A Japanese-specific recurrent mutation and a novel splice site mutation in the LAMC2 gene identified in two Japanese families with Herlitz junctional epidermolysis bullosa.

BACKGROUND: Herlitz junctional epidermolysis bullosa (H-JEB) is an extremely rare genodermatosis characterized by lethality owing to severe blister formation. We report two unrelated Japanese patients with H-JEB. Genetic analyses detected a single nonsense mutation on the LAMC2 gene in these two patients. AIM: To identify the mutation involved and describe the first reported Japanese recurrent mutation in the LAMC2 gene. METHODS: Direct sequencing was performed of DNA from either peripheral blood or fetal cells in amniotic fluid. Reverse transcriptase PCR was used to confirm that an aberrant transcript resulted from the splice site mutation. A haplotype analysis was performed to define the origin of the recurrent mutation. RESULTS: Both patients had blisters and erosions on the trunk and limbs at birth, with nail dystrophy. Patient 1 died as a result of sepsis at 30 weeks of age, and patient 2 died as a result of disseminated intravascular coagulation at 20 weeks of age. Mutation analysis of the LAMC2 gene revealed that patient 1 was compound heterozygous for a nonsense mutation (p.Cys553X) and a novel splice site mutation (c.2868+1delG), and patient 2 was a homozygous for p.Cys553X. Prenatal diagnosis performed during a subsequent pregnancy in family 2 revealed that this second child was heterozygous for p.Cys553X, and was thus not affected. Haplotype analysis suggested that a p.Cys553X allele derived from the same origin had been independently inherited by these two unrelated families. CONCLUSIONS: p.Cys553X in the LAMC2 gene may be a Japanese-specific recurrent mutation as a result of a founder effect, and it may therefore be useful for initial screening in the mutation analysis of H-JEB.

Coronary artery bypass grafting in octogenarians.

Preoperative profiles, postoperative complications, and the early and late results in 32 patients 80 yrs. of age and older (elderly group) who underwent coronary artery bypass grafting were compared with those in patients under 80 yrs. of age (control group). In the elderly group, the prevalence of patients with preoperative creatinine clearance (Ccr.) <50 l/day (34.4%), unstable angina pectoris (78.1%) and left main trunk disease (40.1%) was significantly higher than those in the control group. The incidences of arrhythmia and intensive care unit(ICU) syndrome were also significantly higher in the elderly group than in the control group, however, there was no death due to these complications. In the elderly group, one patient (3.1%) died in the hospital due to low cardiac output syndrome (LOS), while three patients (2.4%) of the control group died in the hospital. As for the long-term results, the 5-yr. survival rates for the elderly group and the control group were 82.6% and 85.2%, respectively, and the effectiveness of surgery was remarkable, with improved postoperative activity in 96.9% of the elderly group. These findings indicate that although the elderly patients have higher risks by undergoing surgery and have a disadvantage in the rate of postoperative complications, the postoperative improvement in activity and survival rate can be similar to those in the younger patients.

Primary malignant lymphoma of the brain: analysis of MMAC1 (PTEN) tumor suppressor gene.

With the use of RT-PCR (reverse transcriptase-polymerase chain reaction), Northern blot analysis, and Western blot analysis, seven primary brain lymphomas were examined for the state of the MMACI tumor suppressor gene. Nucleotide analysis of RT-PCR clones revealed no abnormality in the MMAC1 coding sequence in each case. Although Northern blot revealed variation among cases in the signal intensities for MMAC1 mRNA, Western blot revealed a distinct MMAC1 protein band in all cases, suggesting that the actual MMAC1 expressions were similar. In Western blot analysis of phosphorylated Akt (p-Akt), which is regulated positively by PI3K (phosphoinositide-3 kinase) and negatively by MMAC1, all the lymphomas revealed an Akt band but not a p-Akt band, suggesting that the MMAC1 phosphatase activity was maintained in each case. These findings suggest that the MMAC1 gene is normal in its coding sequence, gene expression, and phosphatase activity in the lymphomas. Thus, unlike the p16 and p15 tumor suppressor genes, which are frequently deleted and inactivated in brain lymphoma and represent a striking contrast to systemic lymphoma, MMAC1 may not play an important role in carcinogenesis in this tumor, as in the systemic counterpart.

Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma.

BACKGROUND: A very rare case of retroperitoneal bleeding due to spontaneous rupture of a large adrenal myelolipoma in a 62-year-old woman is reported. METHODS/RESULTS: She consulted the emergency room of the Nagano Red Cross Hospital with a complaint of sudden left flank pain. A computerized tomography (CT) scan revealed a tumor with areas of fat density and hematoma in the left retroperitoneal space. After her general condition improved, an operation was performed. The tumor strongly adhered to the left kidney and a left nephrectomy with the tumor was curative. Histologic diagnosis was adrenal myelolipoma. No blood transfusion was required. CONCLUSIONS: A CT scan is very useful in the pre-operative diagnosis of adrenal myelolipoma with retroperitoneal hemorrhage. Watch and wait treatments before operation and nephrectomy with adhered tumor are safe and curative.

[Effects of local anesthetics on rat leukocyte functions].

To determine whether local anesthetics affect functions in macrophages, I examined the effects of 5 local anesthetics, lidocaine HCl, mepivacaine HCl, propitocaine HCl, procaine HCl, and tetracaine HCl, on chemotaxis and production of superoxide anion in rat peripheral macrophages. Rats were intraperitoneally injected with 1% glycogen. Peritoneal exudate cells containing macrophages were obtained from the peritoneal cavity 4 days after the administration. Chemotaxis was evaluated using a 48-well microchemotaxis chamber with a polycarbonate membrane filter. Production of superoxide anion was measured spectrophotometrically by a superoxide dismutase-sensitive reduction of ferricytochrome c. All of the local anesthetics examined at a dose of 1 mg ml inhibited (P < 0.05) chemotaxis and production of superoxide anion in macrophages. Moreover, pretreatment of macrophage suspensions with mepivacaine HCl, propitocaine HCl, procaine HCl, or tetracaine HCl at a dose of 1 mg ml resulted in inhibition of the production of superoxide anion. In contrast, pretreatment with lidocaine HCl at this concentration did not significantly affect the production of superoxide anion. These results suggest that all of the local anesthetics examined at a therapeutic concentration inhibit chemotaxis and production of superoxide anion in rat macrophages.

[A case of intrascrotal extratesticular schwannoma].

A 71-year-old man visited our hospital with a complaint of a right intrascrotal mass. An elastic hard mass was palpable in the right intrascrotal extratesticular space. Ultrasonography, computed tomographic scan and magnetic resonance imaging showed a left intrascrotal extratesticular tumor. However, preoperative diagnosis was not decided. Tumor resection was performed, and the histological diagnosis was schwannoma. Intrascrotal extratesticular schwannoma is very rare, and this case was considered as the second report in Japan.

[Clinical analysis in patients undergoing extended resection of pT3 non-small cell lung cancer].

Among pT3 cases there contain various subgroups in terms of the organ which is involved in. We analyzed medical records of 85 consecutive patients who underwent extended surgery with diagnosis of pT3 excluding interlober invasion. As regards to the site of invasion, there are not significant differences in survival between pleural invasion, chest wall involvement, pericardial invasion, and diaphragmatic invasion. However, survival of patients who showed involvement of main bronchus seemed better than other groups. Survival of pT3 cases are in part determined by lymph node involvement, N0 group showed 36.0% 5 year survival rate whereas N1 group 20.0%, and there are no patient with N2 disease who survived 5 years. Among pleural and chest wall involvement group, N0 group showed 34.2% 5 year survival and there are no survival in N1 and N2 group. As regards to histologic subgroups, there are not significant differences between each group. Thus we conclude that in pT3 cases, N0 cases are the best candidate for surgical resection, and that adjuvant therapy is necessary for those with N1 or N2 involvement. Cases with bronchial extension should not be argued in the same field of locally invasive lung cancer because of better survival.

Effect of heparin on infection of cells by equine arteritis virus.

The number of plaques formed by equine arteritis virus (EAV) and Aujesky's disease virus (ADV) was reduced to 14% and 5% of the untreated control (100%), respectively, by 10 U/ml of heparin, but could not be reduced below to 13 and 4%, respectively, by use of concentration up to 100 U/ml. An inhibitory effect of heparin, at concentration up to 100 U/ml, was not observed on parainfluenza virus 3 (PIV-3). Heparinase treatment of RK13 cells reduced the number of EAV-, as well as ADV-induced plaques. On the other hand, the number of PIV-3 induced plaques did not decrease after treatment of RK13 cells with heparinase.

Effect of heparin on infection of cells by porcine reproductive and respiratory syndrome virus.

OBJECTIVE: To investigate whether heparin has any effect on the growth of porcine reproductive and respiratory syndrome virus (PRRSV). SAMPLE POPULATION: 2 isolates of PRRSV, and as control viruses, 1 isolate of pseudorabies virus (PRV) and 1 isolate of parainfluenza 3 virus (PIV-3). PROCEDURES: Plaque assays, using a continuous cell line (MARC-145) derived from African green monkey kidney cell line (MA104), were performed for determination of inhibitory effect of heparin on PRRSV, PRV, and PIV-3. The effect of various doses of heparin and heparinase on the growth of PRRSV, PRV, and PIV-3 was evaluated and compared. In each experiment, value were expressed as the mean value for duplicate samples. RESULTS: The number of plaques formed by PRRSV and PRV was reduced to 24 to 25 and 15% of the untreated control (100%), respectively, by 1 U of heparin/ml, but could not be reduced below 6 to 7 and 3%, respectively, by use of concentrations up to 50 U/ml. An inhibitory effect of heparin, at a concentration up to 50 U/ml, was not observed on PIV-3. Delaying addition of heparin for 30 minutes after the addition of PRRSV and PRV reduced plaque formation by 48 to 51 and 68%, respectively, compared with 91 to 92 and 95%, respectively, if heparin was added at the time of infection. In addition, most PRRSV added was retained by heparin beads, as was PRV. Heparinase treatment of MARC-145 cells reduced the number of PRRSV-, as well as PRV-induced plaques. On the other hand, the number of PIV-3-induced plaques did not decrease after treatment of MARC-145 cells with heparinase. CONCLUSIONS: Addition of heparin to PRRSV or to the MARC-145 cells before virus inoculation and treatment of the cells with heparinase prevented the virus from infecting the cells.

Characterization of porcine reproductive and respiratory syndrome virus hemagglutinin.

Porcine reproductive and respiratory syndrome virus hemagglutinin (HAin) was readily adsorbed on mouse erythrocytes at 4, 22, or 37 degrees C, but not on goose erythrocytes. The adsorbed HAin could not be eluted from the cells by resuspending in phosphate buffered saline, by incubating at 37 or 50 degrees C, or by incubating in the presence of neuraminidase. The hemagglutinating activity was not dependent on the pH and NaCl molarity tested. The receptor of mouse erythrocytes for the HAin was relatively stable to trypsin, neuraminidase, sodium deoxycholate (DOC), potassium periodate (KIO4), dithiothreitol (DTT), 2-mercaptoethanol (2-ME) and formalin treatments. The HAin was inactivated by 2-ME and was gradually inactivated by pepsin, formalin and DTT, but not by beta-glucosidase, trypsin, alpha-amylase, papain, phospholipase C, neuraminidase, KIO4, and ethylendiamine tetraacetic acid (EDTA) treatments. The HAin was stable at 37 degrees C or lower temperatures, but not at 56 degrees C or higher. The HAin was relatively resistant to ultraviolet irradiation and sonication. In the equilibrium centrifugation of the HAin preparation on a CsCl density gradient, the HAin activity showed a sharp peak at 1.17 g/cm2. In the SDS-PAGE analysis, the structural polypeptide of HAin in the peak fraction seems to be the nucleocapsid (N) polypeptide with molecular weight of 15 kDa.

Slow-reacting and complement-requiring neutralizing antibody in swine infected with porcine reproductive and respiratory syndrome (PRRS) virus.

Various conditions were evaluated and modified to enhance the sensitivity of the neutralization (NT) test for detecting antibody in swine infected with porcine reproductive and respiratory syndrome (PRRS) virus. Higher NT antibody titers were consistently obtained by the addition of 10% (v/v) complement, fresh guinea pig serum, to the virus diluent and by the incubation of serum-virus mixture at 4 degrees C for 24 hr. The appearance and persistence of antibodies detected by the modified NT test showed a similar pattern to those of antibodies detected by the indirect fluorescent antibody (IFA) assay, although the antibody titers obtained by the former method were consistently lower than those obtained by the latter method. Slow-reacting complement-requiring NT antibody was detected in sera from pig 2 weeks after infection with PRRS virus. The slow-reacting complement-requiring NT antibody in the early serum samples was sensitive to 2-mercaptoethanol (2-ME), whereas the slow-reacting complement-requiring NT antibody in the late serum samples was resistant to 2-ME. The initial phase may represent the IgM response and the later phase a change to IgG. A NT test was developed in which serum-virus mixtures were incubated at 4 degrees C for 24 hr with complement; this gave an improved sensitivity over the previous incubation at 37 degrees C for 60 min.

Purification of recombinant alpha-amylase by immunoaffinity chromatography with anti-peptide antibody.

Adsorption characteristics of an anti-peptide antibody, obtained by immunization of eight amino acids in the C-terminal region of chimeric alpha-amylase of rice alpha-amylase isozymes, were studied by use of the chimeric enzyme and the peptide used for immunization. This anti-peptide antibody adsorbed the enzyme, as well as the peptide antigen, with sufficient affinity for immunoaffinity purification and was used for purification of the enzyme secreted from yeast cells. Chimeric alpha-amylase was purified by immunoaffinity chromatography to high purity in one step from the fermentation broth. One-third of the secreted enzyme was not adsorbed by the column of anti-peptide antibody because of processing in the C-terminal region.

Smoldering adult T-cell leukemia with B-cell lymphoma and early gastric cancer.

We report a case of smoldering adult T-cell leukemia (ATL) with B-cell lymphoma and early gastric cancer. A 64-year-old man was admitted to our hospital because of proteinuria and hypergammaglobulinemia. Systemic lymphadenopathy, "flower cells" in peripheral white blood cells, and hypergammaglobulinemia with monoclonal gammopathy (IgA, lambda type) were found. As Southern blot analysis revealed monoclonal integration of human T-lymphotrophic virus type I proviral DNA in peripheral blood mononuclear cells, he was diagnosed as having smoldering ATL. The tissue specimen of an inguinal lymph node showed proliferation of abnormal lymphocytes which were stained with anti-lambda antibody, indicating B-cell lymphoma. A polypoid lesion in the stomach was histologically diagnosed as early gastric cancer.

[The influence of the alcohol and the low protein diet on rat pancreas].

We investigated the influence of alcohol and the low protein diet upon rat pancreas. Rats were separated in four groups, 1) Control diet group (Cont), 2) Alcohol diet group (Al), 3) Low protein diet group (Lp), 4) Low protein and alcohol diet group (Lp+Al). They were fed on isocaloric liquid diet compulsorily through the gastric tube. They were sacrificed 3, 6, 12 weeks after. By the light microscopic observation on the rat pancreas which were fed for 12 weeks, lipid droplets in the acinar cells were observed in all groups other than Cont. Apoptosis was founded in Lp and Lp+Al groups. Protein plugs were observed in all groups, and no relation was found between the plugs and the location of the injured acinar cells. By the electromicroscopic observation, in Lp+Al group, acinar cells were typically injured (ER dilation, atrophic nuclei, mitochondria degeneration, etc.) and mesenchymal cells appeared among acinar cells. These results suggest that alcohol causes pancreatic acinar cell injury directly, and relative low protein diet helps to turn it worse.

[Minitracheotomy].

Twenty-four consecutive patients undergoing minitracheotomy were reviewed. Postoperative sputum retention was the major indication. In one case the procedure was not possible. Nineteen patients made an uneventful recovery, and decanulation was done in 17. In four patients minitracheotomy treatment was discontinued because formal tracheotomy was performed subsequently. This method is much simpler, less invasive, and more advantageous than formal tracheotomy. It can also be used for the patients after median sternotomy. On the other hand, in the patients with misswallowing because of recurrent nerve palsy etc., conventional tracheotomy should be performed.

Clinical significance of measuring plasma concentrations of glutamine and glutamate in alcoholic liver diseases.

We investigated the significance of assaying plasma glutamine and glutamate concentrations in various liver diseases. Comparison was made with an aminogram in non-alcoholic liver disease. In alcoholic liver diseases, the plasma glutamate concentration showed a statistically significant elevation compared to the value in non-alcoholic liver diseases. In contrast, the plasma glutamine concentration was elevated in non-alcoholic liver diseases but showed no elevation in alcoholic liver diseases. The glutamate (Glu)/glutamine (Gln) ratio and plasma gamma-GT level correlated well in patients of alcoholic liver diseases. The Glu/Gln ratio became normal after alcohol abstinence. The results suggest that measuring the plasma concentrations of glutamine and glutamate may be a useful method to estimate the pathophysiological state of patients with alcoholic liver diseases.

Ethanol and hydrazine sulfate induced chronic hepatic injury in rats: the curative effect of administration of glucogenic amino acids.

There is a widespread belief that when ethanol is fed to rats for a long time, it produces only fatty degeneration without necrosis or fibrosis. In this study, hydrazine sulfate, an inhibitor of low Km ALDH and gluconeogenetic enzymes, was fed with ethanol to rats, and produced more serious pathological changes compared with those found in Lieber's model. Male Sprague-Dawley rats were fed with a low fat liquid diet as a basal diet with ethanol (4%, w/v) and hydrazine sulfate for 4 weeks. At the end of the experiment, plasma aminotransferase levels were found to be elevated. Histological examination showed not only fatty degeneration but also pericellular fibrosis. Therefore, we have evaluated the curative effect of glucogenic amino acids, alanine and glutamine, on this hepatic injury model and found them to be partially protective.

[Two cases of hepatobiliary scintigraphy of liver transplantation in rejection].

We reported two patients with liver transplantation who are performed hepatobiliary scintigraphy in rejection. In one patient hepatobiliary scintigraphy shows dilatation of bile duct but it shows good clearance from liver. In another patient hepatobiliary scintigraphy shows delayed clearance from liver. Both patients recovered from rejection. There are four main complications--vascular and biliary abnormality, infection, rejection--after liver transplantation. Hepatobiliary scintigraphy shows almost same findings except biliary complication, so it is difficult to distinguish between infection and rejection. But hepatobiliary scintigraphy may be useful to evaluate transplanted liver function in rejection.