Clinical outcomes of recipients with aplastic bone disease after renal transplantation

OBJECTIVES

We expect that if chronic renal failure (CRF) is improved after renal transplantation (RTx), dialysis osteopathy bone lesions would also recover to normal. Nevertheless, it is controversial whether bone lesions really improve after RTx. In this study, we evaluated whether pathological dialysis osteopathy improved after RTx.

MATERIALS AND METHODS

The 84 patients who had undergone living related RTx had also undergone a bone biopsy (Bx) since January 2004, including 13 (16.0%) with a diagnosis of aplastic osteopathy. They included 7 men and 6 women. The average hemodialysis (HD) period was 40.3 months. The immunosuppression was tacrolimus (FK); mycophenalate mofetil (MMF) and steroid. We examined Ca, P, intact-PTH (i-PTH), metabolic bone markers, and bone density (DXA) before and 1 year after RTx. In addition, a Bx was performed after having osteal labeling twice before Bx. In addition 2 cases (15.3%) also underwent a Bx after RTx.

RESULTS

All cases survive with well functioning renal grafts. The mean levels of Ca and P before RTx were 8.7 mg/mL and 6.6 mg/dL, respectively. The mean i-PTH level was 137.8 pg/mL before RTx and of alkaline phosphatase (ALP) was 202.1 U/L before RTx. The total density and % age match of DXA before RTx averaged 398.7 mg/ccm and 96.7%, respectively. The mean bone volume fraction (BV/TV: Bone Volume/Tissue Volume) before RTx was 17.2%. The mean osteoid volume (OV/TV) before RTx was 2.7%. The mean fibrosis volume (Fb.V/TV) before RTx was 0%. The mean bone formation rate (BFR/BV) before RTx was 2.1 %/y. Two cases were also pathologically diagnosed as renal osteodystrophy at 1 year after RTx: 1 case was mixed type, and another was osteomalacia, which was accompanied by a lumbar compression fracture (Fx) during the clinical course.

CONCLUSIONS

Bone metabolism in patients with aplastic ROD histologically improved at 1 year after RTx, presumably due to good renal transplant function. However, it is unknown whether both hypophosphatemia and decrease of FGF-23 improved bone However, patients with aplastic ROD were not completely normalized histologically at 1 year after RTx.

Glucose hypermetabolism in the thalamus of patients with essential blepharospasm

Essential blepharospasm (EB) is classified as a form of focal dystonia characterized by involuntary spasms of the musculature of the upper face. The basic neurological process causing EB is not known. The purpose of this study was to investigate cerebral glucose metabolism in patients with EB whose symptoms were suppressed by an injection of botulinum-A toxin. Earlier studies were confounded by sensory feedback activities derived from dystonic symptom itself. Cerebral glucose metabolism was examined by positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) in 25 patients (8 men and 17 women; age 52.6 +/- 10.1 years) with EB. The patients were awake but with the spasms suppressed by an injection of botulinum-A toxin. Thirty-eight normal volunteers (14 men and 24 women; age 58.2 +/- 7.3 years) were examined as controls. The difference between the two groups was examined by statistical parametric mapping (SPM99). A significant increase in the glucose metabolism was detected in the thalamus and pons in the EB patients. Hyperactivity in the thalamus may be a key pathophysiological change common to EB and other types of focal dystonia. The activity of the striatum and cerebellum are likely to be sensory dependent.

Tissue Doppler-derived index of left ventricular filling pressure, E/E', predicts survival of patients with non-valvular atrial fibrillation

OBJECTIVES

To investigate whether the ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (E') predict prognosis in patients with non-valvular atrial fibrillation.

METHODS

230 patients with non-valvular atrial fibrillation were enrolled and studied. According to E/E' value, patients were divided into groups with lower (group A with E/E' <or= 15) and higher (group B with E/E' > 15) E/E'.

RESULTS

During follow up (average 245 days), 21 (9.1%) deaths were documented. All cause death (15/90 (16.7%) v 6/140 (4.3%)), cardiac death (10 (11.1%) v 2 (1.4%)) and congestive heart failure (16 (17.8%) v 8 (5.7%)) were more common in group B than in group A (all p < 0.01). A Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in group B than in group A (log rank p = 0.0013). By multivariate logistic regression analysis, E/E' (chi(2) = 4.47, odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01 to 1.11, p = 0.03) and age (chi(2) = 6.45, OR 1.06, 95% CI 1.01 to 1.11, p = 0.02) were independent predictors of mortality.

CONCLUSION

The Doppler-derived index of left ventricular filling pressure, E/E', is a powerful predictor of the clinical outcome of patients with non-valvular atrial fibrillation.

A case of multiple sclerosis with homonymous hemianopia examined by positron emission tomography

BACKGROUND

To demonstrate the efficacy of positron emission tomography (PET) for examining multiple sclerosis (MS) patients with hemianopia.

CASE

A 20-year-old man visited us with a complaint of left homonymous hemianopia and headache.

OBSERVATIONS

The patient's visual acuity was 1.2 (n.c.) OD and 0.9 (1.0) OS. Magnetic resonance imaging (MRI) showed a mass in the temporoparietal lobe. A pathological diagnosis of MS was made by brain biopsy. Low glucose metabolism in the lesion and visual cortex was observed by PET with (18)F-fluorodeoxy glucose. PET with (11)C-flumazenyl revealed a reduction of (11)C-uptake in the demyelinated optic radiation, and only a slight reduction of (11)C-uptake in the primary visual cortex. The results of (11)C-flumazenyl PET suggested a slight reduction of neuronal density. In 2 years, the visual field recovered to the normal state.

CONCLUSION

PET can be a useful tool for estimating the visual outcome of patients with hemianopia in MS.

Differential activation of cerebral blood flow by stimulating amblyopic and fellow eye

PURPOSE

Positron emission tomography (PET), the blood flow response in the primary visual cortex (V1) to two visual stimuli, low temporal frequency (6 Hz) to activate the parvocellular system, and high temporal frequency (25 Hz) to activate the magnocellular system were used to investigate pathophysiologic mechanism of amblyopia.

METHODS

Five women and one man who were aged between 26 and 60 years, who were ophthalmologically normal except for amblyopia, and who had corrected visual acuity in the amblyopic eye of 0.6 or worse were examined. An intravenous injection of the H(2)(15)O was given, and the regional cerebral blood flow was measured by PET during full-field stimulation with either 6 Hz or 25 Hz flicker to the amblyopic or the sound eye.

RESULT

The activation of blood flow in the contra-lateral area V1 by the 6-Hz stimulation of the sound eye was greater than that during the stimulation of the amblyopic eye (P<0.05, small volume correction, n=6). With 25-Hz stimulation of the sound and amblyopic eyes, the blood flow in the contra-lateral and ipsi-lateral areas V1 was not significantly different.

CONCLUSION

The decreased activation of blood flow in the contra-lateral V1 by low temporal frequency stimuli supports the hypothesis that the parvocellular pathway in amblyopic eyes is depressed.

CA-125 in menstrual discharge in patients with chronic pelvic pain

CA-125 levels in menstrual discharge were determined in 55 patients with chronic pelvic pain to evaluate whether this test would be useful in differentiating between pelvic pain due to endometriosis and other causes. Of the 28 women with endometriosis, 25 (89%) had CA-125 concentration greater than or equal to 72,000 units/ml. The frequencies of elevated levels in Stage I, Stage II and Stages III/IV were 85.7, 85.7 and 92.8%, respectively. When used for the detection of endometriosis, the test had a sensitivity of 89.3% and a specificity of 96.3%. These results suggest that CA-125 in menstrual discharge may be helpful in the evaluation of women with chronic pelvic pain.

Detection of visual activation of lateral geniculate nucleus by positron emission tomography

PURPOSE

Although activation of the lateral geniculate nucleus (LGN) has been shown by functional magnetic resonance imaging, a quantitative evaluation of the activity has not been reported by positron emission tomography (PET). The purpose of this study was to quantify the degree of activation of the LGN and other vision-related structures by visual stimuli as detected by PET.

METHODS

PET activation was induced by a bolus injection of 15O-labelled water (H2(15)O) in six normal volunteers. The regional cerebral blood flow (rCBF) was measured under three conditions: eyes closed, binocular flickering light stimulation, and binocular viewing of a video movie. Single-subject analysis, group analysis, and correlation analysis were performed.

RESULTS

Although single-subject analysis did not show significant changes, group analysis revealed a significant increase in rCBF in the left LGN induced by flickering light stimulation ( P<0.01) and video stimulation ( P<0.05). Localization of the activation foci in the LGN agreed with the retinotopic organization of the LGN.

CONCLUSION

Although the LGN is relatively small compared with the resolution of the PET image, visually activated blood flow changes could be determined by H2(15)O PET:

Neuroimaging analysis of a case with left homonymous hemianopia and left hemispatial neglect

PURPOSE

To correlate the neuro-ophthalmological observations with the magnetic resonance images (MRI) and positron emission tomographic (PET) findings in a case with left homonymous hemianopia and left hemispatial neglect.

CASE

A 57-year-old woman underwent surgery for a ruptured anterior communicating artery aneurysm. After she recovered consciousness, it was found that she had left homonymous hemianopia and left hemispatial neglect. Although the hemispatial neglect slowly improved, the homonymous hemianopia persisted. MRI and measurements of cerebral glucose metabolism by 2-fluoro-2-deoxy-D-glucose(FDG)-PET were performed 1 year later.

RESULTS

MRI revealed infarctions on the medial surface of the frontal lobe, on the right medial surface of the occipital lobe, and global atrophy of the right cortical hemisphere. FDG-PET disclosed severe glucose hypometabolism in the entire right hemisphere. Glucose metabolism in the right occipital cortex was 61.1% of that in the homologous region on the left side, 62.8% in the right anterior cingulate gyrus, and 93.8% in the temporal-parietal-occipital junction.

CONCLUSIONS

The low glucose metabolism in the right visual cortex explains the persistent left hemianopia, and that in the right anterior cingulate gyrus and the right temporal-parietal-occipital junction may be responsible for the left hemispatial neglect. The relatively mild damage in the right temporal-parietal-occipital junction explained the recovery of the neglect symptom. Measurements of regional cerebral glucose metabolism by PET are useful for determining the cause of cerebral visual dysfunction and its prognosis after a cerebral lesion.

Quantitative assessment of harmonic power Doppler myocardial perfusion imaging with intravenous Levovist in patients with myocardial infarction: comparison with myocardial viability evaluated by thallium-201 single-photon emission computed tomography and coronary flow reserve

BACKGROUND

Intravenous myocardial contrast echocardiography with harmonic power Doppler imaging is a novel technique for assessing myocardial perfusion.

AIMS

The aim of this study was to quantitatively assess myocardial perfusion by harmonic power Doppler imaging in patients with a previous myocardial infarction and compare myocardial contrast echocardiography results with myocardial viability evaluated by thallium-201 single-photon emission computed tomography ((201)Tl-SPECT) and the results of Doppler flow measurement of coronary flow velocity reserve.

METHODS

Twenty-three patients with anterior myocardial infarction who were scheduled for adenosine stress (201)Tl-SPECT underwent myocardial contrast echocardiography with harmonic power Doppler imaging. Harmonic power Doppler imaging was performed at rest and during adenosine infusion (0.15 mg/kg/min) using an intravenous infusion of Levovist. The peak colour pixel intensity ratios of the risk area to the control area were used for quantitative analysis of myocardial perfusion by harmonic power Doppler imaging. Coronary blood flow velocity was measured using Doppler-tipped guidewire in the distal portion of left anterior descending artery and coronary flow velocity reserve was calculated.

RESULTS

In patients with myocardial viability assessed by (201)Tl-SPECT, pixel intensity ratios both at rest and during hyperaemia were significantly higher compared with those in patients without myocardial viability (at rest: 0.62 +/- 0.28 vs 0.37 +/- 0.17, P=0.038, during hyperaemia 0.72 +/- 0.19 vs 0.40 +/- 0.18, P=0.003). Coronary flow velocity reserve was significantly different between two groups (2.35 +/- 0.43 vs 1.49 +/- 0.53, P <0.01).

CONCLUSIONS

Quantitative assessment of microvascular integrity by harmonic power Doppler imaging corresponds to the evaluation of the microcirculation by coronary flow velocity reserve.

Linear lichen planus in the region of the mandibular nerve caused by an allergy to palladium in dental metals

We observed a case of linear lichen planus extending from the right cheek to the jaw, which was accompanied by itching and an unusual sensation in the mouth. The eruption was located along the mandible and aligned with the mandibular nerve. The right molars of the patient contained metal compounds and these were considered to be the cause of his disease. Patch testing with various dental metals showed positive reactions to palladium and platinum. A biopsy specimen showed a lichenoid reaction in the lesional tissue, and dermal contact dermatitis was noted at the palladium patch test site. His dentist reported that palladium-silver-gold or nickel-chrome alloys without platinum had been used in the crown and bridge of his molars. After removal of the dental alloys, the skin eruption resolved with some residual hyperpigmentation. In addition, the peculiar mouth sensation disappeared dramatically within 2 months.

A novel point mutation affecting the tyrosine kinase domain of the TRKA gene in a family with congenital insensitivity to pain with anhidrosis

A nerve growth factor receptor encoded by the TRKA gene plays an important part in the formation of autonomic neurons and small sensory neurons in dorsal root ganglia and in signal transduction through its intracytoplasmic tyrosine kinase domain. Recently, three mutations in the tyrosine kinase domain of TRKA have been reported in patients with congenital insensitivity to pain with anhidrosis, which is an autosomal recessive disorder characterized by recurrent fever due to absence of sweating, no reaction to noxious stimuli, self-mutilating behavior, and mental retardation. We examined the TRKA gene in five generations of a large Japanese family with many consanguineous marriages who live in a small remote island of the southern part of Japan. We found a novel point mutation at nucleotide 1825 (A-->G transition) resulting in Met-581-Val in the tyrosine kinase domain. Two of the three affected patients were homozygous for this mutation; however, the third affected patient was heterozygous. Further analysis revealed that the third patient was a compound heterozygote with the Met-581-Val mutation in one allele and with a single base C deletion mutation at nucleotide 1726 in exon 14 in the other allele, resulting in a frameshift and premature termination codon.

Human T-cell lymphotropic virus type I infects eccrine sweat gland epithelia

Human T-cell lymphotropic virus type I (HTLV-I) is known to be associated with several non-neoplastic inflammatory disorders such as HTLV-I-associated myelopathy/tropical spastic paraparesis, arthropathy, uveitis and lymphadenitis, in addition to neoplastic adult T-cell leukemia/lymphoma (ATLL). A strong relation between HTLV-I infection and Sjögren's syndrome (SS) has been reported, and impaired sweating in SS is well known. We have often encountered dry skin in patients with ATLL. On the basis of these observations, we aimed to determine whether HTLV-I infection is present in isolated sweat glands. Eccrine gland epithelia were isolated from full thickness skin biopsies from 8 HTLV-I-seropositive and 7 seronegative individuals using dispase in Eagle's minimum essential medium supplemented with 13% fetal calf serum. We detected HTLV-IpX sequences in samples of eccrine sweat gland epithelia from 4 samples of the 8 seropositive individuals using nested polymerase chain reaction, but all 7 samples from the seronegative donors had no signal corresponding to the sequence. Our results were confirmed by dot blot hybridization. Our results suggest that eccrine epithelium is one of the target organs of HTLV-I infection.

Membranocystic lesions in a patient with cytophagic histiocytic panniculitis associated with subcutaneous T-cell lymphoma

A 51-year-old Japanese woman had erythematous, tender subcutaneous nodules on her lower legs and buttocks, as well as fever, pancytopenia, and liver dysfunction. Histopathologic examination of the nodules showed subcutaneous T-cell lymphoma with cytophagocytosis and membranocystic lesions. Our patient was unique in having the combination of cytophagic histiocytic panniculitis due to subcutaneous T-cell lymphoma and membranocystic lesions.

Prurigo as a clinical prodrome to adult T-cell leukaemia/lymphoma

We report a case of adult T-cell leukaemia/lymphoma (ATLL) with prurigo as a prodromal skin manifestation. The patient was a 52-year-old woman with a 2-year history of a fluctuating skin condition consisting of pruritic papules and pigmentation on her lower legs and right buttock. Prurigo was diagnosed at her first visit in October 1995, and she was found to be seropositive for human T-cell lymphotropic virus type 1 (HTLV-1). Two years later, the skin lesions had spread over the patient's forearms and dorsa of the hands, and abnormal lymphoid cells had appeared in her peripheral blood. Southern blot analysis revealed monoclonal integration of HTLV-1 provirus in the peripheral blood, but not in a skin lesion. Based on these results, a diagnosis of overt ATLL of the smouldering type was made. The findings in this case indicate that in healthy HTLV-1 seropositive carriers, prurigo requires careful follow-up as a cutaneous prodrome of ATLL.

Expression of cdc25 phosphatases in the germ cells of the rat testis

cdc25A and cdc25C, which encode threonine/tyrosine phosphatases involved in cell cycle regulation, were found to be differentially localized in rat testicular germ cells during spermatogenesis. Northern blot analysis identified two cdc25A transcripts. A transcript of 3.8 kilobases (kb) was expressed in the early germ cells including spermatogonia, and a 3.3-kb transcript was highly expressed in spermatocytes and round spermatids. In situ hybridization showed that the levels of mRNA for cdc25A were highest in diplotene spermatocytes and round spermatids but were undetectable in Sertoli cells. Both transcripts for cdc25A increased with retinol treatment in the vitamin A-deficient testis. Immunolocalization showed that cdc25A protein was distributed in the cytoplasm of germ cells, whereas cdc25C was localized to the nucleus of late spermatocytes and round spermatids. Previous studies have identified two cdc25C transcripts of 2.1 kb and 1.9 kb, which were expressed in spermatocytes and round spermatids, respectively. These results suggest that cdc25A may function during mitosis of spermatogonia. Both cdc25A and cdc25C may function in the regulation of the meiotic cell cycle, although in different manners, as indicated by their subcellular localization.

Steatocystoma multiplex: a case with unusual clinical and histological manifestation

A 35-year-old man at our clinic was found to have steatocystoma multiplex manifested by dome-shaped nodules confined to the scalp and forehead. One of four cyst biopsy specimens revealed large lining cells with granular cytoplasm adjacent to typical steatocystoma epithelial lining cells. Neither fibrosis nor inflammatory changes were noted in the surrounding connective tissue. The large granular lining cells had immunohistochemical characteristics of the macrophage/monocyte lineage. This case appears to be an unusual clinical and histological manifestation of steatocystoma multiplex.

Successful treatment of scleroderma with PUVA therapy

PUVA therapy was carried out on four patients with scleroderma; three of them had cutaneous manifestations of progressive systemic sclerosis and one other exhibited generalized morphea. PUVA therapy was given with daily doses of 0.25J/cm2 or 0.4J/cm2 for 3-8 weeks, resulting in total doses between 3.5J/cm2 and 9.6J/cm2. All four patients responded well to this treatment; improvements of hand closure, skin sclerosis index, and flexion of fingers or knee joints were obtained. Thus, PUVA appeared to be beneficial for treating scleroderma.

Multiple bursitis--a case with an unusual skin manifestation

Bursitis is a periarticular rheumatism which occurs as a result of trauma, infection, metabolic disease or rheumatoid arthritis. The disease is usually manifested as a solitary lesion except in a few reported cases of multiple lesions. We describe here a case of bursitis in a 58-year-old woman with multifocal cystic lesions containing sterile bloody or yellowish fluid in the four extremities. Serological abnormalities were also noted, suggesting the presence of rheumatoid arthritis or another autoimmune connective tissue disease.

HTLV-I messenger RNA is expressed in vivo in adult T-cell leukemia/lymphoma patients: an in situ hybridization study

Adult T-cell leukemia/lymphoma (ATLL) is a malignancy involving peripheral blood, lymph nodes, skin and other organs. Human T-cell leukemia virus type I (HTLV-I) is etiologically associated with ATLL but cannot be detected by conventional methods in fresh samples of peripheral blood and skin taken from ATLL. The aim of this study was to investigate the feasibility of an in situ hybridization technique for detection of HTLV-I mRNA in atypical lymphoid cells of peripheral blood and skin lesions of patients with ATLL. We detected variable amounts of HTLV-I tax mRNA in the nuclei and cytoplasm of these cells in fresh peripheral blood samples and skin lesions from ATLL patients, and also in asymptomatic HTLV-I infected donors to a lesser extent. Out of 10 patients with ATLL, 7 showed strong positive in situ hybridization whereas the other 3 were only weakly positive. However, in the last 3 cases, the reaction became strongly positive after cells had been cultured for 24 hr. Furthermore, all 3 asymptomatic HTLV-I-infected donors exhibited a weakly positive response in their apparently mature lymphoid cells.

Safety of high-dose of nafamostat mesilate: toxicological study in beagles

The acute effects of a high dose of nafamostat mesilate (NM, 6-amidino-2-naphthyl-p-guanidinobenzoate dimethanesulfonate) were studied in 14 beagles (six controls). NM (10 mg kg-1 hr-1) was continuously administered intravenously for 24 hr. The activated coagulation time was dose-dependently prolonged with NM. Plasma electrolyte imbalances such as hyponatremia, hypochloremia, hyperkalemia and active excretion of sodium into urine were found. Aldosterone levels tended to increase in blood and urine after the administration of NM. Although the precise mechanism of these electrolyte imbalances remains unknown, the increase of aldosterone in blood and urine may have been a secondary response to, rather than the cause of, the electrolyte imbalances. Mean arterial pressure gradually decreased after 5 hr of NM. This hypotension may have reflected the vasodilatation with NM. Although the biochemical and histological studies did not reveal significant side effects, further study will be required to confirm the safety of long-term, high-dose NM. These results indicate that the high-dose NM administration at a rate of 10 mg kg-1 hr-1 during 24 hr has no serious side effects.

[Studies of emergency cardiopulmonary bypass (ECPB) for cardiopulmonary-cerebral resuscitation--(3). Neurological outcome and pathological changes of the brain]

Neurological outcome and pathological changes of the brain were studied in 5 female mongrel dogs, which were subjected to normothermic ventricular fibrillation (Vf) cardiac arrest of 15 min and resuscitated by using cardiopulmonary bypass through the femoral artery and veins (F-F bypass). Spontaneous circulation was restored by one or two defibrillating countershocks in all 5 dogs 5.2 +/- 1.1 (mean +/- SD) min after initiation of the F-F bypass. The F-F partial bypass was continued for 164 +/- 30 min under mild hypothermia. After weaning from the bypass, intensive care including controlled ventilation was carried out for the subsequent 6 to 36 h. Intermittent slow waves appeared on the electroencephalogram 62.8 +/- 11.6 min after initiation of the F-F bypass resuscitation and continuous waves at 145.6 +/- 27.5 min. Soon after extubation, the animals barked, moved the forelegs and could drink water. Neurological deficit scores (normal: 0, brain death: 500) improved to become below 100 except in 1 dog. However, macroscopic examination of the brain in 2 dogs with prominent recovery disclosed atrophy of the central gyrus and microscopic examination revealed typical ischemic injuries of the vulnerable neurons at the cerebellum, hippocampus and cerebral cortex in the frontal lobe.

[Reproductive and developmental toxicity study of prednisolone farnesylate (PNF)--study of subcutaneous administration of PNF during the perinatal and lactation periods in rats]

The effects of Prednisolone farnesylate (PNF), a newly synthesized corticosteroid, administrated during the perinatal and postnatal periods were studied in Sprague-Dawley rats. This compound was injected subcutaneously to female rats at dose levels of 0(control), 0.05, 0.5 and 5 mg/kg/day, once a day, for the period from day 17 of pregnancy to day 21 after parturition. Twenty-two to 25 dams in each dose group were allowed to litter naturally, and observations were made on the postnatal growth and development of their offspring. 1. In the dams treated at doses of 0.5 and 5 mg/kg, decreased body weight gains, atrophy of the thymus and retention of the substance at the injected site were noted. However, general signs, food consumption, parturition, lactation and nursing behaviors were not affected by the administration of PNF. 2. In the F1 newborns, the postnatal growth, development, responses, behaviors, learning ability and reproductive ability were not influenced. Additionally, no embryonic or fetal abnormalities of their fetuses (F2) were detected. From these results, the no-effect dose levels of PNF on the parental general states, the parental reproductive ability and those of the F1 offspring are thought to be 0.05 mg/kg/day, 5 mg/kg/day or more and 5 mg/kg/day or more, respectively, under the experimental conditions of this study. Moreover, the F2 fetuses are not affected by doses up to 5 mg/kg/day of PNF.

[A patient with severe ventricular tachycardia who was saved by prolonged extracorporeal lung and heart assist]

A 47-y-o man had been suffering from cardiac failure due to refractory ventricular tachycardia (VT) after myocardial infarction. He underwent resection of the left ventricular aneurysm and cryocoagulation of the arrhythmogenic foci. On the 2nd post-operative day, VT often recurred in spite of repeated cardioversion and drug therapy, and threatened his life, even under IABP. Therefore, a veno-arterial bypass route was made and extracorporeal lung and heart assist, ECLHA, was started with a heparin bonded Maxima lung on the following day. Even under ECLHA, VT continued to recur. Cryocoagulation of the VT foci was tried again, without immediate success. A record high dose of beta-blockers, given under the circulatory support by ECLHA, stopped VT on the following day. The patient was weaned from the ECLHA circuit 12 days after the first operation, then from IABP on the 14th day. During the 10 day course of surgeries and ECLHA, the patient had almost 100 defibrillations. But for ECLHA, we may say that the patient couldn't have survived two open heart surgeries, administration of a great amount of beta-blockers, and repeated cardiac arrest without neurological sequelae.

The direct effect of Hochuekki-To on human sperm fertilizability using the hypoosmotic swelling test

The concentration and motility of human sperm increase is examined following the oral administration of a traditional herbal medicine, Hochuekki-To using the hypoosmotic swelling (HOS) test. After 1 h incubation in Hochuekki-To, the motility of sperm and the results of the HOS test improved, particularly for severely abnormal sperm. For both the original and incubated sperm, the results of the HOS test improved when Hochuekki-To was used in the swim-up medium for the swim-up washing method rather than when Whittingham's T6 solution was used. Hochuekki-To had a favorable, direct effect on human sperm functions, suggesting an effect on the physiological integrity of sperm membrane.

Development, differentiation, and proliferation of epidermal Langerhans cells in rat ontogeny studied by a novel monoclonal antibody against epidermal Langerhans cells, RED-1

An antirat monoclonal antibody (mAb) against nonlymphoid dendritic cells, RED-1, was produced using epidermal Langerhans cells (LCs) as the immunogen. This mAb reacted mainly with the LCs and indeterminate dendritic cells (ICs), interdigitating cells in the T cell areas of lymphoid tissues, and monocyte/macrophages in various organs and tissues of adult rats. In the epidermal sheets prepared from adult rats, it specifically recognized the cell surface antigen(s) present on LCs and ICs. In the fetal rat skin, primitive or fetal macrophages migrated into the epidermis and expressed RED-1 at fetal day 17. With advance of gestation, RED-1-positive cells increased, started expressing Ia antigens at fetal day 18, and subsequently differentiated into dendritic cells. Most of them showed Ia expression by fetal day 20 and differentiated into LCs within a few days after birth. The labeling index of 5-bromo-2'-deoxyuridine in RED-1-positive cells was 18% at fetal day 17 and decreased to 5 to 6% in the postnatal period. These results imply that proliferative capacity of RED-1-positive cells is important for the formation and expansion of the IC population in the fetal stage and for the survival of LCs in the postnatal period.

A case of intravascular malignant lymphomatosis (angiotropic large-cell lymphoma) presenting memory T cell phenotype and its expression of adhesion molecules

A case of intravascular malignant lymphomatosis (angiotropic large cell lymphoma), T cell type was reported. The patient, a 59-year-old woman, had reddish or violaceous indurated macules scattered over the entire body surface. Neither lymphadenopathy nor hepatosplenomegaly was recognized. A chest Roentgenogram, whole body CT scan, and 67Ga-citrate scintigraphy yielded normal findings. Serum anti-HTLV-1 antibody was negative. Histopathologically, lesions showed intravascular large mononuclear cell proliferation associated with occasional fibrin thrombi formation in the dermis to subcutis. Immunohistochemically, the large mononuclear cell immuno-phenotype had a memory T cell character. Also, both lymphocyte function-associated antigen-1s, CD11a and CD18, and intercellular adhesion molecule-1 were demonstrated on the tumor cells and vascular walls in the lesions. To our knowledge, the present case is the fourth case of intravascular malignant lymphomatosis in the T cell lineage.

[Histopathological studies of goats after prolonged ECLA with a heparin-bonded artificial lung]

A pathological study was performed on the effects of prolonged extracorporeal lung assist (ECLA) with a heparin-bonded artificial lung and circuit in goats. A veno-venous ECLA was carried out in 15 goats for 5 to 10 days. Ten of them (Group I) were subjected to heparin-bonded devices and the other 5 (Group II) were subjected to the usual devices as control. The activated clotting time during ECLA was maintained at 130 seconds in Group I vs 200 seconds in Group II. The dose of heparin used in Group I was a half of that in Group II. Thrombi were found only in the lungs and the right side of the heart. The incidence of thrombi formation was low, and it was not significantly different between the two groups. Thrombotic embolism could not be found in any of the vital organs. Except for congestion, histological examination in these groups failed to reveal any remarkable changes. Electron microscopic study showed that heparin-bonded ECLA could maintain the normal alveolar structure. Compared with a usual system, ECLA with a heparin-bonded bypass exerted no significantly different effects on the thrombi formation and tissue histology, in spite of less systemic heparin administration for a prolonged period.

Immunohistochemical aspects of acute rejection of the allografted rat lung

We studied changes in the relative proportions of lymphocyte subsets infiltrating RT1-incompatible transplanted rat lungs during acute rejection. Lungs were examined at different times after transplantation with immunohistochemical staining. In the perivascular and peribronchial region, the ratio of helper to cytotoxic-suppressor T cells was reversed on day 4 when cytotoxic-suppressor T cells became most abundant. In the alveolar region, cytotoxic-suppressor T cells were more abundant than helper T cells from day 3. This rapid change in the proportion of T cell subsets has not been reported for other organ transplants. It may explain why lung allografts are rejected more rapidly than other organs.

[Veno-arterial ECLA (extracorporeal lung assist) for severe respiratory failure due to meconium aspiration]

A full term newborn female, 3262g, aspirated meconium at birth and began to suffer from severe hypoxia and acidosis due to progressing pneumonitis, pneumothorax and pneumomediastinum. She also had severe hypotension and anuria. Venoarterial ECLA with a Kolobow membrane lung via the right internal jugular vein and the right common carotid artery was initiated. Blood gas parameters and blood pressure improved, and urine output increased to normal. ECLA permitted a reduction in FIO2 and airway pressure of mechanical ventilation, as well as frequent lavage of the lung. As the physical condition improved, the bypass flow was gradually decreased from 200 ml.kg-1.min-1 at the start to 130 ml.kg-1.min-1 for maintenance, then to 25 ml.kg-1.min-1 at the end. Bleeding throughout the ECLA for 69 hours could be minimized by a meticulous control of the activated coagulation time with a minimum dose of heparin and the transfusion of fresh frozen and platelet rich plasma. After ECLA, the carotid artery was simply ligated, and mechanical ventilatory support was carried out for 5 days. Her condition improved and she left the hospital without any neurological sequelae. ECLA will become an effective means of life support for a baby with severe MAS irresponsive to conventional ventilatory support.

[Subrenal capsule assay (SRCA) using human lung cancer]

SRCA was performed using surgically removed fresh tissues in 26 cases of lung cancer. The histological examination of day 6 xenograft showed that only a few xenografts contained tumor cells because of the host cell infiltration and stroma. For the assay considered as evaluable, we defined that control mice needed to show delta tumor size larger than -0.5 OMU and histological presence of tumor cell more than 50% in the day 6 xenograft. The evaluable assay rate (EAR) was no more than 25% (4/16). By the pretreatment with X-ray irradiation of 3 Gy, host cell infiltration was significantly suppressed. With this procedure however, only 40% (4/10) of EAR was gained. The reason for this low EAR was due to the difficulty to obtain the specimens enriched with tumor cells because of stroma and necrotic tissue. Then we used specimen obtained from the human lung cancer line xenografted in nude mice, which resulted in a high EAR of 84% (16/19). We concluded that SRCA for fresh surgical materials was still difficult. However SRCA for lung cancer line was feasible, especially for in vivo preclinical chemosensitivity test for new agents and decision for new drug combination. SRCA as a disease oriented chemosensitivity test is expected to develop in the future.