DYSMICROBISM, INFLAMMATORY BOWEL DISEASE AND THYROIDITIS: ANALYSIS OF THE LITERATURE

The human body is colonized by a large number of microbes that are collectively referred to as the microbiota. They interact with the hosting organism and some do contribute to the physiological maintenance of the general good health thru regulation of some metabolic processes while some others are essential for the synthesis of vitamins and short-chain fatty acids. The abnormal variation, in the quality and/or quantity of individual bacterial species residing in the gastro-intestinal tract, is called “dysmicrobism”. The immune system of the host will respond to these changes at the intestinal mucosa level which could lead to Inflammatory Bowel Diseases (IBD). This inflammatory immune response could subsequently extend to other organs and systems outside the digestive tract such as the thyroid, culminating in thyroiditis. The goal of the present study is to review and analyze data reported in the literature about thyroiditis associated with inflammatory bowel diseases such as Ulcerative Colitis (UC) and Crohn’s Disease (CD). It was reported that similarities of some molecular bacterial components with molecular components of the host are considered among the factors causing IBD through an autoimmune reaction which could involve other non-immune cell types. The axis dysmicrobism-IBD-autoimmune reaction will be investigated as a possible etiopathogenic mechanism to Autoimmune Thyroiditis. If such is the case, then the employment of specific probiotic strains may represent a useful approach to moderate the immune system.

Preparation of photocrosslinked fish elastin polypeptide/microfibrillated cellulose composite gels with elastic properties for biomaterial applications

Photocrosslinked hydrogels reinforced by microfibrillated cellulose (MFC) were prepared from a methacrylate-functionalized fish elastin polypeptide and MFC dispersed in dimethylsulfoxide (DMSO). First, a water-soluble elastin peptide with a molecular weight of ca. 500 g/mol from the fish bulbus arteriosus was polymerized by N,N'-dicyclohexylcarbodiimide (DCC), a condensation reagent, and then modified with 2-isocyanatoethyl methacrylate (MOI) to yield a photocrosslinkable fish elastin polypeptide. The product was dissolved in DMSO and irradiated with UV light in the presence of a radical photoinitiator. We obtained hydrogels successfully by substitution of DMSO with water. The composite gel with MFC was prepared by UV irradiation of the photocrosslinkable elastin polypeptide mixed with dispersed MFC in DMSO, followed by substitution of DMSO with water. The tensile test of the composite gels revealed that the addition of MFC improved the tensile properties, and the shape of the stress-strain curve of the composite gel became more similar to the typical shape of an elastic material with an increase of MFC content. The rheology measurement showed that the elastic modulus of the composite gel increased with an increase of MFC content. The cell proliferation test on the composite gel showed no toxicity.

Intraluminal duodenal diverticulum: MR findings

We report a case of intraluminal duodenal diverticulum with special reference to its magnetic resonance imaging findings. An intraluminal duodenal fluid collection surrounded by a hypointense rim on T2-weighted or magnetic resonance cholangiopancreatographic images, the shape of which is changed by peristalsis, is considered to be almost diagnostic for intraluminal duodenal diverticulum.

Regression of gastric mucosa-associated lymphoid tissue lymphoma with reduced telomerase activity after eradication of Helicobacter pylori

Recently, telomerase activity has been demonstrated in a large number of malignant tumors whereas its activity is not detected in most normal somatic cells suggesting its role in the immortalization process. Here we report the first investigation of telomerase activity in a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Elevated telomerase activity was detected in biopsy specimens of the lymphoma. After eradication of Helicobacter pylori, the level of telomerase activity returned to normal with histological regression of the lymphoma. The telomerase activity was associated with the disease activity of the gastric MALT lymphoma after eradication therapy in the present case.

A case of cigarette smoking-induced acute eosinophilic pneumonia showing tolerance

It has been proposed that acute eosinophilic pneumonia (AEP), which is characterized by the absence of recurrence, is associated with cigarette smoking (CS), because Japanese patients with AEP are young and have a high incidence of short-term smoking history. However, there has been no direct evidence that CS causes AEP. We hypothesized that tolerance might develop against repeated resumption of smoking cigarettes in CS-induced AEP cases. In this connection, we challenged a patient with CS-induced AEP with repeated resumption of CS, and it was demonstrated that CS induced AEP in conjunction with tolerance to repeated resumption of smoking.

Acute eosinophilic pneumonia caused by cigarette smoking

It has been suggested that acute eosinophilic pneumonia (AEP) is associated with cigarette smoking because in Japan, the patients with AEP are young and have a high incidence of short-term smoking history. However, there has been no direct evidence to support that cigarette smoke causes AEP. Herein is reported the first case showing the direct evidence and a long-term clinical course of cigarette smoking-induced AEP, in which tolerance to repeated resumption of smoking cigarettes might have occurred. We should pay attention to the history of cigarette smoking in seeing patients with AEP, especially in young patients.

Implication of endogenous nitric oxide in gastric mucosal protective effect of T-593, a novel anti-ulcer agent, in rats

The relationship of endogenous nitric oxide (NO) to the gastric mucosal protective effect of the novel anti-ulcer agent T-593, (+/-)-(E)-1-[2-hydroxy-2-(4-hydroxyphenyl)ethyl]-3-[2-[[[5-(methylamino) methyl-2-furyl]methyl]thio]ethyl]-2-(methylsulfonyl) guanidine, was investigated in rats. T-593 (3-30 mg/kg, p.o.) dose dependently prevented the formation of gastric mucosal lesions induced by oral administration of aspirin (200 mg/kg) in 0.15 N HCl (HCl-aspirin). Pretreatment with N(G)-nitro-L-arginine methylester (L-NAME), a selective inhibitor of NO synthase (NOS), attenuated the mucosal protective effect of T-593. This effect of L-NAME was antagonized by pretreatment with L-arginine, a substrate of NOS, but not with D-arginine. Activity of total NOS composed of inducible and constitutive NOS in the gastric mucosa was decreased by HCl-aspirin, and T-593 inhibited this decrease. On the other hand, HCl-aspirin and T-593 did not affect inducible NOS activity in the gastric mucosa. Furthermore, we confirmed that T-593 inhibits the decrease in gastric mucosal blood flow (GMBF) induced by HCl-aspirin, and this effect is completely inhibited by pretreatment with L-NAME. These results suggest that the mucosal protective effect of T-593 is partly mediated by endogenous NO via improvement of GMBF and that a possible mechanism for the effect of T-593 is the maintenance of constitutive NOS activity in gastric mucosa.

Bafilomycin A1 induces apoptosis in PC12 cells independently of intracellular pH

PC12 cells growth-arrested with bafilomycin A1 died showing apoptotic chromatin condensation in the nuclei. The bafilomycin A1-induced chromatin condensation was preceded by neurite outgrowth (NOG), required higher concentrations of bafilomycin A1 than NOG, and was suppressed by cycloheximide and aurintricarboxylic acid. NH4Cl (10 mM), another acidotropic pH perturbing agent, neither induced apoptotic chromatin condensation by itself nor suppressed that induced by bafilomycin A1, suggesting that bafilomycin A1-induced apoptosis occurs independently of intracellular pH in PC12 cells.

[Recent advance of endoscopic ultrasonography for evaluating gastroenterologic early cancer]

Lutz et al. made the first report in which ultrasonographic probe could differentiate cystic tumor from solid one. After that, endoscopic ultrasonography (EUS) have advanced rapidly in engineering and clinical application. EUS is the most accurate diagnostic method presently available to determine the depth of gastrointestinal cancer invasion. We have proposed the pattern analysis for the differentiation between cancer invasion and ulcer fibrosis, because fibrosis and cancer invasion have of the same echo level. USP is more useful and easy than EUS in cases with small and flat lesion without ulcer, and EUS should perform in remaining lesions that look like early cancer with ulcer and advanced cancer. Clinically, it is believed that the invasion of early gallbladder cancer limited to the proper muscle, the early pancreas cancer is less than 1 cm. It is also practicable with EUS to detect the these cancer easily and diagnose the local stage of gall bladder and pancreas cancer. Now we are performing IDUS (ER-US, PT-US) and 3D-EUS, and believing that these technics will be used commonly in the near future.

Inhibition of NGF-induced neurite outgrowth of PC12 cells by Bacillus cereus sphingomyelinase, a bacterial hemolysin

Sphingomyelinase of Bacillus cereus, a bacterial hemolysin, reduced nerve growth factor (NGF)-induced neurite outgrowth of PC12 cells in a dose-dependent manner. At 200 mU/ml, sphingomyelinase repressed half the neurite outgrowth of the cells at 250 ng/ml NGF. The c-fos superinduction, one of the early responses induced by NGF, was not influenced by this treatment, suggesting that the repression by sphingomyelinase occurred via a protein kinase C-independent pathway.

Inhibition of cell growth by bafilomycin A1, a selective inhibitor of vacuolar H(+)-ATPase

Bafilomycin A1, a potent selective inhibitor of vacuolar H(+)-ATPase, inhibited the growth of a variety of cultured cells dose-dependently, including golden hamster embryo and NIH-3T3 fibroblasts, whether or not they were transformed, and PC12 and HeLa cells. The concentration of bafilomycin A1 for 50% inhibition of cell growth ranged from 10 to 50 nM. The dose response was nearly parallel with that of the bafilomycin A1-induced lysosomal pH increase. The degree of pH increase for growth inhibition produced by bafilomycin A1 was similar to that produced by NH4Cl in which little difference was recognized in effect among cell types.

[A case of tsutsugamushi disease in the urban area of Komatsu City]

Most of patients with tsutsugamushi disease are diagnosed by their clinical histories suggesting the opportunities of Rickettsia infection in a rural region. We reported a 76-year-old female patient, who was considered to be infected in her house in the urban area of Komatsu City. She has shown typical clinical manifestations of tsutsugamushi disease, and was remitted successfully by oral administration of minocycline. Although specific antibodies to Rickettsia tsutsugamushi could not be detected in her serum by the complement fixation (CF) method during her clinical course, their significant elevation was confirmed by the indirect immunofluorescence (IF) method.

Double-blind study with Duovent and placebo in 20 asthmatic children

Duovent activity was compared with placebo in a double-blind study carried out in 20 children, aged between 5 and 14 years, suffering from bronchial asthma. The experiment lasted 2 weeks. The patients were divided into two groups. In the 1st week, group I was treated with Duovent and group II with placebo, in the 2nd week vice versa. There was no reduction in cough or dyspnea in subjects treated with placebo, and only a slight increase (not significant) in peak expiratory flow (PEF). In the subjects treated with Duovent, there was a clear reduction in cough and dyspnea and a significant increase in PEF. The effect of the drug was still evident after 8 h, and it was well tolerated without side effects. The high number of additional sprays required during the placebo period was further evidence of the therapeutic efficacy of Duovent, which in almost all cases met the daily therapeutic requirements of the small patients. Duovent appears to be an effective drug in the treatment of bronchial asthma in children, both clinically and functionally.

[Serum levels and clinical evaluation of CA 19-9 in various diseases]

We evaluated the clinical significance of serum CA 19-9 in various cancers, benign diseases and healthy controls. The percentage of positive cases for CA 19-9 (higher than 37 U/ml) was 83% in pancreas cancer, 78% in biliary tract cancer and 75% in urinary tract cancer. Benign diseases showed a low frequency of positive cases for CA 19-9, and their serum levels of CA 19-9 were low. Benign diseases with high serum levels of CA 19-9 were rarely seen, but they were easy to differentiate from malignant tumors by simultaneous examination of other tumor markers. In cancer patients with high serum levels of CA 19-9, CA 19-9 showed a weak positive correlation to CEA and ferritin.

[Pancreatic cancer in father and daughter]

A 77-year-old male patient was admitted because of jaundice and general malaise. Exploratory laparotomy disclosed pancreatic head cancer with invasion to the intrapancreatic bile duct. Three months later, his daughter, aged 51, was admitted for evaluation because of body weight loss and back pain. CT scan disclosed 3 low-density areas in the pancreas with irregular margins and multiple low-density areas in the liver. Pancreatic cancer with liver metastasis was confirmed by autopsy. In familial pancreatic cancer, it is essential that genetic in addition to environmental factors be examined in pancreatic carcinogenesis.

[An autopsy case of squamous cell carcinoma of the lung presenting with small and large bowel metastasis]

A 81-year-old male with primary squamous cell carcinoma of the lung was admitted because of melena. Upon autopsy, bleeding sites were found in the small and large bowel; they were lesions from the lung carcinoma. Gastrointestinal metastases from primary lung carcinoma are clinically rare, although they are seen in autopsy cases. Review of autopsy data on 1181 cases of primary lung carcinoma showed that 218 (18.5%) manifested gastrointestinal metastases.

[An improved method for the simultaneous analysis of norepinephrine, epinephrine and dopamine at the picogram level by mass fragmentography (author's transl)]

Gas chromatography-mass spectrometry makes possible the simultaneous measurement of norepinephrine (NE), epinephrine (E) and dopamine (DA) at the picogram level. The equipment used was the Shimadzu LKB 9000 GC-MS (MID-MD. The TFA derivatives of the compounds were analysed by the GC-MS system equipped with a 3ft X 3mm column packed with 1.5%OV-1 and the temperature was programed from 135 degrees to 260 degrees C at 10 degrees C/min increments. The mass spectrum showed molecular ions at m/e 552, 566 and 440 which corresponds to the TFA derivatives of NE, E and DA respectively. The base peaks of NE, E and DA were m/e 109, 140 and 328 respectively. The peaks at m/e 126 (NE and DA) and 140 (E) were applied to avail themselves of simultaneous multiple-ion analyses by mass fragmentography. As little as 4pg of the compounds injected into the column could be measured with good reproducibility, and the linearity of the response was maintained up to 120 pg. The sensitivity was of the order of ng or pg which enable quantitation with 1ml of human serum and urine sample. The procedures were simpler and less time consuming than previously reported methods. Recovery rates of NE, E and DA from serum were 25.7%, 13.7% and 76.1%, whereas those from urine were 100%, 89.6% and 100% respectively. The specificity of this method surpasses and cannot be compared to any other existing quantitative methods.

[Analysis of estrone, estradiol and estriol in serum and urine by mass fragmentography using GC-MS (author's transl)]

The first successful analysis of estrogens in serum and urine was performed by mass fragmentography using a GC-MS combined system. The equipment used was Shimadzu LKB 9000 GC-MS (MID-PM). The TMSi derivative of the compounds were analyzed using the GC-MS system equipped with a 3 ft x 3mm column packed with 1.5% OV-1 and the temperature was programed from 200 degrees to 260 degrees C at 10 degrees C/min increments. The mass spectrum showed molecular ions at m/e 342, 416 and 504 which correspond to the TMSi derivatives of Estrone (E-1), Estradiol (E-2) and Estriol (E-3) respectively. Molecular ion peak of each compound was applied to establish the precise quantitative evaluation of E-1, E-2 and E-3. 1) The minimum detectable limits of the compounds injected into the column were ca. 2 pg for E-1, E-2 and 5 pg for E-3 respectively. 2) The sensitivity was of the order of ng or pg which enables quantitation with 2 ml of human serum and urine samples obtained from normally ovulating women. 3) This method was very convenient for extracting the compounds from biological fluids, and the procedure can be carried out easily in a short time. 4) Mass fragmentography makes possible the simultaneous measurements of E-1, E-2 and E-3 in samples obtained from pregnant women.

[Analysis of thyroid hormones in serum and urine by mass fragmentography using GC-MS]

The first successful analysis of iodine compounds in serum and urine by mass fragmentography using GC-MS combined system was performed. The equipment used was Shimadzu LKB 9000 GC-MS (MID-PM). The TMSi derivatives of the compounds were analyzed by GC-MS system equipped with a 3 ft X 3 mm column packed with 1% OV-1 and the temperature was programmed from 200 degrees to 320 degrees C at 10 degrees C/min. The mass specturm showed molecular ions at m/e 523, 649, 741, 867 and 993 which correspond to the TMSi derivatives of MIT, DIT, T2, T3 and T4 respectively. The base peak at m/e 218 was applied to establish the precise quantitative evaluation of T4 and related compounds by mass fragmentography. The following results were obtained: 1) The minimum detectable limits of the compounds injected into the column were ca. 10 pg for MIT, DIT, 20pg for T2, 50pg for T3, and 500 pg for T4 respectively. 2) The sensitivity was of the order of ng or pg which enables quantitation with 1 ml of human serum and urine sample. 3) West's method was very convenient for extracting the compounds from biological fluids, and procedure can be carried out easily in a short time. The recovery rates were ca. 16.0% for MIT, 26.6% for DIT, 61.5% for T2, 71.6% for T3, and 85.1% for T4 respectively. 4) The ability to simultaneously analyze various iodoaminoacids is sure to be effectively utilized in studies to elucidate the relative importance of these hormones and their metabolic changes in various physioloigcal and pathological states of human beings.

Pseudocyst of the pericardium developing during maintenance hemodialysis. Report of two cases

Two cases of pericardial pseudocyst which developed in the course of maintenance hemodialysis are reported. Both patients were usually free of complaints, although there was evidence of the previous pericarditis with recent accumulation of pericardial effusion. As a possible mechanism leading to pericardial pseudocyst formation, distension of a weak area of the thickened pericardium due to an increase in intrapericardial pressure was assumed. Therefore, pericardial pseudocyst is one of the likely complications of patients on maintenance hemodialysis.