Leucocytoclastic vasculitis associated with mixed cryoglobulinaemia and hepatitis C virus infection

Mixed cryoglobulinaemia is frequently associated with chronic hepatitis. We report a patient with mixed cryoglobulinaemia, hepatitis C virus (HCV) infection and palpable purpura. The skin manifestations were diagnosed as leucocytoclastic vasculitis in view of both the clinical appearance and the histological findings. In this study, we demonstrated the presence of IgG–class anti–HCV–antibody. HCV–RNA and IgA–class rheumatoid factor in the cryoprecipitate. These results suggest that the cryoglobulinaemia in this case was caused by aggregation of an immune complex comprised of HCV and anti–HCV antibody with IgA–type–rheumatoid factor, and that this led to a cutaneous vasculitis.     

Fluid and Protein Secretion by the Submandibular Glands of Weanling Rats in Response to Cholinergic and Peptidergic Agonists at Various Doses

Fluid and protein secretion by the submandibular glands of 25-day-old rats were examined and compared in response to three cholinergic and four peptidergic sialogogues at various doses. All cholinergic and peptidergic agonists used were potent sialogogues for the submandibular glands of the weanling rats over the wide range of doses used. The cholinergic agonists, bethanechol and methacholine and the peptidergic agonists, substance P, substance P^Tyr8 and eledoisin-related peptide used intravenously, acted similarly to each other on the submandibular glands of the rats, late in the natural weaning period, but carbachol and physalaemin had slightly different effects. Of the peptidergic agonists, physalaemin was the most potent sialogogue among four tachykinins tested at the low dose. The types of protein secreted by the submandibular glands of the weanling rats in response to all sialogogues used here were typical of the β-type. These results indicate that all agonists used could mainly stimulate the acinar cells of the submandibular glands of the weanling rats which have already fully developed functionally at this time.     

Experimental Assessment of Right Ventricular Function in Normal Pigs with a Left Ventricular Assist Device

Abstract: Right ventricular (RV) failure during the use of a left ventricular assist device (LVAD) is the leading cause of death in circulatory support patients. Previous work, both experimentally and clinically, has shown the difficulties in predicting the behavior of the right ventricle at the start of LVAD. An experimental study has been designed to evaluate RV functional changes during LVAD and its relation to preload changes. The model used adult mongrel pigs (n = 10). Right ventricular functional parameters were measured with a thermodilution RV ejection fraction catheter. The left ventricle was supported by a Nippon Zeon blood pump. Two groups were studied, the first one was the LVAD–off group (n = 5) and the other was the LVAD–on group (n = 5) which was supported by LVAD at maximum flow. Change of cardiac output, mean pulmonary artery pressure (PAP), RV stroke work, and RV ejection fraction in both groups were not significantly different. However, the relationship between right ventricular end–diastolic pressure (RV–EDP) and right ventricular stroke volume (RVSV) was significantly changed at a high level of RV–EDP. When RV–EDP was over 6. 5 mm Hg in the LVAD–off group, RVSV decreased to 52. 3 ± 11. 5 ml while in the LVAD–on group, RVSV increased to 97. 2 ± 22. 0 ml. The change in PAP in the LVAD–on group was lower than in the LVAD–off group. We conclude that, at the volume overload state, LVAD can reduce the afterload of the right ventricle and maintain Frank–Starling's effect, thus having a beneficial effect on right ventricular performance.     

In Vitro TNP-Specific Antibody Formation by Peripheral Lymphocytes from Patients with Systemic Lupus Erythematosus

Immunological reactivity in patients with systemic lupus erythermatosus (SLE) was assessed by investigating in vitro trinitrophenyl (TNP)-specific antibody formation by peripheral lymphocytes. Peripheral lymphocytes from 16 patients with SLE were cultured with TNP conjugated with horse erythrocytes (TNP-HRBC) in the presence of 2-mercaptoethanol. The hemolytic plaque assay was used to detect hapten (TNP)-specific antibody-forming cells. Peripheral lymphocytes from normal individuals failed to produce antibody to TNP, whereas SLE lymphocytes produced a significant number of plaque-forming cells. Co-culture experiments with SLE and normal lymphocytes suggested that patients with SLE have a defect in T lymphocytes, leading to abnormal antibody production.     

Reduced protein tyrosine phosphatase (PTPase) activity of CD45 on peripheral blood lymphocytes in patients with systemic lupus erythematosus (SLE)

To disclose the mechanism of aberrant function of peripheral blood lymphocytes (PBL) in SLE, we focused on the catalytic function of CD45, and determined the CD45 PTPase activity in SLE patients. The sample population consisted of 32 SLE patients with different disease activity. PTPase activity of cell lysates immunoprecipitated by anti-CD45 MoAb was assayed against phosphotyrosine analogue PNPP, followed by measuring the release of para-nitro phenol at 410 nm. CD45 PTPase activity of PBL was significantly decreased in SLE patients, compared with that of normal controls and patients with systemic sclerosis (964 ± 265, 1202 ± 172, 1210 ± 125, respectively; SLE versus normal, P < 0.05). It was correlated with SLE Disease Activity Index (SLEDAI) score (r = 0.597, P = 0.0006), but not with the dose of prednisolone (r = 0.214, P = 0.2657), indicating that CD45 PTPase activity became reduced when the disease was active, but it was not affected by prednisolone. Moreover, it was not corrected by in vitro culture with or without stimulation. The expression of CD45 on PBL was comparable between normal and SLE, raising a possibility that it may be due to aberrant regulation of catalytic function of CD45 in SLE. Given the evidence that tyrosine phosphorylation of cellular proteins by tyrosine kinases and phosphatases is one of the key biochemical events in the signal transduction pathway, the decreased CD45 PTPase activity in SLE may account for the defective signal transduction via TCR/CD3, leading to dysregulated effector function of the lymphocytes.     

Diagnosis of Small Pancreatic Carcinoma

A retrospective analysis was performed to evaluate the clinicalsymptoms and abnormal test findings in small pancreatic carcinoma.Five hundred and thirty-six cases of pancreatic carcinoma withthe histology of duct cell carcinoma were collected from 14medical centers in Japan. In 440 of the cases, tumor size wasmeasured at the time of laparotomy or from the resected specimen.Three hundred and seventy-seven patients (86%) had a carcinomalarger than 3.0 cm; only 30% of these were resectable. Sixty-threepatients (14%) had a carcinoma of 3.0 cm or less, with resectabilityof 97%. Detecting a tumor of "3 cm or less" with a high probabilityof resectability is the objective of early diagnosis with theresulting possibility of a cure. In most cases these small carcinomaswere found easily when obstructive jaundice was present (73%).However, the estimated occurrence of obstructive jaundice associatedwith carcinomas of 3 cm or less was only 10% among the totalcases of pancreatic carcinoma studied. Therefore, it is necessaryfor early diagnosis to detect carcinomas of 3 cm or less presentingwithout jaundice. The symptoms of small carcinoma without jaundiceare weight loss, anorexia, upper abdominal pain, back pain anda palpable abdominal mass. Among the various available examinations,endoscopic retrograde cholangiopancreatography, computerizedtomography and ultrasonography were valuable in diagnosing thesesmall carcinomas.     

EFFECT OF PROSTAGLANDIN E1-INDUCED HYPOTENSION ON CARBON DIOXIDE REACTIVITY AND LOCAL CEREBRAL BLOOD FLOW AFTER SUBARACHNOID HAEMORRHAGE

The effect of prostaglandin E, (PGE,) on local cerebral bloodflow (LCBF) and carbon dioxide reactivity (CO₂R) was studiedduring cerebral aneurysm surgery for subarachnoid haemorrhagein 24 patients under neuroleptanaesthesia. Eleven patients hadgood neurological status (Hunt and Kosnik grade I: group A)and 13 patients poor status (grades II-IV: group B). Arterialhypotension was induced with PGE, 0.1 ng kg^–1 min^–1initially and adjusted to maintain mean arterial pressure atabout 70 mm Hg. PGE, was discontinued at the completion of aneurysmclipping. LCBF and CO2R were measured during and after administrationof PGE,. LCBF was unchanged and CO₂R preserved in both groups.The carbon dioxide response was better in group A than in groupB (P < 0.01). PGE, may be a suitable agent for hypotensiveanaesthesia in these patients     

Influence of gum-chewing on the haemodynamics in female masseter muscle

Summary  Blood flow in active skeletal muscles provides energy substrate, oxygen and reduction of excessive heat and metabolic by-products. Although cyclic jaw motions such as those during mastication and speech articulation are the primitive oro-facial functions, possible effects of the cyclic muscle contractions on the intramuscular haemodynamics of the jaw muscles remains scarcely known. We investigated the masseteric haemodynamics during and after gum-chewing. Ten healthy female adults participated in the study. Electromyography, kinetics of masseter muscle oxygenation, electrocardiogram and blood pressure were recorded simultaneously. The subjects were asked to perform gum-chewing and cyclic jaw motion without gum bolus (empty-chewing task). The haemodynamics parameters were compared between the two experimental conditions. During gum-chewing task, deoxygenated haemoglobin and sympathetic nerve activity increased, while tissue blood oxygen saturation decreased. Blood pressure and parasympathetic nerve activity did not change. The overall behaviour of haemodynamic parameters during empty-chewing task was similar to that observed during gum-chewing task. However, the latency periods from the end of chewing until significant changes in the haemodynamic parameters were notably shorter ( P  < 0·05) in gum-chewing task as compared with those associated with empty-chewing task. The duration of the changes was shorter with empty-chewing than with gum-chewing. Fluctuations in masseter muscle haemodynamics associated with chewing jaw movement differed depending on the level of muscle contraction during movement. The differences became statistically significant immediately after the commencement of chewing and after the cessation movement. During the chewing movement, automatic nerve activities increased in response to the level of muscle contraction during movement.     

Cystosarcoma phyllodes of the seminal vesicle

BACKGROUND: We report here an extremely rare case of cystosarcoma phyllodes of the seminal vesicle. METHODS: A 65-year-old man presented with urinary hesitancy, frequency and constipation. Clinical examinations including two needle biopsies were performed, and the patient had undergone open surgery. RESULTS: The final pathological diagnosis was cystosarcoma phyllodes of the seminal vesicle. Seven months after the operation, a chest X-ray showed lung metastasis, and the patient died 11 months after the operation. CONCLUSION: To our knowledge, only one case of cystosarcoma phyllodes of the seminal vesicle has been previously reported.