Acidic and basic fibroblast growth factors enhance neurite outgrowth in cultured rat spinal cord neurons

We have studied neurotrophic effects of acidic fibroblast growth factor (aFGF) and basic fibroblast growth factor (bFGF) on explanted ventral and dorsal spinal cord cultures from 13- and 14-day-old rat embryos. Cultures treated with aFGF and bFGF significantly enhanced neurite outgrowth with cultures of ventral spinal cord, but not with cultures of dorsal spinal cord. Our data suggest that aFGF and bFGF are potent neurotrophic factors on rat ventral spinal cord neurons in vitro.

Effect of a combination of ecabet sodium and cimetidine on experimentally induced gastric lesions and gastric mucosal resistance to ulcerogenic agents in rats

We studied the effect of single oral administration of ecabet sodium (ecabet), a gastroprotective agent, in combination with the histamine H2-receptor antagonist cimetidine on gastric acid secretion, mucosal prostaglandin E2 (PGE2) production and experimentally induced acute hemorrhagic gastric lesions in rats. The effect repeated administration of ecabet in combination with cimetidine on the vulnerability of gastric mucosa to the ulcerogenic agents 0.6N HCl and aspirin was also studied. In pylorus-ligated rats, oral administration of cimetidine reduced gastric acid secretion, whereas ecabet did not affect the cimetidine-induced reduction in acid secretion. On the other hand, ecabet increased the capacity of gastric mucosa to synthesize PGE2, while cimetidine showed no effect on this parameter either in the presence of absence of ecabet. Both ecabet and cimetidine inhibited the formation of aspirin-induced gastric mucosal lesions, and the combination of ecabet and cimetidine showed a more potent inhibition than either drug alone. After cessation of repeated administration of cimetidine, but not ecabet, the 0.6N HCl- and aspirin-induced gastric lesions were significantly aggravated. The co-administration of ecabet improved the cimetidine-induced aggravation of these gastric lesions. These results suggest that ecabet in combination with cimetidine augments the antiulcer effect of cimetidine and improves the cimetidine-induced increase in gastric mucosal vulnerability to the ulcerogenic agents.

Oral syndrome: an incomplete form of cheiro-oral syndrome?

Cheiro-oral syndrome is a sensory disturbance observed around the corner of the mouth and the palm of the hand on the same side. We had an opportunity to observe a patient in whom sensory disturbance was limited only around the corner of the left mouth but not the hands or other findings. Computed tomography of the brain showed a low density area in the right thalamus. Could our case be called oral syndrome: incomplete form of cheiro-oral syndrome? We have to ask whether the our case is an oral syndrome or whether our case has to be regarded as a thalamic infarction.

Hormone receptors in pulmonary lymphangiomyomatosis

Biochemical assays have demonstrated the existence of hormone receptors in lung tissue from patients with pulmonary lymphangiomyomatosis (LAM). This finding is the biologic corollary to the finding that LAM responds to hormonal therapy. We have examined lung tissue from two patients with LAM for estrogen and progesterone receptors by immunohistochemistry and a biochemical assay. Although specimens from both patients were negative for estrogen receptor activity by the biochemical assay, positive stain of estrogen receptors was observed in both patients with immunohistochemistry.

[Multiorgan abnormalities in myotonic dystrophy--correlation among endocrine disorders, central nervous system involvements and gene analysis]

Myotonic dystrophy (DM) is a disease involving multiple organs. To elucidate the extent of severity of the affected organs in a given individual, we performed an investigation of the Ellsworth-Howard test (EH test), intelligence quotient (IQ), apnea index (AI), and expanded DNA fragment (EF) size in 10 patients with DM. The EF size analyzed by standard Southern blot procedures using EcoRI digested genomic DNA extracted from the peripheral white blood cells and probed with cDNA25. In the EH test, these patients were divided into two groups according to the results of their phosphaturic responses (delta P). Of these, 5 patients (Group I) showed a positive delta P, while remaining 5 patients (Group II) showed a negative one. In both Groups I and II, their urinary cyclic AMP responses were positive. Group II showed a significantly low value in IQ (p < 0.02) and a significantly high value in AI (p < 0.02) as compared with Group I. EF size in Group II was found significantly larger than in Group I (p < 0.01). A positive correlation between delta P and IQ (p < 0.1), a significant negative one between delta P and AI (p < 0.01), and a negative correlation between EF size and delta P (p < 0.2) were observed. IQ was negatively (p < 0.05), and AI was positively (p < 0.05) correlated with EF size, which were statistically significant. Our results suggest that the extent of disease severity of the central nervous system is almost the same as that of endocrine organs, and that EF size is correlated with disease severities in both affected organs.(ABSTRACT TRUNCATED AT 250 WORDS)

Gender difference in long-term prognosis after myocardial infarction--clinical characteristics in 1000 patients. The Kyoto and Shiga Myocardial Infarction (KYSMI) Study Group

To examine gender differences in the long-term prognosis of patients with myocardial infarction, 1000 patients with myocardial infarction were studied after coronary arteriography. Over a follow-up period of 3.3 +/- 2.0 years, 65 patients died from cardiac causes and 301 experienced cardiac events (death, reinfarction and revascularization). Overall, the 5-year cardiac mortality was 8%: that in females (12.4%) was significantly higher than that in males (6.6%) (p = 0.0073). The overall 5-year cardiac event-rate was 35%, with no significant difference between females and males (41.1% vs 33.3%). Univariate analysis revealed that differences in age (57.8 +/- 9.8 years in males vs 64.8 +/- 8.9 years in females, p < 0.0001), presence of smoking habit, obesity, hypercholesterolemia, hypertension, heart failure, right coronary artery disease, nicorandil administration, hypolipidemic, diuretic and anti-hypertensive treatment, and warfarin administration were present between men and women. The mortality rate in elderly females tended to be higher than that in their male counterparts. Multivariate analysis demonstrated that number of diseased vessels, post-infarction angina and left main trunk disease were significant predictors for cardiac death in both sexes, while gender was not. Therefore, gender did not appear to affect the long-term prognosis after age-adjustment among patients with myocardial infarction in the Western part of Japan.

Grades of exophthalmos and thyrotropin-binding inhibitory immunoglobulin in patients with myasthenia gravis

Exophthalmos and thyrotropin-inhibitory immunoglobulin (TBII) were examined in myasthenia gravis (MG) patients with normal thyroid function. Exophthalmos was found in 7 of 31 (22.6%) MG patients, and TBII was detected in 4 of 21 (19.0%) MG patients. The grades of exophthalmos did not decrease after extraocular muscle weakness was improved by treatment. Patients with MG whose diplopia was Tensilon unresponsive were only found among those with exophthalmos. TBII was more frequently detected in MG patients with exophthalmos than in those without. The present study revealed that exophthalmos is not rare in MG patients, even if they do not show any signs of Graves' disease other than exophthalmos and their thyroid functions are within the normal limit. The presence of TBII in MG patients may relate to the development of exophthalmos, and exophthalmos itself might enhance ocular symptoms of MG.

Detection of Palmaz-Schatz stent by ultrafast CT

We present a case of Palmaz-Schatz stent in the anterior descending coronary artery in a patient in whom restenosis occurred repeatedly after balloon angioplasty. The location of the stent was confirmed by ultrafast CT. The Palmaz-Schatz stent is barely visible by fluoroscopy and confirmation of its location by fluoroscopy is difficult after failure of stent delivery. However, ultrafast CT enabled the clear detection of a Palmaz-Schatz stent without artifacts and may be valuable in confirming its location.

DD genotype of the angiotensin-converting enzyme gene is a risk factor for left ventricular hypertrophy

BACKGROUND

The cardiac renin-angiotensin system has been suggested to be involved in the development of left ventricular hypertrophy. In humans, a strong correlation has been found between plasma angiotensin I-converting enzyme (ACE) activity and the insertion/deletion (I/D) polymorphism of the ACE gene, which has been reported to be associated with myocardial infarction, ischemic and idiopathic dilated cardiomyopathy, sudden death in hypertrophic cardiomyopathy, and restenosis after percutaneous transluminal coronary angioplasty. In the present study, we examined the possibility that the genotype of the ACE gene might influence the development of left ventricular hypertrophy.

METHODS AND RESULTS

The study population consisted of 268 subjects randomly selected from our outpatient clinic. In 142 subjects, left ventricular mass (LVM) was determined by echocardiogram. The genotype of the ACE gene was determined by the polymerase chain reaction. ANCOVA revealed that the genotype of the ACE gene had no effect on blood pressure. The percentage of the explained variance of LVM with variables including diastolic blood pressure (DBP, P = .0001), body mass index (BMI, P = .0001), sex (P = .0009), and the genotype of the ACE gene (P = .0017) was 34.61%. Significant differences in the effects of the genotype of the ACE gene on LVM were observed between the II and DD (P = .0004) and between the ID and DD (P = .0077) genotypes. The percentage of the explained variance of the LVM/ht ratio with variables including sex (P = .134), age (P = .3655), the genotype of the ACE gene (P = .0014), BMI (P = .0001), and DBP (P = .0001) was 31.25%. Significant differences in the effects of the genotype of the ACE gene on LVM/ht were observed between the II and DD genotypes (P = .0003) and between the ID and DD genotypes (P = .0091).

CONCLUSIONS

In addition to BMI and DBP, the genotype of the ACE gene was a significant predictor of LVM and LVM/ht in our study population.

Differential inhibition of platelet aggregation and calcium mobilization by nitroglycerin and stabilized nitric oxide

We compared the mechanisms of the antiplatelet effects of nitroglycerin (NTG) and stabilized nitric oxide (NO). Stabilized NO was in the form of S-nitrosothiols [S-nitroso-albumin (S-NO-Alb) and S-nitrosocaptopril (S-NO-Cap)] or heme-NO [sodium nitro-prusside (SNP)]. The molecular structure of S-NO-Cap was confirmed by mass spectrometry. NTG, SNP, S-NO-Alb, and S-NO-Cap inhibited ADP-induced platelet aggregation dose dependently. The inhibitory IC50 value was 109 microM for NTG, 0.98 microM for SNP, 2.99 microM for S-NO-Alb, and 2.5 microM for S-NO-Cap. NTG (200 microM) released 15.4 microM nitrite anion into platelet-rich plasma (PRP) after 60-min incubation, to which platelets contributed 5.4 microM. On the other hand, SNP and S-NO-Cap released undetectable amounts of NO2- when incubated in either PRP or platelet-poor plasma (PPP). The platelet cytosolic calcium ion (Ca2+) concentration was measured fluorometrically in Fura-2-loaded gel-filtered platelets. Thrombin-induced Ca2+ mobilization was significantly inhibited by 10 microM NTG, SNP, S-NO-Alb, and S-NO-Cap, whereas resting Ca2+ was unaltered. Ca2+ mobilization was inhibited 28.6% by NTG, 91.9% by SNP, 90.0% by S-NO-Alb, and 92.7% by S-NO-Cap. These results demonstrate that NTG is an exogenous donor of NO, but releases it only slowly. On the other hand, SNP and S-nitrosothiols inhibited platelet aggregation by the action of stabilized NO incorporated in their structure and did not release NO. NTG and stabilized NO shared a common mechanism of antiplatelet activity, which involved inhibition of calcium mobilization.

[Familial LCAT deficiency]

Familial plasma lecithine: cholesterol acyltransferase (LCAT) deficiency is a disease that is inherited as an autosomal recessing trait. The main clinical abnormalities are corneal opacities, anemia and frequently, though not invariably, proteinuria. These abnormalities result from a failure of LCAT to esterify cholesterol in plasma. Renal failure can be a life-threatening complication. In plasma, all lipoprotein classes show abnormalities including lipid composition, shape, distribution and concentration. Fish eye disease, which is characterized by corneal opacities and plasma lipoprotein abnormalities, is also a result from deficiency of LCAT activity. As LCAT gene has been cloned, molecular defects of both familial LCAT deficiency and fish eye disease have been reported recently.

Molecular genetics of the SA gene

1. We have recently identified a candidate gene for rat genetic hypertension, termed SA, by identifying an mRNA species that shows markedly higher expression in the kidneys of spontaneously hypertensive rats (SHR) than in those of Wistar-Kyoto rats (WKY). 2. Subsequent genetic co-segregation analyses by ourselves and others indicated that the SA gene locus did indeed influence blood pressure. Moreover, in a preliminary association study, we found an association of a polymorphism of the human SA gene with essential hypertension. 3. Further studies to identify functions of the SA gene products are required before reaching a definite conclusion.

Magnetic resonance imaging and neuropathological findings in two patients with Creutzfeldt-Jakob disease

We report 2 autopsy-proven patients with Creutzfeldt-Jakob disease (CJD) showing bilateral decreased signal intensity in the thalamus on T2-weighted images. On post-mortem examination, all affected areas showed the characteristic features of CJD, such as neuronal loss, gliosis, and status spongiosus. These findings are another distinctive MRI appearance in CJD.

[Clinical features and long-term outcome of non-Q wave myocardial infarction in the elderly: comparison with Q wave myocardial infarction]

The clinical features and long-term outcome of non-Q wave myocardial infarction (NQMI) in the elderly were assessed in 24 patients with NQMI and compared with those in 48 patients with Q wave myocardial infarction (QMI). NQMI patients had a significantly lower maximal peak of serum creatine phosphokinase activity and lower incidence of pump failure during the acute phase. In-hospital mortality did not differ significantly between the NQMI and QMI patients. Evaluation of acute-phase coronary angiographic features within 6 hours of onset found a significantly higher incidence of infarct-related vessels in the NQMI patients, but the frequency of multivessel disease and the level of collateral flow did not differ between the two groups. Fifteen of the 24 NQMI patients and 34 of the 48 QMI patients underwent emergency coronary revascularization procedures of percutaneous transluminal coronary angioplasty (PTCA) or intracoronary thrombolysis. Successful recanalization was more frequent and the time to recanalization was shorter in the NQMI patients. The requirement for coronary revascularization (PTCA or coronary artery bypass graft) in the chronic phase for residual stenosis did not differ significantly between the two groups. Left ventricular ejection fractions were significantly better in the NQMI patients. The short- and long-term outcomes in elderly patients with NQMI and QMI were good and did not differ between the two groups, probably reflecting the active performance of revascularization in the acute and chronic phases.

A variant form of hypobetalipoproteinaemia associated with ataxia, hearing loss and retinitis pigmentosa

A six-year-old Japanese boy had ataxia, mental retardation, peripheral neuropathy, proximal myopathy, hearing loss, retinitis pigmentosa and deficiencies in apolipoprotein AI, B, CII and CIII. His clinical features except for hearing loss resembled those of abetalipoproteinaemia or symptomatic hypobetalipoproteinaemia, but his apolipoprotein abnormalities were distinct from these disorders. He had apolipoprotein B-100 with a normal molecular weight. Although most of his neurological manifestations were compatible with those of vitamin E deficiency, their early onset and the presence of hearing loss was unusual for that condition. There has been slight deterioration of ataxia during two years follow-up despite high-dose vitamin E supplementation. Other abnormalities in lipid metabolism might be associated with the neurological damage in this case.

Abnormal sympathetic innervation of the heart in a patient with myotonic dystrophy detected with I-123 MIBG cardiac SPECT

Iodine-123 MIBG is a norepinephrine analog which can be used to image the sympathetic innervation of the heart. The authors report a patient with myotonic dystrophy whose I-123 MIBG SPECT revealed accelerated washout of I-123 MIBG from infero-posterior and a part of lateral wall, although Tl-201 SPECT showed no abnormal finding. The authors conclude that I-123 MIBG can be more sensitive in detecting the cardiac abnormality than Tl-201 SPECT in this disease.

[Assessment of left ventricular count increase with ECG-gated 99mTc-MIBI SPECT using a single-head rotating gamma-camera]

ECG-gated 99mTc-MIBI SPECT was performed in 33 patients, including 17 normal subjects and 16 patients with old myocardial infarction. To compare the findings by echocardiography (UCG), regional wall motion was qualitatively assessed by cine-mode display and quantitatively measured as an increase in regional count from end-diastole to end-systole. The percent count increase and relative count increase was measured to display on the Bull's eye polar map. In the study of normal subjects, the count increase was greater in apical regions and smaller in septal regions. Regional wall motion by this method correlated well with UCG findings (agreement: 97%, complete agreement: 60%). A mild but significant correlation was observed between the count increase by this method and the percent wall thickening by UCG. We conclude that regional wall motion can be accurately evaluated with ECG-gated 99mTc-MIBI SPECT, which thus permits simultaneous assessment of regional wall motion and myocardial perfusion.

Aberrant hepatic duct connected with the main pancreatic duct by anomalous pancreato-biliary ductal union: case report

An aberrant hepatic duct directly connected to the main pancreatic duct with anomalous arrangement of the pancreato-biliary ductal system is reported here, the first report of such a case, to our knowledge. A 53-year-old woman was admitted to our hospital because of cholecystolithiasis with abdominal pain in the right upper quadrant. Endoscopic retrograde cholangiopancreatography (ERCP) showed that an aberrant hepatic duct, which independently drained the right posterior segment of the liver, connected to the main pancreatic duct at a high insertion site distal to the sphincter area of the major papilla. The common bile duct (containing stones), on the other hand, united with the main pancreatic duct in a normal fashion. Cholecystectomy and bile duct lithotomy were performed. The aberrant hepatic duct was separated from the main pancreatic duct just above the junction, and was anastomosed side-by-side to the common hepatic duct. The embryologic development of this lesion is not clear, but is discussed in this report.