Systemic lupus erythematosus complicating autoimmune pulmonary alveolar proteinosis that was worsened by immunosuppressive therapy.

A 26-year-old Japanese woman developed autoimmune pulmonary alveolar proteinosis (PAP) during glucocorticoid therapy for systemic lupus erythematosus (SLE). Intensive immunosuppressive therapy worsened the PAP. De-escalation of immunosuppressive therapy improved the PAP. Autoimmune PAP is rarely associated with systemic autoimmune diseases, and the present case is the first case of autoimmune PAP associated with SLE. Moreover, the present case suggests that immunosuppressive therapy should be avoided or used carefully for the treatment of patients with anti-GM-CSF antibody, such as those with autoimmune PAP.

Interaction between desialylated hepatitis B virus and asialoglycoprotein receptor on hepatocytes may be indispensable for viral binding and entry.

The cellular receptor for hepatitis B virus (HBV) infection has not yet been identified. The purpose of this study was to address the possibility of participation by desialylated HBV and the asialoglycoprotein receptor (ASGP-R) exclusively expressed on liver parenchymal cells, in infection. Assays for viral binding and entry were performed by culturing a hepatoblastoma cell line, HepG2, and HBV particles derived from the HBV carrier in the presence or absence of neuraminidase (NA). Viral binding and entry were clearly enhanced in the presence of NA, and the enhancement of the binding could be blocked by asialo-fetuin and ethylenediamine-tetraacetic acid (EDTA). In addition, covalently closed circular (CCC)-DNA, as a marker of infectivity, was detected in the presence of NA, but not in its absence. The optimal concentration of NA raised infectivity more than 1000 times. We concluded that this method makes it feasible to evaluate the infectivity of HBV in vitro and that ASGP-R may be a specific HBV receptor once viral particles are desialylated.

Antibody masking renders HIV-1 resistant to cationic membrane filtration through alteration of its electrostatic characteristics.

Previously, it was demonstrated that any human immunodeficiency virus type 1 (HIV-1) strain proliferating in peripheral blood mononuclear cells (PBMCs) in vitro, and resuspended in seronegative plasma, could be captured efficiently (mean > 95%) by a porous polypropylene (PP) membrane modified cationically. We investigated if this cationic membrane could capture HIV-1 obtained from seropositive plasma, and confirmed whether this membrane was effective for the preparation of safe plasma products against HIV-1 transmission. Thirty-six seropositive plasma samples derived from HIV-1 positive cohorts in New York and Lusaka (Republic of Zambia), including 18 cases of acquired immunodeficiency syndrome (AIDS) related complex, AIDS and five terminal cases of AIDS, were filtered through the cationic membrane to determine the reduction of RNA concentration, the gag p24 concentration, and infectious titer. Only a small reduction in RNA concentration (mean < 20%) and almost no decrease in gag concentration (mean < 2%) were obtained, despite the fact that the infectivity was eliminated entirely by the filtration. Due to the possibility that anti-HIV-1 antibodies in patients' plasma combine with HIV-1, laboratory-adapted HIV-1(HTLV-IIIB) was mixed with seropositive plasma to test the effect of antibodies on HIV-1 adsorption, and also to investigate the interfacial electrokinetic potential (zeta-potential) of both intact and plasma-treated HIV-1. The zeta-potential of HIV-1(HTLV-IIIB) in the presence of seropositive plasma was neutral as opposed to negative when stored in seronegative plasma or culture medium. Also the rate of HIV-1 capture by the membrane, as determined by the reduction in RNA concentration, sank from 95% to 20%, the same capture percentage observed when filtering plasma of patients. These findings suggested that in patients' plasma, the antibody-masked HIV-1 comprise most of the viral population, and was not trapped on the cationic membrane because of its electrostatic character. Conversely, the cationic membrane was thought to adsorb antibody-free HIV-1 exclusively. It was suggested that each viral swarm had its own zeta-potential, and this difference in electrostatic character determined the extent of the viral adsorption by the cationic membrane.

Elucidation of the HIV-1 virucidal mechanism of methylene blue photosensitization and the effect on primary isolates.

The antiviral activity for primary isolates of human immunodeficiency virus (HIV) type 1 of a combination of methylene blue and light irradiation was investigated, in comparison with their virucidal effects on laboratory-adapted HIV-1. The antiviral mechanism was evaluated in terms of reverse transcriptase activity and viral RNA in the same viral stock. Despite a marked reduction in RNA (>3.07 Log(10)) and infectivity (6.10 Log(10)) under conditions of 1 microM methylene blue and 5 J/cm(2) irradiation when HIV-1(HTLV-IIIB) as a representative HIV-1 was employed, relatively little degradation of the viral envelope (0.20 Log(10)) and reverse transcriptase activity (1.52 Log(10)) was observed. Because no difference in the reduction of infectivity was found between primary isolates and laboratory-adapted HIV-1 (including HIV-2(ROD)), the antiviral mechanism of methylene blue photosensitization may be similar for all types of HIVs. Methylene blue photosensitization seems to deprive HIVs of infectivity, mainly due to RNA damage, and weak structural and functional damage of viral proteins.

Elimination of both cell-free and cell-associated HIV infectivity in plasma by a filtration/methylene blue photoinactivation system.

BACKGROUND: Methylene blue phototreatment effectively inactivates cell-free viruses in plasma while maintaining coagulation activities. However, this treatment is considered to be less effective for cell-associated virus inactivation. This report describes a new virus elimination system designed to eliminate cell-associated viruses with a cell-removal filter followed by methylene blue photoinactivation of cell-free viruses in plasma. STUDY DESIGN AND METHODS: Fresh plasma was inoculated with HIV or HIV-infected Molt4 cells (Molt4(IIIB)). The plasma was transferred to a bag containing methylene blue by passing it through a cell-removal filter and was irradiated with white fluorescent light. HIV infectivity was detected by indirect fluorescence assay. In parallel studies, coagulation activities in identically treated plasma were measured during 1 year of storage at -80 degrees C. RESULTS: Initial cell-free HIV titer of 10(6.2) TCID(50) per 0.1 mL dropped to 10(-0. 3) and <10(-0.5) TCID(50) per 0.1 mL after 10 or 20 J per cm(2) radiation, respectively. Cellular components were not detectable in plasma after filtration. The cell-free state of the plasma was ascertained from the observation that the DNase-resistant beta-globin gene, as a marker of intact WBCs, was not detected in the filtrates by PCR. The infectivity of Molt4(IIIB) was reduced to below the detection limit after filtration and radiation, and proviral HIV DNA was not detected in the filtrates by PCR. Coagulation activities including factor VIII in the treated plasma were maintained at more than 76 percent compared with the percentage in untreated plasma after 1 year of storage. CONCLUSION: The filtration/methylene blue photoinactivation system eliminated both cell-free and cell-associated HIV infectivities from plasma while maintaining coagulation activities for 1 year at -80 degrees C storage.

Anti-HIV-1 activity of an ionically modified porous polypropylene membrane determined by filtration of a viral suspension.

We describe here a unique anti-HIV-1 membrane, derived from a chemically modified porous polypropylene (PP) membrane, which lowers viral infectivity upon the filtration of HIV-1 suspension. A cationic polymer, polyethyleneimine (PEI) was graft-polymerized onto the PP filter membrane (PP-PEI), and infectious HIV-1(HTLV-IIIB) derived from MOLT-4/HIV-1(HTLV-IIIB) cells (HIV-1(HTLV-IIIB(MOLT-4)) was applied. When a viral suspension of high titer (10(3.93) TCID50 ml(-1) was filtered, efficient reduction (>99%) of gag p24 antigen levels and infectious titer resulted. In a viral suspension of medium titer (10(2.37) TCID50 ml(-1), a significant decrease in the p24 antigen did not occur, although the titer was markedly reduced (>95%). Electron microscopic observation suggested that PEI induced viral aggregations under high titer conditions, and under medium titer conditions, PEI deprived HIV-1(HTLV-IIIB(MOLT-4)) of its infectivity alone to avoid virus adsorption. In contrast, HIV-1 propagated in human peripheral blood mononuclear cells (PBMC) such as HIV-1(HTLV-III(PBMC)) was more efficiently trapped by PP-PEI at lower titers as compared with HIV-1(HTLV-IIIB(MOLT-4)) from MOLT-4/HIV-1(HTLV-IIIB) cells. These data suggest host cell modification in the interactions between PP-PEI and HIV-1 strains. Since HIV-1(HTLV-IIIB(MOLT-4)) and HIV-1(HTLV-IIIB(PBMC)) were almost electrically neutral and negative, respectively, we concluded that the divergent effect of PEI on each HIV-1(HTLV-IIIB) resulted from their different electrical characteristics.

Enhancement of human immunodeficiency virus type 1 (HIV-1) infection via increased membrane fluidity by a cationic polymer.

Cationic polymers are known to have potent activity against bacteria, but their effects on viral activity have been little studied. We investigated the effect of one such polymer, polyethyleneimine (PEI), on HIV-1 infection. Although virus-cell binding was significantly inhibited by PEI, HIV-1 infection in human T-cell lines such as MT-4 and MOLT-4 was accelerated conversely when the drug treatment was carried out, after the virus had attached to the cells or PEI was simultaneously added to the virus and cell culture system. This paradoxical effect of PEI on HIV-1 infection was examined using HIV-1 chronically infected cells (MOLT-4/HIV-1). Dissociation of the glycoprotein gp120 (as revealed by exposure of transmembrane protein gp41) from MOLT-4/HIV-1 cells and the resultant fusion of these cells was shown to be induced by the addition of PEI. Accordingly, it was suggested that the binding inhibition of HIV-1 to CD4-positive cells by PEI was due to the shedding of gp120 from HIV-1 particles, and this PEI rather promoted membrane fusion between the virus and cells leading to the enhancement of HIV-1 infection. Similarly, dissociation of gp120 from MOLT-4/HIV-1 was also induced by sCD4. The effect of these reagents on changes in membrane fluidity was evaluated by polarization (p) measurements, and it was observed that the acceleration of membrane fluidity occurred only in the PEI system. Therefore, it is likely that PEI accelerates HIV-1 infection by facilitating virus entry into the host cells through an increase in membrane fluidity.

Role of repeat computed tomography after emergency endoscopic retrograde pancreatography in the diagnosis of traumatic injury to pancreatic ducts.

Endoscopic retrograde pancreatography (ERP) is performed on patients with pancreatic injury after abdominal trauma. To delineate pancreatic ductal injuries more accurately, we performed repeat computed tomography (CT) shortly after completion of ERP. We describe our experiences with six patients to demonstrate the feasibility and utility of this method. In our cases, the diagnosis of pancreatic ductal injury was made with certainty on the basis of the presence of extravasated contrast medium. This protocol is useful for reaffirmation of injuries noted on ERP, for diagnosis of injuries not noted on ERP, and for exclusion of injuries in patients with equivocal results of ERP. Moreover, the protocol is easy to implement because it involves only the transfer of the patient from the endoscopy to the CT suite. The technique can be used to clarify potentially confusing situations.

Difference of EEG spectral powers observed between binocular rivalry and binocular fusion.

Spontaneous EEGs were measured at 12 electrode positions over the entire head when subjects perceived alternately one of two stimuli, that were given separately to the left and right eyes, in binocular rivalry. Upward and downward triangles of the same size were used as the two stimuli. The EEGs when subjects perceived a fused image in binocular fusion by receiving the same stimuli, i.e. upward or downward triangles, to the left and right eyes, under the same experimental conditions to binocular rivalry, were also measured for comparison. The difference of the EEG spectral powers obtained under the two states of binocular rivalry and binocular fusion was analyzed in the theta (4-7 Hz), alpha (8-13 Hz) and beta (16-24 Hz) bands. A significant difference in the power was obtained in the alpha band, although the physical parameters of the stimuli, i.e. the shape, luminance, size and contrast, given to both eyes in the states of rivalry and fusion were identical. A large difference of the alpha power was observed at the occipital, parietal and posterior temporal regions.

[The role of emergent endoscopic retrograde pancreatography (ERP): its usefulness in the diagnosis of pancreatic injury].

To determine the therapeutic modalities for pancreatic injury (PI), it is important for the pancreatic ductal injury (DI) to be present or not. We performed ERPs in 36 patients who had positive findings in physical examinations, serum amylase levels and CT within about 13 hours after injury to diagnose the DIs early after injury and to avoid negative laparotomy. In 33 successful ERP patients (intraoperatively in 3), 22 had PIs (14 DIs) and 11 had non-PIs. Of 14 patients with DIs, 12 with main DIs and one with branch injury were treated surgically. Another patient with branch injury, who was treated conservatively, died of the complications of PI. Nineteen patients without DIs, including 8 PIs, were treated conservatively or operated for the associated abdominal injuries, who had no complications on PIs in the hospital days. Three unsuccessful ERP patients, having PIs, were also operated upon. Among 15 patients, including these 3 patients and 12 treated surgically during the era before introducing ERPs, 2 (13.3%) negative laparotomies were noted. Among 16 patients, who underwent both of ERP and operation, no negative laparotomies were noted. No complications of ERPs occurred. In conclusion, ERP is a reliable modality to detect DIs and to determine the therapeutic modalities for PIs.

Wegener's granulomatosis complicated by arterial aneurysm.

Wegener's granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and kidneys. A 56-year-old Japanese man with Wegener's granulomatosis died of intraperitoneal hemorrhage from a ruptured aneurysm of his left gastric artery. Histological findings revealed necrotizing granulomatous vasculitis involving this artery. No previously published reports have described Wegener's granulomatosis patients with aneurysms in such a large artery. We conclude that this case represents either an atypical form of Wegener's granulomatosis or a polyangiitis overlap syndrome of Wegener's granulomatosis and classic polyarteritis nodosa.

[The reliability and the significance of serum amylase levels in the diagnosis of the pancreatic injury].

To clarify the diagnostic reliability and significance of serum amylase levels (SAL) in the patients with pancreatic injury (PI), we reviewed 67 PIs. The elapsed time between injury and arrival of the hospital (ETAI) in the patients with normal SAL (1.3 +/- 0.2 hours, mean +/- SE) was significantly shorter than those with hyperamylasemia (5.8 +/- 0.9 hours). SAL on arrival significantly correlated to ETAI in the patients with type I (contusion) and type III injury (ductal injury). Among 45 patients who had arrived over 3 hours after injury, none showed normal SAL. Regardless of severity of PIs, one third of the patients showed normal SAL on arrival within 3 hours after injury. Among 23 patients treated conservatively, SAL in 14 patients (60.9%) normalized within 48 hours after injury, and these patients had no complications related to PIs. Three of remaining 9, who had prolonged hyperamylasemia over 48 hours, had pancreatic ductal branch injury or pseudocysts. This frequency was significantly different compared to that in the patients whose SAL normalized within 48 hours after injury. In conclusion, SAL is unreliable and insignificant to diagnose PIs within 3 hours after injury. Not to overlook the PIs serologically, it is important to determine SAL over 3 hours after injury especially in the patients having stable vital signs and to whom PIs are strongly suspected clinically.

Endoscopic retrograde cholangiography in the nonsurgical management of blunt liver injury.

Injury to the intrahepatic bile duct has not been routinely examined in patients with blunt liver injury, despite the risk of formation of a biloma and hemobilia. In this study we examined the role of endoscopic retrograde cholangiography (ERC) in the evaluation of blunt liver injuries. Sixty-four of 106 (60.3%) patients with blunt hepatic injuries, admitted from April 1986 through March 1992, were managed nonsurgically; ERC was performed in conjunction with computed tomographic (CT) scanning to rule out injury to the bile duct in 28 patients. Injury to the bile duct was detected in six patients (21.4%), five of whom developed a biloma. Patients with hepatic parenchymal injuries that were observed on the CT scans were at greatest risk for injury to the intrahepatic bile duct, and our data suggested that the incidence of injury to the intrahepatic bile duct after blunt hepatic trauma is higher than previously reported. Patients with serious hepatic parenchymal injuries who are candidates for nonsurgical management should be considered for ERC to exclude the possibility of injury to the bile duct.

Do anger and aggression affect carotid atherosclerosis?

BACKGROUND AND PURPOSE: Although a number of metabolic and psychosocial factors have been identified as coronary risk factors, no studies have evaluated the relation between personality and cerebrovascular disease. The purpose of the present study was to elucidate the relation between the characteristics of anger or aggression and the severity of carotid atherosclerosis on the basis of the findings of B-mode ultrasonography. METHODS: The Cornell Medical Index was used to measure anger in 34 patients with signs of atherosclerosis or at least one of four recognized risk factors for atherosclerosis (hypertension, hypercholesterolemia, diabetes mellitus, and cigarette smoking). The Rosenzweig Picture Frustration Study and Yatabe-Guilford Personality Test were used to evaluate aggression. High-resolution B-mode ultrasonography was performed, and the severity of carotid atherosclerosis was determined by plaque score. The occurrence of risk factors for carotid atherosclerosis was compared among the patients. RESULTS: The correlation of plaque score with one item that endorses anger was r = .65 (P < .01) and with "extrapersistive" in aggression was r = .50 (P < .01). Multivariate analysis identified significant correlations between plaque score and age, hypercholesterolemia, and anger. CONCLUSIONS: Our results suggest that anger and, perhaps, aggression may be risk factors for cerebrovascular disease.

Cilostazol, a novel cyclic AMP phosphodiesterase inhibitor, prevents reocclusion after coronary arterial thrombolysis with recombinant tissue-type plasminogen activator.

Inhibitors of cyclic nucleotide phosphodiesterase hydrolysis of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate are known to inhibit platelet aggregation, which plays an important role in acute reocclusion after thrombolysis in acute myocardial infarction. In the present study of a canine preparation of coronary artery thrombosis superimposed on high-grade stenosis, we tested whether the antithrombotic agent cilostazol, an inhibitor of cAMP phosphodiesterase, could prevent acute reocclusion or sustain coronary blood flow after thrombolysis when used with recombinant tissue-type plasminogen activator (rt-PA) and heparin. Intravenous infusion of rt-PA (0.5 mg/kg body wt for 30 minutes) and heparin (a 150 IU/kg body wt i.v. bolus and then 25 IU/kg body wt per hour i.v.) was combined with cilostazol (0.6 or 1.8 mg/kg body wt for 60 minutes). Without cilostazol, reperfusion was observed in seven of eight dogs, but reocclusion occurred in six of these seven dogs after 9 +/- 2 minutes. After administration of 1.8 mg/kg body wt cilostazol (group B-2; a 120-minute observation after the start of rt-PA infusion), reperfusion occurred in all seven dogs (p < 0.05 versus control group), and brief cyclic reocclusion was observed in only one dog 63 minutes after reperfusion. At the same dose of cilostazol (group B-2L; a 240-minute observation after the start of rt-PA infusion), reperfusion occurred in all five dogs (p < 0.05 versus control group), and coronary blood flow was well maintained except for one short reocclusion in one dog. Cilostazol inhibited cyclic flow reduction in a dose-dependent fashion.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality of life after total proctocolectomy and ileal J-pouch-anal anastomosis.

We investigated the daily life and opinions of patients after total proctocolectomy and ileal J-pouch-anal anastomosis. Eighty patients answered a questionnaire, completed Cattell's anxiety scale, and recorded bowel function for one month. Both colitis and polyposis patients defecated five times daily, had 1.6 episodes of nocturnal motions weekly, and soiled twice weekly. However, colitis patients were more satisfied with their bowel function and surgical outcome than were polyposis patients. This difference had a close relationship to the personality factors of ego strength and frustration. All patients with either disease who defecated less than three times daily, had no nocturnal motions, and had no soiling showed normal ego strength and frustration and were completely satisfied with their bowel status and operation. In contrast, patients defecating more than seven times daily or more than once per week nocturnally and soiling more than four times weekly had high frustration and were dissatisfied. Thus, satisfaction with surgery correlated not only with the objective outcome but also with personality and lifestyle.

Plasma exudation by activated plasma kallikrein after intraperitoneal injection of lambda-carrageenin or endotoxin in rats.

The experimental study was carried out to examine whether intraperitoneal injection of carrageenin or endotoxin activates plasma kallikrein-kinin system to induce plasma exudation in rats. Intraperitoneal injection of 2% lambda-carrageenin induced plasma exudation in the peritoneal cavity by activation of plasma prekallikrein. Intraperitoneal injection of endotoxin (3mg/kg) also resulted in intraperitoneal plasma exudation, but plasma kallikrein-kinin system did not seem to be involved.

Central nervous system metastasis from gallbladder carcinoma--case report.

Systemic metastases from gallbladder carcinoma occur frequently, but involvement of the central nervous system is rare. We describe such a case in a 68-year-old female. Solitary brain metastasis from gallbladder carcinoma was completely removed 4 months after operation for the primary tumor. Planned chemotherapy was then given to prevent recurrence. She was leading a normal life 4 years later. Patients with solitary brain metastasis from gallbladder carcinoma can achieve a better outcome and longer survival after removal of the brain metastasis if there is no other metastasis.