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Our patient had appendicitis complicated by Chlamydia trachomatis‐induced Fitz‐Hugh‐Curtis syndrome and cervicitis. Differential diagnosis was challenging. A 22‐year‐old Japanese woman was febrile and presented with vomiting and subsequent abdominal pain. She had unprotected sexual intercourse with multiple partners. She had high Alvarado score and lack of cervical motion pain, despite cervical inflammation. Noncontrast CT showed enlarged appendix. Laparoscopic appendectomy revealed acute suppurative appendicitis and perihepatic adhesion. Cervical PCR assay was positive for C. trachomatis. She remained febrile but defervesced after azithromycin therapy. Clinicians should confirm whether females with abdominal pain are sexually active in view of screening for C. trachomatis., Fitz‐Hugh‐Curtis syndrome (FHCS) rarely occurs concurrently with appendicitis, but it can be a differential diagnosis, especially when the clinical course could not be explained by appendicitis alone, as in our patient.

Background and Aims Idiopathic pulmonary fibrosis (IPF) is a fatal disorder without specific treatments. Although the efficacy of intravenous immunoglobulin (IVIG) therapy for autoimmune diseases has been reported, that for IPF remains unknown. This study aims to determine the efficacy and safety of IVIG for IPF. Methods In an exploratory, multicenter, non-randomized and prospective trial, patients with progressive IPF were enrolled. Patients were treated with IVIG for five consecutive days (5-day IVIG) or once monthly for five consecutive months (5-month IVIG). Changes in the vital capacity (VC), diffusion capacity of the lung for carbon monoxide (DLCO), 6-min walk test (6MWT) and high-resolution computed tomography (HRCT) findings were evaluated. Results A total of 10 patients with IPF were treated with IVIG: 6 were in 5-day IVIG and 4 were in 5-month IVIG group. In 5-day IVIG group, the treatment effects were temporal, and physiological and HRCT findings deteriorated in three of six patients. In 5-month IVIG group, changes in %VC, %DLCO and walk distance in 6MWT at 6 months were −0.9 ± 5.3%, 6.9 ± 12.6% and 79 ± 58 m (mean ± standard deviation), respectively, and the treatment effects were long lasting. The change in VC 6 months after starting IVIG was smaller than that of 6–12 months after starting IVIG (after cessation of IVIG) (−0.02 ± 0.15 vs −0.33 ± 0.14 L, P = 0.022). Ground glass opacities were diminished in two of four patients. Adverse events were mild and tolerable. Conclusion This preliminary study shows that once-monthly IVIG treatment may be effective and tolerable in patients with IPF.

Infection with the trematode Clonorchis sinensis is the most common human fluke infection in East Asian populations. Although this infection is associated with obstructive jaundice or choledocholithiasis, portal vein thrombosis has not been reported. Here, we report the first case of a 60-year-old man who had both C. sinensis infection and portal vein thrombosis with severe hyperbilirubinemia (75.4 mg/dl). He initially presented with abdominal pain and jaundice. Computed tomography revealed gallstones, common bile duct calculus, and thrombus in the left main branch of the portal vein. A nasobiliary tube was inserted under endoscopic retrograde cholangiography. Cytology of the bile juice revealed many C. sinensis eggs. The abdominal pain and jaundice improved following choledocholithotomy and combination treatment with a chemotherapeutic agent and anti-coagulant. This case suggests that inflammation around the portal vein as a result of C. sinensis infection has the potential to evoke portal vein thrombosis. Such cases should be treated with both a chemotherapeutic agent and anti-coagulant therapy. In conclusion, the possibility of infection with C. sinensis should be considered in patients presenting with hyperbilirubinemia and portal vein thrombosis, particularly in East Asian populations.

Objective: Only limited information exists concerning the clinical and pathological features of chronic hypersensitivity pneumonitis (HP) in Japan and elsewhere. We present data on clinicopathological features of chronic HP obtained through a Japanese nationwide survey. Methodology: We studied the clinical and pathological findings in 10 patients with chronic HP who underwent surgical lung biopsy or postmortem examination. Results: There were three types of clinical course: six of the 10 patients had persistent symptoms followed by repeated acute episodes; two showed a subacute onset with persistent symptoms; and two exhibited an insidious onset. Five patients made no attempt to avoid antigen exposure and they all had progressive disease. Pathological findings indicated that lesions were mainly centrilobular with or without epithelioid cell granulomas in specimens obtained during the acute or subacute stage. In contrast, most patients in the chronic stage predominantly showed interstitial fibrosis with a usual interstitial pneumonia pattern. Conclusions: The pathological findings of chronic HP depend on the stage of the disease at tissue sampling.

Nyhlin N, Ando Y, Nagai R, Suhr O, El Sahly M, Terazaki H, Yamashita T, Ando M, Horiuchi S (Umea University Hospital, Umea, Sweden and Kumamoto University School of Medicine, Kumamoto, Japan). Advanced glycation end product in familial amyloidotic polyneuropathy (FAP). J Intern Med 2000; 247: 485–492. Objectives. Advanced glycation end products (AGE) are present in amyloid deposits in β2-microglobulin amyloidosis, and it has been postulated that glycation of β2-microglobulin may be involved in fibril formation. The aim of this paper was to ascertain whether AGE occur in amyloid deposits in familial amyloidotic polyneuropathy (FAP). Setting. Department of Medicine, Umea University Hospital and First Department of Internal Medicine, Kumamoto University School of Medicine. Design. The presence of AGE was sought immunohistochemically and biochemically in amyloid-rich tissues from patients with FAP. Subjects. Biopsy specimens from nine patients and 10 controls were used for the immunohistochemical analysis. For amyloid preparation, vitreous samples from three FAP patients were used. Results. Immunohistochemical studies using a polyclonal anti-AGE antibody revealed positive immunoreactivity in intestinal materials, but the pattern of reactivity was unevenly distributed; it was often present in the border of amyloid deposits, or surrounding them. Non-amyloid associated immunoreactivity was also observed in a few regions of the specimens, although the AGE-positive structures were situated in areas containing amyloid deposits. Western blotting of purified amyloid from the vitreous body of FAP patients revealed a significant association of AGE with amyloid fibrils. Conclusion. The immunoreactivity for the AGE antibody suggests that AGE may be involved in fibril formation in FAP.

We examined endothelium-dependent vasodilatation in 15 familial amyloidotic polyneuropathy (FAP) amyloidogenic transthyretin (ATTR) Valine30Methionine (Val30Met) patients and 12 healthy volunteers. Using ultrasonography, we measured the radial artery diameters under both baseline and hyperemic conditions. Endothelium-dependent vasodilatation was expressed as a percent increase in the diameters of the radial artery after induced hyperemia. Endothelium-dependent vasodilatation tended to decrease in the patients, compared with healthy volunteers. Responses were not elicited at all in patients with disease of more than 9 years' duration. Linear negative correlation was observed between endothelium-dependent vasodilatation and disease duration (P < 0.01). Correlation between endothelium-dependent vasodilatation and degree of autonomic dysfunction was significant (P = 0.0524) and for age was close to significance (P = 0.051). These results suggest that the peripheral vasomotor dysfunction in FAP patients may predominantly depend on the amount of amyloid deposition around the vessels through the course of illness.

Respiratory and cardiac motion correction may result in better turbo spin-echo (SE) imaging of the lung. To compare breath-hold cardiac-gated black-blood T2-weighted turbo SE and turbo short-inversion-time inversion-recovery (STIR) magnetic resonance (MR) imaging pulse sequences with conventional breath-hold turbo SE and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences for lesion conspicuity of focal lung lesions, 42 patients with focal lung lesions were prospectively studied with MR imaging at 1.5 T. Helical computed tomography was used as a reference. In comparison with the conventional breath-hold turbo SE sequence, all black-blood sequences had fewer image artifacts arising from the heart and blood flow. The overall image quality for the black-blood turbo SE and turbo STIR sequences was superior to that for the breath-hold turbo SE and HASTE sequence (P < 0.01). Not only focal lung lesions but also surrounding inflammatory changes were clearly visualized with these two sequences. With the HASTE sequence, although several slices could be obtained in one breath-hold, both the tumor and vessels appeared blurred. We conclude that T2-weighted turbo SE and turbo STIR imaging of the lung with effective suppression of flow and motion artifacts provide high-quality images in patients with focal lung lesions.

Background Recent clinical studies have demonstrated the efficacy of erythromycin for treating patients with chronic lower respiratory tract inflammation. Mechanisms related to the anti-inflammatory action are yet to be determined. Objectives The therapeutic efficacy of erythromycin in experimental extrinsic allergic alveolitis (EAA) was evaluated. Methods A murine model of EAA was developed by intratracheal inoculations with particulate Trichosporon mucoides followed by erythromycin or josamycin treatment. Cell populations, specific antibodies, chemotactic activities, TNF-α, IL-1β, MIP-2 and KC of bronchoalveolar lavage fluid (BALF); histopathology of the lung and footpad reaction; myeloperoxidase of the whole lung; and immunohistochemistry of intercellular adhesion molecule-1 (ICAM-1), at 6 and 96 h after the challenge, were examined. Results There was a marked neutrophilic alveolitis and bronchiolitis at 6 h, and lymphocytic alveolitis and perivenule cuffing at 96 h after the challenge. Increase in total inflammatory cells and neutrophils in BALF at 6 h was significantly suppressed by pre-treatment with 5 mg/kg/day of erythromycin intraperitoneally for 5 days (P

Background For all forms of amyloidosis, the amyloid-generating mechanism is unknown. Familial amyloidotic polyneuropathy type I is caused by a variant transthyretin (TTR Met-30). As electrospray ionization mass spectrometry (ESI-MS) discloses both thiol-conjugated and -unconjugated forms of wild-type and variant TTR, we wanted to investigate the relationship between TTR conjugation and clinically overt amyloid disease. Methods Plasma from 35 individuals (12 symptomatic TTR Met-30 carriers, nine asymptomatic and 14 healthy control subjects) were analysed using ESI-MS. Results The total TTR concentration was significantly lower in symptomatic TTR Met-30 carriers than in control subjects. An increased percentage of conjugated TTR Met-30 was found in symptomatic carriers compared with asymptomatic, whereas the percentage conjugated wild-type TTR was similar for control subjects, asymptomatic and symptomatic TTR Met-30 carriers. Conclusion The finding of a decreased ratio of unconjugated to conjugated TTR Met-30 in plasma samples from symptomatic TTR Met-30 carriers indicates that thiol conjugation of TTR could be involved in amyloid formation.

Yoshimatsu S, Ando Y, Terazaki H, Sakashita N, Tada S, Yamashita T, Suga M, Uchino M, Ando M (Kumamoto University School of Medicine; and Saiseikai Hospital, Kumamoto, Japan). Endoscopic and pathological manifestations of the gastrointestinal tract in familial amyloidotic polyneuropathy type I (Met30). J Intern Med 1998; 243: 65–72. Objectives To evaluate the characteristic changes in the gastrointestinal tract in familial amyloidotic polyneuropathy (FAP) (Met30), both fibre gastroscopy and colonoscopy studies were performed in FAP (Met30) patients. Microscopic changes were also examined in autopsied and biopsied materials from patients with FAP, and compared with data from autopsied samples from patients with AL amyloidosis, and secondary amyloidosis patients. Design Endoscopic and histopathological study. Setting Kumamoto University Hospital, Kumamoto, Japan. Subjects Nine patients with FAP (Met30) underwent fibre gastroscopy and colonoscopy. Six autopsied and 23 biopsied gastrointestinal samples from FAP patients, four from autopsied amyloidosis (including two myeloma associated form), and two from autopsied secondary amyloidosis patients were examined for histopathological study. Main outcome measures Fibre gastroscopy and colonoscopy were employed for macroscopic study. Congo red and H-E staining were performed for histopathological study. Macroscopic changes in the gastrointestinal tract and microscopic differences in the amyloid distribution pattern were compared between the different types of amyloidosis. Results Fibre gastroscopy and colonoscopy for nine FAP patients revealed that four showed a fine granular appearance in the duodenum, three showed lack of lustre, and two showed mucosal friability in the gastrointestinal tract; however, no macroscopic abnormality was observed in four other FAP patients. Histopathological examination of tissue from FAP patients revealed that, although a small amount of amyloid was recognized in the submucosa perivascular layer, a significant amount of amyloid was seen in and around the nerves of the gastrointestinal tract, but very little in Auerbach's nerve plexus. In total, the amount of deposited amyloid in the tissues was small compared with that in other types of systemic amyloidosis, such as AL and secondary amyloidosis. Conclusion These results suggest that the major reason why FAP patients show such severe gastrointestinal symptoms, compared with other types of systemic amyloidosis, may be because of the deposition of a significant amount of amyloid in the nerves in the gastrointestinal tract.

We investigated the generation of nitric oxide ( . No) by H 2 O 2 -dependent peroxidation of hydroxyurea in the presence of copper-containing proteins such as Cu,Zn-superoxide dismutase (Cu,Zn-SOD) or ceruloplasmin as a catalyst. In the reaction mixture of hydroxyurea, Cu,Zn-SOD, and H 2 O 2 , . NO generation was identified by measuring the specific electron spin resonance (ESR) signal of 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (PTIO). The ESR signal of the NO-hemoglobin adduct was also detected in human red blood cells during copper-catalyzed peroxidation of hydroxyurea. The . No production during peroxidation of hydroxyurea was quantified as NO 2 - formation, measured by using the Griess assay, and the amount of No 2 - was dependent on the concentration of hydroxyurea of the reaction mixture. ESR spin trapping with 5,5-dimethyl-1-pyrroline N-oxide (DMPO) showed hydroxy radical ( . OH) generation in the reaction of H 2 O 2 with either Cu,Zn-SOD or ceruloplasmin. Several .OH scavengers, such as ethanol, thiourea, DMPO, and dimethylsulfoxide, and the metal-chelating agent diethylenetriaminepentaacetic acid significantly inhibited .NO generation from hydroxyurea. This indicates that . NO release from hydroxyurea may be mediated by . OH derived from the copper-catalyzed Fenton-like reaction. Incubation of hydroxyurea and Cu,Zn-SOD with xanthine oxidase and hypoxanthine in a system forming O 2 - →H 2 O 2 also resulted in appreciable . No production. These results suggest that . NO production from hydroxyurea catalyzed by copper-containing proteins may be the molecular basis of the pharmacological and antitumor action of hydroxyurea.

Nitric oxide synthases (NOS) exist in human tumor cell lines and solid tumor tissues, and it has been suggested that NO may play important roles in growth, progression or metastasis of tumors. We investigated the activity and distribution of NOS in a series of human lung cancer and normal lung tissues. Seventy‐two primary lung cancer samples (44 cases of adenocarcinoma, 18 of squamous cell carcinoma, 4 of large cell carcinoma, 2 of small cell carcinoma, 2 of adenosquamous carcinoma, and 2 of carcinoids) and corresponding normal lung samples were obtained from surgically treated patients. In normal lung tissues, little NOS activity was observed with no correlation between the patients' age and NOS activity. The total NOS activities in lung adenocarcinoma samples were significantly higher than those in other types of lung cancers or normal lung samples (P

A 52-year-old Japanese woman complicated by a sex chromosomal anomaly as a superfemale, a mosaic of XXXXX/XXXX/XXX/XX/XO, with mild mental retardation, was hospitalized for dry mouth, dry eyes, and proteinuria. The sialography of the right parotid gland showed a globular-type gland enlargement. A definite diagnosis of primary Sjögren's syndrome (SS) was made, and further examinations revealed not only typical sicca syndrome but also systemic extraglandular lymphocytic infiltration; interstitial pneumonitis, glomerular- and interstitial nephritis, superficial gastritis, thyroiditis, and a severe excitation conductive impairment of heart. We report a very rare case of superfemale with primary SS which involved systemic organs.

Polymer films consisting of nematic liquid crystal (LC) droplets and polymer networks were prepared by using a low-energy electron beam to irradiate a homogeneous mixture of nematic LC and bifunctional methacrylate monomer. Influences of such polymerization conditions as polymerization temperature, monomer concentration, and radiation energy on electrooptical properties of the compound films were examined. The polymer yield, affecting to a large extent the film properties, depended on the monomer concentration and the radiation energy. Compound films, which have a switching function from the scattering state to transparency by applying approximately 20-30 V between the two sides of the film, were obtained. In addition, it was found that a compound film with excellent electrooptical properties was prepared by changing impure LC in the droplets into pure LC.

It is generally recognized that epithelial cytokeratins (CKs) are expressed in tissue-specific patterns and reflect differentiation, functional specialization, and pathological alterations of the cells. Differential epithelial cell types can thus be distinguished from each other by their selective expression of particular sets of CKs. To determine the characteristics of metaplastic and hyperplastic changes of alveolar-lining epithelial cells in the lungs of idiopathic pulmonary fibrosis (IPF), the expression of individual CKs was studied immunohistochemically using monospecific anti-CK monoclonal antibodies (anti-CKs 7, 8, 10, 13, 14, 16, 17, 18, 19). Biopsy specimens from 17 patients with IPF and normal lung tissues (NL) from seven patients with lung cancer were studied. In the IPF specimens, several kinds of altered epithelial cells were observed, which showed characteristic changes in CK expression compared with NL, especially CKs 8, 14, and 17. Hyperplastic type II cells expressed increased CKs 7, 8, and 19, but not CK 17; flattened or stratified squamous metaplastic cells expressed increased CKs 17 and 14, co-expressed with CKs 7, 8, and 19; bronchiolar metaplastic cells expressed increased CKs 7, 8, and 19, co-expressed with CKs 14 and 17; cuboidal metaplastic cells expressed increased CKs 7, 8, 17, and 19. The quantification of individual CKs in the tissues by enzyme-linked immunosorbent assay revealed increased expression of CKs 8, 14, and 17 in IPF lung tissues compared with NL. These results were consistent with the immunohistochemical observations. The hyperplastic and bronchiolar metaplastic phenotypes were characterized by their increased expression of simple CKs without CK alteration. The squamous metaplastic phenotype showed CK alterations, with the appearance of CKs 17 and 14. Epithelial cells are thus altered not only in shape, but possibly also in differentiation and function, with potential implications for the pathogenesis of IPF.

Alveolar macrophages (AM) have many Fc receptors for IgG, but are less reactive to lymphokines. They have a well-developed oxidative metabolism and contain large amounts of lysosomal enzyme. This suggests that the antibacterial antibody plays an important role in early resistance by AM to intracellular bacterial infection and that a bactericidal agent, dependent on oxygen and lysosomal enzyme, participates in the effects of the antibacterial antibody on bactericidal activities of superoxide (O2-) and lysosomal enzyme from rabbit AM. The number of Listeria monocytogenes in AM increased after pretreatment with saline or normal IgG but decreased by 60% after pretreatment with anti-Listeria and 120 min incubation. Alveolar macrophage-phagocytized Listeria monocytogenes and Bacille Calmette Guérin (BCG) bound with antibacterial antibody enhanced release of O2-, and nitroblue tetrazolium (NBT) formazan reduced by O2- was observed around the bacteria in the phagosomes of AM. We also confirmed that Listeria and BCG were killed extracellularly by O2-released by a superoxide-generating system in vitro and/or by lysosomal concluded that the antibacterial antibody of the IgG class enhances the antibacterial activity of AM thereby increasing the production of 02- and lysosomal enzyme in the phagosome. This finding may be important in the early resistance to intracellular bacteria infection by AM in the alveolar spaces.

To elucidate the mechanism of bacterial exoprotease in promotion of the intravascular dissemination of Pseudomonas aeruginosa, we examined the possible involvement of bradykinin (whose generation is induced by pseudomonal proteases in septic foci) in the invasion by bacteria, and in access of bacterial toxins to systemic blood circulation. P. aeruginosa 621 (PA 621), which produces very little protease, was injected intraperitoneally into mice together with pseudomonal exoproteases (elastase/alkaline protease). Dissemination of bacteria from the peritoneal septic foci to the blood was assessed by counting viable bacteria in the blood and spleen by use of the colony-forming assay. The results showed that pseudomonal proteases markedly enhanced (10- to 100-fold) intravascular dissemination of bacteria in mice. This enhancement was induced not only by pseudomonal proteases but also by bradykinin. More importantly, the increased spread of PA 621 induced by pseudomonal protease and bradykinin was significantly augmented by the addition of kininase inhibitors, indicating the direct involvement of bradykinin in bacterial dissemination. Similarly, bradykinin caused effective dissemination of pseudomonal toxins such as endotoxin (lipopolysaccharide) and exotoxin A when the toxins were injected into the peritoneal cavity with bradykinin. Furthermore, the lethality of the infection with PA 621 was strongly enhanced by pseudomonal proteases given i.p. simultaneously with PA 621. On the basis of these results, it is strongly suggested that pseudomonal proteases as well as bradykinin generated in infectious foci are involved in facilitation of bacterial dissemination in vivo.

This report concerns an 18-year-old boy who is hemizygote for Fabry's disease. Varying degrees of nonpulsating headache crises, lasting from a few hours to several days, began when he was 16 years of age. Painful crises in the extremities, characteristic of Fabry's disease, were not present. Although only occasional, he had several episodes of throbbing headache with vomiting without aura. The meningeal signs were equivocal, although the patient had noninfectious pleocytosis, intracranial hypertension, delayed radioisotope clearance on cisternography, and multiple old cerebral infarcts. Nonsteroidal anti-inflammatory drugs, antidepressants, carbamazepine, and glycerol were of no benefit for his headache. Although its mode of action remains obscure, prednisolone was effective for treating the headache and the aseptic meningeal reaction.

Summer-type hypersensitivity pneumonitis (SHP) is a unique type of hypersensitivity pneumonitis and the most prevalent in Japan. Our previous study clarified that the causative agent of the disease is Trichosporon cutaneum, and that the patients with SHP have high titres of antibodies against the serotype-specific antigen of polysaccharide nature which exist in the high molecular weight fraction of the culture supernatant of the yeast. In this study, we purified the serotype-specific antigen of serotype II T. cutaneum by gel filtration and affinity chromatography using a monoclonal antibody, D-8, specific for a high molecular weight antigen of serotype II T. cutaneum, and elucidated the structure of the antigen. This affinity-purified antigen was shown to be an essentially acidic polysaccharide comprising mannose, xylose, and glucuronic acid (6:44:4.7). Chemical analysis showed that this polysaccharide antigen contains a (1-3)-linked mannan backbone attached with short side chains of (1-4)-linked mannose and a small proportion of (1-2)-linked xylose residues by substituting the 2- or 4-positions of the (1-3)-linked mannose residues of the main chain. Approximately one-fifth of the side chains were terminated with glucuronic acid residues. The antigenic epitope of the serotype-specific antigen was shown to involve the terminal glucoronic acid residues as revealed by immunodiffusion test and sandwich enzyme-linked immunosorbent assay using monoclonal antibody D-8.

We examined muscle sections from 3 patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), using single-fiber polymerase chain reaction, histochemistry, and in situ hybridization. Most type 1 ragged-red fibers showed positive cytochrome c oxidase activity at the subsarcolemmal region, while type 2 ragged-red fibers had little cytochrome c oxidase activity. However, there was no difference in the amount of total (mutant and wild-type) mitochondrial DNAs (mtDNAs) and the proportion of mutant mtDNA between type 1 and type 2 ragged-red fibers. These observations suggest that mitochondrial proliferation and nuclear factors affect muscle pathology, including cytochrome c oxidase activity, in MELAS. Total mtDNAs were greatly increased in ragged-red fibers (about 5-17 times over those in non-ragged-red fibers). The proportion of mutant mtDNA was significantly higher in ragged-red fibers (88.1 +/- 5.5%) than in non-ragged-red fibers (63.2 +/- 21.6%). Thus, the amount of wild-type mtDNA as well as mutant mtDNA was increased in ragged-red fibers in MELAS, failing to support the contention of a replicative advantage of mutant mtDNA. The proportion of mutant mtDNA was significantly higher in the strongly succinate dehydrogenase-reactive blood vessels (83.2 +/- 4.2%) than in non-succinate dehydrogenase-reactive blood vessels (38.8 +/- 16.2%). It seems likely that systemic vascular abnormalities involving cerebral vessels lead to the evolution of stroke-like episodes in MELAS.

Human colorectal carcinomas may be induced from adenomas or they may occur de novo. To examine which is the main pathway, we analyzed point mutations at codon 12 in the c-K-ras 2 gene in 73 colorectal carcinomas, 13 metastatic tumors, 72 adenomas and 30 normal tissues. The c-K-ras 2 codon 12 mutation frequency was 0/30 in normal tissues, 0/17 in adenomas with mild atypia, 3/37 (8.1%) in adenomas with moderate atypia, 15/18 (83.3%) in adenomas with severe atypia, 19/73 (26.0%) in primary carcinomas and 3/13 (23.1%) in metastatic tumors. The mutation frequency in adenomas with severe atypia was much higher than that in carcinomas. These results indicate that many colorectal carcinomas may not be induced through adenomas with severe atypia.

Etude par DSC et diffractometrie RX de la structure et des transitions de phase des monomeres de structure CH 2 =CH-CO 2 -(CH 2 ) n -O-Ph-Ph-O-(CH 2 ) n -O 2 C-CH=CH 2 (n=3,4,5,6,11) et des polymeres obtenus par irradiation electronique

A 61-year-old Korean housewife developed dyspnoea, cough and weight loss in the summer of 1994. The case was diagnosed as definite summer-type hypersensitivity pneumonitis (SHP) according to the criteria proposed for hypersensitivity pneumonitis and for SHP. Her serum antibodies to Trichosporon were positive. Her symptoms were exacerbated after she returned home and Trichosporon was isolated from the patient's home, indicating Trichosporon as the causative antigen. This is the first confirmed case of SHP outside Japan. On the basis of our research in SHP to date, we propose that SHP occurs in other Asian countries and that the assay of anti-Trichosporon antibodies is useful for the diagnosis of the disease.

In an electron beam (EB) polymerization of a urethane-acrylate prepolymer, the polymerization temperature greatly affected the structure and properties of the resulting gel film. Urethaneacrylate, which was synthesized by the reaction of poly(butylene adipate)diol, 4,4′-diphenylmethane diisocyanate, and 2-hydroxyethyl acrylate, was used as a prepolymer. The prepolymer was semicrystalline and showed a melting point in the region of 50–60°C. The maximum polymerization rate of the prepolymer was obtained when the prepolymer film was irradiated in the temperature range of 25–40°C. EB polymerization below the melting point (Tm) of the prepolymer produced semicrystalline polyurethane-acrylate gel films with a spherulitic texture. On the other hand, EB polymerization above the Tm destroyed the crystalline phase of the prepolymer to give transparent gel films. The gel film cured below the Tm had higher stress at yield, Young's modulus, and tensile strength than those cured above the Tm. Such temperature effects are attributed to whether or not the EB polymerization proceeds with retention of crystalline structure of the prepolymer.

The formation mechanism of microporous film which was obtained by casting a methyl ethyl ketone (MEK)/N,N-dimethlformamide (DMF) solution of an electron beam (EB)-reactive urethane-acrylamide prepolymer was discussed. The porosity and crystallinity increased with increasing DMF content in the solvent mixture. This correlation was explained by a progressive slight coagulation and nucleation of the prepolymer due to the difference in volatility between MEK and DMF. As the result, when the DMF content reached 25 vol%, micropores were formed throughout the film. Such a mechanism was supported by the localization of the acrylamide groups at the surface which was induced by the crystallization and by the interaction of amide groups with DMF. The polymerization of acrylamide groups by EB could fix the microporous morphology.

A 51-year-old Japanese male developed morphea profunda over a plaque of pigmented sweating skin on the left chest extending deeply into the lung. Eight years previously, he noted a brown pigmented spot on the left axilla which started to enlarge over the left chest in a band-like manner. Later, the involved skin hardened with profuse sweating. Chest X-ray examination and computer tomography revealed a thickening of the left chest wall and a nodular mass lesion in the left lower lung field. Biopsy specimens from lung, chest wall, and overlying skin revealed a granulomatous tissue in the parenchyma and a marked fibrosis extending from the deep dermis to the pleura. There were no findings suggestive of malignancy or chronic infectious disease. We assume that the process of morphea in this patient extended deeply from the skin to the lung.

Structure and properties of films obtained by the electron beam (EB) and the ultraviolet light (UV) solid-state polymerization of polyurethane–acrylate prepolymer were examined to reveal the characteristics of these radiation polymerizations. The prepolymer was synthesized by the reaction of poly(butylene adipate)diol, 4,4′-diphenylmethane diisocyanate, and 2-hydroxyethyl acrylate. EB polymerization behaviors of the prepolymer produced a unique polymer film different from that obtained by UV irradiation. Although polyurethane–acrylate films from the EB and the UV solid-state polymerizations consisted mainly of amorphous and crystalline phases, it was proved that the film from 10 Mrad of EB irradiation at 25°C had higher crystallinity and larger crystallite size than the film from UV irradiation. This is assumed to be due to the reason that EB irradiation below the melting point of the polyurethane–acrylate can lead to crosslinking without the destruction of the original crystalline structure. On the other hand, the UV polymerization proceeded with the melting of the crystalline structure by absorbing other lights than the UV absorbed by a photoinitiator. The EB-polymerized film which was crosslinked more densely than the UV-polymerized film showed higher mechanical strength than the latter film.