A comparative study of intragastric acidity during post-breakfast and pre-dinner administration of low-dose proton pump inhibitors: a randomized three-way crossover study

BACKGROUND

The absorption and bioavailability of proton pump inhibitors is influenced by food intake. Proton pump inhibitors bind to the parietal cell active proton pump, which is maximally stimulated after dinner: usually the largest meal of the day. However, it has not been fully clarified whether the efficacy of proton pump inhibitors differs between post-breakfast and pre-dinner dosing.

AIM

To perform a pH-monitoring study to clarify this issue for two low-dose proton pump inhibitors.

SUBJECTS AND METHODS

The subjects were 20 healthy male volunteers (seven Helicobacter pylori-positive and 13 H. pylori-negative), who were divided into two groups of 10 and administered 15 mg lansoprazole or 10 mg rabeprazole, respectively. All subjects underwent ambulatory intragastric 24-h pH- monitoring under three conditions allocated randomly: (i) without medication, (ii) seventh day of post-breakfast administration and (iii) eighth day of pre-dinner administration of each drug.

RESULTS

There was no significant difference in the percentage time during which pH > or =4.0 in the 24-h period between post-breakfast and pre-dinner administration of both drugs (56.6% vs. 55.8%; P = 0.557), although intragastric acidity during administration of both drugs was significantly lower than that without medication.

CONCLUSIONS

The timing of drug administration does not significantly influence the efficacy of low-dose proton pump inhibitors.

Interobserver agreement on classifying endoscopic diagnoses of nonerosive esophagitis

BACKGROUND AND STUDY AIMS

The majority of patients with gastroesophageal reflux disease in Japan have low-grade esophagitis, including minimal changes. A modified Los Angeles classification of esophagitis, consisting of erosive esophagitis (grades A - D) and nonerosive esophagitis (grades M and N) has been proposed and is in clinical use in Japan. However, it is unclear whether nonerosive esophagitis with only undemarcated mucosal discoloration (grade M) is clinically significant, since interobserver variations in classification have not been investigated. The aim of the present study was therefore to evaluate interobserver variance and diagnostic agreement in the diagnosis of nonerosive esophagitis (grades M and N).

MATERIALS AND METHODS

A total of 84 endoscopists were enrolled to assess the grade of esophagitis in 30 patients by viewing endoscopic images of the gastroesophageal junction. The images were projected onto a screen, and all of the endoscopists reviewed them concurrently. The diagnosis was selected from the following three categories in the modified Los Angeles classification: grades N, M, or A. The endoscopists were grouped according to their experience, whether they had a board license, and whether they had received specialist training in esophagitis. The kappa coefficient of reliability was calculated.

RESULTS

The kappa coefficient of reliability for all the endoscopists in the diagnosis of cases of grade M and N nonerosive esophagitis was unacceptably low at 0.22 (95 % CI, 0.21 - 0.24). Endoscopists with a board license and those who had completed a special esophagitis diagnostic course had slightly higher kappa values (0.26; 95 % CI, 0.23 - 0.30 and 0.29; 95 % CI, 0.26 - 0.32), respectively.

CONCLUSIONS

Interobserver agreement on the endoscopic diagnosis of nonerosive esophagitis (grades M and N) is too low to be of clinical value.

Evaluation of modified crystal violet chromoendoscopy procedure using new mucosal pit pattern classification for detection of Barrett's dysplastic lesions

BACKGROUND

Pit pattern diagnosis is important for endoscopic detection of dysplastic Barrett's lesions, though using magnification endoscopy can be difficult and laborious. We investigated the usefulness of a modified crystal violet chromoendoscopy procedure and utilised a new pit pattern classification for diagnosis of dysplastic Barrett's lesions.

METHODS

A total of 1,030 patients suspected of having a columnar lined oesophagus were examined, of whom 816 demonstrated a crystal violet-stained columnar lined oesophagus. The early group of patients underwent 0.05% crystal violet chromoendoscopy, while the later group was examined using 0.03% crystal violet with 3.0% acetate. A targeted biopsy of the columnar lined oesophagus was performed using crystal violet staining after making a diagnosis of closed or open type pit pattern with a newly proposed system of classification. The relationship between type of pit pattern and histologically identified dysplastic Barrett's lesions was evaluated.

RESULTS

Dysplastic Barrett's lesions were identified in biopsy samples with an open type pit pattern with a sensitivity of 96.0%. Further, Barrett's mucosa with the intestinal predominant mucin phenotype was closely associated with the open type pit pattern (sensitivity 81.9%, specificity 95.6%).

CONCLUSIONS

The new pit pattern classification for diagnosis of Barrett's mucosa was found to be useful for identification of cases with dysplastic lesions and possible malignant potential using a crystal violet chromoendoscopic procedure.

Dynamical aspects of the photoinduced phase transition in spin-crossover complexes

We report a dynamical study on the photoinduced cooperative changes of the spin configurations in single crystals of the organometal spin-crossover complex. In the photoswitching process between low- and high-spin states, nonlinear characteristics such as thresholdlike behavior, incubation period, and phase separation have been observed. These results demonstrate that the cooperative intersystem crossing mediated by spin-lattice interaction plays a key role in the driving process of a new class of nonequilibrium phenomena so called photoinduced phase transition.

Significance of stem cell factor and soluble KIT in patients with systemic lupus erythematosus

To determine the significance of stem cell factor (SCF) and soluble KIT (sKIT) in the serum of patients with systemic lupus erythematosus (SLE), levels of SCF and sKIT in patients with SLE were estimated, and their correlations with clinical parameters were examined. The sKIT levels in SLE patients (n = 106) were significantly lower than those in healthy controls (n = 40). A significant negative correlation was found between the SCF and sKIT levels of SLE patients. Although the SCF levels correlated with the titre of anti-RNP antibody, no significant relationship was found between SCF levels and blood cell counts, such as white blood cell, red blood cell and platelet counts. sKIT levels were significantly correlated with the platelet count, and were negatively correlated with the white blood cell count, titre of anti-DNA antibody, and SLE activity index (SLEDAI). sKIT levels were also negatively affected by high doses of corticosteroid. These results indicate that serum sKIT levels may be more closely related than SCF to the haematological abnormalities in SLE patients, and may reflect the clinical status of SLE patients and the effectiveness of high-dose corticosteroid treatment.

Inhibitory effect of the immunosuppressant FK506 on apoptotic cell death induced by HIV-1 gp120

Human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein gp120 may play a central role in inducing immunoregulatory disorders after HIV infection. The apoptotic death of normal human peripheral blood mononuclear cells was induced by priming with gp120 followed by stimulation with an anti-T cell receptor (TCR) antibody. Tumor necrosis factor-alpha produced by gp120-binding macrophages may be important to induce this cell death. Treatment of gp120-primed cells with an immunosuppressant (FK506) before TCR signaling inhibited apoptotic cell death, and this blocking effect of FK506 was concentration dependent. FK506 did not have any influence on cell growth and viability over the range of concentrations tested. These findings suggest that FK506 is a potentially useful drug in delaying the onset of AIDS after HIV infection.

Mixed cavernous angioma and glioma (angioglioma) in the hypothalamus--case report

A 54-year-old female presented with a huge mixed cavernous angioma and astrocytoma in the hypothalamus manifesting as headache, visual field defect, gait disturbance, and convulsion. Radiological studies revealed a huge suprasellar tumor encasing all the major cerebral vessels. Craniotomy disclosed a hemorrhagic tumor poorly demarcated from the surrounding brain which was partially removed. Histological examination of the operative specimen revealed cavernous angioma with low grade glioma in the periphery. The residual tumor responded to radiation therapy remarkably well. An autopsy conducted 3 years later revealed a small hypothalamic astrocytoma with abundant vasculature.

Detection of antibodies to HIV-1 gp41- and HLA class II antigen-derived peptides in SLE patients

A role for viruses in the pathogenesis of human autoimmune diseases has long been suspected but has not yet been proven. Highly conserved homologous regions has been reported in the carboxy terminus of human immunodeficiency virus (HIV)-1 gp41 (amino acids 838-844) and the amino-terminal of the beta chain of all human HLA class II antigens (amino acids 19-25). This molecular mimicry between HIV-1 and HLA class II antigens may lead to the generation of autoantibodies and may contribute to the development of autoimmune phenomena in HIV infected patients. We detected antibodies for these homologous peptides from HLA class II and HIV-1 gp41 in systemic lupus erythematosus (SLE) patients without HIV-1 infection. Thirty-seven percent of the SLE patients had IgM antibodies reacting with both HLA class II- and HIV-1 gp41-derived peptides. These results suggest the possibility that a retrovirus may be one of the causative agents of SLE.

Amino acids and peptides. XX. Preparation of beta-cyclododecyl aspartate and its application to synthesis of fibronectin- and laminin-related peptides

beta-Cyclododecyl aspartate was prepared and its application to peptide synthesis was examined. Derivatives of beta-cyclododecyl aspartate are more likely to crystallize and should be useful for peptide synthesis. The cyclododecyl ester was much stable to bases than the benzyl ester and rather more stable than the cyclohexyl ester. It was removable by HF treatment and trifluoromethanesulfonic acid treatment. beta-Cyclododecyl aspartate was used for synthesis of laminin- and fibronectin-related peptides by solid phase and liquid phase methods.

[Acute relapsing disseminated encephalomyelitis (ARDEM) mimicking a temporal lobe tumor]

A case of ARDEM presenting as a temporal lobe tumor is reported. A 19-year-old male was admitted to the hospital, because of headache, right homonymous hemianopsia, and general convulsion. CT scan and MR imaging revealed localized right medial temporal enhanced mass lesion with surrounding brain edema. The craniotomy revealed an elastic hard ill-defined subcortical tumor. Histology showed a demyelinating process with perivascular lymphocyte cuffings. The patients' postoperative course was essentially uneventful until the 7th day when he developed fever, persistent hiccup, vertigo followed by obtundation and respiratory distress. Repeated MR imaging revealed extensive lesions in the left thalamus, brain stem, upper spinal cord and cerebellum. The patient responded to steroid pulse therapy well. Six months later, however, he returned to the hospital with severe memory disturbance. Repeated MR imaging showed diffuse bilateral parieto-occipital white matter lesions. He again responded to steroid pulse therapy well. An immunosuppressant Mizoribine was added to his steroid therapy to prevent recurrence. With the advent of MR imaging, more non-surgical diseases such as multiple sclerosis and Behçet disease are visualized on imaging study. The differentiation of these diseases from intraparenchymal neoplasm is difficult when they present as a single mass lesion. ADEM or ARDEM should be included in the list of such lesions requiring differential diagnosis.

[Myelin basic protein in the cerebrospinal fluid of patients with neurological disease: especially with malignant brain tumors]

Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) of patients with brain tumors and other neurological diseases was measured before, during and after various treatments such as surgery, chemotherapy and irradiation. We assessed the significance of changes in the MBP levels during the course of treatment, and speculate on what the elevated level of MBP in brain tumor patients indicates. In meningeal dissemination of malignant tumors, meningeal carcinomatosis from cancer of the systemic organ showed the highest level of MBP followed by meningeal gliomatosis and meningeal lymphoma. Meningeal carcinomatosis and meningeal lymphoma, which have responded to chemotherapy, showed normal levels of MBP after chemotherapy. Six of eight patients with newly diagnosed malignant glioma showed moderate to high levels of MBP (range 4.6-35.5ng/ml) just before intraarterial chemotherapy with VP-16 and CDDP. The level increased in five patients during the course of chemotherapy and then decreased in relation to the degree of tumor reduction by chemotherapy. In the solid type of metastatic brain tumor, five of seven patients with multiple tumors showed high levels of MBP and these levels also returned to normal after treatment in four patients. As for the influence of irradiation, levels of MBP did not increase after irradiation except in three patients who developed radiation necrosis, local extensive edema or atrophic change. In other brain tumors, levels of MBP were high in a patient with a large meningioma with very extensive edema and during an unstable postoperative condition after total removal of a large craniopharyngioma.(ABSTRACT TRUNCATED AT 250 WORDS)

Nontraumatic intradiploic arachnoid cysts--report of five cases

Five cases of nontraumatic intradiploic arachnoid cysts in elderly patients are reported. All cysts were located in the occipital bone and appeared as well-demarcated radiolucent lesions. The cysts were multiple in three cases. Presenting symptoms included headache or dizziness, but most lesions were asymptomatic and found incidentally. In the most recent three cases, magnetic resonance (MR) imaging revealed intradiploic cysts containing cerebrospinal fluid (CSF) with cerebellar herniation. Operation found the cysts filled with CSF and dural defects through which cerebellar tissue was herniating. In two patients, CSF leakage from the outer table occurred. Intradiploic arachnoid cyst seems to be congenital in origin but commonly found in the elderly. MR imaging is the most useful diagnostic method for differential diagnosis from other osteolytic skull lesions.

[Dysembryoplastic neuroepithelial tumor; a case report]

The authors report a case of dysembryoplastic neuroepithelial tumor which is a new entity of glial tumor proposed by Daumas-Duport et al. A 16-year-old male was admitted to our hospital with a 5-year history of uncontrollable complex partial seizure. CT scan showed a non-enhanced homogeneous low density area without mass effect, simulating old infarction or porencephalic cyst in the right posterior temporal lobe. The inner table of the skull over the lesion was eroded. The lesion showed low signal intensity in T1 weighted MR image and high signal intensity in T2 image. Craniotomy disclosed greyish soft solid tumor without cyst. Histologically, the tumor contained multiple cellular nodules in the microcystic astrocytic part which contained neurons. After the surgery the patient was free from the seizure. Dysembryoplastic neuroepithelial tumor is found in young patients with intractable partial seizures. It is characterized by pseudocystic well-demarcated low density appearance on CT scan. Histologically, it is an intracortical multinodular heterogeneous tumor which, is surgically treatable with favorable prognosis. For differential diagnosis, this tumor must be recognized in the list of low-density intracranial lesions found during CT scan.

[One stage removal of huge glomus tumor]

Surgical removal of a huge glomus jugular tumor has been considered as one of the most difficult skull base surgeries not only because of the difficulty in approaching the tumor, but also because of its highly vascular nature and various possible postoperative complications. We used combined infratemporal fossa and lateral suboccipital approach in a single stage to operate on a 49-year-old male with a huge glomus jugular tumor, which extended from the right cerebellopontine angle to the level of the the third vertebra. With this approach we could expose the tumor extensively and control the feeding arteries easily in spite of marked vascularity of the tumor. Retraction of the cerebellum was only minimal owing to the removal of the petrous bone. The tumor was excised not by piecemeal but in en block manner with preservation of all the cranial nerves but the glossopharyngeal nerve. To prevent postoperative cerebrospinal fluid leakage, the following procedures were very useful; 'blind sack closure' of the external auditory canal, careful closure of the Eustachian tube, use of the pedicled muscle flap from the temporal and the sternocleidomastoid muscle, use of fibrin glue at the time of the wound closure, and placement of preventive spinal drainage. The patient was discharged with hoarseness and facial palsy. However these symptoms had almost completely disappeared within one year. He is working in the same occupation as before.

New Secoiridoid Glucosides from Ligustrum japonicum

Two new secoiridoid glucosides, oleonuezhenide and isonuezhenide, have been isolated along with known secoiridoid glucosides, from the fruits of LIGUSTRUM JAPONICUM. Their structures have been elucidated on the basis of chemical and spectral data.

[Cortical somatosensory evoked potential associated with experimental chronic cord compression by epidural neoplasm in rabbits]

An experimental model of spinal cord compression was developed in rabbits by epidural neoplasms which were injected anterior to the T 13 vertebral body and grew into the spinal canal through the intervertebral foramina. With this experimental model, the neurological condition of the animals was monitored using a scale and changes of somatosensory evoked potentials (SEPs) were studied to evaluate the neurophysiological effect of experimental chronic cord compression. The animals were immobilized with pancuronium bromide and artificial respiration was maintained through a tracheostomy. SEPs were recorded by silver ball electrodes which were positioned epidurally over the somatosensory cortex through small burr holes. A subcutaneous needle placed at the nose served as a reference electrode. Right hind paw was stimulated via two percutaneous needles with 0.1 msec rectangular impulses sufficiently strong to produce motor responses, ranging from 10 to 20 volt in control rabbits. Electrical stimuli were delivered at a rate of 1 Hz. The intensity of electrical stimulation was raised up to 300 volt, when no consistent SEP was observed in the rabbit with spinal neoplasm. The SEP was summated by averaging 50 successive cortical transients with the analysis time of 200 and 500 msec. The cortical SEPs in the rabbit normally consisted of a positive-negative sequence, which we labelled P1, N1, P2, N2 and so on. Early peaks, P1 and N1, were observed constantly with average latencies of 30.1 and 53.3 msec respectively in normal rabbits. The variability of amplitudes seen even in control animals made them a less useful measure of function than latencies. Normal SEPs were preserved until the animals demonstrated moderate paraparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinicoanatomical study of thalamic stimulation for pain relief

Our small experiences with electrical stimulation in the VPL and VPM for dysesthetic pain show that it provoked only paresthesia and induced some relief of pain. It does not increase the beta-endorphin level in CSF. To clarify the anatomical substrata in VPL stimulation, neuroanatomical studies were done about the inputs to VPL in man, monkey and cat by the Fink-Heimer method. The spinothalamic tract terminates in VPL in a patchy fashion in the monkey. The corticothalamic fibers from SI and SII cortex project to VPL and VPM in somatotopical organization in the cat. SI and SII cortices have reciprocal connections, in addition to projections to area 5 or SIII cortex. The corticofugal fibers to the magnocellular and gigantocellular tegmental fields are suggested in addition to the dorsal column nuclei, spinal trigeminal nuclei and spinal posterior horn in cat. The medial lemniscus input to VPL and the above neural circuits are thought to be associated with VPL stimulation.

Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome

Six cases of unclippable vertebral aneurysms were treated by therapeutic occlusion of the proximal vertebral artery. In three cases, the vertebral artery was clipped proximal to the posterior inferior cerebellar artery (PICA), and all of these patients had a postoperative embolic complication or a fatal subarachnoid hemorrhage. In two cases, the vertebral artery was clipped distal to the PICA and in one case the PICA was absent and the vertebral artery was clipped proximal to the aneurysm. All three of these patients did well without any neurological deficit. Possible mechanisms of the complications are discussed, and the importance of not clipping the PICA is stressed.

[Germ cell tumor in the basal ganglia with elevated serum and CSF alpha-fetoprotein levels]

Intracranial germ cell tumors usually locate either in the pineal region or in the suprasellar region or both. Primary occurrence of germ cell tumor in the basal ganglia is rare. To our knowledge, only 17 cases have been reported in the literatures, and all the patients were Japanese. None of these patients presented elevated serum and CSF AFP levels in the literatures. We are reporting a patient with a germ cell tumor which developed in the left basal ganglia and showed high serum and CSF alpha-fetoprotein (AFP) levels. The patient was a 12-year-old boy who had been completely well until five months prior to the first admission when he developed weakness of right extremities. On admission he showed a right hemiparesis of mild degree and right hypesthesia. CT-scans demonstrated a homogeneous high density area over the caudate head and the putamen on the left side. The anterior limb of the left internal capsule and a part of the posterior limb were also involved. The lesion was moderately enhanced by the contrast medium. Stereotaxic biopsy of the lesion was uncontributory and he was discharged for follow up. Five months later, CT-scans demonstrated the enlargement of the high density area with perifocal edema. Then we performed a craniotomy, and the tumor which was soft and dark red in colour was biopsied at the wall of the anterior horn of the left lateral ventricle. Histopathology of the specimen showed germinoma of two-cell pattern.(ABSTRACT TRUNCATED AT 250 WORDS)