A novel compound heterozygote (FAP ATTR Arg104His/ATTR Val30Met) with high serum transthyretin (TTR) and retinol binding protein (RBP) levels

A 64-year-old Japanese male suffering from very slowly progressive amyloidosis was studied by immunohistopathologic, mass spectrometric, and molecular genetic methods. After confirming the immunoreactivity of transthyretin (TTR) in the amyloid deposits using an anti-TTR polyclonal antibody, matrix-assisted laser desorption ionization/time-of-flight-mass spectrometry (MALDI/TOF-MS) was employed to look for the presence of variant TTR(s) in the serum. Two variant forms of TTR, one with a molecular weight 32 Da greater and another with a molecular weight 19 Da less than that of normal TTR encoded by the two respective alleles, were detected in this patient. Direct sequence analysis confirmed the presence of a double substitution: one at codon 30 from GTG (Val) to ATG (Met) and the other at codon 104 from CGC (Arg) to CAC (His) in the two alleles. MALDI/TOF-MS of the parents of the proband revealed that his father was a heterozygote of ATTR Arg104His and his mother was a heterozygote of ATTR Val30Met. The total TTR and retinol binding protein (RBP) concentrations in the serum samples of the proband were very high compared with those of FAP ATTR Val30Met patients and control subjects. We report here a new compound heterozygote in the TTR gene with familial amyloidotic polyneuropathy (FAP).

Participation of the liver in generation of a vigorous anti-donor response after inoculation of donor spleen cells

BACKGROUND

There is a general agreement that a preferential accumulation of alloantigens within the liver could induce hyporesponsiveness to the inoculated antigens. Entrapment of antigens in the liver may evoke an unique immune response in the organ and play a key role in determination of the fate of the transplanted grafts. To understand the immune response in the liver after inoculation of allogeneic donor antigens, we examined the immune response to systemically inoculated alloantigen in rats whose sensitized liver was replaced with that of naive rats or in naive rats whose liver was replaced with that of sensitized rats.

METHODS

Using implantation of syngeneic liver (alloantigen-accumulated/naive) in rats (naive/alloantigen-sensitized), we compared the immune responses to alloantigen between rats with hepatic/extrahepatic alloantigen at 24 hr after alloantigen inoculation. This was called sensitized-liver-grafted (SLG)/sensitized-liver-removed (SLR) treatment. The immune response to donor alloantigen in this model was evaluated by survival of skin or heart grafts, complement-dependent cytotoxicity (CDC) titer and delayed-type hypersensitivity (DTH) response.

RESULTS

Compared with the mean survival time (MST) in donor spleen cell inoculated (DSI) rats (skin and heart, MST: 8.2+/-1.1 and 10.7+/-2.3 days), SLG rats rejected allografts in an accelerated fashion (skin and heart, MST: 5.5+/-0.5 and 4.2+/-0.8 days), associated with higher CDC titer and DTH response. In contrast, allograft survival was moderately prolonged in SLR (skin and heart, MST: 16.5+/-2.6 and 29.5+/-3.7 days) associated with suppressed CDC titer and DTH response. The survival of third-party allograft after SLG or SLR treatment (skin, MST: 9.3+/-1.5 or 9.7+/-0.6 days) indicated that immunological hyper/hyporesponsiveness was donor-specific.

CONCLUSIONS

A strong anti-donor immune response was induced by the transfer of donor antigen-baring liver to naive rats 24 hr after alloantigen inoculation, whereas removal of the liver suppressed alloimmune response. Our results indicate that vigorous anti-alloimmune response occurred in the liver after systemic inoculation of donor spleen cells.

Factors responsible for the prolongation of school refusal

Two hundred and one school refusers (< or =18 years old), excluding schizophrenia, were treated at the Department of Neuropsychiatry, Hirosaki University Hospital between April 1975 and March 1995. Of 56 cases of school refusal, 31 did not improve for more than 2 years (group P), and 25 cases had improved in the degree of school refusal and social impairment (group B). The remaining cases were excluded from the analysis for several reasons. There was no significant difference between groups B and P in age at the first psychiatric evaluation as well as the age of onset of school refusal. The duration from school absence to the first evaluation of group P was significantly longer than that of group B. The duration of school refusal significantly and positively correlated with the duration from school absence to the first evaluation. Introversion and nervousness prolonged the duration of school refusal. The non-presence of volition for school attendance, and a low frequency of school attendance during the 1 month prior to the first evaluation influenced the prolongation of school refusal. The 'duration from school absence to the first evaluation', the 'patient's character', the 'non-presence of volition for school attendance' and the 'frequency of school attendance' influenced the prolongation of school refusal. The introduction of treatment within 10 months of the onset of school refusal is an important factor in preventing the prolongation of the school refusal.

Pretreatment of crude pancreatic islets with mitomycin C prolongs graft survival time in xenogeneic rat-to-mouse model

BACKGROUND

Rejection of pancreatic islet grafts is still a serious problem. We evaluated the effect of mitomycin C (MMC) on the survival of crude islets grafts after xenogeneic islet transplantation.

METHODS

WS (RT1k) rat islets pretreated with various concentrations of MMC (0, 1, 3.2, 10, 32, 50, 100, 320, and 1,000 microg/ml) were transplanted into C57BL/6 mice with streptozotocin-induced diabetes. In vivo graft function was assessed by a daily measurement of nonfasting blood glucose concentration in each animal. We also examined the separate effect of MMC on purified islets and contaminants present in the crude islet preparation.

RESULTS

MMC at doses of 10, 32, 50, and 100 microg/ml resulted in a significant prolongation of the mean graft survival time from a control of 12.4+/-2.5 days to 23+/-7.4, 17.5+/-5.4, 25.5+/-14.7, and 26.7+/-8.9 days, respectively. Deterioration of glucose metabolism was noted when the dose exceeded 32 microg/ml, whereas at 320 microg/ ml, MMC failed to restore normoglycemia. Prolongation of survival time of crude islets was the result of its effect on islets and contaminant components of the crude islet preparation. In vitro study showed that MMC treatment at a higher concentration than 10 microg/ml reduces the stimulatory as well as proliferative capacity of lymph node cells.

CONCLUSIONS

Pretreatment of pancreatic islets with MMC at 10 microg/ml prolongs xenograft survival without deterioration of in vivo graft function. This novel treatment modality represents a new strategy for the modulation of immunity of islets and contaminants in crude islet preparations.

Elevated circulating levels and cardiac secretion of soluble Fas ligand in patients with congestive heart failure

The circulating levels of soluble Fas ligand was increased in patients with advanced congestive heart failure. This study also indicates that the failing heart may contribute to the increased concentration of soluble Fas ligand in patients with congestive heart failure.

Outgrowth of pseudopodial cables induced by all-trans retinoic acid in micromere-derived cells isolated from sea urchin embryos

Cultured cells derived from micromeres of sea urchin embryos underwent pseudopodial cable growth without spicule rod formation in the presence of all-trans retinoic acid (tRA) or insulin. Pseudopodial cable growth caused by tRA or insulin was inhibited by genistein, a protein tyrosine kinase inhibitor. Phosphorylation of protein tyrosine residue was augmented in the cells treated with tRA or insulin and was inhibited by genistein. Probably, protein tyrosine kinase takes an indispensable part in signal transduction systems for tRA and insulin in these cells. In tRA-treated cells, augmentation of the phosphorylation of protein tyrosine residue was accompanied by an increase in the activity of protein tyrosine kinase and was inhibited by actinomycin D, inhibiting cable growth. Activation of this enzyme in tRA-treated cells probably depends on RNA synthesis. In insulin-treated cells, augmentation of tyrosine residue phosphorylation occurred without any appreciable change in this enzyme's activity and was hardly affected by actinomycin D. Phosphorylation of protein tyrosine residue seems to be activated by the binding of insulin to an insulin receptor. Pseudopodial cable growth in these cells treated with tRA or insulin was inhibited by wortmannin. Phosphatidylinositol 3 kinase probably participates in tRA and insulin signal transduction systems.

Microchimerism in thymus is associated with up-regulated T helper type 1 cytokine transcription during cardiac allograft rejection in rats

BACKGROUND

Intrathymic microchimerism (MC) is thought to be responsible for inducing allograft tolerance. However, the role of MC in the thymus gland after transplantation, particularly in the rejection response, is unknown. We investigated serial changes in intrathymic cytokine production associated with MC and allograft rejection.

METHODS

Donor-specific cell injection (DSI) and heterotopic heart transplantation (HTx) were performed in the fully allogeneic combination using DA rats (RT1a) as donors and WS rats (RT1k)as recipients. MC was checked by polymerase chain reaction (PCR) using a donor RT1.Bbeta domain 1 region sequence-specific primers. Reverse transcription (RT)-PCR analysis of cytokine (interleukin [IL]-2, interferon-gamma, IL-4, and IL-10) profiles of the thymus was performed in animals given DSI, HTx, or DSI/HTx.

RESULTS

DSI alone resulted in an immediate development of MC, detected by PCR, in various organs including the thymus, spleen, liver, and blood, of most rats, lasting for over 2 months. However, DSI-induced MC selectively disappeared in the thymus on day 7 after grafting, several days before the rejection of cardiac allograft. RT-PCR analysis of cytokine profiles showed that the levels of Th1 (IL-2 and interferon-gamma) cytokines transcribed in the thymus were higher than in the spleen. MC reappeared in the thymus on day 21 after grafting, but was not associated with elevation of Th1 cytokine transcription when allograft was replaced by fibrosis.

CONCLUSIONS

Intrathymic MC does not always confer unresponsiveness to alloantigen, but can be eliminated after anti-donor response.

[Comparison of propofol and pentazocine combined with thiamylal for laryngeal mask insertion]

We evaluated the combination of pentazocine and thiamylal as induction agents for laryngeal mask airway (LMA) insertion and compared this with propofol. Ninety-four patients, ASA grade 1 or 2, were randomly assigned to one of four induction groups as follows; group P: propofol 2.5 mg.kg-1, group p 0.3: pentazocine 0.3 mg.kg-1 followed by thiamylal 5 mg.kg-1, group p 0.6: pentazocine 0.6 mg.kg-1 followed by thiamylal 5 mg.kg-1, and group T: thiamylal 5 mg.kg-1. In group T (n = 5), insertion of LMA was impossible due to inadequate anesthesia. In contrast, good and acceptable conditions for LMA insertion were obtained in 85.2%, 86.7%, and 96.9% of group P, p 0.3, and p 0.6, respectively. Apneic interval, endtidal CO2 and arterial CO2 were significantly greater in pentazocine groups than in propofol group (group P < p 0.3 < p 0.6). Systolic pressure decreased after induction in all groups. Decreases in systolic and diastolic pressure were significantly greater in group P. Heart rate did not show any significant change. We conclude that the induction with the combination of pentazocine and thiamylal provides suitable conditions for LMA insertion with more stable hemodynamics compared with propofol. Doses of 0.3 mg.kg-1 seem to be desirable for LMA insertion.

Enhanced expression and shedding of tumor necrosis factor (TNF) receptors from mononuclear leukocytes in human heart failure

TNFalpha exerts its functions by engaging two receptors (TNF-RI and TNF-RII). The extracellular parts of the receptors are proteolytically shed to the soluble forms by a matrix metalloproteinase-like enzyme (sTNF-RI and sTNF-RII). The soluble TNF receptors can neutralize TNFalpha activities. Circulating levels of both sTNF-RI and sTNF-RII are elevated in patients with congestive heart failure (CHF). It remains unclear how a large amount of sTNF-RI and sTNF-RII is mobilized into the circulation. Mononuclear leukocytes were obtained from 14 controls and 21 patients with CHF. TNF-RII of the cells from CHF patients was upregulated in the cell-surface expression and mRNA transcripts. Besides enhanced shedding of TNF-RII on the cells from CHF patients with phorbol myristate acetate (PMA), sera from CHF induced shedding of TNF-RII on the cells from normal volunteers. Thus, the enhancement of both expression and shedding of TNF-RII may be related to increased circulating levels of the soluble TNF receptor in patients with CHF. The presence of CHF may affect the regulation of TNF receptors, which may modulate the responsiveness to TNFalpha in the tissues of patients with CHF.

Bopindolol: a slowly dissociating antagonist from the beta-adrenoceptors in guinea pig atria

The dissociating and/or residual inhibitory effects of bopindolol from beta-adrenoceptors of atria strips pretreated with this drug which was then washed out with buffers on the responses to isoprenaline were determined and compared with those of propranolol, pindolol, atenolol, and the two active metabolites of bopindolol: 18-502 and 20-785. Low concentrations of bopindolol (10(-9) to 10(-8) mol/l) and the active metabolite 18-502 (10(-9) mol/l) produced rightward shifts of the concentration-response curves. On the other hand, high concentrations of bopindolol (10(-7) mol/l) and metabolite 18-502 (10(-8) and 10(-7) mol/l) produced a reduced maximum response by isoprenaline, suggesting that these nonparallel rightward shifts have pD2 values of 7.57 (bopindolol) and 7.67 (18-502), respectively, at 0 min after washout with buffers. Pindolol (10(-7) mol/l) and propranolol (10(-7) and 10(-8) mol/l) also produced a rightward shift of isoprenaline response curves, and these concentration-response curves in guinea pig atria strips pretreated with pindolol (10(-7) mol/l) and propranolol (10(-6) mol/l) recovered to control levels. Neither of these drugs, however, reduced the maximum response by isoprenaline. A high concentration (10(-5) mol/l) of atenolol was required for a rightward shift of the isoprenaline concentration-response curve, and this drug also did not reduce the maximum response. Thus, we conclude that bopindolol and metabolite 18-502 slowly dissociate and act as noncompetitive beta-antagonists rather than easily reversible beta-adrenoceptor antagonists.

[A study of the differences between the sexes in epidemiology of urolithiasis]

PURPOSE

Uroithiasis seems to be the dominant disease for male. In the recent Japanese epidemiological report, the sexual ratio was reported 2.3:1. This sexual ratio is almost stable from 1960. We studied epidemiologically based on age and stone components the differences between the sexes.

PATIENTS AND METHOD

From 1977 to 1996 the upper urinary tract stones which spontaneous excretion or surgical removal in our hospital were the subjects of study, Stone analysis was carried out infrared spectrometer. The statistical analyses were performed by the chi-square test and Mann-Whitney's U test. Significance was declared for a probability value of less than 0.05.

RESULTS

In the epidemiology of our treated patients sexual ratio was 1.83:1. We studied sexual ration in age and stone components. The sexual ratio of the patients, 60 years and over was decreased compared with that of the patients under 60 years of age. We found the tendency that the sexual ratio was decreased at 60 years old and over. In the female urolithiasis patients less than 60 years old the frequency of calcium oxalate contained stone patients was predominantly smaller than male. In the female urolithiasis patients of 60 years and over the stone component ratio was similar to male urolithiasis patients.

CONCLUSION

In point of frequency sexual ratio was decreased at 60 years old and over. In the female patients less than 60 years old the frequency of calcium oxalate contained stone was predominantly small. This low frequency of calcium oxalate contained stone in the female less than 60 years old seemed to be a factor of the sex differences of frequency.

Soft X-ray photochemistry beamline at SPring-8

Design and construction of a soft X-ray beamline at SPring-8 is reported. The beamline utilizes high-quality linearly polarized soft X-rays obtainable from a figure-8 undulator for the study of photophysical and photochemical processes of atoms, molecules and surfaces in the inner-shell excitation region. It consists of two experimental stations, a photochemistry station and a chemical vapour deposition (CVD) station. A high-resolution grating monochromator is installed at the photochemistry station, while the intense undispersed undulator radiation is used at the CVD station. Unique features of the experimental chambers and of the analysis and characterization systems are described along with those of the monochromator.

[Effect of ultraviolet-filtering contact lens on rabbit eyes after exposure to ultraviolet light]

We evaluated the protective effect of a newly designed soft contact lens (SCL) on rabbit eyes. This SCL absorbs the ultraviolet B light of wavelengths between 280 nm and 320 nm. Three weeks after resecting the nictitating membrane, the rabbit corneas were covered either by the new SCL or a conventional SCL. The eyes were exposed to ultraviolet light from two 15 W lamps placed 20 cm anteriorly for 3 hours. Another three hours after the exposure, the cornea was examined first with a slitlamp biomicroscope after staining with fluorescein and then by histopathological means after enucleation. Six eyes wearing the new SCL showed moderate superficial punctate keratopathy. Six eyes wearing conventional SCL showed severe superficial keratopathy or corneal erosion. These findings were in good agreement with the histopathological findings. The new ultraviolet-filtering SCL was thus effective in protecting the rabbit cornea under our experimental conditions.

Expanded polytetrafluoroethylene (ePTFE) vascular graft loses its thrombogenicity six months after implantation

Although expanded polytetrafluoroethylene (ePTFE) has been believed to be an inert material for vascular prosthesis, it shows less tendency of graft maturation by means of endothelialization. The aim of this study is to evaluate long-term alteration in thrombogenicity of ePTFE grafts after implantation. Serial levels of thrombin-antithrombin III complex (TAT), D-dimer, C-reactive protein (CRP), and prothrombin time (PT) were examined in 77 patients following ePTFE Y-graft implantation for up to five years. TAT showed biphasic elevation after implantation; TAT increased from 16.4+/-8.6 ng/ml to 27.4+/-10.5 ng/ml at one day, decreased to 18.5+/-4.5 ng/ml at one week, and increased again to 25.3+/-8.5 ng/ml at two weeks. Elevated TAT gradually decreased after the second peak to reach a lower level than that before surgery after six months. There was no significant difference in TAT level after six months due to the difference in diagnosis or anti-thrombotic therapy. We suggest that ePTFE grafts lose their thrombogenicity six months after implantation, after which anti-thrombotic therapy might be unnecessary.

Serum levels of soluble form of Fas molecule in patients with congestive heart failure

Compared with soluble Fas molecule (sFas, an inhibitor of Fas-mediated apoptosis) in normal volunteers, the serum level of sFas significantly increased by 41% in New York Heart Association (NYHA) class III (p <0.05) and by 97% in NYHA class IV patients with congestive heart failure (p <0.001). Furthermore, sFas showed correlations with soluble forms of TNF receptor-p55 (RI) and -p75 (RII) (r = 0.68 and r = 0.56) which inhibit activities of TNF alpha.

[A case of malignant hemangioendothelioma of the lung with rapid growth of pulmonary metastasis]

Malignant hemangioendothelioma of the lung is very rare and difficult to diagnose. The growth is rapid and the prognosis is very unfavorable. We report an operated case of the disease with rapid growth of pulmonary metastasis. The silver, vimentin and factor VIII stainings were available for diagnosis of this disease. The 46-year-old female patient died of bleeding from the pulmonary metastasis eight months after the operation without other distant metastasis. Even if a lung tumor is pointed out and thought to be benign, frequent follow up is necessary. Furthermore, we recommend positive lung biopsy by thoracotomy or video-assisted-thoracic-surgery.

In vitro method for assessing hepatic drug metabolism

We investigated an in vitro metabolic test using rat liver biopsy samples by TLC-autoradioluminography (ARLG), with a view to developing a method to rapidly assess the drug metabolizing activities of individual patients. Drug metabolizing activity was measured in liver biopsy samples collected from rats in four groups: a female control group, male control group, phenobarbital (PB)-administered male group and cimetidine (CM)-administered male group. The productivity of metabolites of 7-ethoxycoumarin (7-EC), debrisoquine (DB) and diazepam (DZ), respectively, was lower in the female control group than in the male control group, but there were no differences in the productivity of metabolites of 5-fluorouracil (5-FU) and tolbutamide (TB), respectively, between the male and female control groups. Those of 7-EC, TB and DZ were higher in the PB-administered group than in the male control group, but those of DB did not differ between these two groups. Those of 5-FU, 7-EC, TB, DB and DZ were lower in the CM-administered group than in the male control group. Using TLC-ARLG, we could detect drug metabolites in rat liver biopsy samples in a relatively short time span at low concentrations similar to those in vivo. We could also measure drug metabolizing activity in cases with and without the involvement of cytochrome P450. When applied in clinical metabolic tests, TLC-ARLG is expected to be useful for assessing the drug metabolizing activities of patients.

Fluid shear stress induces actin polymerization in human neutrophils

We have previously reported that a physiological range of shear stress induces neutrophil homotypic aggregation mediated by lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-3 (ICAM-3) interactions. To further characterized the homotypic aggregation, actin polymerization was investigated in neutrophils stimulated by shear stress in comparison with formyl-methionyl-leucyl-phenylalanine (fMLP). In fMLP-stimulated neutrophils, actin polymerization was localized in the pseudopods, and this reaction was not mediated by a cytosolic level of Ca2+. In contrast to fMLP stimulation, the actin polymerization induced by shear stress in a cone-plate viscometer was localized in cell-cell contact regions, and this polymerization required the increase of intracellular Ca2+. This shear stress-induced actin polymerization was not observed when neutrophils were pretreated with anti-LFA-1 or anti-ICAM-3 antibody. In conclusion, LFA-1 and ICAM-3 interaction mediated by the increase of [Ca2+]i generated the intercellular signal in order to accumulate F-actin in the cell-cell contact regions.

[A patient with HCC successfully treated by ethanol injection therapy with etoposide]

A patient with hepatocellular carcinoma (HCC) who underwent successfully percutaneous ethanol injection therapy (PEIT) with etoposide was reported. A 72-year-old Japanese man with positive HCV-Ab developed multiple tumors of HCC. He underwent transcatheter arterial embolization (TAE) four times and PEIT three times, but the growth of tumors (particularly, S8) could not be controlled by these modalities. Then, the mixture of etoposide (20 mg), ethanol (8.5 ml) and lipiodol (1.5 ml) was injected into S6 tumors. Consistent with the normalization of serum AFP level, CT scan revealed the marked remaining lipiodol in these tumors. PEIT with etoposide is the treatment of choice in patients with HCC refractory to treatment by conventional TAE or PEIT.

[Comparative study on diode laser (680 nm) and krypton laser mild photocoagulation--histological findings and therapeutic outcome for diabetic maculopathy]

A histopathological study of macaca monkey retina-choroid was carried out for one month after mild photocoagulation with a diode laser (680 nm) and a krypton laser (647 nm). Both lasers produced the same damage to the outer layer of retina and to the melanocytes of 1/3 of the inner choroid. Mild focal photocoagulation was done for 6 patients (12 eyes) with diabetic maculopathy. The patients were 41 to 67 years old, suffering from diabetes mellitus for 5 to 25 years. The grade of their retinopathy was Fukuda's classification AI, AII, and BI. AII eyes were tested before and 3-6 months after photocoagulation for corrected visual acuity, fluorescein angiography, and visual field sensitivity by Octopus automated static perimetry. Visual acuity was stable in all cases. Central sensitivity was better in 2 eyes and unchanged in 4 eyes in both types of laser photocoagulation. In cases of total loss, one eye was improved, 4 eyes were unchanged and one eye was worsened by diode laser photocoagulation and one eye was improved, 2 eyes were unchanged and 3 eyes were worsened by krypton laser photocoagulation. The diode laser (680 nm) might be as useful for ophthalmic laser treatment as the krypton laser.

Magnesium ion augmentation of inhibitory effects of adenosine on dopamine release in the rat striatum

The effects of adenosine and magnesium ion (Mg2+) on striatal dopamine release were studied in awake rats by in vivo microdialysis. The mean striatal basal levels of dopamine release at Mg2+ free perfusate were 56.95 +/- 5.30 fmol/sample (for 20 min). By varying the Mg2+ levels in perfusate from 0 mmol/L to 1, 10 or 40 mmol/L, the dopamine release was inhibited by Mg2+ in a level-dependent manner. Perfusion with modified Ringer's solution containing zero Mg2+ and from 5 to 50 mumol/L adenosine, non-selective adenosine agonist, as well as 0.1 mumol/L 2-chloro-N6-cyclopentyladenosine (CCPA), selective adenosine A1 agonist, showed no effect on dopamine release. However, from 5 to 50 mumol/L adenosine and from 0.1 to 1 mumol/L CCPA plus Mg2+ (1 and 40 mumol/L) perfusion decreased the dopamine release. This inhibitory effect of adenosine and CCPA on striatal dopamine release was enhanced by an increase in extracellular Mg2+ levels. Levels of 50 mumol/L of 8-cyclopentyl-1,3-dimethylxanthine (CPT), a selective adenosine A1 receptor antagonist, in perfusate increased the dopamine release under conditions both with and without Mg2+. This stimulatory effect of CPT on striatal dopamine release was reduced by an increase in extracellular Mg2+ levels. As a result, CPT antagonized the inhibitory effects of adenosine and CCPA on dopamine release under conditions of the presence and absence of Mg2+. These results suggest that the inhibition of striatal dopamine release by adenosine was mediated by adenosine A1 receptor. This inhibition was intensified by Mg2+. This study also revealed that the concentrations of Mg2+, which ranged from physiological to supraphysiological, reduced the striatal dopamine release; furthermore it was found that the physiological concentration of Mg2+ potentiated the effects of adenosine agonists, but inhibited adenosine antagonist. Thus, the present study, using in vivo microdialysis preparations, suggests Mg2+ inhibits the calcium ion channels and enhances the adenosinergic function in the central nervous system.

LFA-1/ICAM-3 mediates neutrophil homotypic aggregation under fluid shear stress

We found that human neutrophils undergo homotypic aggregation by loading the physiological range of fluid shear stress (12-30 dynes/cm2). Under the fluid shear stress, an increase of intracellular Ca2+ concentration of neutrophils was observed. This increase of intracellular Ca2+ concentration was caused by Ca2+ influx, and the blockage of the flux by NiCl2 suppressed the neutrophil homotypic aggregation. Furthermore, this neutrophil aggregation under fluid shear stress was completely inhibited by pretreatment with antibody against LFA-1 or ICAM-3. These results suggested that NiCl2-sensitive Ca2+ channel played an important role in LFA-1/ICAM-3-mediated neutrophil homotypic aggregation under fluid shear stress.

Involvement of protein phosphatase 2A in PKC-independent pathway of neutrophil superoxide generation by fMLP

We examined the effects of okadaic acid, a protein phosphatase 1 and 2A inhibitor, on superoxide generation in human neutrophils. Superoxide generation induced by fMLP was inhibited by low-dose okadaic acid (10-100 nM), but it had no effect on superoxide synthesis by PMA, and the fMLP-induced rise of the intracellular Ca2+ concentration was not affected by low-dose okadaic acid. These findings suggested that the inhibitory mechanism of okadaic acid might involve PKC-independent and Ca(2+)-independent pathways in fMLP induced NADPH oxidase activation. Both fMLP-stimulated phosphorylation of serine residues in p47phox and its translocation to the plasma membrane were suppressed by low-dose okadaic acid. On the other hand, PMA-induced phosphorylation and translocation of p47phox were not affected by such a low dose of okadaic acid. These findings suggested that fMLP induced phosphorylation of serine residues in p47phox was regulated by protein phosphatase 2A, and its phosphorylation was necessary for translocation and superoxide generation in fMLP-activated human neutrophils.

[Diffuse B-cell lymphoma associated with hemophagocytic syndrome]

An 84-year-old female was admitted to our hospital because of fever. Physical examination and computed tomography revealed hepatosplenomegaly without lymphadenopathy. Anemia and thrombocytopenia were noted and the serum levels of LDH, IL-6 and sIL-2R were elevated. Bone marrow aspiration showed infiltration of lymphoma cells and proliferation of histiocytes with hemophagocytosis. Southern blot analyses revealed rearrangements of both IgJH and IgJK genes. She received corticosteroids with improvement of her general state but she died on the 110th hospital day. Necropsy of the spleen showed diffusely proliferating large lymphoma cells, immunoreactive for B cell marker L-26, and scattered histiocytes with hemophagocytosis.

Localization of the human IL-2-inducible T-cell kinase gene (ITK) to chromosome band 5q34 and the mouse gene (Itk) to chromosome 15 by fluorescence in situ hybridization

ITK, predominantly expressed on T cells and myeloid cells, is a member of the Tec nonreceptor tyrosine kinase family. Both human ITK and mouse Itk genomic clones were isolated to assign the chromosome location. The human ITK gene was mapped to chromosome band 5q34 and the mouse gene to chromosome 15 by fluorescence in situ hybridization.

Treating early mental health and post-traumatic symptoms of children in the Hanshin-Awaji earthquake

In this article we report on the support facilities for child mental health after the earthquake in Kobe. We believe that the most important function is the ability to cope with the confused situation on-the-spot as there were no means of transport and facilities for medical treatment had been paralyzed. Establishing contact with people outside the stricken area is of great help immediately following a disaster. After the earthquake many children were psychologically confused and people were therefore concerned with mental health care, especially for their children. However, there were only a few cases of patients seeing their doctors in medical centers. They needed information booklets or case reports to refer to. Five months after the disaster symptoms such as acute uneasiness or terror seem to be few and severely ill patients have started to recover. There are few case reports on children who have had difficulties in adapting to educational organization such as day nurseries and elementary schools. However, recently there has been an increase in the number of bone fractures possibly due to decline in resistance. Means of dealing with child mental health are now being examined because some children are still suffering post-traumatic symptoms. In this report we analyze the rapid recognition of children's mental health problems at home, in the school and in society and examine the importance of close mother-child, family and relative relationships.

Study of the de novo synthesis of cholesterol in the rat liver: a newly developed radiotracer technique, "TLC-autoradioluminography"

A possible evaluation technique was devised for examing timely cholesterol synthetic activity in the rat liver. The principle of the technique is to measure the incorporation rate of 14C atoms into a few target metabolites excreted in bile with time after an intraportal injection of [1,2-14C] acetate to the conscious rats. The measuring technique, TLC-autoradioluminography (TLC-ARLG), was devised for much more accurate, quantitative, simple and quick ultramicroanalysis of radioactive metabolites than ever before. Practically, a few microliters of the bile samples were analyzed by TLC before recording of a 2-dimensional radioactive image on the TLC plate. The incorporation ratio of 14C into cholesterol to succinic acid (C/S ratio) varied such that the value found in a 24-h fasting group was less than one-tenth of that in a sufficiently fed control group. For use as an antihyperglycemic drug, the bile C/S ratio in the nicotinic-acid-dosed group was approximately one-fifth of that in the control group.

Involvement of protein phosphatase-1 in cytoskeletal organization of cultured endothelial cells

The phosphorylation and dephosphorylation of cytoskeletal proteins regulate the shape of eukaryotic cells. To elucidate the role of serine/threonine protein phosphatases (PP) in this process, we studied the effects of calyculin A (CLA), a potent and specific inhibitor of protein phosphatases 1 (PP-1) and 2A (PP-2A) on the cytoskeletal structure of cultured human umbilical vein endothelial cells (HUVECs). The addition of CLA (5 min) caused marked alterations in cell morphology, such as cell constriction and bleb formation. Microtubules and F-actin were reorganized, becoming markedly condensed around the nucleus. Although the fluorescence intensity of phosphoamino acids was not significantly different according to immunocytochemistry between cells with and without CLA, polypeptides of 135, 140, 158, and 175 kDa were specifically phosphorylated on serine and/or threonine residues. There was no significant effect on tyrosine residues. The effects of CLA on cytoskeletal changes and protein phosphorylation were almost completely inhibited by the non-selective kinase inhibitor, K-252a. The effect of CLA on cell morphology was at least 100 times more potent than that of okadaic acid, consistent with the inhibitory potency against PP-1. The catalytic subunit of PP-1 was also identified in HUVECs by Western blotting with its monoclonal antibody antibody. These results suggest that PP-1 is closely involved in sustaining the normal structure of the cytoskeleton.

Familial macrothrombocytopenia with unusually elongated mitochondria

We report a familial case of macrothrombocytopenia without inclusion bodies in polymorphonuclear cells or any congenital abnormalities. The results of the hemostatic and platelet function tests were all normal except for the platelet retention rate. The number of megakaryocytes increased slightly and some were relatively small. Electron microscopic studies revealed a unique morphological abnormality of the platelets' mitochondria.

[Subdural catheterization uncovered by severe hypotension during epidural plus general anesthesia]

We experienced three cases of accidental subdural catheterization during epidural combined with general anesthesia. In each case, epidural catheterization was performed before induction of general anesthesia. Aspiration through the catheter and a response to a test dose were negative. Then anesthesia was induced with thiamylal IV and the trachea was intubated with vecuronium IV. Hypotension, which was not easily treated by vasopressors and volume load, occurred after administration of 3 to 8 ml mepivacaine with 1: 200,000 epinephrine through the catheter. We examined position of the catheter by injecting iohexol 240 and confirmed subdural catheterization after surgery. It is often difficult to identify subdural placement of an epidural catheter under general anesthesia since signs of massive sensory blockade are masked by general anesthesia. In each case, we suspected malpositioning of the catheter by severe hypotension due to sympatholysis which was difficult to treat. Subdural catheterization is a complication of epidural anesthesia that probably occurs more frequently than previously recognized and is usually unpredictable during general anesthesia.

PGI2 analogue, sodium beraprost, suppresses superoxide generation in human neutrophils by inhibiting p47phox phosphorylation

Sodium beraprost, a newly synthesized PGI2 analogue inhibited in a dose-dependent manner formyl-methionyl-leucyl-phenylalanine (fMLP) induced superoxide generation of human neutrophils, but it had no effect on the superoxide synthesis by phorbol myristate acetate (PMA) or A23187. Sodium beraprost inhibited Ca2+ influx in fMLP stimulated neutrophils employing fluorometry and confocal microscopy. These findings suggested that the inhibitory effect of sodium beraprost on fMLP induced superoxide generation was due to suppression of Ca2+ influx. To examine the relationship between the effect of sodium beraprost and phosphorylation of p47phox (the 47kDa cytosolic phagocyte oxidase factor), immuno-precipitation of p47phox and western blotting for phospho-amino acids were performed. Phosphorylation of serine residues of p47phox induced by fMLP was reduced in the presence of sodium beraprost in a dose-dependent manner. The reduction in phosphorylation was accompanied by a reduction in p47phox and p67phox translocation to the plasma membrane and superoxide generation. These findings suggested that p47phox phosphorylation was necessary for translocation and superoxide generation in fMLP activated neutrophils, and that p47phox phosphorylation was regulated by a Ca2+ dependent mechanism. These observations suggested that sodium beraprost inhibited fMLP induced superoxide generation of human neutrophils by the inhibition of p47phox phosphorylation and translocation by a Ca2+ dependent mechanism.

[Finding appropriate tube position by the cuff palpation method in children]

The present study was designed to examine whether palpation of the endotracheal tube cuff indicates appropriate positioning in the children. In 59 children, we used a cuffed endotracheal tube (3.5-5 mm ID) to measure the distance from the carina to the distal tip of the endotracheal tube, when we can palpate the endotracheal tube cuff between the cricoid cartilage and the suprasternal notch. Following slow induction of anesthesia and muscle relaxation, each patient was intubated with a cuffed endotracheal tube of size suitable for age. The cuff was inflated with 0.5-1 ml of air, and palpated between the cricoid cartilage and the suprasternal notch. The distance between the carina and the tube tip measured by a fiberscope was more than 1.0 cm, which is thought to be safe to prevent bronchial intubation. The cuff was deflated after measurement. There were no complications attributable to use of cuffed endotracheal tubes. We concluded that the cuff palpation method was a rapid, reliable and simple technique to ensure the proper tube position in children.

Anomalous origin of the right coronary artery from the left ventricle in an adult

A 64-year-old woman was referred to cardiac surgery because of aortic stenosis. At surgery, it was confirmed that the right coronary artery arose from the pars membranacea of the left ventricle 5 mm beneath the commissure between the right coronary and noncoronary cusps.

[Comparative study on frequency-doubled Nd: YAG laser, krypton laser and diode laser photocoagulation for diabetic maculopathy]

Twenty six eyes of thirteen patients with diabetic maculopathy (Fukuda's classification AI, AII, BI) were treated with frequency-doubled Nd:YAG laser (6 eyes) or krypton laser (7 eyes) in one eye and diode laser (13 eyes) in the other eye. Group A was treated with frequency-doubled Nd: YAG laser and diode laser, and group B was treated with krypton laser and diode laser. The visual acuity, visual field (Octopus program 31) and fundus were examined at one month, 3 months, and 6 months after photocoagulation. Visual acuity was stable in all eyes. The central 30 degree visual sensitivity decreased more after diode laser treatment than after that of the other lasers. Krypton laser photocoagulation maintained the better visual function and was easy to use followed by frequency-doubled Nd: YAG laser. Because the appearance immediately after diode laser lesion was weaker than one hour after coagulation, it was difficult to get the proper power setting.

Platelet talin is phosphorylated by calyculin A

Calyculin A and okadaic acid, potent and cell permeable inhibitors of type 1 and type 2A protein phosphatases, inhibit platelet aggregation and secretion. However, the relationship between phosphatase inhibition and inhibition of platelet function is not well understood. We found that in unstimulated platelets, talin (P235) was phosphorylated at threonine residues by calyculin A. Furthermore, the extent of talin phosphorylation by calyculin A was closely correlated with its inhibition of thrombin-induced platelet aggregation. Since the binding of talin to platelet glycoprotein IIb/IIIa complex has been shown to be affected by its phosphorylation, these results suggest that type 1 and/or type 2A protein phosphatases may play a role in the regulation of membrane-cytoskeleton interaction through dephosphorylation of talin.

[Fiberscopic intubation under general anesthesia for children with Goldenhar syndrome]

Goldenhar syndrome is characterised by an eye abnormality such as epibulbar dermoid and lipoma, associated with ear, mandibular, and/or vertebral anomalies. It is well documented that difficult intubation in patient with this syndrome may be expected because of mandibular hypoplasia and limitation of neck movement resulting from vertebral anomalies. We report anesthetic management of two children with Goldenhar syndrome, 9 and 14-year-old. By preoperative examination, two children were expected to be difficult in intubating trachea. We used our newly developed mask adapter which enabled us to perform fiberoptic bronchoscopy-aided tracheal intubation under general anesthesia under controlled ventilation. By using this adapter, under sevoflurane/nitrous oxide anesthesia with vecuronium, we could successfully intubate with a 6 mm spiral tube through the nostril without any major problems. Anesthesia and surgery went uneventfully, and no postoperative complications were noted. We confirmed that our newly developed mask adapter for fiberoptic bronchoscopy is as useful for children with difficult intubation as for adults.

Dissolution of pancreatic stones by oral trimethadione in patients with chronic calcific pancreatitis

The effect of oral dissolution therapy for pancreatic stones was evaluated in patients with chronic calcific pancreatitis. The anti-epileptic agent trimethadione was given orally to 30 outpatients at a dose of 0.9-1.5 g daily. On plain X-ray films and CT scans of the abdomen, pancreatic stones began to be dissolved around 8 months of treatment, and diminished in size and number or disappeared in 21 patients (70%) during the mean follow-up period of 32 months. The effect of trimethadione treatment on dissolution of stones was not closely related to the aetiology of the disease, distribution and size of stones, previous history of surgical interventions, or the degree of pancreatic dysfunctions. In three patients who stopped this medication of their own accord, pancreatic stones re-increased or reappeared about 6 months later. During trimethadione treatment, impaired exocrine pancreatic function returned to normal in four of nine patients examined, and diabetes mellitus was well controlled by either diet therapy alone or oral hypoglycaemic agents in eight of 10 patients who did not need insulin before trimethadione treatment. Complete relief of pain was noted in 73% of patients during the treatment. Overall gains and no change in bodyweight were observed in 83% of patients. Mild photophobia was the most common side effect, but could be easily overcome by wearing sunglasses. No severe side effects were observed in the liver, kidney, blood or the eyeground. Pancreatic stones in 30 patients not treated with trimethadione neither disappeared nor diminished spontaneously. Trimethadione treatment may be a useful tool for chemical dissolution of pancreatic stones.

[A long-survival case of unresectable liver metastasis of colon cancer by hepatic arterial intermittent multidrug infusion chemotherapy]

We experienced a long-survival case with unresectable liver metastasis of sigmoid cancer by hepatic arterial intermittent multidrug infusion chemotherapy. The patient was a 65-year-old man. A movable tumor was palpable at the left lower abdomen. The serum CEA value was 15.6 ng/ml. Abdominal CT scan showed a 3 cm-sized low-density area near the root of the right and middle hepatic vein in segment 4. He had undergone sigmoidectomy, cholecystectomy and cannulation into the proper hepatic artery. Chemotherapy was performed by using 5-FU (250 mg), Adriacin (5 mg) and mitomycin C (4 mg) every second week from 4 months after surgery as an outpatient. In the CT scan image, the low-density area completely disappeared at 10 months after treatment, and the CR interval was 14 months. The patient has been alive for 5 years after surgery.

Effect of dimethadione administered intravenously on pancreatic secretion in dogs

In order to detect both pancreatic excretion of dimethadione (DMO), a weak organic acid, and the effect of pancreatic DMO on secretin-stimulated pancreatic secretion, DMO was given intravenously to dogs with pancreatic fistulae at a dose of 50, 100 and 200 mg/kg. DMO was promptly excreted into pancreatic juice; the concentration decreased exponentially as it did in plasma at the highest dose of the compound. At equilibrium of DMO between pancreatic juice and plasma, the DMO concentration in the juice depended directly on that in plasma; the juice/plasma concentration ratios for DMO exceeded 1.0, ranging from 1.7 to 2.1. Pancreatic DMO caused a small but significant decrease in the water, bicarbonate and sodium secretion at non-equilibrium, and in the bicarbonate secretion at equilibrium. A decrease in the bicarbonate secretion may result largely from the buffer action of bicarbonate on protons provided by the undissociated form of DMO. The sum of both bicarbonate and chloride concentrations in pancreatic juice decreased with the increased DMO concentration in the juice, implying that DMO may compete with the secretion of bicarbonate and/or chloride across the apical membrane of the duct cell. Pancreatic DMO can act as a non-specific inhibitor of pancreatic water and electrolyte secretions.

[Anesthetic management for urological surgery of patients with chronic spinal cord injury]

We evaluated retrospectively the anesthetic management and perioperative complications of 47 patients with chronic spinal cord injury for genitourinary procedures. Of the 69 cases, 38 were performed under general anesthesia, 21 cases under spinal anesthesia, one case under epidural anesthesia, four cases under axillary block, and five cases under either sedation or standby. In preoperative laboratory findings, anemia was observed in 41%, hypoproteinemia in 38%, renal insufficiency in 23%, and restrictive pulmonary dysfunction in 69%. Hypotension and bradycardia were seen in 25% and 16% of patients, respectively. Autonomic hyperreflexia was seen in four cases with cervical cord injury: two under spinal anesthesia and two under either sedation or standby. Patients with chronic spinal cord injury have disorders of various organ systems. Careful preoperative evaluation and anesthetic management are required for prevention and prompt treatment of perioperative complications related to the disorders. Autonomic hyperreflexia can be successfully prevented by either general anesthesia or spinal anesthesia. The increased anesthesia safety can be obtained by the successful management of the cardiovascular instability during surgery.

[Two cases of metastatic lung tumor from leiomyosarcoma of the uterus]

Three pulmonary resections were performed for two cases of metastatic lung tumor from uterine leiomyosarcoma. Case 1 was diagnosed as myoma uteri. Preoperative chest X-ray examination showed an abnormal shadow in the left upper lobe. Postoperative diagnosis was leiomyosarcoma. During radiotherapy for the pelvic lesion, the lung tumor was growing very rapidly and micrometastases were detected bilaterally without distant metastasis. Bilateral pulmonary resections were performed. Three months and 15 days later, second left pulmonary and thoracic wall resections were performed because of lung and pleural recurrence. Seven months after the first pulmonary operation, she died of systemic metastases. Case 2 was admitted to the hospital because of genital bleeding and diagnosed leiomyosarcoma of the uterus. The patient had a metastatic lung tumor in the left lower lobe preoperatively. Eighteen days after hysterectomy, left lower lobectomy was performed because progressive hemoptysis occurred for rapidly enlarged metastatic lesion. She died of intrapelvic bleeding three months after the operation without respiratory symptom. The prognosis of synchronously found out lung metastasis from uterine leiomyosarcoma is very poor. Neither chemotherapy nor radiotherapy is effective. Although it's difficult and controversial to decide the surgical indication, we need to operate on as soon as possible when there is no other distant metastasis. Even if the timing of operation is late, we can find the surgical significance of pulmonary resection for reduction of respiratory symptoms and probability of longer survival.

[An epidemiological study of group A, B, C, and G hemolytic streptococci isolated from elementary school children in the recent 12 years. Part I. Isolation trends. Streptococcal Diseases Study Group]

During a 12-years period between September, 1980 and November, 1992, hemolytic streptococci (group A, B, C, & G) in throats of healthy school children in Osaka were examined every other month. The results were summarized as follows. 1. 5,023 strains of hemolytic streptococci were detected from 11,647 specimens, 43.1%. Among them, 2,395 strains (20.6%) belonged to group A, 1,647 (14.4%) to group B, 767 (6.6%) to group G and 187 (1.6%) to group C. 2. In the first half of the research, group A streptococci were detected predominantly and the last half, group B generally. Both this lower rate of group A to the total strains (47.7%) and this higher rate of group B (33.3%) were due to the small number of lower school grade children from whom group A streptococci are often detected and also due to application of the selective enrichment medium. 3. Group A streptococci were classified T-type. The most common serotype was T-1, and 638 strains (26.6%) were detected, followed by T-12, 377 (15.7%), T-6, 210 (8.8%) and T-13, 203 (8.5%). The dominant serotype was exchanged annually, but only T-1 was the most common serotype for 4 years (1983-1986). 4. In group B, the most common serotype was Ia, and 524 strains (31.3%) were detected, followed by III, 417 (24.9%), Ib, 164 (9.8%), III/R, 130 (7.8%) and Ia/c 122 (7.3%). Annual changes of serotype were as follows; Ia was dominant from 1980 to 1988, III from 1989 to 1990 and NT6 in 1991-1992 generally.

Autoradioluminography, a novel quantitative method of TLC-autoradiography

In pharmacokinetic studies, ordinary methods of identifying or quantitatively measuring metabolites have been complicated and become difficult to handle. Here, a novel TLC-autoradioluminography (TLC-ARLG) is reported. This technique is especially suited for quantitatively measuring a minute amount, below-1 ng, of many radioactive metabolites in plasma, tissues or organs, thus eliminating cumbersome extraction procedures. The method has an extremely wide dynamic range and could offer a powerful analytical technique for studying a radioactive compound and its metabolites in a biological specimen. Autoradioluminography is a new quantitative technology developed by combining autoradiography with radioluminography. Radioluminography is a kind of radiography in which a specially designed radio-sensor plate, called an "Imaging plate (IP)," developed by Fuji Photo Film Co., Ltd., is used. The radio-sensor is made of fine crystals of BaF:Eu2+, and the technology is based on photo-luminescence phenomena.

[An epidemiological study of group A, B, C and G hemolytic streptococci isolated from elementary school children in the recent 12 years. Part II. Susceptibility to antibiotics. Streptococcal Diseases Study Group]

During a 12-years period between 1980 and 1992, 5,023 strains of hemolytic streptococci were detected from throats of school children, and described in part I. Among them, the following strains their susceptibility were tested to 14 kinds of antibiotics; 1,511 strains of group A, 1,038 of group B, 125 of group C, 553 of group G. 1. No resistant strains against both penicillins (PCG, AMPC, ABPC, ACPC) and cephems (CER, CET, CCL, CEX) could be found. Strains of group B were less susceptible than the others to penicillins and cephems. 2. Some resistant strains were found against macrolides (EM, OL & JM), 5.9-8.6%. These resistant strains belonged many to group A and a few to group B & G. Since 1983, the gradual decrease of the resistant strains was noted though few were found after 1986. 3. To TC a number of resistant strains were detected in group A, B, C & G through this study, (12.5-48.4%). 4. To CP some resistant strains were found from 1980 to 1985 among group A, B & G, 3.0-5.1%. Since 1986, the sharp decrease of the resistant strains was noted. 5. Multiresistant strains to TC, CP and macrolides were found since 1980 to 1982. They were found in many of group A and a few of group B and G, but after 1986 decreased sharply. 6. Most of the multiresistant strains of group A belonged to serotype T-12 and group B to serotype Ia. Ia/c, III and III/R. 7. Among the strains of group A type T-13, there were many resistant strains to TC. The rate of resistant occupied over 60% from 1980 to 1986, but decreased slightly thereafter.

[Histological analysis of aging ciliary body]

The aging changes in human ciliary body were studied by histological analysis. Thirty four autopsy eyes were fixed in 2.5% formalin and 1.0% glutaraldehyde mixture. The age distribution was 12 eyes below 50 years of age 13 eyes between 60 and 70 years of age, and 9 eyes over 80 years of age. Serial sections of the ciliary body were made parallel to the limbus and vertical to the ciliary processes. From four areas (transitional portion between pars plana and pars plicata, posterior portion of pars plicata, middle portion of pars plicata, and anterior portion of pars plicata) a central section was selected. Histological analysis was done with the use of Azur II stained light microscopic pictures. The basement membrane of non-pigmented epithelium below 50 years of age was thinner than between 60 and 70 years of age. This finding may be related with lowering aqueous humor secretion with aging. Non-pigmented epithelium, blood vessels in the stroma, and muscle fibers in muscle tissue showed aging changes. The pigment epithelium, basement membrane, and muscle fibers in muscle tissue did not show aging changes in light microscopical analysis, but study of their fine structure is necessary.

The effect of acarbose on blood glucose profiles of type 2 diabetic patients receiving insulin therapy

Nine patients with Type 2 diabetes receiving insulin therapy were treated with acarbose 100 mg thrice daily for 1 week to investigate the effect of acarbose on blood glucose control. Daily blood glucose profiles contained fewer excursions during acarbose administration and low levels were maintained. The M-value, an indicator of blood glucose fluctuation, decreased significantly from a run-in period value of 37.6 +/- 8.7 (SEM) to 16.7 +/- 4.0 during the acarbose period (p < 0.05) and rose again to 28.9 +/- 6.7 (p > or = 0.05) in the follow-up period. The 24-h urinary glucose excretion similarly decreased during acarbose administration. As expected, no decrease in HbA1C was observed due to the short treatment period. The 24-h urinary C-peptide excretions and serum lipids were not influenced by acarbose therapy. Frequent episodes of clinical hypoglycaemia were experienced while on acarbose therapy, indicating a decrease in insulin requirements. Adverse events such as flatulence and abdominal distention were observed in six out of nine cases. Symptoms were generally mild and well tolerated, only one patient dropped out because of diarrhoea and abdominal pain. We conclude that acarbose could usefully be administered to Type 2 diabetic patients treated with insulin to improve blood glucose control and reduce insulin requirement if the appropriate selection criteria were met.