Identification of an epitope for T-cells correlated with antibody response to hepatitis B surface antigen in vaccinated humans.

Two antigenic T-cell epitopes of HBsAg, designated HBs 16-31 and HBs 81-99, were identified using synthetic peptides and HBsAg-specific T-cell lines. HBs 16-31 was recognized by five HBsAg-specific T-cell lines from vaccinees with both high and low antibody titers, whereas HBs 81-99 was recognized by two T-cell lines derived from vaccinees with high antibody titers. The antibody titer against HBsAg was correlated significantly with the proliferation of vaccinee's PBLs in response to HBs 81-99 (r = 0.47) but not to HBs 16-31, suggesting that HBs 81-99 plays a critical role in anti-HBs antibody production in humans vaccinated with HBsAg.

Desmoplastic fibroma of bone.

We present a rare case of benign intraosseous desmoplastic fibroma, occurring in the tibial bone of a 48-year-old woman. The plain film features consist of a lytic, expansile lesion, in the metaphysis and epiphysis of the bone. We present a case involving the long bone in which the correct diagnosis was suggested by CT and MRI. The appearance of the lesion on CT and MR is described.

Case report of malignant splenic tumor.

Primary angiosarcoma and malignant lymphoma of the spleen are uncommon. We report such tumors in a 44-year-old-woman and a 51-year-old-man. The value of diagnostic imaging by US and CT is emphasized. These techniques can establish the solid nature of the mass and may be the first methods to suggest malignancy.

Asymptomatic adult Wilm's tumor (nephroblastoma) incidentally detected by CT.

Wilms' tumor (nephroblastoma), the most common renal neoplasm in children, is rarely found in adults. A 73-year-old woman with asymptomatic adult Wilms' tumor, incidentally detected by CT, is reported. CT and MRI showed a small mass with homogeneous enhancement after the administration of contrast medium. Ultrasonography demonstrated a well-defined echogenic mass with a halo-like, peripheral hypoechoic area. Selective angiography showed no tumor vessels. Although renal cell carcinoma should be considered in the differential diagnosis, it is still difficult to distinguish from small Wilms' tumor like this case.

[Changes in the blood flow in celiac artery and superior mesenteric artery after stellate ganglion block].

We evaluated the effect of stellate ganglion block (SGB) on the blood flow of celiac artery (CA) and superior mesenteric artery (SMA) by using the ultrasonic pulse Doppler technique. The subjects were 15 healthy volunteers (14 males, one female; average 26 years old; 22-38). Right C7-SGB was performed using 5 ml of 1% mepivacaine at the 7th cervical process. Blood pressure, heart rate, mean blood flow velocity and diameter in CA and SMA, were measured after 5 minute rest, before and after SGB. To measure the flow velocity and the diameter of vessels, ultrasonic diagnostic equipment SSA-270A or SSA-260A (Thoshiba CO, Ltd.) with convex electric-phased 3.75 MHz, probe was used. Doppler shiftgrams of the CA and SMA were recorded. Then, we calculated their flow volume and sectional area of vessels. In CA mean blood flow velocity tended to decrease (P < 0.05) and both flow volume and sectional area of vessels tended to increase (P < 0.001). In SMA, mean flow velocity tended to decrease (P < 0.05) and sectional area increased (P < 0.001). But flow volume did not show significant change. Our results indicate that right C7-SGB leads to an increase in the blood flow of CA.

[Treatment and prognostic factors of stage I and II non-Hodgkin's lymphoma].

In order to assess prognostic factors and therapeutic methods, 104 patients (aged 6 to 89; mean age 57.4; male 68, female 36; stage: I 45, II 59) with clinical stages I and II non-Hodgkin's lymphoma treated at our department between 1977 and 1991 were reviewed. Factors, such as sex, age, clinical stage, primary site, presence of general symptoms, pathology, tumor size, LDH and therapeutic methods (radiotherapy alone; initial radiotherapy plus chemotherapy; initial chemotherapy plus radiotherapy) were calculated by univariated analysis to determine important factors influencing the survival. The survival of patients with symptoms and large tumors (more than 70 mm) was shorter than that of those without symptoms and with small tumors (5 years survival: symptom B 17.9%, A 68.2%, p < 0.001; tumor more than 70 mm 44.0%, less than 70 mm 67.1%, p < 0.05). Regarding therapeutic methods, radiotherapy alone achieved a 5-year survival rate of 37.1%; initial radiotherapy plus chemotherapy had 64.6% and initial chemotherapy plus radiotherapy 78.5%, but a significant difference was noticed only between radiotherapy alone and initial chemotherapy plus radiotherapy (p < 0.001). These results suggest that important factors influencing the survival are presence of general symptoms, tumor size and therapeutic methods.

Immunoglobulin G4-related sclerosing disease mimicking invasive tumor in the nasal cavity and paranasal sinuses.

IgG4RSD affecting the nasal cavity and paranasal sinuses is extremely rare. A 71-year-old man presented with an invasive mass in the nasal cavity and paranasal sinuses that was confirmed by immunostaining to be IgG4RSD. The occurrence of this disease in the nasal cavity and paranasal sinuses can resemble a malignant tumor on diagnostic imaging.

[Effects of denervation of the masseter nerve and bite raising on the masseter muscle of developing rats].

The effects of masseteric denervation and bite raising on muscle fiber type differentiation were examined in the masseteric muscle of developing rats by histological and histochemical studies. Three-week-old Wistar rats had of their masseteric nerve at right side dissected, and a part of them were bite raised at anterior region one week after denervation for three weeks. The unoperated side and number of sham animals served as control. The animals were killed 3, 7, 10, 14, 21, 28, 35, 49 days later and then their masseter muscles were removed wholly and weighed them. After freezing of superficial and deep masseter muscles serial sections were made and HE staining carried out, ATPase staining and NADH-TR staining. On the photographs of the HE stained specimens, I measured the diameter of the muscle fibers. Gross findings on the denervated group, revealed the lower incisors shifted to unoperated side and on with the bite raising group, it shifted to the operated side. In denervated animals, the wet weight of the masseter muscle had decreased significantly. The masseteric muscle fibers in three-old-week control rats were undifferentiated on ATPase staining, but it became well differentiated on and after four-old-week. The superficial masseter of control mainly composed of type 2B fibers. In the deep masseter, about 10% type 1 and 2C fibers were found in limited area around the muscle spindles, and surrounded with type 2A and 2B fibers. In superficial masseter muscle of the denervated group, the percentage of type 2A fibers increased, and that of type 2B fibers decreased. The type 2C fibers were found from the 21st days after denervation. In deep masseter muscles, the percentage of type 1 and 2A fibers decreased, and that of type 2B and 2C fibers increased. In the denervated bite raising group, the composition of the muscle fiber type approached the control group. These results as above suggested, masseteric denervation causes degeneration of muscle fiber composition, and the possibility that early preventive treatment like bite raising may recover the muscle fiber composition normally.

[Bacterial mutation in high magnetic fields and radiofrequency radiation].

Epidemiological studies recently have indicated that magnetic fields and radiofrequency (RF) radiation have an adverse influence on the living body. The purpose of this study was to examine the safety of magnetic resonance imaging (MRI) by observing whether bacterial mutation occurs in an approximate MRI environment. We employed a GX-270 FT-NMR unit (JEOL, Ltd.) with a magnetic field strength of 6.3 Tesla. The Salmonella typhimurium tester strains used in the AMES test were exposed, and the incidence of point and frameshift mutations was evaluated. TA98 and TA7001-7006 mixed strains were used to detect frameshift and point mutations, respectively. Tester strains were exposed to the 6.3 Tesla magnetic field with RF radiation (90 degrees and 180 degrees refocusing pulses were repeated using the hydrogen Lamor frequency at 2-second intervals) for 15, 30, 45, and 60 minutes. After each exposure, the rate of revertant mutation was counted. The rates of revertant mutation in mixed strains and the TA98 strain were not statistically significant. Therefore, it was concluded that bacterial mutation is not increased by RF radiation under a 6.3 Tesla magnetic field.

Contribution of HLA class I and class II alleles to the regulation of antibody production to hepatitis B surface antigen in humans.

The HLA multigene family consists of HLA class I (HLA-A, B and C) and class II (HLA-DR, DQ and DP) genes, and plays a central role in the regulation of immune response. To investigate how each HLA gene and each HLA allele contribute to the human immune response, we immunized 339 healthy Japanese medical students with recombinant hepatitis B surface antigen (rHBsAg) and determined the HLA types of all vaccinated subjects at the DNA level. The anti-HBs antibody titers showed a log-normal distribution, implying that the immune response to HBsAg in humans is a multifactorial and continuous trait. A stepwise multiple regression analysis demonstrated the alleles at the HLA-class I (HLA-A and B) and class II (HLA-DRB1, DQA1, DQB1, DPA1 and DPB1) loci significantly contributed to antibody production to HBsAg. The predicting equation of anti-HBs antibody levels for individuals with any HLA phenotype was proposed based on a multiple regression analysis. The multiple correlation coefficient of antibody production to HBsAg with the HLA-DRB1 locus was highest (0.34) among all of the HLA loci, whereas those with whole HLA class I or class II loci were 0.36 or 0.44 respectively. The incorporated correlation coefficient of the presence of all HLA gene families with antibody production became 0.50, suggesting that HLA class I and class II loci within the HLA multigene family are dynamically involved in regulation of the immune response to HBsAg.

A case of Class II malocclusion associated with a deeply impacted maxillary central incisor.

The patient was a 9-year-old girl with a skeletal Class II malocclusion characterized by maxillary protrusion, excessive overjet and deep overbite. The patient's maxillary left central incisor was deeply impacted. During the first stage, a lingual arch was employed after surgical exposure. During the secondary stage, all four first premolar teeth were extracted and then edgewise mechanotherapy was performed. The total treatment time was 6 years. The malocclusion was treated satisfactorily and resulted in correction of the esthetic and functional flaws after 1 year out of retention.

[Prognosis and MRI findings in patients with peripheral facial palsy].

We examined a series of 21 peripheral facial palsy patients attempted to (17 Bell's palsy, 4 Hunt syndrome) with Gd-DTPA-enhanced MRI and attempted to determine the relation between prognosis and MRI findings. We divided patients into two groups based on facial palsy scores of Japanese facial nerve research: a good group (G-Group) and a bad group (B-group). The G-group scored over 20 points on the 20th day after the first visit and the B-group under 20 points. G-group consisted of 9 Bell's palsy and 1 Hunt syndrome patients, and the B-group of 8 Bell's palsy and 3 Hunt syndrome patients. The averaged facial palsy score of both groups was analyzed every week during 4 weeks. Recovery from the palsy was better in the G-group than the B-group (P < 0.05); the scores at the 4th week of the G- and B-groups were 32.6 +/- 15.2 and 7.8 +/- 7.4, respectively. The MRI findings of both groups were examined retrospectively. Nine of 10 G-group and nine of 11 B-group patients had abnormal contrast enhancement. The result of enhanced facial nerve segment was as follows:G-group, auditory canal 1, labyrinthine/geniculate 7, tympanic 7, mastoid 7; B-group, auditory canal 2,labyrinthine/geniculate 8,tympanic 8, mastoid 7. Our results indicate no relation between the prognosis and the MRI findings. Therefore, it is impossible to predict the prognosis of facial palsy from the results of Gd-DTPA-enhanced MRI.

Pulmonary vein and left atrial invasion by lung cancer: assessment by breath-hold gadolinium-enhanced three-dimensional MR angiography.

PURPOSE: The purpose of this work was to evaluate the ability of breath-hold gadolinium-enhanced three-dimensional (3D) MR angiography to assess the invasion of the pulmonary vein and the left atrium by lung cancer. METHOD: Gadolinium-enhanced 3D MR angiography was performed in 20 consecutive patients with lung cancer. RESULTS: At two sites with left atrial invasion shown by MR angiography, associated partial resection of the left atrium was performed. At five sites with invasion of the proximal pulmonary vein within 1.5 cm from the left atrium on MR, partial resection of the left atrium was performed at one site, and the pulmonary vein was resected at the intrapericardial portion at three sites. At two sites with invasion of the proximal pulmonary vein 1.5 cm more distal to the left atrium, the pulmonary vein was resected at the extrapericardial portion. CONCLUSION: Breath-hold gadolinium-enhanced 3D MR angiography is suitable for assessing invasion of the pulmonary vein and the left atrium by lung cancer.

[Non-Hodgkin's lymphoma of stage I and II in elderly patients: a retrospective study in comparison with younger patients].

Forty-one patients with non-hodgkin's lymphoma at stages I and II who had received radiation therapy were reviewed to analyze the prognosis and prognostic factors, with the main focus on a comparison of elderly (age > 65 years) and younger patients. In terms of clinical and histological characteristics, there were no differences between the elderly and younger patients. The 5-year-survival rate (5YS) in elderly patients was 52.8%, compared with 68.6% for younger patients. In patients treated with irradiation alone, the 5YS was 49.5% in elderly patients and 22.1% in younger patients. Combination treatment consisting of irradiation and chemotherapy improved 5YS markedly to 84.9% in the younger patients, while no apparent improvement was seen in the elderly patients, in whom 5YS was 54.1%. Using Cox's multiregression life table, two prognostic factors, the presence of symptoms and LDH, were extracted and found to have a significant influence upon the survival of the elderly patients. Complete response was 90.2% in the elderly patients, although relapse was seen in 54.1% of the complete responders. Relapse occurred overwhelmingly outside the irradiated regions. Since the prognosis of elderly patients could not be improved with the current chemotherapy regimen, some different regimen must be established to lower the high relapse rate in the area outside the irradiated field.

Serum protein determination by high-performance gel-permeation chromatography.

A general high-performance gel-permeation chromatography (HPGPC) method was developed to determine protein in human serum with improved sensitivity and speed. The optimum UV wavelength for protein detection was found to be 210 nm, by comparing the protein values obtained by varying the UV wavelength of the HPLC detection system with the protein values obtained from spectrophotometric protein assays, i.e., the bicinchoninic acid (BCA) method and the biuret method. The analysis time was less than 1 min. Since this HPGPC serum protein assay method is simple and rapid, it is expected to be particularly well adapted for use in clinical laboratories.

Rapid-onset dystonia-parkinsonism: linkage to chromosome 19q13.

Rapid-onset dystonia-parkinsonism (RPD) is an autosomal dominant movement disorder characterized by sudden onset of persistent dystonia and parkinsonism, generally during adolescence or early adulthood. Symptoms evolve over hours or days, and generally stabilize within a few weeks, with slow or no progression. Other features include little or no response to L-dopa, and low levels of homovanillic acid in the central nervous system. Neuroimaging studies indicate no degeneration of dopaminergic nerve terminals in RDP, suggesting that this disorder results from a functional deficit, as in dystonia, rather than neuronal loss, as in Parkinson's disease. We studied 81 members of two midwestern US families with RDP, 16 of whom exhibited classic features of RDP. We found significant evidence for linkage in these two families to markers on chromosome 19q13, with the highest multipoint LOD score at D19S198 (z = 5.77 at theta = 0.0). The flanking markers D19S587 and D19S900 define a candidate region of approximately 8 cM. Although RDP itself is a rare condition, it is important because it has clinical and biochemical similarities to both Parkinson's disease and dystonia. Identification of the genetic defect in RDP holds promise for understanding the underlying disease processes of both of these more common diseases.

The TOR1A (DYT1) gene family and its role in early onset torsion dystonia.

Most cases of early onset torsion dystonia are caused by a 3-bp deletion (GAG) in the coding region of the TOR1A gene (alias DYT1, DQ2), resulting in loss of a glutamic acid in the carboxy terminal of the encoded protein, torsin A. TOR1A and its homologue TOR1B (alias DQ1) are located adjacent to each other on human chromosome 9q34. Both genes comprise five similar exons; each gene spans a 10-kb region. Mutational analysis of most of the coding region and splice junctions of TOR1A and TOR1B did not reveal additional mutations in typical early onset cases lacking the GAG deletion (N = 17), in dystonic individuals with apparent homozygosity in the 9q34 chromosomal region (N = 5), or in a representative Ashkenazic Jewish individual with late onset dystonia, who shared a common haplotype in the 9q34 region with other late onset individuals in this ethnic group. A database search revealed a family of nine related genes (50-70% similarity) and their orthologues in species including human, mouse, rat, pig, zebrafish, fruitfly, and nematode. At least four of these genes occur in the human genome. Proteins encoded by this gene family share functional domains with the AAA/HSP/Clp-ATPase superfamily of chaperone-like proteins, but appear to represent a distinct evolutionary branch.