Clinical evaluation of rounded atelectasis induced by exposure to asbestos]

We encountered 15 patients with rounded atelectasis induced by exposure to asbestos from 1992 to 1999. All patients were men whose ages ranged from 42 to 85 years, with a mean age of 64.2 +/- 11.5 years. Rounded atelectasis was present only in the right lung and two patients had 2 rounded atelectasis in the right lung. In eight cases, the rounded atelectasis was found in segment 10, while in the others, it was found in segments 4, 5, 6, 8, and 9. Although evidence of symptoms was absent, rounded atelectasis was detected in six patients through medical examinations. Others complained of chest pain and dyspnea. Thirteen patients displayed pleural plaques and only 2 patients revealed asbestosis. Malignant complications were discovered in 4 patients, of whom 3 showed primary lung cancer and 1 suffered acute myelocytic leukemia. In their occupational histories, 7 patients had been exposed to asbestos in the shipyards and 5 in the construction field. The mean period of the exposure was 25.1 +/- 12.7 years, and the latency period from the first asbestos exposure to the detection of atelectasis was 35.1 +/- 8.8 years. Five autopsied patients had more than 10,000 asbestos bodies in the lung, which indicated heavy exposure to asbestos. These results suggest that rounded atelectasis may appear after high-dose exposure to asbestos.     

Relative contributions of cardiorespiratory fitness and visceral fat to metabolic syndrome in patients with diabetes mellitus

The objective of this study was to examine the contribution of endurance fitness and visceral fat accumulation on the prevalence of metabolic syndrome in Japanese male patients with either an impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM). The subjects of this cross-sectional study consisted of 135 Japanese male patients with either IGT or type 2 DM who had not taken any medication or intervention. They were classified into three fitness categories (low, moderate, and high) based on the tertiles of their maximal oxygen uptake ( [Formula: see text] O(2)max) predicted by the Astrand nomogram using a cycle ergometer. Metabolic syndrome was defined based on the WHO criteria. The visceral fat area (VFA) was determined using a computed tomography scan. The age- and VFA-adjusted odds ratio was 3.49 (95% CI, 1.13-10.82) for subjects in the low fitness category in comparison to those in the high fitness category. We calculated the odds ratio for the prevalence of metabolic syndrome in the nine categories classified based on the three VFA and three [Formula: see text] (2)max levels. In Moderate- and Low- [Formula: see text] (2) max categories, the odds ratios increased in line with increases in the VFA level. The highest odds ratios were observed in the low fitness and high visceral fat group. In the High- [Formula: see text] O(2)max category, no significant odds ratios were observed in the Moderate- and High-VFA categories. These results indicate that a high degree of cardiorespiratory fitness positively contributed to the low prevalence of metabolic syndrome in Japanese male patients with IGT and type 2 DM.     

Severe exacerbation of hepatitis after short‐term corticosteroid therapy in a patient with “latent” chronic hepatitis B

Abstract: We present a case of severe exacerbation of hepatitis after short‐term corticosteroid therapy for chronic inflammatory demyelinating polyneuropathy (CIPD) with “latent” chronic hepatitis B showing no HBV‐related antigens and antibodies. After corticosteroid pulse therapy for CIPD, the patient had severe exacerbation of hepatitis twice. Although she did not show any hepatitis B virus (HBV)‐related antigens or antibodies, sequences of HBV were detected in serum and liver by a nested polymerase chain reaction. A sequence analysis of HBV at the second exacerbation showed that the G‐to‐A point mutation at nucleotide 1896 that converted codon 28 from tryptophan (TGG) to a stop codon (TAG) in the precore region resulted in amino acid change, which has been frequently observed in fulminant hepatitis and severe hepatitis in Japan.     

Activation of resting human T cells requires prolonged stimulation of protein kinase C.

Purified resting human T cells can be induced to express the alpha subunit of the interleukin 2 receptor and to proliferate by treatment with 12-O-tetradecanoylphorbol-13-acetate plus ionomycin but not with 1,2-dioctanoylglycerol plus ionomycin. Determination of the translocation of protein kinase C showed that 12-O-tetradecanoylphorbol-13-acetate plus ionomycin caused a prolonged membrane association of the enzyme for more than 4 hr, whereas 1,2-dioctanoylglycerol plus ionomycin induced a transient membrane association, which was maximal at 20 min. Delivery of multiple additions of 1,2-dioctanoylglycerol plus ionomycin to the T cells resulted in progressively increased expression of the alpha subunit of the interleukin 2 receptor and proliferation commensurate with the number of multiple additions delivered, suggesting that prolonged protein kinase C activity is required for T-cell activation.     

Clinical Significance of Fasting Serum Bile Acid in the Long-Term Observation of Chronic Liver Disease

Fasting serum bile acid (FSBA) was serially measured by a fluorescent enzyme method in a follow-up study of 61 patients with chronic liver disease. In chronic inactive hepatitis, fluctuation of FSBA was within the normal range in both the exacerbated state and in remission. In chronic active hepatitis, FSBA was abnormally elevated in both states, but the difference was not significant. In chronic active hepatitis where FSBA was elevated in the remission state above its value in the exacerbated state, exacerbation of the disease occurred repeatedly during the follow-up period. In compensated liver cirrhosis progressing into the decompensated form, FSBA levels increased before a decrease in the serum values of albumin, cholesterol, and cholinesterase, and an elevation of bilirubin. In liver cirrhosis, FSBA levels increased above 100 microM, 1-4 months before the appearance of ascites.     

gp130 signaling pathways: Recent advances and implications for cardiovascular disease

gp130 was initially identified as a signal-transducing receptor component that associates with the interleukin 6 receptor (IL-6R) when the receptor is occupied by interleukin 6 (IL-6). It has been revealed that the receptor complexes for IL-6, IL-11, leukemia inhibitory factor (LIF), oncostatin M (OM), and ciliary neurotrophic factor (CNTF) utilize this gp130 protein as a common signal-transducing component, explaining how these cytokines mediate overlapping biological function. Recent observations with mice lacking gp130 or having continuously activated gp130 protein have disclosed an important biological function of gp130 in cardiovascular system: the former mice show extremely hypoplastic development of the ventricular myocardium at 16.5 days postcoitum (dpc), and the latter exhibit hypertrophy of myocardium. These cardiovascular abnormalities are considered to be the results of the perturbation of gp130, which also transduces the signal of cardiotrophin-1 (CT-1), a recently isolated factor causing hypertrophy in cultured cardiomyocytes and having sequence similarity with IL-6, IL-11, LIF, CNTF, and OM. In fact, CT-1 shares gp130 with these cytokines as a critical signaling component. Besides various well-established mechanisms by which cardiac growth and development are regulated, a gp130 signaling may be a newly discovered mechanism that regulates these events.     

Case of multiple intrapulmonary lymph nodes]

A 45-year-old man who had hypertension, hyperthyroidism, and bronchial asthma was admitted to our hospital because of a low-grade fever and chest pain. The physical findings and laboratory data were almost all within normal limits except for evidence of mild inflammation and liver dysfunction. The chest X-ray findings seemed normal, but a computed tomography (CT) scan showed multiple nodules in both lower lung fields. We suspected the cryptococcosis or lung cancer. Biopsy by video-assisted thoracoscopic surgery (VATS) yielded a diagnosis of multiple intrapulmonary lymph nodes. In cases with the above radiologic findings, careful attention should be paid to making the differential diagnosis between intrapulmonary lymph nodes and primary lung cancer. The promotion of diagnostic imaging and advances in techniques have made it easier to identify small peripheral nodules in the lungs, and we now know of their existence. Solitary intrapulmonary lymph nodes are encountered frequently, but multiple or increasing numbers of nodes, as in our case, are very rare. Moreover, because cases with elevated CEA levels have been reported, differentiation from lung cancer appears to be important.     

Percutaneous balloon pericardiotomy by the use of Inoue balloon for the management of recurrent cardiac tamponade in a patient with lung cancer

A 32-year-old man with lung cancer involving pericarditis carcinomatosa underwent pericardiotomy, using an Inoue balloon dilating catheter, to create a non-surgical pericardial window. The procedure was performed from the thoracic wall to the left pleural effusion and parietal pericardium under local anesthesia. The effects of non-surgical pericardial window had been maintained until this patient died from his primary disease. It is concluded that percutaneous balloon pericardiotomy is helpful in the management of massive pericardial effusions particularly in patients with malignancies and poor clinical condition     

B cell hyperactivity and its relation to distinct clinical features and the degree of disease activity in patients with systemic lupus erythematosus

Peripheral blood B cells that were actively proliferating, those actively secreting immunoglobulin, and those expressing an early activation marker, Ba antigens, on the surfaces were quantitated in 25 patients with systemic lupus erythematosus (SLE). B cell hyperactivity was found in almost all of the SLE patients, as demonstrated by any one of these measures of B cell activity. Moreover, we observed a strong positive correlation between the degree of disease activity and the amount of spontaneous incorporation of 3H-thymidine by B cells; the magnitude of the increase in frequency of spontaneous Ig-secreting cells in peripheral blood correlated strikingly with certain clinical features in these patients. Our findings suggest that there is heterogeneity of B cell hyperactivity in individual patients with SLE and, thus, that clinical subsets of SLE can be identified on the basis of B cell hyperactivity.