Radionuclide assessment of left ventricular performance on exercise after external conduit operation

Only limited information is available concerning left ventricular (LV) response to exercise after an external conduit operation for cyanotic congenital heart disease. Sixteen patients who had undergone external conduit repair (EC group) were studied with multi-gated cardiac pool imaging using a supine bicycle ergometer on 20 occasions. Six patients with a history of Kawasaki disease without coronary artery stenosis served as controls (control group). Myocardial imaging and cardiac catheterization were also performed in the EC group. There was no significant difference in left ventricular ejection fraction (LVEF) at rest between the groups. However, on exercise, LVEF of the EC group was significantly lower than that of the control group. Nine patients in the EC group showed a perfusion defect (PD) on 12 occasions. LVEF on exercise of the patients with PD was significantly lower than that of the patients without PD. Furthermore, only the patients with PD showed a LVEF decrease of 5% or more in response to exercise. In the EC group, a significant inverse relationship was demonstrated between right ventricular systolic pressure (RVP) and LVEF response to exercise. However, two out of four patients who underwent external conduit replacement improved their LVEF response to exercise with successful reduction of RVP. These findings indicate that an impaired left ventricular response to exercise was common in patients after external conduit operations. Myocardial damage and right ventricular outflow tract obstruction could be the causes of this left ventricular dysfunction.

[Effect of substrate and diluent for factor VIII activity in highly purified factor VIII concentrate and patient plasma infused factor VIII concentrate]

We studied the difference between congenital factor VIII deficient plasma and factor VIII immuno-depleted plasma on the effect of pre-dilution for factor VIII activity determined by the one-stage assay. When standard curves of one-stage assay for factor VIII: C by GEORGE KING factor VIII deficient plasma (frozen at -80 degrees C), BEHRING factor VIII deficient plasma (lyophilized), DADE factor VIII depleted plasma (lyophilized, von Willebrand factor antigen 0.2 U/ml) and DADE factor VIII depleted plasma (lyophilized, von Willebrand factor antigen 1.0 U/ml) were compared, the difference between the clotting times for 100% and 6.25% of activity in each reagent were 39.5, 29.5, 25.0, 23.0 seconds respectively. Potency values in concentrates without albumin or von Willebrand factor showed a discrepancy between pre-dilution in Owren-Koller buffer and pre-dilution in factor VIII deficient plasma. Potencies of those products pre-diluted in Owren-Koller buffer were 40-60% lower than potencies pre-diluted in factor VIII deficient plasma. These results showed substrate and pre-diluent must be chosen carefully for the accurate assay of factor VIII activity in vitro for the highly purified factor VIII concentrates.

Idiopathic sclerosing peritonitis in a man

Idiopathic sclerosing peritonitis (ISP) is a rare condition which has been mainly reported in young adolescent women as a cause of small bowel obstruction. In these patients the small bowel is sometimes encased in a fibrous sac called an "abdominal cocoon". We describe a 62-year-old man who underwent exploratory laparotomy for ascites and abdominal mass. Laparotomy showed 5.4 l of ascites and the entire small bowel was encased in a fibrous sausage-like cocoon. The pathological findings were characteristic of sclerosing peritonitis.

[Immunoblotting analysis of acquired factor VIII inhibitor in an elderly man]

A case of acquired FVIII inhibitor in a nonhemophilic, 80 year-old man who had no underlying disorder, is presented. The level of inhibitor was 13.3 Bethesda unit/ml, and the antibody was IgG, with lambda light chain. The antibody reacted with the 92 kD fragment of non-treated human FVIII, and the 44 kD fragment of thrombin treated FVIII when analysed by the immunoblot analysis.

Coronary arterial lesions due to Kawasaki disease: selective coronary angiography in five cases with difficult-to-detect localized stenosis

We report five cases of localized stenosis in coronary arterial lesions due to Kawasaki disease which were difficult to demonstrate by routine selective coronary angiography. Of these cases, three had localized stenosis overlapping the aneurysm, one had localized stenosis overlapping another adjacent branch, and the fifth had localized stenosis at the proximal left main trunk of the coronary artery. The reasons for difficulty in demonstrating the stenoses by routine study include: the localized stenosis was often superimposed on the aneurysm and/or the other adjacent branches, and the catheter was pushed into the inlet of the aneurysm on the proximal left main trunk. For a precise demonstration of a localized stenosis by selective coronary angiography, many angiograms from different perspectives should be taken. In addition, when a large aneurysm exists in the left main coronary artery, selective coronary angiography should be taken without pushing the catheter into the inlet of the aneurysm, and each frame of the cine coronary angiography should be carefully examined. Care should also be taken to compare with the initial view of the projection.

Clinical significance of morphologic classification of coronary arterial segmental stenosis due to Kawasaki disease

Coronary arteriograms obtained in 1,392 patients from a cohort of 4,562 with Kawasaki disease showed 395 to have coronary arterial lesions. The specific lesions, known as segmental stenoses, were observed in 62 patients, involving 68 coronary arterial branches. The lesions involved the right coronary artery in 56 cases (14.2% of the group with arterial lesions) and the left coronary artery in the other 12 (3% of the overall group with arterial lesions). Three morphologic variations were observed. Braid-like lesions accounted for 15 lesions, involving the right coronary artery and occurring < 2 years after the onset of Kawasaki disease. Bridging vessels were observed in 40 of 68 arterial lesions, 30 of which involved the right coronary artery. Of these bridging vessels, 86% were present within 4 years of onset of the disease. Pericoronary communications were observed in the remaining 13 of 68 lesions, 11 involving the right coronary artery and appearing at variable intervals, but usually significantly later than the other lesions. Myocardial ischemia was found at the first study in 60% of braid-like lesions, but in only 29% of the lesions at follow-up studies. Of bridging vessels or pericoronary communications, 95 and 77%, respectively, were found to have produced ischemia in the initial study, which persisted in 78 and 77%, respectively. There are 3 different mechanisms involved in the formation of segmental stenosis, with different prognoses for the clinical course of myocardial ischemia.

Isolation and amino acid sequence of a chemotactic protein, LECT/interleukin 8, from a human myeloid leukemia cell line, ML-1

We looked for chemotaxin/interleukin 8 (CT/IL-8) activity in the culture fluids of 97 human leukemia cell lines and found it in two of the T cell lines, six of the myeloid cell lines, and one of the normal B-cell lines. It was particularly strong in the culture fluids of two cell lines. These cell lines secreted a chemotactic protein into the culture fluids under certain conditions of stimulation with phorbol-12-myristate 13-acetate (PMA), lipopolysaccharide, or hemagglutinin-P. A myeloid leukemia cell line, ML-1, secreted an inducible chemotaxin when stimulated with PMA (1 ng/ml) for 24 h. We purified the chemotaxin from ML-1 cell culture fluid using an improved procedure: concentration with DEAE-Sepharose CL-6B and CM-Sepharose CL-6B, CM-Sepharose column chromatography, and reverse-phase 5TMS-300 column on HPLC with the retention time coinciding with that of LUCT/IL-8 [Suzuki et al., 1989, J. Exp. Med. 169, 1895]. The yield was 200 micrograms protein from 6 liters of the culture fluid. The N terminus of CT/IL-8 was AVLPR-SAKELRXQXIKTYSK- - -, the same as that of LUCT/IL-8, which is constitutively secreted from lung giant cell carcinoma LU65C cells. The optimal concentration in the chemotactic activity of CT/IL-8, equivalent to that of bacterial chemotactic peptide fMet-Leu-Phe (10 nM), was found to be 5 nM. The results show that this chemotaxin is identical to LUCT/IL-8.

The role of bradykinin in mediating ischemic brain edema in rats

BACKGROUND AND PURPOSE

We investigated the hypothesis that bradykinin generation may induce ischemic brain edema in spontaneously hypertensive rats.

METHODS

Cerebral ischemia lasting 3 hours was produced by bilateral common carotid artery occlusion in 67 rats. After the ischemic period, the rats were reperfused. Cerebral water content and energy metabolites (adenosine triphosphate, lactate, and pyruvate), as well as plasma and tissue bradykinin, were measured. Additionally, using the same experimental paradigm, bradykinin synthesis inhibitors (aprotinin [n = 7] and soybean trypsin inhibitor [n = 7]) were administered immediately after ischemia induction to determine the relation of bradykinin generation to the progression of ischemic brain edema.

RESULTS

Cerebral water content increased during the 3-hour ischemic period, peaked at 30 minutes of reperfusion, and declined thereafter. Bradykinin levels in plasma and tissue rose markedly 30 minutes after reperfusion and fell thereafter. The progressive loss of adenosine triphosphate was mirrored by the rise in lactate. In the treated groups, aprotinin and soybean trypsin inhibitor administration significantly attenuated cerebral edema (p < 0.01 and p < 0.05, respectively). The treated groups also showed less lactate accumulation and more adenosine triphosphate preservation than did the controls.

CONCLUSIONS

These results demonstrate that bradykinin levels in plasma and tissue corresponded to cerebral edema progression and that bradykinin suppression decreased edema formation. These novel findings indicate that bradykinin activation augments the progression of ischemic brain edema.

Characterization of 17 human immunodeficiency virus-1 carrier cell lines with T cell, myelomonocyte, or megakaryocyte lineages

Of 29 hematopoietic cell lines tested for susceptibility to human immunodeficiency virus (HIV)-1HTLV-IIIB infection, all CD4+ cell lines became infected. Continuous culturing of infected cell lines resulted in nine HIV-1 carrier cell lines, including, for the first time, an HIV-1 carrier megakaryoblastic cell line, MEG-01/HIV. The immunophenotypic profiles of a total of 17 HIV-1 carrier cell lines (nine newly and eight previously established cell lines) were compared with their respective parental noninfected cell lines. Except for total absence of CD4 expression, the expression of other antigens was variable among the 17 HIV-1 carrier cell lines. Persistent and consistent replication of infectious HIV-1 was detected in all of them in varying quantities. The great variability observed in both the altered marker expression, with respect to that of the noninfected parental cell lines, and in the quantities of persistently produced infectious HIV-1 was, nevertheless, specific to the individual cell lines. Furthermore, the present study demonstrates that there is no apparent correlation in the quantity of HIV-1 produced to either T cell, myelomonocytic cell, or megakaryocytic cell types. Instead, the results suggest that a particular interaction between HIV-1 and individual clonal cell lines may provide insight into the extremely complex immune dysregulation associated with the pathogenesis of acquired immune deficiency syndrome. Thus, the 17 HIV-1 carrier cell lines of diverse origin presented here provide valuable and unique models for further understanding acquired immune deficiency syndrome pathogenesis at the cellular and molecular levels.

Regulation of spontaneous acetylcholine release in the hypothalamic vasopressinergic supraoptic nucleus of a freely moving rat: a study by in vivo microdialysis

We employed a brain microdialysis method to examine the possible regulation of spontaneous acetylcholine (ACh) release in the hypothalamic vasopressinergic supraoptic nucleus (SON) of rats. We monitored the basal ACh release in the SON-microdialysate. The addition of tetrodotoxin (10(-6) M) to the perfusate (saline containing 10(-4) M physostigmine) decreased the basal ACh release. A muscarinic receptor antagonist, atropine (non-selective) or pirenzepine (M1-selective), increased the basal ACh release in a concentration-dependent manner. The maximal increase occurred at 20-40 min after the start of the infusion of antagonists. The ED50 values for the stimulatory effects of atropine and pirenzepine were 9.4 x 10(-8) and approx. 10(-4) M, respectively. The effect of atropine (10(-6) M) was inhibited by simultaneous addition of the muscarinic agonist oxotremorine (10(-5) M). The results showed a negative feedback regulation of the spontaneous ACh release through the activation of muscarinic receptors in the SON. The weak effect of pirenzepine in increasing the ACh release, compared with atropine, suggests that ACh release in the nucleus is mainly regulated by the non-M1-muscarinic receptor subtype.

[Surgical management of tetralogy of Fallot with absent pulmonary valve in infancy]

Between November, 1987 and May, 1990, definitive operation was performed in 7 infants for tetralogy of Fallot with absent pulmonary valve. Preoperative respiratory failure was serious in 5 patients and semi-emergency operation was done. Surgical procedure consisted of closure of ventricular septal defect, reconstruction of right ventricular outflow tract using heterograft valved pericardial roll and plication of aneurysmally dilated pulmonary artery with or without pulmonary artery suspension in 5 infants with severe respiratory distress and heart failure, operated on 26 days to 5 months of age. In the other two less symptomatic infants, operated on at 13 months of age, reconstruction of right ventricular outflow tract was performed by transannular bovine pericardial patch with monocusp. There were no operative death and six infants are doing well 6 months to 3 years postoperatively, but one patient died of prolonged respiratory infection and respiratory failure one year after operation. Postoperative pulmonary arteriogram revealed a 42 to 61 (mean 54) percent reduction in right and left pulmonary artery size in 3 patients who underwent extensive plication of pulmonary artery. We suggest that definitive plication with or without suspension of pulmonary artery, together with closure of ventricular septal defect and reconstruction of right ventricular outflow tract is supposed to eliminate air way obstruction.

Late death after arterial switch operation for transposition of the great arteries

Fifty-nine patients survived for more than 1 month after an arterial switch operation (ASO). Diagnoses in these patients included transposition of the great arteries in 27, transposition of the great arteries with ventricular septal defect in 28, and double-outlet right ventricle in four. There were six late deaths (10%) during the follow-up period, and all of them occurred suddenly and unexpectedly. Four of the six late deaths were in patients who had undergone ASO in the neonatal period. Late deaths occurred from 40 days to 10 months after the operation. Autopsies were performed in all six patients. The cause of these late deaths was acute myocardial infarction. Five patients died of subendocardial infarction resulting from stenosis of the left main coronary artery. On pathologic examination, a fibrocellular intimal thickening was noted at the proximal region of the right and left coronary arteries, which resulted in 80% stenosis on average.

Surgical excision of hemophilic pseudotumor of the ilium

The iliac hemophilic pseudotumor is a rare complication of hemophilia occurring in 1-2% of patients with Factor VIII or Factor IX deficiency. It is frequently disabling and life threatening. This report presents a comparative study of postoperative results of two cases of hemophilic pseudotumor of ilium. One patient undergoing partial resection showed a favorable postoperative course, whereas the patient with complete resection of the pseudotumor died of postoperative bleeding and sepsis. Studies on the postoperative results of these two cases indicate that careful preoperative consideration of tumor size and degree of infiltration is of the utmost importance in operative management. Early excision of tumors eliminates the possibility of endogenous infection. Even partial resection of huge tumors, leaving the lateral wall intact for compression, can promote recovery of functions.

Systemic administration of dynorphin A(1–13) markedly inhibits different behavioural responses induced by cocaine in the mouse

The effects of systemic administration (i.p.) of dynorphin A(1-13) on the cocaine-induced behavioural alterations in the mouse were determined by using multi-dimensional behavioural analyses, based upon a capacitance system. A 1.0 mg/kg dose of cocaine did not influence behaviour, while increasing doses to 3-30 mg/kg produced a significant increment in the frequency of behaviour, such as linear locomotion, circling, rearing and grooming. Although a 1.0 mg/kg dose of dynorphin A(1-13) alone produced a significant decrease in grooming behaviour, larger doses (3.0 and 10.0 mg/kg) of the peptide failed to affect different behaviour. The cocaine (3.0 mg/kg)-induced increases in linear locomotion, circling and rearing behaviour were significantly inhibited by dynorphin A(1-13) (10.0 mg/kg). The inhibitory effects of dynorphin A(1-13) (10.0 mg/kg) were antagonized by the opioid antagonist Mr 2266 (5.6 mg/kg). It is thus possible that the systemic administration of dynorphin A(1-13) inhibits different behavioural responses induced by cocaine through the blood-brain barrier, although the instability of amino acid bonds or the relatively large molecular weight of dynorphin A(1-13), may result in the failure to demonstrate opioid activity by the peptide after systemic administration.

Flow cytometric analysis of effects of cytokines on the expression of varicella-zoster virus glycoproteins

Varicella-zoster virus (VZV)-infected human embryonic fibroblast (HEF) cells were stained with monoclonal antibodies directed against VZV glycoprotein I, II and IV, and then labeled with fluorescein isothiocyanate (FITC)-conjugated goat anti-mouse IgG. The cells were analyzed by flow cytometry. VZV-infected cells expressing VZV glycoproteins were clearly distinguished from uninfected cells. This method was useful for analyzing expression of VZV glycoproteins in different experimental conditions. Interferon alpha, beta, and gamma and tumor necrosis factor (TNF)-alpha reduced the percentage of positive cells and the mean fluorescence intensity of the cells expressing VZV glycoproteins. Interleukin(IL)-1 beta, IL-6 and TNF-beta had little effect on the expression of VZV glycoproteins.

Three distinct candidate point mutations of the von Willebrand factor gene in four patients with type IIA von Willebrand disease

Type IIA von Willebrand disease (vWD) is the most common type II vWD and is characterized by the selective loss of large and intermediate sized multimers. One explanation for this disorder has been postulated to be a qualitative defect in von Willebrand factor (vWF) which results in increased susceptibility to proteolysis at the bond between residues Tyr842 and Met843. Four missense mutations that may cause type IIA vWD have recently been identified near the cleavage site. We analyzed the molecular basis for type IIA vWD in six patients. A 512 bp DNA sequence spanning the proteolytic cleavage site was targeted for PCR amplification and sequencing. We exploited a difference in restriction sites between the vWF gene and the pseudogene and have designed allele-specific oligomer used with PCR to distinguish these two genes. Three candidate missense mutations; Ser743 (TCG)----Leu (TTG), Leu799 (CTG)----Pro (CCG), and Arg834 (CGG)----Trp (TGG) were identified in 4 out of 6 patients. The amino acid substitution at Arg834 has been reported previously, but the other substitutions at Ser743 and Leu799 are novel candidate mutations locating 99 and 43 amino acids to the N-terminal side of the cleavage site, respectively. Our results indicate that amino acid substitutions located relatively distant from the cleavage site may also be involved in type IIA vWD.

Poly(ADP ribose) polymerase-defective mutant cell clone of mouse L1210 cells

By a sequential mutation and selection utilizing N-methyl-N'-nitro-N-nitrosoguanidine as a mutagen, we succeeded in separating a poly(ADP ribose) polymerase-defective mutant clone (Cl-3527) from a mouse L1210 cell clone (Cl-3). The enzyme activity per cell in Cl-3527 cells was only 8% of that in wild type L1210 (CCL 219) cells. Immunoblot analysis of the enzyme protein in crude extracts of the mutant and wild type cells revealed that the enzyme defect was manifested as the loss of a 113-kDa wild type enzyme band in Cl-3527. Further analysis of partially purified enzyme from Cl-3527 by immunoblotting revealed that the molecular size of the enzyme in Cl-3527 was 108 kDa and that the amount of the mutant enzyme protein was markedly decreased in Cl-3527. The mutant enzyme was much more heat-labile than the wild type enzyme but the Km for NAD+, requirements for Mg2+ and nicked DNA, and the inhibition by 3-aminobenzamide, a potent inhibitor of the enzyme, however, were not so different from those of wild type enzyme. The mutant cells showed prolonged doubling time, increased temperature-sensitivity, increased percentage of active enzyme on a treatment of cells at high temperature, and increased expression of plasma membrane NADase, compared to wild type cells. Introduction of wild type ADPR pol gene into Cl-3527 cells partially restored the ADPR pol activity and the heat-resistance.

[Thallium-201 myocardial imaging in cases involving transposition of the great arteries after arterial switch operation]

Forty patients, including 39 with complete transposition of the great arteries and one with double outlet right ventricle, after arterial switch operation were studied with thallium myocardial imaging (TMI). In patients who had post-operative cardiac catheterization, the TMI findings were compared to those of catheterization studies. The right ventricular to left ventricular up-take ratio (RV/LV ratio) shown by TMI correlated well with the right-to-left ventricular systolic pressure ratio. Supravalvular pulmonic stenosis with significant pressure gradient was found in 14 patients, and all of them were noted to have an elevated RV/LV ratio. This ratio was noted to increase progressively on serial TMI studies in most patients who had significant pulmonic stenosis on first postoperative catheterization. Three patients had significant perfusion defects indicating the presence of myocardial damage. Two of them had occlusion of the coronary artery, but the other one had no coronary abnormalities able to be found by coronary arteriography. Air embolism or some other intra-operative transient insults to the myocardium were most likely to have been responsible for the perfusion defects. Thus, TMI was valuable as one of the noninvasive tools for follow-up of patients after arterial switching, particularly for those with late complications such as supravalvular pulmonic stenosis and coronary problems.

Retinoic acid-specific induction of a protein kinase C isoform during differentiation of HL-60 cells

Human promyelocytic leukemia cells (HL-60) were treated with several differentiation inducers, then the changes in the activity of cytosolic protein kinase C (PKC) isoforms were examined by hydroxylapatite chromatography and the species of the isoforms were determined immunologically. In three undifferentiated HL-60 cell lines examined, PKC alpha and beta isoforms were present, but PKC gamma isoform was not detected. When the cells were induced by dimethylsulfoxide, dibutyryl cAMP, or nicotinamide to differentiate into granulocytes, these two PKC isoforms each increased to about 2- to 3-fold. When retinoic acid was used as the inducer, in addition to PKC alpha and beta, a third PKC isoform appeared. This isoform was clearly distinct from rat PKC alpha, beta, and gamma, immunologically. This isoform showed a distinctly lower Ca(2+)-requirement (3 microM) than that of PKC alpha or beta (100 microM) and was more dependent on cardiolipin and phosphatidylethanolamine, compared with PKC alpha, beta, and gamma. These results suggest that while the increases in the activities of PKC alpha and beta isoforms are common in the differentiation program initiated by several inducers, including retinoic acid, the emergence of an unclassified PKC isoform is a retinoic acid-specific process.

A female hemophilia A combined with hereditary coagulation factor XII deficiency: a case report

A 2-year-old Japanese girl with easy bruising and arthropathy was demonstrated to have severe hemophilia A (Factor VIII activity: less than 0.01 U/ml). She had normal 46XX karyotype. Her brother also had hemophilia A, and her mother and grandmother seem to be hemophiliac carriers. Additionally, activated partial thromboplastin time (APTT) of the patient was disproportionately prolonged and there were reduced levels of coagulation factor XII in the patients and members of the maternal trait which are compatible with heterozygous factor XII deficiency. Her father had both normal factor VIII and factor XII levels. Southern blotting analysis of genomic DNA from the propositus and family members with factor VIII and factor XII DNA probes revealed no gross alterations. This patient represents a female hemophilia A combined with heterozygous factor XII deficiency. Nonrandom inactivation of a normal X-chromosome (extreme lyonization) may be the basis for the expression of hemophilia A in this female patient.

Immunohistochemical staining patterns of tenascin in invasive breast carcinomas

Eighty-two cases of primary invasive breast carcinoma and adjacent "normal" mammary glands were examined immunohistochemically for tenascin expression and distribution. Formalin-fixed tissues pretreated with actinase were processed by the avidin-biotin complex method using anti-human tenascin monoclonal antibody (RBC1). In normal mammary glands, tenascin was distributed around the ducts and ductules but not around the acini. In carcinomas, a high incidence of tenascin-positive cases (greater than 67%) was seen with various histological appearances, with the exception of lobular carcinoma where a low incidence was found (25%). Although intense staining was seen around cancerous foci when compared with normal mammary glands, tenascin was often expressed at cancer-mesenchymal junctions with dense fibrotic stroma, but not at junctions with active inflammatory change and a loose fibrotic stroma. Tenascin, expression is not an all-or-none marker for mammary malignancy and the staining pattern suggests either a role in stimulating cancer cells or a host defence mechanism accompanied by a desmoplastic response to them.

Activation of lymphocytes by varicella-zoster virus (VZV): expression of interleukin-2 receptors on lymphocytes cultured with VZV antigen

The expression of human leukocyte antigen (HLA-DR) and interleukin-2 receptor (IL-2R; alpha and beta subunits) was significantly increased in peripheral blood mononuclear cells (PBMC) from varicella-zoster virus (VZV)-seropositive donors when PBMC were cultured with VZV antigen for 6 days. The increased expression of HLA-DR and IL-2R was observed in both CD4+ and CD8+ lymphocytes, which suggests that both types of lymphocytes from VZV-seropositive donors were activated when PBMC were cultured with VZV antigen. Adding anti-IL-2R alpha did not inhibit lymphocyte proliferation in response to VZV antigen, although marked inhibition was obtained by adding anti-IL-2R beta. No IL-2 was detected in the supernatant of PBMC cultured with VZV antigen; however, antibody to IL-2 inhibited lymphocyte proliferation on exposure to VZV antigen. These results indicate that IL-2 and expression of IL-2R beta are essential to lymphocyte activation by VZV antigen.

Intravenous gamma-globulin for Kawasaki disease

We studied the effect of gamma-globulin (IVGG) and aspirin (ASA) on the development of the coronary artery lesions (CAL) of Kawasaki disease (KD) in three different protocols. Within 29 days of the onset of KD the echocardiographic evidence of CAL had developed in 39-42% of the patients in the ASA group, but only in 13.7-20.8% of the patients treated with IVGG (200 or 400 mg/kg X 5). In long-term follow-up observation of CAL of these patients the evidence of CAL in both the ASA and the IVGG group regressed gradually; however, the residual rate of CAL was significantly low in the IVGG group at all times up to 24 months after onset. These facts suggest that when using IVGG for KD, we should select a dose of intact gamma-globulin, 1,000 mg/kg or more in total, to prevent the occurrence of CAL. We have demonstrated not only a significant reduction in the occurrence of CAL in patients treated with IVGG but a reduction in the residual rate of CAL for two years as compared with those treated by ASA.