Clonal identification of Burkitt's Lymphoma Arising from Lymphocyte-Predominant Hodgkin's Disease

The occurrence of large cell lymphomas subsequent to, or concurrent with, lymphocyte predominant Hodgkin's disease (LPHD) is a well-documented phenomenon. We present a case of Burkitt's lymphoma of the bladder, occurring after the successful treatment of LPHD of a cervical lymph node. To evaluate the clonal relationship of the two tumours, we amplified the complementarity-determining-region 3 of two samples from paraffin-embedded slides, using the polymerase chain reaction (PCR). The sequences of the PCR products showed 96% homology to each other. These results indicate that the malignant clone of Burkitt's lymphoma arose from the corresponding LPHD.     

A stimulatory effect of recombinant murine interleukin-7 (IL-7) on B- cell colony formation and an inhibitory effect of IL-1 alpha

Using a clonal culture system, we investigated the lymphohematopoietic effects of recombinant interleukin-7 (IL-7) obtained from conditioned media of transfected COS 1 cells. IL-7 alone acted on murine bone marrow cells and supported the formation of B-cell colonies. These colony cells were positive for B220, and some of them were also found to have either IgM or Thy-1. B220+, IgM- cells, but not B220- cells sorted from fresh bone marrow cells were able to form B cell colonies in the presence of IL-7. Thus, IL-7 supported the differentiation of B220+, IgM- cells to B220+, IgM+ cells. B220+, IgM+ cells did not proliferate in the presence of IL-7. IL-7 did not affect the myeloid colony formation supported by IL-3, IL-5, IL-6, granulocyte macrophage colony stimulating factor (GM-CSF), and G-CSF. On the other hand, lymphocyte colony formation was not affected by IL-2, IL-3, IL-4, IL-5, IL-6, GM-CSF, or G-CSF. Interestingly, IL-1 alpha inhibited IL-7- induced B cell colony formation in a dose-dependent manner, while the same concentration of IL-1 alpha enhanced the myeloid colony formation by IL-3. This reciprocal effect of IL-1 alpha may act on hematopoietic progenitor cells without accessory cells. These data show that IL-7 is a B cell growth factor and that IL-1 alpha may play an important role in differentiation of myeloid and lymphoid lineages.     

Unusual cases of acute cholecystitis and cholangitis: Tokyo Guidelines

Unusual cases of acute cholecystitis and cholangitis include (1) pediatric biliary tract infections, (2) geriatric biliary tract infections, (3) acalculous cholecystitis, (4) acute and intrahepatic cholangitis accompanying hepatolithiasis (5) acute biliary tract infection accompanying malignant pancreatic-biliary tumor, (6) postoperative biliary tract infection, (7) acute biliary tract infection accompanying congenital biliary dilatation and pancreaticobiliary maljunction, and (8) primary sclerosing cholangitis. Pediatric biliary tract infection is characterized by great differences in causes from those of adult acute biliary tract infection, and severe cases should be immediately referred to a specialist pediatric surgical unit. Because biliary tract infection in elderly patients, who often have serious systemic conditions and complications, is likely to progress to a serious form, early surgery or biliary drainage is necessary. Acalculous cholangitis, which often occurs in patients with serious concomitant conditions, such as those in intensive care units (ICUs) and those with disturbed cardiac, pulmonary, and nephric function, has a high mortality and poor prognosis. Cholangitis accompanying hepatolithiasis includes recurrent pyogenic cholangitis, an epidemic disease in Southeast Asia. Biliary tract infections, which often occur after a biliary tract operation and treatment of the biliary tract, may have a fatal outcome, and should be carefully observed. The causes of acute cholangitis associated with pancreaticobiliary maljunction differ before and after operation. Direct cholangiography is most useful in the diagnosis of primary sclerosing cholangitis. If cholangiography visualizes a typical bile duct, differentiation from acute pyogenic cholangitis is easy. This article discusses the individual characteristics, diagnostic criteria, treatment guidelines, and prognosis of these unusual types of biliary tract infection.     

Clinical evaluation of the captopril screening test for primary aldosteronism

In order to investigate the validity of angiotensin converting enzyme inhibition with captopril as a screening test for primary aldosteronism (PA), 50 mg of captopril were administered orally to 7 patients with PA, 17 with essential hypertension (EH), 5 with renovascular hypertension (RVH), 2 with renoparenchymal hypertension (RH) and 8 normal volunteers. The plasma aldosterone concentration (PAC) was suppressed to less than 15 ng/dl in all of the EH, RVH and RH patients and normal subjects 90 min after administration of captopril, but not suppressed in 6 of 7 patients with PA. In addition, the plasma renin activity (PRA) was increased to greater than 1 ng/ml/h in 10 of 17 patients with EH and in all with RVH, RH and the normal controls, but to less than that in 6 of 7 PA and the remaining EH patients. The PAC to PRA ratio after captopril was greater than 20 in all patients with PA, while it remained below 20 in EH, RVH and RH patients and normal controls. From these results, we conclude that the PAC to PRA ratio in the captopril administration test is a simple and useful tool to detect PA in hypertensive patients. In addition, the test has a great advantage in that it can be safely applied to outpatients with relatively severe hypertension.     

Characterization of adrenal medullary opioid receptors. II. Coupling of adrenal medullary opioid receptors to GTP binding proteins

We studied possible coupling of opioid receptors to GTP-binding proteins to clarify the mechanism(s) of opioid action in bovine adrenal medullary membranes. Guanylyl imidodiphosphate (Gpp(NH)p) reduced the binding of [3H] D-Ala2-D-Leu5-enkephalin ([3H] DADLE) to bovine adrenal medullary membranes dose-dependently, and enhanced the binding of [3H] diprenorphine to them. Gpp(NH)p (0.1 mM) enhanced the Kd value of the [3H] DADLE binding from 2.9 nM to 3.9 nM, but did not change its Bmax. Pretreatment of bovine adrenal medullary membranes with pertussis toxin (PT) reduced the [3H] DADLE binding. The Gpp(NH)p inhibition for [3H] DADLE binding was diminished by the PT-pretreatment. On the other hand, the [3H] diprenorphine binding to PT-pretreated membranes was higher than that to control membranes. Levorphanol inhibited the adenylate cyclase activity of the rat caudate nucleus crude synaptosomal fraction, but did not change that of bovine adrenal medullary membranes. These results suggest that opioid receptors in bovine adrenal medullary membranes are coupled to PT-sensitive GTP-binding protein which may not influence on adenylate cyclase.     

Increased lysyl oxidase activity in culture medium of nonparenchymal cells from fibrotic livers

Lysyl oxidase, which plays an important role in collagen deposition in chronic liver diseases, was studied in nonparenchymal cell cultures from fibrotic human livers. Liver biopsy specimens were obtained from control patients without apparent hepatic disease, and from patients with chronic persistent hepatitis, chronic active hepatitis, or liver cirrhosis. Nonparenchymal cells from biopsy specimens were cultured. At the third passage of the culture, lysyl oxidase activity was measured in the culture medium and cell layer. Most of the activity in the culture medium of cirrhotic liver cells was significantly higher than that in the medium of liver cells from controls or from patients with chronic hepatitis, whereas no significant difference in activity was noted between chronic persistent hepatitis and chronic active hepatitis cells. In patients with chronic hepatitis, lysyl oxidase activity in the culture medium from liver cells of alcoholics was significantly higher than that in the medium from liver cells of nonalcoholics. Thus, increased lysyl oxidase activity was found in the medium of nonparenchymal cell cultures from patients with cirrhosis and from alcoholics with chronic hepatitis. This increased activity may be related to fibrotic processes in the liver.     

Enzyme immunoassay of human chorionic gonadotropin employing beta-galactosidase as label.

An enzyme-linked immunoassay was applied to the determination of hCG, a glycoprotein hormone usually assayed by RIA. For this purpose, an enzyme hormone conjugate was prepared by reacting hCG with beta-D-galactosidase (beta-Gal.) of E. coli in the presence of N-(m-maleimidobenzoyloxy) succinimide (MBS) as coupling reagent. The conjugate, after purification by affinity and gel chromatographies, was shown to exhibit sufficient enzyme activity and immunoactivity. The immunoassay of hCG was performed by the double antibody method and, using this assay, 0.4-250 mIU/ml hCG were detectable. This was about 10 times as sensitive as the RIA. Difficulty was experienced when this method was utilized for the determination of hCG in plasma samples from patients. Since the presence of the plasma may have affected this assay method, the following improvements were made: 1) the same volume of hormone-free plasma was added to the standard solutions of hCG, and 2) the volume of plasma sample was 10 microliter. The performance and validity of this assay were comparable to the RIA using [125I]hCG as tracer. The dose-response curves of both assay have the same slope and there was no significant difference between the values (correlation coefficient, Y = 0.96X + 1.53).     

A large inferior mesenteric-caval shunt via the internal iliac vein

A large portosystemic shunt between the inferior mesenteric vein and the right internal iliac vein in a 28-yr-old non-cirrhotic man is presented. This collateral was discovered by ultrasound done as a screening examination for gastrointestinal bleeding. The direct communication of the inferior mesenteric vein with the internal iliac vein was demonstrated by computed tomography and percutaneous transhepatic portography. Surgical ligation of the collateral, performed to prevent future portosystemic encephalopathy, resulted in reduction of serum ammonia level and cessation of long-standing hemorrhoidal bleeding.     

Validity of the right ventricular Doppler index for assessment of severity of congestive heart failure in patients with dilated cardiomyopathy

Summary This study was designed to clarify the validity of Doppler indices for assessment of the severity of congestive heart failure in patients with dilated cardiomyopathy. Left ventricular (LV) and right ventricular (RV) Doppler indices, defined as the sum of isovolumic contraction time and relaxation time divided by the ejection time, were obtained in 30 normal subjects and 35 patients with ischemic or idiopathic dilated cardiomyopathy. We analyzed the correlation between New York Heart Association (NYHA) functional class, right-sided cardiac pressure, and the Doppler indices. Patients with dilated cardiomyopathy revealed significantly higher LV and RV Doppler indices than normal subjects; however, the LV Doppler index did not correlate significantly with NYHA functional class or right-sided cardiac pressure. On the other hand, the RV Doppler index correlated significantly with NYHA functional class (rs = 0.83,P < 0.001), pulmonary capillary wedge pressure (r = 0.80,P < 0.001), pulmonary artery systolic pressure (r = 0.81,P < 0.001) and pulmonary artery diastolic pressure (r = 0.77,P < 0.001). Both RV isovolumic contraction and relaxation time also correlated significantly with right-sided cardiac pressure. In 12 patients who improved from NYHA III–IV to I–II after treatment, the RV Doppler index decreased from 0.84 ± 0.25 to 0.33 ± 0.10 (P < 0.001), while the LV Doppler index did not change significantly (0.72 ± 0.27 to 0.68 ± 0.23,P = 0.53). These results suggest that the RV Doppler index is useful for assessment of the severity of congestive heart failure in patients with dilated cardiomyopathy.