Hideto Akama

Mononuclear cells enhance prostaglandin E2 production of polymorphonuclear leukocytes via tumor necrosis factor α

To clarify the interactions between mononuclear cells and polymorphonuclear leukocytes, and to identify the cytokine(s) that mediate the interaction, the effects of a culture supernatant of LPS-stimulated mononuclear cells on production of arachidonic acid metabolites of polymorphonuclear cells were studied. The culture supernatant of LPS-stimulated mononuclear cells increased production of prostaglandin E2 of polymorphonuclear cells. TNF alpha, but not IL-1, IL-2, IL-6, or IFN gamma, enhanced the prostaglandin E2 production when added in vitro. Additionally, an anti-rTNF alpha monoclonal antibody inhibited the stimulating activity of the culture supernatants. TNF alpha, produced by mononuclear cells, appears to play an important role in the development of inflammation, such as rheumatoid arthritis, by enhancing the arachidonic acid metabolism of the polymorphonuclear cells.

Primary adrenocortical micronodular dysplasia : enzyme histochemical and ultrastructural studies of two cases with a review of the literature

The adrenal glands from two patients with primary adrenocortical micronodular dysplasia (PAMD) were studied (no. 1, a 23-year-old man with cardiac myxomas and sarcoidosis; no. 2, a 16-year-old girl). The PAMD cells showed intense activity of 3 beta-hydroxysteroid dehydrogenase (3 beta DH), succinate DH, glucose-6-phosphate DH, alkaline phosphatase (AlPase), and other DHs and lysosomal hydrolases, giving a characteristic staining pattern. The staining patterns correlated well with ultrastructural findings. The larger adrenals (no. 1: 16.6 g) were associated with larger black nodules and internodular cortex (INC) with fairly well-retained enzyme activities, and contained cell clusters and single cells with intense AlPase activity with the appearance of PAMD nodules in the buds. The smaller adrenals (no. 2: 5.4 g) were associated with smaller black/yellow nodules, and had INC with weaker enzyme activity. Analysis of descriptions of INC in 25 previously reported cases revealed that the larger adrenals (more than 10 g) had less atrophic INC than the smaller ones. The characteristic enzyme pattern in PAMD cells explains the paradox that PAMD adrenals smaller than normal can cause Cushings syndrome, and may be useful for investigating neoplastic and non-neoplastic counterparts in other adrenal lesions. The relationship between PAMD cells and INC is not simply one of autonomy versus atrophy, and both cell types may be stimulated by a certain common trophic factor. Thus, PAMD belongs to the category of hyperplasia.

Pulmonary Pseudolymphoma Presented with a Mass Lesion in a Patient with Primary Sjögren's Syndrome: Beneficial Effect of Intermittent Intravenous Cyclophosphamide

A 61-year-old woman with primary Sjögrens syndrome (SS) presented with fever, dry cough, dyspnea on exertion, and a mass lesion with reticular shadowing at both bases on her chest X-ray. Pulmonary pseudolymphoma was diagnosed by transbronchial lung biopsy which revealed infiltration of T cell-like slightly atypical lymphoid cells. After three infusions of cyclophosphamide (750 mg every 4 weeks) combined with prednisolone, the pulmonary mass lesion was diminished and her symptoms improved. Evaluation of the 12 reported cases of pulmonary pseudolymphoma with SS that presented with mass lesions showed an increase in IgM level, frequent pulmonary fibrosis, precedence of SS, and better prognosis with immunosuppressants in those patients.

Progressive renal failure in patients with lupus nephritis

Abstract. Objective. To investigate the mode of progression to renal failure in patients with lupus nephritis in relation to disease activity and responsiveness to corticosteroid therapy.

Methotrexate in the treatment of rheumatoid arthritis.

Clinical effects of methotrexate on rheumatoid arthritis have been repeatedly confirmed by double blind controlled trials. Clinical activities definitely improved as early as 3 weeks of treatment. It was also shown that most of the patients resistant to gold, penicillamine or the other disease modifying drugs, responded to this drug. Although mechanisms of action of methotrexate on rheumatoid arthritis has not been clarified yet, both immunosuppressive and anti-inflammatory effects seems to be involved. Rare but severe side effects include bone marrow suppression, pneumonitis and liver fibrosis, while common but mild side effects are gastrointestinal symptoms and stomatitis.Indication of methotrexate should be restricted only to severe cases, and careful monitoring of patients is essential during methotrexate administration.