[The relationship between visual agnosia and visual pathway for perception]

We report a patient with a unique visual agnosia, who was thought to have lost visual functions except for the primary visual function. The patient was a 71-year-old woman with progressive memory loss and cerebro-cortical atrophy in MRI; her clinical diagnosis was senile dementia of Alzheimer's type. A battery of tests to detect higher visual dysfunctions was performed. First of all, we presented small dots and lines in front of the patient; the patient was able to recognize them. When a triangle, a tetragon, a cube, pieces of paper of different colors and lines of different length were presented, she was unable to recognize those objects. When pictures of her family members or filled circles of different size including small dots and lines were presented, the patient could only detect those small dots and any of lines; she could not recognize the members of her family. The cerebral blood flow was severely reduced in the occipital lobe except for the striate cortex. These data suggested that the visual function of striate cortex was preserved in this patient; the disturbance of higher visual functions was thought to be caused by the dysfunction of extra striate cortex.

Single-channel properties of a G-protein-coupled inward rectifier potassium channel in brain neurons

1. In cultured rat locus coeruleus neurons, somatostatin or met-enkephalin induces an inwardly rectifying K+ conductance. This inward rectifier was analyzed at the single-channel level. 2. Using the inside-out patch-clamp, guanosine 5'-triphosphate (GTP) application to the cytoplasmic side in the presence of somatostatin or met-enkephalin in the pipette produced a large increase in channel activity, which disappeared on switching from GTP to guanosine 5'-diphosphate. 3. The unitary conductance was approximately 30 pS at -95 mV with an extracellular K+ concentration of 156 mM and an intracellular K+ concentration of 124 mM at 23 degrees C. The channel showed burst behavior, and the closed time histogram was fit by two exponentials, with the fast time constant being 0.4 ms. The burst time histogram was also fit by two exponentials, with time constants of 0.24 and 2.0 ms (at 10 nM somatostatin). When the somatostatin concentration was changed from 500 to 1 nM, the kinetic behavior of the channel did not change, except that the open probability of the patch was decreased. 4. The current-voltage relation of the unitary channel current showed inward rectification. The reversal potential coincided with the K+ equilibrium potential, and it shifted according to a change in the K+ equilibrium potential. 5. In the presence of external somatostatin, the application of guanosine 5'-O-(3-thiotriphosphate) to the cytoplasmic side induced an irreversible activation of this channel. 6. These results indicate that this K+ channel is the microscopic counterpart of the somatostatin- or met-enkephalin-induced inwardly rectifying K+ current in whole cell recording, and that the channel is activated by a G protein without a diffusible second messenger. Thus this channel is identified as a neuronal G-protein-coupled inward rectifier K+ channel. 7. Analysis of the burst behavior, based on a close-close-open kinetic model, revealed that there are at least four states in the K+ channel, a short gap, a longer closing, a short opening, and a long opening, and that the neuronal inward rectifier is activated at faster rates than the atrial inward rectifier.

Serum levels of the type IV collagen 7s domain in patients with chronic viral liver diseases

The serum levels of type IV collagen 7s domain (7s collagen) were determined in 80 patients with hepatocellular carcinoma (HCC) and in 105 with chronic liver disease without HCC. Among 86 patients with HCV infection, serum levels of the 7s collagen were significantly higher in those with HCC than-in those without HCC (p<0.05). In contrast, no significant differences were recognized between these two groups in 84 patients with HBV infection. Patients with HCV infection having high serum levels of the 7s collagen exceeding 7.0 ng/ml, were diagnosed as HCC with a sensitivity of 71.8%, a specificity of 74.5%, and a reliability of 77.9%. It was concluded that the progression of hepatic fibrosis plays an important role in the hepatocarcinogenesis of HCV, and that serum levels of the 7s collagen appeared to be useful as a risk factor of the development of HCV-related HCC.

cDNA sequence analysis and characterization of a cytokine-inducing monoclonal antibody derived from autoimmune MRL/MP-lpr/lpr mouse

We have previously reported that a monoclonal antibody 1D11 derived from an autoimmune MRL/Mp-lpr/lpr (MRL/lpr) mouse induced synthesis or increased production of IL-3, IL-6, and TNF-alpha in the IL-3-dependent bone marrow-derived cell line FDC-P2/185-4. In this report, we analyzed a sequence of cDNA encoding the V region of 1D11, and found that VH and VL segments of 1D11 belonged to the J558 and V kappa 21 family, respectively. The nucleotide sequence of 1D11 in the VH segment was highly homologous to that of AM9, a monoclonal RF derived from MRL/lpr mouse, and the only difference was the replacement of 3 nucleotides in the framework region 1 (FR1). However, the deduced amino acid sequence of 1D11 was identical to that of AM9. In contrast with the VH segment, the sequences of the VL regions of these two antibodies were quite different from each other; 1D11 showed a 3 base deletion in the FR2 and a 24 base insertion in the FR3 compared with AM9. At present, the mechanisms of such insertions or deletions in the FRs of autoantibodies are almost unknown. It is generally accepted that the differences in specificity and affinity of these autoantibodies depend on differences of CDR sequence. However, it is possible that not only CDRs but also FRs of autoantibodies play a critical role in pathogenicity and/or specificity in autoimmune diseases.

G protein-coupled inward rectifier modulated by dopamine agonists in cultured substantia nigra neurons

Dopamine release from dopaminergic neurons in the substantia nigra plays an important role in regulating their activity. In the present experiments the whole-cell clamp technique was used to elucidate the modulatory role of dopamine on K+ conductance in substantia nigra neurons in culture. In pars compacta neurons held near the resting potential, dopamine and quinpirole (a D2 receptor agonist) increased membrane conductance. This response was blocked by S(-)-sulpiride, a D2 receptor antagonist. The current-voltage relation of the quinpirole-induced current showed an inward rectification with a reversal potential that approximately equaled the K+ equilibrium potential. Intracellular application of a non-hydrolysable GTP analogue, guanosine 5'-O-(3-thiotriphosphate; 0.1-0.5 mM) into pars compacta neurons produced an initial spontaneous increase in an inwardly rectifying K+ conductance. Quinpirole markedly accelerated this conductance increase. In cells loaded with a poorly metabolized GDP analogue, guanosine 5'-O-(2-thiodiphosphate), the quinpirole response was diminished. Treatment of pars compacta neurons with pertussis toxin abolished the D2 response. Intracellular application of cyclic AMP (1 mM) neither mimicked nor occluded the D2 response. These results indicate that D2 receptor agonists produce neuronal inhibition by activating an inwardly rectifying K+ current, that this D2 agonist effect is mediated by a pertussis toxin-sensitive G protein, and that cyclic AMP does not mediate the D2 response. Unexpectedly, in cells loaded with guanosine 5'-O-(3-thiotriphosphate) after the inwardly rectifying K+ conductance spontaneously reached a maximum, it started to decline slowly. In cells loaded with guanosine 5'-O-(2-thiodiphosphate), the quinpirole response became diminished at first, but then the membrane conductance slowly increased, together with an increase in the quinpirole response. These results were explained by an interplay of two G proteins, one producing an increase and the other producing a decrease in the K+ conductance. In some pars reticulata neurons, R(+)-SKF-38393 (a D1 receptor agonist) reduced an inwardly rectifying K+ conductance; this would excite the neuron under current clamp conditions. The present study shows that cultured substantia nigra neurons produce functional responses to dopamine agonists. Using these neurons, the ionic mechanisms and signal transduction mechanisms of the responses were elucidated in a more critical manner than in previous studies.

Influence of antemortem medication on the determination of brain death

Post-mortem concentration of pentobarbital in the blood and brain of two deceased neurosurgical patients was determined by gas chromatography/mass spectrometry. Patients treated with barbiturate for elevated intracranial pressure after head injury may incur brain death. In the present two cases of brain death a large amount of barbiturate remained in the brain, even when the blood concentration was not detectable, possibly because the blood flow was stagnant in the brain. It is suggested that a patient under barbiturate coma should be given serious consideration as to the determination of brain death, even if barbiturate is negative in the blood.

A mechanism of resistance to partial macrolide and streptogramin B antibiotics in Staphylococcus aureus clinically isolated in Hungary

A plasmid pEP2104 originated from Staphylococcus aureus was clinically isolated in Hungary during 1977. The plasmid mediates inducible resistance to PMS-antibiotics; partial macrolide [the 14-membered macrolides, erythromycin (EM) and oleandomycin and the 16-membered macrolides mycinamicin I (MCM I) and mycinamicin II (MCM II)and type B streptogramin (MKM-B) antibiotics. The sequence of 31 amino acid residues obtained by N-terminal analysis of the 63kDa protein (MsrSA) present in the membrane from 8325(pEP2104) cells whose PMS-resistance was induced by a concentration of 1.35 micrograms EM/ml [EM-induced 8325(pEP2104)], was identical to the corresponding sequence in a membrane protein MsrA related to promoting efflux of [14C]EM [Ross J.I., et al., Mol. Microbiol., 4, 1207 (1990)]. A constitutive PMS-resistant strain 8325(pMC38) was obtained from the 8325( pEP2104) strain in the presence of 1 microgram MCMI/ml. No inactivation of EM in EM-induced 8325(pEP2104) was observed. Moreover, poly (A)-directed polylysine synthesis by a cell-free system containing ribosomes from EM-induced 8325 (pEP2104) cells and S100 from Escherichia coli was inhibited by not only EM but spiramycin and MKM-B [Matsuoka M., et al., Biol. Pharm. Bull., 16, 1288 (1993)]. In addition, ribosomes from both EM-induced 8325 (pEP2104) and 8325(pMC38) strains showed about the same affinity as those from the host stain. NCTC8325. These results suggest, that like MsrA protein, active drug-efflux due to MsrSA protein may be responsible for PMS-resistance. How can the 8325 (pMC38) strain discriminate PMS-antibiotics from most of 16-membered macrolides and lincosamides? A possible explanation is discussed in terms of the pKa-value related to the physicochemical nature of the antibiotics.

Comparison of continuous brachial plexus infusion of butorphanol, mepivacaine and mepivacaine-butorphanol mixtures for postoperative analgesia

We have reported recently that continuous administration of butorphanol into the brachial plexus sheath provided analgesia of a quality superior to that of continuous i.v. administration. In the present study, we have compared postoperative pain relief produced by continuous infusion of one of three types of solution into the axillary sheath: opioid alone, local anaesthetic alone or a mixture of local anaesthetic and opioid. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, we injected one of the three solutions into the axillary neurovascular sheath: butorphanol 2 mg (group B), 0.5% mepivacaine alone (group M) and 0.5% mepivacaine-butorphanol (group MB); the volume of each solution was 50 ml, administered at a rate of 50 ml per 24 h. At 3 h after operation, visual analogue scale (VAS) scores were significantly higher in group M than in group MB (P < 0.01), and higher in group B than in group MB (P < 0.05).

Ki-ras mutations and p53 protein expressions in intrahepatic cholangiocarcinomas: relation to gross tumor morphology

BACKGROUND & AIMS

We previously reported that intrahepatic cholangiocarcinomas (ICCs) can be divided into three categories according to their gross appearance with possible links to biological behavior. Ki-ras and p53 gene alterations are thought to be involved in early and late phases of carcinogenesis, respectively. This study was performed to investigate the relationship between the gross appearance and genetic alterations of ICC.

METHODS

We examined 21 patients with ICC. Ki-ras point mutations were assessed by polymerase chain reaction/single-strand conformation polymorphism methods followed by direct DNA sequencing. Expressions of p53 protein were immunohistochemically assessed.

RESULTS

Ki-ras point mutations were found in 10 patients (48%), and expressions of p53 protein were detected in 4 (19%). Applying the gross classification that we previously proposed, Ki-ras mutations were prominent in the periductal extension type (4 of 6; 67%) and the spicula-forming type (6 of 10; 60%). On the other hand, none of the five mass-forming-type tumors harbored Ki-ras mutations. Expressions of p53 protein did not show any clear association with gross appearance.

CONCLUSIONS

Ki-ras gene alterations may be involved in the cholangiocarcinogenesis of periductal extension and spicula-forming but not mass-forming types, suggesting that the underlying processes of development are different.

[Changes in dementia rating scale scores of elderly patients with femoral neck fracture during perioperative period]

We evaluated changes in dementia rating scale scores in the revised version of Hasegawa's dementia scale (HDS-R), and rated dementia, 2 days before and 7 days after surgery in the elderly patients with femoral neck fracture. The 50 patients examined ranged in age from 70 years to 101 years. A perfect score in the HDS-R is 30 points, and a score below 20 points strongly suggests dementia. The results were as follows. In septuagenarian and octogenarian patients, the scale score was higher after surgery than the value before the surgery. Although the preoperative and postoperative scores of the patients who had been under epidural anesthesia were not significantly different, the score of patients who had been under general anesthesia was higher in the postoperative period than in the preoperative period. In octogenarian patients, there was a negative correlation between "postoperative score minus preoperative score" and "the number of the days from suffering fracture to surgery". These results showed that general anesthesia is more advantageous than epidural anesthesia from the viewpoint of the intellectual faculty in septuagenarian and octogenarian patients with femoral neck fracture, and it is within the bounds of possibility that the intellectual faculty may decline if an octogenarian patient is operated after a long delay from the occurrence of fracture. To prevent this decline, patients must be operated on as soon as possible.

[Calcium metabolism in porcine liver transplantation]

The influence of warm ischemia on calcium metabolism in liver transplantation (LTX) was investigated using temporary portal vein arterialization (PA) technique. Group I pigs were added no warm ischemia (n = 6). In group II, donors were killed by KCl, and the livers were left in situ for 60 min (n = 6). After anastomosing the suprahepatic vena cava, revascularization was carried out employing PA. Initial reperfused blood was collected through the infrahepatic vena cava. All pigs survived more than 4 days in group I, whereas all died within 2 days in group II. In group II, Ca2+ levels of initial reperfused blood were significantly lower than those of arterial blood. Ca2+ levels of initial reperfused blood in group II were significantly lower than those in group I. Within 90 min after revascularization, biliary output and biliary calcium content and excretion in group I recovered to 30%, 100% and 40% of normal, respectively, but in group II only 2 animals could excrete bile. In conclusion, in the liver with 60 min warm ischemia, Ca2+ influx occurred immediately after revascularization followed by decreased calcium excretion in bile, which suggested that accumulation of calcium might be one of the causes of warm ischemic injury.

[Relations between chest CT and pathologic findings in pulmonary infarction associated with lung cancer]

Chest radiographic (mainly CT), and pathological findings in pulmonary infarction associated with lung cancer were studied to obtain information useful for the interpretation of CT findings, and to help determine the cause of infarction. Sixteen cases of lung infarction were chosen from among 518 cases of lung cancer. All patients were operated on between January 1980 and December 1990. Sixteen surgical cases and one autopsy case all with evidence of lung cancer and infarction were chosen. There were 13 men and 4 women with a mean age of 56 years. Adenocarcinoma was found in 8 cases, squamous cell carcinoma in 6, adenosquamous carcinoma in 2, and small cell carcinoma in 1. Chest radiographs and CT revealed infarction shadows in 8 of the 16 cases. Typical CT findings for pulmonary infarction were: shadows located in the same lobe and periphery as the cancer; ill-defined, 10-25 mm nodular shadows; and lesions located both in the subpleural zone and apart from the pleura. Lesion counts in each area were about the same. Observation of one patient for 2 months revealed a decrease in the size of the nodular shadows and clarification of their margins. In most cases, centrally extended cancer resulted in vascular stenosis and infarction.

Role of Epstein-Barr virus in pleural lymphomagenesis

Longstanding inflammation in chronic pyothorax (CP) plays a role in the development of pleural lymphoma; therefore, in 1987, the term pyothorax-associated lymphoma (PAL) was proposed. A recent study showed in the tumor cells of a limited number of patients, the presence of the Epstein-Barr virus (EBV) genome together with the expression of latent infection genes in the tumor cells of PAL. The purpose of the present study is to evaluate an association of EBV with PAL in a large number of patients. In addition, the presence of the EBV genome was examined in cases with CP without PAL. Histologic, immunohistochemical studies, and analyses by polymerase chain reaction (PCR) and in situ hybridization method for EBV were performed on 34 PAL and 16 CP collected by nationwide study. Median age of the patients in both diseases was approximately 70 years with a marked preponderance in men. Mean duration of CP in patients with CP alone and with CP complicated with PAL was 33 and 37 years, respectively. Histologically all PAL were non-Hodgkin's lymphoma, with immunoblastic type being the most common. Immunohistochemistry revealed 28 of 34 PAL to be B-cell type. Combined PCR, in situ hybridization method, and immunohistochemistry showed that the EBV genome was detected in lymphoma cells in 85% of PAL with almost constant expression of latent membrane protein-1. The EBV genome was detected by PCR in only one of 16 CP.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on structure of light degradation products of (-)-(S)-10-(1-aminocyclopropyl)-9-fluoro-3-methyl-7-oxo-2,3-dihyd ro-7H- pyrido[1,2,3-de][1,4]benzoxazine-6-carboxylic acid (T-3761) in aqueous solution and solid state]

The structures of light degradation products of (-)-(S)-10-(1-aminocyclopropyl)-9-fluoro-3-methyl-7-oxo-2,3-dih ydr o-7H- pyrido[1,2,3-de][1,4]benzoxazine-6-carboxylic acid (T-3761) in aqueous solution and in the solid state were investigated. In aqueous solution, ten products were detected using HPLC and in the solid state, one main product was detected. All these light degradation products were isolated and their structures were elucidated. It was revealed that in almost all light degradation products only the 1-aminocyclopropyl side chain at the 10-position of T-3761 is changed to various structures by light oxidation. Surprisingly we found a unique light degradation product, in which carboxylic acid at the 6-position of T-3761 is changed to the hydroxy moiety.

Expression of bone-related protein messenger RNA in human meningiomas: possible involvement of osteopontin in development of psammoma bodies

Meningiomas often contain concentric calcified foci, referred to as psammoma bodies. Since calcium phosphate deposits in both psammoma bodies and bone tissues, we examined whether messenger (m) RNA of bone-related extracellular matrix proteins and bone morphogenetic proteins (BMP) were expressed in human meningioma tissues. Northern blotting demonstrated the expression of osteopontin (OPN), matrix Gla protein (MGP), osteonectin (ON) and BMP-4 mRNA but not bone sialoprotein, osteocalcin and BMP-2 mRNA. In situ hybridization revealed that most OPN mRNA-expressing cells were located around the psammoma bodies in meningothelial whorls. Moreover, combination of in situ hybridization and immunohistochemistry on serial sections showed that the OPN mRNA-expressing cells were CD68-positive, suggesting they were macrophages. Immunohistochemistry with anti-OPN antibody and von Kossa staining on the adjacent section showed that the deposition site of OPN protein was consistent with that of calcium phosphate. Neither MGP nor ON mRNA expression appeared to correlate with the calcification. The present result suggests that OPN produced by CD68-positive macrophages may play a significant role for development of psammoma bodies in meningiomas.

[Advantages and disadvantages of the intraarterial chemotherapy using a reservoir as postoperative adjuvant therapy for hepatocellular carcinoma]

We conducted a retrospective study on the efficacy and disadvantages of intraarterial chemotherapy using a reservoir (ICUR), as postoperative adjuvant therapy for hepatocellular carcinoma (HCC). One hundred and seventy HCC patients who underwent hepatectomy since 1987 to 1992 in our institute were enrolled in this study. Ninety-two patients were postoperatively treated with ICUR (group R), and seventy-eight patients without it (group N). There were no significant differences between the two groups in the preoperative evaluations of the characteristics of patients, tumors, and operative procedures. Although statistical significances were not found, disease-free rates within 1 year and cumulative survival rates appeared to be higher in group R than in group N. Patency of the catheter of reservoirs at one and two years were maintained in 80.3 and 44.1% of the patients, respectively. HCC recurred after an occlusion of the reservoir in 18 patients. In four out of these 18 patients, transcatheter arterial embolization (TAE) for recurrent tumors was not feasible, because of occlusion of the hepatic artery. TAEs for recurrent lesions would have been impossible in about 10% of all patients treated with ICUR. Thus, both the advantages and disadvantages should be taken into consideration on the indication of ICUR, and the maintainance of the catheter is important for successful ICUR.

Column-switching high-performance liquid chromatographic system with a laser-induced fluorimetric detector for direct, automated assay of salivary cortisol

In order to measure human stress, an easy and rapid, fully automated method for the determination of cortisol in saliva has been developed, using column-switching high-performance liquid chromatography with laser-induced fluorescence detection, which involves post-column labeling with sulfuric acid. The developed system requires only 0.1 ml of saliva, and a simple pretreatment consisting of dilution and filtration is sufficient. The column-switching system consisted of a Polymer-Coated Mixed-Functional silica (PCMF) column for deproteinization, and a CN column for frontal concentration and separation. An ODS column in place of the CN provided a better separation, but required a post-column make-up of water for safe reaction. Detection limit of cortisol was 8 fmol (signal-to-noise ratio = 3), which is adequate for routine determination of normal levels of cortisol (1-20 pmol/ml). The analysis time was about 40 min and reproducibility was excellent with an R.S.D. of less than 5%.

Increased muscle sympathetic nerve activity after glucagon administration in man

Muscle sympathetic nerve activity (MSNA) after glucagon administration was quantitatively measured in five healthy male volunteers (age: 20-28 years old). After an overnight fasting, 1 mg glucagon dissolved in a 1-ml vehicle was injected i.v. as a bolus. MSNA, ECG and blood pressure were simultaneously recorded 15 min before and after the injection. MSNA (bursts/min), heart rate (HR), and systolic and diastolic blood pressures (dBP and sBP) were significantly increased at 2-3 min after glucagon injection. Their means and standard deviations of control for 15 min vs. 3 min after the injection were in the five subjects; MSNA, 10 +/- 6 vs. 30 +/- 10 bursts/min, HR, 61 +/- 10 vs. 76 +/- 8 beats/min, dBP, 66 +/- 9 vs. 91 +/- 9 mmHg and sBP, 122 +/- 12 vs. 152 +/- 11 mmHg. These results suggest that glucagon has a direct facilitatory effect on the central sympathetic nervous system.

Sandwich capture enzyme immunoassay for water soluble blood group B substance in secretor saliva

Sandwich capture enzyme immunoassays (EIA I and EIA II) are described. Water soluble B substance was reacted simultaneously with affinity-purified dinitrophenyl goat anti-B IgG and affinity-purified goat anti-B IgG-peroxidase conjugate. The complex formed of B substance, dinitrophenyl IgG and IgG-peroxidase conjugate was trapped onto a polystyrene ball coated with affinity-purified goat anti-dinitrophenyl bovine serum albumin IgG. After washing, peroxidase activity bound to the ball was assayed by fluorometry (the sandwich capture EIA I). In the sandwich capture EIA II, the complex was, after thorough washing, eluted from the ball with dinitrophenyl-L-lysine, and then peroxidase activity in the eluate was assayed. The thorough washing and elution processes improved the sensitivity 3.3-fold, and B substance in saliva samples from type B and AB secretors could be detected 200- to 500-fold more sensitively than hemagglutination inhibition, a method commonly used in forensic practices.

Effect of tumor necrosis factor-alpha and interferon-gamma on the growth of human prostate cancer cell lines

Human recombinant tumor necrosis factor-alpha (rTNF-alpha, 10(-12)-10(-8) M) inhibited the proliferation of androgen-dependent LNCaP cells by 32-56%. In contrast, proliferation of androgen-independent PC-3 and JCA-1 cells was only slightly inhibited, or not inhibited at all, respectively. Human recombinant interferon-gamma (rIFN-gamma, 500 U/ml) decreased proliferation of PC-3 and JCA-1 cells by 35% and 53%, respectively, but had no effect on LNCaP cells. Interestingly, the combination of rIFN-gamma and TNF-alpha had greater antiproliferative effects on JCA-1 cells than treatment with either cytokine alone. However, the antiproliferative effects of this combination were similar to those observed for PC-3 or LNCaP cells treated with rIFN-gamma or TNF-alpha alone, respectively. These data suggest that some forms of androgen-independent prostate cancer may benefit from a combination therapy of IFN-gamma and TNF-alpha, while the use of IFN-gamma alone may be more efficacious in others.

[The use of high concentration ferric ammonium citrate (FAC) solution as a negative bowel contrast agent: application in MR cholangiography]

Ferric ammonium citrate (FAC) can be used as a negative contrast agent on T2- weighted images, with the use of a high concentration resulting in a significant T2 shortening effect. Ten healthy volunteers underwent MR cholangiography (MRC) using Turbo Spin Echo. High-concentration FAC was administered at a normal dosage, but was diluted in a smaller amount of water than usual. Although all precontrast images showed high intensity intestinal fluid, which aggravated visualization of the bile duct, all postcontrast images obtained 6 to 14 minutes after administration showed blackening out of the fluid, improving the overall image quality of MRC.

[A case of atopic dermatitis treated with stellate ganglion block--the change of serum IgE and blood eosinophil levels]

Stellate ganglion block (SGB) therapy was tried on a patient with severe adult type atopic dermatitis. SGB was performed 102 times in total and clinical symptoms improved gradually. Serum IgE and blood eosinophil levels, which correlate with disease severity, increased gradually following repeated SGB. After a series of SGB was stopped, clinical symptoms became worse and serum IgE and blood eosinophil levels increased again. We conclude that although SGB is presumably one of the effective therapies for severe adult type atopic dermatitis, it might be difficult to improve atopic constitution entirely because the patient was not cured completely following repeated SGB.