[A case of rheumatoid arthritis (RA) with drug-induced acute pancreatitis due to mizoribine]

A rare case of mizoribine-induced acute pancreatitis is presented. A 39-year-old female with RA was admitted to our hospital because of upper abdominal pain, fever and the elevation of serum amylase concentration. Acute pancreatitis was diagnosed. Mizoribine (MZB) had been administered for 12 days for the treatment of RA before the onset of pancreatitis. Withdrawal of MZB soon resulted in the improvement of the disease. She was asymptomatic for the next few weeks. The pancreatitis recurred 36 hours after she took MZB again on her own judgement for arthralgia. This clinical course strongly suggested that her pancreatitis was due to MZB. Acute pancreatitis due to MZB has never, to our knowledge, been reported. MZB is commonly used for the treatment of RA. Therefore the clinician should take care for the complication of acute pancreatitis even though it is rare.

A multiparametric analysis of occlusal and periodontal jaw reflex characteristics in young adults with normal occlusion

Periodontal jaw reflex, duration of percussion sounds, tooth mobility, and time-moment analysis of occlusal contacts by the T-scan system was recorded in nine periodontally healthy volunteers. The results showed that (i) reflex responses to the pressure applied to the uppercentageral incisors in the lingolabial direction varied, depending on the background jaw-clenching force (BCF) of the same-sided first molars. The BCF levels to elicit excitatory reflexes were 6-8 Kgf, and inhibitory reflexes were clearly elicited with a BCF of 10 Kgf and beyond. (ii) Duration of percussion sounds via an occlusal sound analyser (4.73-4.84 mS: upper first molars, 4.89-5.00 mS: uppercentageral incisors) and tooth mobility using a 'Periotest' (3.3-3.5: upper first molars, 5.5-5.6: uppercentageral incisors) showed a normal value. (iii) The time moments of occlusal contacts were symmetrical toward the midsagittal axis of the occlusal plane. The centre of the anteroposterior occlusal contacts was located in the first molar regions.

Comparative studies on the histochemical properties of M. iliotibialis lateralis from Kumamoto Cochin crossbred roaster and broiler chickens

1. Histochemical properties of M. iliotibialis lateralis were compared between Kumamoto Cochin (a Japanese native breed) crossbred roasters (KC roasters, 112 d of age) and normal broilers (56 d of age). 2. Myofibres were divided into Types II-R, II-I and II-W showing high, moderate and low reduced nicotinamide adenine dinucleotide dehydrogenase (NADH-DH) activities, respectively. 3. Subsarcolemmal formazan granules indicating very strong NADH-DH activity in Type II-R fibres were observed only in KC roasters. In both sexes the percentage of Type II-R fibres present was greater in KC roasters than in broilers. 4. These results indicated marked differences in histochemical properties and meat quality between KC roasters and broilers.

Right atrial separation procedure for eliminating chronic atrial fibrillation associated with atrial septal defect

Chronic atrial fibrillation (AF) had been documented in a patient with atrial septal defect for 7 years. A right atrial separation procedure was performed for ablation of chronic AF, concomitant with repair of the atrial septal defect, and followed by atrial electrophysiological mapping. A horizontal transectional incision extending to the borders of the atrial septum and the tricuspid annulus was made. Cryolesions of the atrial isthmus between the margin of the upper incision and the tricuspid valve annulus were created at -60 degrees C for 2 minutes at a time. After the operation, the patient had restored normal sinus rhythm during a subsequent follow-up period of 48 months.

Gene expression of albumin and liver-specific nuclear transcription factors in liver of protein-deprived rats

Protein-energy malnutrition causes hypoalbuminemia. Recent work has suggested that this may be partly due to decreased transcription of the albumin gene. This study examined the role of cis-acting and transacting elements of the albumin gene during protein deprivation. Male 7-wk-old Donryu rats were fed a protein-free diet (0% casein diet) for 10 d or given restricted (pair-fed control) or free access (freely fed control) to a 25% casein diet. Serum albumin concentrations were significantly lower in the protein-deprived rats (29 +/- 1 g/L) than in the pair-fed controls (42 +/- 3 g/L) or the freely fed controls (45 +/- 3 g/L). The albumin mRNA level was also significantly lower in livers of protein-deprived rats (36% of pair-fed control). However, gel mobility shift analysis using liver nuclear extracts did not show any significant difference between the protein-deprived rats and the pair-fed controls in the binding activity to the B and D sites of the albumin promoter. Furthermore, gel mobility shift-Western blot analysis showed no significant difference between the two groups in the protein levels of nuclear transcription factors binding to the D sites. The amounts of mRNA of hepatocyte nuclear factor-1 binding to the B site were not significantly different between these two groups. These results suggest that the proximal promoter region may not play a major role in the down-regulation of the albumin gene during protein deprivation.

Neonatal alloimmune thrombocytopenia associated with anti-human platelet antigen-3a antibody

A sister and brother with neonatal alloimmune thrombocytopenic purpura (NAITP) caused by maternal anti-human platelet antigen (HPA)-3a are reported. The children had transient severe thrombocytopenia in the newborn period, and were treated with intravenous gamma-globulin and platelet concentrates from random donors. Although the sister had intracranial hemorrhage on day 2 postnatally, the development of the child has been normal and no neurological sequelae have been observed. The brother only had bloody stool when the platelet count was low, and did not have severe hemorrhagic manifestations. The diagnosis of NAITP was made by the sera from the mother, which contained anti-HPA-3a antibody directed against platelets of the children. The rate of recurrence might be high in this family, because the father of the patients was found to be homozygous for the HPA-3a gene.

Xenon provides faster emergence from anesthesia than does nitrous oxide-sevoflurane or nitrous oxide-isoflurane

BACKGROUND

Xenon, an inert gas with anesthetic properties (minimum alveolar concentration [MAC] = 71%), has an extremely low blood:gas partition coefficient (0.14). Therefore, we predicted that xenon would provide more rapid emergence from anesthesia than does N2O+isoflurane or N2O+sevoflurane of equivalent MAC.

METHODS

Thirty American Society of Anesthsiologists class I or II patients undergoing total abdominal hysterectomy were randomly assigned to receive 60% xenon, 60% N2O + 0.5% isoflurane, or 60% N2O + 0.70% sevoflurane (all concentrations are end-tidal: n = 10 per group). After placement of an epidural catheter, anesthesia was induced with standardized doses of midazolam, thiopental, and fentanyl. Thirty minutes later, xenon, N2O+isoflurane, or N2O+sevoflurane was started as previously assigned. These regimens were supplemented with epidural anesthesia with mepivacaine so that the mean arterial pressure and heart rate were controlled within 20% of the preoperative values. At the end of operation lasting approximately 2 h, all inhalational anesthetics were discontinued, and the patients were allowed to awaken while breathing spontaneously on an 8 l/min inflow of oxygen. A blinded investigator recorded the time until the patient opened her eyes on command (T1), was judged ready for extubation (T2), could correctly state her name, her date of birth, and the name of the hospital (T3), and could count backward from 10 to 1 in less than 15 s (T4).

RESULTS

Emergence times from xenon anesthesia were: T1, 3.4 +/- 0.9 min; T2, 3.6 +/- 1 min; T3, 5.2 +/- 1.4 min; and T4, 6.0 +/- 1.6 min (mean +/- SD). These were one half to one third of those from N2O+sevoflurane (T1, 6.0 +/- 1.7 min; T4, 10.5 +/- 2.5 min) or N2O+isoflurane (T1, 7.0 +/- 1.9 min; T4, 14.3 +/- 2.8 min) anesthesia. The three groups did not differ in terms of patient demographics, the duration of anesthesia, the amount of epidural mepivacaine administered, or the postoperative pain rating. No patient could recalls intraoperative events.

CONCLUSIONS

Emergence from xenon anesthesia is two or three times faster than that from equal-MAC N2O+isoflurane or N2O+sevoflurane anesthesia.

[A case of MPO-ANCA positive progressive systemic sclerosis with status epileptics]

A 37-year-old female, who had been suffering from progressive systemic sclerosis (PSS) with long-term renal failure, was diagnosed as MPO-ANCA positive PSS in active stage. She had systemic scleroderma, normotensive renal failure and pulmonary fibrosis. Respiratory management and steroid therapy under the control of CVVH were done for her treatment. She developed hemolytic anemia and thrombocytopenia during the treatment. She was diagnosed as microangiopathic hemolytic anemia, and was treated with plasma exchange treatment. About eight weeks after her admission, she developed status epileptics. Cerebral computed tomography and lumbar puncture did not reveal any abnormal sign. The case reported herein is a MPO-ANCA positive PSS with normotensive renal failure. Generally, PSS rarely reveals neurological sign. This case suggests possibility of association between MPO-ANCA and systemic vasculitis in PSS.

CYP1A1, CYP2E1 and GSTM1 polymorphisms are not associated with susceptibility to squamous-cell carcinoma of the esophagus

We investigated the genetic polymorphisms of CYP1A1, CYP2E1 and GSTM1 in Japanese esophageal cancer patients (n = 53) with a histological diagnosis of squamous-cell carcinoma, to determine whether susceptibility to esophageal cancer is associated with these polymorphisms. There were no significant differences in the frequency distribution of any one of the 3 polymorphisms between esophageal cancer patients and 132 healthy Japanese controls. The genotype distributions in tobacco smokers or alcohol drinkers were also quite similar for male patients and male controls. The age at onset of esophageal cancer was also similar for patients with any genotype of the 3 polymorphisms. We conclude that the 3 polymorphisms are unlikely to be associated with esophageal cancer susceptibility.

CYP1A1, CYP2E1 and GSTM1 polymorphisms are not associated with susceptibility to squamous-cell carcinoma of the esophagus

We investigated the genetic polymorphisms of CYP1A1, CYP2E1 and GSTM1 in Japanese esophageal cancer patients (n = 53) with a histological diagnosis of squamous-cell carcinoma, to determine whether susceptibility to esophageal cancer is associated with these polymorphisms. There were no significant differences in the frequency distribution of any one of the 3 polymorphisms between esophageal cancer patients and 132 healthy Japanese controls. The genotype distributions in tobacco smokers or alcohol drinkers were also quite similar for male patients and male controls. The age at onset of esophageal cancer was also similar for patients with any genotype of the 3 polymorphisms. We conclude that the 3 polymorphisms are unlikely to be associated with esophageal cancer susceptibility.

The attenuating effect of carteolol hydrochloride, a beta-adrenoceptor antagonist, on neuroleptic-induced catalepsy in rats

It is known that beta-adrenoceptor antagonists are effective in the treatment of akathisia, one of the extrapyramidal side effects that occur during neuroleptic treatment. Neuroleptic-induced catalepsy, a model of neuroleptic-induced extrapyramidal side effects, was considered suitable as a model for predicting neuroleptic-induced akathisia in humans, although neuroleptic-induced catalepsy was not considered a specific test for neuroleptic-induced akathisia. Therefore, the effects of carteolol, a beta-adrenoceptor antagonist, on haloperidol-induced catalepsy in rats were behaviorally studied and compared with those of propranolol and biperiden, a muscarinic receptor antagonist. Carteolol, as well as propranolol and biperiden, inhibited the haloperidol-induced catalepsy. The inhibitory effect of carteolol was almost comparable to that of propranolol, but was weaker than that of biperiden. Carteolol did not evoke postsynaptic dopamine receptor-stimulating behavioral signs such as stereotypy and hyperlocomotion in rats. Carteolol did not antagonize the inhibitory effects of haloperidol on apomorphine-induced stereotypy and locomotor activity in rats. In addition, carteolol did not evoke 5-HT1A receptor-stimulating behavioral signs such as flat body posture and forepaw treading and did not inhibit 5-hydroxytryptophan-induced head twitch in rats. Finally, carteolol did not inhibit physostigmine-induced lethality in rats. These results strongly suggest that carteolol improves haloperidol-induced catalepsy via its beta-adrenoceptor antagonistic activity and is expected to be effective in the treatment of akathisia without attenuating neuroleptic-induced antipsychotic effects due to its postsynaptic dopamine receptor antagonistic activity.

CYP1A1, CYP2E1 and GSTM1 polymorphisms are not associated with susceptibility to squamous-cell carcinoma of the esophagus

We investigated the genetic polymorphisms of CYP1A1, CYP2E1 and GSTM1 in Japanese esophageal cancer patients (n = 53) with a histological diagnosis of squamous-cell carcinoma, to determine whether susceptibility to esophageal cancer is associated with these polymorphisms. There were no significant differences in the frequency distribution of any one of the 3 polymorphisms between esophageal cancer patients and 132 healthy Japanese controls. The genotype distributions in tobacco smokers or alcohol drinkers were also quite similar for male patients and male controls. The age at onset of esophageal cancer was also similar for patients with any genotype of the 3 polymorphisms. We conclude that the 3 polymorphisms are unlikely to be associated with esophageal cancer susceptibility.

Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations

BACKGROUND

We have devised a simple surgical procedure to be performed on the posterior wall of the left atrium for the treatment of chronic atrial fibrillation (AF) associated with mitral valve disease. The effectiveness of this procedure for serial mitral valve operations was then evaluated. We postulated that chronic AF associated with mitral valve disease could be attributable to a distended left atrium. The refractory period of the distended left atrium was significantly shorter in the left posterior atrial wall, especially at the base of the left atrial appendage and at the orifice of the left posterior pulmonary vein. We hypothesized that the left posterior atrial wall with its shorter fibrillatory cycle length would act as a driver for maintaining the AF, and therefore, surgical ablation of this critical area in the left atrium could terminate the chronic AF.

METHODS

The surgical patients were divided into two groups. In group 1 (control group), 15 patients with chronic AF were operated on by the mitral valve procedure only. In group 2, 36 patients underwent this procedure in combination with a concomitant mitral valve operation. The disappearance rate of the AF was estimated by electrocardiography, and atrial function was estimated by transthoracic and transesophageal echocardiography.

RESULTS

The chronic AF had been reduced significantly or eliminated at discharge in 4 of 15 patients (26.7%) in the group 1, versus 31 of 36 patients (86%) in group 2 (p < 0.05). In group 2, 29 of the 31 patients (94%) whose AF had disappeared recovered the atrial kick of their right atrium, and 21 patients (22/31; 71%) recovered the atrial kick of their left atrium.

CONCLUSIONS

Surgical ablation of the posterior wall of the left atrium was effective in the treatment of chronic AF associated with mitral valve disease. This simple procedure could restore a sinus rhythm and also recovered atrial systolic function. We conclude that the left atrium may act as a driver for sustaining AF in mitral valve disease.

Protective effect of a novel free radical scavenger, OPC-14117, on wobbler mouse motor neuron disease

A possible protective effect of a novel free radical scavenger, OPC-14117, on the progressive motor neuron death in wobbler mice was examined. Clinical parameters such as mortality, body weight, motor activity as a rolling number of circular cage, and forelimb muscle power as grasping on a rolling column, an angle of slipping down from slope, and hanging ability on a flat plate were compared every 4 weeks from 4 to 36 weeks of age among mice groups treated with vehicle or daily oral administration of OPC-14117 of 10 or 30 mg/kg body weight. The treatment with OPC-14117 dose dependently improved the clinical parameters such as mortality, motor activity, and forelimb weakness. Pathological analysis showed that a diffuse neurogenic change in the forelimb muscle was improved at 36 weeks of age in the drug treated mice with a marked preservation of motor neurons in the spinal cord. Treatment of the mice with the drug reduced age-dependent increase of lipid peroxides in the spinal cord in vivo, and a supplement of the drug to the homogenate of spinal cord in vitro ameliorated the formations of lipid peroxides generated by an exogenous addition of ascorbate or xanthine/xanthine oxidase. These results suggest that OPC-14117 has a protective effect on the motor neuron death probably as a free radical scavenger, resulting in an improvement of clinical symptoms in wobbler mice.

Effects of cyclic and continuous parenteral nutrition on albumin gene transcription in rat liver

To evaluate schedule-dependent effects of parenteral nutrition on albumin gene expression and regulation, mRNA levels for albumin and its promoter-binding nuclear factors in the liver were measured in rats receiving cyclic or continuous parenteral nutrition. Rats were divided into three groups: the control group (n = 5) received a nonpurified diet, the continuous parenteral nutrition group (n = 5) received a continuous infusion of a defined parenteral nutrition formula, and the cyclic parenteral nutrition group (n = 5) received a cyclic (between 2000 and 0800) infusion of the same formula. After 7 d, rats were killed to obtain serum and liver. The serum albumin concentrations were 44 +/- 3 g/L in the controls, 31 +/- 2 g/L in the continuous parenteral nutrition group, and 33 +/- 3 g/L in the cyclic parenteral nutrition group. The mRNA for albumin and D site binding protein (DBP) was more abundant and mRNA for CCAAT/enhancer binding protein beta (C/EBP beta) was less abundant in the cyclic parenteral nutrition group than in the continuous parenteral nutrition group. Gel-shift assay for D site and gel-shift Western blotting of DBP carried out using another three rats in each group revealed an increase of DBP in rats receiving cyclic parenteral nutrition compared with continuous parenteral nutrition. In conclusion, although parenteral nutrition decreases serum albumin concentrations, cyclic parenteral nutrition maintains transcription of the albumin gene to a greater extent than does continuous parenteral nutrition. Cyclic parenteral nutrition, in contrast with continuous parenteral nutrition, sustains the mRNA and concentrations of DBP.

Expression of GATA transcription factors in myelogenous and lymphoblastic leukemia cells

In the hematopoietic lineage, the transcription factors GATA-1 and GATA-2 show restricted and largely overlapping expression profiles, but GATA-2 is uniquely expressed in early hematopoietic progenitors. GATA-3 is found exclusively in T cells of hematopoietic lineage. To clarify whether these expression profiles are preserved or changed during the development of malignancies, we analyzed the expression of GATA factors in the blasts from leukemic children. A total of 18 myelogenous leukemia and 24 lymphoblastic leukemia (ALL) cases were investigated. In the majority of the former cases, GATA-2 mRNA expression and the expression of CD34 and c-kit antigens on leukemic cells were demonstrated. In contrast, GATA-2 mRNA and c-kit antigen could not be detected in CD34-positive cells from ALL patients. GATA-3 mRNA was expressed in all T-ALL cases, but not in any precursor B-ALL. These findings suggest that down-regulation of GATA-2 and expression of GATA-3 are important events for the commitment of cells to lymphoid and T cell lineage, respectively. The expression profiles of GATA factors in leukemic cells are generally consistent with those in their normal counterparts, and thus provide a useful tool to determine the lineage commitment of unclassified leukemia.

Echocardiographic evaluation of global left ventricular function during high thoracic epidural anesthesia

OBJECTIVES

To assess the effects of high thoracic epidural anesthesia on left ventricular (LV) diastolic filling and systolic function in patients without heart disease.

DESIGN

Prospective study.

SETTING

University hospital.

PARTICIPANTS

24 ASA physical status I and II patients scheduled for elective noncardiac surgery.

INTERVENTIONS

Patients received high thoracic (HTE; n = 12) or low thoracic (LTE; n = 12) epidural anesthesia.

MEASUREMENT AND MAIN RESULTS

Left ventricular diastolic filling was noninvasively determined by precordial echocardiography using a pulsed Doppler technique and with a newly developed acoustic quantification (AQ) method that automatically detects endocardial borders and measures cavity area. All measurements were performed in awake premedicated patients. In the HTE group, the extent of sensory blockade of T1-T5, at the least, was induced with 2% lidocaine 5 ml. During HTE, systolic blood pressure (119 +/- 16 vs. 108 +/- 14 mmHg, p < 0.01), heart rate (73 +/- 9.8 vs. 63 +/- 6.8 beats/min, p < 0.01), cardiac output (CO; 4.5 +/- 1.1 vs. 3.8 +/- 1.2 L/min, p < 0.05), and fractional area change (50 +/- 11 vs. 37 +/- 11%, p < 0.01) decreased significantly, whereas end diastolic area (9.4 +/- 1.4 vs. 10.3 +/- 1.1 cm2, p < 0.01) and end systolic area (4.8 +/- 1.3 vs. 6.0 +/- 1.1 cm2, p < 0.05) showed a significant increase. As a result, stroke volume was kept constant (63 +/- 14 vs. 60 +/- 19 ml). Pulsed Doppler derived indices such as peak velocity during the early filling (E) and the atrial contraction (A) phases, peak early to atrial velocity ratio (E/A), and acceleration time remained unchanged. AQ derived peak dA/dt during the early diastolic (D1) and the atrial contraction phases (D2) and D1/D2 also remained unchanged. In contrast, in the LTE group, no significant differences were noted in all systolic and diastolic indices obtained by pulsed Doppler and AQ method.

CONCLUSIONS

High thoracic epidural anesthesia causes a decrease in CO without changing LV ejection and diastolic filling performance in healthy subjects.