Elevated expression of interleukin-6 (IL-6) and serum amyloid A (SAA) in the skin and the serum of recessive dystrophic epidermolysis bullosa: Skin as a possible source of IL-6 through Toll-like receptor ligands and SAA

The effect of persistent skin inflammation on extracutaneous organs and blood is not well studied. Patients with recessive dystrophic epidermolysis bullosa (RDEB), a severe form of the inherited blistering skin disorder, have widespread and persistent skin ulcers, and they develop various complications including anaemia, hyperglobulinaemia, hypoalbuminaemia and secondary amyloidosis. These complications are associated with the bioactivities of IL-6, and the development of secondary amyloidosis requires the persistent elevation of serum amyloid A (SAA) level. We found that patients with RDEB had significantly higher serum levels of IL-6 and SAA compared to healthy volunteers and patients with psoriasis or atopic dermatitis. Both IL-6 and SAA were highly expressed in epidermal keratinocytes and dermal fibroblasts of the skin ulcer lesions. Keratinocytes and fibroblasts surrounding the ulcer lesions are continuously exposed to Toll-like receptor (TLR) ligands, pathogen-associated and damage-associated molecular pattern molecules. In vitro, TLR ligands induced IL-6 expression via NF-κB in normal human epidermal keratinocytes (NHEKs) and dermal fibroblasts (NHDFs). SAA further induced the expression of IL-6 via TLR1/2 and NF-κB in NHEKs and NHDFs. The limitation of this study is that NHEKs and NHDFs were not derived from RDEB patients. These observations suggest that TLR-mediated persistent skin inflammation might increase the risk of IL-6-related systemic complications, including RDEB.

Staphylococcal enterotoxin B- and lipopolysaccharide-induced toxic shock syndrome in a burn patient

Toxic shock syndrome (TSS) is caused by toxic shock syndrome toxin 1 or enterotoxins secreted by Staphylococcus aureus. Lipopolysaccharide (LPS) has also been shown to play a major role in the development of sepsis. Staphylococcal superantigens and LPS operate synergistically in conditioning cytokine release and lethal shock in mice. An 80-year-old woman was admitted because of a 20% mixed-depth flame burn. Despite two excisions and grafts, necrotic ulcers with methicillin-resistant Staphylococcus aureus (MRSA) colonization remained. On the 7th day after the operation, she developed shock with an erythematous rash. Blood examination revealed evidence of disseminated intravascular coagulation, and liver and renal dysfunction. A blood culture revealed a staphylococcal enterotoxin B (SEB)-producing strain of MRSA and Klebsiella pneumoniae. The septic symptoms were prolonged, but the condition gradually improved with extensive treatment. T-cell receptor analysis demonstrated a marked accumulation of SEB-mediated Vβ T cells. Stimulation of peripheral blood mononuclear cells in the recovery phase with SEB and LPS induced additive effects on tumor necrosis factor-α, interferon-γ, and interleukin-6 production. Although the present case did not fulfill the clinical criteria for TSS, the additive effects of SEB and LPS might have caused the severe septic shock.

Multifaceted Analyses of Epidermal Serine Protease Activity in Patients with Atopic Dermatitis

The serine proteases kallikrein-related peptidase (KLK) 5 and KLK7 cleave cell adhesion molecules in the epidermis. Aberrant epidermal serine protease activity is thought to play an important role in the pathogenesis of atopic dermatitis (AD). We collected the stratum corneum (SC) from healthy individuals (n = 46) and AD patients (n = 63) by tape stripping and then measuring the trypsin- and chymotrypsin-like serine protease activity. We also analyzed the p.D386N and p.E420K of SPINK5 variants and loss-of-function mutations of FLG in the AD patients. The serine protease activity in the SC was increased not only in AD lesions but also in non-lesions of AD patients. We found, generally, that there was a positive correlation between the serine protease activity in the SC and the total serum immunoglobulin E (IgE) levels, serum thymus and activation-regulated chemokine (TARC) levels, and peripheral blood eosinophil counts. Moreover, the p.D386N or p.E420K in SPINK5 and FLG mutations were not significantly associated with the SC’s serine protease activity. Epidermal serine protease activity was increased even in non-lesions of AD patients. Such activity was found to correlate with a number of biomarkers of AD. Further investigations of serine proteases might provide new treatments and prophylaxis for AD.

Toll-like receptor signalling induces the expression of serum amyloid A in epidermal keratinocytes and dermal fibroblasts

BACKGROUND

Toll-like receptors (TLRs) play critical roles in innate immune response by sensing pathogen- or damage-associated molecular patterns. Epidermal keratinocytes and dermal fibroblasts also produce proinflammatory cytokines and chemokines under stimulation with TLR ligands. Serum amyloid A (SAA) is an essential factor in the pathogenesis of secondary amyloidosis, and also has immunomodulatory functions. SAA are produced mainly by hepatocytes but also by a variety of cells, including immune cells, endothelial cells, synoviocytes, and epidermal keratinocytes. However, SAA expression in human dermal fibroblasts has not been shown to date.

AIM

To investigate the effect of TLR ligands on SAA expression in epidermal keratinocytes and dermal fibroblasts.

METHODS

We investigated whether TLR ligands induce the expression of SAA in normal human epidermal keratinocytes (NHEKs) and normal human dermal fibroblasts (NHDFs) by real-time quantitative PCR and ELISA. The effect of SAA on its own expression in NHDFs was also studied.

RESULTS

SAA expression was induced via nuclear factor-κB by TLR1/2, 3, 5 and 2/6 ligands in NHEKs. In NHDFs, TLR1/2 and TLR2/6 ligands increased SAA expression. SAA further induced its own expression via TLR1/2 and NF-κB in NHDFs, as previously reported for NHEKs.

CONCLUSIONS

Our results provide new evidence that the skin's innate immune response contributes to the production of SAA, which might lead to an increased risk of systemic complications such as secondary amyloidosis of recessive dystrophic epidermolysis bullosa.

Cathelicidin antimicrobial peptide LL-37 augments interferon-β expression and antiviral activity induced by double-stranded RNA in keratinocytes

BACKGROUND

Cathelicidin antimicrobial peptide LL-37 has the capacity to kill a wide range of microbes and to modify host immunity. Recently, our group observed that the activation of keratinocytes by LL-37 and DNA greatly increases interferon (IFN)-β through Toll-like receptor (TLR)9. However, the effect of LL-37 on the induction of IFN-β through TLR3, a sensor of double-stranded (ds) RNA, in keratinocytes is not well known.

OBJECTIVES

To investigate whether LL-37 could affect TLR3 signalling and antiviral activity in normal human epidermal keratinocytes (NHEKs).

METHODS

We investigated the production of IFN-β in NHEKs stimulated with a TLR3 ligand, poly (I:C), in the presence of LL-37. To examine the effect of LL-37 and poly (I:C) on antiviral activity, a virus plaque assay using herpes simplex (HS) virus type-1 was carried out. The uptake of poly (I:C) conjugated with fluorescein isothiocyanate (FITC) into the keratinocytes was observed in the presence of LL-37. Immunostaining for TLR3 and LL-37 was performed using skin samples from HS.

RESULTS

LL-37 and poly (I:C) synergistically induced the expression of IFN-β in NHEKs. Furthermore, co-stimulation with LL-37 and poly (I:C) significantly decreased the viral plaque numbers compared with poly (I:C) or LL-37 alone. LL-37 enhanced the uptake of FITC-conjugated poly (I:C) into cells. Immunohistochemical analysis demonstrated that the expression of TLR3 and LL-37 is upregulated in HS lesions.

CONCLUSIONS

Our findings suggest that LL-37 augments the antiviral activity induced by dsRNA in keratinocytes, which may contribute to the innate immune response to cutaneous viral infections such as HS.

Relationship among risk factors of atherosclerosis, leukocyte count, and soluble intercellular adhesion molecule-1

We investigated the effects of risk factors of atherosclerosis on soluble intercellular adhesion molecule-1 (sICAM-1) concentration and leukocyte count by using multivariate statistical analysis. The subjects were 90 people who were hospitalized for a complete check-up examination. Eight risk factors were selected as candidates for predictor variables: age, body mass index (BMI), uric acid, glycohemoglobin A1c, number of cigarettes smoked daily, total cholesterol, triglyceride, and high density lipoprotein (HDL)-cholesterol. The predictor variables were selected using a stepwise method, [criterion variable - predictor variable (standardized regression coefficient)]; sICAM1 - age (0.1859), number of cigarettes (0.2558), triglyceride (0.2447); leukocytes - number of cigarettes (0.2827), triglyceride (0.2526), HDL-cholesterol (-0.2800); stab leukocytes - number of cigarettes (0.2460); segmented leukocytes - glycohemoglobin A1c (0.1495), number of cigarettes (0.2716), HDL-cholesterol (-0.3254); lymphocytes - BMI (0.2639), number of cigarettes (0.1495), triglyceride (0.3520); monocytes - glycohemoglobin A1c (0.2617). These findings indicated that the risk factors of atherosclerosis may influence sICAM1 concentration and leukocyte count.

Detection and monitoring of simple renal cysts with computed tomography

We retrospectively investigated the incidence of simple renal cysts in 1,288 healthy subjects, and monitored the growth and formation of such cysts in 39 subjects using abdominal computed tomography (CT). Simple renal cysts were detected in 138 (10.7%) of the 1,288 subjects. The incidence of simple renal cysts increased significantly with the subject's age (p < 0.001). We found that cyst size increased significantly with age and over time on serial CT studies (p < 0.001). Exoparenchymal cysts, comprising greater than 50% of extraparenchymal lesions, were significantly larger than endoparenchymal cysts (p < 0.001), and showed a greater tendency to increase in size over time.

Sensitivity and specificity of lung cancer screening in Osaka, Japan

Sensitivity and specificity were evaluated for lung cancer screening conducted at 8 municipalities in Osaka Prefecture during 1981-1985. As a screening policy, all attendants were examined by miniature chest X-ray, and the high-risk group, defined as those who smoked cigarettes or had bloody sputum, were also examined by 3-day pooled sputum cytology. A total of 33,599 screening tests for 19,028 people who were 40 years old or more at the time of screening were conducted, resulting in 33,490 miniature chest X-ray examinations for 18,992 people and 11,420 sputum cytologies for 7,070 people. As a result, 43 lung cancer cases were detected. All test-negatives were followed by means of record linkage with the files of the Osaka Cancer Registry up to the end of 1986. There were 24 cases who were diagnosed as having lung cancer without having given a positive screening result in 1981-1986. Assuming the preclinical detectable phase of lung cancer to be one year uniformly, the sensitivity and specificity for the lung cancer screening were estimated to be 71.6% and 95.3%, respectively. The feasibility of increasing the sensitivity is discussed.

Analysis of oxygen equilibria of the giant hemoglobin from the earthworm Eisenia foetida using the Adair model

Oxygen equilibrium curves of the giant hemoglobin from the earthworm Eisenia foetida were determined at various concentrations of cations. Using the Adair model of 12 oxygenation steps, we succeeded in fitting the data better than the simple concerted model (MWC model). Analysis of the Adair constants (K1 to K12) indicated that the increase in oxygen affinity occurs in the last six steps (K7 to K12) of the oxygen binding and that it is enhanced by increase in Ca2+ concentration. The Hill coefficient (nmax) at pH 7.5 attained a maximum value of 9.76 at 20 mM CaCl2. In the presence of physiological levels of Ca2+ (5 mM), the Bohr effect was similar to that seen in vertebrates. The data were consistent with the release of two Bohr protons being accompanied by the oxygen-linked binding of one Ca2+. Mg2+ and Na+ exerted a similar effect on the hemoglobin, though to a lesser extent. The stoichiometry of Ca2+ binding of the hemoglobin revealed the presence of two classes of binding sites, of which the affinities are high (Ka = 8.8 x 10(3) +/- 103 M-1) and low. The number of high affinity sites per heme was found to be 0.3, comparable to the number of oxygen-linked Ca2+ binding sites.

Dissociation of Limulus polyphemus (horseshoe crab) hemocyanin

A solution X-ray scattering study has been performed on Limulus polyphemus (horseshoe crab) hemocyanin and its dissociated fragments at various pH values in the presence and absence of Ca2+. The scattering patterns of native hemocyanin (48-mer), the half molecule (24-mer), quarter molecule (12-mer) and monomer fraction were measured. The radii of gyration for the four molecular species were calculated from the Guinier plots to be 110.7, 91.3, 77.3, and 36.5 A, respectively. Models which yield good fits to the experimental data are presented. The models were constructed using eight, four and two spheres with a radius of 58 A, assuming the sphere to be the submultiple composed of six subunits. The radii of gyration were calculated on the basis of the model and the values found to be 106, 94 and 73 A, respectively, in good agreement with the experimental results.

[Roentgenographic manifestations of peripheral bronchogenic carcinomas]

Peripheral bronchogenic carcinomas in early clinical stage are discovered by plain chest roentgenogram, and good prognosis will be expected by surgical resection. 20 bronchogenic carcinomas (18 adenocarcinomas, one squamous cell carcinoma, and one large cell carcinoma) in 19 patients were examined. 9 cases presented noduler lesion on the plain chest roentgenogram, and the other presented 7 focal patchy shadow and 4 band-like shadow. Thin-section CT could demonstrated indented pleura (95%), notch (95%), convergence of peripheral vessels (70%), irregular border (75%). In adenocarcinomas, thin-section CT demonstrated airbronchogram or airbronchiologram (61%), multiple small cavitation (61%), and heterogeneous density (56%). CT-pathologic correlation proved thin-section CT could demonstrate tumor's internal texture and fine detail of tumor-lung interface. Small peripheral lung cancer in early stage could be discovered by plain chest roentgenogram, and thin-section CT was useful for the diagnosis of small peripheral bronchogenic carcinomas, especially adenocarcinomas.

[Computed tomography of gastric cancer]

CT scans of 52 patients with advanced gastric cancer were reviewed, and the layer structure of the gastric wall was analyzed. Administration of 600 ml water, orally, expanded the gastric wall, while patients were in the prone position. Intravenous infusion of contrast media was routinely administered. We found that the normal layer structure of the gastric wall could be shown despite the cancer in the lesion. Borrmann 3 and 4 types. We guess that CT has a possibility in the assessment of the spread in the wall of gastric cancer.

Visualization of jugular vein on a thallium-201 scan for thyroid cancer

A 52 year-old woman with recurrent thyroid cancer showed an accumulation of Tl-201 chloride in the left side of the neck. This proved to be reflux and retention of Tl-201 chloride in the left internal jugular vein and was verified with a Tc-99m HSA flow study. This phenomenon could be mistaken for metastases of thyroid cancer.

Cardiomyopathy characterized by abnormal accumulation of desmin-type intermediate filaments in cardiac muscle fibers. A case report and review of the literature

A 42-year-old Japanese male, who had been suffering from congestive heart failure and electrocardiographic abnormalities (A-V block, intraventricular conduction disturbance, ventricular tachycardia), died after a clinical course of 2 years and 1 month. Macroscopic investigation revealed dilation of the left ventricle and thickening of the right ventricular wall. The unique finding in this case was a circumferential fibrous scar in the median circular layer and outer oblique layer of the left ventricular wall. Biopsy and autopsy materials revealed diffuse loss of myofibrils in the central zone of cardiac muscle fibers, and replacement with aniline blue-positive homogeneous material (17-35% of the area of one muscle fiber). Electron microscopy revealed abnormal accumulation of fine filamentous material (7.5-25 nm in diameter), which was immunohistochemically proved to be desmin-type intermediate filament. Moreover, sarcoplasmic reticulum-like material was detected in the degenerated area. At autopsy, degeneration was detected all over the heart. The ventricular muscle fibers were more severely affected than the atrial muscle fibers. The conduction system was also affected, in some parts more severely than the surrounding ordinary muscle fibers. The pathogenesis of this disorder remains to be clarified.

Oxygen exchange reaction during ATP hydrolysis by glycerinated muscle fibers, myofibrils, and synthetic actomyosin filaments

The oxygen exchange during ATP hydrolysis by glycerinated muscle fibers, myofibrils, and synthetic actomyosin filaments was studied from the distribution of the [18O]Pi species produced by the hydrolysis of [gamma-18O]ATP. The products were mixtures of two species, one with a low extent of oxygen exchange and the other with a high extent. The low and high extents of oxygen exchange in these two Pi species were the same as those of the acto-S-1 ATPase reaction through the routes with and without the dissociation of actomyosin, respectively (Yasui, M., Ohe, M., Kajita, A., Arata, T., & Inoue, A. [1988] J. Biochem. 104, 550-559). During isometric contraction of glycerinated muscle fibers at 20 degrees C, the fraction of ATP hydrolysis with low extent of oxygen exchange was 0.83 and 0.70, respectively, in 0 and 120 mM KCl. In myofibrils, the fraction of ATP hydrolysis with a low extent of oxygen exchange was 0.72-0.88 in 0-120 mM KCl at 20 degrees C. Therefore, in glycerinated muscle fibers and myofibrils ATP seems to be mainly hydrolyzed through a route without the dissociation of actomyosin, especially at low ionic strength and at room temperature when the tension development is high. ATP hydrolysis through this route may be coupled with muscle contraction.

[Thin-section computed tomography of intrapulmonary metastases after surgical resection of lung cancer]

To evaluate the morphology of small peripheral intrapulmonary metastases of lung cancers, we studied thin-section computed tomography (CT) images of 12 lesions in 5 cases (1 squamous cell carcinoma, and 4 papillary adenocarcinomas). All lesions were resected, and histopathological diagnosis of them was performed in comparison with primary lesions to differentiate multiple primary lung cancers from intrapulmonary metastases. Thin-section CT images showed mildly lobulated nodules in connection with supplying pulmonary vessels, however, indented pleura and vascular convergence were less frequently seen in intrapulmonary metastases in contrast with primary lung cancers. Thin-section CT is helpful for distinguishing multiple primary lung cancers from intrapulmonary metastases in patients with a history of surgical resection for lung cancers.

Oxygen exchange during the acto-subfragment-1 ATPase reaction: evidence for the two-route mechanism of the actomyosin ATPase reaction

The oxygen exchange occurring during the acto-S-1 ATPase reaction was analyzed based on the distribution of 18O-labeled species of P1 using [gamma-18O]ATP as a substrate. Evidence was found for the two-route mechanism in which ATP is hydrolyzed via the dissociation of acto-S-1 into F-actin and the S-1-phosphate-ADP complex, S-1PADP, and their recombination, and also hydrolyzed without the dissociation of acto-S-1 (Inoue, A., Shigekawa, M., & Tonomura, Y. (1973) J. Biochem. 74, 923-934; Inoue, A., Ikebe, M., & Tonomura, Y. (1980) J. Biochem. 88, 1663-1677). When ATP was mainly hydrolyzed without the dissociation of acto-S-1, the extent of oxygen exchange was low. When ATP was hydrolyzed by both routes, the distribution of product P1 with 3, 2, 1, and 0 18O atoms showed a mixture resulting from low and high oxygen exchange. The rate of ATPase without the dissociation of acto-S-1 can be estimated from the rate of the overall reaction (v), the rate of recombination of S-1PADP with F-actin (vr), and the extent of dissociation of acto-S-1 (a). The distribution of the P1 species measured was almost equal to that calculated from the ratio of ATP hydrolysis via the two pathways as avr and v-avr, respectively. This result indicates that the rates of the dissociation of acto-S-1PADP into S-1PADP and F-actin and their recombination are much lower than the rate of decomposition of the acto-S-1PADP complex into acto-S-1 + ADP + Pi.

Adrenocortical carcinoma in infancy. Report of a case with immunohistochemical and ultrastructural studies

A case of adrenocortical carcinoma associated with congenital heart defect in a 6-month-old Japanese girl is reported. A fist-sized tumor was incidentally noted in the right hypochondrium upon admission for cardiac surgery. No clinical endocrinopathy was evident in this case. The resected tumor was encapsulated with smooth surface and no invasion to adjacent tissues or organs was observed. Histologically, the tumor was composed of small cells with granular or clear cytoplasm, and occasional giant cells with single or multiple nuclei. By electron microscopy, the tumor cells showed various nuclear contours with distinct nucleoli and had a moderate amount of cytoplasm containing abundant rough endoplasmic reticulum and mitochondria with variable-sized electron-dense granules. Intercellular desmosome-like junctions were observed in some tumor cells. Immunohistochemically, the tumor cells contained granules positive for estriol, progesterone and cortisol. These morphological findings including electron microscopic features suggested that the tumor cells had a malignant character.

An autopsy case of diffuse myelomatosis associated with systemic kappa light chain deposition disease (LCDD). A patho-anatomical, immunohistochemical and immunobiochemical study

A case of systemic light chain deposition disease in a 48-year-old man is presented. Clinically, the patient showed the signs of multiple organ (liver, heart and kidney) failure, but multiple myeloma was not diagnosed. Autopsy revealed generalized deposition of hyaline, a Congo red-negative substance, especially in the arterial walls of various organs. In the bone marrow, myelomatous proliferations of plasma cells positive for kappa light chain were recognized. The deposited substance was ultrastructurally different from amyloid fibrils, and was identified as kappa light chain by immunohistochemistry. A liver tissue extract was immunobiochemically examined and the deposited substance was confirmed to consist of kappa light chain, its molecular weight being approximately 14,000 to 17,000 Da.

Potentiating effects of verapamil on cardiovascular teratogenicity of phenobarbital in the chick embryos

Teratogenic to subteratogenic doses of phenobarbital were administered to young chick embryos together with a calcium-blocking agent, verapamil, at doses where it alone induces no cardiovascular malformations. The cardiovascular teratogenicity of phenobarbital was significantly potentiated by verapamil (5 X 10(-11), 1 X 10(-10) mol). The alteration of calcium movement into the cell and/or depressed cardiac function following impaired calcium transport by verapamil are suggested as modus operandi in the potentiation of phenobarbital-induced cardiovascular malformations.

Silicon carbide in lung tissue of a worker in the abrasive industry

Lung tissue of a worker in an abrasive manufacturing plant, whose duration of dust exposure was about 10 years, was analyzed by means of bulk analysis and in situ analytical electron microanalysis. The content of the total dust in the lung was 120 mg/g of the dried lung tissue. This value is close to the average concentration of the total dust in the lungs of coal miners with massive fibrosis. The lung dust composition in this case was approximately 43% silicon carbide, 24% aluminium oxide, 2.3% cristobalite, 2.0% quartz, and trace of talc and feldspar. Silicon carbide may be one of the major etiologic agents in this case of pneumoconiosis.

Quantitative analysis by digital computer of 99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) hepatogram in diffuse parenchymal liver diseases

99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) hepatograms were analyzed to provide information about the liver and bile duct. Calculations were based on a four compartmental model and included corrections for blood, tissue, hepatic parenchymal and bile backgrounds. The time activity curves for 99mTc-PMT in the cardiac region were described as the sum of two exponential functions, while curves for the hepatic regions were described as the sum of three exponential components. The measured hepatograms were compared with simulations and good agreement between the two curves showed that the compartmental model adequately described the blood and bile activities in vivo. Hepatic excretion rate constants were 0.179 +/- 0.026 in three normal subjects, 0.102 +/- 0.012 in four patients with chronic hepatitis and 0.082 +/- 0.034 in six patients with liver cirrhosis. In the case of diffuse parenchymal liver disease, there were lower rate constants for the excretion from the liver to the bile ducts than in normals, and the relative distribution volumes were also larger than normal. Prior to the development of this compartmental model, no useful kinetic model had been found which could satisfactorily explain the time activity curves. Experience in human studies proves this method to be accurate in determining the rate constants for the hepatobiliary transport of 99mTc-PMT.

Primary pulmonary hypertension. Study of eight autopsy cases

Eight autopsy cases of primary pulmonary hypertension were studied. All cases were diagnosed as primary plexogenic arteriopathy. Microscopical study of the lungs showed in every case hypertensive arterial changes of Grade II-VI after Health & Edwards' criteria. Truncal pulmonary artery of three cases revealed aneurysm or severe dilatation with thrombus, and dilation was also recorded in another three cases. Histology of gross pulmonary artery in several cases presented disruption and defect of elastic fiber and alcian-blue positive microcystic change in media, lymphoid cell infiltration in outer media and inner adventitia, adventitial thickening, and intimal fibrosis. The liver of 7 cases showed secondary congestive changes and in one case intrahepatic portal vasculitis.

Hemoglobin Sendagi (beta 42 Phe----Val): a new unstable hemoglobin variant having an amino acid substitution at CD1 of the beta-chain

Hb Sendagi, a new unstable hemoglobin variant, was found in a Japanese male and his daughter, who have a moderate hemolytic anemia. The variant showed decreased stability upon heat and isopropanol precipitation tests. The variant did not separate from hemoglobin A by electrophoresis, but the abnormal beta-chain emerged ahead of the normal beta-chain on reverse-phase HPLC. Structural analyses revealed that the phenylalanine beta 42 (CD1), one of the critical amino acid residues in the heme pocket, had been replaced by valine. Oxygen equilibrium studies of the patient's hemolysates indicated that Hb Sendagi had a lowered oxygen affinity and a normal response to 2,3-diphosphoglycerate. Hb Hammersmith (beta 42 Phe----Ser) and Hb Louisville (Bucuresti) (beta 42 Phe----Leu) have previously been reported to have varying degrees of molecular instability and altered oxygen binding function. Hb Sendagi provides an additional model for elucidation of the role of the phenylalanine beta CD1 on the structure and function of hemoglobin.

Radiographic microstructures of early esophageal carcinoma: correlation of specimen radiography with pathologic findings and clinical radiography

To clarify the exact radiologic features of mucosal carcinoma of the esophagus with a favorable prognosis, contact radiography was performed on 8 surgical specimens diagnosed preoperatively as showing early or superficial carcinoma. Mucosal carcinoma appeared as a well-defined smooth or nodular protrusion or as a feathered flat mucosa with tiny nodulations and barium poolings. Submucosal carcinoma showed a mound-like defect. The size of tumor was not a good index for estimating the depth of invasion. Protruded lesions were easily demonstrated on clinical radiographs and their profile was useful in determining the depth of invasion. Flat lesions were not easy to recognize; attention must therefore be paid not only to mucosal patterns but also to the contour of the esophageal wall.

Cornelia de Lange syndrome associated with a suprasellar germinoma

A case of Cornelia de Lange syndrome complicated by a suprasellar germinoma is presented. The patient was an 18 years old girl with severe mental retardation and characteristic facial and other malformed features. She was admitted because of polyuria and polydipsia. Endocrine investigation showed defects of hypothalamic-pituitary function. The most striking finding on postmortem examination was the existence of a suprasellar germinoma extending to the optic tract and pituitary lobes. We discussed a diagnostic problem caused by the coexistence of these two uncommon entities.

Cornelia de Lange syndrome with intracranial germinoma

An autopsy case of Cornelia de Lange syndrome with intracranial germinoma is reported. Clinically, the patient was diagnosed as having this syndrome at one year of age, she was found to be suffering from diabetes insipidus at 18 years of age and soon she had an accidental death. The autopsy disclosed that the tumor grew from the hypothalamus to the optic nerve and the posterior lobe of the hypophysis. Microscopically, this tumor was a germinoma with a "two cell pattern". On the other hand, examination by peroxidase-antiperoxidase complex (PAP) method of the anterior lobe of the hypophysis demonstrated that thyroid-stimulating hormone (TSH) and follicle-stimulating hormone (FSH) producing cells had decreased.

[Therapy for recurrent breast cancer]

A multimodal treatment strategy for recurrent breast cancer is described. Occasionally, there are a few patients who have no other detectable distant metastases at the time of locoregional recurrence or of appearance of solitary lung metastasis. In such cases, curative results may be obtained with surgical treatment. In cases too extensive for surgical resection, irradiation is the treatment choice for local control. Radiotherapy is also helpful for painful bone lesions. The important basis for the multimodal approach to recurrent breast cancer is a well-balanced combination of local therapy with surgery or irradiation and systemic polychemoendocrine therapy or polychemotherapy followed by maintenance therapy, to improve the quality of life and survival of patients. Concerning the combined chemoendocrine therapy, many investigators have reported an improved effect with simultaneous or sequential use, but not all of these studies have confirmed the advantage of combination therapy over endocrine- or chemo-therapy alone, either in response rate or survival time. Further prospective randomized studies correlating ER status are needed to evaluate this approach. Immunotherapy used as a maintenance therapy may prolong the duration of remission and survival time.

Congenital nephrotic syndrome (Finnish type)

The case was a one year and four months old boy, who had been diagnosed as congenital nephrotic syndrome on the 4th day of life. He died of septicemia from peritonitis. Large pale kidneys, dilated trunk of pulmonary artery, and thickened left atrial endocardium were observed at autopsy. Renal histology seemed to be compatible with congenital nephrotic syndrome of the Finnish type. Viral antigens of herpes simplex type 1 and varicella-zoster in paraffin-embedded sections were proven to be negative. Besides renal change, increased number of pancreatic islets without hypertrophy was noticed.

Radiologic spectrum of rectal carcinoid tumors

Radiographs of 12 carcinoid tumors of the rectum were reviewed and compared with pathologic findings. There was a good correlation between the radiologic and pathologic findings with respect to tumor invasion and extent. Nine tumors that radiologically presented a smooth round defect less than 2.0 cm in diameter did not invade the muscular layer and did not metastasize. Three tumors that presented a deep crater with an irregular edge greater than 2.0 cm were found to have invaded the muscular layer and metastasized to the lymph nodes or the liver. The double-contrast enema showed an excellent detection rate; no lesion was missed by it.

Different pharmacokinetics between natural and recombinant human interferon beta in rabbits

The pharmacokinetic behavior of recombinant (r) HuIFN-beta was compared with that of fibroblast-derived HuIFN-beta in rabbits using a pharmacokinetic model analysis with a computer curve-fitting. The observed data were in good agreement with a two-compartment open model in intravenous experiment, and with a one-compartment open model in intramuscular and continuous infusion experiments. Although the parameters of elimination phase (beta, Kel or K10) were almost the same in both IFNs, there were significant differences for the parameters (alpha, K12, K21, V1, V2, Vdss) of distribution phase in intravenous experiment and for the parameter (Vd) of the steady-state level in continuous infusion experiment. These results indicate that rHuIFN-beta has a larger distribution volume and a higher distribution rate from the central compartment to the peripheral. The serum levels in intramuscular experiment represented so-called flip-flop type of kinetics. Although the absorption rate from the injection site to the blood circulation was similar in both IFNs, the availability of rHuIFN-beta was higher than that of fibroblast-derived HuIFN-beta. These results suggest that the deficiency of carbohydrate moiety conjugated with IFN molecule may influence the distribution property in vivo.