Acoustic intensity histogram pattern diagnosis of liver diseases

Display information on the histogram pattern includes echo intensity and echo frequency in the region of interest (ROI). The level and frequency of the center of gravity and the width of the echo level at 0%, 10%, and 50% of normalized frequency are calculated from the histogram. The width of the echo from the liver is significantly elongated on the X axis (P less than 0.001) but that of the center of gravity is not. Fatty liver shows the same attenuation rate curve as normal liver, although echo intensity is greatly increased. The curve of the attenuation rate derived from the histogram can be used to distinguish between liver cirrhosis and the tissue of normal or fatty liver. This study clearly demonstrates the clinical usefulness of the histogram as a diagnostic tool.     

Maleness as risk factor for slowly progressive IDDM

The effect of sex on longitudinal changes in serum C-peptide immunoreactivity (CPR) response to the oral glucose tolerance test (OGTT) was examined up to 48 mo in 30 islet cell antibody-positive (ICA+), non-insulin-dependent diabetes mellitus (NIDDM) subjects (15 men, 15 women) who were matched for age, duration of diabetes, and mode of treatment. The subjects were recruited from 2858 NIDDM patients screened for ICA between 1980 and 1984. In male NIDDM subjects, CPR levels to OGTT decreased insidiously, and 8 of 15 men developed the insulin-dependent state with abolished CPR. Only 2 female NIDDM subjects progressed to the insulin-dependent state (P less than .05, women vs. men). Thus, CPR in female subjects tended to decrease less than in male subjects. There were no significant differences between the two groups in human leukocyte antigens (HLA) or titer of ICA during the follow-up period. These results suggest that maleness is a major risk factor for slowly progressive beta-cell dysfunction in adult-onset insulin-dependent diabetes mellitus (IDDM).     

Management of pregnant women complicated with idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura(ITP) is occasionally manifested during pregnancy by routine prenatal screening for blood cell counts. Since ITP can potentially cause serious hemorrhage both in mother and fetus, the accurate assessments as well as appropriate clinical managements are necessary for successful delivery. Several guidelines were introduced to manage the maternal thrombocytopenia by ITP in pregnancy and in labor. However, there still remain several controversies regarding the indication of measurement of fetal platelet counts by fetal blood sampling, especially by percutaneous umbilical blood sampling, to decide mode of delivery. The current obstetrical managements and their potential limitation are discussed in this review.     

Diagnostic and epidemiological implications of regional differences in serum concentrations of proteins observed in six Asian cities.

The IFCC Committee on Plasma Proteins has been investigating regional differences for commonly assayed plasma proteins to determine whether universal reference intervals can be applied. As a part of this study, we launched an Asian project analyzing the concentrations of 13 serum proteins whose values are standardized to CRM470, and five newer analytes: retinol-binding protein (RBP), cystatin C (CysC), light-chain-kappa (L-kappa), and light-chain-lambda (L-lambda). In Tokyo, Seoul, Kuala Lumpur, Hong Kong, Taipei and Shanghai, serum samples were collected from 146 to 415 apparently healthy individuals with nearly equal gender ratios. All assays were performed in Tokyo on a Behring Nephelometer II (BN II). Seven chemical analytes (aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (gammaGT), creatinine, total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)) were also measured. These results were used for excluding individuals with possible latent clinical disorders. Positive acute phase reactants were consistently lower, and negative ones were higher, in Tokyo than those in other cities. The most conspicuous difference was observed in C-reactive protein (CRP). There were no regional differences in transferrin, albumin, or CysC. Creatinine was much lower in Tokyo despite comparable CysC levels. ALT and gammaGT were higher in Shanghai, Taipei and Seoul; gammaGT and TG were higher in Shanghai; and HDL-C was higher in Tokyo. Gender-related differences in reference intervals were observed for immunoglobulin (Ig)M, haptoglobin, RBP, transferrin, alpha2-macroglobulin (A2M), transthyretin, alpha1-acid glycoprotein, CysC, and C4 in all cities. Slight age-related differences were observed, irrespective of the region, in IgA and ceruloplasmin (increase) and A2M (decrease). Environmental factors and lifestyle seem to have a great influence on many commonly measured analytes.     

Combination therapy with an angiotensin-converting enzyme inhibitor and an angiotensin II receptor blocker synergistically suppresses chronic pancreatitis in rats

We recently demonstrated that both lisinopril and candesartan, an angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor blocker, respectively, attenuate pancreatic inflammation and fibrosis in male Wistar Bonn/Kobori (WBN/Kob) rats. The purpose of the present study was to assess whether combination therapy with low doses of both, ineffective when given alone, might synergistically exert protective effects. Lisinopril, candesartan, or a combination of both in drinking water was administered to 10-week-old male WBN/Kob rats for 10 weeks. Parameters of inflammation and fibrosis, positive immunostaining for alpha-smooth muscle actin, and gene expression of cytokine and growth factors were assessed, as well as circulating renin-angiotensin system components. Dose-dependent effects of combination therapy were also investigated. Only combination therapy attenuated gross alterations in the pancreas, as quantitatively confirmed by increases in pancreatic weights and decreases in myeloperoxidase activity, hydroxyproline content, histologic scores, relative fibrosis area, and relative area of alpha-smooth muscle actin-positive cells. Combination therapy suppressed up-regulation of tumor necrosis factor-alpha, platelet-derived growth factor-receptor beta, and transforming growth factor-beta1 mRNA in the pancreas. Dose dependence of combination therapy was recognized with reference to improvement in these parameters. The conclusions are that combination therapy synergistically alleviated pancreatic inflammation and fibrosis in male WBN/Kob rats. This effect may be related to suppression of tumor necrosis factor-alpha, platelet-derived growth factor-receptor beta, and transforming growth factor-beta1 mRNA. Compared with the either therapy alone, combination therapy with an angiotensin-converting enzyme inhibitor and an angiotensin II type 1 receptor blocker may be more beneficial for treating chronic pancreatitis.     

Inhibition of IgE-dependent mouse triphasic cutaneous reaction by a boiling water fraction separated from mycelium of Phellinus linteus

Phellinus linteus, a mushroom, contains constituents that exhibit potent antitumor effects through activating immune cells. Recently, anti-inflammatory and anti-allergic properties of P. linteus extracts have also been implicated. In the present study, therefore, we separated the constituents of mycelium of P. linteus into five fractions-chloroform-soluble (CF), ethyl acetate-soluble (EA), methanol-soluble (AE), water-soluble (WA) and boiling water-soluble (BW) fractions-and examined their suppressive effects on the IgE-dependent mouse triphasic cutaneous reaction. The triphasic reaction was induced in the ear of BALB/c mice passively sensitized with anti-dinitrophenol IgE by painting with 2,4-dinitrofluorobenzene 24 h later. Ear swelling appeared triphasically with peak responses at 1 h, 24 h and 8 days after the challenge. ME, WA and BW given orally at a dose of 100 mg kg significantly inhibited the first and second phase ear swelling, and BW also inhibited the third phase response. CF only inhibited the second phase. The inhibition by BW was the most potent and almost dose-dependent at doses of 30-300 mg kg. BW also inhibited vascular permeability increase caused by passive cutaneous anaphylaxis and histamine, and ear swelling caused by tumor necrosis factor-alpha. In contrast, BW apparently potentiated the production of interleukin-4 and interferon-gamma from anti-CD3-stimulated mouse splenocytes. These results indicate that BW derived from mycelium of P. linteus contains some constituents with anti-allergic as well as immunopotentiating properties.     

Studies on frequency-dependent attenuation in the normal liver and spleen and in liver diseases, using the spectral-shift zero-crossing method

This report presents results of studies using the spectral-shift zero-crossing method to measure frequency-dependent attenuation (FDA) in normal liver and spleen and in diseased liver. We developed a new system for attenuation analysis that calculated FDA in dB/cm/MHz according to the following equation: (formula: see text). Data are collected from the region of interest on the scan image. Graphite-gel phantoms of known attenuation value are used to create a high degree of accuracy in this new system. Mean attenuation of normal livers was 0.55 +/- 0.05 dB/cm/MHz, while that of normal spleen was 0.37 +/- 0.06 dB/cm/MHz. No correlation between FDA and age could be seen. FDA was 0.81 +/- 0.17 dB/cm/MHz in fatty liver, 0.63 +/- 0.13 dB/cm/MHz in liver cirrhosis, and 0.64 +/- 0.12 dB/cm/MHz in chronic hepatitis. These values are higher than those obtained from normal liver, while tumor masses in the liver (hepatocellular carcinoma, hepatoblastoma, hemangioma) and diffuse infiltration by malignant lymphoma produced lower than normal values, averaging 0.38 +/- 0.08 dB/cm/MHz.