Autopsy case of hepatocellular carcinoma associated with lupoid hepatitis and complicated by malignant lymphoma

An 81-year-old woman in whom liver dysfunction had been pointed out 3 years previously was diagnosed as having liver cirrhosis due to lupoid hepatitis. Considering the poor prognosis of cirrhosis and her age, immunosuppressive therapy was not adopted. Nine months later, a small liver tumor was found by ultrasonography and was diagnosed as hepatocellular carcinoma (HCC). The tumor was treated with transcatheter arterial embolization, but grew continuously. She also developed gingival lymphoma that was successfully treated. Three years after initial diagnosis of lupoid hepatitis, she died of hepatic failure. An autopsy was performed and confirmed the clinical diagnosis, liver cirrhosis with HCC. HCC is regarded as a rare complication of lupoid hepatitis, but cases of HCC complicating lupoid hepatitis may increase with progress in treatment methods and elongation of survival. The present case suggests that any malignancy can be developed in long-term surviving patients with lupoid hepatitis.

Spatial features of calcium transients during early and delayed afterdepolarizations

Although changes in intracellular Ca2+ concentration ([Ca2+]i) are spatially heterogeneous during spontaneous contraction in mammalian cardiac muscle, it has not yet been observed how [Ca2+]i changes spatially within cardiac myocytes during delayed (DADs) and early (EADs) afterdepolarizations. The aim of this study is to characterize the spatial features of the increase in [Ca2+]i during such afterdepolarizations and to understand the ionic mechanisms responsible for them. Myocytes were enzymatically isolated from guinea pig ventricles and loaded with fura 2-acetoxymethylester, the Ca2+ fluorescence indicator dye. Membrane potential was recorded with a conventional microelectrode technique, and spatiotemporal changes in fura 2 fluorescence and cell length were recorded using a digital television system. After superfusion with potassium-free Tyrode solution, DADs and EADs were induced. During DADs, fluorescence transients were heterogeneous within myocytes (n = 11). Furthermore, they often propagated within myocytes as if they were "waves." In contrast, during EADs, fluorescence transients showed no waves within myocytes but rather showed synchronous changes throughout the myocytes (n = 15). The results of this study suggest that the spatial features of the increase in [Ca2+]i differ between the DADs and EADs. We concluded from these differing features that the ionic mechanisms responsible for the two triggered activities are different.

Studies of HIV-1 protease inhibitors. II. Incorporation of four types of hydroxyethylene dipeptide isosteres at the scissile site of substrate sequences

Human immunodeficiency virus type 1 (HIV-1) protease inhibitors containing four types of hydroxyethylene dipeptide isosteres were designed and synthesized. These inhibitors consist of eight stereoisomers of phenylalanylproline (Phe-psi[H.E.]-Pro), four stereoisomers of phenylalanylalanine [Phe-psi[H.E.]-Ala), and one stereoisomer each of phenylalanylglycine (Phe-psi[H.E.]-Gly) and cyclohexylalanylalanine (Cha-psi[H.E.]-Ala) hydroxyethylene dipeptide isosteres. For the synthesis of the latter two isosteres, a newly developed synthetic method for gamma-lactone was applied. The inhibitory activities of these peptides were evaluated by cleavage assay of partially purified gag proteins or purified synthetic peptide. Of the inhibitors examined, compounds 2c (Z-Asn-(2S,3R,4S,5S)-Phe-psi[H.E.]-Pro-NHB(un); Bu(n) = n-butyl, Ki = 0.50 microM), 21a (Z-Asn-(2R,4S,5S)-Phe-psi[H.E.]-Ala- NHBu(n), Ki = 0.34 microM) and 23 (Z-Asn-(2R,4S,5S)-Cha-psi[H.E.]-Ala- NHBu(n), Ki = 0.46 microM) were moderately potent inhibitors. The results revealed that the alkyl substituent at C2 is essential, and the stereochemistry of the hydroxyethylene dipeptide isosteres greatly affected their inhibitory activities.

Moyamoya disease associated with bilateral renal artery stenosis

Recent research has suggested that an association exists between moyamoya disease and fibromuscular dysplasia which involves systemic vessels, including renal arteries. We report a 3 year old girl with moyamoya disease associated with bilateral renal artery stenosis. This case may support the common etiology of these two clinical conditions. To our knowledge this is the youngest case of moyamoya disease associated with bilateral renal artery stenosis.

Human promyelocytic cell line HL60 has the specific binding sites for prolactin and its ornithine decarboxylase, DNA synthesis and cellular proliferation are induced by prolactin

Human prolactin (hPRL) induced ornithine decarboxylase (ODC) activity, subsequently DNA synthesis and cellular proliferation on human promyelocytic cells, HL60, cultured in a serum-free medium. HL60 cells had 2100 specific binding sites for hPRL per cell, showing a dissociation constant of 1.1 x 10(-10) M. Binding of 125I-PRL to the cells was not blocked by simultaneous addition of human growth hormone. ODC activity and DNA synthesis were activated maximally at 5 and 20 h, respectively, after the addition of 0.05 nM hPRL. These effects of PRL on cellular proliferation, ODC activity and DNA synthesis were abolished by the simultaneous addition of anti-hPRL antibody. Simultaneous addition of an irreversible inhibitor of ODC, difluoromethyl ornithine (DFMO), also abolished the inductions of ODC and DNA synthesis by hPRL. The inhibitory effect of DFMO on hPRL-induced DNA synthesis was reversed by the addition of putrescine to the culture medium. These results suggest that hPRL binds to the prolactin receptor on HL60 cells and induces ODC activity to increase cellular polyamine levels, which eventually stimulates DNA synthesis and cellular proliferation.

Primary cutaneous T-cell-rich B-cell lymphoma

A 61-year-old man presented with a skin tumour in the right axilla of 2 months' duration. An excision biopsy revealed a malignant lymphoma, of diffuse mixed small and large cell type, morphologically suggestive of T-cell lymphoma, but shown to be a T-cell-rich B-cell lymphoma by subsequent immunohistochemical staining. A review of the literature revealed 47 cases of T-cell-rich B-cell lymphoma with descriptions of primary sites, 35 nodal and 12 extranodal, of which only one was a cutaneous primary.

Studies of HIV-1 protease inhibitors. I. Incorporation of a reduced peptide, simple aminoalcohol, and statine analog at the scissile site of substrate sequences

Inhibitors of the protease of human immunodeficiency virus type-1 (HIV-1) were designed and synthesized. A reduced peptide, simple aminoalcohol, and statine analog, 4-amino-3-hydroxy-5-phenylpentanoic acid (AHPPA), were inserted at the scissile site of substrate sequences of HIV-1 protease. While both reduced peptides and simple aminoalcohol derivatives were weak inhibitors, the peptides containing AHPPA demonstrated moderate inhibitory activity. The more potent alcohol configuration of AHPPA is (R), which is opposite to the configuration in potent inhibitors of other aspartic proteases. In particular, compound 28 ((3R,4S)-4-(N-tert-butoxycarbonyl- L-glutaminyl-L-asparaginyl)amino-3-hydroxy-5-phenylpentanoic acid 2'-methylbutylamide) had a Ki of 0.36 microM and exhibited excellent enzyme specificity.

Angiomyolipoma of the liver. Ultrasound, CT, MR imaging and angiography

Angiomyolipoma, a rare benign liver tumor, was observed in a 50-year-old woman examined with US, CT, MR imaging and angiography. Dynamic studies using CT and MR imaging were valuable in differentiating the disease from hepatocellular carcinoma with fat deposits.

Role in growth regulation of cytokines and cytokine receptors in acute lymphoblastic leukaemia expressing myeloid markers

The biological roles of cytokines and cytokine receptors were examined in acute lymphoblastic leukaemia cells expressing myeloid antigens (My+ ALL). Interleukin-3 (IL-3), granulocyte-colony stimulating factor (G-CSF), granulocyte-macrophage-CSF (GM-CSF), and low molecular-weight B-cell growth factor (LW-BCGF) could induce DNA synthesis in certain cases of My+ ALL. Whereas in My- ALL the stimulatory effects were shown only with LW-BCGF. Acute myelogenous leukaemia (AML) cells were activated with multiple cytokines including interleukin-1 (IL-1), IL-3, G-CSF and GM-CSF. Specific receptors for IL-1 and IL-3 were strongly expressed on both My+ and My- ALL cells. These receptors, however, were weakly detectable on AML cells. Additionally we studied the production of tumour necrosis factor-alpha and IL-1 by leukaemic blasts and found that distinct amounts of both cytokines were released from My+ ALL cells and AML cells, but not from My- ALL cells. The profiles of cytokines and cytokine receptors expressed by My+ ALL showed both similarities and differences to those in My- ALL or AML. The proliferation of My+ ALL cells was dependent on multiple cytokines that would regulate growth and maturation in a lineage-restricted fashion. These data suggested that My+ ALL cells might originate from uncommitted haematopoietic precursor cells coexpressing features of both lymphoid and myeloid lineages.

[Dietary control for out-patients in urinary stone clinic]

We studied the dietary habits of 113 upper urinary tract stone formers and 24-h urine specimens before and after dietary control. Protein intake was decreased in male patients after dietary control but urinary risk factors were not changed significantly. The excretion of urinary risk factors (calcium, uric acid and oxalate) was decreased in the patients who had calcium excretion of more than 250 mg per day or uric acid excretion more than 650 mg per day or oxalate excretion more than 45 mg per day before the control. The daily protein intake was significantly correlated to urinary uric acid, calcium, and phosphate excretion and the daily vitamin C intake to urinary citrate excretion. There was a negative correlation between the daily calcium intake and urinary oxalate. The mean stone episode rate of these patients was significantly decreased from 0.174 to 0.059 stones per year by dietary control (p < 0.005).

Cloning and expression of the chicken c-kit proto-oncogene

The Kit protein is a cell-surface tyrosine kinase receptor encoded by the c-kit proto-oncogene. cDNA clones encoding chicken Kit were isolated from a chicken brain cDNA library, and the nucleotide (nt) sequence of a cDNA clone containing the entire protein-coding region was determined. The deduced amino acid (aa) sequence of chicken Kit shows 63% identity to mouse Kit, and suggests that chicken Kit shares common structural and functional features with mouse Kit. RNA blot analysis indicated that the expression pattern of the chicken c-kit transcript in chicken organs was similar to that of mouse c-kit in mice, suggesting that chicken Kit has biological roles analogous to those of mouse Kit.

Superficial temporal artery interposition graft after resection of bilateral anterior cerebral arteries. Case report

A patient with an olfactory neuroblastoma in the frontal skull base was treated with primary tumor excision and partial resection of the A2 segment of both anterior cerebral arteries (ACA's). Revascularization was carried out using a superficial temporal artery (STA) interposition graft between the proximal and distal stumps with A3 segment-to-A3 segment end-to-side anastomosis. This technique established flow to the peripheral territories of the ACA's through the interposed STA graft. The technical aspects and possible role of this procedure are presented.

Deletion of WT1 and WIT1 genes and loss of heterozygosity on chromosome 11p in Wilms tumors in Japan

Six of 39 sporadic Wilms tumors had gross homozygous or hemizygous WT1 and WIT1 deletions. Two Wilms tumor-aniridia-genitourinary abnormalities-mental retardation syndrome patients had total hemizygous WT1 and WIT1 deletions in both constitutional and nonsporadic type tumor cells. Four of the 8 tumors with WT1 and WIT1 deletions showed loss of constitutional heterozygosity (LOH) for markers limited to the 11p13 region. Seven of 19 Wilms tumors with neither WT1 nor WIT1 deletions also had LOH on 11p; 4 in the 11p15-11p13 region, one in the 11p15 and possibly also 11p13 regions, and two solely in the 11p15 region. Thus, 15 of the 41 Wilms tumors (37%) had WT1 and WIT1 deletions or LOH on 11p, and only 2 of the 27 tumors whose nonneoplastic normal tissues were available for study showed LOH limited to the 11p15 region. None of the 7 non-Wilms childhood renal tumors showed WT1 or WIT1 deletions, or LOH on 11p. These data suggest that Japanese Wilms tumors may be characterized by a higher incidence of the gross WT1 deletion and a lower incidence of LOH limited to the 11p15 region than the Caucasian counterparts. These molecular-genetic features may be contributing to the lower incidence of Wilms tumors in Japanese children than in Caucasian ones.

Sequence of a cDNA encoding chicken stem cell factor

Stem cell factor (SCF) is a polypeptide growth factor and the ligand for the c-kit proto-oncogene product. We cloned a chicken cDNA encoding a protein homologous to the mouse and human SCFs. The deduced amino acid (aa) sequence shows 53 and 52% identity to the mouse and human SCFs, respectively.

Effect of restricted blood flow on intracellular pH threshold of working muscle

Threshold of decline in intracellular pH of muscle (pHT) during incremental wrist flexion was studied by 31P-MRS, under two levels of occlusions in which the cuff of the upper arm was inflated to systolic (ES) and diastolic blood pressure (ED), and no occlusion (E). To observe the effect of occlusion per se, intracellular pH at rest under the same two levels of occlusion was measured. Additionally, NIRS was applied to monitor the oxygenation and blood volume of the tissue during the same experimental protocol as the 31P-MRS study. Ten healthy Japanese males participated as subjects in the 31P-MRS study, and three of them in the NIRS study. They performed wrist flexion in incremental loads of 0.14 W/min ramp until voluntary exhaustion. 31P-MRS and NIRS were obtained from wrist flexor muscles. Change in intracellular pH (pH) during wrist flexion showed a threshold behavior even in ischemic conditions, although pH did not decrease at rest under the same two levels of occlusion. This finding indicated that decrease in pH under occlusion is also resulted from exercise induced lactic acidosis. Obtained pHT in ES was smaller than in ED and E significantly, and there was no significant difference between pHT in ED and that in E. From the results of NIRS study, it was confirmed that only venous outflow but not arterial inflow was restricted under an occlusion at a pressure of diastolic blood pressure, but both under an occlusion at a pressure of systolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of ramp slope on intracellular pH threshold during progressive exercise

The purpose of this study was to examine the effect of ramp slope during progressive exercise test on the intracellular pH threshold (pHT) of working muscle. To attain the purpose, we measured intracellular pH of wrist flexor by 31P-MRS during four kinds of ramp wrist flexion. Five Japanese males participated as subjects. They performed wrist flexion in a bore of MRS system, with ramp increments of 0.14, 0.20, 0.26 and 0.31 W/min till exhaustion. Intracellular pH of wrist flexor muscle was estimated from a chemical shift between inorganic phosphate (Pi) and phosphocreatine (PCr) on a 31P-MR spectra. Pi-to-PCr ratio (Pi/PCr) as an index of oxidative phosphorylation potential was also calculated. pH and Pi/PCr were obtained as minute-by-minute data throughout the exercise. pHT was determined as a work rate (W) just before that at which the intracellular acidosis (acidemia) occurred. Although work endurance was shortened significantly, achieved maximal work rate (WRmax) was increased with an increase in ramp slope. pHT both in the unit of W and %WRmax was not affected significantly by the ramp slope. On the other hand, Pi/PCr at pHT decreased with an increase in ramp slope, significantly. These results suggested that intracellular homeostasis with reference to acid-base equilibrium was not dependent on oxidative phosphorylation status, but a work output of the muscle.

Long-term therapeutic efficacy of interferon for patients with chronic hepatitis C

Interferon is being used for therapy of chronic hepatitis C, but its long-term results have not been reported. We studied 65 patients with this disease who were monitored for at least 2 years after completion of the therapy. Almost all patients who had responded to therapy at 6 months after the end of therapy had normal levels of alanine aminotransferase (ALT) when evaluated later. The level of ALT became normal for the first time in some patients more than 6 months after therapy ended. The level of ALT in many of the patients without HCV RNA had become normal 6 months after the end of the therapy. One of three schedules was employed: three times weekly long-term; daily for two weeks and none for two weeks in a cycle; and daily for several weeks; 57%, 29%, and 17% of the patients on these schedules came to have normal ALT levels. Patients without HCV RNA at six months after completion of therapy tended to have higher responses in terms an increased level of 2',5'-oligoadenylate synthetase of mononuclear cells in vitro before therapy began. However, therapy three times per week was effective even for some patients judged not responsive to IFN by this test. The results showed that IFN therapy was effective for chronic hepatitis C when judged by long-term results.

Method for detection of intracellular pH threshold; comparison between subjective observation and regression analysis

The aim of this study is to examine the objectivity and reproducibility of intracellular pH threshold (pHT) detected by eye (E), and by regression analysis on linear (L), semilog (SL) and log-log (LL) models. Threshold for inorganic phosphate-to-phosphocreatine ratio (PT) was also examined by three regression analysis. Fifteen males volunteered as subjects. They performed wrist flexion in a ramp protocol of 0.14W/min till exhaustion. Throughout the exercise, 31P-MRS was obtained continuously from wrist flexors. Intracellular pH and phosphate compound in the muscle tissue were monitored as minute-by-minute data. In E, three observers determined pHT subjectively as a work rate just before pH decrement. In three regression analysis, pHT was detected as an intersection of a pair of linear regression lines which was selected statistically or subjectively. pHT detected by four methods showed significant reproducibility between each other, although PT did not. These results provide one of the evidences of threshold behavior of change in pH, and a question of existence of PT in contrast to pHT.

[Surgical aspects of automatic implantable cardioverter defibrillator (AICD) in patients with life-threatening ventricular tachyarrhythmias]

Implantations of automatic implantable cardioverter defibrillator were performed in five patients with life-threatening ventricular tachyarrhythmias. Preoperative diagnoses of arrhythmias were sustained ventricular tachycardia (VT) in two cases, ventricular fibrillation (VF) in two cases and sustained VT+VF in one case. Four of five cases had basic diseases respectively (broad anterior myocardial infarction, dilated cardiomyopathy, arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy), and the other case was idiopathic. Preoperative CTR were 43-65% (mean 57.4%) and left ventricular ejection fraction were 26-76% (mean 51.2%). Implantation of AICD was indicated for patients who survived circulatory arrest or life-threatening VT. Median sternotomy (3) or left antero-lateral thoracotomy (2) were performed for implantation of large-small patch electrodes for defibrillation. AICD generators were implanted in the pocket under abdominal rectal muscle in all cases. Postoperatively myocardial insufficiency, pericarditis, pleuritis occurred in three cases respectively. In the follow-up periods (2-25 months, mean 13 months), AICD worked effectively in two patients with spontaneous VT (6 months, 1 year after operation) and no cardiac death was experienced. We concluded that AICD system is effective for the life-threatening ventricular tachyarrhythmias, although the further estimation in longer follow-up periods are warranted.

An experimental recurrence model for malignant fibrous histiocytoma induced by 4-hydroxyaminoquinoline 1-oxide in the rat

To clarify the relationship between local recurrence of mesenchymal tumors and their malignant potentiality, we made an experimental recurrence model for malignant fibrous histiocytoma (MFH) induced by 4-hydroxyaminoquinoline 1-oxide in the rat by repeated excisional operations. By the repeated excision, the number of recurrent tumors increased, and the doubling time of tumor growth was shortened. The mean doubling time of primary tumors was 6.6 days, that of the first locally recurrent tumors was 4.3 days, and that of the second locally recurrent tumors was 3.3 days. However, mitotic count and 5-bromo-2-deoxyuridine (BrdU) labeling index did not change. This study proved experimentally that MFH shows more rapid growth through repeated local recurrences, and this experimental model may provide a better understanding of the local recurrence of MFH.

The 8;21 chromosome translocation in acute myeloid leukemia is always detectable by molecular analysis using AML1

The AML1 gene was rearranged in leukemic cells with t(8;21)(q22;q22) or its variant, complex t(8;V;21) translocations from 33 acute myeloid leukemia (AML) patients. The AML1 rearrangement was also detected in three AML patients without t(8;21); two had a normal diploid karyotype, and one had a karyotype of 45,X, - X. The AML1 rearrangement in the t(8;21) breakpoint cluster region was not detected in leukemic cells with cytogenetic abnormalities other than t(8;21), or with normal diploidy obtained from 23 AML patients. Because leukemic cells of the five patients with complex t(8;V;21) translocations had a der(8)t(8;21) chromosome with a break in band 8q22 in common, the juxtaposition of the 5' side of AML1 to a predicted counterpart gene located in the breakpoint region of 8q22 may be an essential step in the leukemogenesis of AML with t(8;21). Our findings show that the 8;21 translocation, its variants, and the masked t(8;21) may all be detectable by the Southern hybridization method using the AML1 probes.

Low R-wave amplitude in the right precordial leads in children with symptomatic doxorubicin cardiomyopathy

Electrocardiographic (ECG) findings were studied in four patients with doxorubicin cardiomyopathy. In all patients with congestive heart failure (CHF), the ECGs had a low R-wave and low R/S ratio in lead V1. Our study suggests that increased injury to myocardial cells in the regions of the anterior septum and anterior left ventricular wall may be important in the pathogenesis of doxorubicin cardiomyopathy. Eight years later, cardiac recovery from CHF occurred with a normal ECG and left ventricular ejection fraction in one patient, indicating that CHF may be reversible in certain cases.

[Phase II study of a novel combination regimen composed of cisplatin, carboplatin and etoposide against unresectable non-small cell lung cancer]

Phase II study of a novel combination regimen composed of cisplatin, carboplatin and etoposide (CPVP) was conducted against unresectable non-small cell lung cancer. The treatment schedule consisted of cisplatin 50 mg/m2 on day 1, carboplatin 200 mg/m2 on day 1, and etoposide 100 mg/m2 on days 1, 3, 5 every 3 or 4 weeks. The response rate and toxicities were evaluated in 28 patients, who were diagnosed and treated in the Cancer Institute Hospital (GANN-KEN) from March 1991 to September 1992. Partial response (PR) was found in sixteen out of 28 patients (57.1%). In myelotoxicities, 5 out of 28 patients (17.9%) showed grade 4 thrombocytopenia, but, white blood cell count and hemoglobin level stayed at grade 3 or milder in most patients, revealing safety of this regimen. In gastrointestinal toxicities, the median number of days in the patients suffered from nausea and loss of appetite was about 3 and 7 days, respectively. Median weight loss of the patients through the entire treatment was 2.3 kg. These results suggest that CPVP regimen is no less effective, but more tolerable, in other words, more favorable in QOL than standard regimens, and that it warrants further study in phase III trials.