A case of MPO-ANCA-related vasculitis with chronic alveolar hemorrhage]

It has been reported that alveolar hemorrhage caused by ANCA-associated vasculitis occurs in the seriously acute stage. However, we report a rare case of chronic alveolar hemorrhage in a 26-year-old woman who had been on maintenance hemodialysis because of rapidly progressive glomerulonephritis (RPGN) since the age of 17. On a regular checkup at her clinic, chest radiographs revealed diffuse micronodular opacities in both lung fields when she was 22 years of age, and anemia was identified at 24. Before the patient was referred to our hospital, the shadows on the radiographs remained almost unchanged, whereas the anemia, for reasons unknown, slowly deteriorated. She was referred to our hospital because of micronodular opacities detected on a chest radiogram in an annual health check at the age of 26. She was asymptomatic, but her laboratory data showed a normochromic anemia (hemoglobin 6.3 g/dl), and the serum level of MPO-ANCA was 195 EU. Bronchoalveolar lavage at bronchoscopy macroscopically revealed bloody fluids containing hemosiderin-laden macrophages. Histological examination of the biopsy specimen by video-assisted thoracoscopic lung biopsy revealed pauci-immune pulmonary capillaritis and alveolar hemorrhage. She was diagnosed as having MPO-ANCA-related vasculitis, especially microscopic polyangiitis preceding RPGN, and the clinical course suggesting alveolar hemorrhage was progressing slowly. The diagnosis was therefore "chronic alveolar hemorrhage". We emphasize that it is necessary to consider alveolar hemorrhage when a patient who has been on maintenance hemodialysis for RPGN has a combination of anemia and diffuse micronodular opacities, even if the condition is not accompanied with any respiratory symptoms.     

Simultaneous occurrence of Basedow's disease and autoimmune hemolytic anemia

A 43-year-old man with a 7-year history of low antinuclear factor titer developed Basedow's disease and autoimmune hemolytic anemia (AIHA) simultaneously. Such simultaneous occurrence of these autoimmune disorders has been reported only rarely. Administration of methimazole for Basedow's disease and prednisolone for AIHA was effective for ameliorating both conditions. The patient had the HLA DR2, DRB1 1501 and DPB1 0501 alleles, suggesting a genetic predisposition for these diseases.     

Impaired ventricular relaxation during myocardial ischemia and after reperfusion in isolated perfused canine hearts

The goal of this study was to investigate the mechanisms of impaired relaxation in ischemic and reperfused hearts without asynergic wall motion. To test the hypothesis that muscle elongation during ischemia does not improve the slowed relaxation, the time constant (T) of the isovolumic left ventricular pressure decay was obtained during volume loading in 14 isolated perfused canine hearts. In the nonischemic condition (coronary perfusion pressure: 107 +/- 3 mmHg), T progressively decreased as the peak left ventricular pressure was increased by volume loading. In contrast, in the ischemic condition (coronary perfusion pressure: 51 +/- 3 mmHg), T did not decrease despite an increase in peak left ventricular pressure by volume loading. These results indicate that during ischemia the impaired relaxation is not improved by an increase in preload. Moreover, reperfusion after a brief ischemia also increased T despite an increase in the contractile force, i.e., left ventricular pressure. The maximal change in the relaxation rate occurred much earlier than the maximal overshoot of the contractile force and coincided with an increase in coronary blood flow. These results indicate that prolongation of relaxation immediately after reperfusion is partly attributable to an increase in the electile force induced by the refilling of the coronary arteries. These mechanisms of impaired relaxation during ischemia and reperfusion may deteriorate ventricular filling and hence, cardiac output.     

Restoration of spermatogenesis by lentiviral gene transfer: offspring from infertile mice

Disruption of spermatogenesis found in azoospermia and oligozoospermia is thought to be of primarily genetic origin. Sl/Sl(d) mutant mice offer a model system in which lack of transmembrane type c-kit ligand (KL2) expression on the somatic Sertoli cell surface results in disruption of spermatogenesis. We investigated the ability of adeno-, adeno-associated-, retro-, and lentiviral vectors to transduce Sertoli cells and found that transduction with either adeno- or lentiviral vectors led to reporter gene expression for more than 2 mo after testicular tubule injection. Because adenoviral vectors showed toxicity, lentiviral vectors were used to express the c-kit ligand in Sl/Sl(d) Sertoli cells. Restoration of spermatogenesis was observed in all recipient testes. Furthermore, the sperm collected from recipient testes were able to generate normal pups after intracytoplasmic sperm injection. None of the offspring carried the transgene, suggesting the inability of lentiviral vectors to infect spermatogenic cells in vivo. We propose that lentiviral vectors can be used for gene therapy of male infertility without the risk of germ-line transmission.     

Prognosis of bronchial artery embolization in the management of hemoptysis

BACKGROUND: Bronchial artery embolization (BAE) is a well-accepted and widely used treatment modality for the management of massive and recurrent hemoptysis. However, few reports have previously investigated the long-term results. OBJECTIVES: To investigate the prognosis of patients with hemoptysis who had undergone BAE. METHODS: Twenty-two patients with hemoptysis underwent BAE. The underlying diseases included bronchiectasis in 9, aspergillosis in 3, chronic bronchitis in 2, idiopathic bronchial bleeding in 4, and other diseases in 4. The follow-up period ranged from 25 to 88 months (median 47 months). RESULTS: After the initial BAE, 11 of 22 (50%) patients had re-bleeding (5 patients with hemoptysis and 6 patients with minor hemosputa). Among them, 1 patient suffered from recurrent massive hemoptysis and died from airway obstruction within 1 month after BAE. In addition, 10 of these 11 (90.9%) patients experienced recurrent airway bleeding within 3 years after BAE. Recurrent cases of hemoptysis were seen in 6 of 22 patients (27.3%) within 3 years and no case recurred later than 3 years after BAE. A recurrence of hemoptysis was frequently seen in patients with either bronchiectasis or pulmonary-bronchial artery (P-B) shunt. Although BAE is an effective treatment for the immediate control of hemoptysis, 5 of the patients experienced recurrent bleeding in the long-term follow-up. CONCLUSIONS: It is important to follow-up such patients until 3 years after initial BAE, especially when either ectatic changes of the bronchi on a CT scan or a P-B shunt on angiographic findings are detected.     

A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma

Received: January 9, 2001 / Accepted: May 11, 2001     

Augmentation of tumor necrosis factor family-induced apoptosis by E3330 in human hepatocellular carcinoma cell lines via inhibition of NFκB

AIM: To investigate the reduction of cell viability in human hepatocellular carcinoma (HCC) cell lines induced by inhibition of nuclear factor κB (NFκB).METHODS: HLE, SKHep1, and HepG2 were incubated and E3330 was used to compare the stimulation of some chemotherapeutic drugs with that of TNF family, Fas ligand, TNFα and TNF-related apoptosis-inducing ligand (TRAIL) at the point of the reduction of cell viability by inhibiting NFκB.RESULTS: E3330 decreased NFκB levels in HLE cells stimulated by TNF and TRAIL. The cytotoxicity of the combination of TRAIL, TNFα, Fas ligand, and E3330increased synergistically in a dose-dependent manner compared to either E3330 alone in all HCC cell lines by MTT assay. However, the combination of some chemotherapeutic drugs and E3330 did not decrease the cell viability.CONCLUSION: Inhibition of NFκB sensitizes human HCC cell lines to TNF-mediated apoptosis including TRAIL, and TRAIL-based tumor therapy might be a powerful potential therapeutic tool in the treatment of human HCC.     

Studies on plasma insulin-like growth factor (IGF)-I levels in normal subjects and in patients with various endocrine and metabolic diseases using radioimmunoassay for synthetic IGF-I (26-46)

Determination of plasma IGF-I concentrations is not easily accessible to clinical use at present because of extremely limited supply of purified natural IGF-I essential for its assay system. Thus, an alternative method has recently been introduced by the development of a specific radioimmunoassay (RIA) for IGF-I (26-46). We examined the specificity and sensitivity of this assay system, and then investigated the changes in plasma concentrations of IGF-I in normal children, adults and in patients with various endocrine and metabolic diseases. Each plasma sample was subjected to acid-ethanol treatment before assay to separate IGF-I from its binding protein. The recovery rate of known amount of IGF-I (26-46) added to untreated plasma sample was more than 90%. The coefficients of variation of intra- and interassay were 9.0% and 13.6%, respectively. This assay system was able to detect IGF-I as low as 10 pg/tube. When plasma sample of a patient with active acromegaly was applied to Sephadex G-75 column, immunoreactive IGF-I was eluted at the position of 7,000 molecular weight. An inhibition curve of plasma extract from an acromegalic patient was parallel to that of IGF-I (26-46), indicating that the RIA could detect IGF-I. There was no remarkable difference between IGF-I values of plasma and serum from the same individual. The value of IGF-I concentration of cord plasma was considerably low (144 +/- 6.7 pg/ml, M +/- SEM) as compared with that of sera of 49 normal children aged 7-12 12 years (320 +/- 14.3 pg/ml). The highest value (460 +/- 54 pg/ml) was attained at the age of 13 years, followed by gradual decrease toward adult age. Plasma IGF-I concentration of normal adults between 20 and 69 years of age was 290 +/- 10 pg/ml. When plasma IGF-I values of adult males and females were separately plotted against age group of each decade, the value declined gradually with age in males while in females there was a remarkable increase in plasma IGF-I concentration at 4th and 5th decades, suggesting the effect of hormonal change at menopause on plasma IGF-I levels. There was a good correlation between disorders of GH secretion and plasma IGF-I concentrations. In 10 cases of active acromegaly the level was 506 +/- 67 pg/ml (285-970 pg/ml). On the other hand in 20 patients with pituitary dwarfism it was only 180 +/- 15 pg/ml.(ABSTRACT TRUNCATED AT 400 WORDS)     

Characterization of peptide YY receptors in the brain

We studied the pharmacological and structural characteristics of peptide YY (PYY) receptors in porcine brain. PYY and neuropeptide Y (NPY) bound with high affinity to crude membrane preparations from the hippocampus, but their C-terminal fragments bound with 30- to 450-fold lower affinity Guanine nucleotides, especially the nonhydrolyzable GTP analog GTP gammas inhibited the binding of [125I]PYY, but other transmitters, hormones, and central nervous system-acting drugs did not, except for gangliosides at high concentrations. These results suggest that PYY receptor binding resides in the N-terminal part of the PYY molecule and is coupled to a guanine nucleotide regulatory protein. To elucidate PYY receptor structure, we used the cross-linking reagent disuccinimidyl suberate to covalently attach [125I]PYY to its receptors in the hippocampus membrane. Gel electrophoresis followed by autoradiography revealed a band centered at the mol wt of 50,000. Competitive inhibition of binding by unlabeled PYY resulted in a parallel inhibition of labeling of the 50,000 mol wt protein. The reducing agent 2-mercaptoethanol did not affect the appearance of this band, suggesting that the PYY receptor does not have subunits connected by sulfhydryl bonds. Furthermore, cross-linking [125I]NPY to its receptors in the porcine hippocampus produced the same 50,000 mol wt band regardless of 2-mercaptoethanol. The identity in the size of NPY and PYY receptors together with their similarities in binding properties including regional distribution and peptide specificity, indicate that NPY and PYY regulate brain function through interaction at a common receptor site.