Influence of transplanted dose of CD56+ cells on development of graft-versus-host disease in patients receiving G-CSF-mobilized peripheral blood progenitor cells from HLA-identical sibling donors.

We investigated effects of variations in the cellular composition of G-CSF-mobilized peripheral blood progenitor cell (G-PBPC) allografts on clinical outcomes of allogeneic PBPC transplantation. We retrospectively analyzed transplanted doses of various immunocompetent cells from 27 HLA-identical sibling donors in relation to engraftment, incidence of graft-versus-host disease (GVHD), and survival. Significant variability was documented in both absolute numbers and relative proportions of CD34+, CD2+, CD3+, CD4(high)+, CD4+25+, CD8(high)+, CD19+, CD56+, and CD56+16+ cells contained in these allografts. Stepwise Cox regression analysis revealed that the CD56+ cell dose was significantly inversely correlated with the incidence of GVHD. Thus, there was a significantly higher incidence of grade II acute GVHD in patients receiving a lower CD56+16+ cell dose (hazard ratio (HR) 0.0090; 95% confidence interval (CI), <0.00001-3.38; P=0.031), a higher incidence of chronic GVHD in those receiving allografts with a lower CD56+16+ to CD34+ ratio (HR <0.00001; 95% CI <0.00001-0.0007; P=0.0035), and a higher incidence of extensive chronic GVHD in those receiving allografts with a lower CD56+ to CD34+ ratio (HR <0.00001; 95% CI <0.00001-0.053; P=0.0083). These results suggest that CD56+ cells in G-PBPC allografts from HLA-identical sibling donors may play an important role in preventing the development of GVHD.

Effective and selective prevention of retinal leukostasis in streptozotocin-induced diabetic rats using gliclazide.

AIMS/HYPOTHESIS: Early stage leukocyte entrapment in the retinal microcirculation (retinal leukostasis) is considered to be one of the important pathogenetic events in diabetic retinopathy. Gliclazide, a sulphonylurea, was reported to reduce leukocyte adhesion to endothelial cells in hyperglycaemia in vitro, thus suggesting possible selective efficacy of this sulphonylurea in preventing leukostasis in diabetic patients. This study evaluated the effectiveness and selectivity of gliclazide treatment on retinal leukostasis of diabetic rats in vivo. METHODS: Streptozotocin (STZ) (65 mg/kg)-induced diabetic rats were divided into three groups (n = 8 each): an untreated diabetic group, a gliclazide-treated diabetic group, and a glibenclamide-treated diabetic group. Gliclazide or glibenclamide was administered orally during a 3-week period. Non-diabetic rats were used as a control (n = 8). Retinal leukostasis was quantitatively evaluated in vivo by acridine orange leukocyte fluorography using a scanning laser ophthalmoscope. RESULTS: The number of leukocytes trapped in the area around the optic disc in the untreated diabetic group (36.9 +/- 5.1 cells) increased significantly compared with the non-diabetic control group (21.9 +/- 2.9 cells; p = 0.0007). The number of leukocytes trapped in the gliclazide-treated diabetic group (23.5 +/- 4.0 cells) decreased significantly compared with untreated diabetic group ( p = 0.0008). In contrast, no reduction of retinal leukostasis was found in the glibenclamide-treated diabetic group (37.8 +/- 5.8 cells; p = 0.7923). CONCLUSION/INTERPRETATION: This suggests that gliclazide could directly improve abnormalities in the retinal microcirculation independent of blood glucose control and possibly have selective therapeutic benefits in preventing early, critical events in diabetic retinopathy compared with other sulphonylurea drugs.

[A case of mucoid impaction of bronchi (MIB) due to Schizophyllum commune].

A 51-year-old woman was admitted because of a productive cough. Atelectasis of the left upper lobe and eosinophilia were noted. The atelectasis was resolved after bronchoscopic removal of the mucous plug. Pathologically, it consisted of eosinophil accumulation with hyphae. Cultures of sputum samples revealed Schizophyllum commune. We diagnosed this case as mucoid impaction of bronchi due to S. commune. Eight months later, a productive cough developed again. Chest radiography showed atelectasis of the right middle lobe. Cultures of bronchial washings yielded S. commune and Aspergillus niger. The atelectasis was resolved by four months of administration of itraconazole (200 mg daily).

Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction.

OBJECTIVES: To perform pelvic venoablation with ethanol injection into the deep dorsal vein for the treatment of 10 patients with venogenic erectile dysfunction. This procedure was easily performed without any selective embolization technique. The efficacy and safety of this technique are discussed. METHODS: A total of 10 patients with veno-occlusive dysfunction, severe enough to make vaginal insertion impossible, underwent pelvic venoablation with ethanol. The mean patient age was 67.1 years. Under spinal anesthesia, after the venous leaks were identified by cavernosography, a 20-gauge flexible needle was inserted into the deep dorsal vein. The pelvic venogram obtained with deep dorsal venography was included in what was revealed by the venogram obtained with cavernosography. A mixture of absolute ethanol and contrast medium (4:1) was used as a sclerosing agent. Under fluoroscopic control, the sclerosing agents were injected into the deep dorsal vein through a flexible needle. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. RESULTS: The follow-up ranged from 25 to 37 months (mean 32.3). At the short-term follow-up visit (less than 6 months), 7 patients (70%) reported erections sufficient for vaginal insertion; at the long-term follow-up visit, 5 men (50%) reported sustained, sufficient potency and 5 (50%) reported persistent erectile dysfunction. No serious complications occurred. CONCLUSIONS: Our pelvic venoablation technique using ethanol was effective, minimally invasive, and cost-effective.

[Spontaneous renal rupture resulting from ureteral tumor left untreated for 6 years: a case report].

A 57-year-old man, 6 years after discovery of a left ureteral tumor was admitted to our hospital complaining of severe left abdominal pain. With the diagnosis of acute abdomen, the patient was examined by computed tomography, which showed severe left hydronephrosis with renal rupture. Retrograde and antegrade pyelography showed the hydroureteronephrosis due to the tumor in the lower ureter, so left nephroureterectomy was performed. The ureteral tumor was diagnosed as transitional cell carcinoma, grade 3 and pT2. The present case is the 9th case of spontaneous renal rupture caused by renal pelvic and ureteral tumors in Japan.

New anabaenopeptins, potent carboxypeptidase-A inhibitors from the cyanobacterium Aphanizomenon flos-aquae.

Anabaenopeptins I (1) and J (2), two new ureido bond-containing cyclic peptides, were isolated from the cultured cyanobacterium Aphanizomenon flos-aquae (NIES-81) as potent carboxypeptidase-A (CPA) inhibitors. The gross structures of 1 and 2 were established by spectroscopic analysis, including the 2D NMR techniques. The absolute configurations of 1 and 2 were determined by spectral and chemical methods. Anabaenopeptins I and J inhibited CPA with IC(50) values of 5.2 and 7.6 ng/mL, respectively.

[Cooperative study of intraarterial preventive chemotherapy after resection of hepatic metastasis from colorectal cancer].

This is a compilation of the results of preventive intraarterial infusion following resection of hepatic metastasis from colorectal cancer at four surgical centers. The cases studied included two groups: A) 76 patients who underwent normal liver resection only, and B) 78 patients who underwent resection with adjuvant chemotherapy. Methods included: 1) WHF, 50 cases; 2) other methods using 5-FU, 18 cases; and 3) intraarterial infusions other than 5-FU, 10 (2 cases, outcome unknown). Survival rates for groups A and B for 1 and 5 years were 71.2, 18.9% and 91.5, 56.2%, respectively, with the rates for the intraarterial infusion group showing far better results. The 1- and 5-year survival rates in terms of infusion methods were: 1) 90.7% and 64.6%; 2) 94.4% and 39.3%; and 3) 90% and 60%, respectively, showing no remarkable differences between methods. Total doses of 5-FU were (a) less than 5 g, 7 patients (b) 5-15 g, 16 patients (c) 15-30 g, 22 patients (d) greater than 30 g, 23 patients. A comparison of 1- and 5-year survival rates shows (a) 85.7% and 17.1%; (b) 66.5% and 44.3%; (c) 100% and 62.7%; (d) 100% and 66.5%, respectively, with doses (c) and (d) showing markedly better results than the (a) dosage. From this we conclude that the group undergoing intraarterial hepatic infusion had a markedly improved prognosis compared to the group not undergoing any type of adjuvant therapy. Also, groups receiving a dosage of 15 g or greater of 5-FU showed prolonged survival rates.

Pulsed-Field Ionization Zero-Kinetic-Energy Photoelectron Spectra of Ar(2).

The pulsed-field ionization (PFI) zero-kinetic-energy (ZEKE) photoelectron spectra of Ar(2) were measured between 117 000 cm(-1) (14.5 eV) and 128 300 cm(-1) (15.9 eV) using the penetrating field technique and synchrotron radiation at resolutions of up to 1 meV. The A(2)Sigma(+)(1/2u) ground state and B(2)Pi(1/2g) and C(2)Pi(3/2u) excited states were assigned to those spectra. The first adiabatic ionization potential of Ar(2) was determined to be 14.4572 +/- 0.0007 eV. A Le Roy-Bernstein plot and a Birge-Sponer plot were used to determine the dissociation limit of the A(2)Sigma(+)(1/2u) ground state. The vibrational level of the C(2)Pi(3/2u) excited state was observed for the first time. The effective lifetime for high-n Rydberg states converging on the vibrational levels of the C(2)Pi(1/2u) excited state is estimated to be shorter than those of the A(2)Sigma(+)(1/2u), B(2)Pi(1/2g), and C(2)Pi(3/2u) states, because the spectrum could not be observed on the PFI-ZEKE experiment. The threshold photoelectron-photoion coincidence spectra of Ar(2) were also measured and compared with the spectra obtained from the PFI-ZEKE experiment. Copyright 1999 Academic Press.

Prenylagaramides A and B, new cyclic peptides from two strains of oscillatoria agardhii

Prenylagaramides A (1) and B (2), two new cyclic peptides, were isolated from the cultured cyanobacteria Oscillatoria agardhii (NIES-205) and O. agardhii (NIES-596), respectively. The structures of 1 and 2, which both contain a rare O-prenyltyrosine (Ptyr) unit, were established as cyclo(-Ptyr1-Gly2-Thr3-Gly4-Glu5-Phe6-Phe7-Asn8-Pro9-) and cyclo(-Ptyr1-Leu2-Tyr3-Pro4-Ile5-Asn6-Pro7-), respectively, by spectroscopic analysis and chemical degradation.

Anabaenopeptins G and H, potent carboxypeptidase A inhibitors from the cyanobacterium Oscillatoria agardhii (NIES-595).

Anahaenopeptins G (1) and H (2) were isolated from the cultured cyanobacterium Oscillatoria agardhii (NIES-595) as potent carboxypeptidase A (CPA) inhibitors. The gross structure of 1 and 2 were established by spectroscopic analysis including the 2D NMR technique and the absolute configurations of 1 and 2 were determined by the spectral and chemical methods. 1 and 2 inhibited CPA with IC50's of 0.0018 and 3.4 microg/mL, respectively.

[Giant testicular tumor: a case report].

We report a case of giant testicular tumor. A 30-year-old man visited our department complaining of a painless swelling of the right scrotal contents. In chest X-ray and abdominal computerized tomography (CT) there were no abnormal findings. Serum alpha-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase levels were normal. Right high orchiectomy was performed. The size of the removed specimen was 13.5 x 8.5 x 7.5 cm, and weight 530 g. The pathological diagnosis was immature teratoma. The patient has received no further therapy. There has been no recurrence for 7 months postoperatively.

[Change on chest CT findings of "primary infection of pulmonary Mycobacterium avium complex"].

We reviewed the chest CT findings of 15 patients with "primary infection of Mycobacterium avium complex". All of them were female and the average age of them was 64.9 years old. They received no or only insufficient therapy. Comparing the chest CT findings followed up for the average of 60.9 months interval, only three patients showed clear progression. All of the cases with less than three lobes involved at the onset unchanged or improved. On the radiographic features at the onset, small nodulousor infiltrative shadows were seen in all patients, and bronchiectasis in three patients. Cavity was not seen. The lesions of 12 patients were located in the right upper lobe, 13 patients in the right middle lobe and 14 patients in the left lingula. Mild and limited cases may have potential with no or very slow progression, and case by case selective treatment should be considered.

[A case of bronchiectasis with abundant expectoration of Mycobacterium gordonae].

A 68 year old woman consulted our hospital because of 6 month history of dry cough. Her chest X-ray revealed bronchiectasis in the left lung. Three sputum specimens were culture positive for acid fast bacilli (AFB) 200 colonies. The bacilli were scotochromogenic, niacin test was negative and hydrolysis of tween 80 was positive, and they were identified as M. gordonae. M. gordonae is rarely implicated as a pathogen but a few reports suggest it may be pathogenic. Though our patient had clinical symptom and expected abundant M. gordonae, her chest X-ray revealed no progression. Thus, it was hardly possible to consider this case as a case caused by the infection with M. gordonae. In previous reports of M. gordonae pulmonary disease, chest X-ray findings showed cavity, infiltration and consolidation, however, no case with bronchiectasis was reported and chest X-ray findings of this case are interesting.

[Prognosis of hepatic metastasis from colorectal cancer following hepatic resection and arterial infusion chemotherapy--assessment from the percentage of tumor involved area].

Prognosis of hepatic metastasis from colorectal cancer following hepatic resection and arterial infusion chemotherapy was studied from the percentage of tumor involved area (PTIA). The PTIA was calculated by the following formula: sigma S'/sigma S, with S' as the tumor area and S as the liver area on each CT slice. The subjects were 25 cases of hepatic resection (HR), and 31 cases of hepatic arterial infusion chemotherapy (HAI). The PTIA of the cases of HR and that of HAI was 1.5 to 25.9% and 0.8 to 31.3%, respectively. For comparison, all cases were divided into group A, which was not more than 10% of the PTIA, and group B, which was more than 10% of the PTIA. In the cases of HR, the prognosis of group A was significantly better than that of group B (p < 0.05). In the cases of HAI, the prognosis of group A was better than that of group B. Even in group A, the prognosis of the cases of HR was significantly better than that of HAI (p < 0.05). These results suggest that the PTIA in the cases of HR and HAI for metastasis from colorectal cancer is important factor which reflects the prognosis.

Haplotypic diversity of DQA1*03 and *05 subtypes differing at amino acid residue 160 encoded in the third exon in 2215 Japanese individuals.

We analyzed the frequencies and haplotypes of DQA1*03 and *05 subtypes, DQA1*03011 or DQA1*0302 and DQA1*0501 or DQA1*0503, respectively, differing only at codon 160 in the non-polymorphic third exon of the DQA1 gene. Of these, 1,862 and 337 individuals selected as DQA1*03- and DQA1*05-positive samples, respectively among 2,215 unrelated Japanese were typed for their nucleotide variation at residue 160 using PCR-SSP. As observed in other populations, all the samples carrying DQA1*03011 (Gene Frequency, GF: 7.8%) were found to share DQB1*0302, whereas those carrying DQA1*0302 (GF: 44.3%) were associated with a variety of DQB1 alleles including DQB1*0302. Both of the DQA1-DQB1 haplotypes with DQA1*03011 and DQA1*0302 carrying DRB1*0406, DQA1*03011-DQB1*0302 and DQA1*0302-DQB1*0302, showed a strong linkage disequilibrium with B62 (p < 0.001, p < 0.05). These results suggested that DQA1*03011 was generated from a single amino acid change at residue 160 in the DQA1*0302-DQB1*0302 haplotype. However, none of the haplotypes with two different DQA1*03 subtypes carrying DRB1*0403,*0405,*0802 and *0901 showed a linkage disequilibrium with any common B-locus antigens, revealing extensive haplotypic diversity of the DQA1*03 group. For example, DRB1*0802 haplotypes showed linkage disequilibria with two different B-locus antigens, B35 and B61 depending on the presence of DQA1*03011 and DQA1*0302, respectively. The GFs of DQA1*0501 and *0503 were 5.1% and 2.7%, respectively. The DQA1*05 associated haplotypes in the DR52-antigen group with DQB1*0301 were divided into two groups, depending on the bimorphism at residue 160. Such a high degree of haplotypic diversity in association with DRB1 and B alleles observed in the DQA1*03 and *05 groups related to amino acid variation at residue 160, which may affect biological function such as the interaction between CD4 and HLA-DQ molecules, seems to reflect selective pressure in the evolutionary process of HLA antigens.

Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms.

SUMMARY: We compare the results of detachable coil embolization with those of surgical clipping in patients with posterior circulation aneurysms. Surgical procedure was performed in 31 patients (basilar tip: 13 cases, SCA: 8 cases, basilar trunk: 1 case, VA: 9 cases). Thirty one aneurysms were treated by embolization with Guglielmi detachable coil (GDC) and interlocking detachable coil (IDC) (basilar tip: 14 cases, SCA: 1 case, basilar trunk: 6 cases, VA: 10 cases). In surgical cases, clinical outcome at discharge showed good recovery (GR) in 14 cases, moderate deficits (MD) in 11 cases, severe deficits (SD) in 2 cases, and dead (D) in 4 cases. In embolization cases, clinical outcome at discharge showed GR in 19 cases, MD in 4 cases, SD in 1 case, and D in 1 case. Embolization with detachable coils is less invasive than surgical clipping in the management of patients with posterior circulation aneurysms. Embolization with detachable coils in ruptured posterior circulation aneurysm cases at an early stage of SAH may improve clinical outcome.

[Prognosis of hepatic metastasis from colorectal cancer following arterial infusion chemotherapy--assessment from the percentage of tumor involved area and tumor markers].

Prognosis of hepatic metastasis from colorectal cancer following arterial infusion chemotherapy was studied from the percentage of tumor involved area (PTIA) and tumor markers. The PTIA was calculated by the following formula: sigma S'/ sigma S, with S' as the tumor area and S as the liver area on each CT slice. The PTIA was 0.76 to 31.1%, and the average was 6.84%. As for the correlation between the PTIA and the prognosis, a statistically significant reverse correlation was found in the cases of death (r = -0.455, p < 0.05, n = 22). In the tumor regression effect of NC cases, the 50% survival time was 24.4 months in cases showing a decrease in CEA or CA19-9 and 18.7 months in the cases showing an increase. Prognosis of the former cases was significantly better than that of the latter cases (p < 0.05). Therefore, PTIA and the decrease in CEA or CA19-9 in the cases of hepatic arterial infusion chemotherapy for metastasis from colorectal cancer seemed important factors reflecting prognosis.

[Limited operation and simple lobectomy for primary lung cancer in poor risk patients].

During the years 1990 to 1994, 54 poor risk patients were performed relative noncurative operation for primary lung cancer, such as limited operation or lobectomy without mediastinal lymphnodal dissection. The indication for lesser resection were mainly cardiopulmonary diseases and the elderly over 75 years old. 3 were bilobectomies, 32 were lobectomies, 1 was lobectomy and segmentectomy, 10 were segmentectomies, 8 were wedge resections. The number of cases with stage I were 41 (75.9%). Postoperative complications occurred in 13 patients (24.1%). The overall 5-year survival rate was 63.5%. The 5-year survial rate of p 0 approximately p 1, pN 0 cases was 73.9%. Relative noncurative cases undergoing lesser resection showed relatively good result compared to standard lobectomy. It was considered that lesser resection for such poor risk patients with stage I can be a beneficial therapeutic modality.

[Therapeutic effectiveness of 131I-MIBG on malignant pheochromocytoma--results of long-term follow-up].

The therapeutic response of 131I-MIBG was evaluated in 4 patients with malignant pheochromocytoma who had been treated with 131I-MIBG and followed-up over 5 years. The patients were 2 men and 2 women with ages ranging from 41 to 69 years old (mean 53 years). The primary tumors in 3 of 4 patients had been resected four to eight years before 131I-MIBG treatment. One patient was diagnosed as adrenal pheochromocytoma, and two were retroperitoneal paraganglioma. And in one patient, the resection of primary mediastinal tumor was not performed due to the adhesion to pericardium but the diagnosis of paraganglioma was obtained by biopsy of bone lesion. All patients showed the clear accumulation of 131I-MIBG in tumor on scintigraphy. The number of doses of 131I-MIBG ranged from one to three times with 3.7 GBq per administration and a cumulative activity from 3.7 to 11.1 GBq. Treatment effect was obvious in one patient with lung, bone, and lymph node metastases whose cumulated absorbed dose with 11.1 GBq of 131I-MIBG exceeded over 150 Gy. At the present time, the duration of survival since the beginning of initial 131I-MIBG therapy is over 5 yrs. The other three patients, however, showed little effects, and died with the disease in 2.6 to 4.1 years after the initial 131I-MIBG therapy. 131I-MIBG will become a promising agent for therapy in patients with malignant pheochromocytoma with high degree of accumulation.