Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience

From 1986 to 1993, 15 patients with malignant pleural mesothelioma were treated by pleurectomy/decortication and intrapleural cisplatin (100 mg/m2) and cytosine arabinoside (1,200 mg). All patients were without known extrathoracic disease and had a mean age of 63 +/- 7.9 years (range 51-78); 13 were male. Histologic subtype of disease were epithelial (47%), sarcomatoid (27%), and mixed-biphasic (27%). The major morbidity and mortality rates were 13% and 0%, respectively. The mean length of hospital stay was 6.5 +/- 2.1 days. Postoperatively, adjuvant chemotherapy and radiation therapy were given to 46% and 73% of the patients respectively. Median survival from date of treatment was 11.5 months. Those patients with an epithelial histologic subtype experienced significantly improved survival compared to those of sarcomatoid subtype (P = 0.024). Whether adjuvant chemotherapy or radiation therapy were given had no significant effect on survival. These data suggest that although this treatment regimen can be administered with very limited morbidity and no mortality, the role of this approach in the treatment of malignant pleural mesothelioma appears limited and cannot currently be recommended.

Intravenous dopexamine in the treatment of acute congestive heart failure: results of a multicenter, double-blind, placebo-controlled withdrawal study

Acute hemodynamic effects of intravenous infusion of dopexamine were evaluated by a placebo-controlled withdrawal study in patients with acute congestive heart failure. Twenty patients were enrolled at 10 centers in Japan. All patients had a pulmonary capillary or diastolic pressure of 15 mmHg or greater and a cardiac index of 2.5 l/min/m2 or less. Phase I: Intravenous dopexamine was introduced in a single-blind, uncontrolled fashion at the rate of 0.5 micrograms/kg/min and was titrated up to achieve a 30% or more increase in the cardiac index. Two patients withdrew from the study due to sinus tachycardia and ventricular ectopy or exacerbation of heart failure. Phase II: The remaining 18 responders who were free of limiting side effects were randomized in double-blind fashion to continue dopexamine or to switch to placebo for an additional 60 minutes. At the end of phase II, the hemodynamic improvement obtained in phase I of the study disappeared completely after substitution of placebo but was maintained in dopexamine-treated patients. Our findings suggest that dopexamine, when given in appropriate doses to selected patients, shows balanced vasodilator action suitable for the treatment of acute congestive heart failure.

Self-introduction of unusual foreign body into the urethra: a case report

An 89-year-old male developed chronic urinary retention for five days due to a lobster tentacle impacted in his penile urethra. Because the penile deformity and abscess formation, he received external urethrotomy with removal of foreign body and suprapubic urinary diversion. There was no psychiatric problem in this patient.

The susceptibility of five stains mice to infections with Angiostrongylus cantonensis

The susceptibility to the infection of Angiostrongylus cantonensis was studied in five inbred stains of mice including four H-2 haplotypes. Three weeks after infection, C57 BL/10J (H-2b) and C57BL/6J (H-2b) stains of mice showed the lowest, CBA (H-2k) and A/J (H-2a) stains showed intermediate, and the BALB/cJ (H-2d) mice showed the greatest susceptibility to infection. BALB/cJ mice also displayed the most body weight loss, the highest number of worms and showed the least number of days of survival. The s susceptibility of C57BL/6J (H-2b) and C57BL/10J (H-2b) strains of mice sharing same H-2 haplotype was the same despite their different genetic backgrounds. These data suggested that the H-2 gene might influence the susceptibility of mice to A. cantonensis.

Molecular cloning of the cDNA and gene for an elastinolytic aspartic proteinase from Aspergillus fumigatus and evidence of its secretion by the fungus during invasion of the host lung

Hydrolysis of structural proteins in the lung by extracellular proteinases secreted by Aspergillus fumigatus is thought to play a significant role in invasive aspergillosis. This fungus was found previously to secrete an elastinolytic serine proteinase and a metalloproteinase. We report that A. fumigatus also secretes an aspartic proteinase (aspergillopepsin F) that can catalyze hydrolysis of the major structural proteins of basement membrane, elastin, collagen, and laminin. The pH optimum for the enzymatic activity was 5.0 with elastin-Congo red as the substrate, and the activity was not significantly inhibited by pepstatin A, diazoacetyl norleucine methylester, and 1,2-epoxy-3-(p-nitrophenoxy) propane. The cDNA and gene encoding this aspartic proteinase were cloned and sequenced. The open reading frame, interrupted by three introns, would encode a protein of 393 amino acids composed of a putative 21-amino-acid signal peptide and a 49-amino-acid propeptide preceding the 323-amino-acid mature protein. The amino acid sequence of A. fumigatus aspartic proteinase has 70, 66, and 67% homology to the sequences of those from Aspergillus oryzae, Aspergillus awamori, and Aspergillus saitoi, respectively. The active-site motif (DTG) and the catalytic aspartic residues characteristic of aspartic proteinases are found in the presently described enzyme, indicating that it belongs to a family of aspartic proteinases. Polyclonal antibodies were produced in rabbits against both the mature and precursor forms of the aspartic proteinase expressed in Escherichia coli. Immunoblotting with both antibodies detected a 39-kDa mature enzyme in the culture supernatant of A. fumigatus. The aspartic proteinase activity was inhibited by the antibodies, suggesting that the aspartic proteinase in the culture supernatant corresponds to the product of the cloned gene. Immunogold electron microscopy showed that the aspartic proteinase was secreted by A. fumigatus invading neutropenic mouse lung and its secretion was directed toward the germ tubes of penetrating hyphae.

Primary structure of BMK1: a new mammalian map kinase

Mitogen-activated protein (MAP) kinases comprise a family of conserved, eukaryotic enzymes that mediate responses to a wide variety of extracellular stimuli. We have identified a new human MAP kinase gene here termed BMK1. BMK1 encodes a protein of 816 amino acid residues and has at least three different forms of mRNA. BMK1 messages are abundant in heart, placenta and kidney but not detectable in liver. Although BMK1 has the dual phosphorylation site of MAP kinases characterized by the TEY sequence found in ERK1 and ERK2, it has a distinct C-terminal and loop-12 structure when compared to other mammalian MAP kinases. This suggests BMK1 may regulate signaling events distinct from those controlled by the ERK group of enzymes.

Evaluation of embolization effect of hepatocellular carcinoma by hepatic arterial flow study with Tc-99m MAA SPECT

The degree of hepatocellular carcinoma vascularity in eight patients was assessed with Tc-99m MAA radionuclide angiography before and after treatment. For chemoembolization therapy, lipiodol and doxorubicin hydrochloride were administered intraarterially along with Gelfoam particles. The ratio of radioactivity in the hepatocellular carcinoma compared to that in the surrounding uninvolved tissue before therapy was 6.5-19.0 with a mean of 12.0. After therapy, the ratio dropped to 0.5-1.3. Because survival improved significantly after the therapeutic regimen used in these patients, radionuclide Tc-99m MAA angiography appears to be an accurate method for demonstrating successful embolization of the vascular supply in hepatocellular carcinoma.

Two mechanisms for IgG uptake in cultured human trophoblast: evidence for a novel high affinity Fc receptor

The mechanism of IgG transport by the placental trophoblast was examined by studying IgG uptake by purified trophoblast maintained in culture. This model retains the ability to bind and endocytose human IgG from human serum. Comparison of the relative IgG uptake by the trophoblast among the four subclasses of both human and mouse IgG indicates that the trophoblast IgG receptor has different affinities from those described for the three known human Fc gamma receptors, FcR gamma I, FcR gamma II, and FcR gamma III. These results suggest the presence of a novel trophoblast Fc gamma receptor. Although Fc gamma RIII has been reported to be present on trophoblasts, immunocytochemical studies failed to detect binding to the cell surface of antibody-specific for Fc gamma RIII, 3G8 MAb. In addition, blocking studies with MAb 3G8 did not interfere with IgG uptake. Scatchard analysis of human IgG uptake revealed a biphasic curve consistent with two distinct mechanisms for the transport of IgG by the trophoblast. The first is a higher affinity system (Ka = 1.7 x 10(7) M-1, 1.7 x 10(4) binding sites/cell) which exhibits IgG subclass and species specificity, and the second is a low affinity system (Ka = 6.9 x 10(3) M-1, 7.5 x 10(7) binding sites/cell).

Reduction of dopamine beta-hydroxylase gene expression by calcium in bovine chromaffin cells

We determined the effect of Ca++ influx on dopamine beta-hydroxylase (DBH) gene expression in primary cultured bovine chromaffin cells. The Ca++ ionophore A23187 (100nM) specifically reduced DBH mRNA to 15 +/- 10% of the untreated control while tyrosine hydroxylase was induced (142 +/- 15%) and phenylethanolamine N-methyltransferase was unchanged (107 +/- 11%). This effect on DBH was also observed with ionomycin, reversed by EGTA and unaffected by cycloheximide. Depolarization by potassium also resulted in DBH reduction which was reversed by the voltage dependent Ca++ channel blockers nifedipine and verapamil. DBH mRNA level reduced by A23187 could be re-induced by forskolin and DBH induced by forskolin could be reduced by the ionophore, suggesting that the cAMP and Ca++ pathways might act independently in regulating DBH gene expression.

Detection of malignant melanoma by Tc-99m HMPAO

A number of radiopharmaceutical agents have been evaluated for the detection of malignant melanoma. Because anamine is necessary for melanin synthesis, melanotic tumors may possess numerous amine receptors. Tc-99m HMPAO consists of macrocyclic amine radicals. The purpose of this study was to evaluate Tc-99m HMPAO as an effective agent for localizing malignant melanomas on the radioisotope imaging. Six patients, with malignant melanomas were studied. Tc-99m HMPAO SPECT images were obtained in all patients. SPECT was used for the localization of the primary focus, and whole body scans were used for the evaluation of unexpected metastatic lesions. The results were compared with MRI and CT. Tc-99m HMPAO SPECT revealed a high correlation with CT and MRI for the primary focus. Abnormally increased activity at the unexpected metastatic lymph nodes in two patients were also noticed. This was confirmed by CT and MRI for those sites. Tc-99m HMPAO appears to be a useful agent for the localization of both the primary focus and unexpected metastatic lesion in patients with malignant melanoma.

Serum levels of insulin-like growth factor I and insulin-like growth factor-binding protein-1 and -3 in women with regular menstrual cycles

OBJECTIVE

To investigate the cyclic changes of serum insulin-like growth factor (IGF-I), IGF-binding protein-1 (IGFBP-1) and IGFBP-3 levels during ovulatory menstrual cycle.

DESIGN

A prospective study following a preset protocol.

SETTING

A tertiary-care academic medical center.

PARTICIPANTS

Thirty young female adults with regular menstrual cycles were recruited (18 with normal luteal phase and 12 with inadequate luteal function confirmed by serum P levels).

MAIN OUTCOME MEASURES

Serum concentrations of IGF-I, IGFBP-1, and IGFBP-3 from women with regular menstrual cycles were assayed. Circulating E2 and P levels also were determined to certify the ovulatory cycles.

RESULTS

In women with normal luteal function, there was a peak of serum IGFBP-1 levels before ovulation concomitant with the preovulatory E2 peak. The nadir of serum IGFBP-1 levels was in the midluteal phase. Circulating IGFBP-1 elevated rapidly during late luteal phase and reached a peak on the 1st day of menstruation then declined slightly until a preovulatory IGFBP-1 peak occurred. In women with inadequate luteal function (midluteal serum levels of P < 10 ng/mL [conversion factor to SI unit, 3.180]), the preovulatory increase in serum IGFBP-1 was not significant and the circulating IGFBP-1 levels fluctuated throughout the menstrual cycle except for a unique peak of serum IGFBP-1 on the 1st day of menstruation. By contrast, there were no cyclic changes of serum IGF-I and IGFBP-3 levels in women with regular menstrual cycles, including both normal nad inadequate luteal functions.

CONCLUSIONS

The preovulatory increase in serum IGFBP-1 levels may be of follicular origin and associated with the subsequent luteal function in females with ovulatory cycles. However, the involvement of IGFBP-1 in the process of follicular maturation and luteogenesis, as well as the regulation of luteal function, needs to be explored further.

Indium-111-pentetreotide imaging in intra-axial brain tumors: comparison with thallium-201 SPECT and MRI

Highly undifferentiated glial tumors do not express somatostatin receptors (SSR) in contrast to low-grade astrocytomas which contain SSR. To differentiate a malignant glioma from a low-grade astrocytoma and to distinguish an SSR-positive intra-axial brain tumor from an SSR negative one, 111In-pentetreotide brain SPECT was prospectively undertaken.

METHODS

Eight patients with intra-axial brain tumors (three glioblastoma multiforme, one low-grade astrocytoma, one lymphoma, one medulloblastoma, one neurocytoma and one metastatic tumor) were studied. Thallium-201 and 111In-pentetreotide brain SPECT were performed with a 3- to 4-day interval before surgery. The SPECT findings were compared with those of Gd-enhanced MRI.

RESULTS

Increased uptake of 111In-pentetreotide was observed in all of the patients with glioblastoma multiforme (Grade in two and Grade + in one) despite lack of SSR. Low-grade astrocytoma exhibited minimal uptake of 111In-pentetreotide (Grade +). Remaining tumors had intense uptake of 111In-pentetreotide. Thallium-201 SPECT showed similar findings to those of 111In-pentetreotide scintigraphy except in two patients with glioblastoma multiforme: One with 201TL negative scan showed increased uptake of 111In-pentetreotide and the other showed increased thallium uptake but minimal uptake of 111In-pentetreotide. The uptake pattern of both 201Tl and 111In-pentetreotide appeared to correlate with Gd-enhanced MRI.

CONCLUSION

Indium-111-pentetreotide scintigraphy is sensitive in the detection of intra-axial brain tumors; however, it has no role in assessing the tumor grading and in the definition of the receptor profile.

Effects of labor on serum levels of insulin and insulin-like growth factor-binding proteins at the time of delivery

BACKGROUND

The purposes of this study were to explore whether serum levels of insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor-binding protein-1 (IGFBP-1) and IGFBP-3 in both maternal and fetal compartments were affected by the stress of labor, and to investigate the relationship between the fetal birthweight and serum levels of insulin, IGF-I and IGFBPs.

METHODS

Blood samples were collected at the time of delivery from 147 parturients with vaginal delivery and 128 cases of Cesarean section (112 cases without labor and 16 cases with arrest of cervical dilatation during the active phase of labor). Serum concentrations of insulin, IGF-I, IGFBP-1 and IGFBP-3 were determined by radioimmunoassays (insulin, IGFBP-1 and IGFBP-3) and immunoradiometric assay (IGF-I).

RESULTS

Maternal circulating IGFBP-1 levels in parturients with normal spontaneous delivery (NSD) and in subjects receiving Cesarean section (CS) due to arrest of cervical dilatation during active phase of labor were higher than those undergoing scheduled CS without labor. By contrast, insulin levels in both maternal and umbilical cord serum were higher in parturients with CS without labor than those with NSD. No difference in maternal serum IGFBP-3 levels was observed between NSD and CS at the time of delivery. As for all measurements (insulin, IGF-I, IGFBP-1 and IGFBP-3), serum levels in pregnant women (from both NSD and CS) were strikingly higher than those in the fetus. Serum levels of IGFBP-1 in umbilical cords from both groups of NSD (p < 0.02) and scheduled CS (p < 0.01) were inversely correlated with birthweight (BW). By contrast, serum concentration of insulin and IGF-I in umbilical cords from NSD (p < 0.005 and p < 0.01; respectively) and scheduled CS (p < 0.01 and p < 0.05; respectively) were positively related to BW.

CONCLUSIONS

From the present results, we conclude that insulin appears to be a regulator for circulating IGFBP-1 during pregnancy. The fetal growth may not be well reflected by maternal serum IGFBP-1 levels, nor by IGFBP-3. By contrast, cord serum IGFBP-1 from CS group without labor may preeminently reflect fetal weight. In additional, serum concentration of insulin and IGF-I in umbilical cord may also be good indicators to reflect the result of neonatal birthweight.

Interleukin-4 inhibits the expression of tumour necrosis factors alpha and beta, interleukins-1 beta and -6 and interferon-gamma

T cell-derived IL-4 inhibits the expression of several inflammatory cytokine genes. In this study, IL-4 downregulated TNF-alpha and -beta, IL-1 beta IL-6 and IFN-gamma steady-state mRNA and protein production by blood leukocytes. In a detailed kinetic analysis, cytokine mRNA levels were significantly decreased in the presence of IL-4, suggesting an early and prolonged downregulatory effect. These findings support the general thesis that IL-4 is an important regulator of the inflammatory immune response.

Localization of intracellular monoclonal antibody specific for mycobacteria in experimentally induced pulmonary tuberculous lesion

To determine the intracellular localization of intravenously injected infection-specific monoclonal antibodies (mAbs) in the infected cells, immunohistochemical staining was carried out in an animal model having pulmonary tuberculous lesions induced by inoculation of heat-killed Mycobacterium tuberculosis H37Rv. One milligram of intact mouse mAb against mycobacteria (group I, n = 10) and F(ab')2 (group II, n = 6) was intravenously injected to the rabbits of each group. Immunohistochemical staining using an antimouse Ab was performed at days 1, 3, 5, 7 and 8 in group I and at days 1, 2 and 3 in group II by the streptavidin-biotin method. For the control study, 1 ml of nonspecific polyclonal human IgG (group III, n = 10) and 100 micrograms of normal rabbit IgG F(ab')2 (group IV, n = 6) was injected to rabbits and guinea pigs having tuberculous inflammation, respectively. Both groups (group I and II) showed a positive antigen (Ag)-Ab reaction within the cytoplasm of monocytes. A weak but positive reaction was observed intracellularly in group III; however, no positive reaction was seen in group IV. Our results suggest that an intracellular Ag-Ab reaction plays an important role in the localization of infection by immunoscintigraphy using specific mAb fragments.

Reactivity of murine and human recombinant LPS-binding protein (LBP) within LPS and gram negative bacteria

The serum lipopolysaccharide (LPS) binding protein, LBP, has been shown to greatly enhance cellular responses to low concentrations of LPS. Purified LBP facilitates the transfer of LPS to membrane-bound or soluble CD14; the CD14/LPS complex then triggers a signal in responsive cells. We have cloned and sequenced a cDNA encoding murine LBP, and produced recombinant murine LBP using a baculovirus expression system. Using either a solid-phase or a cytofluorometric assay, recombinant murine and human LBP were found to bind avidly to free LPS, but only weakly to live bacteria from most LPS-containing Gram negative strains. Binding correlated loosely with the length and composition of the polysaccharide O chains. However, recombinant LBP did bind well to all heat-killed bacterial preparations. These findings suggest that LBP could be implicated in the response to killed but not live Gram negative bacteria.

Tracheopathia osteoplastica simulating asthmatic symptoms. Diagnosis by bronchoscopy and computerized tomography

Tracheopathia osteoplastica (TO) is a relatively rare benign disease of the trachea and major bronchi, characterized by cartilaginous and bony submucosal nodules covered by intact mucosa, which may cause narrowing and rigidity of the upper airways. The diagnosis of TO is rarely considered because of a lack of awareness of this entity, rather than the reported rare occurrence. We intend to report herein a case initially misinterpreted as bronchial asthma but later disclosed through computerized tomography (CT) and bronchoscopic biopsies as TO.

Effects of vanadate on prostacyclin and endothelin-1 production and protein-tyrosine phosphorylation in human endothelial cells

The ability of vanadate, an inhibitor of protein-tyrosine phosphatases, to affect the production of prostacyclin (PGI2) and endothelin-1 (ET-1) and protein-tyrosine phosphorylation in human umbilical vein endothelial cells (HUVEC) was studied. The addition of vanadate to monolayers of cultured HUVEC caused a sustained release of PGI2 from HUVEC in a time- and dose-dependent manner. When aspirin-treated HUVEC, which have lost the ability to increase PGI2 production in response to arachidonate, were incubated with vanadate, the cells recovered their ability to increase PGI2 production in response to arachidonate. This recovery of inducible PGI2 production in aspirin-treated HUVEC was completely inhibited either by cycloheximide, a protein synthesis inhibitor, or by actinomycin D, an RNA synthesis inhibitor. In contrast, the same concentration of vanadate suppressed the basal release of ET-1 from HUVEC. Vanadate also caused an increase in protein-tyrosine phosphorylation in HUVEC. These data indicate that vanadate induces opposite effects on PGI2 and ET-1 production with a concomitant increase in protein-tyrosine phosphorylation in HUVEC.

Differential induction of gene expression of catecholamine biosynthetic enzymes and preferential increase in norepinephrine by forskolin

We examined the effect of forskolin, an adenylate cyclase activator, on gene expression and the activities of the three enzymes specific for catecholamine biosynthesis [tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH) and phenylethanolamine N-methyltransferase (PNMT)] and on the amounts of available catecholamines in primary cultured bovine adrenomedullary chromaffin cells. The results showed that TH was increased by 4.7 +/- 0.7-fold and 69% in mRNA and activity levels, respectively, compared with the untreated control. DBH was elevated by 3.2 +/- 0.2-fold in mRNA and 45% in activity. The increase in PNMT, on the other hand, was smaller: 1.7 +/- 0.2-fold in mRNA and 13% in activity. This relatively small increase in PNMT was reflected in the catecholamine levels in that the total epinephrine (EPI) was elevated by only 16% while norepinephrine (NE) was elevated by 99%, which caused a shift in the molar ratio of EPI to NE from 7.0 in the untreated control to 4.1 after forskolin treatment. A large portion of the elevated catecholamines was found in the medium, which represented a 10.1-fold increase for NE and a 6.4-fold increase for EPI compared with the control. Interestingly, this caused the remaining intracellular NE and EPI to be only 117 and 66% of the control, respectively. Thus, forskolin caused coordinate up-regulation of gene expression and enzyme activities of the three catecholamine-synthesizing enzymes but to different degrees, resulting in a relatively larger increase in NE than in EPI, both of which were released dramatically. This large enhancement of catecholamine release, as well as the dramatic shift in their ratio, implicates an important physiological role for cAMP in the regulation of in vivo sympathetic activities.

Immunoglobulin and T-cell receptor gene rearrangement analysis in malignant lymphoid neoplasms

Gene rearrangement analysis using Southern-blot hybridization technique is a standard method for evaluating clonal receptor gene rearrangement. Both clonality and lineage can be identified in lymphoid neoplasms by the demonstration of one or more rearranged antigen receptor genes of the immunoglobulin supergene family-immunoglobulin and T-cell receptor genes. To evaluate the diagnostic applicability of antigen receptor gene rearrangements in the diagnosis of malignant lymphomas and leukemias, the authors performed a gene rearrangement analysis of 54 cases by southern blot hybridization technique. One or two clonally rearranged bands were detected in the malignant lymphomas and in the lymphoblastic leukemias with a false-negative rate of 13.8%. No clonal, rearranged band was detected in benign reactive hyperplasias, carcinomas or non-lymphocytic leukemias. Rearrangement analysis could resolve the lineage, clonality and stage of differentiation of malignant lymphoid neoplasms.

Evaluation of post-ischemic myocardial metabolism by 1H-magnetic resonance spectroscopy in the rabbit heart

To assess myocardial metabolism during ischemia and reperfusion, 36 rabbits were divided into 4 groups; a control group (Control), an ischemia group in which the circumflex branch was ligated for 30 min (Ischemia), a 5 min reperfusion group (5-RP) and a 30 min reperfusion group (30-RP). The concentrations of metabolites (lactate, alanine and free-carnitine) in the myocardium determined by 1H-magnetic resonance spectroscopy (MRS). The concentration of free carnitine was lower in Ischemia than in Control (2.0 +/- 0.4 vs 5.2 +/- 1.4 mumol/wet.g, p < 0.01), and remained reduced in 30-RP (3.0 +/- 0.6 mumol/wet.g, p < 0.01). On the other hand, the concentration of lactate and alanine were higher in Ischemia than in those of Control (54.9 +/- 8.5 vs 8.8 +/- 0.8, 6.5 +/- 1.0 vs 2.5 +/- 0.5 mumol/wet.g, respectively; p < 0.01), and remained elevated in 30-RP. These findings indicate that recovery from an ischemia-induced disturbance in myocardial metabolism to the pre-ischemic level apparently requires a prolonged period after reperfusion, and that 1H-MRS is a useful new method for evaluating myocardial ischemia.

A MAP kinase targeted by endotoxin and hyperosmolarity in mammalian cells

Mammalian cells respond to endotoxic lipopolysaccharide (LPS) by activation of protein kinase cascades that lead to new gene expression. A protein kinase, p38, that was tyrosine phosphorylated in response to LPS, was cloned. The p38 enzyme and the product of the Saccharomyces cerevisiae HOG1 gene, which are both members of the mitogen-activated protein (MAP) kinase family, have sequences at and adjacent to critical phosphorylation sites that distinguish these proteins from most other MAP kinase family members. Both HOG1 and p38 are tyrosine phosphorylated after extracellular changes in osmolarity. These findings link a signaling pathway in mammalian cells with a pathway in yeast that is responsive to physiological stress.

[Induction of coronary artery spasm by combined cold pressor and hyperventilation test in patients with variant angina]

To examine whether or not a combination of nonpharmacologic provocative tests potentiated the occurrence of coronary spasm, the cold pressor test combined with hyperventilation was studied in 22 consecutive patients with variant angina admitted to our hospital. After a 12-lead electrocardiogram and blood pressure were recorded, the patient was asked to hyperventilate vigorously at a rate of 30 respirations per min for 6 min under continuous electrocardiographic monitoring. Immediately after hyperventilation, the cold pressor test was performed with the patient's right hand submerged in ice water for 2 min. In some patients who showed a positive response to the combined test, a hyperventilation and cold pressor test was performed on another day. Positive response (ST segment elevation > or = 0.1 mV) to the combination test was seen in 18 of 22 patients (82%). Positive response to the hyperventilation test was seen in seven of 11 patients (64%). The response to cold pressor test was all negative in seven patients. The onset of electrocardiographic changes by the combined test occurred an average of 120 sec (30-240 sec) after the end of hyperventilation, whereas the onset by hyperventilation test occurred an average of 210 sec later (60-370 sec). These results suggest the combination of the cold pressor test and hyperventilation test potentiated the occurrence of coronary spasm. The combined cold pressor and hyperventilation test is a powerful and useful nonpharmacologic provocative test for coronary artery spasm in patients with variant angina.

Increased thallium-201 uptake in collapsed lung: a pitfall in scintigraphic evaluation of central bronchogenic carcinoma

This study evaluated whether 201Tl scintigraphy can differentiate a central bronchogenic cancer from a distal collapse consolidation.

METHODS

Nine patients with squamous carcinoma with collapse confirmed by surgery and pathology were included. All patients underwent SPECT 1 hr after an intravenous injection of 3 mCi of 201Tl. Four-hour delayed SPECT was performed in five of the nine patients. The thallium activity in tumor and collapse was visually assessed on the basis of the pathologic findings. The specimens were prepared to have the same orientation and level with the SPECT image.

RESULTS

The tumor activity appeared higher than that of the collapse in four patients, equal in three patients and lower in two patients. Both collapsed lung with and without superimposed inflammation also showed increased thallium activity. Delayed SPECT aided in tumor detection within a collapsed lung in only two of the five patients.

CONCLUSION

Our study illustrates the need for caution in the interpretation of thallium scintigraphy in patients with central bronchogenic cancer and distal collapse.

Polyangiitis overlap syndrome: cutaneous leukocytoclastic vasculitis associated with polyarteritis nodosa

A rare case of polyangiitis overlap syndrome is described. The patient was a 25-year-old man who had palpable purpura on his legs which showed leukocytoclastic vasculitis, and polyarteritis nodosa. Superior mesenteric arteriography showed microaneurysms in jejunal branches with focal segmental necrotizing arteritis of small and medium sized muscular arteries in the jejunum. Deposits of IgA and C3 in the superficial blood vessels of the lesional skin were consistent with the features of Henoch-Schönlein purpura. The patient died about two months after initial admission in spite of cytotoxic agent and steroid administration.

EBV in situ hybridization study for non-Hodgkin's lymphomas

Epstein-Barr virus(EBV) has been implicated in the pathogenesis of B-lymphoproliferative disorders, T-cell lymphomas and Hodgkin's disease. In this report, we performed an in situ hybridization study on EBV genome in 10 cases of nasal non-Hodgkin's lymphoma(NHL), 20 cases of Waldeyer's ring(WR) NHL, and 20 cases of nodal NHLs to document EBV association with lymphomas in Koreans. For immunophenotyping, monoclonal antibodies for CD 20, MB 2, CD 45Ro & CD 43 were used. For in situ hybridization study, EBV DNA probe for Bam HI 'V' fragment and EBV RNA probe for EBER and BHLF were used. Twenty two cases(44%) of malignant lymphomas were positive for EBV genome. Generally, T-cell lymphomas showed a higher positive rate(61%) than B-cell lymphomas(24%). Among T-cell lymphomas, nasal lymphomas showed a higher positive rate(80%) than WR(50%) or nodal lymphomas(50%). Of 22 EBV genome positive cases, 10 cases were positive for EBER, 10 cases for BHLF, and 2 cases for both EBER and BHLF. The histologic types by Working Formulation(WF) were not correlated with EBV genome positive rate, whereas lymphomas showing the histologic spectrum of polymorphic reticulosis(PR) showed a higher positive rate(65%) than lymphomas without PR-like features(40%). These results indicate that nasal T-cell lymphomas with the histologic spectrum of PR are strongly associated with EBV and that the anatomic site may be an important factor in this association.

Massive retroperitoneal hemorrhage from spontaneous rupture of a renal angiomyolipoma during pregnancy. A case report

We present the case of a 29-year-old, pregnant woman who, at 27 weeks' gestation, suffered an acute abdomen with hypovolemic shock that led to intrauterine fetal death in spite of an emergency laparotomy. The final diagnosis was ruptured renal angiomyolipoma, which caused a massive retroperitoneal hemorrhage.

Effects of low density lipoprotein on type IV collagen production by cultured rat mesangial cells

Hyperlipidemia, especially hypercholesterolemia, may contribute to glomerulosclerosis as it does to atherosclerosis. Low density lipoprotein (LDL) stimulates the production of extracellular matrix by mesangial cells in culture as well as the proliferation of mesangial cells. This study was carried out to examine the effects of LDL on the type IV collagen (CIV) production by cultured rat mesangial cells (CRMC). Subconfluent CRMC monolayers which were grown in RPMI with 20% lipid-free fetal calf serum for 48 h were challenged with LDL (0, 50, 100, 150 and 200 micrograms/ml) for another 48 h. LDL was prepared from normal human plasma. Mesangial cell proliferation was examined by [3H]-thymidine uptake. Production of CIV was evaluated as the expression of CIV on the cell surface by flow-cytometric analysis. The collagen synthesis was measured by the [3H]-proline uptake. Total RNA was extracted from CRMC at 6 and 24 h of incubation with 150 micrograms/ml LDL, and Northern blotting and hybridization was performed with cDNAs for alpha 1-CIV, for 72-kD collagenase and for tissue inhibitor of metalloproteinase (TIMP)-2. The amount of total mRNA was corrected with beta-actin mRNA. Mesangial cell proliferation increased in all concentrations studied and had a peak value of 221% with 150 micrograms/ml of LDL. Expression of CIV increased by 30-60% in 100-200 micrograms/ml of LDL. Collagen synthesis also increased by 50-70% in 150-200 micrograms/ml of LDL. The mRNA ratio (procollagen alpha 1(IV)/beta-actin) increased to 133% at 24 h. The mRNA ratio (TIMP-2/beta-actin) increased to 137% at 24 h. mRNA ratios at 6 h showed no change.(ABSTRACT TRUNCATED AT 250 WORDS)

Endotoxin induces rapid protein tyrosine phosphorylation in 70Z/3 cells expressing CD14

CD14, a glycosylphosphatidylinositol-anchored glycoprotein of leukocytes, binds endotoxin (lipopolysaccharide (LPS)) with high affinity. After the murine pre-B cell line 70Z/3 is transfected with DNA encoding human CD14 (hCD14), the resultant stably transfected cell line, 70Z/3-hCD14, responds to 1000-fold lower LPS concentrations than the parental CD14-negative line. We have used 70Z/3-hCD14 cells, RAW264.7 cells, and elicited murine peritoneal exudate macrophages (PEM) to study LPS-induced protein tyrosine phosphorylation. LPS induces the rapid tyrosine phosphorylation of a 38-kDa protein (p38) in 70Z/3-hCD14 cells, PEM, and RAW264.7 cells and of two isoforms of mitogen-activated protein kinases (MAPK) in only RAW264.7 cells and PEM. p38 can be distinguished from the MAPK isoforms based on differences in mobilities on SDS-polyacrylamide gel electrophoresis and the lack of reactivity of p38 with anti-MAPK antibody even after dephosphorylation with potato acid phosphatase. Synthetic lipid A induces p38 phosphorylation in 70Z/3-hCD14 cells, whereas phorbol 12-myristate 13-acetate and interferon-gamma fail to induce tyrosine phosphorylation of p38. Pretreatment of 70Z/3-hCD14 cells with anti-hCD14 monoclonal antibody or the tyrosine kinase inhibitor herbimycin A inhibits LPS-induced tyrosine phosphorylation of p38. These results suggest that increased protein tyrosine phosphorylation occurs rapidly after LPS binds to CD14 and is likely to be an important event in mediating LPS-induced cell activation.

Analysis of lipopolysaccharide binding by CD14

The cell surface protein CD14 binds bacterial lipopolysaccharide (LPS) in the presence of the serum protein, LPS-binding protein (LBP). This interaction is important for LPS-induced activation of mammalian myeloid cells. We performed quantitative studies of 3H-labeled LPS binding to human CD14 expressed on Chinese hamster ovary cells and on a human macrophage cell line (THP-1). At the concentrations studied (20-100 nM) LPS binding required the expression of CD14 and could be inhibited by a subset of anti-CD14 monoclonal antibodies. LBP was required for LPS binding to CD14. The binding occurred within 10 min and was relatively unaffected by temperature over the range of 4-37 degrees C. Quantitative binding assays were performed at 10 degrees C, or at 37 degrees C, using Chinese hamster ovary cells depleted of ATP. In both cases, 75-90% of the LPS could be released by treatment with phosphatidylinositol-specific phospholipase C, suggesting that it remains associated with the glycosyl phosphatidylinositol-anchored CD14. The apparent dissociation constant of recombinant human CD14 expressed on Chinese hamster ovary cells for LPS at 10 degrees C was 2.74 (+/- 0.99) x 10(-8) M; the apparent dissociation constant of CD14 expressed on THP-1 cells at 10 degrees C was 4.89 (+/- 1.42) x 10(-8) M. In both cell lines, at saturating LPS concentrations, the molar ratio of LPS bound per surface CD14 was approximately 20:1. At 37 degrees C the apparent dissociation constant of recombinant human CD14 for LPS at 37 degrees C was 2.7 (+/- 1.2) x 10(-8) M, and the molar ratio of LPS bound per surface CD14 was approximately 8:1. Although the difference in molar ratio of LPS bound per surface CD14 at the two temperatures is difficult to interpret, it is clear that at both temperatures the molar ratio is not 1:1. The basis of this phenomenon is unclear, but may involve the repeated leucine-rich motifs, which are found within CD14.

Increased cerebral perfusion after detachable balloon embolization of carotid cavernous fistula on technetium-99m-HMPAO brain SPECT

Most symptoms and signs associated with a carotid cavernous fistula (CCF) are thought to be related to regurgitation of flow into cortical veins and to venous congestion. Arteriovenous shunting and secondary perfusion insufficiency is regarded as less important in causing symptoms. We describe a 27-yr-old male patient who had improvement of neurologic symptoms and signs after detachable balloon embolization of traumatic CCF. The pre- and postocclusion 99mTc-HMPAO brain SPECT scan showed improved cerebral blood flow after occlusion. The CCF had shown marked arteriovenous shunting without significant venous congestion on pre-occlusion cerebral angiogram. The postocclusion cerebral angiogram revealed complete occlusion of the CCF with increased blood flow in the ipsilateral middle cerebral artery distribution. These findings suggest that cerebral dysfunction may be related to perfusion insufficiency from the CCF. Brain SPECT scanning can assess the functional status of cerebral perfusion and may be a useful, noninvasive adjunct to angiography.

Glycosyl-phosphatidylinositol-anchored or integral membrane forms of CD14 mediate identical cellular responses to endotoxin

Endotoxin stimulates leukocytes to release cytokines that initiate septic shock in humans and animals. CD14, a glycosyl-phosphatidylinositol-anchored membrane glycoprotein, is an endotoxin receptor on leukocytes, and endotoxin binding to CD14 induces cytokine production. Here we show that glycosyl-phosphatidylinositol-anchored or integral membrane CD14 mediates identical cellular responses to endotoxin, including NF-kappa B activation and protein tyrosine phosphorylation. We also show that an anti-CD14 monoclonal antibody that does not block endotoxin binding to CD14 nonetheless inhibits cell activation by endotoxin. These findings suggest that binding of endotoxin to cell-surface CD14 is followed by subsequent interactions of the endotoxin-CD14 complex with additional membrane component(s) that enable transmembrane signaling. This function of CD14 may be prototypic for other members of the glycosyl-phosphatidylinositol-anchored family of proteins that do not play a primary role in signal transduction but rather are the principal ligand-binding units of membrane-bound receptor complexes.

Atomic force microscopy of mammalian sperm chromatin

We have used the atomic force microscope (AFM) to image the surfaces of intact bull, mouse and rat sperm chromatin and partially decondensed mouse sperm chromatin attached to coverglass. High resolution AFM imaging was performed in air and saline using uncoated, unfixed and unstained chromatin. Images of the surfaces of intact chromatin from all three species and of an AFM-dissected bull sperm nucleus have revealed that the DNA is organized into large nodular subunits, which vary in diameter between 50 and 100 nm. Other images of partially decondensed mouse sperm chromatin show that the nodules are arranged along thick fibers that loop out away from the nucleus upon decondensation. These fibers appear to stretch or unravel, generating narrow smooth fibers with thicknesses equivalent to a single DNA-protamine complex. High resolution AFM images of the nodular subunits suggest that they are discrete, ellipsoid-shaped DNA packaging units possibly only one level of packaging above the protamine-DNA complex.

A case of primary hepatic actinomycosis

Actinomycosis is a chronic suppurative and granulomatous disease characterized histologically by sulfur granules with extensive necrosis, fibrosis and sinus formation. Depending on the site of primary infection, actinomycosis is generally classified as cervicofacial, thoracic and abdominal type. The liver is known to be the primary site of infection in 15% with abdominal actinomycosis. The authors have experienced a case of liver abscess in a 24-year-old male. The sono-guided aspiration biopsy revealed findings of infiltration of neutrophils and characteristics sulfur granules by light microscopy. This case was thought to represent an instance of liver actinomycosis. Although there have been a lot of reports on actinomycosis of the liver in other countries, only 3 cases were reported in Korea.

Scintigraphic diagnosis of syphilitic lesions in rabbits by radiolabelled monoclonal antibodies specific for Treponema pallidum

Immunoscintigraphy with radiolabelled monoclonal antibodies has been widely used to detect solid tumours. The purpose of this study was to investigate its potential for the specific localization of syphilitic lesions. F(ab')2 fragments were prepared from murine monoclonal antibodies against Treponema pallidum produced in our laboratory and labelled with 131I. Bilateral testicular infections were created in rabbits by inoculation with T. pallidum or Staphylococcus aureus. Seven to 10 days after inoculation, radiolabelled antibodies were injected intravenously. Serial gamma images were then taken 2 h after the injection and at 24 h intervals thereafter. Beginning as early as 2 h post-injection, the testicles could be visualized with either specific or non-specific antibodies. Gamma images in the monoclonal antibody-treated, T. pallidum-infected group persisted up to 48 h post-injection. Lesions were not discernible from background in the S. aureus-infected group injected with the monoclonal antibody and the S. aureus-infected and T. pallidum-infected groups injected with the polyclonal antibody at 24 h post-injection or later. Therefore, due to its ability to differentiate between specific and non-specific antibody-generated images from 24 h post-injection, immunoscintigraphy using monoclonal antibodies specific for T. pallidum may be employed as one of the methods to diagnose difficult cases of syphilitic internal organ involvement as well as syphilis infection in seronegative HIV-infected patients.

The effects of high-fat and high-carbohydrate diet loads on gas exchange and ventilation in COPD patients and normal subjects

Reducing the CO2 production (VCO2) is a plausible means to lower the ventilatory demand in the treatment of patients with COPD. The purpose of this study was to examine the effects of high-fat and high-carbohydrate (high-CHO) diet loads on gas exchange and ventilation in the COPD patients and normal subjects. The percentage of changes in the averaged values of VCO2, O2 consumption (VO2), respiratory quotient (RQ), minute ventilation (VE), and end-tidal CO2 (ETCO2) measured by a mass spectrometer for 5 min every 30 min after the diet were compared between diets and between study subjects. Compared with the high-fat diet, the high-CHO diet can lead to significantly higher levels of VCO2, VO2, RQ, and VE in the COPD patients 30 to 60 min after the diet, and the differences can last for about 1.5 h. The comparison between COPD patients and normal control subjects also showed that the high-CHO diet load can result in significantly higher levels of VCO2, VO2, and VE, and significantly lower level of ETCO2 in the COPD patients, whereas the high-fat diet cannot. In addition, enhanced thermic effect of food within 150 min (TEF150) occurred in the COPD patients as compared with that of normal controls, and the increase in TEF150 occurred only with the high-CHO diet. This study suggested that a high-fat diet is more beneficial to the COPD patient than a high-CHO diet, and that the gas exchange and energy utilization of the COPD patients following a high-CHO diet might be different from that of normal control subjects.

Crow-Fukase syndrome associated with pulmonary hypertension

A 60-year-old woman suffering from heart failure was found to have Crow-Fukase syndrome. A precise cardiovascular study revealed the existence of pulmonary hypertension (PH), cardiomegaly and myocardial hypertrophy in addition to manifestations of this syndrome such as hyperpigmentation, hypertrichosis, finger clubbing, polyneuropathy, organomegaly and plasma cell dyscrasia. These findings suggest the possibility that patients with Crow-Fukase syndrome have cardiopulmonary disorders including PH and cardiomegaly which might cause some cardiovascular symptoms such as peripheral edema and finger clubbing.

Metabolic alkalosis induced by plasmapheresis in a patient with systemic lupus erythematosus

We report a patient with systemic lupus erythematosus (SLE), who had developed metabolic alkalosis during plasmapheresis. The metabolic alkalosis could be promptly corrected by reducing the amount of citrate load. The development of metabolic alkalosis can be explained by the citrate load during plasmapheresis. Careful monitoring of acid base status is mandatory in patients with limited renal function and the reduction of citrate load may be advisable in plasmapheresis.

Evidence for possible involvement of an elastolytic serine protease in aspergillosis

A number of isolates of Aspergillus fumigatus obtained from the hospital environment produced extracellular elastolytic activity. This activity was found to be catalyzed by a single 33-kDa protein which was purified and characterized to be a serine protease. A. fumigatus, when grown on the insoluble structural material obtained from murine and bovine lung, produced the same extracellular 33-kDa elastolytic protease, indicating that this enzyme is likely to be produced when the organism infects the lung. Polymerase chain reaction with an oligonucleotide primer based on the N-terminal amino acid sequence of the elastolytic enzyme yielded a cDNA which was cloned and sequenced. The active serine motif showed more similarity to subtilisin than to mammalian elastase. The amino acid sequence showed 80% identity to the alkaline protease from Aspergillus oryzae. Screening of hospital isolates of Aspergillus flavus showed great variation in the production of elastolytic activity and a much lower level of activity than that produced by A. fumigatus. The elastolytic protease from A. flavus was shown to be a serine protease susceptible to modification and inactivation by active serine and histidine-directed reagents. This protease cross-reacted with the antibodies prepared against the elastolytic protease from A. fumigatus. Immunogold localization of the elastolytic enzyme showed that A. fumigatus germinating and penetrating into the lungs of neutropenic mice secreted the elastolytic protease. An elastase-deficient mutant generated from a highly virulent isolate of A. fumigatus caused drastically reduced mortality when nasally introduced into the lung of neutropenic mice. All of the evidence suggests that extracellular elastolytic protease is a significant virulence factor in invasive aspergillosis.

The effect of a physician education program on hospital length of stay and total patient charges

An experimental-control group study was carried out in a large community hospital in which the experimental variable consisted of a one-time exposure of physicians to clinical and financial specifics regarding their individual treatment and management of pneumonia patients. A computerized report generating technology was used to create individualized reports for physicians detailing their practice patterns with respect to pneumonia patients. It was found that providing physicians with specific information about their practice behavior resulted in these same physicians using fewer hospital resources as expressed in total billed charges and Length of Stay. At the same time there was no compromise in outcomes for patients as measured by mortality, readmission rates, and infection/complication rates. The improvement in resource utilization was observed for two years following the provision of practice specific data to the experimental physicians.

Cross-linking of lipopolysaccharide (LPS) to CD14 on THP-1 cells mediated by LPS-binding protein

Recent work has established that bacterial endotoxin (LPS) binds to the plasma protein LPS-binding protein (LBP) forming high affinity complexes (LPS-LBP), that LBP is an opsonin for LPS-bearing particles, and that LPS-LBP complexes are potent agonists for monocytic cells (MO). mAb to the MO plasma membrane protein, CD14, inhibit LBP-dependent binding of LPS to MO, and LPS-LBP-dependent stimulation of cytokine release from MO. These data suggest that CD14 functions as a membrane receptor for LPS but do not demonstrate a direct association of LPS with CD14. Calcitriol was used to induce a high level of CD14 expression in the human monocyte-like cell line THP-1, resulting in enhanced responses of these cells to LPS-LBP complexes manifested by enhanced binding of LPS and a decrease in the amount of LPS needed to induce IL-8 release. An Re595 LPS derivative containing a radioiodinated, photoreactive, phenyl azide (125I-ASD-LPS) was used in cross-linking experiments to identify membrane proteins in calcitriol-treated THP-1 cells that interact with LPS. 125I-ASD-LPS was added to calcitriol-induced THP-1 cells in the presence or absence of LBP, the mixture photolyzed, and the resultant radioiodinated proteins analyzed by SDS-PAGE and autoradiography. We observed strong cross-linking of 125I-ASD-LPS to a 55-kDa membrane protein when LBP was present, but failed to observe radiolabeling of any other proteins with apparent molecular masses distinct from CD14. The cross-linked product was identified as CD14 by immunoprecipitation with anti-human CD14 mAb. Studies with human CD14 expressing transfectants of the murine B cell line 70Z/3 also revealed LBP-dependent cross-linking of 125I-ASD-LPS to CD14. These data document binding of LPS to a specific membrane protein that serves as an LPS receptor.

Cross-linking of lipopolysaccharide (LPS) to CD14 on THP-1 cells mediated by LPS-binding protein

Recent work has established that bacterial endotoxin (LPS) binds to the plasma protein LPS-binding protein (LBP) forming high affinity complexes (LPS-LBP), that LBP is an opsonin for LPS-bearing particles, and that LPS-LBP complexes are potent agonists for monocytic cells (MO). mAb to the MO plasma membrane protein, CD14, inhibit LBP-dependent binding of LPS to MO, and LPS-LBP-dependent stimulation of cytokine release from MO. These data suggest that CD14 functions as a membrane receptor for LPS but do not demonstrate a direct association of LPS with CD14. Calcitriol was used to induce a high level of CD14 expression in the human monocyte-like cell line THP-1, resulting in enhanced responses of these cells to LPS-LBP complexes manifested by enhanced binding of LPS and a decrease in the amount of LPS needed to induce IL-8 release. An Re595 LPS derivative containing a radioiodinated, photoreactive, phenyl azide (125I-ASD-LPS) was used in cross-linking experiments to identify membrane proteins in calcitriol-treated THP-1 cells that interact with LPS. 125I-ASD-LPS was added to calcitriol-induced THP-1 cells in the presence or absence of LBP, the mixture photolyzed, and the resultant radioiodinated proteins analyzed by SDS-PAGE and autoradiography. We observed strong cross-linking of 125I-ASD-LPS to a 55-kDa membrane protein when LBP was present, but failed to observe radiolabeling of any other proteins with apparent molecular masses distinct from CD14. The cross-linked product was identified as CD14 by immunoprecipitation with anti-human CD14 mAb. Studies with human CD14 expressing transfectants of the murine B cell line 70Z/3 also revealed LBP-dependent cross-linking of 125I-ASD-LPS to CD14. These data document binding of LPS to a specific membrane protein that serves as an LPS receptor.