Novel paracrine signaling mechanism in the ocular ciliary epithelium

The ciliary body contains an epithelial bilayer consisting of an outer pigmented cell layer (PE) and an inner nonpigmented cell layer (NPE) responsible for aqueous humor secretion. Secretion may be mediated in part by cytosolic Ca2+ concentration ([Ca2+]i), but whether or how the two layers could coordinate their Ca2+ signals to regulate secretion is unclear. To investigate interactions between PE and NPE, we examined [Ca2+]i signaling in isolated intact ciliary epithelial bilayers using confocal microscopy. Phenylephrine selectively increased [Ca2+]i in PE and acetylcholine increased [Ca2+]i in NPE, but epinephrine increased [Ca2+]i in both layers. This increase spread from PE to NPE, and [Ca2+]i signaling across the bilayer remained coordinated during [Ca2+]i oscillations. All epinephrine-induced [Ca2+]i signaling was blocked by the alpha1-adrenergic antagonist prazosin, whereas signaling in the NPE but not PE was blocked by the beta-adrenergic antagonist propranolol, the gap junction blockers octanol and 18alpha-glycyrrhetinic acid, or the A kinase inhibitor Rp diastereomer of adenosine 3',5'-cyclic monophosphothioate. The beta-adrenergic agonist isoproterenol failed to increase Ca2+ by itself, but isoproterenol plus phenylephrine-induced [Ca2+]i signals across the bilayer similar to those induced by epinephrine. Finally, isoproterenol increased cell-to-cell spread of lucifer yellow via gap junctions, whereas cell-to-cell spread of [Ca2+]i signals could be induced by photorelease of caged inositol 1,4,5-trisphosphate. Thus, calcium signals are coordinated in the epithelial bilayer so that adrenergic stimulation can increase [Ca2+]i in NPE, but only if NPE are primed by activation of endogenous adenylyl cyclase, whereupon they receive stimulation from adjacent PE via gap junctions. This novel interplay between endocrine and paracrine pathways may coordinate [Ca2+]i signaling across the ciliary epithelial bilayer.

Stimulatory interaction between vascular endothelial growth factor and endothelin-1 on each gene expression

The precise regulation of cell growth in the vascular wall maintains vascular integrity, and its disruption leads to cardiovascular disorders including atherosclerosis and restenosis. Vascular endothelial growth factor (VEGF) is a specific mitogen for endothelial cells, and endothelin-1 (ET-1) is known to stimulate the proliferation of smooth muscle cells. The aim of this study was to explore a potential interaction between VEGF and ET-1 on each expression in vascular cells. VEGF enhanced preproET-1 mRNA expression and ET-1 secretion in bovine aortic endothelial cells (BAECs). Similarly, in rat vascular smooth muscle cells (VSMCs), ET-1 enhanced VEGF mRNA expression and stimulated VEGF secretion. ET-1-induced VEGF mRNA expression was abolished by a selective ET(A) receptor antagonist, BQ-485, but not by an ET(B)-selective blocker, BQ-788. It was also inhibited by pretreatment with actinomycin D but not by pretreatment with cycloheximide. Furthermore, the actinomycin D chase experiment revealed that ET-1 did not alter VEGF mRNA stability. Coculture of BAECs and VSMCs enhanced both ET-1 and VEGF gene expression in these cells, and the conditioned media from BAECs and VSMCs reproduced the augmentation of each gene expression, which was partially inhibited by BQ-485 or an antibody specific to VEGF. Our results indicate that VEGF and ET-1 have stimulatory interactions on each expression, which may play an important role in concomitant proliferation of endothelial and smooth muscle cells in the vascular wall.

[Snare injury in coronary artery bypass grafting on the beating heart: report of 2 cases]

From June to November 1997, 8 patients underwent coronary artery bypass grafting on the beating heart. The first 2 patients had snare injury. Postoperative angiography showed coronary stenosis distal to the LITA-LAD anastomosis in the first case and a pseudo-aneurysm at the septal branch of the LAD in the second case, most likely due to snaring maneuver with 3-0 prolene or 3-0 GORE-TEX suture with a sharp needle. Since then, we have been satisfactorily utilizing the RETRACT-O-TAPE (a silicone tape with blunt needle, QUEST Medical, Inc.) for coronary occlusion to avoid injury to the native vessels and their branches.

Alterative expression of the collagenase and adhesion molecules in the highly metastatic clones of human colonic cancer cell lines

Human colonic carcinoma cell lines, KM12C, KM12SM and KM12L4, were previously established and their in vivo metastatic potentials have been well evaluated. The highly metastatic cell lines KM12SM and KM12L4 were derived from the parental low metastatic cell line KM12C in vivo. To evaluate the metastatic behavior of these cell lines in vitro, we examined colony formation on monolayers of the pulmonary arterial endothelial (CPAE) cells. On day 4, the highly metastatic cell lines showed an approximately 2-fold increase in number of colonies on CPAE cell monolayers relative to the parental KM12C cell line. To investigate what evidence is correlated with their metastatic and invasive abilities, Northern blot analysis and flow cytometry were performed in all cell lines. According to the results of Northern blot analysis, the levels of matrix metalloproteinase (MMP)-2 and c-met mRNA expression were increased in highly metastatic cell lines as compared with the parental cell line. We also examined the cell-surface expression of several adhesion molecules by flow cytometry. The levels of expression of sialyl Lewisa antigen (sLe(a)) in KM12SM and KM12L4 were twice higher than that in KM12C. However, the levels of expression of E-cadherin in KM12SM and KM12L4 were decreased to half that in KM12C. The alterative expression of the collagenase and adhesion molecules might contribute to their metastatic/invasive abilities of these cell lines both in vivo and in vitro.

High proportion of missense mutations of the BRCA1 and BRCA2 genes in Japanese breast cancer families

Mutations in either of two recently identified genes, BRCA1 and BRCA2, are thought to be responsible for approximately two-thirds of all cases of autosomal-dominantly inherited breast cancer. To examine the nature and frequency of BRCA1 and BRCA2 mutations in Japanese families exhibiting a high incidence of breast cancer, we screened 78 unrelated families in this category for mutations of these two genes. Examining the entire coding sequences as well as exon-intron boundaries of both genes by polymerase chain reaction (PCR) single-strand conformation polymorphism (SSCP) and multiplex-SSCP analysis, we identified possible disease-causing alterations in BRCA1 among affected members of 15 families and in BRCA2 in another 14 families. In 15 of those 29 families, the affected individuals carried missense mutations, although most germline mutations reported worldwide have been deletions or nonsense mutations. Our results, indicating that missense mutations of BRCA1 and BRCA2 tend to predominate over frameshifts or nonsense mutations in Japanese breast cancer families, will contribute significantly to an understanding of mammary tumorigenesis in Japan, and will be of vital importance for future genetic testing.

Histological evaluation of the effects of intraarterial chemotherapy for advanced breast cancer: a long-term followup study with respect to the survival rate

To evaluate the effects of intraarterial infusion chemotherapy (IAIC) for advanced breast cancer, we examined the grade of histological responses of preoperative IAIC on tumors at the time of operation and estimated the patients' prognoses for 19 years. IAIC was done preoperatively using timely epochal anticancer drugs on 105 patients with locally advanced (Stage IIIa, IIIb) and metastatic (Stage IV) breast cancer. The survival rate of the Stage IIIb patients who showed a good histological response (Grade IIb< or =) to IAIC was 68.1% for 5 years, and 62.4% for 10 years, respectively. This was in contrast to that of the patients classified as Stage IIIb who showed a poor histological response (Grade IIa> or =) to IAIC. On the other hand, there was no significant difference in the survival rates between the Stage IIIa and IV patients with good and poor histological responses to IAIC. However, the findings showed that a good histological response to IAIC reflected a prolonged survival while the Stage IIIb and IV patients acquired a "down clinical staging" by IAIC. These results strongly suggest that IAIC thus appears to be a useful modality in the multidisciplinary treatment of advanced breast cancer, especially for Stage IIIb patients.

Is IgG anti-GT1a antibody associated with pharyngeal-cervical-brachial weakness or oropharyngeal palsy in Guillain-Barré syndrome?

The pharyngeal-cervical-brachial variant (PCB) of Guillain-Barré syndrome (GBS) has clinical features similar to those of botulism and diphtheria. Mizoguchi et al. (1994) [Mizoguchi, K., Hase, A., Obi, T., Matsuoka, H., Takatsu, M., Nishimura, Y., Irie, F., Seyama, Y., Hirabayashi, Y., 1994. Two species of antiganglioside antibodies in a patient with a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. J. Neurol. Neurosurg. Psychiatry 57, 1121-1123] reported a patient with PCB-like symptoms who had serum IgG anti-GT1a antibodies which did not cross-react with GQ1b. We assumed that PCB is associated with anti-GT1a antibodies that do not have reactivity to GQ1b and made a serological study of a PCB patient. We searched for PCB patients prospectively and found one with PCB. This patient had IgG anti-GT1a antibodies which were not absorbed with GQ1b in an absorption study, whereas IgG anti-GT1a antibodies from Fisher's syndrome patients were. The frequency of positive IgG anti-GT1a antibody did not differ in patients with and without bulbar palsy. Our findings indicate that IgG anti-GT1a antibodies which do not cross-react with GQ1b are specifically detectable in PCB and can be used as a diagnostic marker of PCB.

Regulatory roles of complexins in neurotransmitter release from mature presynaptic nerve terminals

Complexins are presynaptic proteins whose functional roles in synaptic transmission are still unclear. In cultured rat hippocampal neurons, complexins are distributed throughout the cell bodies, dendrites and axons, whereas synaptotagmin I and synaptobrevin/VAMP-2, essential proteins for neurotransmitter release, accumulated in the synaptic-releasing sites as early as 1 week in culture. With a maturation of synapses in vitro, complexins also accumulated in the synaptic release sites and co-localized with synaptotagmin I and synaptobrevin/VAMP-2 after 3-4 weeks in culture. Complexins I and II were expressed in more than 90 and 70% of the cultured neurons, respectively; however, they were largely distributed in different populations of synaptic terminals. In the developing rat brain, complexins were distributed in neuronal cell bodies in the early stage of postnatal development, but gradually accumulated in the synapse-enriched regions with development. In mature presynaptic neurons of Aplysia buccal ganglia, injection of anticomplexin II antibody caused a stimulation of neurotransmitter release. Injection of recombinant complexin II and alphaSNAP caused depression and facilitation of neurotransmitter release from nerve terminals, respectively. The effect of complexin was reversed by a subsequent injection of recombinant alphaSNAP, and vice versa. These results suggest that complexins are not essential but have some regulatory roles in neurotransmitter release from presynaptic terminals of mature neurons.

Carcinoma arising from ectopic pancreas in the stomach: endosonographic detection of malignant change

We present a case of a submucosal tumor in the stomach that was suspicious for malignancy on preoperative endosonography. The resected tumor was histologically diagnosed as a ductal adenocarcinoma that originated in ectopic pancreatic tissue in the gastric wall. Although malignant transformation in ectopic pancreas is extremely rare, it remains an important consideration in the differential diagnosis of gastric submucosal masses.

N-glycolylneuraminic acid-containing GM1 is a new molecule for serum antibody in Guillain-Barré syndrome

To clarify the pathogenesis of Guillain-Barré syndrome (GBS) after parenteral injections of bovine brain gangliosides, we searched for new molecules in bovine brain gangliosides recognized by sera from GBS patients. Gangliosides fractionated in a Q-Sepharose column were used as the antigens, and the binding of serum IgG or IgM was examined by thin-layer chromatography/immunostaining. Fourteen of 175 serum samples from the patients reacted with the monosialoganglioside fraction 2. In the neutral solvent system, a band in this fraction migrated with N-acetylneuraminic acid-containing GM1 [GM1(NeuAc)], whereas in the alkaline solvent system it migrated slower. This suggested that the band was N-glycolylneuraminic acid-containing GM1 [GM1(NeuGc)]. In both solvent systems, its mobility was almost the same as that of authentic GM1(NeuGc) from mouse liver. Secondary ion mass spectrometry showed that the ganglioside's structure was consistent with that of GM1(NeuGc). IgG anti-GM1(NeuGc) antibodies in sera from the GBS patients were significantly absorbed by GM1(NeuAc), indicative that the anti-GM1(NeuGc) antibodies cross-react with GM1(NeuAc). N-Glycolylneuraminic acid-containing gangliosides are so highly immunogenic in humans that the injection of GM1(NeuGc) could induce the production of IgG anti-GM1(NeuGc) antibody, which cross-reacts with GM1(NeuAc).

Expression of NOS, PSA-N-CAM and S100 protein in the granule cell migration pathway of the adult guinea pig forebrain

To investigate the possible role of nitric oxide (NO) in adult neurogenesis and neuron-glial migration in the rostral migratory stream (RMS), we used a double-labeled immunofluorescence technique together with confocal laser scanning microscopy, and examined the localization of nitric oxide synthase (NOS), the highly polysialylated isoform of neural cell adhesion molecule (PSA-N-CAM), and the astroglial marker in brain, S100 protein (S100), throughout the length of the subependymal layer (SEL) to olfactory bulb (OB) pathway of the adult guinea pig forebrain. Blast-like, beaded, clustered immature cellular elements stained for PSA-N-CAM and those having a typical astrocytic phenotypes positive for S100 protein were densely interlaced throughout the entire length of the SEL. Some S100 positive ependymoglial cells (tanycytes) gave off their basal projections into the closely packed PSA-N-CAM immunopositive clusters in the rostral extension of the subependymal zone (SEZre). The SEL was devoid of NOS immunoreactivity. A dense network of punctate, fenestrated and radially oriented immature cellular elements positive both for NOS and PSA-N-CAM intermingled and overlapped in the inner part of the internal granular layer (IGr), whereas in the outer part, PSA-N-CAM expression gradually diminished and the cells shifted to mature bipolar, spherical or spindle-shaped granule cells with uniform cellular contours, which were exclusively immunopositive for NOS. Radially oriented astroglial phenotypes were intertwined with PSA-N-CAM neuronal clusters in the SEL, and were closely apposed to NOS neuronal elements in the IGr. In summary, these results showed a distinct separation of neurons and glia as revealed by PSA-N-CAM and S100 protein immunostaining, and an inverse spatio-temporal correlation of expression between PSA-N-CAM (immature neuroblasts) and NOS (mature neurons) in the adult guinea pig RMS.

The plasma FK506-binding protein 12 level is related to acute cellular rejection in small bowel transplantation

Since FK506 binding protein (FKBP12) inhibits dose-dependently the immunosuppressive activity of FK506 in vitro, plasma FKBP12 levels were measured after rat small bowel transplantation (SBTx). The mean plasma FKBP12 level in untreated recipients increased significantly at the onset of acute cellular rejection (ACR) compared to that in FK506-treated recipients without rejection at the same time after SBTx (P < 0.05). In both groups, however, the mean plasma FKBP12 level did not increase at 1 day after SBTx. These results suggest that plasma FKBP levels may be affected by ACR, but not by ischemia-reperfusion injury. Therefore, the plasma FKBP12 level should be considered as one of the parameters related to the immunosuppressive activity of FK506 in SBTx.

Venous drainage from the posterior aspect of the pancreatic head and duodenum

Eighty-three pancreatic head and duodenum specimens, selected from 214 specimens, were dissected minutely to clarify the configurations of the posterior superior pancreaticoduodenal vein (PSPDv) with special reference to its topographical relationship to the common bile duct (CBD) and to whether an artery accompanied the PSPDv. The PSPDv frequently (71.1%) ran postero-inferior to the CBD without the accompaniment of an artery. Moreover, several tributaries draining the second and third portions of the duodenum sometimes (28.9%) joined together without arterial association and formed a stem, the so-called dorsal pancreatic vein. Variations of PSPDv were discussed in relation to the general vascular configuration of the small intestine.

[Clinical application of multi-shot diffusion EPI in neurological disease]

Using the multi-shot EPI method we investigated the clinical application of diffusion weighted imaging (DWI) in the diagnosis of neurological disease. The multi-shot method provided better susceptibility artifact-free DWI than the single-shot method particularly in the region of the posterior cranial fossa. DWI using the multi-shot EPI method readily shows the pyramidal tract extending from the internal capsule to the brainstems which is inaccessible by the conventional single-shot EPI method, and providing three-dimensional and distinct images of pyramidal tract changes in amyotrophic lateral sclerosis or cerebral infarction with pyramidal tract disturbance. Our findings suggest that the use of DWI with the multi-shot EPI method would provide a technique for the easy diagnosis and evaluation of various neurological diseases.

Effects of a low-protein diet on prolactin- and growth hormone-producing cells in the rat pituitary gland

BACKGROUND

It is well known that an unbalanced diet induces various changes in the pituitary gland. However, little attention has been paid to the molecular aspects of this perturbation. We studied the influence of a low-protein diet (LPD) on the prolactin (PRL) and growth hormone (GH) cells in the rat pituitary gland using immunohistochemical staining and in situ hybridization.

MATERIALS

Rats aged 20 days were fed a diet containing 27% protein or one with 8% protein (LPD) for 30 days. Pituitary glands were obtained and subjected to either immunohistochemistry or in situ hybridization. Quantitative morphological analysis was then conducted to determine cell number and area as well as the percentage of cells stained by the respective antisera and/or cDNA probe in each experimental group.

RESULTS

The average sectional areas of both PRL- and GH-producing cells in the LPD group were smaller in size than those in the controls. The cell numbers per unit area (mm2) of PRL-positive cells and PRL mRNA-positive cells were 3,596.5 and 3,948.6, respectively, in the LPD group, and 3,179.6 and 4,888.5, respectively, in the controls. The numbers per unit area of GH-positive cells and GH mRNA-positive cells in the LPD group were similar (2,252.3 and 2,224.4), as compared to 2,161.3 and 1,684.2, respectively, in the well-fed rats. Whereas PRL-positive cells comprised about 27% of the total number of cells in both animal groups, those given the LPD contained a lower percentage (29%) of PRL mRNA-positive cells as compared to the controls (44%). On the other hand, GH mRNA-positive cells numbered about 15% of the total cell population both animal groups; however, the malnourished rats contained a lower percentage (16%) of GH-positive cells than did their well-fed counterparts (20%).

CONCLUSIONS

Taken together, these results indicate that in the rat pituitary gland, administration of an LPD reduced the size of PRL- and GH-positive cells as well as differentially affecting a subpopulation of the PRL mRNA-positive cells and the GH-positive cells.

CYFRA 21-1, a cytokeratin subunit 19 fragment, in bronchoalveolar lavage fluid from patients with interstitial lung disease

1. It has been suggested that CYFRA21-1, a cytokeratin subunit 19 fragment, is potentially useful for diagnosis and monitoring of lung carcinoma. However, serum levels of CYFRA21-1 are also increased in a high proportion of patients with interstitial lung disease. In this study we measured CYFRA21-1 levels in bronchoalveolar lavage fluid from 10 normal subjects, 18 patients with idiopathic pulmonary fibrosis and 14 patients with sarcoidosis, and determined whether any relationship exists between CYFRA21-1 levels in bronchoalveolar lavage fluid and clinical parameters. 2. CYFRA21-1 levels in bronchoalveolar lavage fluid were significantly higher in patients with sarcoidosis (mean value 8.3 ng/ml, P < 0.01) and idiopathic pulmonary fibrosis (42.5 ng/ml, P < 0.005) than in normal controls (1.0 ng/ml). Moreover, higher CYFRA21-1 levels in bronchoalveolar lavage fluid were found in sarcoidosis patients in radiological stage 2 or 3 than in those in stage 1. In patients with idiopathic pulmonary fibrosis, there was a significant correlation between CYFRA21-1 levels, and percentage of inflammatory cells in bronchoalveolar lavage fluid (r = 0.56, P < 0.05) and the magnitude of the alveolar--arterial oxygen pressure difference [P(A-a)O2] gradient (r = 0.66, P < 0.01). 3. Serial bronchoalveolar lavage samples were obtained from six patients with clinically active pneumonitis after they had undergone systemic corticosteroid therapy. CYFRA21-1 levels were significantly lower after these patients exhibited clinical improvement (P < 0.05). 4. These findings suggest that the level of CYFRA21-1 in bronchoalveolar lavage fluid is a useful marker for the clinical diagnosis of pneumonitis, and is also adequate for the evaluation of disease activity, especially over the course of treatment.

Ability to remove immunoglobulins and anti-ganglioside antibodies by plasma exchange, double-filtration plasmapheresis and immunoadsorption

In Japan, patients with Guillain-Barré (GBS) and Fisher's (FS) syndromes often receive plasma exchange (PE), double-filtration plasmapheresis (DFPP), or immunoadsorption (IA). To determine whether DFPP and IA are as effective as PE, we compared their abilities to remove immunoglobulins and anti-ganglioside antibodies. Plasma samples were obtained from 55 GBS patients and 53 FS patients, before and after each session of the treatments. PE decreased the IgG concentration more than DFPP did, its abilities to remove anti-ganglioside IgG antibodies in PE markedly being superior to the abilities of the other plasmaphereses. IA on a tryptophan-immobilized column adsorbed anti-ganglioside IgG antibodies more effectively than IA on other affinity columns.

Separate determination of human urinary conjugated and unconjugated 3-methoxy-4-hydroxyphenylethyleneglycol

A new determination procedure for human urinary 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) was established. In addition to the previously established solid-phase extraction method for unconjugated MHPG, another solid-phase extraction method for conjugated MHPG was developed. Unconjugated MHPG was adsorbed on a Sep-Pak Diol cartridge and selectively recovered by elution with ethyl acetate. The eluate was evaporated and the residue was redissolved and analyzed by reversed-phase high-performance liquid chromatography with fluorimetric detection. Conjugated (sulfate plus glucuronide) MHPG was adsorbed on a Sep-Pak Accell QMA cartridge and quantitatively eluted with 0.2 M NaCl. After enzymatic hydrolysis, deconjugated MHPG was extracted using a Sep-Pak Diol cartridge and analyzed in the same manner as unconjugated MHPG. The new method is simple and rapid and can quantitate conjugated and unconjugated MHPG discriminatively.

Downregulation of cytokine-induced neutrophil chemoattractant and prolongation of rat liver allograft survival by interleukin-10

We investigated whether the administration of recombinant human interleukin-10 (rhIL-10) regulates the production of cytokine-induced neutrophil chemoattractant (CINC) and improves graft survival in rat orthotopic liver transplantation (OLTx). Allograft recipients received injections of rhIL-10 at doses of 2, 10, 20, or 50 micrograms/kg/day. The allograft recipients that received rhIL-10 at 10 or 20 micrograms/kg/day showed a slight but significant prolongation of graft survival to 13.0 +/- 0.4 and 13.8 +/- 0.3 days, respectively, compared with 9.6 +/- 0.2 days in untreated allografts. Conversely, the administration of high-dose rhIL-10 shortened the allograft survival. In the rhIL-10 treatment groups, the mean serum and tissue levels of CINC at every time point after OLTx were reduced significantly compared with those in the no-treatment group. The mean peak neutrophil counts in the peripheral circulation (PC) of the groups given rhIL-10 at 10, 20, or 50 micrograms/kg/day from the samples obtained 12h after reperfusion were decreased significantly compared with the no-treatment group. Furthermore, the mean peak neutrophil counts in the PC of the groups given rhIL-10 at 10 or 20 micrograms/kg/day from the samples obtained between postoperative days (PODs) 7 and 10 were decreased significantly compared with the no-treatment group. The magnitude of liver damage and leukocyte infiltration in the rhIL-10-treated allografts on PODs 1 and 7 was reduced compared with that of untreated allografts. Our data indicate that the administration of rhIL-10 downregulates CINC production during the period of reperfusion injury and acute cellular rejection after OLTx, and prolongs liver allograft survival, suggesting that IL-10 therapy is potentially beneficial in OLTx.

[Unilateral gustatory disturbance by pontine infarction]

We reported a case of pontine infarction presenting as diminished taste on the contralateral side. A 67-year-old man was hospitalized with a sudden onset of right hypogeusia. No neurological abnormalities were found except diminished taste in the areas innervated by the chorda tympani, greater petrosal and glossopharyngeal nerves on the right side. Brain MRI demonstrated a lesion with low-intensity on T1-weighted images and high-intensity on T2-weighted images in the left suprapontine tegmentum. Cases of pontine disease presenting as contralateral dysgeusia have rarely been reported. In the present case, we considered that infarction occurred superior to the pontine taste are (PTA). It is suggested that the gustatory pathway superior to PTA takes a chiasmal tract ascending in the brainstem.

Cyclophosphamide, adriamycin, 5-fluorouracil and high-dose toremifene for patients with advanced/recurrent breast cancer. The Japan Toremifene Cooperative Study Group

BACKGROUND

Multi-combination chemotherapy consisting of anthracyclines has been effective but has not invariably prolonged the survival period in advanced/recurrent breast cancer. The possibility has been discussed that chemoendocrine therapy combined with endocrine agents is more effective.

METHODS

In order to evaluate the toxicity and efficacy of a new endocrine therapy for advanced/recurrent breast cancer, we ran a pilot study during the period from July 1994 to July 1996.

RESULTS

Twenty-two patients with advanced/recurrent breast cancer were treated with chemoendocrine therapy consisting of cyclophosphamide (100 mg/body) p.o. daily for 14 days, with adriamycin (40 mg/m2) i.v. and 5-fluorouracil (500 mg/body) i.v. on day 1 (repeated every 3 weeks for 9 weeks) (CAF therapy), and high-dose toremifene (120 mg/body) p.o. daily. Of 20 evaluable patients, two showed complete response (10%), eight partial response (40%), six no change (30%) and four progressive disease (20%). The overall response rate was 50%, and the median duration of response was 69.5 days (28-133+ days). The major toxicities were drug-induced alopecia, gastrointestinal toxicity and hematological toxicity, but these were clinically well tolerated. No serious cardiac, liver or renal symptom was seen.

CONCLUSIONS

Based on these results, we consider the addition of high-dose toremifene to the CAF therapy to be useful in the treatment of advanced and recurrent breast cancer.

Nitric oxide is produced via 5-HT1B and 5-HT2B receptor activation in human coronary artery endothelial cells

The aim of this study is to clarify the serotonin (5-HT) receptor subtypes responsible for 5-HT-induced nitric oxide (NO) production in cultured human coronary artery endothelial cells (HCAECs). Reverse transcription-polymerase chain reactions revealed that HCAECs possessed only 5-HT1B and 5-HT2B receptor mRNAs. 5-HT (0.001-10 mumol/L) induced nitrite production from HCAEC. A selective 5-HT1B/1D agonist sumatriptan (0.01-10 mumol/L) caused nitrite production. A selective 5-HT2 agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane hydrochloride (DOI, 0.01-10 mumol/L) also mimicked the effect of 5-HT. The 5-HT-induced nitrite production was completely inhibited by the nonselective 5-HT1/2 antagonist methiothepin (0.1 mumol/L), but not by the 5-HT2A/2C antagonist ketanserin (0.1 mumol/L). Each of these agonists evoked the elevation of intracellular Ca2+ concentration in HCAECs. These findings suggest that 5-HT-induced NO production is mediated by both of 5-HT1B and 5-HT2B receptor activation in HCAECs. Thus, the 5-HT-evoked endothelium-dependent relaxation of human coronary arteries in vivo might be evoked by net effects of the activation of these receptor subtypes.

[Bickerstaff's brainstem encephalitis associated with nystagmus]

A 29-year-old man developed drowsiness, ophthalmoplegia and cerebellar ataxia following upper respiratory tract infection. We diagnosed the patient as having a Bickerstaff's brainstem encephalitis. There was upbeating nystagmus which appeared with upward gaze, and bilateral horizontal gaze-evoked nystagmus in both directions. On electronystagmography, eye-tracking test showed saccadic pattern with impaired smooth pursuit eye movement. The horizontal optokinetic nystagmus test showed diminution of response. These results suggested that brainstem and cerebellum were widely involved. Presence of nystagmus may help to speculate the lesion of Bickerstaff's brainstem encephalitis.