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Recently, the roles of inflammatory processes in the pathogenesis of asthma have been emphasized. To elucidate the roles of T lymphocytes in local inflammatory sites in asthma, we examined T cell phenotypes with flow cytometry and carried out cytokine message amplification phenotyping (MAPPing) of bronchoalveolar lavage (BAL) cells taken from patients with steady-state asthma (n = 11). The percentage of CD4+ T cells in total lymphocytes correlated significantly (r = 0.784, p0.005) with that of lymphocytes in total CD45+ BAL cells. The positivities of T cell activation markers (CD25, HLA-DR) in CD4+ T cells were inversely correlated with the ratio of CD3+ T cells to total CD45+ BAL cells (CD25, r = 0.648, p = -0.059, HLA-DR, r = -0.741, p0.05). Most CD4+ T cells were of the CD45 RO+ "memory" phenotype. With cytokine MAPPing, IL-2 or IFN gamma were detected in only 2 of 11 patients, but IL4 or IL-5 were detected in 8 patients. These results suggest that non-activated TH2 type memory CD4+ T cells accumulate in local inflammatory sites of the bronchi of patients with steady-state asthma, and that these cells releases cytokines (IL-4, IL-5) when activated by some stimuli, which can lead to an asthma attack.

We present here thirteen patients (5 men and 8 women, aged 31 to 73, mean 55 years) with spastic paraparesis who showed clinical features similar to those of HTLV-1 associated myelopathy without HTLV-1 antibody, but with positive antibody to hepatitis B virus (HBV). All of these patients showed slowly progressive difficulty in walking. Five patients had previous histories of blood transfusion, of these one with history of B hepatitis. Neurologically, muscle weakness, spasticity and exaggerated deep tendon reflexes in the lower extremities were common to all the patients. Seven patients showed Babinski's reflex. Disturbance of micturition was noted in 3 patients. None showed organic changes of the spine on magnetic resonance image (MRI). None was serologically positive for syphilis and had cryoglobulin and hypergammaglobulinemia. Elevated levels of the liver enzymes were noted in two patients. All patients were positive for hepatitis B surface antibody (HBs-Ab) (EIA) but negative for hepatitis B surface antigen (HBs-Ag) (EIA). Five patients were seropositive for hepatitis C virus (HCV) (PHA). In 3 of them, reverse transcriptase polymerase chain reaction was performed but failed to detect HCV-RNA. All patients underwent spinal tap, and showed normal cell count and protein concentration in their cerebrospinal fluid (CSF). Atypical cells were not observed in all the patients. The CSFs from three patients were tested for HBs-Ag and HBs-Ab. HBs-Ag was negative in all three patients, but HBs-Ab was positive in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Recently, "low-dose and long-term" erythromycin (EM) has been reported to be effective in treatment of diffuse panbronchiolitis (DPB), but its mechanism is still obscure. We studied the effect of EM on cytokine mRNA expression by using LPS-stimulated human whole blood as an experimental vivo model. IL-8 mRNA was expressed in biphasic fashion with peak expression at 6 hours and 20 hours from the start of LPS stimulation. When whole blood was pretreated with EM (2 micrograms/ml) for 1 hours. IL-8 mRNA expression was depressed at 20 hours (p0.025) from the start of LPS (1 microgram/ml) stimulation. However, when pretreated for 12 hours, it was not depressed. EM (2 micrograms/ml) also depressed IL-1 beta (p0.025) and TNF alpha (p0.05) mRNA expressions at 6 hours from the start of LPS stimulation. From the above results, it was suggested that the direct inhibition of IL-1 beta and TNF alpha production by EM resulted in subsequent depression of production of IL-8 that is a potent chemotactic factor for neutrophil, and consequently, EM acts to protect the bronchiole tissues of DPB patients from destruction by proteolytic enzymes released from neutrophils. This assumption seems to be supported by our previous observation that when patients with DPB were treated with EM a marked decrease in number of neutrophil in bronchoalveolar lavage fluid (BALF) was accompanied by clinical and radiographic improvement.

Recently, the incidence of opportunistic infections in patients with hematological neoplasms has been markedly increasing. However, early and definitive diagnosis and treatment of these infections remain difficult. In this study, we report three patients, a 47-year-old female with ATL, a 54-year-old female with CML and a 65-year-old female with ATL. All these cases were complicated with pneumonia caused by Pneumocystis carinii (Pc) or cytomegalovirus (CMV). They were successfully treated with sulfamethoxazole/trimethoprim or ganciclovir after detection of the respective microorganisms from sputum samples in the early stage of the infections by polymerase chain reaction (PCR) method. The above clinical evidence demonstrated the PCR technique to be a rapid and sensitive diagnostic procedure for the detection of Pc or CMV and to be helpful for the early initiation of appropriate treatment of the infections in patients with hematological neoplasms.

Clinical and angiographic results were studied after 121 classic Blalock-Taussig shunts (CBT) and 74 modified Blalock-Taussig shunts (MBT) with polytetrafluoroethylene grafts. 1. The actuarial shunt patency rate in all 195 patients showed a significant difference in patency between CBT and MBT at six months after operation. (CBT = 91.6%, MBT = 98.6%, p0.05). The patency rate of 4-mm MBT grafts was lower than that of CBT of grafts. 2. The 109 patients who underwent postoperative angiography were evaluated for morphological features of anastomosis. The incidence of pulmonary arterial stenosis caused by anastomosis was 15.3% with CBT and 18.9% with MBT; these values were not significantly different. The primary characteristic of CBT anastomosis was a funnel-shaped stenosis at the side of shunt vessel, but this feature did not disturb pulmonary artery growth. In contrast, MBT grafts sometimes narrowed along their entire length, causing deterioration of pulmonary artery growth. 3. The 60 patients in whom pre- and post-operative pulmonary artery sizes were able to be evaluated were studied for pulmonary artery growth. The development ratio (DR) was calculated as the ratio of postoperative to preoperative pulmonary artery index (post-PAI/pre-PAI). a) DR in patients with lower preoperative PAI was greater than that in patients with higher preoperative PAI. b) DR in patients under the age of 6 months was greater than that in older patients. c) There were no significant differences in DR between CBT and MBT or between pulmonary stenosis and pulmonary atresia. d) Relative to the BT shunt, the ipsilateral pulmonary artery grew to the same degree as the contralateral artery.(ABSTRACT TRUNCATED AT 250 WORDS)

The development of the thyroid, parathyroid and ultimobranchial body was examined by immunohistochemistry and morphometric analysis in the larvae of Xenopus laevis Daudin from the time immediately after hatch to the end of metamorphosis. The thyroid appeared at stage 43 and began to secrete thyroglobulin from stage 47/48. Both the volume of the thyroid and the height of the follicular epithelium reached the peak at stage 61 and decreased thereafter towards the end of metamorphosis at stage 66. The parathyroid first appeared at stage 43 as the thickening of the wall of the third and fourth visceral pouch. The volume of the parathyroid gradually increased with the progress of development until the end of metamorphosis. The ultimobranchial body appeared at stage 45 as a recess of the epithelium lining the floor of the pharynx. It became follicular in the structure at stage 53. Its volume reached the peak at stage 61 and decreased thereafter towards the end of metamorphosis. Calcitonin-immunoreactive cells first appeared in the ultimobranchial body at stage 47/48, showed the most intense reaction at stage 59, and rapidly decreased in number thereafter towards the end of metamorphosis.

Our recent experiences of the autogenous pericardial patch augmentation of Blalock-Taussig anastomotic orifice are reported. In Case 1, the direct suture between the left subclavian artery and the left pulmonary artery was difficult on the anterior wall because of the shortness of the left subclavian artery. Therefore, a piece of the patient's own pericardium was excised and sutured anteriorly between the two vessels by interrupted 7-0 polypropylene sutures. A 19 months postoperative angiogram showed so-called parrot-beaking of the subclavian artery probably due to tension, but there was no distortion or stenosis of the pulmonary artery. In Case 2, the right subclavian artery distal to the bifurcation of the vertebral artery was longitudinally split measuring approximately 2.5 cm in length, and widened by a piece of the autogenous pericardium in a wedge shape. Then, it was anastomosed to the right pulmonary artery without undue tension. Seven months postoperatively the patient died from severe AV valve regurgitation. The autopsy showed widely patent anastomosis and good healing as well as slight expansion of the pericardial patch but without aneurysm formation. In Case 3, the same operation as in Case 2 was performed. A 6 months postoperative angiogram showed no stenosis or distortion of either the subclavian or the pulmonary artery. Although it is premature to draw any conclusion, the use of the autogenous pericardium may be indicated to widen the anastomotic orifice of Blalock-Taussig shunt without sacrificing the length of the subclavian artery even in small infants or neonates.

A simple and fast method to measure the natural killer (NK) cell cytotoxicity has been established. In our novel assay, following the incubation of K562 target and effector cells, the cells were stained with FITC-conjugated anti-transferrin receptor (CD71) mAb. The K562 targets alone were labeled with anti-CD71 mAb, since CD71 is highly expressed on K562 cells but not on mononuclear cells. The fluorescence intensity of CD71 on K562 cells were analyzed using flow cytometry, and the cytotoxicity was evaluated. In our assay, designated as a "CD71 assay", no spontaneous release of anti-CD71 mAb was observed from labeled K562 cells and living K562 cells were able to be divided from dead K562 cells. The data obtained by this assay was well correlated with that by the standard 51Cr-release assay as well as the C-FDA assay. In addition, the CD71 assay is a safe and simple analytic procedure since no isotope is required.

Relapsing polychondritis is a rare disorder of uncertain origin characterized by recurrent inflammation of cartilage. A case of myelodysplastic syndrome (MDS) associated with relapsing polychondritis is reported. A 60-year-old man who had been diagnosed as MDS was admitted because of pain and swelling in the bilateral preauricular regions and cheek. A diagnosis of relapsing polychondritis was made by coexistence of auricular chondritis, arthropathy, ocular inflammation and audio-vestibular disturbance. He also developed ocular palsies and optic neuritis. He was treated with prednisolone, azathioprine, dapsone, and then with steroid pulse therapy. Moreover, plasmapheresis and high dose gamma-globulin therapy were undertaken. However, all these treatments were unsuccessful and he died of respiratory failure.

We analyzed the effect of an unknown factor, which derived from serum, on platelet associated IgG (PA-IgG) and we established the novel immunofluorescence method to measure the level of PA-IgG. Blood samples were obtained from 20 patients with idiopathic thrombocytopenic purpura (ITP). After the treatment of platelets with neuraminidase, the value of PA-IgG positive platelets (%PA-IgG) were significantly increased in patients with ITP, but not in controls. When the platelets pretreated with neuraminidase were incubated with human serum, %PA-IgG was remarkably decreased in ITP patients. In healthy individuals, when platelets bound to aggregated human IgG pretreated with human serum, the binding of FITC-conjugated anti-human IgG was inhibited. And the value of mouse anti-GP II b/III a monoclonal antibody positive platelets was decreased, when the platelets preincubated with mouse serum. The binding of FITC-conjugated anti-human IgG and anti-mouse IgG antibody was apparently inhibited by some unknown factor in serum. Our results showed that this substance had species specificity. We called this substance "Serum Derived Blocking Factor (SDBF)".

The results of a serum inquiry for detection of antibodies against the Human Immuno-deficiency Virus in a non selected group of children, patients of a general pediatric ward, are reported. Of the 441 cases, the ELISA test gave a positive result for 1.1% of them. This result was confirmed by the Western-Blot or ImmunoBlot test. None of the five children who tested positive had a previous history of blood transfusion. These children's mothers showed positive results to the ELISA test. Of four cases, at least one of the parents was IV drug addicted. In every case the transmission was vertical. On the basis of these findings, it is suggested that hospital staff should take the necessary precautions when manipulating blood and secretions and it is recommended that serum inquiries be made on the wards of general hospitals in the attempt to establish reliable data on the prevalence of HIV.

A 22-year-old female was admitted to our hospital because of general fatigue. The lymph nodes, liver and spleen were not palpable. She was without cutaneous lesions. Haematological examinations revealed leukocytes 3,200/microliters with 44% blasts of myelomonocytic origin, and platelets 15,000/microliters. Bone marrow smears were hypercellular marrow with 51% blasts of myelomonocytic origin and focal involvement of mast cells. Serum histamine and vitamin B12 level was high. Mast cells were round with rounded or segmented nuclei. The nucleoli were inconspicuous and the cytoplasm contained a number of metachromatic granules. Cytochemically, mast cells stained positive for alpha-naphthol-AS.D-chloroacetate esterase and acid phosphatase, and negative for peroxidase, Sudan black B and alpha-naphthyl butylate esterase. In toluidine blue staining, mast cells had stained similarly with pH values from 2.5 to 6.5. She was diagnosed as acute myelomonocytic leukemia with benign mastocytosis, and treated with BH.AC-DNP. A complete remission was obtained, but mast cells in the marrow did not decrease. Relationship between leukemia and mastocytosis was not known, but it was suggested that mast cells responded to the proliferation of the leukemic cells.

The current paper describes the process by which an inservice training curriculum was developed by a universe (15) of community-based residential treatment programs. The programs were independently operated and often geographically isolated. A wide variety of treatment philosophies were represented: teaching-family model, psychodynamic, re-education, and eclectic. Offered in a twelve-month, three-phase format, the inservice training program (how the curriculum is to be taught) is presented.

An attempt is made to make a clear statement concerning the roles of the direct care worker in group home treatment programming. For several reasons these roles have not been adequately defined over time. The roles include descriptions of the direct care worker as therapeutic counselor, as manager, as teacher and as relationship builder. The direct care worker is identified as a generalist, a role on the treatment team that is no less important than the role played by the social worker and the psychologist. In the final analysis the professionalization of the direct care worker will depend upon the development of a national focus which can be translated into real college preparatory curricula; into standards which can be utilized to develop certification procedures, and into a hierarchy of jobs for which the direct care worker is the first step.

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Present works describe the developments of the equiaxed Fe-Cr-Co permanent magnets with high coercivity and high energy products. The studied alloy compositions are Fe-(26-32)wt%Cr-15wt%Co-3wt%Mo. The magnetic properties of the alloys have been enhanced by the two-step thermomagnetic treatment (two-step TMT) and by prolonging all of the heat-treatment time. The energy products above 43 kJm-3(5.4MGOe) are obtained for almost all of the studied compositional alloys. Fe- 30%Cr-15%Co-3%Mo alloy gives good magnetic properties as iHc=76.8 kAm-1(960 Oe), (BH)max=49.6 kJm-3(6.2 MGOe). The highest coercivity achieved with Fe-32%Cr- 15%Co-3%Mo alloy is 80.8 kAm-1(1010 Oe).

Twenty four complete and 15 partial moles, and the lymphocytes from the parents were analyzed for human lymphocyte antigen (HLA-A and HLA-B specificities), and karyotyping was done in each molar tissue by the direct method. Twelve of the 24 complete moles expressed homozygous A and/or B specificities identical to those of the father. No cases expressed A or B specificities derived from the maternal side. All had a 46, XX karyotype. On the other hand, in 6 of the 15 partial moles, the antigen specificities were heterozygous for A locus and 10 of the 15 expressed A and/or B specificities derived selectively from the maternal side. In chromosome studies, 8 of the 15 had a 69,XX karyotype, 5 had a 46,XX karyotype and 2 was impossible of analysis. These results show that complete moles are mostly androgenetic in origin but partial moles are not; that is, pathogenesis distinguishes complete from partial moles.

Although the rate of occurrence of tuberculosis is steadily falling in most parts of the world, this disease remains a significant world-wide health problem.

Complications subsequent to flexible bronchofiberscopy are as follows: 1. Dyspnea caused by narrowed air passage; 2. Pneumoria caused by an unsanitary flexible bronchofiberscope; 3. Intoxication due to lidocaine; 4. Pulmonary hemorrhage secondary to biopsy, curettage and brushing, and 5. Pneumothorax caused by transbronchial lung biopsy.

A 61-years old woman who had been healthy without history of abnormal bleeding, developed widely spread ecchymosis and intramuscular bleeding in March, 1987. She was hospitalized for this hemorrhagic diathesis in May, 1987 and the following laboratory data were revealed: activated partial thromboplastin time (APTT), 76.7 seconds; factor VIII procoagulant activity, 2%; factor VIII inhibitor, 27 Bethesda units/ml. The inhibitor was an immunoglobulin of IgG type. Her clinical data of the blood were normal, and tests for antibodies, such as RA test, LE test and thyroid test were negative. Physical examination revealed ecchymosis over her right arm and swelling and pain in the right arm. She was first treated with a large dose of factor VIII concentrates, but the effect was insufficient. Then prednisolone was given, which resulted in decreasing of the inhibitor and improvement of the coagulation profiles. This treatment appeared to offer effective control on severe hemorrhage in patients with factor VIII inhibitors.

At Kitasato University Hospital, almost all bronchofiberscopic procedures are performed with a direct connection to a TV camera, and important findings are recorded by VTR. This method is very useful for the progress of diagnostic accuracy, smooth examination and medical education. In particular, playing the VTR scene is especially valuable for the education of medical students and residents.

A large number of human mononuclear cells were simultaneously separated into fractions enriched in B cells, T cells, large granular lymphocytes (LGL) and monocytes by centrifugal elutriation. Lymphocyte populations were analyzed using monoclonal antibodies. In particular, highly enriched natural killer cells, Leu7+ cells, were collected in the intermediate fractions. Monocytes, which were identified as esterase positive cells, and Leu M3 cells were collected at higher counterflow rates and in the final fraction. The purity of monocytes in the final fraction was 81%. The oxidative metabolic activity (H2O2 production) and non-specific esterase activity of individual monocytes was estimated in the analysis of functional heterogeneity of monocytes using flow cytometry. 2',7'-dichlorofluorescein diacetate (DCFH-DA) and fluorescein diacetate (FDA) were used as indicators in the measurement of H2O2 generation and esterase activity. Intracellular generation of a fluorescence product (H2O2 Production; average percentage of fluorescence positive cells) of monocytes in the stimulation of phorbol myristate acetate (PMA, 100 ng/ml) was greater in larger than smaller cells. H2O2 production gradually increased from 6% and 25-38% and 60% in the intermediate and final fractions respectively. Furthermore, the average fluorescence intensity of the large monocyte population in the final fraction was 1.13-1.31 fold more active than that of the smaller cells. Thus, the functional heterogeneity of human monocytes was further confirmed in the assays of H2O2 production exposed to PMA and FDA hydrolysis using flow cytometry. Furthermore, the CCE system can isolate lymphocyte subsets and LGL.

The incidence of hydatidiform mole, found in Fukushima Prefecture from 1975 to 1979 (5 years), in all pregnant women was statistically studied according to their age. 1) The number of pregnant women was 238,776, and the number of hydatidiform moles was 478. The incidence of hydatidiform mole in pregnant women was 2.00%. 2) The incidence of hydatidiform mole was approximately 1-2% in mothers under 40. The incidence tended to be greater in mothers over 40. The incidence was 27.26% in mothers aged 45 to 49 and 303.03% in mothers over 50 (150 times greater than usual). These results show a clear relationship between the incidence of hydatidiform mole and the mothers age. We believe an increase in abnormal ova is the cause of the increased incidence of hydatidiform mole in older mothers.

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