Effect of varicella zoster virus antigen-antibody complexes on hydrogen peroxide generation by human polymorphonuclear leukocytes

Hydrogen peroxide (H₂O₂) generation by human polymorphonuclear leukocytes (PMN) incubated with varicella zoster virus (VZV) antigen was studied by cytofluorography. Hydrogen peroxide generation was detected in the presence of VZV-seropositive sera. When seropositive sera were heat-inactivated, H₂O₂ generation was reduced. When PMN were pre-incubated with Leu-1 1b, a monoclonal antibody to the Fc receptor on PMN, H₂O₂ generation was also reduced. These results suggest that VZV antigen-antibody-complement complexes induce H₂O₂ generation by PMN after these complexes attach to Fc receptors on PMN.     

Improvement of peripheral blood lymphocyte subsets in primary biliary cirrhosis after ursodeoxycholic acid therapy

Immunological abnormalities frequently observed in patients with primary biliary cirrhosis are considered to be related to the pathogenesis of this disease. We performed a prospective trial to evaluate whether immune mechanisms play a role in the effectiveness of ursodeoxycholic acid (UDCA) therapy. Fifteen female patients with primary biliary cirrhosis were followed for 1 year and were then treated with UDCA (600 mg/day) for another year. Laboratory tests, including peripheral blood lymphocyte subsets assessed by dual colour fluorescence analysis using monoclonal antibodies against respective T cell markers, were evaluated at the beginning of the study, at the start of therapy and at the end of therapy. In primary biliary cirrhosis, the proportion of cytotoxic T cells, suppressor inducer T cells and αβ-receptor bearing T cells were significantly lower than in healthy controls. No significant changes were observed in the proportions during the year before the therapy. These reductions, however, recovered to normal ranges after 1 year of UDCA therapy. These changes were associated with an improvement in the serum levels of aspartate aminotransferase, alkaline phosphatase, γ-globulin and IgM. The close correlation between the improvement in the imbalance of lymphocyte subsets after the therapy and the clinical status suggests that an immunological process may play a role in the effectiveness of therapy in primary biliary cirrhosis.     

Contractile state is the major determinant of functional outcome in patients with left ventricular dysfunction treated with enalapril

Large-scale drug trials have focused primarily on mortalityand morbidity and less on the functional state of the myocardium.A model was developed to assess myocardial contractile statein patients with left ventricular (LV) dysfunction and to addressthe questions of differences in function between patients withand without overt heart failure, effects of enalapril, and bestpredictors of functional outcome. Pressure-angiographic data were obtained from 16 patients withovert heart failure and 47 without heart failure. Repeat studieswere conducted in 41 patients following 1 year's treatment withenalapril or placebo. Left ventricular silhouettes were dividedinto 18 segments to estimate regional ejection fraction, wallstress and myocardial damage (% myocardial damage). Contractilestate was assessed and ranked by ejection rate-preload-afterloadrelationships and by a score method based on 10 myocardial andventricular function parameters. End-diastolic and end-systolicvolumes (EDV, ESV) were significantly greater (P<0·001),ejection fraction (EF) lower (P<0·009), % myocardialdamage greater (P<0·008) and contractile state moredepressed in patients with overt heart failure. Changes in EDV and ESV (placebo vs enalapril) were significant(EDV, P<0·003; ESV, P<0·014). Directionalshifts in the diastolic pressure-volume relationships with enalaprilor placebo depended primarily on the basal contractile stateand diastolic volume range. The best single predictors of post-treatmentEF were the score index (a surrogate parameter for the contractilestate) and ESV. Added benefits of enalapril include the preventionof further dilatation in patients with less depressed contractilestate and delay in the onset of heart failure. Asymptomaticpatients with LV dysfunction should also be considered for angiotensinconverting enzyme (ACE) inhibitor therapy.     

Granular cell tumor of the suprasternal space

A case of granular cell tumor (GCT) was reported. We encountered a 33‐year‐old woman with a painless, elastic, hard mass in the soft tissue of the suprasternal space. The tumor was excised with several millimeters margin of normal tissue above the deep cervical fascia and the wound was closed primarily. Histological examination on hematoxylin–eosin stain showed a tumor growth in the mid‐ to deep dermis and eosinophilic small granules that were consistent with granular cell tumors. Immunohistochemical studies showed positive staining for S‐100 protein. We experienced a case of a granular cell tumor occurring in the suprasternal space and report the importance of including it in the differential diagnosis of subcutaneous soft tissue tumors.     

Neurosurgical Management of Childhood Spasticity: Functional Posterior Rhizotomy and Intrathecal Baclofen Infusion Therapy

A paradigm shift is currently ongoing in the treatment of spasticity in childhood in Japan. Functional posterior rhizotomy (FPR), which was first introduced to Japan in 1996, is best indicated for children with spastic cerebral palsy, regardless of the clinical severity of spasticity. Surgery is generally carried out in the cauda equina, where the posterior root is separated from the anterior one, and neurophysiological procedures are used to judge which nerve root/rootlet should be cut. The outcome of FPR is favorable for reducing spasticity in the long-term follow-up. Intrathecal baclofen (ITB) treatment for childhood spasticity was approved in 2007 in Japan and the number of children undergoing ITB pump implantation has been gradually increasing. ITB treatment is best indicated for children with severe spasticity, especially those with dystonia, regardless of the pathological background. Since it is a surgery performed to implant foreign bodies, special attention should be paid to avoid perioperative complications such as CSF leakage, meningitis, and mechanical failure. Severely disabled children with spasticity would benefit most from ITB treatment. We would especially like to emphasize the importance of a strategic approach to the treatment of childhood spasticity. The first step is to reduce spasticity by FPR, ITB, and botulinum toxin injection. The second step is to aim for functional improvement after controlling spasticity. Traditional orthopedic surgery and neuro-rehabilitation form the second step of treatment. The combination of these treatments that allows them to complement each other is the key to a successful treatment of childhood spasticity.     

Primary adenocarcinoma of the rete testis with preceding diagnosis of pulmonary metastases

We report a case of primary adenocarcinoma of the rete testis in a 55-year-old man with pulmonary metastases that were detected 11 months prior to the diagnosis of the primary lesion. Primary adenocarcinoma of the rete testis is an extremely rare malignant tumor with a poor outcome. The most common primary symptom is a scrotal mass, often accompanied by hydrocele and chronic epididymitis. The diagnosis is often delayed because of non-specific clinical presentation and symptoms. We cannot forget that rete testis is a possible primary site for a primary, unknown metastatic adenocarcinoma.     

Decreased L-selectin expression in CD34-positive cells from patients with chronic myelocytic leukaemia

Abnormal adhesive interaction between bone marrow stroma and progenitors, one of the causes of unregulated proliferation in chronic myelocytic leukaemia (CML), may be caused by some alterations in adhesion molecules on CML progenitors. We investigated the expression of adhesion molecules (CD44, VLA-5, VLA-4, LFA-1, ICAM-1, L-selectin and c-kit) on bone marrow CD34⁺⁺ cells from 16 CML patients by three-colour flow cytometry. The mean percentage of cells expressing L-selectin in the CD34⁺⁺CD38^{+  ∼  ++} fraction from untreated CML patients was significantly lower, and that in the CD34⁺⁺CD38⁻ fraction tended to be lower than that from normal controls. Among 11 CML patients treated with interferon-α (IFN-α), the mean percentage of the cells expressing L-selectin in the CD34⁺⁺CD38⁻ fraction from three patients with a low percentage of Ph¹(+) cells in bone marrow was significantly higher than that from five patients with a high percentage of Ph¹(+) cells. In addition, L-selectin expression rate was inversely correlated to the percentage of Ph¹(+) cells. There was no significant difference between the untreated patients and normal controls with regard to the expression rates of the other adhesion molecules in each CD34⁺⁺ fraction except LFA-1. These data suggest that decreased L-selectin expression in CML CD34⁺⁺ cells reflects one of the features of malignant CML progenitors.     

The Influence of Endoscopic Injection Sclerotherapy on Organs Surrounding the Esophagus

Abstract: Endoscopic injection sclerotherapy (EIS) is widely accepted as a means of treating esophageal varices. However, various complications of EIS have been reported. To investigate the cause of chest complications after EIS, chest CT and bronchofiberscopy (BF) were carried out in patients undergoing EIS. A contrast medium was added to the sclerosant in a 1: 4 ratio, and a chest CT examination was performed 30 minutes after the EIS procedure. BF was performed before and after EIS. CT findings were classified into four types, i. e., Type I : ring-enhanced esophageal wall, Type II : ring-enhanced paraesophageal wall, Type III : locally enhanced esophageal wall, and Type IV : beltlikeenhanced parietal pleura. The CT findings depended on the frequency of EIS rather than the total volume of sclerosant. After injection into the Paravariceal wall, the sclerosant unexpectedly moved beyond the local injection site during the first or second EIS procedures. During the third or subsequent procedures the sclerosant tended to abide locally in the esophageal wall. Before EIS, bronchial venous dilatation, present mainly in the left main bronchus, was noted and its degree was correlated with the form and location of the esophageal varices. Bronchial venous dilatation decreased in three patients after EIS. The change in venous dilatation seemed to reflect alterations in the esophageal variceal blood flow. After EIS bronchial ulceration was found in the main bronchus in 3 patients. This phenomenon was attributed to both the direct effects of the sclerosant and the physical effects of the endoscopic examination itself_: Minor complications such as pleural effusion, chest pain, and fever were not associated with either CT or BF findings. Patients undergoing EIS should be carefully monitored to facilitate the early detection and management of potential chest complications.     

A flow cytometric method for measurement of hydrogen peroxide generation by pediatric polymorphonuclear leukocytes stimulated by Staphylococcus aureus and Escherichia coli

The generation of hydrogen peroxide (H₂O₂), one of the reactive oxygen species, by polymorphonuclear leukocytes (PMN) stimulated by Staphylococcus aureus and Escherichia coli was studied in infants by cytofluorography. After heparhized whole blood was incubated with bacteria for 60 min, generated H₂O₂ was measured. The positive rate of H₂O₂ generation of PMN and mean fluorescent intensity of positive PMN stimulated by S. aureus and E. coli were significantly reduced in infants aged < 1 year and H₂O₂ generation increased with advancing age. In 10–15 year old children, the level of generated H₂O₂ reached adult levels. When sera from 1 year old children were added to separated PMN from healthy adults, H₂O₂ generation was reduced. In contrast, H₂O₂ generation by PMN from 1 year old children was increased by the addition of adult sera. These results suggest that the ability to generate H₂O₂ in response to S. aureus and E. coli is lower in infants and that such reduced activity may be related to the susceptibility of such infants to S. aureus and E. coli infections.     

Isoflavone Regulates Lipid Metabolism via Expression of Related Genes in OVX Rats Fed on a High-fat Diet

Objective To investigate the effects of isoflavone on body weight, fat mass, and gene expression in relation to lipid metabolism. Methods Thirty-six female SD rats were ovariectomized or sham-operated and fed on a high-fat diet. Two months later, abdominal incision was made, blood was collected to separate serum, and the liver and adipose tissue were immediately collected and weighed. Some portions of these tissues were frozen in liquid nitrogen and stored at -80℃. Results Ovariectomy （OVX） with a high-fat diet could induce obesity in rats, while treatment with isoflavone significantly inhibited the increase in body weight and fat mass in abdomen. Serum total cholesterol and leptin were significantly decreased in isoflavone group, compared with the OVX group. The mRNA expression of liver fatty acid synthase （FAS） in the OVX group was significantly higher than that in sham-operated group, while this difference was not observed in the isoflavone group. The mRNA expression of liver hormone-sensitive lipase （HSL） in the OVX rats tended to be lower than that in the sham-operated rats. Furthermore, a large amount of isoflavone maintained the mRNA expression at a sham level. Conclusion Isoflavone may prevent obesity induced by ovariectomy with a high-fat diet, in part by modulating gene expression related to lipid metabolism.