Intercellular adhesion molecule-1 expression on human corneal epithelial outgrowth from limbal explant in culture.

AIM: To investigate the relation between intercellular adhesion molecule (ICAM)-1 expression and cellular dynamics occurring concomitantly with epithelial cell movement. METHODS: Outgrowing epithelial sheets of human corneal epithelial (HCE) cells from cultured limbal explants were examined by immunoperoxidase staining with anti-ICAM-1 monoclonal antibody. An adhesion assay was performed using the epithelial sheets of HCE cells and an Epstein-Barr virus (EVB) infected B cell lymphoma cell line (EVB(+)BJAB) expressing CD11a/CD18, a counter-receptor of ICAM-1. Also, the effect of calphostin C, a specific protein kinase C (PKC) inhibitor, on ICAM-1 expression on the outgrowing epithelial sheets of HCE cells was examined. RESULTS: Strong positive staining for ICAM-1 was found predominantly on HCE cells in the marginal segment of the epithelial sheet, particularly on the cells at the leading edge. EBV(+)BJAB cells adhering to the HCE cells corresponded well to the area of ICAM-1 staining. Treatment of outgrowing epithelial sheets with calphostin C markedly decreased the ICAM-1 expression on the HCE cells. CONCLUSION: ICAM-1 is actively expressed on HCE cells in the marginal segment of the outgrowing epithelial sheets where there is active movement mediated through a PKC dependent mechanism, suggesting the role of ICAM-1 in epithelial cell motility such as the spreading and migration of cells.

Hand-assisted laparoscopic harvesting of an omental pedicle in the treatment of complicated chronic empyema.

We describe a new method for hand-assisted laparoscopic harvesting of an omental pedicle and its use in the treatment of chronic empyema with a bronchopulmonary fistula. This technique may also be appropriate as a less invasive surgical procedure in the treatment of a number of other thoracic infectious conditions.

[Hepatic arterial injection of degradable starch microspheres (DSM) combined with adriamycin (ADM) and mitomycin C (MMC) in patients with liver metastasis of colorectal cancer].

We evaluated the adverse effects, response rates, and changes in CEA-doubling time before and during DSM.ADM.MMC therapy (DSM therapy) in 8 patients with liver metastases of colorectal cancer. In principle, 600 mg/body DSM, 30 mg/body ADM, and 10 mg/body MMC were injected into the hepatic artery, and this treatment was repeated as often as possible. A total of 26 injections revealed no severe adverse effects. In 5 patients who received 3 or more injections of DSM, the response rate was 20% (partial response, one) and an improvement of CEA-doubling time was confirmed in 3 patients (60%). Two patients who demonstrated the shortening of CEA-doubling time after this therapy had shorter survival. It is suggested that to compare CEA-doubling times before and during DSM therapy is useful for selecting candidates for this treatment.

[Histological study of gelatinous drop-like dystrophy following excimer laser phototherapeutic keratectomy].

PURPOSE: Investigation of effects of excimer laser phototherapeutic keratectomy (PTK) on gelatinous drop-like dystrophy. OBJECT AND METHODS: The patient was a 28-year-old woman with gelatinous drop-like dystrophy. She had a history of penetrating keratoplasty and underwent PTK for recurrent lesions by spot mode several times. Finally her sight deteriorated and she underwent lamellar keratoplasty. We divided the corneal specimen into 2 halves, the non-ablated area and the ablated area. The corneal specimens were investigated histologically. RESULTS: Light microscopy showed a decrease in thickness of the epithelial layer, absence of Bowman's layer, and amyloid positive materials at the subepithelial layer in both areas. Electronmicroscopy showed irregularly arranged amyloid fibrils in the subepithelial layer of the non-ablated area. In the ablated area, two different types of amyloid fibrils were identified. In the middle and deep stromal layer, the collagen lamellar structure was intact and keratocytes were normal in both areas. CONCLUSIONS: In the subepithelial layer, two different types of amyloid fibrils were identified in the ablated area. These findings might show that the original disease was affected by excimer laser ablation. In the middle and deep stromal layer, collagen lamellar structure was intact and keratocytes were normal in both areas. These findings suggest that PTK has less effect on the tissue beneath the ablated area, indicating that PTK is a useful and safe technique to remove corneal opacities.

Familial case of keratoconus with corneal granular dystrophy.

A family with keratoconus combined with corneal granular dystrophy is reported. The patients are a mother and her two sons. The mother and her elder son have both keratoconus and corneal granular dystrophy; the younger son has keratoconus. Thus, the keratoconus in this family is thought to be of autosomal dominant inheritance. These familial cases suggest that the gene loci for both diseases localize in proximity or have a close relationship.

[Histological and ultrastructural study of corneal endothelium after excimer laser ablation in rabbit].

To investigate the effect of excimer laser ablation on the corneal endothelium in the early period, an excimer laser ablation was performed on rabbit cornea. Electron microscopy revealed an irregular space in the endothelial membrane facing Descemet's membrane 48 hours after the laser ablation. At 60 hours, electron-dense material was observed between the endothelial cells and Descemet's membrane. At 72 hours, electron-dense material was observed in Descemet's membrane, but no morphologic change was observed in the endothelium. These results suggest that excimer laser ablation may affect reversible corneal endothelium and it is important to perform a long-term follow-up of the corneal endothelium after excimer laser ablation in humans.

[A familial case of keratoconus with corneal granular dystrophy].

We report a familial case of keratoconus with corneal granular dystrophy. The mother and first son have both keratoconus and corneal granular dystrophy and the second son has keratoconus alone. The keratoconus in this family is thought to be an autosomal dominant or an X-linked inheritance pattern. Granular dystrophy is an autosomal dominant inheritance. This familial case suggests that the gene loci of the two diseases are close together or have a close relationship.

[An immunohistological study on a failed case of keratoepithelioplasty form alkali burn on the ocular surface].

We performed immunohistochemical study on a failed case of keratoepithelioplasty (KEP). A 33-year-old man underwent KEP with lammellar keratoplasty (LKP) for an alkali burn suffered 5 years previously. After several rejections, the cornea developed opacity. We performed surgery a second time with the same method, and investigated the removed keratoconjunctival tissue including the lenticule using enzyme labelled antibodies UCHL-1, MB-1, CD4, CD8, CD54 (ICAM-1), CD68, and HLA-DR. Conjunctival tissue extended to the lamellar corneal graft over the lenticule. Either UCHL-1, CD4, or CD8 positive lymphocytes infiltrated the subconjunctival tissue dominantly, but they were blocked by the lenticule or Bowman's membrane of the graft cornea. In the stroma of the lamellar graft cornea, CD4 or CD8 positive, ICAM-1 or HLA-DR expression cells were detected. It was concluded that the lenticule and Bowman's membrane of the lamellar graft block infiltration of the immune cells.

Magnetic resonance tomographic angiography: diagnostic value in trigeminal neuralgia.

A combination of MRI, MR angiography and MR tomographic angiography (MRTA) was used to study the relationship of the root exit zone of the trigeminal nerve to surrounding vascular structures in seven patients with trigeminal neuralgia (TN) and ten patients with no evidence at a lesion in this region. MRTA is the technique for showing the relationship between vessels, cranial nerves and brain stem. MRTA clearly demonstrated the presence of a vessel at the root exit zone of the trigeminal nerve in all patients with TN. In the ten other patients, examination of 20 trigeminal nerves revealed that only one nerve (5%) was in contact with a vessel at the root exit zone. This study supports vascular compression of trigeminal nerves as a cause of TN, and demonstrates the value of MRTA as noninvasive technique for demonstrating compression.

Immunocytochemical study on endothelial markers with the cerebral vessel from a patient with familial moyamoya disease.

The immunocytochemical study of thrombomodulin (TM), a newly recognized anticoagulant endothelial surface protein, was performed with a surgical specimen of a superficial temporal artery (STA) obtained from a 29-year-old woman with familial moyamoya disease. The staining of TM showed positive immunoreactivity in smaller vessels in the surrounding connective tissue of the specimen, whereas negative in STA. Immunoelectronmicroscopically the luminal plasma membrane of endothelial cells was positive for TM. These staining pattern was the same as that in controls. She concurrently suffered from von Willebrand disease type I, and she had two cerebral hemorrhagic attacks. A quantitative defect of the von Willebrand factor in the endothelium was demonstrated immunocytochemically.

A case of insulin resistant diabetes with possible antibodies to insulin receptors.

A case of a 19-year-old, non-obese female with insulin resistant diabetes mellitus and polycystic ovary syndrome was reported. The maximal insulin requirement attained 360 units per day, but a satisfactory control of diabetes did not follow. The patient's serum contained not only anti-insulin antibodies, but also possible anti-insulin receptor antibodies which were demonstrated by the 125I-insulin binding test using insulin receptors derived from human placental plasma membrane. The insulin resistance in this case was assumed to be caused primarily by possible blocking antibodies to insulin receptors and partly by anti-insulin antibodies because of the following observations. First, high serum free insulin (165 microunits/ml) without hypoglycemia indicates the presence of insulin resistance due to other factors than antiinsulin antibodies. Second, the titer of 125I-insulin binding capacity of serum was not unusually higher than those seen in chronically insulin-treated diabetics. Third, immunologically heterospecies insulin (fish insulin) was also ineffective. The clinical features such as absence of ketoacidosis and association with polycystic ovary syndrome resemble those of an unique diabetic syndrome reported previously though acanthosis nigricans and endogenous hyperinsulinemia were not found in this case. Her insulin resistance remitted spontaneously and over the next 18 months' observation, her diabetes remained regulated without insulin therapy.