Jiro Takahara

Pathological and radiological changes in resected lung specimens in Mycobacterium avium intracellulare complex disease

The present study was designed to evaluate the pathological and immunohistochemical findings of Mycobacterium avium intracellulare complex (MAC) lung infection. A retrospective study was performed in five cases with positive cultures for MAC in whom lung resections were performed between January 1989 and December 1996. A determination of whether or not MAC caused pulmonary disease was made using the 1997 criteria defined by the American Thoracic Society. In addition, MAC was cultured from all of the five lung specimens. Pathological and immunohistochemical findings as well as chest computed tomography (CT) findings were evaluated in these five patients. Pathological findings of bronchiectasis, bronchiolitis, centrilobular lesion, consolidation, cavity wall and nodules were demonstrated, respectively, in relation to chest CT findings. Extensive granuloma formation throughout the airways was clearly demonstrated. Immunohistochemical staining demonstrated: 1) epithelioid cells and giant cells; 2) myofibroblasts extensively infiltrating the cavity wall; and 3) B-cells detected in aggregates in the vicinity of the epithelioid granulomas. This study identified pathological and immunohistochemical characteristics of Mycobacterium avium complex infection relative to chest computed tomography findings and allowed the conclusion that bronchiectasis and bronchiolitis were definitely caused by Mycobacterium avium complex infection.

Clinical features of Stenotrophomonas maltophilia pneumonia in immunocompromised patients

Between January 1988 and December 1992, 68 patients admitted to our Department of Internal Medicine with haematological malignancies or solid tumours showed colonization of the respiratory tract with Stenotrophomonas maltophilia. To characterize the significance of respiratory tract colonization by S. maltophilia, we retrospectively reviewed the medical records of the 68 patients colonized with this organism. Twenty-nine of these 68 patients developed pneumonia, with S. maltophilia being implicated in 10 cases. The majority of these 10 patients showed lobular infiltration on chest X-ray. Pleural effusion was observed in two (20%) of the 10 patients. All 68 strains of S. maltophilia were resistant to imipenem. Latamoxef was effective against 98 center dot 5% of strains, while minocycline was effective against 100% of strains. This report describes the clinical features of nosocomial S. maltophilia pneumonia in immunocompromised patients.

Clinical features of non-specific interstitial pneumonia

The clinical features of 24 patients with non-specific interstitial pneumonia (NIP) were evaluated. The patients consisted of seven men and 17 women, with a median age of 60 years. In seven patients, the disease was idiopathic and eight had collagen vascular diseases. Cough, dyspnoea and fever were frequently observed. The time interval between the onset of symptoms and open lung biopsy was 3 months. Mild increases of IgG, CRP, and LDH were also frequently observed. The average per cent VC was 65.1 +/- 3.2% and the average PaO2 was 71.3 +/- 2.4 Torr. Bronchoalveolar lavage was done in 20 patients, and a moderate increase in lymphocytes (27.8 +/- 6.7%) with a low CD4/CD8 ratio (0.86 +/- 0.22) was observed. Multiple patchy infiltration or diffuse interstitial shadows, located predominantly in the lower fields of both lungs were the characteristic chest CT findings. Lung biopsies in this group were characterized by varying proportions of chronic interstitial inflammation and fibrosis which was temporarily uniform. Patients were given steroid pulse therapy or oral steroids. The results were mild to marked improvements in chest roentgenographic findings and lung functions. Four patients (16.7%) died because of respiratory failure caused by NIP. This is the first report to describe clinical features of NIP since the original report by Katzenstein and Fiorelli.

Immunohistochemical demonstration of the localization of corticotropin releasing factor-containing neurons in the hypothalamus of mammals including primates

SummaryThe presence of the CRF-containing neurons in the hypothalamus was investigated in four different species (cats, dogs, pigs, and monkeys) by the peroxidase-antiperoxidase technique using specific anti-serum to CRF. In all animals examined, CRF-containing perikarya were found mainly in the paraventricular and supraoptic nuclei, and a small number of the immunoreactive cells were observed in the accessory supraoptic nucleus and the lateral hypothalamic area. The size of the CRF-containing perikarya ranged from 20–35 μm in diameter. These findings suggest that the magnocellular paraventricular and supraoptic nuclei are the center not only of the classical neurosecretory system for the production of the posterior lobe hormones, but also that of the CRF neuronal system.

Successive follow-up of chest computed tomography in patients with Mycobacterium avium-intracellulare complex

The aim of this study was to evaluate the changes in chest CT findings examined successively in patients with Mycobacterium avium-intracellulare complex (MAC) infection. We carried out a retrospective study of 25 patients with MAC infection who had serial CT scans. Patients included 18 women and seven men with a median age of 66 years. Mean (+/- SE) follow-up interval between the first and second CT was 27.5 +/- 4.2 months. The serial chest CT scans were reviewed with consensus reading by two observers. At the first chest CT examination, we found the following: bronchiectasis (in 133 of 250 fields), cavity formation (11 of 250 fields), centrilobular nodules (167 of 250 fields), air-space disease (30 of 250 fields) and nodules (81 of 250 fields). The middle lobe and lingula were frequently involved. Centrilobular nodule scores improved in seven patients; disease progressed in nine patients and was stable in nine patients. In addition, bronchiectasis scores improved in four patients; disease progressed in 15 patients and was stable in six patients. The score of bronchiectasis in the second CT was significantly higher than in the first CT. In conclusion, our data suggest that centrilobular nodules and bronchiectasis are frequent observations in patients with MAC. In addition, progression of bronchiectasis appeared to be caused by MAC infection.

Immunohistochemical identification of neurons containing corticotropin-releasing factor in the rat hypothalamus

SummaryA specific rabbit anti-CRF serum and the immunoperoxidase technique were used to show that CRF-containing neurons are mainly distributed in the paraventricular and supraoptic nuclei of the rat hypothalamus. In addition, immunoreactive neurons are scattered in other hypothalamic regions. These neurons are 20–30 μm in diameter. From the present and previous investigations it may be concluded that the hypothalamic magnocellular nuclei, i.e., paraventricular and supraoptic, and other hypothalamic accessory nuclei, are the producing sites not only for vasopressin and oxytocin, but also for corticotropin-releasing factor.

Heterogeneous point mutations of the p53 gene in pulmonary fibrosis

Lung cancer is a frequent complication in pulmonary fibrosis. Overexpression of p53 proteins has been demonstrated by immunostaining in bronchoepithelial cells in patients with idiopathic pulmonary fibrosis. However, it is still unclear whether this overexpressed p53 protein is wild-type or mutant. It was hypothesized that pulmonary fibrosis may be a precancerous lesion with deoxyribonucleic acid point mutations in bronchoepithelial cells. Mutations of the p53 gene were tested for by fluorescence-based single-strand conformation polymorphism (FSSCP), cloning-sequencing and immunostaining techniques. Out of 10 tissue samples that demonstrated overexpression of p53 protein by immunostaining, nine (90%) exhibited point mutations and eight (80%) exhibited heterogeneous point mutations of the p53 gene. The mutations found in pulmonary fibrosis were scattered throughout the central part of the p53 gene, and both guanine (G):cytosine (C) to adenine (A):thymine (T) and A:T to G:C transitions were frequently observed. In conclusion, frequent heterogeneous point mutations of the p53 gene were detected in pulmonary fibrosis. These mutations may have resulted from several types of deoxyribonucleic acid damage that occurred in bronchoepithelial cells and this may explain previous findings of a very high incidence of lung cancer complicating pulmonary fibrosis.

A specific radioimmunoassay for Cortricotropin Releasing Factor (CRF) using synthetic ovine CRF

This newly developed specific radioimmunoassay for corticotropin releasing factor (CRF) had a sensitivity range of 25 pg/tube to 4 ng/tube. Intra and interassay coefficient of variation were 4.6% and 9.8%, respectively. Rat median eminence extracts showed a parallel dose response curve with synthetic ovine CRF and a significant cross reaction was not evident with other tested neuropeptides. The highest mean levels of CRF were found in the median eminence (6.61 ng/mg protein). Considerable amounts of CRF were found in the arcuate nucleus, paraventricular nucleus, dorsomedial nucleus, suprachiasmatic nucleus and ventromedial nucleus. The immunoreactive CRF of the rat medial basal hypothalamus coeluted with bioassayable CRF and with iodinated CRF on Sephadex G-75 chromatography. The results indicate that rat hypothalamus contains a CRF similar to ovine CRF.

Expression of a photoreceptor protein, recoverin, as a cancer-associated retinopathy autoantigen in human lung cancer cell lines.

Recently, a photoreceptor protein, recoverin, has been recognised as an autoantigen of cancer-associated retinopathy (CAR), a rare paraneoplastic neurological syndrome often associated with patients with small-cell lung cancer (SCLC). Although until quite recently the specific expression of recoverin in cancer cells had not been indicated, Polans et al. (Polans AS, Witkowska D, Haley TL, Amundson D, Baizer L, Adamus G 1995, Proc. Natl. Acad. Sci. USA, 92, 9176-9180) demonstrated the specific expression of recoverin in lung tumour and primary cultured tumour cells from a CAR patient. We examined the expression of recoverin in human lung cancer cell lines by reverse transcription polymerase chain reaction (PCR), Northern blotting and Western immunoblotting. Recoverin was expressed in only one SCLC cell line from a patient with CAR. The sequence of recoverin cDNA from the cells was identical to the human recoverin sequence. These findings strongly support the hypothesis that the ectopic expression of wild-type recoverin in SCLC induces the cancer-retina immunological cross-reaction, leading to visual loss in CAR.

Distribution and Characterization of Corticotropin-Releasing Factor and Arginine Vasopressin in Rat Hypothalamic Nuclei

Corticotropin-releasing factor (CFR) was bioassayed and arginine vasopressin (AVP) radioimmunoassayed from punched-out hypothalamic nuclei. The highest concentration of CFR was found in the median eminence (ME), followed by the paraventricular nucleus (PVN), supraoptic nucleus (SON), suprachiasmatic nucleus (SCN), arcuate nucleus (ARC), dorsomedial nucleus (DMN) and ventromedial nucleus (VMN). The AVP concentration was in the order of ME, SON, PVN, SCN, ARC, VMN and DMN. Sephadex G-25 gel filtration of the ME extracts showed one peak for AVP and two peaks for CRF. One CRF peak appeared on the void volume (big CRF) and the other (small CRF) was coeluted with AVP. Gel filtration of the PVN and SON extracts showed one peak for AVP but three or four peaks for CRF. The addition of anti-AVP serum (AVP-AS) to pituitary cell cultures reduced the CRF activities of AVP and ME extracts by approximately 80 and 40%, respectively. When the small CRF fraction of ME extracts was treated with AVP-AS on affinity chromatography, the unbound fraction (AVP-free) still showed significant CRF activity. Re-examination of CRF concentration using AVP-AS showed that it was still highest in ME, but was significantly higher in PVN than in SON, SCN and ARC. These results suggest that the PVN is an important nucleus for producing corticotropin-releasing hormone.