Idiopathic renal arteriovenous fistula demonstrating a huge aneurysm with a high risk of rupture: report of a case

This paper reports a case of an idiopathic renal arteriovenous fistula demonstrating a huge guitar-shaped aneurysm, which required a total nephrectomy. Although the patient insisted on having been asymptomatic, echocardiography and cardiac catheterization clearly revealed that the influence on hemodynamics was unexpectedly significant. Interestingly, the aneurysm was also considered to have a high risk of rupture, which was preoperatively suggested by an aneurysm wall projection discernible on both computerized tomograms and angiograms, and this suspicion was also convincingly supported by the perioperative and histopathological findings.

Immune responses of blood donors to peptides of various lengths and those with genotypic sequence variations corresponding to the N-terminal portion of the core protein of hepatitis C virus

Immune reactivities of blood donor sera with the peptides of various lengths (24, 30, 40 and 50 mer) and those with genotypic sequence variations in the N-terminal portion of the core protein of hepatitis C virus (HCV) were compared by enzyme-linked immunosorbent assays. It was found that a 40-mer oligopeptide (amino acids 2-41) was recognized more frequently than other peptides even in serum samples that did not react with the C22-3 (core) by the recombinant immunoblot assay (RIBA-II). On the other hand, a 30-mer peptide (amino acids 1-30) had good correlation with viremia as confirmed by the polymerase chain reaction (PCR). In addition, four individuals showed the obvious differences in the immune responses to 30-mer oligopeptides representing the 4 genotypic variations. As a result, some samples that were PCR-positive but nonreactive by a commercial assay were found to react with short synthetic peptides in the N-terminal portion of the core protein.

Rapid assay for detection of toxic shock syndrome toxin 1 from human sera

A noncompetitive enzyme-linked immunosorbent assay that enables the quantitation of toxic shock syndrome toxin 1 (TSST-1) to as little as 30 pg/ml and the detection of TSST-1 to 10 pg/ml in phosphate-buffered saline including 33% human serum or plasma was developed. It takes only 3 h to complete this assay after plate preparation. In this study, 64 human serum samples obtained from 30 patients with toxic shock syndrome or toxic shock syndrome-like symptoms were subjected to testing for the detection of TSST-1. With a cutoff level for TSST-1 of less than 100 pg/ml, 28 samples obtained from 12 patients were positive for TSST-1. The mean and maximum concentrations for these TSST-1-positive samples were 440 and 5,450 pg/ml, respectively. Of these 12 patients, 8 were Staphylococcus aureus culture positive, 3 were negative upon bacterial culturing, and 1 had no cultures done.

Globin chain synthesis in hemolytic anemia reticulocytes. A case of hemoglobin Burke

Peripheral red blood cells from an anemic patient were incubated with [14C]Leu and the labeled globin chains were analyzed by CM-cellulose column chromatography in 8M urea. The radioactivity almost equal to that of beta chain emerged between beta and alpha chains. The newly appeared materials were found to be derived from an abnormal hemoglobin (Hb), Hb Burke [beta 107(G9)Gly to Arg], by the sequence analyses of abnormal globin chain and beta globin mRNA from the patient.

A sensitive serodiagnosis of hepatitis C virus (HCV) infection with two non-fused peptides: comparison of antibody responses detected with a newly developed assay and a commercial second-generation test

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of anti-HCV antibody. We assayed for antibodies against either oligopeptide (S29-1) deduced from the nucleocapsid gene or the product of nonstructural region (NS3) synthesized in a recombinant Escherichia coli (S4). To reduce false-positive results induced by non-specific binding of antibodies with a carrier protein and to increase the sensitivity of an immunoassay, non-fused S4 peptide was prepared by the recombinant DNA technique and site-specific proteolysis (by factor Xa). In 71 non-A, non-B hepatitis patients with chronic liver disease, 70 (98.5%) were positive by S29-1/S4 ELISA as well as by a second-generation test (Abbott II). On the other hand, of 40 serum samples from blood donors, in which anti-N14 (core) and C100-3 antibodies were not detected but hepatitis C virus (HCV) RNA was detectable by polymerase chain reaction (PCR), 24 (60%) were positive by S29-1/S4 ELISA, whereas only 18 (45%) were diagnosed by Abbott II. In addition, based on results in a small group of 92 blood donors, detection of anti-S29-1/S4 antibody correlated well with HCV viremia as confirmed by PCR. These results indicated that the preparation of nonfused protein (S4) by recombinant DNA technique and a combination of S29-1 and S4 as immobilized antigens in an ELISA provide a sensitive and specific diagnosis for HCV infection with good correlation with the presence of viral RNA as confirmed by PCR.

Molecular cloning of the immunodominant regions of hepatitis C virus type III and IV by immunoscreening

We have identified the immunodominant regions of hepatitis C virus (HCV) type III and IV by immunoscreening of a lambda gt11 cDNA library, which was constructed with RNA extracted from pooled sera of patients. In addition to the nucleocapsid protein, nonstructural region 3 (NS3), and NS4 regions, we found that the region at the N terminus of NS5 in type III and IV were also immunoreactive as well as in the prototype and type II, although amino acid homologies were approximately 60% between the prototype (or HCV type II) and HCV isolates of type III or IV. This result indicated that the region at the N terminus of NS5 may be a candidate for serotyping studies of HCV. This report presents the primary structure of immunodominant portions at the N terminus of NS5 in two HCV subtypes and a preliminary study of the immune responses to these antigens.

Neutralizing antibodies to human interleukin 6 reverse hypercalcemia associated with a human squamous carcinoma

Bone resorbing cytokines may be associated with abnormalities in bone cell function and calcium homeostasis in a number of pathological conditions. One of these cytokines is interleukin 6 (IL-6), which is a multifunctional cytokine which has been shown to be associated with increased formation of bone resorbing osteoclasts in vitro. In this report, we demonstrate that neutralizing antibodies to human IL-6 lower the blood calcium in nude mice carrying a human tumor associated with increased IL-6 production. There was no effect on blood calcium in hypercalcemic nude mice carrying tumors not associated with increased IL-6 production and normocalcemic tumor-bearing nude mice. These results suggest that increased production of IL-6 may contribute to disturbances in calcium homeostasis in some malignancies, and suggest that neutralization of IL-6 effects can lower the serum calcium in these tumors.

A highly sensitive enzyme-linked immunosorbent assay for the measurement of interleukin-8 in biological fluids

Interleukin-8 (IL-8) is a chemotactic and activating cytokine for neutrophils, which plays an important role in acute inflammatory responses. We aimed to develop a sensitive enzyme-linked immunosorbent assay (ELISA) for IL-8 and established 18 clones of anti-IL-8 monoclonal antibodies (mAbs). These mAbs were evaluated in terms of their antigen-binding affinities, and five clones were selected and used for the comparative study of various combinations of antibodies in sandwich ELISA. Affinity purified rabbit polyclonal antibody was also used in this study. One antibody pair, which showed relatively high sensitivity and which was not severely interfered with blood components, was selected and the assay conditions were optimized by choosing the appropriate buffer for sample dilution and by directly labeling the second antibody with enzyme. The finalized ELISA, using polyclonal antibody as first (coated) antibody and horseradish peroxidase-labeled mAb (clone EL139) Fab' fragment as second antibody, could detect as low as 2.5 pg/ml (0.125 pg/well) of IL-8 by in total 2 h incubation, without being affected by body fluid components. The ELISA was specific to IL-8, showing no cross-reactivity with other cytokines or various IL-8 family proteins which share some amino acid sequence homology with IL-8. As an example of its application to clinical specimens, plasma samples from patients with septic shock were measured. The results showed that sepsis patients contain significantly higher levels of plasma IL-8 compared to normal controls. When analyzed by gel-filtration chromatography, IL-8 in sepsis plasma was eluted in a molecular weight (M(r) region corresponding to the monomer form. The ELISA established here is expected to be effectively used for further investigations on the relationship between IL-8 and various diseases.

Antithrombogenicity of polyacrylonitrile-polyethyleneoxide hollow fiber membrane developed for designing an antithrombogenic continuous ultrafiltration system

To develop a continuous arteriovenous hemofiltration (CAVH) system, which does not need systemic anticoagulation, for patients of acute renal failure having bleeding tendencies, a totally antithrombogenic continuous ultrafiltration system (ACUS) was designed, which consists of an antithrombogenic polyacrylonitrile-polyethyleneoxide (PAN-PEO) hollow fiber membrane and ionically heparin-bound catheter, tubing, and module header. Antithrombogenicity of PAN-PEO membrane, which occupies more than 90% of total inner surface area of ACUS, was considered to be due to highly concentrated PEO near the inner surface of the membrane and the finely dispersed (less than 500 A) microstructure of the inner surface. ACUS was applied to 24 patients without systemic anticoagulation, and one filter worked for an average of 32 h without deteriorating their bleeding tendencies. Any significant changes in major parameters of biocompatibility during those treatments were not observed. More than 200 ml/h of ultrafiltrate was obtained even under very low mean blood pressure, less than 70 mm Hg. Based upon these results, ACUS was concluded to be suitable for mild and sustained treatment to control fluid and electrolyte balance in patients of acute renal failure with bleeding complications.

Development of a new antithrombogenic continuous ultrafiltration system

By interfacing a polyacrylonitrile (PAN)-polyethyleneoxide (PEO) membrane with an ionically heparin-bound catheter, tubing, and module header, a totally antithrombogenic continuous ultrafiltration system (ACUS) was developed and its performance, persistent antithrombogenicity, and well-maintained ultrafiltration level were confirmed through animal experiments. Although the amount of heparin released and accumulated in vitro from those heparinized parts was very low and stable (on the order of 1 x 10(-2) U/cm2/min), partial thromboplastin time evaluated in vivo was not elongated during passage through the ACUS. Extracorporeal circulation time with the ACUS in unheparinized dog model was 458 +/- 302 min (n = 24), whereas those of partially modified (antithrombogenic) system did not exceed 100 min. As compared with that in a conventional continuous arteriovenous hemofiltration system, an extracorporeal circulation with the ACUS in an unheparinized dog model revealed significantly less fluctuation of platelet count, and no adherent platelets were observed on the surface of the PAN-PEO membrane. An ACUS consisting of a PAN-PEO membrane and heparinized parts was thus demonstrated to have good platelet compatibility. An ACUS with a surface area of 0.25 m2 was applied to two patients with acute renal failure. Hemofiltration without systemic heparinization lasted for 44 h per hemofilter, and a stable level of ultrafiltration was maintained. This system seems to be applicable for the clinical management of volume overload, especially in patients with bleeding tendencies or postoperative bleeding.

An enzyme-linked immunosorbent assay for the measurement of human interleukin-6

An enzyme-linked immunosorbent assay has been developed to measure human interleukin-6. The assay, based on the avidin-biotin amplified two-step sandwich method, is quick (requiring 4.5 h), sensitive (detecting 9.5 pg/ml) and satisfactory in reproducibility and specificity. It shows good correspondence with the results of bioassays, and it is not affected by serum and plasma components. These results indicate that this ELISA is suitable for application to clinical samples, which is a major advantage over the widely used bioassays.

Establishment of strongly neutralizing monoclonal antibody to human interleukin-6 and its epitope analysis

Three monoclonal antibodies against human interleukin-6 were established and characterized. One antibody was shown to strongly neutralize both the Ig-inducing and hybridoma/plasmacytoma growth activity of interleukin-6. The results of its epitope analysis using protease treated interleukin-6 and immobilized antibody indicated that this neutralizing antibody binds to a peptide corresponding to Leu151-Lys171 of interleukin-6 molecule. Further analysis using synthetic peptides showed that a shorter peptide corresponding to Ala153-Thr162 can also inhibit the binding of the antibody to interleukin-6. These results suggest that this carboxyl-terminal region plays a crucial role in interleukin-6 functions.

[A case of facial nerve neurinoma originated from the cerebellopontine angle portion]

Facial nerve neurinomas are relatively rare and most of them appear at the vertical portion of the facial nerve. Facial nerve neurinoma originated from the cerebellopontine (c-p) angle portion is less frequently reported. A 51-year-old woman was admitted to our hospital complaining of severe headache and nausea. She had had dizziness and unsteady gait for the previous two weeks. She did not complain of hearing disturbance, but otological examination revealed sensorineural deafness. She had no facial palsy. Skull x-ray showed no erosion of the internal auditory canal. Plain CT-scan revealed a large, unenhanced, low-density mass in the right c-p angle cistern. At the time of the operation, this tumor originated from the right facial nerve. Histological diagnosis of this tumor was schwannoma. After the operation, right facial nerve palsy appeared but hardness of hearing was no worse than previously. This tumor seemed to be facial nerve neurinoma in the c-p angle cistern. To the present, 121 facial nerve neurinomas have been reported in the previous literature. Facial nerve neurinomas in the c-p angle cistern, however, have only been reported in 5 cases. The most frequent symptom of facial nerve neurinoma in the temporal bone is facial nerve palsy, but that of facial nerve neurinoma in the c-p angle cistern is hearing loss, as in an acoustic neurinoma. Preoperative diagnosis of facial neurinoma in the c-p angle cistern using neurological symptoms alone is difficult. Furthermore, differential diagnosis from acoustic neurinoma in the c-p angle cistern using only skull x-rays and CT-scanning is also difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Neoexpression of ABH and Lewis blood group antigens in human hepatocellular carcinomas

Expression of blood group ABH, Lewis, and sialylated-Lea antigens in human hepatocellular carcinomas and the adjacent nontumorous liver tissues was investigated with the use of seven monoclonal antibodies against these carbohydrate determinants. Chromatogram antibody-binding assay and solid-phase enzyme immunoassay of the upper-phase neutral glycolipids revealed the tumor-associated expression of blood group A-active glycolipids incompatible with blood-type status of the patients, a blood group A-active glycolipid with mobility on thin-layer chromatography between the known 6- and 8-sugar blood group A-active glycolipids in human erythrocytes, blood group H-active glycolipids, and blocked synthesis of Lea-active glycolipids with or without concomitant accumulation of Leb-active glycolipids. Immunohistochemical analysis of the fixed tissues with the use of an avidin-biotin-peroxidase complex method revealed blood group antigens in biliary epithelial cells but not in parenchymal liver cells. However, hepatocellular carcinoma cells in some cases expressed H and Leb antigens. Although only type 1 chain H antigen was detected in biliary epithelial cells, both type 1 and type 2 chain H antigens were found in hepatocellular carcinoma cells.

Inhibitory effects of beta 2-microglobulin on in vitro calcification of osteoblastic cells

Elevated levels of aluminum and beta 2-microglobulin have been demonstrated in chronic dialysis patients. The role of aluminum in the pathogenesis of renal osteodystrophy has also been shown. We report on the effects of beta 2-microglobulin on calcification in vitro using osteoblastic cells, clone MC3T3-El. At concentrations comparable to those in plasma of chronic dialysis patients, both beta 2-microglobulin and aluminum suppressed calcification while collagen synthesis and alkaline phosphatase activity were maintained. These observations may be related to the impaired bone mineralization frequently observed in chronic dialysis patients.

Removal of aluminum from chronic dialysis patients by administration of desferrioxamine and dialysis

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

A new form of amyloid protein associated with chronic hemodialysis was identified as beta 2-microglobulin

Amyloid fibrils were isolated from amyloid-laden tissue obtained from a chronic hemodialysis patient with carpal tunnel syndrome. After solubilization in guanidine HCl, a significant amount of the protein was located in a homogeneous low molecular weight fraction. The protein was found to be identical to beta 2-microglobulin, with regard to its molecular weight of 11,000, amino acid composition and 16 amino-terminal amino acids: Ile-Gln-Arg-Thr-Pro-Lys-Ile-Gln-Val-Tyr-Ser-Arg-His-Pro-Ala-Glu-. These results demonstrate that the amyloid associated with chronic hemodialysis contains as major component a new form of amyloid fibril protein that is homologous to beta 2-microglobulin.

Ocular inserts for controlled release of antibiotics

Ocular inserts impregnated with antibiotics (erythromycin and erythromycin estolate) which have sustained release characteristics were prepared, mainly for the purpose of trachoma therapy. In vitro experiments showed that the elution rate of a drug with low solubility in water (erythromycin estolate) is constant when the water content of the hydrogel insert is more than 30%. In the case of a drug with higher solubility (erythromycin), the elution rate depends on the water content. Some in vivo experiments using rabbit eyes were also reported.

Spontaneous rupture of the spleen in acute myeloid leukemia

The results of an autopsy of an 80-year-old Japanese male with acute myeloid leukemia who died of spontaneous rupture of the spleen are reported. The patient was admitted because of anorexia, fatigue, weight loss, and multiple skin eruptions. Hematological examinations indicated a rapid increase in myeloblasts. The patient collapsed on the 28th hospital day, immediately after complaining of severe epigastralgia and vomiting. He died ten hours later. The autopsy revealed extensive leukemic infiltration of the bone marrows, spleen, lymph nodes, skin, and other internal organs. The spleen was enlarged and was ruptured in places at the hilar portion. Massive intraperitoneal hemorrhage from the rupture was the direct cause of death. The mechanisms of splenic rupture are discussed.

Pseudomyxoma peritonei of ovarian origin--an autopsy case

The autopsy case of an 80-year-old female with pseudomyxoma peritonei arising in the left ovary is reported. The patient was admitted with complaints of anorexia, sense of fullness and abdominal distension of two months' duration, and died of intestinal obstruction four months later. The autopsy revealed extensive tumor dissemination over the entire peritoneal cavity without any visceral invasion or distant metastasis. A part of the sigmoid colon showed marked stenosis and perforation with abscess formation. Histologically, the tumor was composed of various sized multiple cysts which were completely or incompletely lined by a layer of mucin-producing columnar epithelial cells with moderate nuclear hyperchromatism, and of a papillary pattern in some parts, indicating low grade malignancy.

High Rates of controlled ultrafiltration combined with optimal diffusion: recent advances in hemodialysis technique

A system which permits high rates of middle molecule removal while preserving the removal of low molecular weight substances is described. It consists of a high fluid flux hollow fiber artificial kidney and an ultrafiltration controller. When used in combination, high rates of convective transport can be achieved through rapid ultrafiltration and reconstitution of blood with physiologic salt solutions. The theoretical impact of changing from conventional dialysis to this form of therapy on the body burden of middle molecules is estimated.

Performance and clinical use of a convertible hemodialysis (HD) - ultrafiltration (UF) system

A hemodialysis-ultrafiltration system has been developed and evaluated. It may be used either as a conventional hemodialyzer or as a nondialytic ultrafilter. When used as a dialyzer an ultrafiltration controller is required to fix ultrafiltration rate at the desired level. Rates of low molecular solute removal are compatible with those observed in commercially available artificial kidney systems, higher clearances are obtained for middle molecules, and the rate of ultrafiltration can be controlled within narrowly prescribed limits.