bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic analysis of pancreatic duct hyperplasia in Otsuka Long–Evans Tokushima Fatty rats: Possible association with a region on rat chromosome 14 that includes the disrupted cholecystokinin‐A receptor gene
Authors: Kanemoto Naohide , Kondo Mari , Iwanaga Tomoyuki , Hishigaki Haretsugu , Ono Toshihide , Mizoguchi‐Miyakita Ayako , Oga Keiko , Tsuji Atsushi , Okuno Shiro , Watanabe Takeshi K. , Nose Masato , Tanigami Akira
Published: March 2003

An Otsuka Long–Evans Tokushima Fatty (OLETF) strain of rat spontaneously developed hyperglycemia, hyperinsulinemia, insulin resistance and mild obesity, which had been studied as animal model for type II diabetes mellitus (T2DM). Recently, we observed that this strain coincidentally developed atypical hyperplasia of the choledocho‐pancreatic ductal epithelium with a complete incidence. In an effort to locate genes responsible for this hyperplasia, we prepared 288 backcross progeny from a mating between OLETF rats and BN rats (which do not develop hyperplasia), and performed a genome‐wide scan using 207 polymorphic genetic markers. We observed a prominent association of hyperplasia with a region involving a marker locus D14Mit4 (P = 0.00020, Fisher's exact test) and Cckar (the cholecystokinin‐A receptor gene; P = 0.00025, Fisher's exact test) which is known to be disrupted in an OLETF strain. Our findings indicated that epithelial hyperplasia of the choledocho‐pancreatic duct is associated with a region on rat chromosome 14 around the Cckar gene in an additive fashion with another two susceptible loci, each on chromosome 9 and 7. This implied the possibility that Cckar deficiency could result in a predisposition towards pancreatic duct hyperplasia.
Low‐grade pulmonary myxoid sarcoma of uncertain histogenesis
Authors: Inayama Yoshiaki , Hayashi Hiroyuki , Ogawa Nobuo , Mitsui Hideaki , Nakatani Yukio
Published: March 2003

The present report describes an unusual case of low‐grade pulmonary sarcoma with extensive myxoid change in a 60‐year‐old man. During 30 months, the tumor enlarged gradually and thereafter rapidly to 9 cm. Preoperative biopsy and cytology gave negative results. The resected mass, located at the periphery of the right upper lobe, was well circumscribed and showed gelatinous without necrosis or hemorrhage. Histologically, the tumor was composed of slightly atypical, spindle‐shaped or stellate cells, which were loosely distributed within a prominent myxoid stroma. Epithelial differentiation was not seen. Lacunar structures were occasionally evident, but no cartilaginous matrix was seen. Mitotic figures were infrequent. Immunohistochemistry failed to clarify the nature of the neoplastic cells except vimentin positivity. Histochemically, the myxoid ground substance was composed of hyaluronic acid and acid mucopolysaccharide. Electron microscopy revealed no specific differentiation other than aggregates of filaments, which were seen in a number of neoplastic cells. Flow cytometric analysis of the neoplastic cells revealed a diploid pattern. These findings indicated that the neoplasm was a low‐grade myxoid sarcoma; however, a definite diagnosis could not be made. The tumor might have been a variant of extraskeletal myxoid chondrosarcoma, especially considering the histochemical results.
p53 expression in gastrointestinal stromal tumors
Authors: Al‐Bozom Issam A.
Published: March 2003

The understanding of gastrointestinal stromal tumors (GIST) is complex because of their divergent differentiation and unpredictable behavior. However, our understanding is becoming clearer, despite some cases of tumors which are exceptions from the typical cases. Tumor size, mitotic rate and, to a lesser degree, location, are the most important predictive parameters for the behavior of GIST. In this study, expression of p53 protein was evaluated in 15 cases of GIST. Tumors were divided into three groups: (i) benign (mitotic index [MI] < 5/50 high‐power fields [HPF] and size < 5 cm); (ii) borderline (MI < 5/50 HPF and size ≥ 5 cm); and (iii) malignant (MI ≥ 5/50 HPF, irrespective of size). The mean values of p53 expression in the three groups were significantly different (benign, 10.6%; borderline, 33.8%; and malignant, 71%). The conclusion of the present study is that p53 overexpression correlates well with the malignant potential of GIST.
Solitary fibrous tumor in the mental region
Authors: Hirano Masato , Tanuma Jun‐ichi , Shimoda Toru , Sugihara Kazumasa , Tsuneyoshi Masazumi , Kitano Motoo
Published: March 2003

Solitary fibrous tumor (SFT) is a rare, benign, soft tissue tumor that most commonly occurs in the pleura; however, it has recently been described in other sites of the body. To date, eight examples of oral SFT have been reported. This paper is a description of the first case of an SFT occurring as a soft tissue tumor in the mental region. Histologically, the tumor was composed predominantly of rather uniform spindle‐shaped fibroblastic cells arranged in vague fascicles or in a haphazard fashion, intermingled with abundant collagen fibers. Immunohistochemically, the tumor cells were positive for CD34 and vimentin, and weakly positive for muscle actin and α‐smooth muscle actin. The diagnosis of SFT may be difficult as this tumor shares a number of histological features with other soft tissue tumors. Awareness of its occurrence in the oral cavity is important so that confusion with other spindle cell neoplasms can be avoided.
Esophageal anthracosis: Lesion mimicking malignant melanoma
Authors: Murata Tetsuya , Imai Takazumi , Hoshino Ken‐Ichiro , Kato Masami , Tanigawa Kenji , Higuchi Tetsuya , Kozuka Yuji , Inoue Rie , Watanabe Masatoshi , Shiraishi Taizo , Takubo Kaiyo
Published: March 2003

A case of anthracosis of the esophagus is reported. The patient was a previously healthy 69‐year‐old Japanese woman. A black and slightly elevated lesion was detected in her esophagus by upper gastroesophageal fiberoscopic examination. Endoscopically, the lesion looked like malignant melanoma. Thoracic esophagotomy was then performed. Histological examination revealed a pigmented lesion beneath the mucosal epithelial layer. The lesion consisted of an aggregation of histiocytes containing an abundance of tiny black pigments. A few mature lymphocytes and plasma cells were also evident in the periphery of the lesion. Histologically, these findings looked like lymph nodes in the pulmonary hilus; however, no lymph nodal structure was evident in the esophageal wall. Traction diverticula were also noted in the pigmented lesion. The patient has remained well without disease for 9 months since the surgery. Although anthracosis is a rare condition in the esophagus, the present case gave warning to pathologists and clinicians that it does indeed occur. Endoscopists and pathologists should differentiate anthracosis from malignant melanoma because the treatment and outcome are quite different for each.
Mucinous cystadenoma of the testis
Authors: Nokubi Mitsuhiro , Kawai Toshiro , Mitsu Sumitaka , Ishikawa Shinya , Morinaga Shojiroh
Published: March 2003

A 35‐year‐old man complained of a painless enlargement of the right testis. Imaging diagnostic procedures demonstrated a multiloculated cystic tumor, 9 cm in maximal diameter, in the right testis with hydrocele. Orchidectomy specimen showed that the tumor was confined within the testis and separated from the epididymis. The locules of the tumor were lined by single‐layered columnar epithelium, intermingled with MUC2 immunopositive goblet and chromogranin‐A immunopositive neuroendocrine cells, exhibiting intestinal differentiation. No ciliated cell, teratomatous element or intratubular germ cell neoplasia were seen. Channels of rete testis were compressed peripherally by the tumor but there was no connection with the tumor locules. The tumor was diagnosed as mucinous cystadenoma of the testis. This seems to be the first published case of benign mucinous cystadenoma occurring within the testis. This intratesticular tumor with intestinal differentiation may represent a benign monodermal teratoma.
Neural fibrolipoma of the superficial peroneal nerve in the ankle: A case report with immunohistochemical analysis
Authors: Akisue Toshihiro , Matsumoto Keiji , Yamamoto Tetsuji , Kizaki Tomohiko , Fujita Ikuo , Yoshiya Shinichi , Kurosaka Masahiro
Published: March 2003

This report presents a case of neural fibrolipoma arising from the superficial peroneal nerve in the ankle. A 28‐year‐old woman was referred with a soft tissue mass in the anterior aspect of the right ankle, which had been gradually enlarging for the past 10 years. Magnetic resonance imaging showed a mass lesion, measuring approximately 8 × 3 × 2 cm, with high to partially low signal intensity on both T1‐ and T2‐weighted images. A band of low signal intensity within the lesion, which is indicative of coexistence with the tumor and the superficial peroneal nerve, could be detected on both T1‐ and T2‐weighted images. The patient underwent an excisional biopsy. The specimen microscopically consisted of nerve bundles and fibro‐fatty proliferation with abundant collagen fibers. Immunoreactivity for CD34 antigen antibody was detected in fibrous spindle cells. This is the first report to present an immunohistochemical profile of neural fibrolipoma. Neural fibrolipoma should be considered as a differential diagnosis when a lipomatous lesion is encountered in the foot or ankle as well as in the upper extremities.
Tumorous deformity of mitral valve leaflet after chordal rupture in a child
Authors: Tamura Koichi , Sugisaki Yuichi , Ogawa Shunichi , Yamauchi Hitoshi , Okada Ryozo
Published: March 2003

A case with tumorous deformity of the posterior mitral valve leaflet after spontaneous chordal rupture in a child is described. A partial rupture in the chordae tendineae of the posterior mitral leaflet was found by echocardiography in a 9‐year‐old Japanese boy. Tumorous bulging was gradually developed in the leaflet and was surgically excised 5 years later. Multiple nodular tumors were found on the atrial surface of the posterior mitral leaflet. Histological examination revealed that the tumorous bulging consisted of myxomatous materials in which collagen fibrils and very fine elastic fibers were distributed loosely and irregularly. Normal‐looking endothelial cells covered the luminal surface of the bulging lesion. Vimentin‐positive spindle‐shaped mesenchymal cells were scattered in the bulge area. The labeling index of proliferating cell nuclear antigen (PCNA) in these cells was 29.3%. These spindle cells were positive for matrix metalloproteinase (MMP)‐1 in the entire bulge area. The cells and matrix were positive for MMP‐2 and tissue inhibitor of MMP (TIMP)‐1 in the basal area of bulging, but were weakly positive or negative at the surface area. Reactivity for TIMP‐2 in the cells in the bulge area was obviously weaker than that in the cells at the spongiosa of the anterior mitral leaflet, which was obtained from the patient at the valve replacement operation 9 months after the initial operation. These findings indicated that the tumorous deformity of the mitral valve was formed by the overgrowth of valve tissue under the stimulation of mitral regurgitation in this child, and the imbalance of MMP and TIMP might play an important role in the bulge formation.
Primary sclerosing lipogranuloma with broad necrosis of the scrotum
Authors: Terada Tadashi , Minami Sotaro , Onda Hajime , Inatsuchi Hiroaki , Sekido Yasutomo , Shimamura Kazuo , Osamura Yoshiyuki
Published: March 2003

A‐25‐year‐old man was admitted because of a painless tumor of the scrotum. The patient denied a history of exogenous material injection and trauma in the scrotum. Physical and radiological examination revealed a mass in the scrotum, and blood laboratory tests showed no significant findings except for mild eosinophilia (5.6%). Resection of the mass was performed. The mass was isolated and located in the subcutaneous tissue of the scrotum. The mass was rectangular and symmetrical, and measured 65 × 45 × 15 mm. Histologically, the mass was composed of adipose tissue with fibrosis. Many epithelioid granulomas with multinucleated giant cells of foreign body and Langhans’ types and heavy infiltrates of lymphocytes and eosinophils were recognized. Characteristically, the lesion showed broad coagulative and lytic necrosis. Congestion and edema suggestive of ischemia were seen in some areas. Special stains for acid‐fast bacteria, gram‐positive bacteria and fungi failed to detect any microorganisms. Polymerase chain reaction for mycobacterium tuberculosis revealed no reaction products. Immunohistochemically, the majority of lymphocytes were CD45RO‐positive T cells, and S‐100 protein‐positive cells and CD68‐positive macrophages were scattered in small amounts. The appearances were typical for sclerosing lipogranuloma except for the necrosis. Although the pathological mechanism of the broad necrosis is unclear, the necrosis might be the result of ischemia. Our case suggests that primary sclerosing lipogranuloma of the scrotum might show broad necrosis, and that T‐cell‐mediated immune response might play a part in the formation of lipogranuloma.
Volume‐pressure properties of the upper airway in normal subjects and patients with obstructive sleep apnoea
Authors: Wu Denan , Hida Wataru , Kikuchi Yoshihiro , Okabe Shinichi , Kurosawa Hajime , Ogawa Hiromasa , Shirato Kunio
Published: March 2003

The aim of this study was to examine the volume‐pressure (V‐P) characteristics of isolated upper airways in normal subjects and patients with obstructive sleep apnoea (OSA) and to ascertain whether an increase in upper airway muscle activity affects these characteristics. We studied upper airway pressure changes during volume changes by inflation and deflation of air volumes of 5, 10, 15 and 20 mL without and with submental electrical stimulation, during voluntary closing of the glottis, in seven normal subjects and 13 OSA patients. Volume‐pressure properties of the upper airway were assessed by elastance (Euaw) which was obtained from the slope of the regression line of the V‐P relationships. Euaw in OSA patients was 0.52 ± 0.08 cmH2O/mL, which was greater than in normal subjects (0.26 ± 0.06 cmH2O/mL). Submental stimulation increased Euaw in both OSA patients and normal subjects (0.70 ± 0.11 cmH2O/mL and 0.41 ± 0.11 cmH2O/mL, respectively). These results suggest that upper airways of OSA patients during wakefulness are less collapsible than those of normal subjects, and that, in both groups, submental stimulation may stiffen the upper airway.
Thoracoscopic procedure for intrathoracic diseases: Current status in mainland China
Authors: Ren Hua
Published: March 2003

One hundred and five patients underwent a procedure of video‐assisted thoracoscopic surgery (VATS) during a period of 5 years, in the Department of Cardiothoracic Surgery, Peking Union Medical College Hospital, Beijing, China. Among them, there were 36 cases suffering from spontaneous pneumothorax, 24 having a nodule of the lung, nine intrathoracic multiple nodules, 10 undefined pleural effusions, eight mediastinal mass, 15 interstitial fibrosis, two pericardial effusion, and one severe emphysema. In all patients of this series, the diagnosis was demonstrated and the suitable management was performed.
Intermittent hypoxaemia without orthodeoxia due to right‐to‐left shunting related to an elongated aorta
Authors: Tan Keng‐Leong , Robinson Ttracey D , Celermajer David S , Hughes Clifford F , Young Iven H
Published: March 2003

An elderly woman presented with unexplained, intermittent hypoxaemia unrelated to posture. Subsequent investigations revealed intermittent and variable right‐to‐left interatrial shunting through a patent foramen ovale in the presence of normal pulmonary arterial and intracardiac pressures, caused by right atrial compression from a horizontal, elongated ascending aorta. Surgical closure of the foramen resulted in marked clinical improvement.
Sleep apnoea syndrome in Ramathibodi Hospital: Clinical and polysomnographic baseline data
Authors: Charoenpan Poonkasem , Thanakitcharu Sitthep , Muntarbhorn Kanit , Kunachak Somyos , Boongird Prasert , Likittanasombat Khanchit , Suwansathit Woragod
Published: March 2003

Objective:

The aim of this study was to determine clinical and baseline polysomnographic data on obstructive sleep apnoea (OSA) in Thai patients. This prospective study was performed at the Sleep Laboratory Center, Ramathibodi Hospital, Mahidol University, Thailand.

Methodology: Ninety adult cases clinically suspected of having OSA were studied. The study included clinical, blood chemistry, electrocardiogram, chest radiograph, arterial blood gas, spirometry and full night polysomnography.

Results: Fifty‐nine cases (65.6%) out of a total of 90 cases had an abnormal apnoea (i.e. apnoea index (AI) of 5 or more). The incidence of upper airway abnormality among cases with AI of 5 or more was 79.7% (47/59 cases). Among 59 patients with abnormal AI, associated medical problems comprised hypertension (n = 22), obesity hypoventilation (n = 9), hypothyroidism (n = 4), chronic airflow obstruction (n = 4), diabetes mellitus (n = 3) and chronic renal failure (n = 1). Obstructive sleep apnoea was present in all 59 cases. Central apnoea and mixed apnoea were rare.

Conclusion: Symptoms and signs suggestive of OSA can lead to a high detection rate and confirmation of OSA by polysomnography. The OSA characteristics of Thai patients were similar to the patients in the Western world.
Interleukin‐4‐producing cells in idiopathic pulmonary fibrosis: An immunohistochemical study
Authors: Ando Masaru , Miyazaki Eishi , Fukami Tetsujiro , Kumamoto Toshihide , Tsuda Tomiyasu
Published: March 2003

Objective:

Interleukin‐4 stimulates collagen synthesis in fibroblasts in vitro. The purpose of this study was to clarify the role of interleukin‐4 in the pathogenesis of idiopathic pulmonary fibrosis.

Methodology: We compared interleukin‐4 expressing cells in tissues from 11 patients with pathologically confirmed idiopathic pulmonary fibrosis with early stage inflammatory lesions versus advanced lesions. We also performed double staining in order to elucidate which inflammatory cells produce interleukin‐4 in idiopathic pulmonary fibrosis.

Results: Greater numbers of interleukin‐4 positive cells were observed in the advanced lesions than in the early lesions. We also found that early stage lesions showed a predominance of CD3/interleukin‐4 double positive cells whereas, the advanced stage lesions had higher percentages of the EG2/interleukin‐4 double positive cells and the tryptase/interleukin‐4 double positive cells.

Conclusions: Our results suggest that interleukin‐4 may be involved in progression of interstitial fibrosis in idiopathic pulmonary fibrosis, in which we confirmed a significant contribution of eosinophils and mast cells to interleukin‐4 production.
The interaction of neutrophils with respiratory epithelial cells in viral infection
Authors: Wang Shan‐Ze , Forsyth Kevin D
Published: March 2003

Abstract:

Viral respiratory infection is very common. Respiratory syncytial virus (RSV) infects almost all children during the first 2 years of life. Respiratory syncytial virus is the most frequent cause of bronchiolitis, which is strongly linked with asthma. However, the pathophysiology of RSV bronchiolitis is unclear. Neutrophils are the predominant airway leucocytes in RSV bronchiolitis and other viral infections. Neutrophils and their products are likely to play an important role in viral infection. Current evidence indicates that: (i) viral infection of epithelial cells increases the production of neutrophil chemoattractants or chemokines, which induce neutrophil migration into the inflammatory sites; (ii) the expression of adhesion molecules on neutrophils and epithelial cells is up‐regulated in viral infection, and neutrophil‐epithelial adhesion is increased; (iii) neutrophils augment epithelial damage and detachment induced by viral infection and contribute to the pathophysiology of viral disease; (iv) neutrophil apoptosis is up‐regulated in RSV infection, which may be an in vivo mechanism to limit neutrophil‐induced epithelial damage; (v) inhibitors of chemokines, adhesion molecules or neutrophil proteases may be useful in prevention of neutrophil‐induced epithelial damage. In conclusion, neutrophils play an important role in viral infection, and intervention to prevent neutrophil‐induced epithelial damage may be a potential clinical therapy.
Causes of pleural exudates in a region with a high incidence of tuberculosis
Authors: Liam Chong‐Kin , Lim Kim‐Hatt , Wong Catherine Mee‐Ming
Published: March 2003

Objective:

To define the causes of exudative pleural effusions in our region.

Methodology: A retrospective study was performed on consecutive patients with exudative pleural effusion seen in our hospital during a 4‐year period.

Results: Of 186 patients with a mean age (± SD) of 51.2 (± 19.2) years with exudative pleural effusions, 131 (70.4%) were males and 55 (29.6%) were females. The most frequent cause of exudative pleural effusions was tuberculosis (44.1%), followed by malignancy (29.6%). The majority (94.5%) of malignant pleural effusions were due to lung cancer. Apart from a patient with bilateral pleural effusions due to cryptococcosis, patients with tuberculous pleural effusion (mean age ( ± SD), 39.7 (± 17.5)) were significantly younger than the rest (P < 0.05). Tuberculous effusions were most frequent in the first five decades (60/82, 73.2%) and were the most common type of pleural effusion, accounting for 60 (69.8%) of 86 cases, in this age range. Malignant effusions were more frequent among the older age groups, 74.5% (41/55) of patients with malignant effusions being older than 50 years. Most types of pleural effusions showed a preference for the right side. Of the 44 cases of large effusions, 28 (63.6%) were caused by malignancy.

Conclusions: In our region with a high incidence of tuberculosis, the most frequent cause of pleural exudates is tuberculosis followed by malignancy, particularly lung cancer.
A case of pulmonary tumour embolism mimicking miliary tuberculosis
Authors: Chai Louis , Ong Kian Chung , Ng Siok Bian
Published: March 2003

Pulmonary metastases from choriocarcinoma can very rarely give rise to a ‘miliary’ pattern on the chest X‐ray. A 23‐year‐old woman with a diffuse nodular pattern on chest X‐ray died due to acute respiratory failure and cor pulmonale. At autopsy, choriocarcinoma of the uterus was found. In the lungs, multiple macrovascular tumour emboli within branches of pulmonary muscular arteries in the region of segmental/subsegmental bronchi were detected. There was no evidence of pulmonary parenchymal metastases, pneumonia or tuberculosis. The ‘miliary’ pattern of pulmonary metastases described in cases of choriocarcinoma may be due to large vessel intra‐arterial tumour emboli rather than disseminated parenchymal metastases.
Early unplanned readmission of patients with newly diagnosed tuberculosis discharged from acute hospital to ambulatory treatment
Authors: Chu Chung Ming , Yung Cho Yiu , Leung Wah Shing , Chan Veronica L. , Leung Edward M. F.
Published: March 2003

Objective: The aim of this study was to examine whether patients with newly diagnosed tuberculosis (TB) discharged to ambulatory treatment are at risk of unplanned readmission through the emergency department within 28 days of discharge, and the risk factors associated with such readmission.

Methodology: A cohort of 134 patients admitted to an acute medical department with TB, who were subsequently discharged to ambulatory treatment of TB, were studied by a retrospective record review for unplanned readmission in 28 days. Potential risk factors associated with the readmission were recorded during hospital stay and follow‐up visits, including age, sex, length of stay, substance abuse, need of assistance in the activities of daily living (ADL), comorbidities, non‐compliance, drug complications and use of non‐standard drug regimen.

Results: Up to 20.1% of patients were readmitted. Factors independently associated with early unplanned readmission were need of assistance in ADL, drug complications, the need to use a non‐standard drug regimen and more than three non‐chest comorbidities.

Conclusions: A significant readmission rate was found in these patients and potential risk factors were identified. Ambulatory treatment for TB may not be appropriate for selected patients. Local guidelines for the management of TB patients at high risk of readmission is needed.
Replication‐deficient adenovirus‐mediated transfer of B7‐1 (CD80) cDNA induces anti‐tumour immunity in isolated human lung cancer
Authors: Iwakami Shin‐Ichiro , Setoguchi Yasuhiro , Saijo Yasuo , Azuma Miyuki , Fukuchi Yoshinosuke
Published: March 2003

Objective: Interaction between the co‐stimulatory molecule B7‐1 (CD80) on antigen‐presenting cells and its counter‐receptor CD28 on T lymphocytes plays a key role in the induction of cell‐mediated immune responses. Many tumours, including lung cancer, lack expression of B7‐1 and this has been suggested to contribute to the failure of immune recognition of these diseases. Based on this knowledge, we hypothesized that the co‐stimulatory signal delivered through the B7‐1 molecule expressed on lung cancer cells using replication deficient adenovirus vector would induce efficient tumour immunity in T lymphocytes.

Methodology: To evaluate this hypothesis, we constructed two adenovirus vectors: AdCMVhB7 (an E1‐deleted‐Ad5‐based vector containing human B7‐1 cDNA driven by cytomegalovirus immediate early promoter and enhancer) and AdNull (same vector as above without expression of exogenous gene) as control. Using these adenovirus vectors, efficient generation of tumour immunity in T lymphocytes was studied using primary cultured lung cancer cells and peripheral blood lymphocytes (PBL) obtained from patients with lung cancer.

Results: Inoculation of lung cancer cells with 10 multiplicity of infection of AdCMVhB7 resulted in rapid and efficient cell surface expression of B7‐1 molecule (> 90% of cells at 24 h). Cytolytic activity of PBL in 51Cr‐release assay (E/T = 40) demonstrated that effector lymphocytes induced by hB7‐1 (+) lung cancer cells treated with AdCMVhB7could lyse parental lung cancer cells hB7‐1 (–). In contrast, effector lymphocytes induced by lung cancer cells treated with AdNull as control virus or PBS as control could not lyse parental lung cancer cells at all. Furthermore, cytolytic activity of the effector lymphocytes induced by B7‐1‐transduced lung cancer cells was inhibited by addition of anti‐CD3 antibody.

Conclusions: These data demonstrate that primary‐cultured lung cancer cells treated with AdCMVhB7 would efficiently generate tumour immunity in T lymphocytes. Adenovirus‐mediated‐hB7‐1 gene transfer may be a useful means for gene therapy of lung cancer using adoptive immunotherapy.
Comparing transforming growth factor beta‐2 and fibronectin as pleurodesing agents
Authors: LEE Y. C. GARY , MALKERNEKER DEE , DEVIN CLINTON J. , THOMPSON PHILIP J. , JOHNSON JOYCE E. , LANE KIRK B. , LIGHT RICHARD W.
Published: March 2003

Background: We have recently demonstrated that transforming growth factor beta‐2 (TGF‐β2)
can produce effective pleurodesis. Whether this effect can be reproduced by the use
of its downstream proteins is not known. This study compared the effectiveness of
TGF‐β2 and fibronectin in inducing pleurodesis in rabbits.

Methodology: New Zealand white rabbits (1.5–2.0 kg) were given 1.7 μg of TGF‐β2
(n = 5) or 2.0 mg of cellular fibronectin (n = 4) intrapleurally via a chest tube. The induced pleural fluid was collected and analyzed. The rabbits were sacrificed after 14 days. The pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50%).

Results: All rabbits in the TGF‐β2 group developed effective pleurodesis
while none in the fibronectin group had scores > 2 (pleurodesis scores 7.0 ±
0.6 vs 1.3 ± 0.3, P < 0.001). Rabbits that received TGF‐β2
produced large amounts of pleural fluid initially (< 4 days). Microscopically,
the pleura of rabbits in the TGF‐β2 group showed prominent spindle
cell proliferation and collagen deposition, but no significant inflammation or mesothelial
proliferation. Pleural tissues of rabbits in the fibronectin group had occasional
thin collagen deposits only. The intrapleural administration of 2.0 mg of fibronectin,
a downstream product of TGF‐β, did not induce effective pleurodesis, as did the
intrapleural administration of TGF‐β2.

Conclusions: The present study suggests that the mechanism by which TGF‐β2 induces pleurodesis is not predominantly dependent on the production of fibronectin.
Effect of pulse steroid therapy in a patient with Langerhans’ cell histiocytosis
Authors: AKÇAY S¸ULE , EYÜBOGLU FÜSUN ÖNER , ARİCAN ALI , DEMİRHAN BEYHAN
Published: March 2003

Langerhans’ cell histiocytosis (LCH) is a condition in which granulomas form in various tissues through the accumulation of abnormal histiocytes (Langerhans’ cells), granulocytes and lymphocytes. An important distinction between LCH and primary pulmonary histiocytosis (PPH) is that smoking cessation is known to often lead to spontaneous improvement in PPH patients, while this has not been demonstrated in patients with multisystem LCH. In this case report, we describe the case of a 20‐year‐old man who presented with cough and palpably enlarged lymph nodes in his neck. An inguinal lymph node biopsy led to the diagnosis of multisystem LCH in the lungs, the cervical, intra‐abdominal, and inguinal lymph nodes and the spleen. The patient was a smoker, and had averaged 30 cigarettes per day for 7 years. To address the multisystem involvement, intravenous pulse steroid therapy was administered (30–40 mg/kg daily) in two 3‐day treatment periods separated by 3–4 weeks. The patient was also advised to stop smoking, and did so. Serial follow‐up examinations confirmed an objective improvement with complete remission. The patient was still healthy at 18 months post‐treatment, reflecting a dramatic and positive response to pulse steroid therapy. This encouraging result makes this case an important one to highlight.
Clinical, laboratory findings and microbiologic characterization of bronchiectasis in Thai patients
Authors: PALWATWICHAI APIRAK , CHAOPRASONG CHUTIMA , VATTANATHUM ANAN , WONGSA ADISORN , JATAKANON ANON
Published: March 2003

Objective: The aim of the present study was to characterize the clinical features, underlying disease states, laboratory findings and microbiological characterization of bronchiectasis in Thai patients.

Methodology: For a 2‐year period all consecutive patients diagnosed with bronchiectasis at Phramongkutklao Hospital, Bangkok, Thailand, were recruited. Data including history, physical examination, underlying disease and laboratory studies were carefully reviewed and recorded.

Results: Fifty patients diagnosed with bronchiectasis were enrolled. Their mean age was
58 years. The most common background aetiology was tuberculosis. Six per cent of
the patients were diagnosed as having diffuse panbronchiolitis. Normal chest radiographs
were found in 10%. The common organisms isolated were Pseudomonas aeruginosa
(20%), Haemophilus influenzae (14%), Klebsiella pneumoniae
(14%) and Streptococcus pneumoniae (6%). Non‐tuberculous mycobacteria
which included Mycobacterium kansasii and Mycobacterium chelonae were found in 6%.

Conclusion: We report the characteristics of bronchiectasis in Thai patients. The most common identifiable aetiology was tuberculosis.
What is the optimal approach for using a direct amplification test in the routine diagnosis of pulmonary tuberculosis? A preliminary assessment
Authors: LIM T. K. , ZHU DAVID , GOUGH ANNIE , LEE KANG‐HOE , KUMARASINGHE GAMINI
Published: March 2003

Objective: The aim of this study was to determine the most appropriate strategy for the rapid diagnosis of pulmonary tuberculosis (PTB) using a nucleic acid amplification (NAA) test.

Methodology: This was a prospective study of 128 adult patients in whom respiratory secretions were tested for Mycobacterium tuberculosis by the AMPLICOR assay. The basis for starting PTB treatment was noted for each patient. The optimal approach was determined by using Bayes’ theorem to compare different combinations of pretest probability, smear results with the AMPLICOR test.

Results: The incidence of PTB was 15.6%. In only one patient was treatment for PTB commenced because of a positive AMPLICOR result. The rest were managed according to the conventional approach which relied upon clinical judgment and direct smear. The optimal approach was to treat patients with high or intermediate pretest risk for PTB who returned positive AMPLICOR tests. The overall accuracies of the conventional approach, AMPLICOR test and optimal approach were 89.8, 95.3 and 96.1%, respectively.

Conclusion: This small study suggests that NAA testing be limited to patients with high or intermediate pretest risk of PTB. In this group, positive results demand treatment while the management of those with negative results still relies on clinical judgment.
Preliminary evaluation of soluble IL‐2 receptor and type III procollagen N‐terminal aminopeptide in pleural fluid for differentiating tuberculous, carcinomatous and parapneumonic pleural effusions
Authors: HARITA SHINGO , NOGAMI NAOYUKI , KIKUCHI TAKESHI , KIBATA MASAYOSHI
Published: March 2003

Objective: The aim of the study was to clarify the possibility of using pleural fluid levels of soluble IL‐2 receptor (sIL‐2R) and type III procollagen N‐terminal aminopeptide (PIIIP) for differentiating tuberculous, carcinomatous and parapneumonic pleural effusions.

Methodology: Fifty patients with pleural effusions were investigated retrospectively. The pleural effusions were due to tuberculosis (n = 11), carcinoma (n = 22), pneumonia (n = 9) and heart failure (n = 8). The concentrations of sIL‐2R and PIIIP were measured in pleural effusion using commercially available kits.

Results: Soluble IL‐2 receptor concentrations were highest in the patients with tuberculosis (6856 ± 3212 U/mL), followed by those with carcinoma (4680 ± 1872 U/mL), pneumonia (2227 ± 525 U/mL) and heart failure (1439 ± 244 U/mL). Significant differences were found between tuberculosis and carcinoma (P = 0.023), carcinoma and pneumonia (P = 0.015), and pneumonia and heart failure (P = 0.002) groups. Type III procollagen N‐terminal aminopeptide concentrations were higher in the patients with tuberculosis (262.5 ± 157.9 U/mL) and pneumonia (257.0 ± 96.7 U/mL) than in those with carcinoma (48.0 ± 27.7 U/mL) and heart failure (10.9 ± 5.6 U/mL). Significant differences were found between tuberculosis and carcinoma (P < 0.001) and pneumonia and carcinoma (P < 0.001).

 To differentiate effusions, the cutoff points of sIL‐2R (2980 U/mL) and PIIIP (110.0 U/mL) were obtained from the highest concentration in the pneumonia group and in the carcinoma group, respectively. Using these criteria, the sensitivities for differentiating tuberculous, carcinomatous, and parapneumonic effusions were 90.9, 86.4 and 88.9%, respectively, with 100, 95 and 100% specificity, respectively.

Conclusions: The simultaneous determination of sIL‐2R and PIIIP concentrations in pleural effusions may be clinically useful in differentiating tuberculous, carcinomatous, and parapneumonic effusions. Further assessments are required to determine the broad clinical application of this assay.
Agreement in surfactant measurements of sputum induced with hypertonic and normal saline
Authors: CHANG Anne B. , HILLS Yvette , HARRHY Veronica A. , HILLS Brian A.
Published: March 2003

Objective:  The contribution of surfactant to the airway epithelial barrier is increasingly being recognized. Dipalmitoyl phosphatidycholine (DPPC), the major constituent of surfactant, is affected by lung injury. Hypertonic saline‐induced sputum is a convenient and reliable method of assessing airway cells and mediators. However, the influence of hypertonic saline on DPPC content of sputum is unknown. In this study the level of DPPC in induced sputum obtained using hypertonic saline is examined and compared with that obtained using normal saline.

Methodology:  Sputum was induced on two occasions using nebulized hypertonic saline and normal saline, in 15 well non‐smoking adults, in random order on different days. DPPC content (µg/mL of sputum) was measured using a standard spectrophotometric method.

Results:  The mean of log10 DPPC level in sputum obtained using hypertonic saline was 1.88 µg/mL sputum (95% CI 1.53, 2.13) and that obtained using normal saline was 1.83 (95% CI 1.62, 2.14). The mean difference of the two methods was −0.03 (95%CI −0.27, 0.33). Bland and Altman plot showed an equal distribution around the mean and all points were within the mean ± 2 SD.

Conclusion:  We conclude that DPPC concentration of sputum can be easily measured in induced sputum and that the use of hypertonic saline does not influence the DPPC levels.
Timing and intensity of herbivory: Its influence on the performance of clonal woodland herbs
Authors: Whigham Dennis , Chapa Anita
Published: March 2003

Herbaceous woodland species account for a significant amount of the biodiversity of temperate deciduous forests. A wide diversity of life‐history strategies is known for woodland herbs, and several systems have been used to categorize the range of life‐history characteristics. Clonal growth, one common feature of many woodland herbaceous species, provides several benefits including the ability to respond to disturbances by sharing resources among ramets. There is evidence that resource sharing is common among ramets of some species of woodland herbs but not others. Herbivory is a common form of disturbance among woodland herbs, but little is known about effects of the timing and intensity of herbivory. In this paper, we use an existing system of classification of life‐history traits of clonal species to make predictions about how woodland herbs would respond to the timing and intensity of defoliation. Examples from a preliminary study in Maryland, USA, are used to demonstrate that the timing and intensity of herbivory can play an important role in determining patterns of future growth and resource allocation.
Anti‐interleukin‐8 auto‐antibodies in cerebrospinal fluid of children with purulent meningitis
Authors: Takasaki Jiro , Ogawa Yunosuke
Published: March 2003

Abstract

Background
: Cerebrospinal fluid (CSF) of patients with purulent meningitis contains a high concentration of interleukin (IL)‐8. Recently, the presence of anti‐IL‐8 auto‐antibodies was noted in blood and alveolar fluid. Therefore, measurement of the concentration of anti‐IL‐8 auto‐antibodies was attempted in CSF of children with and without meningitis.

Methods and Results
: We measured the concentration of anti‐IL‐8 auto‐antibodies in CSF of children with purulent or aseptic meningitis and those without meningitis. The CSF obtained on admission showed a significantly higher concentration of anti‐IL‐8 IgG and IgM auto‐antibodies in children with purulent meningitis, compared with those with aseptic meningitis or without meningitis. Among the three groups of children, the concentration of IL‐8 was also significantly higher in CSF of children with purulent meningitis.

Conclusion
: Because the anti‐IL‐8 IgG auto‐antibody binds to IL‐8 and inhibits IL‐8 interaction with specific receptors on neutrophils, the presence of anti‐IL‐8 auto‐antibodies seems to provide a mechanism that limits the bioavailability of free IL‐8 in CSF.
Adult survivors of children’s cancer and their offspring
Authors: Bessho Fumio , Kobayashi Miyuki
Published: March 2003

Abstract

Background
: Although it is anticipated in Japan that the number of long‐term survivors of children’s cancer will rapidly increase and that they will have children, reports of studies concerning the offspring of such survivors have come mainly from western countries. For this reason, it seems that the results of this study will be important.

Methods
: Ninety‐seven survivors of children’s cancer, who were diagnosed between 1962 and 1989 and are now older than 20 years old, and their offspring were studied.

Results
: Of 97 survivors, 30 have married and 23 survivors or their spouses had been pregnant (33 total pregnancies). Twenty‐five babies were born and seven pregnancies ended in spontaneous abortion. The abortion rate was not different from that of the Japanese general population. The birthweights of babies born to survivors tended to be lower than those of control subjects. The proportion of babies with birthweights under 2500 g was significantly greater for babies born to survivors than to the control subjects. None of the 25 babies born had congenital anomalies. Subsequent development of these children has been uneventful with no malignancies after a median follow‐up period of 4 years 10 months (range: 10 months to 16 years, 3 months).

Conclusions
: The reproductive activity of children’s cancer survivors and the health status of their offspring seem to be satisfactory. However, the sample size of the present study is too small to draw any definite conclusions. Because it is anticipated that the number of long‐term survivors of children’s cancer will rapidly increase in Japan, it is important to establish an effective system of following up these survivors and their offspring in order to provide them with appropriate suggestions for a better quality of life.
Angiotensin‐converting enzyme gene insertion/deletion polymorphism and renal damage in childhood uropathies
Authors: Al‐Eisa Amal , Haider Mohammad Z , Srivastva Braham S
Published: March 2003

Abstract Background: The activation of the renin–angiotensin system in various renal disorders is well established. Congenital urological abnormalities, such as obstruction and reflux, are common causes of renal failure in children contributing to approximately 25% of chronic renal failure in this age group. While the outlook relates to the severity of initial renal damage, there is considerable heterogeneity in renal parenchymal destruction among individuals and the reasons for this heterogeneity are not fully understood. A polymorphism within intron 16 of the angiostensin‐converting enzyme (ACE) gene has been shown to influence the activity of the renin–angiotensin system, thus, it may also have an impact on the expression of renal disorders. We have determined the incidence of this ID polymorphism of the ACE gene in 47 Kuwaiti children with different urological abnormalities leading to variable degrees of renal impairment and in 48 healthy control subjects with a similar ethnic background.

Methods
: Blood samples were collected from the patients (n=47) and controls (n=48), total genomic DNA extracted and the ACE genotypes were determined using a polymerase chain reaction‐based method.

Results
: The DD genotype was detected in 27/47 (57%) cases compared with 25/48 (52%) controls (P=0.439). The heterozygous genotype ID was found in 14/47 (29%) cases compared with 22/48 (46%) controls (P=0.0138). The homozygous II genotype was detected in 6/47 (13%) cases compared with 1/48 (2%) controls (P=0.0247). The D allele of ACE gene was detected in 41/47 (87%) uropathy cases when individuals with homozygous DD and heterozygous ID genotypes were considered collectively. The incidence of parenchymal damage was considerably higher in uropathy cases with DD genotype (62%) compared with those having ID (26%) and II (12%) genotypes.

Conclusions
: Our data suggest an association of D allele of the ACE gene insertion/deletion polymorphism and congenital urological abnormalities, which result in parenchymal damage in Kuwaiti Arab children.
Child health in the new millennium
Authors: Gracey Michael
Published: March 2003

Abstract In today’s modern, industrialized and affluent countries, like Japan and Australia, better living conditions and hygiene, plentiful nutritious food and rapid advances in biology and medical technologies have helped to bring about dramatic improvements in child health. The previous heavy burdens of infections and undernutrition have been eliminated or can now be controlled or effectively treated. In these countries, child health standards are higher than ever and expectation of life at birth is much higher than in the past. Some of the technological advances that have helped bring about this transformation are immunization, antimicrobial therapy, successful treatment of childhood leukemias, transplantation of vital organs and implementation of genetic diagnosis and gene therapy. The use of genetically modified foods and the prospects for cloning of humans are areas of intense interest and controversy. However, these advances have their disadvantages (e.g. antibiotic‐induced drug resistance). Urbanization has encouraged the ‘westernization’ of dietary patterns and the long‐term ‘lifestyle diseases’ that can follow in adults. Accidents, violence and drug abuse are major problems in many parts of the world. Changes in attitudes to sexuality and the spread of HIV/AIDS is another major problem, especially in Africa and Asia. Environmental pollution and the degradation of agricultural lands, rivers and seas are also important. Ironically, standards of child health and the prospects for long life in countries like Japan are better than ever before, but social and environmental changes are presenting children and their carers with new and unanswered challenges as we enter the 21st century and the new millennium.
Restenosis after balloon angioplasty of coarctation: Relationship with ductus arteriosus
Authors: Takahashi Ken , Ino Toshihiro , Ohkubo Mataichi , Akimoto Katsumi , Kishirou Masahiko
Published: March 2003

Abstract

Background
: Recently, balloon angioplasty (BA) has been used for the treatment of coarctation of the aorta (CoA) and the effectiveness of this treatment has been reported. However, the restenosis rate following BA in native CoA in the infant is high and the cause may be related to tissue properties at the origin of the ductus arteriosus (DA). However, the mechanisms responsible for restenosis remain uncertain.

Methods/Results
: The present study was designed to examine transformation of the smooth muscle cell (SMC) phenotypes using immunohistologic studies and to investigate the cause of restenosis of CoA following BA. A CoA model was surgically created in 15 newborn pigs (10–14‐days‐old; 2.4–4.1 kg). Balloon angioplasty was performed 1 month after the initial operation. One or 3 months after BA, animals were killed and immunohistologic studies on smooth muscle cell (SMC) antibodies against SM1, SM2 and SMemb of the myosin heavy chain (MHC) isoform were performed in the aorta at the CoA and DA. In the neointima, only SMemb was positive. In the SMC layer of the DA, only SM2 was positive. One month after BA, the external layer of the tunica media was strongly positive for SM2 only in the area around the origin of the DA.

Conclusions
: The first cause of restenosis is obstructive neointimal formation caused by the proliferation of undifferentiated SMC into the subendothelial tissue. This proliferation seems to be triggered by BA. The distribution of SM2 1 month after balloon angioplasty showed a similar pattern of proliferation of SMC in the external layer around the DA. This may represent a second mechanism of restenosis.