Immunoglobulin gene rearrangement in T-cell-rich reactive pleural effusion of a patient with B-cell chronic lymphocytic leukemia

Pleural effusion in chronic lymphocytic leukemia (CLL) is a relatively rare phenomenon. We report a case of a pleural effusion associated with B-cell CLL but with predominantly reactive T lymphocytes in the effusion. A cell surface phenotype study showed that T lymphocytes predominated in the pleural effusion, although B lymphocytes were predominant in the peripheral blood. Genotypic analysis of the cells in the peripheral blood, bone marrow, lymph node, and pleural effusion showed the same rearrangement pattern of the immunoglobulin heavy chain genes consistent with a B-lymphocytic neoplasm (CLL). A pleural biopsy demonstrated diffuse infiltration of lymphoid cells. Most of the cells demonstrated T cell markers, although some cells revealed B cell markers by immunologic staining. These results suggested that the pleural involvement by B-CLL may have caused a reactive T-lymphocyte proliferation in the pleura and pleural effusion. To our knowledge, this is the first published case indicating that genotypic analysis of immunoglobulin heavy chain gene rearrangement may be useful in the diagnosis of a pleural effusion associated with B-cell CLL.

Steady-state kinetics of Thr35 and Thr39 mutants in human adenylate kinase by site-directed mutagenesis

Adenylate kinase (AK; EC 2.7.4.3, hAK1) catalyzes the reaction: MgATP(2-)+ AMP2- reversible MgADP-(+) ADP3-. To elucidate the catalytic and structural roles of threonine residues in human AK, Thr35 and Thr39 mutants were analyzed by steady-state kinetics. The K(m) values of T35P and T35Y were not changed for MgATP2- and AMP2-, and the kcat values were decreased by 1/39 compared to those of wild-type AK. Thr35 was suggested to be essential for catalysis. The K(m) values of T39S, T39V and T39P were increased 5.6- to 59.0-fold for AMP2-; however, the kcat values were not reduced. Although the K(m) values of T39F and T39L were unchanged, the kcat values were reduced by more than 1/57. Thr39 appears to play an important role in the binding of AMP2- and to be essential for catalysis. As noted above, a hydroxyl group of the Thr residue in human AK appears to be important.

The visual estimation of intraoperative myocardial ischemia

We report a case who had myocardial ischemia after release of the aortic cross clamp during mitral valve replacement. Myocardial ischemia was visually estimated by use of intraoperative MCE (myocardial contrast echocardiography). After appropriate treatment the ischemic area disappeared and the patient showed a good postoperative course. MCE is a useful method with which to detect visually the wash out pattern of cardioplegia from myocardium after reperfusion during open heart surgery.

Successful treatment of bronchial mucoepidermoid carcinoma in an 11-year-old boy by bronchoplasty: report of a case

We report herein the rare case of an 11-year-old boy in whom mucoepidermoid carcinoma of the right upper lobe bronchus was successfully treated by bronchoplasty. The patient underwent bronchoscopy to investigate the cause of relapsing respiratory infections over the past 2 years, which revealed a tumor at the orifice of the right upper lobe bronchus. Thus, a right upper sleeve lobectomy was effectively carried out, preserving right pulmonary function. The tumor was observed to partially invade the bronchial wall, but not the lung parenchyma. Histological examination confirmed a diagnosis of mucoepidermoid carcinoma, classified as grade 2 by Conlan's classification. The patient has been well and free of recurrence for 3 years postoperatively.

Modulation of sensitivity to mitomycin C and a dithiol analogue by tempol in non-small-cell lung cancer cell lines under hypoxia

We examined the mechanisms involved in the bioactivation of mitomycin C (MMC) and a newly developed MMC analogue: 7-N-(2-([2-(gamma-L-glutamylamino)ethyl]dithio)ethyl)mitomycin C, KW-2149, in non-small-cell lung cancer (NSCLC) cell lines under aerobic and hypoxic conditions. To investigate these mechanisms, we used MMC-resistant non-small-cell lung cancer cell lines (PC-9/MC4) that had been established in our laboratory from the parent PC-9 cell line by continuous exposure to MMC. We previously reported that the MMC-resistant cell line (PC-9/MC4) was poor in NAD(P)H dehydrogenase (quinone) activity and approximately 6-fold more resistant than the parent cells (PC-9) to MMC on 2-h exposure under aerobic conditions. In this study, the subline PC-9/MC4 was 6.7-fold more resistant to MMC than PC-9, the parent cell line, under aerobic conditions, and 5.2-fold more resistant under hypoxic conditions after 2-h exposure to MMC. However, on co-incubation with tempol, an inhibitor of the one-electron reduction pathway, the sensitivity of PC-9/MC4 to MMC was impaired under hypoxic conditions, but the impairment was not evident under aerobic conditions. KW-2149, the newly developed MMC analogue, was cytotoxic for both PC-9/MC4 and PC-9 cells, and the sensitivity of both cell lines to KW-2149 was not changed by exposure to hypoxic conditions or by coincubation with tempol. There were no significant differences in the intracellular uptake of MMC and the activities of cytosolic detoxification enzymes between the PC-9 and PC-9/MC4 cell lines. These results support the hypothesis that the one-electron reduction pathway plays a partial role in the bioactivation of MMC, but not of KW-2149, and that KW-2149 is excellent at circumventing resistance to MMC in NSCLC.

MAT-1, a monoclonal antibody that specifically recognizes human tyrosinase

There is no available monoclonal antibody which reacts specifically recognizes human tyrosinase. Employing a synthetic peptide, MEKEDYHSLYQSHL, corresponding to the carboxyl terminus of human tyrosinase as an immunogen, we produced a mouse monoclonal antibody MAT-1 of the IgG1 isotype. The epitope for MAT-1 was determined to be EDYH, the sequence of which is not present in human tyrosinase-related protein-1 (TRP-1) or tyrosinase-related protein-2 (TRP-2). By transient expression assays and immunofluorescence technique, we show that MAT-1 reacts specifically with cells expressing human tyrosinase cDNA but not with cells expressing TRP-1 or TRP-2 cDNA. The results of immunohistochemical staining also confirmed that MAT-1 reacts specifically with epidermal melanocytes in human skin sections. MAT-1 should be invaluable for studying the interaction between tyrosinase and TRPs and for detecting the changes in the levels of tyrosinase expression. In addition, MAT-1 should be useful as a sensitive immunohistochemical tool for investigation of various pigmentary disorders and possibly for the diagnosis of melanoma.

Picture imperfect: hidden problems among Asian Pacific islander elderly

Asian Pacific Islander (API) elderly represent the fastest growing group of ethnic elderly in the United States, yet their social and health needs remain little understood in the field of ethnogerontology. Existing literature generally portrays API elderly as in equal or better health compared to whites. However, aggregate API data cloud the bimodal distribution in socioeconomic and health status. We review existing literature on API elderly, and examine selected national data to illustrate the effects of a bimodal distribution on our understanding of API elderly socioeconomic and health status. Implications for research and policy are discussed.

Correlation between immunophenotypic diversity and clinical features in B-cell lymphoblastic lymphoma

Lymphoblastic lymphoma (LBL) is a highly malignant subtype of non-Hodgkin's lymphoma (NHL) and generally carries a T-cell phenotype with mediastinum or central nervous system (CNS) involvement. However, only a small proportion of LBL exhibit a B-cell phenotype (B-LBL), and these frequently present at the head and neck without mediastinum or CNS involvement. Three immunological subgroups may exist. The most predominant CD10-positive pre-B-cell type, corresponding to a precursor B-cell neoplasm, frequently involves the head and neck. The second, CD10-negative or mature B-cell type, defined by the absence of CD10 or presence of surface membrane immunoglobulins combined with expression of CD19 or CD20, often involves the mediastinum. The final group is a CD5-positive B-cell type corresponding to a blastic variant of mantle cell lymphoma (MCL). Its clinical course is less aggressive, patients are often older, and nodal lesions are more frequent than extranodal involvement. Thus, B-LBL is immunologically diverse, but its biological behavior correlates with the immunophenotype.

NS-49, a novel alpha 1a-adrenoceptor-selective agonist characterization using recombinant human alpha 1-adrenoceptors

alpha 1-Adrenoreceptors comprise a heterogeneous family and subtype-selective ligands are valuable in studying the functional role of each receptor subtype. Using the Chinese hamster ovary (CHO) cells stably expressing the cloned human alpha 1-adrenoceptor subtypes (alpha 1a, alpha 1b, and alpha 1d)1, we have compared a newly synthesized phenethylamine class agonist (R)-(-)-3'-(2-amino-1-hydroxyethyl)-4'-fluoromethanesulfonanilide hydrochloride (NS-49) with imidazoline class agonist oxymetazoline in their binding affinities and intrinsic activities in causing transient increases of cytosolic Ca2+ concentrations ([Ca2+¿i response). Radioligand binding studies with 2-[beta-(4-hydroxyl-3-[125I]iodophenyl)ethylamino-methyl]tetralone ([125I]HEAT) showed NS-49 and oxymetazoline had higher affinities at alpha 1a-than at alpha 1b- and alpha 1d-subtypes (-log Ki values at alpha 1a-, alpha 1b-and alpha 1d-subtype: 6.18, 5.13, and 5.38 for NS-49: 8.19, 6.50, and 6.44 for oxymetazoline, respectively). In functional studies, both oxymetazoline and NS-49 worked as a selective and partial agonist at alpha 1a-subtype: however, NS-49 is more efficacious than oxymetazoline. NS-49 is the phenethylamine class of alpha 1-adrenoceptor partial agonist relatively selective and efficacious for the human alpha 1a-adrenoceptor subtype, NS-49 would be potentially useful for studying the physiological role of alpha 1-adrenoceptor subtype.

Additive effect of continuous low-dose ofloxacin on erythromycin therapy for sinobronchial syndrome

It has been established that long-term low-dose erythromycin therapy (EM therapy) is very effective for sinobronchial syndrome, a common condition in Japan characterized by chronic upper and lower airway inflammation. The effect does not result from its bacteriocidal activity and the detailed mechanisms are not known. It takes 3-6 months for EM therapy to improve the symptoms. This study was designed to evaluate the additive effect of continuous low dosage or intermittent usual dosage of ofloxacin (OFLX) on EM therapy in patients with sinobronchial syndrome. Patients with sinobronchial syndrome were randomly allocated to receive one of the following four regimens. Patients in Group A received both low-dose OFLX and EM therapy daily for 6 months. Patients in Group B received EM therapy and intermittent treatment of OFLX for 6 months. Patients in Group C underwent EM therapy for 6 months. Patients in Group D received neither OFLX nor EM therapy. All patients were given carbocystein for more than 2 months before starting each treatment and during the study period. In patients receiving OFLX and/or EM therapy, these antimicrobial agents were well-tolerated during the treatment period. Amount of sputum in the morning was significantly less in Group C than in Group D after 3-6 months, and decreased significantly in Group A as compared with Group B after 2 weeks, Group C after 2 weeks to 2 months, and Group D after 2 weeks to 6 months. Other symptoms such as number of expectorations, difficulty of expectoration and severity of cough also improved rapidly in Group A. These findings suggest that it is useful to add low-dose OFLX to EM therapy for sinobronchial syndrome, especially within 1-2 months from starting treatment, and it may be cost-effective as this combination therapy can shorten the treatment period of EM therapy.

Area of paresthesia as determinant of sensory block in axillary brachial plexus block

BACKGROUND AND OBJECTIVES

Paresthesia is widely considered a useful indicator for locating components of the brachial plexus using the axillary approach. While establishing axillary brachial plexus blocks, the authors attempted to correlate the area of paresthesia with the effectiveness of the sensory block.

METHODS

Axillary brachial plexus blocks were established in 222 consecutive adult patients scheduled for elective surgery of the hand or forearm. After paresthesia was elicited in the distribution of one of the three terminal nerves of the hand (median, radial, or ulnar nerve), 30 microliters 1.5% mepivacaine without epinephrine was injected after advancing an indwelling catheter. Sensory block of each terminal nerve was assessed 20 minutes after the injection.

RESULTS

The median and radial nerves were blocked with the highest reliability (87% and 93%, respectively) after paresthesia was elicited in the areas supplied by the corresponding nerves. The ulnar nerve was blocked most reliably ( > 85%) after the elicitation of paresthesia in its area of distribution as well as when no paresthesia was induced. The most reliable block of the musculocutaneous nerve (72%) was achieved after paresthesia was induced in the area supplied by the median nerve.

CONCLUSION

Eliciting paresthesia at the nerve supplying the area of a planned surgical incision is a reliable determinant of successful axillary brachial plexus block.

Aneurysm of the transverse cervical artery occurring in association with a cavernous hemangioma as a complication of Klippel-Trénaunay syndrome: report of a case

We report herein the case of a 14-year-old girl with Klippel-Trénaunay syndrome who developed an aneurysm of the transverse cervical artery. Because it was continuing to increase in size, with an associated risk of rupture, an aneurysmectomy was performed. Pathological examination of the resected specimen revealed a cavernous hemangioma located near the aneurysm. To our knowledge no other case of an aneurysm occurring in association with a cavernous hemangioma as a complication of Klippel-Trénaunay syndrome has ever been reported.

Effects of adrenalin on the conversion ratio of tryptophan to niacin in rats

The administration of glycemia-affecting chemicals such as alloxan, streptozotocin, and 6-aminonicotinamide decreases the conversion ratio of tryptophan to niacin. Adrenalin is also known to increase the glucose level. For this reason, the effects of adrenalin on the conversion ratio were investigated. We found that the conversion ratio of tryptophan to niacin was reduced to half by the intraperitoneal injection of adrenalin at 75 micrograms/day/rat (body weight, about 250 g) every day for 7 days. Niacin decreases adrenalin-stimulated glycogenolysis via stimulating phosphodiesterase activity or depressing adenyl cyclase activity. Accordingly, in urgent need of energy, animals would have to decrease the concentration of niacin within the body.

[A case of cerebral infarction in a young adult following an abuse of cocaine and other drugs]

We reported a case of cerebral infarction in a young adult following an abuse of cocaine and other drugs. A 27-year-old male was admitted to our hospital because of the abrupt onset of right hemiplegia and dysarthria. Brain CT and MRI examinations showed cerebral infarction in the region of the left caudate head and the left corona radiata. Cerebral angiography revealed total occlusion at the origin of the left middle cerebral artery, with neither vascular malformation nor atherosclerotic change. There were no obvious causes that might lead to cerebral infarction in young adults, including potential cardiac sources of embolism, abnormalities of blood coagulation, or collagen vascular diseases. From his history we learned he had started abusing cocaine and other drugs at the age of 16 years, and that he had been addicted to these drugs up to at least 2 months earlier than the onset of cerebral infarction, so we suggested his drug abuse might have affected the occurrence of cerebral infarction. We would like to emphasize that using 'drugs' should be taken into consideration as a possible cause of cerebral infarction in young adults.

Effects of vitamin B6 deficiency on the conversion ratio of tryptophan to niacin

To investigate how vitamin B6 (B6) deficiency affects the whole metabolism of tryptophan-niacin, rats were fed for 19 days with each of the following four kinds of diets; a complete 20% casein diet (control diet), the control diet without B6, the control diet without nicotinic acid, and the control diet without nicotinic acid and B6, and the urinary excretion of such tryptophan metabolites as kynurenic acid, xanthurenic acid, nicotinamide, N1-methylnicotinamide, N1-methyl-2-pyridone-5-carboxamide, and N1-methyl-4-pyridone-3-carboxamide each and the enzyme activities involved in tryptophan-niacin pathway were measured. The urinary excretion of kynurenic acid decreased while that of xanthurenic acid increased drastically in the two B6-deficient groups, when compared with the B6-containing groups. These results indicate that the rats fed with the B6-free diets were in the vitamin-deficient state. The conversion ratio was calculated from the ratio of the urinary excretion of sum of nicotinamide, N1-methylnicotinamide, N1-methyl-2-pyridone-5-carboxamide, and N1-methyl-4-pyridone-3-carboxamide, to the Trp intake. The ratio was statistically lower in the B6-free diet than in the B6-containing diet under the niacin-free conditions.

Assessment of genetic variations within populations of Sika deer in Japan by analysis of randomly amplified polymorphic DNA (RAPD)

Random amplified polymorphic DNA (RAPD) was exploited as a genetic marker to assess the level of genetic variation in populations of Sika deer, Cervus nippon, in Japan. DNA samples were collected from three local populations in Japan, namely, Kinkazan, Goyozan and Ashoro populations. Four arbitrary primers, when used individually, amplified an average of five RAPD fragments in the polymerase chain reaction (PCR). The number of polymorphic bands was scored to calculate band-sharing coefficients within populations. Average band-sharing coefficients revealed a higher degree of homogeneity in the Kinkazan population. Samples collected from larger populations, namely, Ashoro and Goyozan, revealed greater polymorphism than samples from the Kinkazan deer. Our data suggest that RAPD is useful as a marker for detecting genetic variations in populations of Sika deer with reduced levels of genetic diversity.

AIDS-associated mycoplasmas possess phospholipases C in the membrane

Phosphatidylinositol- and phosphatidylcholine-hydrolyzing activities existed in the cell lysates of AIDS-associated Mycoplasma species, including Mycoplasma fermentans IID 812, M. fermentans incognitus, and M. penetrans GTU-54-6A1. These activities were found to be attributable to phospholipases C, because the water-soluble product from phosphatidylcholine digested by the cell lysate of M. fermentans IID 812 was phosphorylcholine. M. fermentans IID 812 was examined for localization of these enzymes, and it was found that they were associated with the membrane.

Tenodesis of extensor digitorum in treatment of brachial plexus injuries involving C5, 6, 7 and 8 nerve roots

Restoration of motor function in the hand is difficult in brachial plexus injuries in which the C5, 6, 7 and 8 roots are involved, because there are insufficient motors available for transfer to restore the extensors of the fingers and wrist. We have used extensor digitorum tenodesis in 11 cases and found it effective and simple.

Dexamethasone down-regulates the expression of endothelin B receptor mRNA in the rat brain

The present study was designed to examine effects of dexamethasone on the steady state level of endothelin B(ETB) receptor mRNA in in vivo the rat brain. ETB receptor mRNA was very high at the hypothalamus and cerebellum but was comparatively low at the striatum and amygdala. Dexamethasone, 1 and 7 mg/kg, i.p., markedly and dose-relatedly decreased ETB receptor mRNA level with slow onset of 8hr at the hypothalamus and cerebellum, but did not induced a marked decrease at other areas. On the contrary, dexamethasone produced an increase of ET-1 mRNA which preceded to the decrease of ETB receptor mRNA at the same brain areas. Phosphoramidon, a endothelin-converting enzyme inhibitor, did not antagonized but potentiated the effect of dexamethasone. Besides, phosphoramidon per se markedly stimulated the expression of ET-1 mRNA. The results suggested that dexamethasone down-regulates ETB receptor mRNA level at the hypothalamus and cerebellum of rat brain and these effects may be involved in the increase of ET-1 peptide gene transcription.

Solution structure of endothelin B receptor selective antagonist RES-701-1 determined by 1H NMR spectroscopy

The three-dimensional structure of the endothelin B receptor (ETB) selective antagonist RES-701-1 has been determined by 1H NMR in deuterated dimethyl sulphoxide. RES-701-1 consists of 16 amino acid residues with a novel internal linkage between the beta-carboxyl group of Asp9 and the alpha-amino group of Gly1. The structural calculations were carried out with the combined use of distance geometry and simulated annealing. The result indicates that RES-701-1 adopts an extraordinary folding; the 'tail' (Trp10-Trp16) passes through the 'ring' region (Gly1-Asp9). Several critical NOEs directly support this extraordinary folding. The folding of RES-701-1 turned out to be the same as that Frèchet et al. calculated for RP 71955 which possesses the same internal linkage as RES-701-1. The obtained structure suggested that the region consisting of Thr6, Ala7, Tyr14 and Tyr15 and/or, the region consisting of Asn2, Tyr14 and Tyr15 are involved in a binding with ETB.

Epidural anesthesia modifies cardiovascular responses to severe hypoxia in dogs

Hypoxia is a critical and sometimes fatal complication of anesthesia. Since there is little information on the cardiovascular response to hypoxia during epidural anesthesia, we assessed the effects of epidural anesthesia on the cardiovascular response to hypoxia and on survival in dogs. We randomly assigned 36 mongrel dogs to one of three groups according to the anesthetic technique used: the thoracic group (n = 12) received thoracic epidural anesthesia plus general anesthesia, the thoracolumbar group (n = 12) received thoracolumbar epidural anesthesia plus general anesthesia, and the control group (n = 12) received general anesthesia alone. We monitored hemodynamics and plasma catecholamine concentrations and assessed survival in these groups during normocapnic hypoxia (FiO2, 0.09 for 120 min). During hypoxic challenge, PaCO2 and PaO2 values were similar in all groups. In both groups that received epidural anesthesia, heart rate, systolic and diastolic arterial pressures, and plasma epinephrine and norepinephrine concentrations were lower and arterial pH was greater than in the control group. There was no significant difference in survival among groups. Epidural anesthesia modified both the physiologic cardiovascular and catecholamine responses to hypoxia. Epidural anesthesia of the thoracic region did not appear to accelerate cardiac arrest, but it attenuated the development of metabolic acidosis during hypoxia.

Effect of dietary linoleic acid on the tryptophan-niacin metabolism in streptozotocin diabetic rats

To make clear the mechanism of change of tryptophan-niacin metabolism in diabetic rats, we investigated the effect of dietary linoleic acid on the tryptophan-niacin metabolites and the activity of liver, alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD), a key enzyme of tryptophan-niacin metabolism, in streptozotocin diabetic rats. Moreover, we investigated the involvement of linoleic acid in the induction of hepatic ACMSD activity by streptozotocin diabetes. In diabetic rats, the sum of urinary excretion of nicotinamide, N1-methylnicotinamide (MNA), N1-methyl-2-pyridone-5-carboxamide (2-Py) and N1-methyl-4-pyridone-3-carboxamide (4-Py) was higher in the fat free diet group than in the linoleic acid group, that was accompanied by the increase of tryptophan intake and reduction of body weight in the fat free diet group. In diabetic rats, hepatic ACMSD activity was higher in the fat free diet group than in the linoleic acid group. The results indicated that the induction of hepatic ACMSD activity by diabetes was not due to removal of the suppressive effect of the linoleic acid on the enzyme. In the diabetic+insulin group, hepatic ACMSD activity was significantly lower than in the diabetic group.