Can scores on alexithymia distinguish patients with peptic ulcer and erosive gastritis?

This study examined alexithymic characteristics of 57 patients with peptic ulcer and 198 with erosive gastritis. The prevalence rate of alexithymia, as measured on the 20-item Toronto Alexithymia Scale, was significantly higher for the peptic ulcer group (51%) than for the erosive gastritis group (21%). Scores of the Profile of Mood States were significantly higher for the peptic ulcer group than for the erosive gastritis group. The alexithymia scores were significantly correlated with the scores on the Profile of Mood States. However, discriminant analysis indicated that the alexithymia scores could account for significant additional variance beyond mood states as measured by the Profile of Mood States.

Quantitative analysis of interferon alpha/beta receptor mRNA in the liver of patients with chronic hepatitis C: correlation with serum hepatitis C virus-RNA levels and response to treatment with interferon

We analysed the expression of interferon (IFN) alpha/beta receptor mRNA in the liver of patients with chronic hepatitis C and examined the relationship between the expression of this receptor gene and the level of hepatitis C virus (HCV)-RNA as well as the response to 16 weeks of 6 x 10(6) units IFN. The mean level of IFN alpha/beta receptor mRNA in patients with chronic HCV infection (expressed as delta cycle; 10.8 +/- 1.9 (mean +/- SD); n = 39) was significantly higher than that of control subjects (9.4 +/- 0.5; n = 6; P < 0.01). There was a significant negative correlation between the level of IFN alpha/beta receptor mRNA and serum HCV-RNA in 39 patients with chronic hepatitis C (R = -0.546; P < 0.01). The mean level of IFN alpha/beta receptor mRNA in six patients who showed a complete response to IFN therapy (12.3 +/- 1.6) was higher than that of 15 patients who failed to respond to therapy (10.1 +/- 1.5; P < 0.01). Our results are consistent with the suggestion that the anti-viral activity of IFN depends on the level of the IFN alpha/beta receptor on hepatocytes in patients with chronic hepatitis C.

Acute myelitis associated with hyperIgEemia and atopic dermatitis

We herein describe 4 adult patients with upper cervical myelitis presenting with paresthesia in the distal parts of all four limbs and who also all had hyperIgEemia. Two of them had full-blown atopic dermatitis at the time of neurologic illness, while the others had a preceding history of atopic dermatitis. All showed high signal intensity lesions at either the C3 or C4 segment, which mainly affected the posterior column on the T2-weighted spinal cord magnetic resonance imaging. All patients had specific IgE antibodies to two mite antigens and their onset of myelitis coincided with the seasonal increase of the mite antigens in Japan. Therefore, it is possible that the atopic conditions with hyperIgEemia in these patients may thus have contributed to the development of myelitis.

Majonoside-R2, a major constituent of Vietnamese ginseng, attenuates opioid-induced antinociception

The effects of majonoside-R2 on antinociceptive responses caused by the mu-opioid receptor agonist morphine and the selective kappa-opioid receptor agonist U-50, 488H were examined by the tail-pinch test in mice. Intraperitoneal (IP) or intracerebroventricular (ICV) injection of majonoside-R2 (3.1-6.2 mg/kg, IP or 5-10 micrograms/mouse, ICV) and diazepam (0.1-0.5 mg/kg, IP or 0.5-1.0 microgram/mouse, ICV), as well as an opioid receptor antagonist naloxone (2 mg/kg, IP or 5 micrograms/mouse, ICV), dose-dependently attenuated the antinociception caused by subcutaneously administered morphine and U-50,488H. Moreover, when co-administered ICV or intrathecally (IT) with morphine (4 micrograms/mouse) or U-50,488H (60 micrograms/mouse), majonoside-R2 (5-20 micrograms/mouse) also exhibited antagonism against the antinociceptive action of these opioid receptor agonists in the tail-pinch test. The inhibitory effects of majonoside-R2 (10 micrograms/mouse, ICV) and diazepam (1 microgram/mouse, ICV) were reversed by flumazenil (2.5 micrograms/mouse, ICV), a selective benzodiazepine receptor antagonist, and picrotoxin (0.25 microgram/mouse, ICV), a GABA-gated chloride channel blocker. These results suggest that majonoside-R2 attenuates the opioid-induced antinociception by acting at the spinal and supraspinal levels, and that the GABAA receptor complex at the supraspinal level is involved in the effect of ICV administered majonoside-R2.

Two adult cases of primary small bowel volvulus: usefulness of computed tomographic diagnosis

Small bowel volvulus is usually secondary to conditions such as malrotation, congenital bands, postoperative adhesions, and internal hernias. Primary small bowel volvulus in an adult is rare, and only 14 cases had been reported in Japan as of 1994. Preoperative diagnosis is difficult, because clinical examinations and plain films are of limited diagnostic value. In our cases, CT showed signs of small bowel volvulus such as a U-shaped configuration or radial distribution of distended and fluid-filled loops of the small bowel converging toward the point of torsion, tightly twisted mesentery around the point of torsion (whirl sign), fusiform tapering loop (triangular sign in the cross section or beak sign in the longitudinal section), and signs of bowel ischemia or infarct such as attached mesenteric fluid and blurred mesenteric folds. CT enabled us to diagnose not only small bowel volvulus but also bowel ischemia or infarct.

Flat cancers do develop in the polyp-free large intestine

PURPOSE AND BACKGROUND

Qualitative and quantitative analysis of many flat early cancers that have been discovered during the last decade led us to recognize that a flat route of cancer development de novo is as important a route as the polypoid one. We aim to prove through a longitudinal study that these flat early cancers indeed develop in flat mucosa and not in an adenomatous polyp.

METHODS

From January 1, 1990, to July 31, 1994, 554 patients underwent at least two colonoscopies. These patients consisted of 364 males, and average age was 59 years. We searched for flat early cancers developing in polyp-free colorectal mucosa on or after a second colonoscopy. Polyp-free mucosa here means an intestinal segment proved to possess no adenomatous polyp during the preceding colonoscopies, irrespective of the presence of polyps elsewhere.

RESULTS

Four flat early cancers were found developing in polyp-free colonic mucosa in four patients. Average age of the patients was 67 years. Locations of the cancers were the transverse (3) and descending colons (1). The shapes were all depressed, and average size of the lesions was 11 mm. Two lesions were endoscopically resected, and two by surgery.

CONCLUSION

These four depressed cancers developing in polyp-free mucosa show that flat early colorectal cancers do arise de novo and not from an adenomatous polyp having collapsed on itself.

Long-term, high dose interferon-alpha treatment in HTLV-I-associated myelopathy/tropical spastic paraparesis: a combined clinical, virological and immunological study

The efficacy of long-term, high dose interferon-alpha (IFN-alpha) therapy was studied in seven patients with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). IFN-alpha was administered at a dose of 6 x 10(6) international units daily for the initial 2 weeks and thereafter 3 times a week for the following 22 weeks. Five patients showed a sustained improvement in motor performance during and up to 6 months after the completion of IFN-alpha. The other patient who responded to IFN-alpha initially dropped out at 3 months because of depression, while another patient first deteriorated and thereafter dropped out. In the six responders, the absolute number of peripheral blood lymphocytes (PBL) harboring the HTLV-I genome as evaluated by the quantitative polymerase chain reaction method decreased significantly during the therapy period (28.6 +/- 16.6% reduction, P = 0.0083), whereas the one deteriorated patient showed a 2.5-fold increase in HTLV-I-infected cells. The autoproliferation of CD4+ T clone cells from a single cell culture was markedly depressed even after the cessation of IFN-alpha in the responders who completed long-term IFN-alpha therapy. In addition, the CD8+DR+ T cells in the peripheral blood and soluble IL-2 receptor levels in the sera increased significantly during the therapy in all patients (P = 0.0431 and P = 0.0041, respectively). Therefore, the results of our study suggested that both the reduction of HTLV-I proviral DNA load and immunomodulation by long-term IFN-alpha therapy contributed to its sustained clinical benefits.

Preconditioning with 15-minute ischemia extends myocardial infarct size after subsequent 30-minute ischemia in rabbits

Ischemic preconditioning (PC) induced by 1 cycle of 5-min coronary occlusion and 5-min reperfusion limits infarct size (IS) after 30-min sustained ischemia in rabbits. The shortest ischemic period that induces the PC effect in rabbits is 3 min. To establish the maximum ischemic period to induce a beneficial PC effect, we examined the effect of PC periods of 10 and 15 min on IS after sustained ischemia. The IS in control rabbit hearts after 30 min of sustained occlusion of the left anterolateral coronary artery and 48-h reperfusion was compared with that of hearts treated as follows before being subjected to PC: 5-min occlusion and 5-min reperfusion; 10-min occlusion and 5-min reperfusion; or 15-min occlusion and 5-min reperfusion. In addition, the IS after 15-min or 45-min occlusion and 48-h reperfusion was measured. There was no significant difference in blood pressure, heart rate, or area at risk (AAR) among the rabbits in 5 groups. The IS measured histologically was 40 +/- 4% of AAR in the control, 10 +/- 3% after 5-min PC, and 12 +/- 2% after 10-min PC. However, in the 15-min PC group, the IS was 77 +/- 4% of AAR, which was significantly larger than that of the controls, but similar to that of hearts subjected to 45-min ischemia and reperfusion (67 +/- 3%). As 15 min of preconditioning ischemia alone caused small infarcts (18 +/- 1% of AAR), the infarcts caused by sustained ischemia per se in the 15-min PC group was estimated to be 72 +/- 5% of AAR, which was still significantly higher than in the control groups. We conclude that the maximum period of preconditioning ischemia that induces cardioprotection in rabbits is 10 min. When the ischemic period is longer than this, the IS after sustained ischemia is increased rather than restricted. However, the infarcted size in the 15-min PC group was not higher than that in the group subjected to 45-min continuous ischemia. This may be a major limitation for any clinical application of PC.

Primary human immunodeficiency virus type 1 viremia and central nervous system invasion in a novel hu-PBL-immunodeficient mouse strain

We established four new mouse strains with defective T and B cells as well as defects in innate immunological reactions using an NK cell depletion antibody and showed that all mutant mouse strains efficiently received human peripheral blood leukocyte (PBL) engraftment (hu-PBL-scid mice). Higher levels of human immunodeficiency virus type 1 (HIV-1) replication were observed in these new hu-PBL-scid mice than in conventional hu-PBL-C.B-17-scid mice. In one particular strain, hu-PBL-NOD-scid mice, high levels of HIV-1 viremia (more than 10(6) 50% infectious doses per ml) were detected after infection with HIV-1. The plasma viral load was about 100 to 1,000 times higher than that observed in other hu-PBL-scid mice infected with HIV-1. Although high-level viremia did not correlate with the total amount of HIV-1 RNA in cells from infected mice, high levels of free virions were detected only in hu-PBL-NOD-scid mice. HIV-1 viremia induced systemic HIV-1 infection involving the liver, lungs, and brain. PCR in situ hybridization confirmed that HIV-1-infected cells invaded the brain tissue of the hu-PBL-NOD-scid mice. Our results suggest that the genetic background, including innate immunity, is critical in the development of primary HIV-1 viremia and subsequent central nervous system invasion with HIV-1. The hu-PBL-NOD-scid mouse represents a useful model for the study of the pathogenesis of HIV-1 in vivo, especially brain involvement, and therapy of primary HIV-1 viremia.

Cucurbitane-type compounds from Hemsleya carnosiflora antagonize ecdysteroid action in the Drosophila melanogaster BII cell line

The ecdysteroid agonist and antagonist activities of 3 cucurbitanes, 2 cucurbitane glycosides and 2 cucurbitacins isolated from Hemsleya carnosiflora (Cucurbitaceae) have been determined in the Drosophila melanogaster BII bioassay. Carnosiflogenins A and C and carnosiflosides II and VI possess antagonistic activity. Carnosiflogenin A was also found to induce the formation of spindle-shaped cells with high frequency in both the agonist and antagonist assays. At 10(-3) M, carnosiflogenins B and C were cytotoxic, 23,24-Dihydrocucurbitacin F and 25-acetoxy-23,24-dihydrocucurbitacin F are also antagonistic at high concentrations. The concentration dependencies of the antagonistic activities of these two cucurbitacins, carnosiflosides II and VI and carnosiflogenin C are presented. The biological and ecological significance of these results are discussed in relationship to the concentrations present in the rhizomes of H. carnosiflora.

Increased incidence of cytomegalovirus (CMV) infection and CMV-associated disease after allogeneic bone marrow transplantation from unrelated donors. The Fukuoka Bone Marrow Transplantation Group

Cytomegalovirus (CMV) infection and CMV-associated disease were monitored using the CMV antigenemia assay in 72 patients who received allogeneic bone marrow transplantation (BMT), and their incidences were compared between related and unrelated donor transplant patients. The incidence of CMV infection after BMT was significantly higher in patients who received transplants from HLA-matched unrelated donors than from HLA-matched sibling donors (87% vs 53%, P < 0.05). CMV-associated disease developed in 73% of unrelated and in 14% of sibling donor transplant patients (P < 0.01). The peak levels of CMV antigenemia were significantly higher in unrelated donors than in sibling donor transplant patients (16 vs 1 CMV antigen-positive cells per 50000 WBCs, P < 0.01). The median number of CMV antigen-positive cells on first detection was also significantly higher in unrelated donor transplant patients (15 vs 1, P < 0.01). The detection of CMV antigen-positive cells preceded the development of CMV-associated disease in 18% of unrelated donor transplant patients, suggesting a lower predictive value of CMV antigenemia for subsequent CMV-associated disease in unrelated donor BMT. Careful monitoring and further studies are needed for the early diagnosis and prevention of CMV-associated disease in unrelated donor BMT.

Acute cellular damage in medial smooth muscle cells following experimental coronary angioplasty in dog. Damage of cytoskeleton and apoptosis

The purpose of the present study was to investigate the responses of the cytoskeleton and the presence of apoptosis following acute damage of medial smooth muscle cells after percutaneous transluminal coronary angioplasty (PTCA). We killed 20 dogs, 4h and 4 days after PTCA (n=10 in each group). Ten dogs without PTCA were used as controls. PTCA was achieved by inflating balloon catheters two times, for 60s each time, to 150 PSI, followed by a 60-s deflation. The coronary artery obtained from each dog was fixed in 10% formalin neutral buffer solution. The response of the cytoskeleton was studied immunohistochemically. using monoclonal antibodies against alpha-smooth muscle actin, vimentin, and beta-tubulin. Proliferation was determined by proliferating cell nuclear antigen (PCNA), and DNA fragmentation indicating apoptosis was determined by in situ nick end labeling. Four h after PTCA, endothelial denudation, microscopic mural thrombi, rupture of the internal elastic membrane, medial tear, and stretched smooth muscle cells with nuclei were found at the PTCA site. An immunohistochemical study revealed diffuse reduction or defective immunoreactivity in each cytoskeleton of medial smooth muscle cells, 4h after PTCA. The extent of positive immunoreactivity in the media decreased to 45+/-11% in alpha-smooth muscle actin (control value, 80+/-10%), 9+/-8% in vimentin (control value, 83+/-9%), and 10+/-7% in beta-tubulin (control value, 75+/-8%). The decrease was more significant in vimentin and beta-tubulin than in alpha-smooth muscle actin. Four days after PTCA, the features were diffuse cell death and the focal proliferation of medial cells, as well as macroscopic intramural thrombi. The extent of positive immunoreactivity in the media was 15+/-9% in alpha-smooth muscle actin, 13+/-7% in vimentin, and 14+/-11% in beta-tubulin. There were no smooth muscle cells with positive PCNA (0%) in the control and 4-h groups, but 4 days after PTCA the percentage was 19+/-4%. In situ nick end labeling showed DNA fragmentation in the nuclei of medial smooth muscle cells at a rate of 15+/-5% 4h after PTCA and at 8+/-6% 4 days after PTCA, compared with 0% in the control. We concluded that severe damage of the cytoskeleton and medial smooth muscle cell death were induced immediately after PTCA, followed by proliferation of smooth muscle cells. Apoptosis may be partially involved in the death of smooth muscle cells, in addition to necrosis. Damage to the cytoskeleton and apoptosis may play an important role in the pathogenesis of acute lesions and the proliferation of smooth muscle cells after PTCA.

Involvement of supraspinal GABA receptors in majonoside-R2 suppression of clonidine-induced antinociception in mice

Majonoside-R2 (MR2) is a major constituent of Vietnamese ginseng (Panax vietnamensis, Ha et Grushv. Araliaceae) that is known to exhibit antagonistic activity against opioid-induced antinociception. In this study, we investigated the effect of MR2 on the antinociception caused in mice by the alpha2-adrenoceptor agonist clonidine, and elucidated the role of supraspinal GABAergic systems in this effect of MR2. The systemic administration of clonidine (0.5-2.5 mg/kg, s.c.) dose-dependently suppressed the nociceptive response of mice in the tail-pinch and hot-plate tests. The intraperitoneal (i.p.), intracerebroventricular (i.c.v.) or intrathecal (i.t.) administration of idazoxan (a selective alpha2-adrenoceptor antagonist) significantly antagonized the antinociceptive effect of clonidine in both tests. MR2 administered systemically (1.5-6.2 mg/kg, i.p.) or centrally (5-10 microg/mouse, i.c.v. or i.t.) dose-dependently antagonized the clonidine (1 mg/kg, s.c.)-induced antinociception in the tail-pinch test but not in the hot-plate test. The antagonistic effect of i.c.v. MR2 on the systemic clonidine-induced antinociception in the tail-pinch test was significantly reversed by i.c.v. administrations of the selective benzodiazepine receptor antagonist flumazenil (5 microg/mouse) and the GABA(A) antagonist picrotoxin (0.25 microg/mouse). These results suggest that the supraspinal GABA(A)/benzodiazepine receptors are involved in the antagonistic effect of MR2 on the clonidine-induced antinociception in the tail-pinch test in mice.

Majonoside-R2 reverses social isolation stress-induced decrease in pentobarbital sleep in mice: possible involvement of neuroactive steroids

Majonoside-R2 (MR2) is a major ocotillol-type saponin constituent of Vietnamese ginseng. We investigated the effect of MR2 on the social isolation stress-induced decrease in pentobarbital sleep in mice, and elucidated the possible involvement of neurosteroidal sites of the GABA(A) receptor complex in the pharmacological activity of MR2. MR2 (3.1-6.2 mg/kg, i.p. or 5-10 microg, i.c.v.) dose-dependently reversed the decrease in pentobarbital sleep caused by social isolation stress to the level of sleep in the group-housed mice, but it had no effect on pentobarbital sleep in group-housed mice. Allotetrahydrodeoxycorticosterone (5alpha-pregnane-3alpha,21-diol-20-one, allo-THDOC; 12.5 microg, i.c.v.), the positive allosteric modulator of the GABA(A) receptor, and alpha-helical CRF(9-41) (alpha hCRF; 25 microg, i.c.v.), the corticotropin-releasing factor (CRF) antagonist, also reversed the decrease in pentobarbital sleep caused by social isolation stress. The reversing effects of i.c.v. MR2 and i.c.v. allo-THDOC on the decrease in pentobarbital sleep in isolated mice were significantly attenuated by pregnenolone sulfate (10 microg, i.c.v.), the steroidal negative allosteric modulator of the GABA(A) receptor. In contrast, when injected i.c.v., MR2, as well as allo-THDOC and alpha hCRF, significantly reversed the decrease in pentobarbital sleep induced by pregnenolone sulfate (10 microg, i.c.v.) and CRF (10 microg, i.c.v.) in group-housed mice. These results suggest that the reversing effect of MR2 on the social isolation stress-induced decrease in pentobarbital sleep is mediated by the neurosteroid site on the GABA(A) receptor complex in mice.

[Comparison between monotherapy with imipenem/cilastatin sodium (IPM/CS) and combinations of IPM/CS and other drugs for treating bacterial infections in patients with hematopoietic disorders]

One hundred and nine patients with infections concurrent with hematopoietic disorders were treated with imipenem/cilastatin sodium (IPM/CS) either alone (IPM/CS monotherapy) or in combination with other antimicrobial drugs (IPM/CS combination therapy). The following results were obtained. 1. One hundred and nine patients were allocated at random to two groups: 53 patients to IPM/CS monotherapy and 56 patients to IPM/CS combination therapy. Fourteen patients (6 and 8 in the 2 groups, respectively) were excluded from the clinical evaluation. There were not significant differences between the two groups with respect to the background. 2. The efficacy rates of the 2 treatments against bacterial infections were as follows: in the IPM/CS monotherapy group, 62.5% in 8 patients with sepsis, 75.0% in 23 patients with fever of undetermined origin (FUO), 50.0% in 10 patients with pneumonia, and 68.3% in the 47 patients, and in the IPM/CS combination group, 85.7% in 7 patients with sepsis, 63.6% in 24 patients with FUO, 50.5% in 8 patients with pneumonia, and 67.4% in the 48 patients. The differences between the two groups were not significant. 3. Among the drugs used in combination with IPM/CS, antibiotics other than penicillins, cephalosporins, and aminoglycosides were used in 12 patients and a high efficacy rate of 91.7% was obtained. 4. Bacteriologically, 19 and 17 strains were isolated from the IPM/CS monotherapy and combination therapy groups respectively, and the eradication rates were 100% and 88.9% respectively. 5. Side effects were noted in 2 patients in the IPM/CS monotherapy group and 7 in the combination therapy group, but all of these resolved after discontinuation or completion of the treatment. The efficacies against severe bacterial infections in the presence of hematopoietic disorders were not different between IPM/CS alone and IPM/CS in combination with other antibiotics. Adverse reactions were uncommon with the monotherapy.

[Effect of FUT-187, oral serine protease inhibitor, on inflammation in the gastric remnant]

Excessive enterogastric reflux following partial gastrectomy is believed to be responsible for the cause of inflammation in the gastric remnant. We examined the effect of FUT-187, a synthetic serine protease inhibitor, on symptoms and endoscopic findings in 33 patients who were diagnosed endoscopically as postgastrectomy gastritis. Patients took 50 mg FUT-187 orally after each meal and at bedtime for 8 weeks. Before treatment, 30 patients (91%) suffered from several symptoms including regurgitation and/or bitter taste in the mouth (49%), epigastric pain (42%) and nausea (36%). From endoscopic observation, erythema was detected in 32 patients, edema in 23 patients and erosion and/or ulcer in 9 patients. After treatment the global improvement rating for subjective symptoms was 76.7% (23/30) and the improvement of endoscopic findings was 63.6% (21/33). Diarrhea was observed in one patient but could be easily controlled by discontinuation of the drug. Our results suggest that FUT-187 can be a useful drug for the treatment of postgastrectomy gastritis with its efficacy and safety.

Identification of arginyl residues located at the ATP binding site of sarcoplasmic reticulum Ca2+-ATPase. Modification with 1,2-cyclohexanedione

Sarcoplasmic reticulum vesicles were treated with 1, 2-cyclohexanedione (CHD) in sodium borate (pH 8.0). The Ca2+-ATPase activity was completely inhibited. Inhibition of Mg.ATP and Mg.ADP binding to the high affinity ATP binding site as well as inhibition of phosphorylation with ATP occurred simultaneously with the inhibition of the Ca2+-ATPase activity. Phosphorylation with acetyl phosphate was not inhibited. The Ca2+-ATPase was strongly protected by Mg.ATP, Mg.ADP, and Mg.AMP against this inhibition. Binding of acetyl phosphate or Pi to the enzyme gave no protection. Phosphorylation with acetyl phosphate also had no protective effect. Peptide mapping of the tryptic digests, detection of peptides containing CHD-modified arginyl residues with Girard's reagent T, and sequencing revealed that Arg-489, Arg-505, and Arg-678 were modified with CHD. Arg-489 and Arg-678 were almost completely protected by Mg.ATP against this modification, but partially protected by prelabeling with fluorescein 5-isothiocyanate, which occupies the adenosine binding region in the ATP binding site. In contrast, Arg-505 was slightly protected by Mg.ATP and almost completely protected by prelabeling with fluorescein 5-isothiocyanate. Taken together, these findings suggest that Arg-489 and Arg-678 are located in or near the region occupied by the triphosphate moiety of ATP, either or both of these residues being in or close to the region occupied by the alpha-phosphoryl group in the high affinity ATP binding site and involved in the CHD-induced inhibition of this enzyme and that Arg-505 is very close to (but slightly out of) the adenosine binding region in the ATP binding site. The acetyl phosphatase activity and phosphorylation with Pi were also inhibited by the CHD treatment, but the inhibitions were considerably slower than those described above. This suggests that the arginyl residues involved in these inhibitions are distinct from that involved in the inhibition of the Ca2+-ATPase activity.

Taste-modifying triterpene glycosides from Staurogyne merguensis

Five new oleanane-type triterpene glycosides named strogins 1-5 were isolated from leaves of Staurogyne merguensis. Their structures were determined on the basis of chemical and spectral evidence. After strogins 1, 2 and 4 were held in mouth, water elicited a sweet taste. On the other hand, strogins 3 and 5 had no activity. The structure-activity relationship is discussed.

Immunological and chemical types of reversible hypothyroidism; clinical characteristics and long-term prognosis

OBJECTIVE

Spontaneous improvement occurs in about one-half of patients with primary hypothyroidism who reside in an iodine-sufficient area of Japan, but the pathogenetic factors related to reversible hypothyroidism are still not fully understood. We therefore investigated the clinical features and prognosis of patients with reversible hypothyroidism with or without iodine excess and antithyroid antibodies.

DESIGN

Amelioration of hypothyroidism was diagnosed when the elevated serum TSH concentrations (serum TSH concentration > or = 40 mU/l) decreased by 50% or more during an iodine restriction period of 2-15 weeks without replacement therapy. Reversible hypothyroidism occurred in a post-partum group (n = 20) and a non-post-partum group (n = 91). The latter was then further classified into chemical (n = 28), immunological (n = 20), and mixed (n = 43) groups, according to the presence of iodine excess (serum non-hormonal iodine level > 50 micrograms/l or a history of excess iodine ingestion), antithyroid autoantibody, or both, respectively.

MEASUREMENTS

Clinical characteristics and long-term prognosis were compared among the four groups. The rate at which hypothyroidism recovered was expressed as the number of days required for a 50% decrease in the serum TSH concentration. The level of thyroid echogenicity was measured by 10-MHz ultrasonography.

RESULTS

In the chemical group, the mean age, male:female ratio, and serum non-hormonal iodine concentrations were all higher than those in the immunological group. The estimated rate at which hypothyroidism recovered was rapid (6.1 +/- 3.1 (mean +/- SD) days), the levels of thyroid echogenicity were near normal, and a histological examination (n = 7) revealed either colloid goitre or a normal thyroid in the chemical group. In the immunological and post-partum groups, the recovery rate was slow (16.8 +/- 9.6 days and 16.2 +/- 5.8 days, respectively). The levels of thyroid echogenicity were markedly reduced but increased after the spontaneous recovery of the thyroid function in both groups. Aspiration cytology suggested lymphocytic infiltration in all patients examined in the immunological (n = 6) and post-partum groups (n = 4). Relapse to overt hypothyroidism was observed more frequently in the immunological (38%) and mixed groups (35%) than in the chemical group (5%).

CONCLUSION

Thyroid damage was more severe, recovery slower and the rate of relapse higher in the immunological than in the chemical type of reversible hypothyroidism.

Ovarian and hemolymph ecdysteroids in the terrestrial isopod Armadillidium vulgare (Malacostracan Crustacea)

Ovarian and hemolymph ecdysteroids in Armadillidium vulgare were analyzed at four stages of ovarian maturation through the reproductive molt cycle using high-performance liquid chromatography and radioimmunoassay. The major ecdysteroids in the ovaries and hemolymph of A. vulgare were 20-hydroxyecdysone and ecdysone in free and conjugated forms. The concentration of ovarian ecdysteroids reached a maximal level in maturing ovaries during stage D (premolt period) of the molt cycle. At the end of stage D, a high level of ecdysteroids was detected in fully matured ovaries. On the other hand, hemolymph ecdysteroid titers in reproductive females showed a peak during stage D and declined rapidly to a low level at the end of stage D. No appreciable differences in the amounts of hemolymph ecdysteroids and in molecular species of them were apparent in females in reproductive and nonreproductive molt cycles. The amounts of hemolymph ecdysteroids were about fivefold higher in females than those in males. These ecdysteroids may have a role in controlling ovarian development in female A. vulgare.

Western versus Asian types of multiple sclerosis: immunogenetically and clinically distinct disorders

The polymorphism of HLA-DRB1, -DRB3, and -DRB5 genes as well as magnetic resonance images of the brain and spinal cord were studied in 57 Japanese patients with multiple sclerosis (MS). Twenty-three patients clinically displayed selective involvement of the optic nerve and spinal cord and were classified as having Asian-type MS. The other 34 patients had disseminated central nervous system involvement and were classified as having Western-type MS. Patients with Asian-type MS had fewer brain lesions shown by magnetic resonance imaging, but more gadolinium-enhanced spinal cord lesions than did patients with Western-type MS (47% vs 17%). Furthermore, the DR2-associated DRB1*1501 allele and DRB5*0101 allele were associated with Western-type MS (41.2%), but not with either Asian-type MS (0%) or healthy control subjects (14.2%). Heterogeneity in the immunogenetic background and in the magnetic resonance imaging features between the two subtypes of MS thus suggests the presence of two etiologically distinct diseases in Asians.

Indomethacin treatment during initial period of acetic acid-induced rat gastric ulcer healing promotes persistent polymorphonuclear cell-infiltration and increases future ulcer recurrence. Possible mediation of prostaglandins

The study was performed to examine whether indomethacin administered during the initial period of acetic acid-induced gastric ulcer healing affects future ulcer recurrence. Gastric ulcers were produced in rats by subserosal injection of acetic acid. Indomethacin (1 mg/kg/day, orally) administered either alone or concomitant with ornoprostil (50 micrograms/kg/day, orally) was started on the fourth day and continued for 56 days. In rats whose ulcer healed at the 90th day after production of ulcer, endoscopy was done every 30 days to examine recurrence of ulcer. Gastric specimens were obtained 10, 30, 60, 90, and 240 days after ulcer production for histology, to quantitate the height of regenerated mucosa, thickness of fibrous tissue, degree of polymorphonuclear cell infiltration, and PAS-positive cells. Cumulative ulcer recurrence rate was significantly higher in rats initially treated with indomethacin than in controls. Increased polymorphonuclear cell infiltration was the major histologic abnormality persisting after cessation of indomethacin. Ornoprostil reversed these abnormalities caused by indomethacin. In conclusion, the administration of indomethacin during the initial period of the ulcer healing promoted persistent polymorphonuclear cell infiltration and increased ulcer recurrence rates, possibly via a prostaglandin-dependent mechanism.

Bacopasaponin D--a pseudojujubogenin glycoside from Bacopa monniera

A new dammarane-type pseudojujubogenin glycoside, bacopasaponin D, has been isolated from the reputed Indian medicinal plant Bacopa monniera and defined as 3-O-[alpha-L-arabinofuranosyl(I-->2)beta-D-glucopyranosyl]pseudojujub ogenin by spectroscopic methods and some chemical transformations. The 13C signals of the saponin were assigned by DEPT, 1H-1H COSY and HSQC techniques.