[A case of hypersensitivity angitis associated with pulmonary infarction and tibial artery occlusion].
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Biomedical subjects
Publications and source records attributed to T Ise.
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Analysis of our data in conjunction with other recent literature allows the following conclusions regarding the role of endothelin in the tubuloglomerular feedback control mechanism and in the pathogenesis of acute ischemic renal failure: (1) Endothelin reduces nephron filtration rate in the nephrons with interrupted signal perception at the macula densa, in accord with preglomerular arteriolar constriction. Yet, the increase in filtration fraction in the whole kidney clearance study suggests a preferential postglomerular arteriolar constriction. Taken together, endothelin, which is a very potent renal vasoconstrictor, seems to constrict both preglomerular and postglomerular arterioles with a predominant constriction of the latter at the doses employed. (2) The endothelin-induced natriuresis is due to a fall in tubular reabsorption, reflecting a direct tubular action, possibly related to an elevation in blood pressure. (3) At the doses of endothelin used and under the present experimental conditions, changes in the magnitude of tubuloglomerular feedback (TGF) response or the feedback characteristic could not be detected. (4) No evidence was found for a participation of endothelin in the pathogenesis of acute postischemic renal failure, as evidenced by the absence of an improvement in glomerular filtration after treatment with endothelin antiserum.
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A case of coma due to the drinking of a liquid cement for polyvinyl chloride resin, containing acetone, methyl ethyl ketone, cyclohexanone and polyvinyl chloride is described. The patient also simultaneously ingested the alcoholic beverage, sake. After gastric lavage, plasma exchanges and direct hemoperfusions, the patient recovered. The concentrations of these chemicals in plasma and urine were analyzed at various time intervals to estimate the clearance. The elimination half lives for acetone and methyl ethyl ketone were 18 hours and 10 hours, respectively. Although cyclohexanone made up the largest component in the solvents, the blood level was extremely low and a large amount of cyclohexanol, a metabolite of cyclohexanone was detected in the blood and urine. The glucuronide metabolite of cyclohexanol was also estimated after the hydrolysis with beta-glucuronidase. Since the conversion of cyclohexanone to cyclohexanol is known to be catalyzed by alcohol dehydrogenase, possible interactions between sake ingestion and cyclohexanone metabolism is proposed.
To clarify the effects of norepinephrine and angiotension II (Ang II) on plasma atrial natriuretic peptide (ANP), both pressor substances were infused into normal volunteers, and plasma ANP levels and venous return were determined. When norepinephrine infusion elevated mean arterial pressure by 15 mm Hg, a transient increase of plasma ANP was observed. However, Ang II infusion showed no effect on plasma ANP levels, even though it also elevated arterial pressure. Superior vena cava flow and left atrial area, which were determined echocardiographically as the index of venous return, increased in the norepinephrine infusion study. However, in the study of Ang II infusion, there was no significant change in either superior vena cava flow or left atrial area. From these results, it was concluded that increased left atrial volume due to increased venous return is the major factor inducing ANP release in norepinephrine infusion.
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The effect of prostaglandin E1 (PGE1) on liver dysfunction due to high-dose methotrexate (HD-MTX) was investigated in children with malignant diseases. Eight children received 45 doses of HD-MTX. Group 1 (33 cases) received no PGE1. Group 2 (4 cases) received PGE1 intravenously 8 times every 12 hours for 3 consecutive days. Group 3 (8 cases) received infusion of PGE1 continuously for 4 days (1 day before and 3 consecutive days after MTX infusion). No significant difference was observed among the serum levels of transaminase in these 3 groups as well as the corresponding levels in the same patients who were treated with or without PGE1. There are reports suggesting that in spite of the lack of any difference in serum transaminase levels in rats with drug-induced hepatic injury given PGE1 infusion, data on DNA synthesis and survival ratio indicate the existence of 'hepatocytoprotection'. Further investigation will be necessary in order to decide whether PGE1 infusion is indeed effective.
Seventy-nine patients with rhabdomyosarcoma (RMS) received treatment at the National Cancer Center Hospital between 1962 and 1985. The patients ranged in age from 4 months to 74 years with a median age of 6 years. Forty-six patients were male and 33 were female. The primary tumor site of RMS was the same as in the previous report. The head and neck region was the most frequent site (40.5%), followed by the extremities (34.1%), genitourinary region (15.2%), trunk (5.1%) and retroperitoneum (5.1%). Histologic types were embryonal RMS in 45 patients, alveolar RMS in 23 patients, pleomorphic RMS in 8 patients and unclassified RMS in 3 patients. As of October 1985, 14 of the 79 patients were still alive. Between 1962 and 1971, 38 patients were not treated by any protocol. After 1972, 41 patients received treatment using a 3 stage-related, multiple-modality program. In the first protocol, chemotherapy consisted of Vincristine, Cyclophosphamide, and Actinomycin-D, and 1 of 18 patients have survived more than 5 years. The cumulative 5-year survival rate of the first protocol was 11.1%. In the second treatment program, which involved Adriamycin in addition to the 3 drugs cited above, 4 of 23 patients have survived more than 5 years. The cumulative 5-year survival rate, 33.2%, was very improved.
A cooperative multicenter clinical study on cisplatin in children with malignant solid tumors was conducted in seventeen institutions. Of 63 children entered into the study, 18 patients were treated with cisplatin alone, 33 with a VCAP regimen (VCR, CPA, ADM and CDDP) and 12 with other combination regimens. The numbers of evaluable patients were 14, 27 and 7, respectively. Response rates for neuroblastoma were 37.5% (3/8) with cisplatin alone and 79.2% (19/24) for the VCAP regimen. Major adverse effects were gastrointestinal symptoms, bone marrow suppression and renal impairment. Hearing difficulty, electrolyte imbalance and transient elevation of transaminase were also observed. However, these adverse effects were within a tolerable range of severity. The results of this study demonstrate that cisplatin is a useful drug in the treatment of neuroblastoma.
Wedge biopsy of the testis was performed in 46 children who had received long-term chemotherapy for acute lymphoblastic leukemia. Occult testicular infiltration was noted in three children (6.5%). Two of three children with biopsy-proven infiltration died of systemic disease in spite of local irradiation and reinduction chemotherapy. Six of 43 children shown to be negative by testicular biopsy relapsed 11 months to 15 years later, and 3 of 6 patients died of systemic disease, but none of the cases developed testicular disease. Chemotherapy-induced gonadal damage was observed in 30 of 46 children, and tubular damage was occasionally still seen 4 years after cessation of treatment. Although gonadal damage usually depends on the cumulative dosage of cyclophosphamide, intact tubular fertility index was found in several children who had received a greater dose of cyclophosphamide intermittently. Induction and maintenance chemotherapy for acute lymphoblastic leukemia had little influence on hormonal function. Testicular biopsy at the time of cessation of chemotherapy seems to be worthwhile for the subsequent strategy of treatment, and long-term surveillance for gonadal damage of long-term survivors will be required.
The presence of testosterone in yolk sac tumor of the infant testis was investigated immunohistochemically. All 16 cases tested were positive for the hormone. The antigen-positive tumor cells were primitive mesenchymal cells and columnar cells forming small ducts, which resembled Leydig cells and Sertoli cells, respectively. These cells accounted for about 1 to 20% of tumor cells and were intermingled with typical yolk sac structures. In contrast, no yolk sac tumor of adult testis was definitely positive for the antigen. In view of its distinctive histological and immunohistochemical features and clinical behavior, yolk sac tumor in the infant testis is most likely a separate and specific entity, composed of a mixture of germ cell and sex cord stroma derivatives.
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Sixty-six cases of multiple primary neoplasms in children in Japan were collected, including 8 cases of our own. These could be divided into 19 synchronous and 47 metachronous multiple neoplasms. Metachronous or multiple primary neoplasms comprised leukemia, osteosarcoma, mesenchymal sarcoma, epithelial carcinoma and others in contrast to synchronous neoplasms which consisted of many pairs of embryonic tumors. The presumptive factors for multiple primary neoplasms suggested radiotherapy-associated cancers in 30%, radiochemotherapy-associated in 13%, chemotherapy-associated in 34%, and genetic factor-related in 36% of cases. Chromosomal analysis was performed in 12 cases. Three of 4 leukemias revealed major karyotypic abnormalities in the leukemic cells. No 13q14, deletion was detected in 5 cases with multiple primary neoplasms developed with retinoblastoma. Frequent incidence of sister chromatid exchange (SCE) was detected in cultured fibroblasts or lymphocytes from one of 3 cases of second primary neoplasms associated with chemotherapy. The time interval between both neoplasms ranged from 2 to 15 years in the majority of cases. Chemotherapy-associated multiple primary neoplasms seemed to appear more quickly than radiotherapy-associated multiple primary neoplasms. Seven children out of 459 long-term survivors of childhood cancer developed multiple primary neoplasms during the period from 5 to 20 years after diagnosis of the first tumor at the National Cancer Center Hospital, Tokyo. The relative risk was suggested to be 14 times higher than the expected incidence of childhood cancer in Japan. Refinement of treatment, long-term monitoring and protective procedures for high-risk patients against multiple primary neoplasms are therefore warranted.
N-myc, which has partial sequence homology to the oncogene c-myc, was isolated from human neuroblastoma cell lines. We have surveyed amplification of N-myc, clone 8 and pG21 in human neuroblastoma cell lines, xenografts and in primary tumors and found that amplification frequently occurred in tumors classified as stage III and IV. In situ hybridization studies demonstrated that in neuroblastomas, chromosome aberrations such as HSR (homogeneously staining region) and DMs (double minutes) are cytological manifestations of the amplification of these clones. The N-myc-related gene seems to contribute to cell growth or differentiation of the nerve cell and its amplification with enhanced expression promotes the progression of the tumor with poor prognosis.
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We attempted to determine whether all cases of AWTA (anirida-Wilms tumor association) or any of the following groups of patients show 11p deletion: cases of Wilms tumor with congenital abnormalities other than aniridia, those without any congenital abnormalities, tumor itself in cases of Wilms tumor without constitutional 11p deletion and cases of aniridia or hemihypertrophy without Wilms tumor. We studied a total of 29 index patients including five cases of AWTA, four cases of Wilms tumor with various congenital abnormalities, 16 cases of Wilms tumor without other abnormalities, three cases of aniridia in one of which Wilms tumor developed later and a case of hemihypertrophy. In all five cases of AWTA and in a case of aniridia who later developed Wilms tumor, 11p deletion involving the p13 band was detected. The mother of the latter also showed an identical 11p deletion. The common segment of deletion was the middle part of the p13. Two possible hypotheses on the mechanism through which Wilms tumor might develop were evaluated, based on the distribution of break points. All other cases, including five with tumor culture, showed a normal karyotype.
The biological effects of tritiated water and of [6-3H]thymidine or [methyl-3H]thymidine incorporated into DNA were compared with those induced by 60Co gamma rays. The killing efficiencies of tritiated water and the tritium-labeled bases were very similar, between 1.8 and 2.0 in terms of the RBE of 60Co gamma rays when compared with the absorbed dose to the bacterial nucleus. The frequency of His+ revertants induced by the decay of [6-3H]thymidine was 3.5 times higher than that induced by [methyl-3H]thymidine or tritiated water; these revertants were most often the result of A:T leads to G:C transitions. In comparison, the other treatments efficiently induced both transitions and transversions. The mutational spectrum resulting from the decay of tritiated water was also determined in the lacI forward-mutagenesis system of Escherichia coli. Transitions predominated at the low dose (2.5 krad), while both transitions and transversions were recovered after a high dose (18 krad). These results are very similar to those observed with 60Co gamma rays and are consistent with the hypothesis that mutagenesis resulting from the decay of [6-3H]thymidine is the result of a position effect, while mutagenesis resulting from the decay of [methyl-3H]thymidine and tritiated water is due to beta-particle ionization.
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