Ultrastructural studies on the formation and distribution of lipid droplets in the lung capillary endothelial cells in patients with sarcoidosis.

BACKGROUND AND AIM OF THE WORK: We previously reported the presence of definite morphological alterations in the capillary endothelium of sarcoid lung. The aim of this study was to examine ultrastructural changes and distribution of lipid droplets in the endothelium of lung capillaries of patients with sarcoidosis. METHODS: Tissue specimens were obtained by transbronchial lung biopsy or open lung biopsy from 16 patients with sarcoidosis and 13 controls. Biopsies were evaluated by electron microscopy following lead citrate and uranyl acetate staining. RESULTS: Typical lipid droplets were observed in pulmonary capillaries of 11 out of 16 sarcoid patients (69%); the droplet frequency was higher in sarcoid patients than in control specimens. Lipid droplets were characterized by biphasic density: most droplets contained eccentrically located vacuoles (saturated fatty acids) others were characterized by low density areas (unsaturated fatty acids). Biphasic droplets were covered by large lysosomal granules and were mainly distributed in the endothelium and pericytes. Interestingly, in the latter, vacuoles increased in size while small amounts of lysosomal granules were detectable. CONCLUSION: Our findings suggest that biphasic droplets increase in number in pulmonary capillaries of patients with sarcoidosis with a characteristic distribution pattern from the endothelium to pericytes.

Prognostic significance of febrile episodes in lung cancer patients receiving chemotherapy.

The prognostic significance of neutropenic fever in lung cancer patients receiving chemotherapy with or without radiotherapy was investigated. Male patients and patients with squamous cell lung cancer had a higher incidence of febrile episodes than female patients and patients with other cell types, but the differences were not significant. Patients with a poor performance status had a significantly higher incidence of febrile episodes. An indwelling central venous catheter was an important risk factor for febrile episodes, indicating that bacteremia was one of the major causes of fever. The median survival time of the patients who developed febrile episodes during chemotherapy was significantly shorter than that of patients without fever (6.1 vs 12.0 months), whether or not cases of early death within 3 months were excluded (8.9 vs 13.1 months). The prevention of infectious complications during anticancer treatment by the use of rh G-CSF and the early initiation of antimicrobial chemotherapy, although the results are inconclusive, may be worthwhile.

Diagnostic features and therapeutic outcome of erosive and ulcerous endobronchial tuberculosis.

SETTING AND OBJECTIVE: Erosive and ulcerous endobronchial tuberculosis (EBTB) is distinct from pulmonary tuberculosis in some aspects. We evaluated the clinical features of 56 patients (26 males and 30 females) with EBTB to characterize the clinical features of the disease. RESULTS: The chief complaint in 70% of patients was intractable cough, particularly in those with tracheal tuberculosis. The predominant radiological features were patchy bi-apical infiltrates of variable intensity without cavitation; for six patients, however, plain radiographs revealed no abnormalities. The ulcerous lesions could be classified into three stages: active, healing and scarring. Furthermore, we divided scarring stage into two subtypes, polypoid and non-polypoid. Most of the patients were treated with isoniazid, rifampin, and streptomycin (SM) or ethambutol. Approximately one-third of the patients, not randomly selected, were treated with aerosolized SM and corticosteroids in addition to conventional oral therapy. CONCLUSION: EBTB involves typical clinical and radiographic features. In this uncontrolled series, it was our impression that the period of time to healing of ulcerous lesions seemed to be shorter in those treated with aerosol therapy including streptomycin and corticosteroids.

[Inflammatory reactions and microorganisms cultured from sputum and blood in association with terminal stage infection of patients with lung cancer].

We reviewed our experience with terminal stage infections in patients with lung cancer over an 11 year period at Kurume University Hospital. In patients with end-stage lung cancer, the infection is common and a mortal disease. We examined the clinical features and significance of pathogenic microbes isolated from sputum and blood in patients with lung cancer during their last month. Bacteriological examinations from blood done frequently in patients with episodes of fever revealed that bacteremia was one of the most important disease in terminal stage infection. In the blood cultures from the 22 patients various species of pathogenic microbes were recovered, and nine of which were fungi; five Candida albicans, three Candida tropicalis and one Candida parapsilosis. The major species of bacteria isolated from sputum were Staphylococcus aureus, including methicillin-resistant strain, and Gram-negative bacilli; P. aeruginasa, A. calcoaceticus, K. pneumoniae and E. cloacae, which are known to be frequently involved in hospital-acquired infections. However, S. pneumoniae and H. influenzae which were well known to be microbes of respiratory infections were rare. We concluded that we had to reveal the feature of terminal stage infection in order to reduce the fee for medical treatment and improve the QOL of patients with terminal stage lung cancer.

Hereditary partial deficiency of plasminogen activator inhibitor-1 associated with a lifelong bleeding tendency.

We report a family with a partial deficiency of plasminogen activator inhibitor-1 (PAI-1). The affected family members had had lifelong bleeding episodes, such as rebleeding after tooth extraction and trauma. This bleeding tendency in the propositus was autosomally transmitted from grandfather to son. The characteristic abnormalities of fibrinolysis in the patients were shortened eugloblin lysis time, low PAI activity with low antigen levels of plasminogen activator inhibitor-1 in plasma and serum. Furthermore, plasma 'active PAI' which indicates the quantity of plasminogen activator inhibitor-1 bound with plasminogen activator added was very low in these patients. These parameters were markedly low after the venous occlusion test. Moreover, two of the affected members had a much lower level of platelet PAI-1 than the normal controls. Tranexamic acid (Transamine) was useful to control bleeding in these patients.

Further association study on dopamine D2 receptor variant S311C in schizophrenia and affective disorders.

The dopamine D2 receptor gene is a candidate gene for schizophrenia because the potency of certain neuroleptics correlates with their affinity for this receptor. Case-control studies in 291 schizophrenics, 78 patients with affective disorders, and 579 controls on an association of a molecular variant of S311C of the dopamine D2 receptor with psychiatric disorders were conducted. The frequency of individuals with S311C was significantly higher in schizophrenics with the absence of negative symptoms (17.1%, P < 0.00001), but similar in schizophrenics with the presence of negative symptoms (5.7%, P = 0.46) when compared with the controls (4.1%). The frequency of S311C was significantly higher in familial schizophrenics from one local area but not in those from other areas. It was significant that S311C was frequently present in patients with mood-incongruent psychotic affective disorders (33.3%, P < 0.0001), but not in those with other affective disorders. These data suggest that S311C might be one of the genetic factors for symptomatic dimensions of delusions and hallucinations and might be involved in underlying clinical heterogeneity in schizophrenia and affective disorders.

Extraction of a Vanadium-Binding Substance (Vanadobin) from the Blood Cells of Several Ascidian Species.

A combination of techniques, including chromatography on Sephadex G-15 and SE-cellulose columns and neutron activation analysis for vanadium determination, was used to extract (at low pH) a vanadium-binding substance (vanadobin) from the blood cells of the ascidian species: Ascidia ahodori OKA, A. gemmata SLUITER, A. zara OKA, Corella japonica HERDMAN, and Ciona intestinalis (LINNE). In general, ascidians can be classified into two different categories based on vanadium content: species of the family Ascidiidae contain high levels of vanadium, whereas those in the Cionidae and Corellidae do not always have such high amounts. Because Ciona intestinalis and Corella japonica do have vanadobin in their blood cells, vanadobin may well be a universal complex in ascidians, having the role of accumulating vanadium in blood cells and maintaining its concentration. The blood cells of A. gemmata contained the highest amount of vanadium. Vanadobin extracted from these cells exhibits absorption spectra, not only in the ultraviolet region, but also in the visible region; such spectra correspond to those observed in vanadium complexes in oxidation states of +3 and +4.

[Long-term pathophysiological studies on loop ileostomy and ileoanal anastomosis].

Mucosal proctectomy with ileoanal anastomosis (IAA) had been performed on 37 patients with adenomatosis coli and 16 with ulcerative colitis between 1978 and 1987. These patients were followed up for a mean of 7.5 years. In 38 cases (73%), this procedure was completed by closure of loop ileostomy. The mean number of bowel movements per 24 hours was 6.0. Seven patients had occasional episodes of minor nocturnal soiling. The postoperative maximum resting anal pressure was the most important parameter reflecting clinical results and it rose from 72 to 92 cm of water during 5.3 year follow-up period after IAA. The pathophysiological studies on loop ileostomy and IAA were performed in these patients. Postoperative small bowel transit time evaluated by radioopaque markers was shortened. Daily output of water and sodium, and Na/K ratio in the ileal excreta increased and total counts of anaerobes in feces decreased. On the other hand, daily volume, Na/K ratio and PH of urine fell significantly. These phenomena were remarkable in patients who received loop ileostomy with about 60 cm defunctioning terminal ileum. These results indicate that it is necessary to maintain intestinal continuity in the ileal pouch-anal procedures.

Idiopathic thrombocytopenic purpura subsequent to Graves' disease and insulin-dependent diabetes mellitus.

We report a woman with idiopathic thrombocytopenic purpura (ITP) subsequent to Graves' disease and insulin-dependent diabetes mellitus (IDDM). The patient was affected by Graves' disease at the age of 29 and developed IDDM the following year. The ITP occurred after 8 years of well-controlled Graves' disease and IDDM with appropriate treatment, but subsided with prednisolone therapy, followed by splenectomy. Graves' disease was observed also in the parents. The serum anti-thyroid-microsome antibody, anti-parietal-cell antibody, anti-pancreas-islet-cell antibody and anti-platelet antibody were all positive. HLA analysis revealed that haplotypes including DR4, DRw9 and DRw53 were positive in both the patient and her mother. In Japanese IDDM patients with autoimmune diseases, these three haplotypes have been reported to be significantly frequent. These findings indicate that the patient of this study is a typical case of the primary autoimmune type of diabetes mellitus proposed by Irvine and Bottazzo. However, the combination of Graves' disease, IDDM and ITP has not been hitherto reported to our knowledge.