postoperative day (mean: 18 days). In most of the patients, faint reticular shadows initially appeared in the lower lobe of the nonoperated lung, rapidly spread to the upper lobe, and finally affected the whole lung. Among these eight patients, the initial five patients died because steroids were only administered after the pneumonia had become widespread, whereas the last three patients received early steroid therapy and were saved. The findings that 1) this pneumonia originated from the lower lobe of the nonoperated lung where blood flow is highest postoperatively, 2) the eosinophil count increased just before the onset of pneumonia, and 3) early steroid therapy and immunosuppressive therapy were effective suggest that an allergic or autoimmune mechanism may play some role in its development. When characteristic reticular shadows appear in the lower lobe on the nonoperated side in a lung cancer patient, even if not associated with any symptoms, an early diagnosis of interstitial pneumonia and initiation of steroid therapy is mandatory to ensure survival.

Effects of activin A on deoxyribonucleic acid synthesis, iodine metabolism, and cyclic adenosine monophosphate accumulation in porcine thyroid cells

We have recently shown the presence of activin A in human thyroid cells. To determine whether activin A affects the growth and function of the thyroid, we investigated its effects on DNA synthesis, iodine metabolism, and cAMP accumulation in cultured porcine thyroid cells. Activin A increased DNA synthesis. This effect was abolished by addition of follistatin but additively enhanced by epidermal growth factor. In contrast, activin A significantly reduced uptake and release of iodide by the thyroid and also TSH-induced cAMP accumulation but did not inhibit the cAMP accumulation induced by forskolin. These data indicate that activin A stimulates thyroid growth irrespective of cAMP accumulation and inhibits thyroid function.

Expression of the hepatitis C virus genome in rat liver after cationic liposome-mediated in vivo gene transfer

The lack of a small animal model of hepatitis C virus (HCV) infection has impeded elucidation of the pathogenesis of HCV. The aim of this study was to develop an HCV-expressing animal model by means of cationic liposome-mediated in vivo gene transfer. To examine the feasibility of this strategy, pActLacZ, an expression vector composed of the LacZ gene driven by the beta-actin promoter, complexed with lipofectin, was injected retrogradely into the common bile ducts of adult rats. X-Gal histochemical staining clearly showed that the LacZ gene was expressed in hepatocytes, but not in biliary epithelial cells. Maximal expression was observed at a DNA to lipofectin ratio of 1:4. Based on this observation, pAGS3M091, an expression vector containing the full length of HCV complementary DNA (cDNA) preceded by the beta-actin promoter, was evaluated. Two days after in vivo intrabiliary administration of pAGS3M091 complexed with lipofectin, polymerase chain reaction (PCR) amplification of reverse-transcribed liver RNA demonstrated the 5' and 3' portions of HCV transcripts derived from pAGS3M091. Immunohistochemical analysis showed the HCV core protein in a small number of hepatocytes scattered in the hepatic lobules. We conclude that the full-length HCV genome was successfully expressed in adult rat liver by means of cationic liposome-mediated in vivo gene transfer. This model will be useful for determining the immunopathological role of HCV in vivo.

Overseas transport of a patient with an extracorporeal left ventricular assist device

An 18-year-old boy with end-stage cardiomyopathy who was undergoing support with an extracorporeal pneumatic left ventricular assist device was transported from Japan to the United States. During the 17-hour flight, the patient's condition was stable, and the pneumatic assist device worked well under low atmospheric pressure in the cabin. Subsequently, he had a successful heart transplantation after 119 days of left ventricular assist device support.

Influence of molecular weight on passive tumour accumulation of a soluble macromolecular drug carrier

The molecular weight-dependence of tumour capture of N-(2-hydroxypropyl)methacrylamide (HPMA) copolymers (fractions of mw 22,000-778,000) was studied in vivo using subcutaneous (s.c.) Sarcoma 180 or B16F10 melanoma models. At 10 min, all fractions were already detectable in the tumour (1.5-3% of dose administered per gram) and those of molecular weight greater than the renal threshold showed progressive tumour accumulation up to 20% of dose administered per gram after 72 h in the Sarcoma 180 model. Tumour-selective uptake was confirmed for all copolymer fractions in both tumour models and in the sarcoma 180 model, the ratio (accumulation index, AI) of the AUC in tumour to AUC in skeletal muscle (a typical normal tissue) increasing from six to 12 with increasing copolymer molecular weight. The tumour/blood AI was greater (1-3) in the Sarcoma 180 model than the B16F10 melanoma model (0.4-1.0).

Ventilatory responses during incremental exercise in men under hyperoxic conditions

The aim of the present study was to explore the role of the carotid chemoreceptors in the regulation of breathing during incremental ramp exercise. We measured minute ventilation (VE), oxygen uptake (VO2), carbon dioxide output (VCO2), end-tidal PO2 and PCO2 (PETO2 and PETCO2), and heart rate (HR) during incremental exercise in healthy young men breathing air and 50% O2. During incremental exercise (15 W/min, from 0 to 300 W) VCO2 in hyperoxia did not differ from the normoxic response, but VE in hyperoxia increased more linearly with an increasing load in comparison to the curvilinear rise of normoxic VE. The isocapnic buffering of PETCO2 observed in normoxia at the transition from moderate to heavy work did not appear in hyperoxia until a very heavy work load had been attained. This agrees with the observation that normoxic VE/VCO2 that was consistently falling with load and became flat near the isocapnic point and then turned upward with a further increase in work load, while VE/VCO2 in hyperoxia decreased continuously during heavy exercise. These results would suggest the delayed onset of anaerobic metabolism and the depression of VE under hyperoxic conditions. However, we found that VE and HR increased from a specific work rate with a steeper slope during incremental exercise under both normoxic and hyperoxic conditions. There was a significant correlation between the work rates at which the inflection points of the VE and HR slopes were observed. These findings suggest that factors unrelated to peripheral chemoreceptor activity and affecting both the ventilatory and circulatory systems may be responsible for hyperpnea during heavy exercise.

Plasma catecholamine and cortisol concentrations during acceleration stress

Serial changes in catecholamine (CA) and cortisol (Col) concentrations of human subjects exposed to acceleration stress with the vector in the head-foot direction (+ 5Gz for 1 min) were determined using a newly designed continuous blood sampling system. The results demonstrated that the time course changes in noradrenaline (NA), adrenaline (A) and Col concentrations were quite different from each other during and after the Gz exposure. The NA remained relatively unchanged during the exposure, and showed a marked increase at the end of the exposure, peaking at about 110 s after the end of the exposure. The A showed a gradual increase from the start of the exposure and continued to rise during and after the exposure. Its maximal peak was also found at about 110 s after the exposure. The A showed a sevenfold increase, while NA showed only about a threefold increase as high as pre-exposure levels. The more rapid and greater magnitude of increase in A concentration during exposure may have reflected the larger emotional stress and strenuous physical activities involved in the Gz exposure. Heart rate showed a rapid increase upon exposure and remained significantly increased during the exposure; it then showed a transient fall immediately after the exposure, despite the increase in CA. An interesting observation was a decrease in Col during the Gz exposure. A plausible explanation would appear to be the result of an enhanced rate of Col removal from the plasma. From these observations, the importance of serial determination of hormonal excretion during Gz stress for the precise analysis of hormonal response to Gz stress was confirmed.

Allogeneic peripheral blood stem cell transplantation for treatment of induction failure in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia

We report a successful case of allogeneic peripheral blood stem cell transplantation (PBSCT) for the treatment of primary induction failure in acute lymphoblastic leukemia (ALL). The patient was a 46-year-old male with Ph-positive ALL and failed to achieve complete remission (CR). His HLA genotypically identical brother refused to donate bone marrow. Instead, PBSCs were collected by apheresis from the brother after administration of G-CSF at a dose of 10 micrograms/kg. For allogeneic PBSCT, the patient was conditioned with marrow ablative chemotherapy and received the PBSC harvest containing 7.8 x 10(4)/kg of CFU-GM, 1.8 x 10(6)/kg of CD34-positive cells and 2.7 x 10(8)/kg of T lymphocytes. After transplant, the neutrophil count exceeded 0.5 x 10(9)/l on day 16 and the platelet count exceeded 20 x 10(9)/l on day 22. CR was confirmed with tri-lineage engraftment in bone marrow samples on days 28 and 49; disappearance of the Ph-chromosome was documented. Sustained engraftment was also confirmed cytogenetically using a variable number of tandem repeat (VNTR) markers. Acute graft-vs.-host disease did not develop with conventional prophylaxis of methotrexate and cyclosporine. However, on day 85 the patient developed leukemia relapse and died on day 97. This clinical trial suggests that allogeneic PBSCT may be an alternative to allogeneic bone marrow transplantation in some limited situations.

[Esophageal perforation by alkalis--a case report with conservative therapy]

In May 1993, a 59-year-old woman attempting suicide with toilet detergent (1% sodium hydroxide) was hospitalized as an emergency case. She developed sudden high fever (38-39 degrees C) on the 26th admission day. Thereafter diagnosis of left pyothorax due to perforation on caustic esophageal ulcer was made. Subsequent to thoracentesis continuous dranage of the left thoracic cavity ceased the fever after three days. Oral intake began on the 28th and extubation of the dranage was done on the 42nd after admission. Following hospital course of the patient was uneventful and the patient was discharged on the 111th day after admission. Esophagofluoroscopy taken at 6 months after discharge revealed no esophageal stenosis, and the patient returned to full social activities in good health.

Effect of work rate on cardiorespiratory response to rhythmic-static exercise

Influence of work rate (30 and 30 rpm) on exercise hyperpnoea, respiratory entrainment and cardiovascular system was studied in 9 healthy men performing rhythmic-static exercise (RSE). Respiratory frequency (f), tidal volume (VT), minute ventilation (VE), heart rate (HR), stroke volume (SV), and cardiac output (Q) were continuously measured. RSE was performed in upright position on a special motor-driven cycloergometer with an intensity of 40% VO2max for 5 min. The subjects opposed the flywheel movement by pressing the pedal alternately with left and right leg. It was found that in both work rates respiratory frequency followed the rhythm of exercise. The increases in f (28v35 breaths/min. p < 0.05) were associated with decreased VT (1.3v1.0L, p < 0.05) but they did not influence VE which was 33 and 36 1/min (NS). Accelerations of f and VE were faster for 30 than 60 rpm reaching respective values of 2.70v0.75 breaths/min/s (p < 0.05), and 0.59v0.31 1/min/s (p < 0.05). Cardiac response and its kinetics were found to be similar for both exercise rhythms. It is concluded that breathing entrainment does not affect either ventilation or the cardiac response during the RSE exercise. Since changes in acceleration of ventilation were not accompanied by appropriate changes in cardiac output acceleration the cardiodynamic hypothesis of exercise hyperpnoea does not seem to be valid for rhythmic-static exercise.