[Successful thoracoscopic ligation and transection of racemose hemangioma of bronchial artery].

We used thoracoscopy for the successful ligation and transection of a racemose hemangioma of bronchial artery. The patient was a 61-year-old woman who had been admitted to our hospital because of hemoptysis. Bronchoscopic examination revealed bulging lesions covered with normal bronchial mucosa in the right B5 and B8, and bronchial arteriography revealed a shunt between the right bronchial arteries and pulmonary arteries and veins. Ligation and transection of the right bronchial artery under thoracoscopy was performed. Hemoptysis has not recurred 9 months after the operation. Thoracoscopic ligation and transection of bronchial artery may be an effective and less invasive procedure for the treatment of racemose hemangioma.

Signaling through the beta2 integrin prolongs eosinophil survival.

BACKGROUND: Recently, adhesion molecules have been suggested to play an important role in allergic inflammatory diseases such as bronchial asthma. It is unclear whether eosinophil activation and paracrine or autocrine synthesis of eosinophilopoietic growth cytokines is mediated through signaling by intercellular adhesion molecule-1 (ICAM-1) and the beta2 integrin family. OBJECTIVE: We examined whether signaling by ICAM-1 and its ligands (beta2 integrins) could prolong eosinophil survival. METHODS: Eosinophils were isolated from patients with hypereosinophilia by modified CD16 negative selection. After culture with or without recombinant soluble ICAM-1, eosinophil viability was measured by trypan blue dye exclusion. RESULTS: Eosinophil survival was prolonged in cultures with recombinant soluble ICAM-1 compared with cultures without it (P <.01 on days 2, 4, and 6); this effect was dose-dependent. Eosinophil survival in cultures with recombinant soluble ICAM-1 was significantly inhibited by antibodies against ICAM-1 (P <.01), complement receptor 3 (P <.01), and lymphocyte function-associated antigen-1beta (P <.01). Anti-IL-3 showed no effect on eosinophil survival, whereas anti-IL-5 caused partial inhibition of survival. Interestingly, anti-granulocyte/macrophage colony-stimulating factor caused the complete inhibition of eosinophil survival in cultures with recombinant soluble ICAM-1. CONCLUSION: These results suggested the importance of the beta2 integrins in eosinophil-mediated allergic inflammation.

Type 1 T-helper cell predominance in granulomas of Crohn's disease.

OBJECTIVE: The pathogenesis of Crohn's disease (CD) is thought to be associated with production of several cytokines, especially type-1 cytokines. To elucidate the in situ cytokine profiles in CD, cytokine-containing cells were localized by immunohistochemistry, with special attention to noncaseating granulomas. The results were compared with those from studies of ulcerative colitis (UC). METHODS: We adopted the biotin-streptavidin-peroxidase method on frozen sections obtained at surgery from patients with CD or UC, and we immunohistochemically examined the expression of several cytokines (interferon-gamma, interleukin-2, -4, -10, and -12). RESULTS: In normal colonic tissue, expression of these cytokines was rare except for interleukin-4. In actively inflamed areas of CD, increased expression of all cytokines by mononuclear cells was observed. In contrast, granulomas in CD involved interferon-gamma+ lymphocytes and interleukin-12+ macrophage-lineage cells (epithelioid cells and multinucleated giant cells) but few interleukin-4+ or -10+ cells. Actively inflamed areas of UC also showed an increase in the number of cytokine-containing cells; however, quantitative analysis revealed that there was more expression of interferon-gamma and interleukin-12, and less of interleukin-10, in CD than in UC, indicating the presence of more type 1 T-helper cells in CD tissue than in UC. CONCLUSIONS: The findings of the present study suggest that granulomas of CD are coupled with type 1 T-helper responses; these responses may contribute to the pathogenesis of this disease.

Degranulation of eosinophils mediated by intercellular adhesion molecule-1 and its ligands is involved in adhesion molecule expression on endothelial cells-selective induction of VCAM-1.

BACKGROUND: Adhesion molecules and eosinophils may play an important role in the pathogenesis of allergic inflammatory reactions. OBJECTIVE: We attempted to clarify eosinophil activation, such as degranulation, by signaling through adhesion molecule and to determine whether degranulation is involved in adhesion molecule expression on endothelial cells. METHODS: Eosinophils were cultured with or without recombinant soluble intercellular adhesion molecule-1 (ICAM-1), and the levels of eosinophil cationic protein and eosinophil-derived neurotoxin were determined. The influence of these eosinophil granule proteins or supernatant from eosinophil cultured with ICAM-1 on the expression of ICAM-1 or vascular cell adhesion molecule-1 (VCAM-1) on endothelial cells was also examined by flow-cytometric analysis. RESULTS: Supernatant levels of eosinophil granule protein were significantly increased by culture for 4 hourss or 16 hours with recombinant soluble ICAM-1, suggesting degranulation by adherence to ICAM-1. Both granule proteins and the supernatants of eosinophils cultured with recombinant soluble ICAM-1 induced expression of ICAM-1 and VCAM-1 on endothelial cells, with the latter showing a more prominant increase. CONCLUSION: Degranulation mediated through adherence to endothelial cells by ICAM-1 and its ligands may be involved in the expression of adhesion molecules, such as ICAM-1 or VCAM-1, on these cells. Our finding of the selective induction of VCAM-1 expression suggests that eosinophil adherence to endothelial cells, even if it is because of ICAM-1, may be involved in selective eosinophil recruitment and accumulation at sites of allergic inflammation.

RANTES augments eosinophil lucigenin-dependent chemiluminescence.

BACKGROUND: RANTES (regulated on activation, normal T expressed and secreted) has been shown to possess chemotactic activity for eosinophils. Eosinophils have been considered to play a key role in the allergic inflammation through the release of inflammatory molecules such as radical oxygen products. Thus, in this study, we examined the effect of RANTES on radical oxygen products from eosinophils. METHODS: Eosinophils were isolated from heparinized venous blood of patients with bronchial asthma by the modified CD16-negative depletion method. Radical oxygen products were examined in terms of lucigenin-dependent chemiluminescence. To a mixture of 50 microl of eosinophils (2x10(6)/ml) and 50 microl of lucigenin (5x10(-4)M), 50 microl of calcium ionophore A23187 (final concentration 10(-5)M) was added, and radical oxygen products were determined for 600 s. RESULTS: RANTES treatment resulted in the enhancement of peak value (0.64+/-0.23 RLU) and integrated value (119.08+/-20.52 RLU) as compared to untreated cells (0.15+/-0.03 RLU, 29.48+/-8.92 RLU, respectively). CONCLUSIONS We could conclude that RANTES might play an important role in the pathogenesis of allergic inflammation through involvement in selective eosinophil infiltration and eosinophil activation by augmentation of eosinophil oxidative metabolism.

[The correlation between the outbreaks of asthma attack and meteorologic parameters in Okinawa].

The correlation between the outbreaks of asthma attack and meterologic parameters was analyzed in Okinawa island which belongs to the subtropics. The epidemiologic outbreaks of asthma was investigated for 2 years from the asthma diaries described by 27 patients. The severity of asthma attack was expressed as the asthma score on the basis of asthma diaries. The number of patients carried to hospitals by ambulance on asthma attacks was investigated for 3 years. Two-by-two contingency tables were computed for the meteorologic parameters and analyzed with the method of chi-square test. From the view point of asthma scores, the total scores of 27 patients were increased when a mean and a minimum temperature were respectively higher than each mean value in the period of investigation (p < 0.05, respectively). From the view point of the number of patients carried to hospitals by ambulance on asthma attacks, it was suggested that asthma attacks tended to occur when a mean, a maximum and a minimum temperature, and a vapor pressure were lower than each mean value (p = 0.0001, p = 0.0001, p = 0.0001, p = 0.0002), and a barometric pressure was higher than a mean value in the period of investigation (p = 0.0016). From the further analysis of these data by multiple regression analysis, it was suggested that the number of patients carried to hospitals by ambulance on asthma attacks was influenced by low temperature. In addition, it was suggested that the changes of meteorologic parameters on the passing over of typhoon, especially, the decrease of temperature and barometric pressure, were related to induce asthma attacks.

Functional diversity of infiltrating macrophages in inflamed human colonic mucosa ulcerative colitis.

1. Phenotypical heterogeneity of macrophages infiltrating the colonic mucosa of patients with ulcerative colitis has been shown in many reports. The functional diversity of macrophages in inflamed colonic mucosa remains unclear. 2. Intestinal macrophages have been characterized by immunohistochemical staining and their ability to generate free oxygen radicals in inflamed and non-inflamed mucosa. 3. No correlation was found between RFD1 (activated dendritic cells), RFD7 (tissue macrophages) or RFD9 (epithelioid cells, giant cells in association with granuloma) positivity and either CD68 or human histocompatibility complex class II antigen (HLA-DR) positivity. The proportions of RFD7- and RFD9-positive cells were significantly increased in inflamed colonic mucosa. Nitroblue tetrazolium-reducing mononuclear cells were CD68 or RFD7 positive but they were rarely positive for HLA-DR and RFD1. 4. These results suggest that nitroblue tetrazolium-reducing macrophages are (scavenger) macrophages.

Serum Amylase elevation following hepatic resection in patients with chronic liver disease.

BACKGROUND: Factors liable to cause hyperamylasemia after hepatectomy were studied retrospectively in 140 patient with chronic liver disease. METHODS: The pringle maneuver was performed in 113 patients (Pringle group), the hemihepatic vascular occlusion technique in 21 (hemihepatic group), and no vascular occlusion in 6 (no-occlusion group). RESULTS: In the Pringle group, postoperative serum amylase levels were elevated significantly in comparison with the preoperative levels, but were not elevated in hemihepatic and no-occlusions groups. In the Pringle group, there were 4 patients whose postoperative serum amylase levels exceeded 3.5 times the upper limit of the normal range together with serum pancreatic isoamylase or lipase elevation or both. When compared with the other 109 patients, these 4 patients had a significantly longer vascular occlusion time (51 +/-3 minutes versus 94 +/- 8 minutes P<0.005). One of them developed pancreatitis and died from hepatic failure. CONCLUSION: Prolongation of portal congestion carries a potential risk of serum amylase elevation and pancreatitis after hepatectomy in patients with underlying liver disease.

Extended lateral segmentectomy using intraoperative ultrasound to obtain a partial liver graft.

The important features of extended lateral segmentectomy to obtain a partial liver graft comprising the left lateral segment and the left half of the medial segment are described with special reference to anatomical variation of the hepatic venous system. Ramification patterns of the hepatic vein tributaries around the juncture of the major hepatic veins with the inferior vena cava are delineated before starting liver resection, using intraoperative ultrasound. The left medial vein draining the left part of the medial segment is recognized close to the confluence of the middle and left hepatic veins. This tributary flows into the left hepatic vein in the majority of cases, but sometimes into the middle hepatic vein. The liver transection line is established in order to obtain the graft, including the drainage area of the left medial vein. Intraoperative ultrasound is indispensable for identifying the left medial vein in extended lateral segmentectomy.

Eosinophil cationic protein induces insulin-like growth factor I receptor expression on bronchial epithelial cells.

Although the biologic activity of eosinophil-specific granule proteins, e.g. eosinophil cationic protein (ECP) has been attributed to cytotoxic properties, it has also been shown to be attributable to non-cytotoxic activation of various inflammatory cells. In addition, airway epithelial cells have been reported to express insulin-like growth factor I (IGF-I) receptor and proliferate in response to IGF-I. The present study examined the regulation of expression of IGF-I receptor on bronchial epithelial cells by eosinophil granule proteins was examined. ECP significantly induced IGF-I receptor expression on bronchial epithelial cells compared with unstimulated cells. These findings suggest that eosinophils participate in the repair process of injured bronchial epithelial cells in the inflamed focus through augmentation of IGF-I receptor expression by suboptimal degranulation of eosinophil granule proteins, e.g. ECP.

Expression of CD23, CD32, Mac-1 and other adhesion molecules in eosinophils in strongyloidiasis and HTLV-I-positive patients.

The relationship between human T-lymphotropic virus I (HTLV-I) infection and strongyloidiasis has recently become an important problem. This study compared the expression of CD23, CD32, Mac-1 and other adhesion molecules in eosinophils of patients with strongyloidiasis positive for anti-(HTLV-I) antibodies and in those negative for the antibodies. The expression of CD23, Mac-1 and intercellular adhesion molecule-1 (ICAM-1) on eosinophils of patients with strongyloidiasis was augmented in comparison with normal subjects and HTLV-I carriers. There were no significant differences, however, in the expression of CD23, CD32, Mac-1 and adhesion molecules (ICAM-1, leukocyte function-associated antigen-1 alpha (LFA-1 alpha), LFA-1 beta, very late antigen-4) on eosinophils of patients with strongyloidiasis positive for anti-HTLV-I antibodies in comparison with those negative for these antibodies.

Regulation of eosinophil cell death by adhesion to fibronectin.

Fibronectin is an extracellular matrix (ECM) that binds to very late antigen-4 (a beta 1 integrin molecule) expressed by eosinophils. To investigate the effect of adherence to fibronectin on regulation of eosinophil cell death, survival of eosinophils was examined by trypan blue exclusion and Fas antigen expression on the cell surface using an eosinophilic cell line (EoL-1). Adhesion to fibronectin resulted in prolongation of eosinophil survival (fibronectin vs. bovine serum albumin (BSA), 62.9 +/- 5.10 vs. 53.9 +/- 4.30% viability at 72 h) and the decreasement of Fas antigen expression on EoL-1 (fibronectin vs. BSA, 24.3 +/- 2.15 vs. 74.5 +/- 8.25% positive). These findings suggest that eosinophil adhesion to ECM via adhesion molecules plays an important role in the pathogenesis of allergic inflammation, which involves eosinophil accumulation at the inflammatory site, through regulation of eosinophil cell death.

[Effect of cytokine RANTES on induction of activated eosinophils].

The cytokine RANTES (regulated on activation, normal T expressed and secreted) is a member of the platelet factor 4 superfamily and is a chemoattractant for eosinophils. To study the effect of RANTES on induction of activated eosinophils, flow cytometry was used to measure the expression of intracellular EG2 in eosinophils. The concentration of eosinophil cationic protein in the culture supernatant of eosinophils stimulated with RANTES was also measured. Expression of EG2 and the mean fluorescence intensity ratio were greater in eosinophils stimulated with RANTES than in control eosinophils. Eosinophils stimulated with RANTES also produced more eosinophil cationic protein than did control eosinophils.

Criteria for safe hepatic resection.

BACKGROUND: To lower morbidity after hepatic resection, the authors examined the influence of predictor variables including: age, sex, preoperative risk factors, serum total bilirubin level, plasma retention rate of indocyanine green at 15 minutes, underlying liver disease, operative blood loss, operation time, amount of whole blood transfused, vascular occlusion time, surgical procedure employed, and extent of hepatic resection. PATIENTS AND METHODS: Between January 1990 and December 1992, 172 patients underwent hepatic resection based on our own criteria for hepatectomy, including the presence or absence of ascites, serum total bilirubin level, and the plasma retention rate of indocyanine green at 15 minutes in patients with chronic liver disease. The morbidity rate was 37.2%, and the hospital and operative mortality rates were 2.3% and 0.6%. RESULTS: The multiple logistic model revealed that the risk of morbidity was increased by longer operation time, major hepatic resection, and preoperative cardiovascular disease. CONCLUSIONS: Shortening the operation time without increasing operative blood loss and further modalities for making major hepatectomy safer are future problems to be addressed.

[Effect of rantes (regulated on activation, normal T expressed and secreted) on eosinophil adhesion to plasma coated glass using eosinophilic cell line (EoL-1)].

Recently, adhesion molecules expressed on various inflammatory cells, especially on eosinophils are considered to play an important role in allergic inflammation such as bronchial asthma. RANTES (Regulated on activation normal T expressed and secreted) seems to be the most important chemokine which belongs to Platelet factor 4 (PF4) superfamily, since RANTES is revealed as a chemotactic factor for eosinophils as well as memory T cells or monocytes. In this study, we examined the effect of RANTES on eosinophil adhesion to plasma coated glass using eosinophilic cell line named EoL-1. RANTES augmented EoL-1 adherence to Plasma coated glass and EoL-1 adherence to plasma coated glass was inhibited by anti-VLA-4 antibody, anti-CR3 antibody. On the other hand, RANTES did not augment expression of adhesion molecules (VLA-4, CR3) on EoL-1. These findings indicate that RANTES intensify the adhesion of eosinophils without augmentation of their expression, and suggest that it induce qualitative, but not quantitative changes in their adherence. Taken together, our study suggest that RANTES up-regulates the inflammatory reaction through augmentative effect on adhesion of eosinophils in bronchial asthma.

Results of hepatic resection for hepatocellular carcinoma.

The results of 122 hepatic resections in 112 patients with hepatocellular carcinoma are described. The type of liver resection performed was selected according to the patient's liver function. Forty-nine patients underwent anatomic resections, including 1 trisegmentectomy, 5 lobectomies, 11 segmentectomies, and 32 subsegmentectomies; the remaining 63 patients had nonanatomic resections. The 1-, 2-, and 3-year survivals after liver resection for all patients, taking into account one operative and one hospital death (0.9% each), were 92.4%, 85.0%, and 78.9%, and disease-free survivals at 1, 2, and 3 years were 68.6%, 46.2%, and 32.6%, respectively. Twenty-one repeat hepatic resections (17.2% of the total of 122 resections) were performed with no hospital mortality. Cumulative survival from the time of repeat hepatectomy in these 21 patients was 84.2% and 56.3% at 1 and 2 years, respectively. Among the factors that may affect survival or disease-free survival, the absence of vascular invasion (p < 0.05) and intrahepatic metastases (p < 0.01) were significantly related to the disease-free survival time. A good outcome was obtained after liver resection in 112 patients with hepatocellular carcinoma through appropriate choice of the type of resection, careful follow-up, and a vigorous surgical approach for recurrence.