Induction of immunological tolerance by oral, but not intravenous and intraportal, administration of ovalbumin and the difference between young and old mice

BACKGROUND

Induction of immunological tolerance is dependent on the route of antigenic administration, the dose of an antigen and the age of animals.

OBJECTIVES

We investigated the effect of age on the tolerance induction in mice by administration of antigen through different routes and at different doses.

DESIGN

Young and old BDF1 mice were orally, intraportally or intravenously administrated with a low or a high dose of ovalbumin (OVA). Then, delayed-type hypersensitivity (DTH) responses and serum anti-OVA antibody levels were assessed after systemic immunization of OVA with alum after appropriate intervals.

RESULTS

In the young mice, oral administration of OVA suppressed DTH response and anti-OVA IgG1, IgG2b, IgM and IgE level in a dose-dependent manner. In the old mice, however, the suppression of IgG1 and IgE levels was induced by oral administration of a low dose of OVA, but no suppression by a high dose. On the other hand, intraportal or intravenous injection of OVA did not suppress DTH response and enhanced anti-OVA antibody levels in a dose-dependent manner in both young and old mice. Production of anti-OVA IgG2a antibody after systemic injection of OVA was detected in the mice, which had been treated with intraportal or intravenous injection of OVA, but not detected in the mice, which had been treated with oral administration of OVA. On the contrary, suppression of anti-OVA IgE antibody was observed only in the mice, which had been treated with oral administration of OVA.

CONCLUSION

The oral administration of OVA, neither intravenous nor intraportal, induced immunological tolerance to OVA. An adequate dose of OVA for the tolerance induction and the suppression of antibody production are different between young and old mice. The suppression of IgE antibody was observed only by oral administration of OVA, much obviously in young mice than in the old. The results also indicated that the antigen processing in the liver did not play a major role in the induction of oral tolerance to OVA.

Predicting Autism Spectrum Quotient (AQ) from the Systemizing Quotient-Revised (SQ-R) and Empathy Quotient (EQ)

BACKGROUND

Empathizing is a specific component of social cognition. Empathizing is also specifically impaired in autism spectrum condition (ASC). These are two dimensions, measurable using the Empathy Quotient (EQ) and the Autism Spectrum Quotient (AQ). ASC also involves strong systemizing, a dimension measured using the Systemizing Quotient (SQ). The present study examined the relationship between the EQ, AQ and SQ. The EQ and SQ have been used previously to test for sex differences in 5 'brain types' (Types S, E, B and extremes of Type S or E). Finally, people with ASC have been conceptualized as an extreme of the male brain.

METHOD

We revised the SQ to avoid a traditionalist bias, thus producing the SQ-Revised (SQ-R). AQ and EQ were not modified. All 3 were administered online.

SAMPLE

Students (723 males, 1038 females) were compared to a group of adults with ASC group (69 males, 56 females).

AIMS

(1) To report scores from the SQ-R. (2) To test for SQ-R differences among students in the sciences vs. humanities. (3) To test if AQ can be predicted from EQ and SQ-R scores. (4) To test for sex differences on each of these in a typical sample, and for the absence of a sex difference in a sample with ASC if both males and females with ASC are hyper-masculinized. (5) To report percentages of males, females and people with an ASC who show each brain type.

RESULTS

AQ score was successfully predicted from EQ and SQ-R scores. In the typical group, males scored significantly higher than females on the AQ and SQ-R, and lower on the EQ. The ASC group scored higher than sex-matched controls on the SQ-R, and showed no sex differences on any of the 3 measures. More than twice as many typical males as females were Type S, and more than twice as many typical females as males were Type E. The majority of adults with ASC were Extreme Type S, compared to 5% of typical males and 0.9% of typical females. The EQ had a weak negative correlation with the SQ-R.

DISCUSSION

Empathizing is largely but not completely independent of systemizing. The weak but significant negative correlation may indicate a trade-off between them. ASC involves impaired empathizing alongside intact or superior systemizing. Future work should investigate the biological basis of these dimensions, and the small trade-off between them.

Synthesis of cyclopentadienones catalyzed by methylidynetricobalt nonacarbonyl

Easily prepared and air-stable methylidynetricobalt nonacarbonyl could be used as a catalyst for the intramolecular [2 + 2 + 1]-cocyclization of diynes and carbon monoxide producing cyclopentadienones.

The effects of allopurinol on immune function in normal BALB/c and SCID mice

To clarify the relationship between purine metabolism and immunity, the in vivo immunosuppressive effects of allopurinol (AL), a xanthinoxidase (XO) inhibitor, were studied using normal BALB/c and severe combined immunodeficient (SCID) mice. Following AL administration for 14 weeks (long term), a decreased immune response to ovalbumin (OVA) in the peripheral blood was observed in normal mice, which might not be only due to direct B cell suppression but also due to suppression of helper T cell function. In the SCID mice, there was a markedly late and reduced recovery of surface immunoglobulin (sIg) positive cells, which are markers for mature B lymphocytes, in the peripheral blood after AL administration. The total immunoglobulin G (IgG) titers in the AL treated group were significantly lower than in the control group 6 weeks after stem cell transfer, but increased until there was no difference in the titers between the two groups at week 14. CD4 positive helper T cells and CD8 positive T cells were slow to recover, though these gradually recovered to reach normal levels in the mature stage. These data suggest that the administration of AL may modulate B cell and T cell responses in OVA-immunized antibody formation. Furthermore, this study showed that AL could influence immune functions during the pre-natal and developmental periods and that its effects might differ according to the stages of maturity of the immune cells.

Vitamin E enhances the immune functions of young but not old mice under restraint stress

Young and old C57BL/6 male mice were given a diet containing a high dose of vitamin E (VE treatment) and its effect on the immune system was examined before and after the exposure to restraint stress. The VE treatment per se gave rise to a slight increase of splenic T cells in percentage and a significant enhancement of Con A response of spleen cells in young, but not in old mice. The VE treatment also resulted in the enhancement of production of IL-2 and IFNgamma in young, but not in old mice. Restraint stress led to thymic involution in both young and old mice. This thymic involution was not ameliorated by the VE treatment. Percentage of splenic T cells and their mitogenic response decreased just after the stress, but soon rebounded over the control level. The VE treatment further enhanced the recovery after the stress in young mice, but on the contrary suppressed the recovery in old mice. The results in the present study suggested that the VE treatment was effective in the prevention of immunological decline of young mice before and after the exposure to the stress. On the other hand, such a preventive effect was not observed in old mice that were already in the depressed state of immunological functions.

Differential age effect of oral administration of an antigen on antibody response: an induction of tolerance in young mice but enhancement of immune response in old mice

Sheep red blood cells (SRBC) were orally administered to young (4 months old) and old (22 months old) mice, and its effect on the antibody production after systemic immunization was compared between young and old mice. The results showed that the dose-dependent suppression of antibody response (oral tolerance) was observed in young mice which had been previously treated with oral administration of SRBC. On the contrary, the enhancement of antibody production was observed in old mice which had been treated in the same way. The enhanced level of IgG antibody in old mice was higher than that of young mice. The critical age determining either suppression or enhancement of antibody response after the oral administration of the antigen was present between 6.5 and 10.5 months of age. When the oral administration of the antigen was performed in young (3 months old) and middle-aged mice (12 months old), the oral tolerance for young and the enhanced antibody response for middle-aged mice were observed even at 6 months after the treatment. The analysis by in vitro antibody response using T and B cells prepared from young and old mice showed that age-related alteration of T and B cells is responsible for the suppression and the enhancement of antibody response after oral administration of SRBC, respectively.

Age-related alteration of cytokine production profile by T cell subsets in mice: a flow cytometric study

Spleen cells from young and old C57BL/6 mice were stimulated with a combination of anti-CD3 and anti-CD28 antibodies, and the profile of cytokine production was examined by two different methods; the concentrations of cytokines as measured by ELISA, and identification of cytokine-positive cells by flow cytometry. The ELISA method revealed that IL-2 production by spleen cells after stimulation was significantly lower in the old mice compared to the young mice. while IFN-gamma production was the reverse. The flow cytometric analysis showed that the percentage of IL-2 positive cells in spleen cells after the stimulation was significantly lower in the older mice than in the young mice, and vice versa for the percentage of IFN-gamma-positive cells. Regarding the T cell subsets, CD4+ T cells were a major source of IL-2 in both the young and old mice. IL-2-positive cells in both CD4+ and CD8+ T cells showed a significant decrease with age. On the contrary, CDX T cells were the major source of IFN-gamma. An age-related increase of IFN-gamma positive cells was observed in both CD4+ and CD8+ T cells. CD4 T cells were the major source of IL-4, and the percentage of IL-4-positive CD4+ T cells also increased with age, although the level of IL-4 production was modest in C57BL/6 mice compared with IL-2 and IFN-gamma. Such age-related changes of cytokine production are presumed to play an important role in the alteration of immunological capacity with age.

Role of inhibition of penicillin binding proteins and cell wall cross-linking by beta-lactam antibiotics in low- and high-level methicillin resistance of Staphylococcus aureus

We have investigated the relationships between the minimum inhibitory concentrations (MICs) of eight beta-lactams and their binding affinities of penicillin binding proteins in low- and high-level methicillin-resistant Staphylococcus aureus (MRSA). For high-level MRSA (H-MRSA), a significant correlation was found between IC50 for PBP2A and MIC, whilst no clear relationship was apparent for low-level MRSA (L-MRSA). However, the product of the IC50s for PBP2A and PBP4 significantly correlated with the MIC in L-MRSA. Since PBP4 is thought to mediate secondary cross-linking of the staphylococcal cell wall, we analyzed the effect on cell wall cross-linking of L- and H-MRSA of two representative drugs (cefoselis and flomoxef). Interestingly, the decrease in cell wall cross-linking, which was clearly observed in L-MRSA, was diminished with H-MRSA. It is concluded that for L-MRSA, a reduction in cell wall cross-linking caused by inhibiton of PBP4 may contribute to the antimicrobial activity of beta-lactam antibiotics, while for H-MRSA, inhibition of PBP2A mainly determines the antimicrobial activity. Since neither alteration of expression nor binding affinity of PBP4 were observed in these studies, unknown factors must operate to diminish the effect of PBP4 inhibition and contribute to the mechanism of high level resistance of MRSA.

Relationship between apolipoprotein E polymorphism, menopausal symptoms, and serum lipids during hormone replacement therapy

OBJECTIVE

Menopausal women receive hormone replacement therapy (HRT) to relieve symptoms and to help prevent osteoporosis or atherosclerotic disease. We investigated the association of apolipoprotein (apo) E polymorphism with menopausal symptoms, body fat mass and lipid profile in 236 women, together with the lipid changes accompanying HRT administration in 172 women from this population who were postmenopausal.

STUDY DESIGN

The subjects were divided into three groups according to apo E phenotype: group E2, apo E2/2 and 2/3; group E3, apo E3/3; group E4, apo E4/3 and 4/4. Typical menopausal symptoms were classified into four degrees of severity; body fat mass, lipid profile, and serum lipid levels were measured before and 6 months after oral HRT.

RESULTS

There were no significant differences between the symptoms of the three groups. The serum levels of apo E were the highest in group E2 and lowest in group E4. Analogous tendencies were seen in the mean levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and apo B, with group E4 having the highest levels and group E2 the lowest. Triglyceride levels (TG) were the highest in group E2, but the difference was not significant. These parameters suggest that group E4 had the highest risk of cardiovascular disease. The LDL-C/high density lipoprotein cholesterol (HDL-C) ratio was improved from 2.18 before HRT to 1.52 after HRT in group E2; from 2.26 to 1.92 in group E3; and from 2.57 to 2.10 in group E4.

CONCLUSION

The apo E phenotype was not associated with any difference in menopausal symptoms. Group E4 had the highest risk for cardiovascular disease, and group E2 the lowest. Oral HRT could be recommended for the women in group E4.

Anatomic segmental resection of the lung by thoracoscopy: an experimental study

In patients who are unable to undergo a lobectomy for a small peripheral lung cancer, a partial thoracoscopic resection appears to be one viable alternative. However, since the regional lymphatics are disrupted in an anatomical fashion with a segmentectomy, it appears superior to a wedge resection. This experimental study was conducted to determine whether or not an anatomical segmental resection is feasible by thoracoscopy. A segmental resection of porcine lungs was performed using thoracoscopy. The segmental vessels were divided between ligatures. The segmental bronchus was divided by an endoscopic stapler. The intersegmental lung parenchyma was divided using a cotton dissector and a contact neodymium-yttrium aluminum garnet laser. Forty-three pigs were divided into seven groups as follows. Group 1: S1 + 2; group 2: S3; group 3: upper division; group 4: lower division; group 5: S6; group 6:S8; and group 7: S9 + 10. The operating times ranged from 145 +/- 15 min to 191 +/- 47 min. Blood loss ranged from 36 +/- 35 ml to 151 +/- 48 ml in all groups. The blood loss in the group with a resection of S6 and S9 + 10 was significantly greater than that of the other five groups. Most of the blood loss occurred during the division between the intersegmental planes. In conclusion, a thoracoscopic segmentectomy is considered to be technically feasible; however, further refinements in this technique are warranted before beginning clinical trials.

Biochemical and pharmacological characterization of FK706, a novel elastase inhibitor

FK706, sodium 2-[4-[[(S)-1-[[(S)-2-[[(RS)-3, 3, 3-trifluoro-1-isopropyl-2-oxopropyl]aminocarbonyl]pyrrolidin -1-yl]carbonyl]-2-methylpropyl] aminocarbonyl] benzoylamino] acetate, C26H32F3N4NaO7, is a synthetic water-soluble inhibitor of human neutrophil elastase. This compound demonstrated a competitive and slow-binding inhibition of human neutrophil elastase with a Ki of 4.2 nM. In studies using synthetic substrates, FK706 inhibited human neutrophil elastase activity and porcine pancreatic elastase activity with respective IC50 values of 83 and 100 nM. FK706, however, inhibited more weakly, (IC50 values > 340 microM) other serine proteinases such as human pancreatic alpha-chymotrypsin, human pancreatic trypsin and human leukocyte cathepsin G. FK706 also effectively inhibited the hydrolysis of bovine neck ligament elastin (2 mg/ml final concentration) by human neutrophil elastase (4 microg/ml final concentration) with an IC50 value of 230 nM. FK706 protected animals against human neutrophil elastase (50 microg/animal)-induced lung hemorrhage with ED50 values of 2.4 microg/animal by intratracheal administration and 36.5 mg/kg by intravenous administration, respectively. Subcutaneous administration of FK706 significantly suppressed human neutrophil elastase (20 microg/paw)-induced paw edema in mice in a dose-dependent manner (47% inhibition at a dose of 100 mg/kg). These results suggest that FK706 would be a useful tool for investigating the role of human neutrophil elastase in inflammatory disorders associated with an excess of elastase, such as pulmonary emphysema, adult respiratory distress syndrome, septic shock, cystic fibrosis, chronic bronchitis and rheumatoid arthritis.

Regulation of experimental autoimmune orchitis by the presence or absence of testicular antigens during immunological development in SCID mice reconstituted with fetal liver cells

Severe combined immunodeficient (SCID) mice were immunologically reconstituted by the transfer of fetal liver cells (FLC) of BALB/c mice (SCID-FLC mice). In peripheral blood (PB) of SCID-FLC mice, B and T cells started to appear 2 and 5 weeks, respectively, after the transfer of FLC, and had attained normal levels by 7 weeks. Orchidectomy and transplantation of testis under the kidney capsule were conducted at various stages of immunological maturation, and the induction of experimental autoimmune orchitis (EAO) was performed after immunological maturation in SCID-FLC mice. The experimental system was used to establish that the presence of testicular antigens in the early stage of immunological development influences the induction of EAO; grade of EAO was reduced in the presence of the antigens, and enhanced in their absence. In other words, the existence of self tissue antigens in the early stage of immunological development was essential for proper establishment of tolerance to the self tissue. These findings suggested that the SCID-FLC mouse is a suitable model with which to analyse the interaction between self antigens and cells of the developing immune system, which is otherwise observed only in the fetal or perinatal stage in experimental animals.

Development of the immune system in severe combined immunodeficiency mice reconstituted with transferred fetal liver cells

Severe combined immunodeficiency (SCID) mice were immunologically reconstituted by the transfer of fetal liver cells (FLC) from BALB/c (SCID-isoFLC mice) or C57BL/6 mice (SCID-alloFLC mice). The developmental process of the immune system in the peripheral blood (PB) was almost comparable between SCID-isoFLC and SCID-isoFLC mice. Analysis of the lymphoid organs and the PB from SCID-alloFLC mice indicated that slg+ B cells appeared and were distributed to the periphery within 2 weeks after the transfer of FLC. It was also suggested that precursor T cells entered the thymus before 4 weeks after the transfer, and were differentiated into mature CD4+ or CD8+ T cells which then migrated to the periphery by 6 weeks. All of mature lymphocytes in the periphery of the SCID-alloFLC mice were shown to express donor-type H-2 antigens. Additionally, in the SCID-isoFLC mice, cell-mediated immunity such as rejection against alloantigens was functioning from 6 weeks, and humoral immune function was suggested by the detection of cells generating antigen-specific antibodies. We discuss that development of the immune system in SCID mice receiving transferred FLC was comparable to that normally seen in the fetal and neonatal stages.

Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy

OBJECTIVE

Total esophagectomy with en bloc mediastinal lymphadenectomy for cancer carries a substantial morbidity and mortality rate. To investigate the feasibility of thoracoscopic technique, we carried out an extensive laboratory study. Encouraged by our excellent results, we conducted a clinical trial.

METHODS

From September 1994 to September 1995, 39 patients thoracic esophageal cancer lesions not invading surrounding organs underwent total esophagectomy with mediastinal lymphadenectomy by means of thoracoscopy. Ages ranged from 47 to 86 years. The procedures were conventional except for the thoracic portion, which was performed as a thoracoscopic procedure with six trocar holes instead of thoracotomy. All harvested lymph nodes were counted for each station. Spirometric data and plethysmographically determined vital capacity were measured before and after operation for all patients.

RESULTS

All procedures were accomplished as scheduled, and none was converted to open thoracotomy. The operating time was 200 +/- 41 minutes (mean +/- standard deviation). Estimated blood loss was 270 +/- 157 ml. The harvested lymph nodes numbered 19.7 +/- 11.1 per patient. Seventeen patients (45%) had positive lymph nodes. There were no in-hospital deaths within 30 days. Twenty-two patients did not require postoperative ventilatory support. Vital capacity decreased to 85% +/- 11% of the preoperative values, and forced expiratory volume in 1 second decreased to 82% +/- 16%.

CONCLUSIONS

Thoracoscopic mediastinal lymphadenectomy is technically feasible, and its completeness is comparable to that of the open technique. The decline in pulmonary function is significantly less than that seen in our previous experience with the open technique.

Prevalence of severity of hypoxemia following clinical voluntary hyperventilation

The voluntary hyperventilation (VHV) test is used in many clinical examinations. However, arterial hypoxemia following a clinical VHV test is not a well-studied phenomenon. We analyzed the arterial blood gases (ABGs) of 61 patients during a VHV test. The ABG were taken prior to (PaO2-Prior), immediately following (PaO2-Immediate), and 5 min after (PaO2-After) the VHV test. The patients' average PaO2 rose significantly (p < 0.0001) from the PaO2-Prior (88 +/- 8 mm Hg; mean +/- SD) to the PaO2-Immediate (118 +/- 13 mm Hg) and then dropped significantly (p < 0.0001) to the PaO2-After (74 +/- 16 mm Hg). Two of the 20 patients who experienced an angina pectoris attack (AP(+)) following the VHV test showed severe arterial hypoxemia (PaO2-After < 60 mm Hg), whereas 9 of the 41 patients who did not experience an angina pectoris attack (AP(-)) showed a PaO2-After < 60 mm Hg. The PaO2-After did not correlate with the PaO2-Prior. The decrease in the PaO2-Prior to After did not correlate significantly with the left ventricular ejection fraction rate (n = 58, r = 0.18, not significant). However, the decrease in the PaO2-Prior to After correlated well with the degree of recovery of the PaCO2 following the VHV test (r = -0.69, p < 0.0001). The age, gender ratio, changes in arterial blood gases, number of patients who experienced PaO2-After < 60 mm Hg, and left-ventricular ejection fraction rate were not significantly different between the AP(-) and AP(+) groups. Posthyperventilation hypoxemia developed frequently following the VHV test during coronary angiography. Although this arterial hypoxemia was not directly correlated with the occurrence of AP attacks following VHV in this study, continuous SaO2 monitoring is recommended whenever a VHV test is used as a diagnostic technique to avoid the potentially deleterious effects of arterial hypoxemia.

Unilateral thoracoscopic laser pneumoplasty of diffuse bullous emphysema

The technical details of thoracoscopic laser pneumoplasty (TLP) by means of a contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is described. Retrospective analysis of 769 unilateral TLPs indicated that the operative risk is acceptable (6% 3-months mortality rate), and significant subjective and objective improvement was achieved. Recurrent bullous emphysema is discussed. TLP is an effective treatment of advanced emphysema.

Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema

BACKGROUND

Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema by means of a contact neodymium:yttrium-aluminum garnet laser was evaluated by a retrospective analysis of the first consecutive 500 procedures in 443 patients. The indication for thoracoscopic laser pneumoplasty was intractable dyspnea.

METHODS

Advanced age (mean age, 67 years), high oxygen dependency (70%), steroid use (46%), and markedly diminished physical capacity (2% bedridden and 27% wheelchair-bound) were noted. Thoracoscopic laser pneumoplasty was carried out under general anesthesia and one-lung ventilation. Type 3 bullae (381 procedures) were contracted by contact neodymium:yttrium-aluminum garnet laser and type 4 bullae (199 procedures) excised. The operative mortality rate was 4.8%.

RESULTS

Subjective improvement was reported by 87% of the patients. Follow-up functional evaluation was available in 229 patients, which showed highly significant improvement. A comparison of preoperative and postoperative functional tests between type 3 and 4 bullae patients showed no significant difference, except the latter had higher decrease in airway resistance, residual volume, and total lung capacity.

CONCLUSIONS

Thoracoscopic laser pneumoplasty is an effective treatment for both type 3 and 4 bullous emphysema with an acceptable risk.

[Successful treatment of a giant bulla by thoracoscopic excision and laser ablation]

A 39-year-old male complaining of shortness of breath on mild exertion. Radiographs revealed that a giant bulla occupied more than half the area of the right lung field. Thoracoscopic excision of the giant bulla was performed using some autosutures. After the emphysematous lesion was consolidated by laser ablation, it was sutured using PDS thread. The bulla in the left lung was similarly excised 3 weeks after the first procedure. The FEV1.0% improved from 72% to 89% after excision and laser ablation of a giant bulla and bullae. Thoracoscopic excision and laser ablation of a giant bulla appears to be an effective alternative to conventional thoracotomy.

Thoracoscopic partial lung resection in patients with severe chronic obstructive pulmonary disease. A preliminary report

OBJECTIVE

To determine if patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection.

DESIGN

Patients with non-small-cell lung cancers were selected from 583 cases undergoing laser treatment. The parameters studied included sex, age, tumor size, spirometry (forced vital capacity, forced expiratory volume in 1 second), operating time, operative mortality rate, postoperative ventilatory time, and length of hospital stay. The follow-up period varied from 4 to 30 months.

SETTING

A private community hospital with nationwide referrals.

PATIENTS

Nine consecutive patients (five men, four women) were found to have lung cancer before (four patients) or at (five patients) surgery. Their mean (+/- SD) age was 71.2 +/- 3.8 years; tumor size, 3.3 +/- 1.6 cm; forced vital capacity, 2.04 +/- 0.50 L (49.7% +/- 10.2%); and forced expiratory volume in 1 second, 0.66 +/- 0.11 L (22.2% +/- 5.5%).

INTERVENTIONS

With patients under general anesthesia with one-lung ventilation, the tumor was resected and coexisting diffuse bullae were treated by a contact neodymium:YAG laser. Four patients received adjuvant therapies: chemotherapy, one; radiation and chemotherapy, one; radiation, one; and brachytherapy, one.

MAIN OUTCOMES

All patients tolerated surgery; there were no deaths. Mean (+/- SD) operating time was 4.9 +/- 1.4 hours; postoperative ventilatory time, 10.3 +/- 6.8 hours; and length of hospital stay, 15.2 +/- 13.2 days.

RESULTS

One patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients remained free of tumors.

CONCLUSIONS

Patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection but an effort should be made to reduce local recurrence.

[Postoperative intravesical installation of tetrahydropyranyl-adriamycin (THP) and cytosine arabinoside (CA) for superficial bladder cancer: clinical results of prophylactic effects on recurrence]

Intravesical instillation of tetrahydropyranyl-adriamycin (THP) and cytosine arabinoside (CA) was performed on 42 patients with superficial bladder cancer after transurethral resection (TUR) for the purpose of prophylaxis of recurrence. The instillation was carried out with 30 mg of THP dissolved in 30 ml of distilled water and 200 mg of CA (total 40 ml). These drugs were instilled 7 times for the initial 2 weeks after TUR, and then 7 times every two weeks, 8 times every month, and 4 times every three months. Cases eligible for evaluation of efficacy were 38 out of 42 patients. The cumulative non-recurrence rate at one, two and three years were 94%, 84% and 75%, respectively. These high non-recurrence rates were demonstrated regardless of the size, number and pathological grade of the tumors. Severe bladder irritability was demonstrated in 8 (19%) of 42 patients, but generalized side effects were not seen in any case. The reformed regimen with 20 mg of THP in 30 ml of physiological saline solution was then performed on trial in several patients and there were no severe symptoms. THP combined with CA seems to be remarkably effective for the prophylaxis of recurrence, while a high concentration of THP in distilled water may lead to severe bladder irritability.

[Trend in person-situation controversy about personality research]

The purpose is to review the trend in "person-situation controversy", and to comment on recent literature and their implications. "Person-situation controversy" is related to whether people do or do not have consistent personality traits. Although the topic is not at all new, it aroused a great deal of interest since the publication of Mischel's (1968) "personality and assessment". Here, we began with Mischel's criticism against the trait approach, then, we discussed two opposite viewpoints of situationism and interactionism. Situationism is the idea that situational variables influence more on the behavior of people than personality traits, while interactionism is the idea that personality traits and situations interact with each other to influence behavior. Furthermore, this article focussed on three conceptual issues, such as consistency, prediction, and meaning of traits. Finally, the reconsideration and evaluation of the two viewpoints were presented from a viewpoint of personality psychology.

Thoracoscopic technique for management of giant bullous lung disease

Giant bullae of the lungs are readily recognizable on plain chest x-ray films and are rare. Only 17 of more than 500 cases of thoracoscopic treatment of bullous lung disease over the past 3 years involved giant bullae, which included both types 1 and 4. Type 1 bullae have smooth internal lining without trabeculae and type 4 have trabeculae. The indications were dyspnea in 10 cases, spontaneous pneumothorax in 6, and infection in 1. The mean age of the patients was 55 years. Five patients were oxygen dependent, 1 was wheelchair-bound, and 3 were steroid dependent. Preoperative spirometry was available in 1 patient with type 1 bullae (forced vital capacity = 95% and forced expiratory volume in 1 second = 55% of the predicted values) and in 10 patients with type 4 bullae (forced vital capacity = 46.90% +/- 15.29% and forced expiratory volume in 1 second = 23.50% +/- 7.46% of the predicted values). Under general anesthesia with one-lung ventilation, the giant bullae were excised, plicated, or contracted by the laser, depending on the type, by means of thoracoscopy. Thoracoscopic surgery was successful in all patients, and no procedure was converted to thoracotomy. The duration of anesthesia was 4.44 +/- 1.49 hours, postoperative ventilatory support 42.24 +/- 64.22 hours, and postoperative air leaks 14.59 +/- 14.11 days. All patients did very well and pain was minimal. There was no recurrence for up to 3 years of follow-up. In conclusion, thoracoscopic treatment of giant bullae of the lungs is an effective alternative to conventional thoracotomy with minimal morbidity.

Anatomic lobectomy of the lung by means of thoracoscopy. An experimental study

We conducted this study in an attempt to investigate whether anatomic lobectomy can be performed through a thoracoscope. Twelve lower (seven left and five right) and six left upper lobectomies were done in 17 pigs weighing 60 to 90 kg. With the use of general anesthesia and one-lung ventilation, a thoracoscope and operating instruments were inserted through four or five trocars. First, the incomplete fissure was bluntly dissected with specially designed cotton-tipped dissectors and divided by an electrocautery spatula or sapphire contact-tip neodymium: yttrium aluminum garnet laser probe. The pulmonary artery and its branches were similarly dissected. Two ligatures were passed around the vessels by endoscopic right-angle clamps and tied by means of an extracorporeal tying technique. The vessels were clipped and divided. In two animals, a hidden branch of the pulmonary artery was inadvertently cut. Bleeding was readily controlled with the dissector until metal clips could be applied. The bronchus was similarly dissected and divided and the proximal stump was closed with sutures. The pulmonary vein was dissected bluntly by the same technique and divided. The excised lobe was placed in a plastic bag and pulled out through one of the trocar holes after the hole had been enlarged to 3 cm. Blood loss was minimal. In conclusion, anatomic lobectomy of the lung by means of thoracoscopy was feasible in the pig.

Expanded applications of diagnostic and therapeutic thoracoscopy

From 1971 to 1990, 315 thoracoscopies were performed. Recent advances in optic/video systems and endoscopic operating instruments have made thoracoscopy easier and more accurate than 20 years ago. The operative mortality rate was low (1%) and the diagnostic accuracy high (99%). Thoracoscopy has been performed at an increasing frequency in recent years because of its expanded applications, especially in the areas of therapeutic or operative procedures such as carbon dioxide laser treatment of spontaneous pneumothorax or diffuse bullous emphysema, neodymium:yttrium-aluminum-garnet laser vaporization of pleural malignant tumors, and thoracoscope/laser-aided pleurectomy, pericardiectomy, or lung resection. Further technologic advancement in thoracoscopy will have a considerable impact on the future of thoracic surgery.

Thoracoscopic carbon dioxide laser treatment of bullous emphysema

A new technique of thoracoscopic laser ablation of pulmonary bullae suitable for patients with multiple bullae and diffuse emphysema was developed and assessed in 22 patients. 20 of 22 patients survived. Pre-operative and postoperative functional evaluation is available for the 11 patients followed up for more than a month; at 1 to 3 months postoperatively there were increases in FVC (mean 2.0 litres pre-operatively to 2.7 litres postoperatively, p less than 0.001), in FEV1 (0.74 to 1.06 litres, p = 0.01), and in maximum exercise treadmill times (5.4 min to 8.0 min, p less than 0.01). Postoperative air leaks lasted a mean of 13 days and usually resolved spontaneously. Other complications were bleeding (1 patient) and unilateral acute lung injury (1 patient). These results suggest that selected patients with diffuse emphysema and pulmonary bullae may benefit from thoracoscopic carbon dioxide laser ablation.

Thoracoscopic treatment of spontaneous pneumothorax using carbon dioxide laser

In an effort to improve the success rate of the previously described thoracoscopic electrocautery ablation technique of spontaneous pneumothorax, the carbon dioxide laser was evaluated in 12 patients. The recurrent (5 patients) or persistent (7 patients) spontaneous pneumothoraces were caused by rupture of (1) blebs in 6 patients, (2) intrapulmonary apical type II bullae in 3 patients, and (3) diffuse bullous emphysema, type III, in 3. The air leaks were successfully sealed in all but 1 patient with ruptured type II bulla. Surgical specimen from this single failure suggested that the entire inner lining of the bullae must be thermocoagulated. This technical modification led to successful outcome in 2 subsequent cases. With the use of carbon dioxide laser, it was possible to treat not only small blebs but all types of bullae causing spontaneous pneumothorax. Laser thoracoscopy is effective and safe in treating spontaneous pneumothorax.

[The therapeutic effect of norfloxacin on chronic prostatitis]

The clinical efficacy of norfloxacin (NFLX) was evaluated on 40 patients. They had subjective symptoms suggestive of prostate inflammations and more than five white blood cells (WBC)/hpf in their prostatic secretions (EPS) or VB3. Of these, gram negative rods were isolated from the EPS in 3 patients and gram positive cocci were obtained in 26 patients. The overall clinical efficacy was determined at the second week. The effectiveness rate of the subjective symptoms was 82.5%. The effectiveness rate of the WBC in the EPS was 47.4%. The effectiveness rate of the bacteria in the EPS was 64.3%. The overall clinical effectiveness rate was 77.8%. A subjective side effect was observed only in one patient who had skin eruption like urticaria. Mild liver dysfunction of blood chemistry analysis was shown only in two patients but they had had long standing chronic hepatitis. We conclude that NFLX is an effective drug for the patients with chronic prostatitis.

Clinicopathological study on end-stage reflux nephropathy in renal-transplanted children

Five children with end-stage reflux nephropathy underwent kidney transplantation at our clinic. Reflux nephropathy was studied clinically and histologically. All children had proteinuria before starting hemodialysis, and hypertension was present in 2 cases. Three children underwent antireflux operations prior to transplantation. The original kidneys exhibiting reflux were removed during renal transplantation. All original kidneys exhibited atrophy and scarring. Focal and segmental glomerulosclerosis was found in 4 cases. PAS deposition in the interstitium, suggestive of Tamm-Horsfall glycoprotein, was found in all cases. No recurrent signs of focal and segmental glomerulosclerosis have been found in the children who have been followed up from 1 to 6 years after transplantation.

Thoracoscopic ablation of blebs in the treatment of recurrent or persistent spontaneous pneumothorax

Recurrent (6 patients) or persistent (4 patients) spontaneous pneumothorax was treated with thoracoscopic ablation of blebs using an electrocautery as an alternative to lung resection. Patients' ages ranged from 17 to 39 years (mean age, 29 years). Ablation was successful in 9 but failed in 1. The mean postoperative hospital stay of the successful cases was 2.1 days. The only failure in this series had an extensive bullalike air cyst involving the apex, and cauterization could not ablate it completely. The follow-up period ranged from 2 to 22 months. During this period, no recurrence was noted.

A case of successful coronary artery bypass grafting in a patient with angina pectoris and hypothyroidism

There is a clinical dilemma in the treatment of patients with hypothyroidism and coronary artery disease; excess thyroid hormone administration may exacerbate anginal symptoms, and yet inadequate thyroid replacement may induce congestive heart failure. A case of successful coronary artery bypass grafting in a patient with angina pectoris and hypothyroidism is described in this paper. A 55 year-old woman with this complication initially received thyroid replacement therapy under strict monitoring. Forty days after the start of the thyroid replacement therapy, serum levels of thyroid hormone had reached the normal range, and then coronary artery bypass grafting was successfully performed. She recovered without any complications, and is now free from chest pain in spite of thyroid replacement therapy.

[A case of traumatic rupture of the testicle]

Traumatic rupture of the testicle is rare because of the protection afforded by surrounding structures. Many clinicians now speculate that this entity is underreported due to misdiagnosis. However, the condition should not be overlooked because of the importance of early treatment for the preservation of testicular function. A more aggressive approach to scrotal hematoma has been advocated. A case of traumatic rupture of testicle in a 21-year-old patient is reported. The testicle was surgically explored 6 days after trauma to the scrotum. The tunica albuginea was repaired and the testicle was preserved. Discussion is made especially on the injury to scrotum.

[Percutaneous nephro-ureterolithotripsy in patients after urinary diversion or reconstruction using the intestine: report of 5 cases]

Five patients who developed urolithiasis after urinary diversion or reconstruction using the intestine were treated with percutaneous nephro-uretero lithotripsy (PNL). These patients were successfully treated, and we did not experience any severe complications. For the stone removal in this case, PNL seems to be superior to other open surgery methods.

[Extracorporeal shock-wave lithotripsy for children]

We performed extracorporeal shock wave lithotripsy (ESWL) on a 5-year-old and 8-year-old. Ureteral calculi in both patients were disintegrated, and all fragments were passable spontaneously. The 5-year-old girl was the youngest of the cases of ESWL reported in Japan. As this patient was 107 cm in height, we put a styrofoam layer on the back of this patient. This protected her lung from the shock wave, and the height limit was released from the ESWL treatment. These cases and the peculiarities and devices for ESWL in the pediatric field are discussed.

[Pathological study on reflux nephropathy]

Four hundred patients with primary vesicoureteral reflux were followed clinically in our department between 1975 and 1984. Histopathological studies including immunofluorescent study were carried out on 13 of them. Their renal function was followed by intravenous pyelography, and from serum creatinine values, proteinuria and radioisotope renograms. Renal deterioration was found in 4 patients. Proteinuria was observed since the first consultation in three of them. Microscopically, mesangial proliferation was observed in all patients but none of them showed focal glomerulosclerosis. An immunofluorescent study was carried out on 7 patients. IgM deposition was found in 3 patients (43%), C8 deposition in only 2 of 3 patients (29%), IgG deposition in 1 of them (14%), and IgA deposition in 1 patient (14%). Proteinuria, renal disorders and mesangial proliferation were correlated with reflux nephropathy. Especially, intrarenal reflux could cause reflux nephropathy but it is impossible to deny immunological factors.

Angiographic comparison of the internal mammary artery graft and the saphenous vein graft within 2 months and 6 to 12 months after coronary artery bypass surgery

Angiographic status of the saphenous vein graft (SVG) and the internal mammary artery graft (IMAG) anastomosed to the left anterior descending artery were compared at two different postoperative periods; - within 2 months and at 6 to 12 months after the operation. In 50 SVGs and 35 IMAGs which were studied at the early postoperative period, the rate of intact, stenosed and occluded grafts were almost the same in these two kinds of grafts. However, in 35 SVGs and 25 IMAGs which were studied at the later period, the stenosis of SVG increased significantly while IMAG remained intact. The rate of intact, stenosed and occluded grafts at postoperative 6 to 12 months were 71%, 23% and 6% in SVG, and 88%, 8% and 4% in IMAG, respectively. Considering the better angiographic quality of IMAG, use of IMAG to bypass the most important coronary artery should be considered especially when the patients are younger.

[A case of syphilitic orchitis with aortic aneurysm]

A case of syphilitic orchitis with aortic aneurysm is presented. The patient was a 72-year-old man who was diagnosed as having aortic aneurysm of thorax and abdomen by angiography. He visited our clinic with the complaint of swelling of the scrotal contents with tenderness after aneurysmectomy. Antibiotics were not effective against the swelling or tenderness, and right orchiectomy was performed. Histological diagnosis was syphilitic orchitis and aortitis.

[Extracorporeal shock wave lithotripsy of urolithiasis]

A total of 159 patients underwent 194 treatments with extracorporeal shock-wave lithotripsy for upper urinary tract calculi between August 4 and November 30, 1986. A single treatment was performed in 76% of the patients with renal stones and 90% of the patients with ureteral stones. Treatment was successful in 153 patients (93%). Seventy percent of the patients with renal stones and 95% of those with ureteral stones were stone-free over the one-month follow-up, while about 15% had small and asymptomatic fragments believed to be passable spontaneously. Only one patient required surgical removal of the calculi due to severe ureteral edema. Adjunctive urological management is required in about 9% of the patients preoperatively or postoperatively. The period of hospitalization averaged about 11 days after treatment and patients usually returned to work within a few days after their discharge. Extracorporeal shock-wave lithotripsy is the preferred form of management for symptomatic ureteral and renal calculi.

[Extracorporeal shock wave lithotripsy--difficulties in ESWL]

At Kanbara Hospital, 187 patients with urolithiasis have been treated by extracorporeal shock-wave lithotripsy (ESWL) since the first ESWL treatment in December, 1986. Some cases in which ESWL could not be performed easily were experienced. These difficulties were analyzed retrospectively and some problems in the ESWL treatment are discussed.

[A study of cyclothymic personality in personality type theory: a structural interpretation of syntonic and immodithymic personalities in the cyclothymic personality type]

This study was undertaken to explore various fundamental characteristics of the cyclothymic personality type. The subjects were 474 students who were classified into three basic personality types -cyclothymic, schizothymic and collathymic- on the basis of their performance on the VERAC Personality Inventory (VPI). Analyses of two questionnaires (TSPS and Self-Differential) completed by the subjects indicated that students classified as cyclothymic had a stronger tendency to recognize their own personality type and to adjust images which could or might be recognized by others. To explore the cyclothymic personality in greater detail, this group was classified into two sub-types -hypomanic and immodithymic types- and two additional tests (EPPS and EFT) were administered to these subjects. Analysis of the responses to these tests revealed that (a) the differences between the two sub-types in EPPS coincided to some degree with earlier reports in the clinical literature, (b) there was no difference between the sub-types in terms of reaction time or number of errors in EFT, and (c) the differences obtained between EPPS and EFT were not so clear as those obtained among the three basic personality types. Overall, these results supported the contention that cyclothymic personality type is a viable sub-category in personality type theory.

[Conservative treatment of benign prostatic hypertrophy: reevaluation of the effect of eviprostat by subjective symptoms and uroflowmetry]

The clinical effect of Eviprostat was evaluated in 53 patients with benign prostatic hypertrophy. Subjective symptoms were improved in 86.2% of the patients who were treated with Eviprostat. Nomogram unit of uroflowmetry also improved in 51.4% of the patients. The overall clinical efficacy estimated by the combination of subjective symptoms and uroflowmetry was observed in 90.9% of the patients. In conclusion, Eviprostat was considered to be useful in patients with discomfort symptoms who had no immediate indication for prostatectomy.

[Persistent Müllerian duct syndrome with seminoma: report of a case]

Persistent Müllerian duct syndrome is a male hermaphroditism in which remnants of Müllerian ducts occur from abnormality of Müllerian inhibitory factor and often cause transverse testicular ectopia or hernia uteri inguinalis. A 22-year-old-man was admitted with the chief complaint of painless swelling of the right scrotal content. Preoperative diagnosis was right testicular tumor and left undescended testis. High orchiectomy was done. At operation left transverse testicular ectopia and a remnant Müllerian duct was found incidentally. The right testicular tumor was seminoma pT1. Sixty-seven cases of transverse testicular ectopia have been reported in Japan, 37 of which are reports of a remnant Müllerian duct. Ten of these cases were accompanied by tumors. The pathogenesis and treatment of persistent Müllerian duct syndrome were discussed with review of the literature.

[Long term follow-up-study of selective vagotomy with pyloroplasty--physiological and electron microscopical studies of gastrin]

The function of residual G cells after selective vagotomy with pyloroplasty (SV + P) in 24 duodenal ulcer patients was assessed by physiological and electron microscopical studies. We studied the mechanism of gastrin release following insulin-induced hypoglycemia with respect to plasma catecholamines in mongrel dogs. Basal serum gastrin was significantly increased one month after surgery. Integrated gastrin response to meat extract and insulin hypoglycemia stimulation was also increased significantly six months postoperatively. The G cells were still increasing in number six months after SV-P, and G cell hyperplasia became more remarkable after one year. Emiocytotic figures were observed in denervated G cells which were stimulated by meat extract or insulin hypoglycemia. Both serum gastrin and plasma epinephrine began to increase 15 minutes after administration of insulin, peaked at the 45th minute, and decreased thereafter in control dogs and vagotomized dogs. In bilaterally adrenalectomized dogs, both responses were significantly inhibited. In control dogs, the gastrin response was seen under continuous infusion of epinephrine (0.5 micrograms/kg/min). Therefore, our results suggest that regardless of the presence or absence of vagal innervation, gastrin is released from G cells mainly due to epinephrine secreted from the adrenal medulla under insulin-induced hypoglycemia.