FAMILIAL HYPERKERATOSIS LENTICULARIS PERSTANS

A 58-year-old male patient with familial hyperkeratosis lenticularis perstans (HLP) was reported. Six members of his family have died of cancers of the stomach, liver, and colon. There may be some relationship between genes participating in oncogenesis and HLP genes. Histologically, serial sections of several papules revealed no marked thinning of the epidermis nor severe cell infiltration in the upper dermis, suggesting that the cell infiltration in the upper dermis was secondary.     

MALC,a novel microinjection method for loading of macromolecules into cultured neurons

Microinjection is one of the most useful and important methods in cellular neurobiology. However, direct insertion and retraction of a capillary produce physical stresses inside cells that make it difficult to apply on small and fragile cells, especially the central nervous system (CNS) neurons. In this study, we developed a novel method called MALC (microinjection method assisted with laser activated chromophore) to avoid this disadvantage of the conventional method. In MALC, a capillary is just attached on cell surface, and combination of a newly developed photosensitizer with a laser pointing system makes the plasma membrane permeable to molecules. This novel method can expand the application of the microinjection method and realize molecular manipulations inside CNS neurons.     

Problems and reformation of the board of medical specialties in Japan

The Board of Medical Specialties, which is closely related to postgraduate training in Japan, including the Board of Surgery, has serious defects in its system because it has developed on its own initiative and has been administered by a medical society. Many of the public are not aware of its existence, and its workings are difficult for them to understand. In the past 20 years, the Organization for the Board of Medical Societies (tentative English translation) has aimed to ensure sound development of the Board of Medical Specialties. Along with the activities of this organization, the Japan Surgical Society also decided to improve and reform its Board of Surgery and the boards of its subspecialties. The management, examination, and evaluation of the board system should be under the control of a third party separate from the medical societies. The ideal Board of Medical Specialties should not only foster gifted physicians but also benefit the public, communities, and medical societies.     

Mitogenic and antiapoptotic effects of various growth factors on human corneal fibroblasts

PURPOSE: To investigate both the effects of various growth factors on the proliferation of human corneal fibroblasts and the abilities of these factors to protect the cells from apoptosis. METHODS: Cultured human corneal fibroblasts were incubated separately with 11 different growth factors whose receptors are expressed by these cells. Cell proliferation was evaluated by measurement of [(3)H]thymidine incorporation. The activation of the protein kinase Akt, which plays an important role in antiapoptotic signaling, was assessed by immunoblot analysis with antibodies specific for a phosphorylated form of the enzyme. Apoptosis was quantitated by the TdT-mediated dUTP-biotin nick-end labeling (TUNEL) assay. RESULTS: Of the 11 growth factors examined, platelet-derived growth factor, insulin, insulin-like growth factors-1 and -2, and epidermal growth factor, each stimulated the proliferation of corneal fibroblasts, induced the activation of Akt in these cells, and protected them from apoptosis induced by sodium nitroprusside (SNP). Basic fibroblast growth factor, keratinocyte growth factor, nerve growth factor, and hepatocyte growth factor stimulated cell proliferation but did not induce Akt activation or protect the cells from SNP-induced apoptosis. Transforming growth factor-beta1 and -beta2 did not stimulate proliferation and had no effect on Akt activity or on SNP-induced apoptosis. CONCLUSIONS: In terms of their modulatory effects on the proliferation and apoptosis of human corneal fibroblasts, the 11 growth factors examined can be classified into three groups. These growth factors may both contribute to maintenance of the cornea and coordinate the proliferative and apoptotic responses of corneal fibroblasts during corneal wound healing.     

Globus sensation caused by gastroesophageal reflux disease

Objectives: This study was designed to examine whether or not gastro esophageal reflux disease (GERD) is implicated in globus sensation. Methods: The subjects were 25 patients (16 men/9 women; mean age: 51, range 25–69 years) complaining of globus sensation with one or more of four laryngeal findings suspected of having GERD, such as pooling of saliva, erythema of posterior one-third of larynx, inter-arytenoids edema, and granuloma. All 25 patients were administrated a proton pump inhibitor (PPI) for a period of 8 weeks. All were given esophageal endoscopies, laryngoscopes, and questionnaire before and after PPI dosing. The questionnaire survey was conducted to investigate changes in globus sensation and three symptoms specific to GERD including heartburn, regurgitation, and belching. Subjective symptoms were totalled by the over all scores of the three subjective symptoms which served as an index of severity of GERD. Results: Fifty-two percent (13/25) of patients had reflux esophagitis. The esophagitis were improved after PPI administration except one case. The incidences of GERD symptoms were high (heart burn 68% (17/25), belching 49% (10/25) and regurgitation 76% (19/25)), and most of these symptoms ameliorated by PPI administration. The laryngeal findings were improved in all patients. Subjective symptoms were improved in 68% (17/25) of globus patients. The improvement rate of total score (before PPI dosing/after PPI dosing) was compared between the two groups: one with improved globus sensation (17 patients) and the other without (8 patients). The improvement rate was significantly higher in the group with improved globus sensation (P<0.05). This means that globus sensation improved because of the improvement in GERD. Conclusion: GERD is therefore concluded to be an inducing factor of globus sensation.     

A case of focal xanthogranulomatous pyelonephritis difficult to differentiate from renal cell carcinoma

A 34-year-old female with left flank pain persisting for 3 months consulted us on 19 Feb, 2001. Ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI) and renal angiography revealed a cystic renal tumor in the upper pole of the left kidney invading the spleen, and paraaortic lymph node swelling. Left radical nephrectomy combined with splenectomy and partial diaphragmectomy was performed under a tentative diagnosis of renal cell carcinoma. However, histopathological findings revealed xanthogranulomatous pyelonephritis (XGP). XGP is a rare, severe, chronic inflammatory disease characterized by accumulation of lipid laden macrophages. XGP is classified as diffuse or focal type. Preoperative diagnosis of focal XGP is difficult because of radiological similarities to renal cell carcinoma. Our case was more difficult to diagnose because she showed few signs of inflammation and had no history of urinary tract infection or stones.     

Particulate matter and particle-attached polycyclic aromatic hydrocarbons in the indoor and outdoor air of Tokyo measured with personal monitors

Using two types of personal monitors for suspended particulate matter of diameter under 10 microm (PM-10) and for particles of diameter under 1 microm with attached polycyclic aromatic hydrocarbons (PPAH), we measured the PM-10 and PPAH concentrations in the indoor and outdoor air in various locations in the Tokyo area. The major findings were as follows. (1) The PPAH concentrations in a clean living room increased rapidly within several minutes after one cigarette was smoked. (2) Using the average indoor concentrations of PM-10 and PPAH in a department store as control concentrations, respectively, where the average indoor PM-10 concentration was closest to an annual average outdoor concentration in Japan, the mean value for indoor air concentrations of PM-10 by location ranged from 2.2 to 6.2 times the control concentration, and the mean value for indoor air concentrations of PPAH by location ranged from 1.0 to 32.2 times the control concentration. (3) Using the same control concentrations, the mean value of outdoor concentrations of PM-10 by location ranged from 1.6 to 8.5 times the control concentration, while the mean value of outdoor concentrations of PPAH by location were up to 353.7 times the control concentration. The major polluted places were main traffic roads, highways, and street tunnels. (4) The correlation coefficient between the PM and the PPAH concentrations in the total monitoring time was 0.014, which was not significant (P>0.05).     

Morphological changes in the optic disc after vitrectomy and fluid–air exchange

Background Although many investigators have previously reported various ocular complications induced by vitrectomy, little is known about post-operative morphological changes in the optic disc. The purpose of this study is to evaluate the effect of vitrectomy and fluid–air (F-A) exchange on the post-operative morphology of the optic disc.Methods We examined 31 eyes that had undergone vitrectomy for macular holes (22 eyes) or epiretinal membranes (9 eyes). Only the patients with macular holes were treated by fluid–air exchange. Morphological changes in the optic disc were evaluated using the Heidelberg Retina Tomograph.Results C/D area ratios significantly decreased for 6 months post-operatively. The rim volumes significantly increased for 1 month following surgery. Cup volumes significantly decreased at 3 months after surgery. No significant change of mean cup depth was observed post-operatively. The eyes that had not been subjected to F-A exchange showed no significant morphological change following surgery. In contrast, the eyes that had undergone F-A exchange showed significant decrease in C/D area ratio and cup volume and an increase in rim volume and mean cup depth for considerable periods following surgery. Any of the patients showed no post-operative visual field loss.Conclusion Whereas no visual field loss is observed, vitrectomy with F-A exchange induces morphological changes in the optic disc for significant periods following surgery.     

Clarithromycin-induced eosinophilic pneumonia

Clarithromycin (CAM) has been widely used for the treatment of respiratory infection. Macrolides are generally well tolerated and their adverse reactions are rare. An 80-year-old woman with nontuberculous mycobacterium infection was treated with combined chemotherapy, including isoniazid, rifampicin, and ethambutol. She developed a fever and peripheral blood eosinophilia, and new subpleural consolidations were observed on chest radiography three days after add-on therapy with CAM. The symptoms and clinical findings improved with the withdrawal of CAM. Histopathologic examinations confirmed the diagnosis of eosinophilic pneumonia. This is the first report of CAM-induced eosinophilic pneumonia.