Large and cholesteryl ester-rich high-density lipoproteins in cholesteryl ester transfer protein (CETP) deficiency can not protect macrophages from cholesterol accumulation induced by acetylated low-density lipoproteins

High-density lipoprotein (HDL) has been speculated to have an anti-atherogenic function. Many in vitro studies have demonstrated that HDL has the ability to remove cholesteryl ester (CE) from lipid-laden macrophages. However, the effect of alteration in chemical composition and particle diameter on the in vivo function of HDL is unknown. In the study described here, we have isolated the HDL from patients homozygous for cholesteryl ester transfer protein (CETP) deficiency and examined its function in vitro, in order to clarify the anti-atherogenic property of HDL in CETP-deficient subjects. Apolipoprotein (apo) E-free HDL2 from the patients, separated by heparin-Sepharose column chromatography, was rich in CE, poor in triglycerides (TG), and enlarged in size on 4-30% nondenaturing polyacrylamide gradient gel electrophoresis. In contrast, HDL3 from the patients was normal in size and in its chemical composition. First, we examined the effect of HDL on CE accumulation in macrophages. After mouse peritoneal macrophages had been incubated with both acetylated low-density lipoproteins (Ac-LDL) and HDL, cellular CE content was determined by an enzymatic, fluorometric method. Ac-LDL alone induced a 9-fold accumulation of CE. The addition of apo E-free HDL2 and HDL3 from controls and patients' HDL3 prevented CE accumulation in macrophages, while patients' HDL2 had no preventive effect. We next investigated the in vitro ability of HDL to remove cellular CE from lipid-laden macrophages after incubation with Ac-LDL. After loading of macrophages with cholesterol by Ac-LDL, HDL was added to the culture medium and the cellular CE content was measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of multidrug resistance-associated protein (MRP) in anaplastic carcinoma of the thyroid

Although the incidence is very low, the prognosis of anaplastic carcinoma of the thyroid is very poor regardless of the results of various therapeutic trials. We found that the mechanism of anti-cancer drug resistance in anaplastic carcinoma of the thyroid was not explicable only in terms of expression of the mdr1 and its gene product, P-glycoprotein. Therefore, expression of multidrug resistance-associated protein (MRP) mRNA was examined in 11 anaplastic thyroid carcinomas and eight anaplastic thyroid carcinoma cell lines. High MRP mRNA expression was recognized in 7/11 and 8/8, respectively. Our results may contribute to elucidation of the mechanism of anti-cancer drug resistance in this neoplasm.

Increased plasma cholesteryl ester transfer protein in obese subjects. A possible mechanism for the reduction of serum HDL cholesterol levels in obesity

It is well known that obesity is frequently associated with low levels of serum high-density lipoprotein (HDL) cholesterol. However, the mechanism for this reduction has not been fully clarified. Cholesteryl ester transfer protein (CETP) transfers cholesteryl ester from HDL to apolipoprotein B-containing lipoproteins and plays an important role in regulating the concentration and composition of HDL. To elucidate the mechanism for the reduction of serum HDL cholesterol in obesity, we analyzed serum lipoproteins, CETP, and postheparin lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) activities in 30 obese subjects (17 women and 13 men, age 44 +/- 14 years, mean +/- SD). We also investigated the relationship between these variables, total adiposity, and indices of body fat distribution. The average body mass index of the obese subjects was 33.1 +/- 4.8 kg/m2 (range, 26.4 to 43.8 kg/m2). The obese subjects showed significantly lower serum HDL cholesterol levels than control subjects (1.04 +/- 0.28 versus 1.50 +/- 0.34 mmol/L, P < .01). In the obese subjects, both activities and protein mass of CETP and postheparin HTGL activities were significantly increased, whereas postheparin LPL activities were significantly decreased. CETP activities, independent of postheparin HTGL and LPL activities, were correlated negatively with HDL cholesterol (r = -.39, P < .05) and the cholesteryl ester to triglyceride ratio of HDL2 and HDL3 (r = -.36, P < .05; r = -.46, P < .05, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Ritodrine induced pulmonary edema after caesarean section for a triplet pregnancy]

Selective beta-sympathomimetic drugs are frequently used for tocolysis. But, since these drugs exhibit some beta-1 activity as well, they may bring about pulmonary edema, myocardial ischemia, cardiac arrhythmia and others as side effects. A 29 year-old female with a triplet pregnancy had premature contraction at 26 weeks of gestation. High doses of IV ritodrine were given for tocolysis for 8 weeks until caesarean section. One hour after caesarean section at 35 weeks of gestation, she complained of dyspnea. Urinary output decreased and chest X-ray showed pulmonary edema. She was intubated and artificial ventilation with PEEP was performed in ICU. Echocardiogram showed left ventricular dilatation. ECG showed inverted T waves on all leads. We diagnosed her as suffering from acute heart failure, pulmonary edema and acute renal failure. Hemodialysis was performed for 6 hrs but PCWP was still 18 mmHg. So CVVH was added to hemodialysis. Five hrs after the start of CVVH, her symptoms gradually started to subside. Total fluid removal was 5.8 l over 16 hrs. Three days after admission she was extubated and five days later returned to her ward. We concluded that pulmonary edema, heart failure and renal failure were induced by the long-term high dose medication of ritodrine, resulting in volume overload and myocardial dysfunction.

[Thrombotic thrombocytopenic purpura (TTP) with a low level of apolipoprotein A-I (Apo A-I) which responded to combination of vincristine and beraprost]

A 51-year-old man was admitted to the psychiatric ward because of increasing confusion and irrational behavior. He was later transferred to our department due to anemia and thrombocytopenia. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was made based on the presence of thrombocytopenic purpura, microangiopathic hemolytic anemia, neurological symptoms and fever. Corticosteroids, plasma exchange (PE), dextrans, dipyridamole and vincristine (VCR) were given without satisfactory response. Beraprost sodium was prescribed followed by a dramatic improvement and complete remission. A number of reports indicated that prostacyclin metabolism was involved in the pathogenesis of TTP. Recently Apo A-I was identified to be a prostacyclin-stabilizing factor, which was initially low in this patient. If patients do not respond to either PE or VCR, consideration should be given to treatment with beraprost, especially when the level of Apo A-I is low.

DNA amplifications and elevated expression of proto-oncogene in addition to altered DNA ploidy in metastatic brain tumors

The histopathological characteristics, proto-oncogene amplification, immunohistopathology of the c-erbB-2 product distribution, and the DNA content of nuclei were examined in metastatic brain tumors, which consisted of seven adenocarcinomas, a large cell carcinoma, a squamous cell carcinoma, a renal cell carcinoma and a mucoepidermoid carcinoma. A very high incidence of DNA changes was seen in these tumors. Proto-oncogene amplification and abnormal DNA content in the nuclear portion were found in 64% (7/11) and 67% (6/9) of cases, respectively. We also found double oncogene alteration in three cases metastasizing from lung, esophagus and kidney, and triple oncogene alteration in one case metastasizing from breast. We could not identify the common alterations in the group of metastatic brain tumor cells. These data suggest that the proto-oncogene amplifications and the alteration of DNA ploidy pattern may contribute to the metastatic process.

[A case of hemifacial hyperhidrosis on the opposite side of the pancoast tumor]

An 82-year-old man was referred to our pain clinic for the relief of pain arising from Pancoast tumor on the right side. The pain was controlled well by cervical epidural morphine, but one month after admission, he complained of unilateral hyperhidrosis on the face, head and neck on the left side. Massive sweating occurred only during the sleep. At this stage Horner's sign on the right side was recognized. Cervical epidural block diminished sweating. Massive sweating was observed until his death two months after admission. We speculate that paralysis of the right cervical sympathetic system caused by invasion of Pancoast tumor elicited sympathicotonia of the opposite side, resulting in left hemifacial hyperhidrosis, which was exaggerated during the sleep when the activity of perspiration center increased. We recommend that the presence of hemifacial sweating should be closely evaluated, because it can be caused not only by irritation of the ipsilateral sympathetic nervous system, but also by the paralysis of the contralateral sympathetic nervous system due to malignant tumors or other diseases in the neck and upper mediastinum.

[Successful VEP-IFN-alpha therapy in a case of non-secretory plasma cell leukemia (BJ-kappa type)]

Plasma cell leukemia is a rare disorder with poor prognosis. We present a case of non-secretory primary plasma cell leukemia (Bence-Jones kappa type), which was treated successfully by VEP-IFN-alpha therapy. A 82-year old man was admitted to Kanazawa Medical University in May 1991, because of emaciation and dehydration. Clinical findings showed decreased level of gamma-globulin (IgG, IgA and IgM were all decreased markedly), hypercalcemia, renal dysfunction and increased serum beta-2 microglobulin. The peripheral blood leukocyte count was 30,100/microliters with 64% plasma cells, and 80.4% plasma cells were also observed in the bone marrow. Only light chain-kappa was detected in plasma cells by an immunohistochemical staining method, but immunoelectrophoresis showed no M-bow either in serum or urine. Electron microscopy revealed typical plasma cells with prominently developed rough endoplasmic reticulum. From these results, the diagnosis of non-secretory primary plasma cell leukemia was established. He was treated with VEP-IFN-alpha regimen, and plasma cells decreased markedly in both peripheral blood and bone marrow. Serum immunoglobulin recovered to within the normal range. After 6 courses of VEP-IFN-alpha, complete remission was achieved and the remission was maintained until he died of an unrelated event, bronchial obstruction due to misswallowing, in April 1992.

Benign schwannoma of the esophagus: report of two cases with immunohistochemical and ultrastructural studies

Two cases of benign schwannoma of the esophagus are presented. The tumors were found in the thoracic esophagus of women of 56 and 64 years of age, respectively, who had complained of dysphagia and back pain. Tumorectomies were performed and the tumors were found to be located within the esophageal wall arising from the muscularis propria. The tumors were examined immunohistochemically and ultrastructurally. These tumors were identical in gross, histological and electron microscopic features. Grossly, the tumors showed yellowish-white cut surfaces without hemorrhage or necrosis. Microscopically, they were composed of spindle-shaped cells showing moderate variation in size and shape, and nuclear palisading. Lymphoid aggregates with germinal centers surrounded the tumors. Immunohistochemically, strong reactions for S-100 protein and neuron-specific enolase were observed in the cytoplasm of spindle cells, whereas reactions for muscle actin and desmin were negative. These findings, together with electron microscopic observations, supported the Schwann cell origin of these tumors.

Effects of neopterin on ischemic neuronal damage in gerbils

The effects of neopterin on ischemic neuronal damage were examined. Cerebral ischemia was produced in the gerbil by bilateral common carotid occlusion for 8 min or unilateral occlusion for 30 min, which resulted in delayed neuronal death in the CA1 region of the hippocampus. However, preischemic treatment with neopterin (3 mg/kg i.p.) markedly reduced hippocampal neuronal damages in both cases. Since neopterin serves both as an antioxidant and as an oxidant depending on its redox state, these findings indicate that neopterin attenuates the ischemic neuronal injury by scavenging oxygen free radicals and/or by inhibiting their generation.

Cytoplasmic p105 index is an accurate mitotic index, but is not related to prognosis in cervical carcinoma

The monoclonal antibody p105 (clone 780-3) recognizes proliferation-associated nuclear antigen p105 in conventionally fixed and processed histological materials. Formaldehyde solution-fixed and paraffin-embedded specimens excised from 184 patients with stage III squamous cell carcinoma of the cervix who were treated with radiation therapy alone were investigated for p105 positivity using an immunohistochemical method. Mitotic cancer cells were strongly positive for p105, showing cytoplasmic p105 positivity in almost all cases. The mean cytoplasmic p105 index was 2.02%, and the mean mitotic index in hematoxylin-eosin-stained preparations was 0.65%. There was a correlation between the cytoplasmic p105 index and mitotic index in hematoxylin-eosinstained preparations (y = 0.32x-0.003, r = .63). There was no significant relationship between the cytoplasmic p105 index or mitotic index in hematoxylin-eosin-stained preparations and prognosis. These results indicate that the cytoplasmic p105 index is not a predictive indicator for prognosis in patients with cervical squamous cell carcinoma, although this index is a more accurate mitotic index than the mitotic index itself in hematoxylin-eosin-stained preparations.

Development of a transcutaneous blood-constituent monitoring method using a suction effusion fluid collection technique and an ion-sensitive field-effect transistor glucose sensor

The paper describes a method for the transcutaneous monitoring of blood constituents. It combines the use of a suction effusion fluid (SEF) collecting technique with a silicon on sapphire/ion-sensitive field-effect transistor (SOS/ISFET) biosensor. SEF is directly collected by a weak evacuation through skin from which the stratum corneum has been removed. An SEF collecting cell with a stainless-steel mesh at the bottom is kept in a weak vacuum condition, and SEF is sucked up through the mesh and deposited in a reservoir above. An ISFET glucose sensor is able to detect glucose concentrations in very small SEF samples through the use of two small ISFETs and an immobilised enzyme membrane. The reliability of transcutaneously obtained SEF was first confirmed in an experiment using rabbits. A clinical analyser was used to determine levels of glucose, urea nitrogen and creatinine in SEF obtained transcutaneously; these results are compared with results obtained by the same analyser directly from sera. The ISFET glucose sensor was successfully tested on human subjects for the monitoring of blood glucose levels. During these tests, glucose level changes in the SEF followed actual blood glucose level changes with a slight time delay. Results suggest the feasibility of non-invasive, transcutaneous monitoring of low molecular weight substances in the blood without the use of ordinary blood sampling.

Functional and morphological effects of tumour necrosis factor alpha in an interleukin 6-producing pulmonary large cell carcinoma with sarcomatoid features

We established a clonal cell line, HAT.MC8, derived from a human pulmonary large cell carcinoma with sarcomatoid features. This cell line was successfully maintained in a protein-free medium and exhibited sarcomatoid fibroblastic features in vitro. The cells constitutively produced a large amount of interleukin 6 (IL-6) in vitro. Tumour necrosis factor alpha (TNF-alpha) not only stimulated HAT.MC8 cells to produce IL-6, but also induced a morphological change from sarcomatoid fibroblastic to epithelial features. Although this change was related to actin and zonula adherens, there was no evidence that E-cadherin participated in the change. Interleukin 1 beta (IL-1 beta) had a stimulatory effect on IL-6 production by HAT.MC8 cells, but no influence on the morphology of the cells.

[The mechanism of antigen-presentation of porin from Salmonella typhimurium to T lymphocytes]

Porins from wild type strains of Salmonella typhimurium are known to consist of three species of proteins named 34, 35 and 36K. It is understood that these three species of proteins construct porin trimers and the porin trimers from the wild type strain of S. typhimurium are constructed from homologous species of porin subunits. However, we have demonstrated previously that only porin trimers from wild type strains but not mixtures of homologous porin trimers from mutant strains of S. typhimurium could induce antigen-specific cell-mediated immunity (CMI). In this study, therefore, a mechanism of antigen-presentation of porin from a wild type strain of S. typhimurium to T cells was studied. Our data showed that porin proteins from the wild type strain received antigen-processing as well as other protein antigens in murine macrophages and were presented with Ia antigen to T cells. These results suggested that porin trimers from wild type strains of S. typhimurium were constructed from heterologous species of porin subunits and only heterologous porin trimers held epitopes for a CMI-eliciting antigen.

[Response to a questionnaire on DNR-order from 307 trustee members of Japanese Medical Societies]

A questionnaire on the use of DNR-order was conducted on 427 trustee members of Japan Society of Reanimatology, Intensive Care Medicine and Anesthesiology with responses from 307 or 71.9%. The results of the questionnaire are as follows: DNR-order is unnecessary, 2.9%. Necessary depending on the situation, 96.7%. Here dying in dignity was the main reason for necessity of DNR-order and ethical, legal and technical problems were the reasons cited for objection. Patients' will is indispensable for DNR-order, 11.4%. Patients' will is not indispensable, 84.9%. Quality and quantity of treatment after the decision of DNR-order should not be limited or withdrawn, 21.2%. Should be withdrawn except for respirator, 60.6%. The percentage of those who had carried out a DNR-order was 69.1% (most of them more than once), but half of them did not describe the order on the chart. A guideline for a DNR-order by scientific societies and/or governmental policy for a DNR-order should be made and publicized not only for the benefit of the patients and their families but also for physicians themselves.

Immunophenotypic analysis of primary malignant lymphoma of the brain

The immunophenotypes in three cases of primary malignant lymphomas of the brain were analyzed by flow cytometry using a panel of monoclonal antibodies. In all three cases the immunophenotypes were CD10 negative, CD19 positive, and CD20 positive, and in two cases human leukocyte antigen (HLA)-DR positive. CD20 showed high positivity (80-97%), while CD19 revealed low positivity (30-50%). These neoplastic cells apparently became malignant at the B-cell differentiation stage, when they expressed both CD19 and CD20. Differentiation continued until CD19 was no longer expressed, when further differentiation stopped between the last stage of B-cell differentiation and the early stage of plasma cell formation (Case 3 was CD38 positive). Case 1 was immunoblastic type lymphoma and the cells were both surface immunoglobulin and HLA-DR negative. At least 40% of Case 2 cells showed both B-cell and T-cell markers. Immunophenotypic study can help determine the cell lineage, clonality, and stage of differentiation of lymphoid neoplasms.

Use of M4PO and oxygen-17 in the study on hydroxyl radical generation in the hypoxanthine-xanthine oxidase reaction

To determine whether hydroxyl radicals (.OH) are generated in the hypoxanthine (HPX)-xanthine oxidase (XOD) reaction, we examined the electron paramagnetic resonance (EPR) spectra of the spin adducts formed. In the EPR study, we used 3,3,5,5-tetramethyl-1-pyrroline-N-oxide (M4PO) as a spin trap, sodium formate (HCOONa) as a .OH scavenger, and oxygen-17 gas as an oxygen source. In the HPX-XOD reaction, both M4PO-OOH and M4PO-OH were observed in the reaction products. The formation of M4PO-OH was independently inhibited by HCOONa resulting in the formation of M4PO-CO2- and in no effects on the formation of M4PO-OOH. With oxygen-17 gas as an oxygen source in the HPX-XOD reaction, both M4PO-17OOH and M4PO-17OH were observed in the reaction products. These results indicate that M4PO-OH is not produced by decomposition of M4PO-OOH and .OH is actually generated during the HPX-XOD reaction.

Clinicopathological study on a case of neuro-Behçet's disease: in special reference to MRI, SPECT and neuropathological findings

A case of neuro-Behçet's disease with dementia and personality changes is described with magnetic resonance imaging (MRI), single photon emission tomography (SPECT) and neuropathological findings. MRI disclosed high signal areas in the cerebral white matter and the brain stem. SPECT showed a marked reduction of blood flow in the frontal cortex. Neuropathologically, multifocal necrotizing lesions with perivascular lymphocytic infiltration and glial proliferation were detected mainly in the brain stem, namely the midbrain and the pons. From these findings, it is suggested that mental disorders of neuro-Behçet's disease are related to the secondary dysfunction of the frontal cortex due to the damage of the subcortical structures, mainly the brain stem.

Sweet's syndrome during therapy with granulocyte colony-stimulating factor in a patient with aplastic anaemia

A patient with aplastic anaemia developed Sweet's syndrome (a febrile neutrophilic dermatosis) during granulocyte colony-stimulating factor (G-CSF) therapy. Three repeated episodes of appearance and disappearance of erythematous nodules after administration and withdrawal of G-CSF confirmed that G-CSF induced Sweet's syndrome in the patient. Sweet's syndrome has been reported in patients with myelodysplastic syndrome and acute leukemia, but not in patients with aplastic anaemia. This is the first report of a patient with aplastic anaemia who developed G-CSF-induced Sweet's syndrome.

Chiral separation by capillary affinity zone electrophoresis using an albumin-containing support electrolyte

Chiral separations of some pharmaceutical compounds were studied by capillary affinity zone electrophoresis. Bovine serum albumin (BSA) was used as a chiral selector and added to electrolyte. For the chiral separation of new quinolone bactericidal reagents, phosphate buffer was more appropriate than borate buffer solution as the support electrolyte. The effects of BSA concentration, albumin type, pH, chiral additive, and voltage on separation were observed. As a result, chiral separations were performed in the pH range 7-8. The migration and stereoselectivities of enantiomers were changed by varying the protein concentration (more than 0.2% w/v) and voltage and by adding amino acids as chiral modifiers. This procedure is easily applicable to other compounds for chiral separation or for studies of protein binding interaction.

Radioimmunoscintigraphy of CEA/CA 19-9 producing tumors with I-131 labeled monoclonal antibodies

A total of 7 (4 males and 3 females) patients were included in this retrospective study to determine the sensitivity of radioimmunoscintigraphy with I-131 labeled anti CEA/CA 19-9 monoclonal antibodies. Out of 7 patients 2 had ascending colon cancer, one had sigmoid colon cancer, one had rectal cancer and one had adenocarcinoma in the CBD and the remaining two had metastatic tumor (one in the lungs and the other in the liver). Whole body as well as spot images showed a 72% (5/7) positive scan. But post operative specimen counts and imaging showed a high tumor to non-tumor ratio and a good tumor to non-tumor contrast of activity of I-131 labeled monoclonal antibody. We did not find any relation between CEA/CA 19-9 levels and scan findings. A case of liver metastasis was also detected by this radioimmunoscintigraphy.

Reduced expression of apoptosis-related antigens in thymuses from patients with myasthenia gravis

Expression of the apoptosis-related antigens, Fas and BM-1, in thymuses from patients with myasthenia gravis (MG) was examined using immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR). Fas antigen was markedly decreased in lymphoid follicles in thymuses from patients with MG, but was expressed diffusely in the remaining thymus tissues and in neonatal thymuses. BM-1 antigen was not expressed in the lymphoid follicles or other parts of the thymus. Fas mRNA was also decreased to various degrees in the thymuses from MG patients. Therefore, Fas antigen may play an important role in autoimmune diseases including MG.