Prolactin regulatory element-binding protein is involved in suppression of the adiponectin gene in vivo

PURPOSE

Prolactin regulatory element-binding protein (PREB), a member of the WD-repeat protein family, has been recognized as a transcriptional factor that regulates prolactin promoter activity in the anterior pituitary of rats. PREB is expressed not only in the pituitary but also in various other tissues, including the adipose tissue. Previous studies have shown that PREB acts as a transcriptional regulator and suppresses the expression of the adiponectin gene in cultured 3T3L1 preadipocytes. The aim of this study was to further examine the potential role of PREB in adipose tissue in vivo.

METHODS

Transgenic mice that overexpressing PREB (PREB transgenic mice) were generated. Insulin resistance was evaluated in PREB transgenic mice using glucose and insulin tolerance tests. Adiponectin expression in the adipose tissue was examined by western blot analysis and quantitative polymerase chain reaction (qPCR). The expression levels of stearoyl-CoA desaturase (Scd) and adiponectin receptor 2(ADIPOR2) were quantified by qPCR.

RESULTS

Glucose and insulin tolerance tests revealed insulin resistance in PREB transgenic mice. Serum adiponectin and leptin concentrations were decreased. Adiponectin gene expression was decreased in the adipose tissue, which was confirmed by the downregulation of the adiponectin-dependent hepatic Scd gene and upregulation of the ADIPOR2 gene in the liver of PREB transgenic mice. We also found that pioglitazone, an agonist for the peroxisome proliferator-activated receptor-r, improved the insulin resistance in the PREB transgenic mice after a 10-day feeding period.

CONCLUSIONS

These results demonstrated that PREB might contribute to the regulation of adiponectin gene expression in vivo.

Clinical evaluation of plasma insulin and C-peptide levels with 3 different high-flux dialyzers in diabetic patients on hemodialysis

AIM

Changes in plasma immunoreactive insulin (IRI) and connecting-peptide immunoreactivity (CPR) concentrations during hemodialysis (HD) were evaluated in diabetic HD patients with 3 different high-flux membranes. The removal properties of the membranes were compared.

METHOD

In this prospective controlled study, 15 stable diabetic patients on HD were randomly selected for 6 HD sessions with 3 different membranes: polysulfone (PS), cellulose triacetate (CTA), and polymethylmethacrylate (PMMA). Blood samples were obtained from the blood tubing at the arterial (A) site at the beginning and end of the sixth HD session. At 60 minutes after dialysis initiation, blood samples were obtained from both the A and venous (V) sites of the dialyzer to investigate the clearance and removal properties of the membranes.

RESULTS

The plasma IRI and CPR levels decreased significantly at each time point with all 3 membranes. IRI clearance with the PS membrane was significantly higher than that with the CTA and PMMA membranes. No difference was observed in the IRI reduction rate between the 3 membranes. CPR clearance and reduction rate with the PMMA membrane were lower than with the PS and CTA membranes. No significant difference was observed in serum creatinine clearance and reduction rates between the 3 membranes; however, serum urea nitrogen clearance was significantly lower with the PMMA membrane compared with the PS and CTA membranes. A significantly high beta2-microglobulin clearance and reduction rate was achieved in the order PS > CTA > PMMA.

CONCLUSION

Plasma IRI and CPR are cleared by HD; their clearance rates differ with the dialyzer membranes. Plasma IRI clearance with the PS membrane is higher than that with the CTA and PMMA membranes.

Recurrent chondromyxoid fibroma of the thoracic spine 30 years after primary excision: case report and review of the literature

We report a case of late recurrence of chondromyxoid fibroma (CMF) arising in a thoracic vertebra in an 11-year-old male. This was treated by curettage, and 30 years later, the patient noticed shoulder pain and leg weakness. A recurrent mass appeared at the same site in the spinous process of T6. The histologic features of the recurrent tumor were similar to those of the primary lesion. A total of 38 cases of CMF of the vertebra have been reported. Only 3 of 38 previously reported vertebral CMF recurred. Tumors recurred 2 years after operation in 2 cases, and 7 years after operation in 1 case.

Immunoglobulin D myeloma presenting as an extraosseous soft tissue tumor

We report a 69-year-old man who suffered an extraosseous tumor of immunoglobulin D myeloma (lambda type) in the shoulder girdle, mimicking a primary soft tissue sarcoma. The tumor was isointense with adjacent muscle on T1-weighted MR images, and hyperintense on T2-weighted images. No continuity with the neighboring bone was noted. After administration of gadolinium, the central part of the tumor showed marked contrast enhancement. Although the tumor showed a complete response to the initial chemotherapy, the patient died of the disease 31 months after its initial manifestation. Several bone marrow aspirations and biopsies of the ilium and sternum had shown no increase in plasma cells (range 0.6-1.2%) until the disease became advanced 19 months after its initial manifestation.

Intravascular ultrasound imaging before and after angioplasty for stenosis of arteriovenous fistulae in haemodialysis patients

BACKGROUND

Complications of haemodialysis vascular access have emerged as a major cause of patient morbidity. Intravascular ultrasound imaging is a new technical modality providing visualization of the vessel lumen and wall structure in a cross-sectional fashion. Percutaneous transluminal angioplasty has long been used in the treatment of stenoses of arteriovenous fistulae. However, there is no detailed quantitative information on the stenotic lesion and the morphological change by angioplasty.

METHODS

Intravascular ultrasound studies were performed in 40 haemodialysis patients with 63 stenoses in arteriovenous fistulae who had percutaneous transluminal angioplasty. The patients were qualitatively and quantitatively evaluated for echogenic patterns and morphological changes before and after angioplasty.

RESULTS

Morphological plaque features in stenotic lesions were classified as 37 soft (58%), five hard (8%), 20 mixed (32%), and one calcified sites. Plaque fractures after angioplasty were detected in 45/63 (71%) instances. The lumen cross-sectional area was found to be dilated approximately threefold (from 3.8+/-2.4 to 11.1+/-4.5 mm(2)) and the external elastic membrane cross-sectional area was dilated approximately twofold (from 11.1+/-5.3 to 19.8+/-8.1 mm(2)) after angioplasty.

CONCLUSION

These results indicate that intravascular ultrasound allows both qualitative and quantitative assessments of arteriovenous fistulae in haemodialysis patients. The results further suggest that the mechanism of expansion of arteriovenous fistulae stenoses by percutaneous transluminal angioplasty involves stretching of the vessel wall as well as plaque fractures.

[The influence of correction of acidosis on plasma level of branched-chain amino acids in chronic hemodialysis patients]

Seven patients undergoing chronic hemodialysis three times a week and whose plasma bicarbonate concentration on predialysis was consistently under 18 mmol/l due to bicarbonate dialysis (BCD), were treated with BCD for 2 weeks, then switched to acetate-free biofiltration (AFB) for 8 weeks. In both periods, the same high flux dialyzer (AN69HF) was used. The treatment time, dialysate flow rate and blood flow rate were kept constant in each patient during both periods. Plasma bicarbonate concentration (HCO3-), serum urea nitrogen (SUN), serum creatinine (Cr) and plasma amino acids concentrations (AA) were measured before dialysis and KT/V was calculated on the 2nd days of the last week in both periods. HCO3- on AFB was significantly higher than that on BCD (16.4 +/- 0.9 vs 19.9 +/- 1.8 mmol/l; p < 0.05). SUN on AFB was significantly lower than that on BCD even though the dialysis schedule and dietary content were not changed (84.7 +/- 3.7 vs 76.6 +/- 3.8 mg/dl; p < 0.05). TP, Cr and KT/V were not significantly different. Plasma total amino acid concentration (TAA) and plasma essential amino acid concentration (EAA) were not significantly different in both periods. In contrast, plasma branched-chain amino acid concentrations (BCAA) on AFB were significantly higher than that on BCD (313.5 +/- 44.3 vs 390.3 +/- 50.7 mumol/l; p < 0.05). Plasma BCAA concentrations, valine (VAL), leucine (LEU) and isoleucine (ILE), were significantly higher on AFB than that on BCD, respectively (p < 0.05). These findings suggest that optimal correction of the metabolic acidosis in chronic hemodialysis patients by AFB leads to a significant increase in plasma BCAA concentration.

Characterization of the binding of nuclear envelope precursor vesicles and chromatin, and purification of the vesicles

The binding of nuclear envelope precursor vesicles and chromatin was characterized by using an in vitro system constituted from a Xenopus egg extract and demembranated Xenopus sperm chromatin. The results of binding studies in the presence of salts, urea, and a chelator showed that the binding involves an ionic interaction. Chemical modification studies suggested that a protein(s) in the vesicles, which is responsible for the binding with chromatin, has essential lysine, histidine, and methionine residues. The vesicle protein could not be extracted from vesicles with 1 M KCl, 2 M urea, or 0.1 M Na2CO3, suggesting that it is an intrinsic membrane protein. The protein was denatured with 8 M urea and 0.1 M Na2CO3, and could be renatured by incubation at 23 degrees C, suggesting that the native conformation of the protein is important for the binding. Affinity purification of nuclear envelope precursor vesicles was achieved by binding to chromatin and dissociation with 0.24 M NaCl. The vesicle fraction thus obtained exhibited the ability to form nuclear envelope on incubation with chromatin in Xenopus egg cytosol without any other membrane fraction. These results suggested that there is a nuclear envelope precursor vesicle population containing both a chromatin targeting protein and vesicle fusion machinery.

Effect of the hydroxyl group on the oxidative cleavage (beta-oxidation) of steroidal side chain for bile acid biosynthesis in rat liver homogenate

Mono-, di-, tri-, and tetrahydroxy-5 beta-cholestan-26-oic acids were incubated with rat liver homogenate (800 x g supernatant and light mitochondrial fraction) to study substrate specificity in the side-chain cleavage reaction (beta-oxidation) of bile acid biosynthesis. The C27-intermediates (5 beta-cholest-24-en-26-oic acids and 24-hydroxy-5 beta-cholestan-26-oic acids) in beta-oxidation and the corresponding C24-bile acids were quantitatively determined by capillary gas chromatography. Monohydroxy-5 beta-cholestan-26-oic acid was not converted into C24-bile acid. Di- and trihydroxy-5 beta-cholestan-26-oic acids were effectively transformed into the C27-intermediates and C24-bile acids. Tetrahydroxy-5 beta-cholestan-26-oic acids were also converted into C27-intermediates and corresponding C24-bile acids. The intermediate 24-hydroxy-5 beta-cholestan-26-oic acids could not be detected in the products by incubation with the light mitochondrial fraction. The total specific activity of protein in the light mitochondrial fraction for the production of C27-intermediates and C24-bile acids was higher than that of 800 x g supernatant solution. The effects of the number and the position of hydroxyl groups on the side-chain degradation are discussed.

Neuropathological findings in the cerebro-oculo-facio-skeletal (Pena-Shokeir II) syndrome

An autopsy case is described of an infant with cerebro-oculo-facio-skeletal (COFS) (Pena-Shokeir II) syndrome who died of pneumonia at the age of 5 months, and the pathology of the CNS in this case and the cases in literature were reviewed. Neuropathological examination revealed a partial defect of the corpus callosum, lobulation of the caudate nucleus and putamen, polymicrogyria in the parietal lobes and neuronal heterotopia in the cerebral and cerebellar white matter. The migration disorders suggest that the onset starts in the early fetal period.

Primary biliary cirrhosis sera recognize not only gp210 but also proteins of the p62 complex bearing N-acetylglucosamine residues from rat liver nuclear envelope. Anti-p62 complex antibody in PBC

We have recently observed reactivity of primary biliary cirrhosis (PBC) sera with several proteins bearing N-acetylglucosamine residues from rat liver nuclear envelopes. The aim of this study was to characterize the reactive antigens. Sera from 31 patients with PBC, 30 with rheumatoid arthritis (RA) and 30 with Sjögren's syndrome (SS) were examined. Rim-like immunofluorescence staining was observed in 15 of 31 (48%) sera from patients with PBC, in 1 of 30 with RA and in 1 of 30 with SS. Upon immunoblotting using preparations of whole rat liver nuclear envelopes and their Triton X 100-KCl extract as antigen sources, a 200 kDa protein band was observed in 9 of sera with PBC. Furthermore, upon immunoblotting using the wheat germ aggulutinin-bound fraction of rat liver envelope as antigen, 62, 60 and 54 kDa protein bands corresponding to components of the p62 complex in the nuclear pore complex (Kita et al. Biochem. 113, 377-382) were observed in 7, 5 and 6 samples respectively, of the 31 PBC sera. Our data suggest that PBC sera recognize not only the 210 kDa protein but also the p62 complex proteins.

[Operative removal of esophageal leiomyosarcoma: a case report]

This is a case report of 56-year-old man complaining of dysphasia. Upon admission, his chest X-ray film revealed medium amount of fluid accumulation in the right pleural space. Cytological examination of the aspirated fluid revealed nothing particular. Preoperative radiological examination including esophagogram, CT and MRI demonstrated cystic appearance of mass lesion, measuring approximately 5 cm in size located in posterior aspect of the lower portion of the mediastinum. Upon operation, it was found that a tumor with pedunculated connection to the esophageal muscle layer, suspecting diagnosis of leiomyoma of the esophagus. Then, tumor was removed together with the part of esophageal muscle. Postoperative pathology reported leiomyosarcoma of the esophagus with low grade malignancy. We added no esophagectomy. He made uneventful recovery without no sign of recurrence of the malignancy, 4 years after the surgery.

Inheritance of seed α-amylase inhibitor in the common bean and genetic relationship to arcelin

The inheritance of seed α-amylase inhibitor in the common bean and the genetic relationships among the variants and six arcelin variants in the common bean were investigated by crossing between accessions containing different αAI and arcelin variants. All seed proteins in parental, F1 and F2 seeds from the crosses were examined by Western-blot analysis. All F1 seeds gave combined αAI banding patterns from parents on the blotting membranes. The segregation of F2 seeds for αAI variants indicated that the polypeptides of αAI variants were inherited as single co-dominant units. Moreover, αAI and arcelin behaved as a single block in crosses, indicating a close linkage relationship between the genes controlling these proteins.

Variation of seed α-amylase inhibitors in the common bean

Variation of seed α-amylase inhibitors was investigated in 1 154 cultivated and 726 non-cultivated (wild and weedy) accessions of the common bean, Phaseolus vulgaris L. Four α-amylase inhibitor types were recognized based on the inhibtion by seed extracts of the activities of porcine pancreatic α-amylase and larval α-amylase and larval α-amylase of the Mexican bean weevil, Zabrotes subfasciatus Boheman. Of the 1 880 accessions examined most (1 734) were able to inhibit porcine pancreatic α-amylase activity, but were inactive against the Z. subfasciatus larval α-amylase; 41 inhibited only the larval α-amylase activity, 52 inhibited the activities of the two α-amylases, and 53 did not inhibit the activity of either of the α-amylases. The four different inhibitor types were designated as αAI-1, αAI2, αAI-3, and αAI-0, respectively. These four inhibitor types were identified by the banding patterns of seed glycoproteins in the range of 14-20 kDa by using SDSpolyacrylamide gel electrophoresis. Additionally, four different banding patterns were recognized in accessions with αAI-1, and were designated as αAI-1a, 1b, 1c, and 1d. Two different patterns of the accessions lacking an α-amylase inhibitory activity were identified and designated as αAI-0a and αAI-0b. The largest diversity for seed α-amylase inhibitors was observed in non-cultivated accessions collected from Mexico where all eight inhibitor types were detected. The possible relationships between the variation of seed α-amylase inhibitors and bruchid resistance are discussed.

Effects of recombinant human erythropoietin (rHuEPO) on nutritional status of hemodialysis patients: investigation of direct anabolic effects of rHuEPO

To investigate whether the nutritional improvement achieved by recombinant human erythropoietin (rHuEPO) treatment is the result of anemia correction with rHuEPO or the direct anabolic effects of rHuEPO per se, nutritional assessment was performed in 2 studies (study I and II) on hemodialysis (HD) patients. Nutritional assessment included blood biochemistry determinations, anthropometric measurements, daily protein intake (DPI) and dialysis efficiency. In study I, 5 HD patients who had not been given rHuEPO and had a hematocrit (Hct) of < or = 25%, were administered rHuEPO at the initial dose of 96.2 U/kgBW. Nutritional assessment of these patients was performed before rHuEPO treatment and every 4 weeks until the 24th week after rHuEPO treatment. In study II, the same nutritional assessment as in study I except for DPI, was performed in 2 groups with the same Hct level and dialysis regimen; an EPO group (n = 8) previously given rHuEPO (88.2 +/- 13.7 U/kgBW, 25.8 +/- 2.5 mos) and a non-EPO group (n = 8) not given rHuEPO. In study I, the mean Hct level was significantly increased 4 weeks after rHuEPO treatment (23.3 +/- 0.6 to 26.9 +/- 0.9%). However, the nutritional parameters and dialysis efficiency were nearly constant over 24 weeks, suggesting either the absence of a short-term direct anabolic effect of rHuEPO or masking of such an effect due to general condition improvement by anemia correction with rHuEPO. In study II, no significant differences in nutritional assessment were confirmed between the groups, suggesting that a long-term direct anabolic effect of rHuEPO may not exist and nutritional improvement may result from correction of anemia with rHuEPO.(ABSTRACT TRUNCATED AT 250 WORDS)

A case complicated with SLE during maintenance hemodialysis

A 40-year-old woman suffered from toxemia of pregnancy in 1977 and was admitted to hospital. Thereafter, she developed nephrotic syndrome, underwent a renal biopsy, and a diagnosis of membranoproliferative glomerulonephritis (MPGN) was made. She received steroid therapy, immunosuppressive drug and anticoagulant therapy, and recovered sufficiently to be discharged from hospital in April, 1979. During subsequent ambulatory treatment at our outpatient department, her renal function deteriorated gradually, and maintenance hemodialysis was started from June, 1990. In July, 1991, she was admitted to our hospital with pleurisy and pericarditis. There was no improvement despite antibiotic treatments. Laboratory data revealed leukopenia and lymphopenia. Under suspicion of systemic lupus erythematosus (SLE), relevant tests were carried out. Immunological abnormalities such as positive LE cells and the presence of various autoantibodies, together with clinical signs of hypersensitivity to sunlight, stomatitis and serositis, satisfied the diagnostic criteria of the ARA and a diagnosis of SLE was made. This case did not exhibit any clinical or serological abnormalities except for the renal disorder for a 10-year period after the histological diagnosis of MPGN, but was eventually diagnosed as SLE as a result of the manifestation of SLE symptoms for the first time after one year of maintenance hemodialysis. Immunological abnormalities and SLE during maintenance hemodialysis are discussed in relation to other reports.

How long can continuous ambulatory peritoneal dialysis be continued?

We investigated how long continuous ambulatory peritoneal dialysis (CAPD) could be continued in the face of peritoneal sclerosis. 15 CAPD patients with no experience of peritonitis were selected and the time limitation for CAPD was examined retrospectively, based on the dialysate osmolality, serum creatinine concentration, etc.. The values for the dialysate osmolality and serum creatinine concentration increased gradually with the duration of CAPD and were significantly increased from 6 months. 5 patients whose serum creatinine concentration during the first 6 months after initiation of CAPD increased more than 5 mg/dl, could not continue CAPD for more than 24 months because of the appearance of peritoneal membrane failure. When the time limitation for CAPD was assessed in 10 stable patients, close relationships between the mean dialysate osmolality and duration of CAPD (Y = 0.52X + 351.25, r = 0.83, P < 0.01), and between the mean serum creatinine concentration and duration of CAPD (Y = 0.18X + 6.84, r = 0.95, P < 0.001) were recognized. If the practical limitation for CAPD was set at 400 mOsm/l in terms of the dialysate osmolality or 20 mg/dl in terms of serum creatinine concentration, its value became 94.1 months or 73.1 months, respectively. It is concluded that the time limitation for CAPD can be expected to be approximately 6 to 8 years in stable CAPD patients, and we need to resolve CAPD-induced problems involving the peritoneal membrane in order to continue CAPD for more than 10 years.

A clinicopathological and immunohistochemical study of osteofibrous dysplasia, differentiated adamantinoma, and adamantinoma of long bones

A clinicopathological and immunohistochemical study of 12 cases of osteofibrous dysplasia (OFD), two cases of differentiated adamantinoma, and five cases of adamantinoma of long bones is presented. Although OFD and differentiated adamantinoma showed similar radiologic findings, differentiated adamantinoma was more likely to be a recurrent lesion than osteofibrous dysplasia and seemed to require a more extensive surgical procedure. Immunohistochemically, cytokeratin- and vimentin-positive cells were seen in both OFD and differentiated adamantinoma. The positive cells were scattered in the former, and were both scattered and nest-like in the latter. Both these lesions, however, were negative for epithelial membrane antigen. Excluding two cases of Ewing-like adamantinoma, the other three cases of adamantinoma were also positive for cytokeratin and vimentin. These results suggest that these three lesions share the same histogenetic origin. The two cases of Ewing-like adamantinoma differ from tibial adamantinoma in their radiological, histological and immunohistochemical aspects, and seem to constitute a distinct variant of adamantinoma with a different histogenesis.

Malignant fibrous histiocytoma and osteosarcoma in association with fibrous dysplasia of bone. Report of three cases

Three cases of bone sarcomas arising in fibrous dysplasia (FD) without prior radiation therapy were reported. One of the tumors was a conventional osteoblastic osteosarcoma (OS) and the other two were malignant fibrous histiocytomas (MFH). The lesion of FD was monostotic in two patients and polyostocic (monomelic) in one. Bone sarcomas and FD were detected simultaneously in all cases. One of the MFH cases died 6 months after diagnosis, and the other MFH case and the OS case are alive without disease 3 years and one and a half years after surgery, respectively. Conservative treatment has been selected in most of the patients of FD. We should closely follow up these patients, because bone sarcomas such as OS and MFH could arise at the site of FD. This is the first report of the cases of MFH of bone arising in FD.

Retrotransposon families in rice

Three families of retrotransposons of rice (Tos1, Tos2, and Tos3) were isolated by using a method based on the sequence conservation of the primer binding site for reverse transcription. This method should be generally applicable for cloning retrotransposon of other plants. One retrotransposon, Tos3-1, was studied in detail. Tos3-1 is 5.2 kb long, has structures common to retrotransposons, such as long terminal repeats (LTR), a primer binding site complementary to the initiator tRNA, a polypurine tract, and generates target sequence duplications flanking the inserted element. Southern blotting analysis showed that sequences homologous to Tos1, 2 and 3 are found in wild rice species as well as in cultivated rice species, but not in maize and tobacco. The copy number and genomic location of the families vary in different strains of one species of wild rice, suggesting that these elements may still be active. Retrotransposons were also screened for by amplification of the reverse transcriptase coding region using the polymerase chain reaction (PCR). At least two types of copia-like elements (Tos4 and Tos5) were found. The total copy number of retrotransposons in the rice genome was estimated to be about 1000. These results suggest that, as in Drosophila, retrotransposons are the major transposon class in rice.

Case report 727. Juxtacortical adamantinoma of humerus (simulating Ewing tumor)

A case of adamantinoma of the humerus with Ewing-like pathological features has been reported. In addition to the unusual pathological features, the apparently juxtacortical location of the lesion is of great interest--also a highly unusual feature for an adamantinoma.

Structural homology between semidwarfism-related proteins and glutelin seed protein in rice (Oryza sativa L.)

Two semidwarfism-related proteins, SRP-1 and SRP-2, were detected as major spots in a long-culm rice cultivar, Norin 29 and its semidwarf near-isogenic line, SC-TN1, respectively, by two-dimensional gel electrophoresis (2D-PAGE). The testcross showed that SRP-1 and SRP-2 are controlled by codominant alleles, Srp-1 and Srp-2, respectively, at a single locus Srp. This locus was considered to be closely linked with the semidwarfing gene locus sd-1. SRP-1 and SRP-2 were separated by 2D-PAGE, electroblotted onto a polyvinylidene difluoride membrane, and sequenced by a gas-phase protein sequencer. The N-terminal amino acid sequences, however, could not be determined due to the blockage of the N-terminals of these proteins. After removal of the N-terminal residue with pyroglutamyl peptidase given to the membrane, the amino acid sequence in the N-terminal region was determined. The N-terminal and internal amino acid sequences of SRP-1 and SRP-2 were highly homologous with those of the glutelin α-subunits of seed endosperm storage protein, which were deduced by the cDNA sequences. In the seed endosperms of Norin 29 and SC-TN1, a total of eight glutelin α-subunits was identified by 2D-PAGE. The amino acid sequences in the N-terminal and internal regions of these proteins were determined. This experiment confirmed that SRP-1 and SRP-2 are almost identical in structure with the glutelin α5a- and α5b-subunits, respectively, which were identified in several organs such as endosperms, embryos, and leaves, unlike the other glutelin α-subunits.

[A case of adult type of anomalous origin of left coronary artery from pulmonary artery--with a referential consideration to the disease in Japan]

A case of a 33-year-old man with anomalous origin of the left coronary artery from the pulmonary artery (ALCP) was reported with a referential consideration to the adult type of ALCP previously reported in Japan. The patient visited our hospital for further examination of cardiac murmur detected on a mass physical checkup. He was found to have a continuous murmur, the loudest in the left sternal border of 3rd intercostal space, and developed evidence of ischemia during the exercise stress test in the ECG leads of L2, L3, aVF, and V2 through V6. In addition, studies using echocardiography and color Doppler-echocardiography detected a hypertrophied intraventricular septum and a pattern of turbulent blood flow in the proximal pulmonary artery. Cardiac catheterization and aortography proved the existence of ALCP with a markedly developed collateral circulation from the right coronary artery to the left coronary artery. After surgical restoration by ligating the anomalous opening of the left coronary artery, and by bypass grafting to the left coronary artery, it was clear that dilation and kinking of the right coronary artery was lessened and hypoperfusion in the anterior left ventricular wall was improved. As far as we know, this case is the 35th of adult type ALCP reported in our country. Results from this case and others suggest that early detection and therapy for adult type ALCP is important from the point of view preventing ischemic progression, and indicate that restoration by ligation and bypass grafting may be one of the effective surgical procedures for ALCP.

[Coronary venous oxygen saturation dynamics during intracoronary infusion of ergonovine or acetylcholine in vasospastic angina]

We investigated changes in coronary venous oxygen saturation (CSO2-Sat) dynamics during intracoronary infusion of ergonovine (ERG) or acetylcholine (ACh) in patients with vasospastic angina. In 16 patients with suspected vasospasm in the left coronary artery, intracoronary ERG injection provoked vasospasm in 4 out of 6 patients, and intracoronary ACh in 6 out of 11 patients. A gradual decrease in CSO2-Sat, anteceding angina and ischemic ECG evidence, was characteristic in ERG-induced vasospastic patients, while no significant change of CSO2-Sat was observed in non ERG-induced patients. Intracoronary infusion of ACh was followed in all 11 patients by a transient increase in CSO2-Sat, suggesting decreased myocardial oxygen extraction due to increased coronary blood flow with ACh. However, earlier and sudden decreases in CSO2-Sat below the control levels were characteristic in 6 patients with ACh-induced vasospastic angina. These findings suggest that effects of ERG and ACh on coronary flow dynamics are essentially different although both drugs can provoke vasospasm.

Histological grading and morphometric analysis of cartilaginous tumours

Morphometric analysis of cartilaginous tumours was performed on 25 chondrosarcomas, 9 cases of enchondroma (ENCH), and 2 chondroblastic osteosarcomas (CBOS). The chondrosarcomas were classified into three grades of malignancy according to Evans' histological classification and were further divided into low and high grades of malignancy. Cellularity, nuclear area, binucleate cells and mitotic figures were examined using formalin-fixed and paraffin-embedded specimens. The cellularity was significantly higher in high-grade chondrosarcoma (HGCS) than in low-grade chondrosarcoma (LGCS) (P less than 0.005). The nuclear area was larger in more malignant lesions. Significant differences in the nuclear area were found between ENCH and LGCS (P less than 0.005) and between LGCS and HGCS (P less than 0.01). Binucleate cells were found more frequently in LGCS than in ENCH (P less than 0.005). Although a few mitotic figures were found in HGCS, they were extremely rare in chondrosarcomas. Mitotic figures, however, were easily found in CBOS when compared with HGCS (P less than 0.05). These results suggest that nuclear area and binucleate cells are useful for differentiation between benign and malignant cartilaginous lesions and that easily detectable mitotic figures are a reliable marker for neoplastic cartilage in osteosarcoma.

Identification and genetic analysis of semidwarfism-related proteins in rice (Oryza sativa L.)

By transferring a semidwarf gene (sd-1) from Taichung Native 1 into a tall Japanese cultivar, Norin 29, through seven backcrosses, a semidwarf near-isogenic line SC-TN1 was obtained. The proteins of the embryo in Norin 29 and SC-TN1 were separated by two-dimensional electrophoresis. Most of the proteins showed the same electrophoretic pattern. However, it was found that there was a difference in the appearance of two basic glycoproteins designated as SRP-1 and SRP-2. These proteins exhibited the same molecular mass, but different isoelectric points. Hybridization results indicated that a single locus controls SRP-1 and SRP-2 with codominant alleles. The gene symbol Srp was given to this locus, with alleles Srp-1 and Srp-2 responsible for SRP-1 and SRP-2, respectively. Srp-2 was found in all of the semidwarf cultivars and lines having sd-1, except a tall cultivar Tsaiyuan-chung. This finding suggests that Srp-2 may be closely linked with sd-1. The amounts of these proteins markedly increased after water absorption of the seed, suggesting that these proteins may be related to the early development of the plant.

[Estimation of myocardial oxygen extraction dynamics in effort angina by continuous measurement of coronary venous saturation]

To estimate myocardial oxygen extraction dynamics in the situation of increased myocardial oxygen requirement, we made a continuous measurement of coronary venous oxygen saturation (CSO2-Sat) using the fiberoptic catheter system and a measurement of myocardial lactate extraction ratio (MLER) in 14 patients. Ten patients showed ischemic ST depression and/or anginal episodes during the pacing loading, while 4 patients did not. Although transient decreases in CSO2-Sat were observed in the non-ischemic 4 patients immediately after the initiation of pacing or with the increase in pacing rate. CSO2-Sat and MLER remained almost unchanged from the start of pacing to the time of maximal pacing. However, in the 10 patients who developed ischemia, CSO2-Sat fell from 39.5 +/- 1.8% before pacing to 32.9 +/- 2.8% at the time of maximal pacing (p less than 0.05), with an average decrease of 6.6 +/- 2.8%. Data of MLER obviously indicated the appearance of myocardial ischemia (32.1 +/- 4.7% to 9.2 +/- 10.3%, p less than 0.05). These findings suggest that myocardial oxygen extraction will increase transiently or continuously to meet the myocardial oxygen demand when increase in coronary blood flow is limited. Continuous measurement of coronary venous saturation may be useful for the early detection of myocardial ischemia.

[A case of myocardial infarction due to the left main trunk lesion, in which percutaneous coronary recanalization and emergency coronary-aorto bypass graft, and subsequent percutaneous coronary angioplasty were effective not only from a viewpoint of survival but from comeback to social life]

A case of acute myocardial infarction due to the lesion in the left main coronary artery was reported. A 50-year male was referred to our department for suspected acute myocardial infarction. Physical examination on admission revealed slight cyanosis with cold sweating due to severe chest pain. Pulse was irregular and heart rate was 78 beats/min. Blood pressure was 100/80 mmHg. A series of electrocardiograms (ECG) and laboratory data provided the diagnosis of wide-ranged anterolateral infarction in the left ventricle. Emergency coronary angiograms taken without delay showed a subtotal occlusion (99% stenosis) of the left main coronary trunk (LMT) before the initiation of intracoronary thrombolysis (PTCR). Following the intracoronary infusion of urokinase of 1,200,000 units, symptoms and ECG changes transiently improved but worsened later, and LMT stenotic lesion and delayed filling of myocardium were similar with before PTCR. Emergency coronary-aorto bypass graft (CABG) was undertaken without a significant delay to both the left anterior descending artery (LAD) and left circumflex coronary artery (LCX). With these treatments, the patient could survive despite the wide area of infarction due to LMT lesion. Coronary angiograms performed 37 days after the CABG showed that the graft to LAD was completely occluded and the LCX graft was patent with partial stenosis. Treadmill test at this time induced an anginal episode with ischemic ECG changes on moderate exercise, indicating the presence of significant area of ischemic myocardium. For salvage of the ischemic myocardium, percutaneous transluminal coronary angioplasty (PTCA) was successfully performed for the LMT stenosis, resulting in no episode of angina nor ischemic ECG changes during exercise loading.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary hemodynamics in a patient developing chest pain in the middle age in congenital coronary-pulmonary fistula]

Recently reports of congenital coronary-pulmonary fistula have been increasing with the wide-spread use of coronary angiography. However, the cause of the angina sometimes seen as a chief complaint in coronary fistula has not been well demonstrated although it has been suggested that coronary steal phenomenon accounts for it. This report documented coronary hemodynamics in a patient who came to develop anterior chest pain in the middle age owing to congenital coronary-pulmonary fistula, measuring coronary flow before and after the fistula-closure operation. A 35-year-old woman suffered from a sudden onset of severe anterior chest pain in April, 1986. She was referred to our hospital on suspicion of ruptured aneurysm of Valsalva. Auscultation disclosed continuous murmur at 3 LSB, but no evidence of ruptured aneurysm of Valsalva was detected by echocardiography nor aortography. Coronary angiography showed both left and right coronary fistula into the stem of pulmonary artery and otherwise normal angiogram. Great cardiac vein flow (GCVF) measured with regional thermodilution method was 25 ml/min at rest (70 bpm) and 30 ml/min during rapid atrial pacing (150 bpm) before the operation, and 30 ml/min (78 bpm) and 58 ml/min (150 bpm) after the operation, respectively. Before the surgery, anterior coronary resistance (CRant) was higher than that in normal subjects at rest and remained almost steady during atrial pacing. After the surgery, CRant was still higher at rest but remarkably reduced during pacing of 150 bpm. These findings suggest that the gradual increase in peripheral coronary resistance for a long time may lead to the inducement of coronary steal in the middle-later age in patients with coronary fistula.

[Radiological and electron microscopic examination on epulis osteoplastica]

Epulis osteoplastica was examined with soft X-ray radiography, scanning electron microscopy (SEM) and electron probe X-ray microanalizer (EPMA). Extracted epulis tissue from the incisor region of mandible was offered to this examination. The soft X-ray radiograms showed well defined radiopaque trabecular structures in the soft tissue. The pathological findings with HE staining revealed that these structures were bone tissues. The SEM images demonstrated irregularly shaped trabecular structures with fine bone tissues. The EPMA images obtained from the same specimen supported the findings.

[A case of left atrial ball thrombus observed in a patient with combined valvular heart disease, accompanying anomalous coronary venous run]

A 53-year woman, who had been under observation for combined valvular heart disease, was admitted to our hospital for further examination of embolic episodes to brain and kidney. Echocardiographic examination showed the evidence of free-moving ball thrombus in the left atrium, and emergent cardiac catheterization following the echocardiography confirmed the diagnosis of it as well as mitral stenosis, aortic regurgitation with stenosis, and tricuspid regurgitation. In addition, coronary angiography disclosed the anomalous coronary venous run. With these findings, the cause of embolic episodes was found to be due to the thrombus in the left atrium. In the surgery performed a ball thrombus of 40 x 35 x 36 mm and a mural thrombus of 15 x 35 x 20 mm in size in the left atrium were detected and removed, and both mitral and aortic valves were replaced to artificial ones. She had a good hospital course after the surgery and discharged without any complication. In this report, we discussed a case of left atrial thrombus observed in a combined valvular heart disease, with 29 literatures reported in our country.

Rhabdomyosarcoma with bone marrow metastasis simulating acute leukemia. Report of two cases

Rhabdomyosarcoma manifested as a systemic disease is very rare and cases showing diffuse metastasis in the bone marrow are most unusual. Recently we encountered two cases of rhabdomyosarcoma with diffuse bone marrow metastasis which were clinically manifested as acute leukemia. The first patient was a 15-year-old female, who was admitted in 1982 with pancytopenia and many large primitive cells in bone marrow aspirates, hematological malignancy being diagnosed. Thereafter the bilateral breasts showed rapid swelling and a biopsy specimen revealed the histological features of typical alveolar rhabdomyosarcoma. The primary site of the neoplasm remained undetermined during the course. At autopsy, it was disclosed that the neoplasm originated from the left thigh and showed generalized metastasis. The second patient was a 38-year-old man, who was admitted in 1986 because of a nasal polyp obstructing the nasal cavity, and persistent nasal bleeding. Peripheral blood samples showed leukoerythroblastosis and thrombocytopenia, and large primitive cells were found in bone marrow aspirates, so that hematological malignancy was initially diagnosed. A biopsy specimen of the nasal polyp showed proliferation of large round cells and electron microscopy demonstrated the ultrastructural features of rhabdomyosarcoma.

Acute, massive, haemorrhagic adrenal necrosis experimentally produced by the Shwartzman mechanism in rabbits

Acute and severe haemorrhagic necrosis of the adrenal was produced experimentally in rabbits by means of intravenous injection of endotoxin after pretreatment by adrenocorticotropic hormone (ACTH) administration. The change occurred mainly in the zona fasciculata of the adrenal cortex, and its pathology was quite similar to that of the Shwartzman reaction. Numerous microthrombi were found in and around the lesion, but no marked changes were seen in other parts of the body. Heparin administration was very effective in preventing the necrosis. The pathogenesis of this lesion was postulated to be a univisceral Shwartzman mechanism in the adrenal. This seems to be a good experimental model for massive haemorrhagic necrosis of the adrenal in man, for example in the Waterhouse-Friderichsen syndrome, the pathogenesis of which has been assumed to involve intravascular clotting. It is suggested that hyperfunction of the adrenal cortex caused by ACTH administration could be a preparative condition for the Shwartzman reaction.

Adenosine triphosphatase activity of crystalline inclusions in alveolar soft part sarcoma. An ultrahistochemical study of a case

A case of alveolar soft part sarcoma was studied by light and electron microscopy and by electron microscopic enzyme histochemistry of adenosine triphosphatase (ATPase) and 5'nucleotidase(5'Nase). The tumor showed distinct alveolar pattern and diastase resistant PAS positive crystalline inclusions were found in the cytoplasm. Ultrastructurally, characteristic rhomboid crystals and dense granules were observed and they were positive for Mg++- and Ca++-ATPases but negative for 5'Nase. Tumor cell membrane also showed positive activity of ATPase in addition to 5'Nase. These results would support the myogenous derivation of alveolar soft part sarcoma.

[Right ventricular free wall imaging using thallium-201 exercise myocardial scintigraphy with special reference to coronary angiography]

Right ventricular wall images of ischemic heart disease were evaluated during exercise myocardial scintigraphy using thallium-201. Among 33 subjects, ten were normal controls, 11 had left coronary artery disease (LAD group), 12 had right coronary artery disease (RCA group), all of whom received exercise myocardial scintigraphy. The submaximal or symptom-related ergometer exercise test was performed by the protocol being with 25 watt (W) loading, and then increased by 25 W every 3 min, while 3 mCi thallium-201 were injected intravenously at the maximal exercise point. Early imaging was obtained 5 min after exercise; delayed imagings, 1 and 4 hours after exercise. Early imaging and delayed imaging at 4 hours after exercise were obtained in the AP, lateral, LAO 30 degrees, LAO 45 degrees, and LAO 60 degrees projections. Only the LAO 45 degrees was obtained for delayed imaging 1 hour after exercise. To assess the radioactivity in the right ventricular wall, with regions of interest (ROI) in the upper part of the right ventricle [RV (U)] lower part of the right ventricle [RV (L)] and the most radioactive region in the left ventricle [LV (P)], we calculated the count ratio of the RV(U) or RV(L) to the LV(P) and defined it as the RV uptake ratio [RV(U)/LV(P)] or [RV(L)/LV(P)]. The results obtained were as follows: There were no significant changes in the RV uptake ratio between the early and delayed images both in the control and LAD groups, but the RV uptake ratio decreased significantly in the delayed images compared with an early image in the RCA group.(ABSTRACT TRUNCATED AT 250 WORDS)

A pathological study of fulminant hepatic disease

Among 4,030 autopsies, 67 cases of fulminant hepatic failure were selected and studied from a pathological viewpoint. No sex difference in incidence was seen and the patients' age ranged very widely from 3 months to 78 years, showing comparatively high risk in the 20 s and 30 s in both sexes. Hepatitis virus was the most common cause, followed by toxic chemicals, shock, etc. Histopathological study revealed severe and extensive hepatic cell necrosis as the most conspicuous and common change of the liver, which was pathomorphologically quite similar to that experimentally produced by focal intravascular coagulation in rabbit. This evidence, as well as pathological findings of the other organs obtained at autopsy and the patients' reported clinical course, including laboratory data, were consistent with our proposal of a pathological disease entity, fulminant liver disease, which corresponds to the clinical symptom-complex known as fulminant hepatic failure. It is suggested that the characteristic feature of acute, severe and extensive hepatic cell necrosis which is seen in such cases is probably a result of an anoxic state caused in most instances by intrahepatic circulatory disturbances. Besides, we consider that fulminant liver disease can be regarded as a group of systemic diseases with the main focus of illness in the liver, rather than a specific disease of a single organ, the liver.

Epithelioid sarcoma. Enzyme histochemical and ultrastructural study

A case of epithelioid sarcoma was studied by electron microscopy and by light and electron microscopic enzyme histochemistry comparing with several control soft tissues. In addition to previously reported ultrastructural features, such as abundant 10 nm cytoplasmic filaments, desmosome-like cell junctions and small cystic spaces surrounded by filopodia or microvilli of the tumor cells, we encountered 10 nm cytoplasmic filaments showing electron dense condensation with a concentrically oriented or whorled pattern and a finger-print-like arrangement and 5'-nucleotidase activity of tumor cell membrane. Among the control soft tissues, 5'-nucleotidase activity was found only in synovial and endothelial cells. Both tumor and synovial cells showed no activity of adenosine triphosphatase, while marked activity of the enzyme was found in endothelial cells. These results support the concept that epithelioid sarcoma is derived from mesenchymal cells undergoing differentiation toward synovial cells during neoplastic transformation.

Retinal amacrine cell involvement in Tay-Sachs disease

Ultrastructural study of the retina from a patient with Tay-Sachs disease disclosed that amacrine cells as well as ganglion cells were loaded with numerous membranous cytoplasmic bodies, suggesting an accumulation of GM2 ganglioside, whereas the horizontal cells, bipolar cells, and photoreceptor cells were intact. Chromatography of lipids from the retina showed a prominent spot of GM2 ganglioside. These facts suggest that lipid metabolism in amacrine cells may be different from that in other retinal cells.