The effect of lovastatin on proliferation of cultured rat mesangial and aortic smooth muscle cells

In order to investigate the anti-proliferative effect of 3-hydroxy-3-methylglutaryl coenzyme. A reductase inhibitor, we evaluated the effects of lovastatin on DNA replication and the proliferation of rat mesangial and aortic smooth muscle cells, both of which were mesenchymal origin cells. Proliferations were determined by measuring [3H]thymidine uptake, and counting the number of cells. Growth-arrested mesangial and aortic smooth muscle cells were exposed to platelet-derived growth factor (PDGF), endothelin (ET) and angiotensin II (Ang II) to stimulate mitogenesis. All agents exhibited dose-dependent stimulation of [3H] thymidine uptake. PDGF was more potent than the others. Ang II increased [3H] thymidine uptake without demonstrable mitogenic activity. Lovastatin inhibited PDGF (10 ng/ml in mesangial cell, 25 ng/ml in smooth muscle cell)-, ET (10(-7)M)- and Ang II (10(-7)M)-induced [3H] thymidine uptake significantly in a dose-dependent manner in both cells. The increase of cell number in response to PDGF and ET treatment were also inhibited at 10 microM of lovastatin. The inhibitory effect of lovastatin was largely overcome in the presence of exogenous mevalonate at 200 microM, with 75.5% restoration from lovastatin-induced inhibition on PDGF-induced [3H] thymidine uptake in mesangial cells (77.8% in aortic smooth muscle cells). However, the addition of cholesterol did not prevent inhibition by lovastatin. In conclusion, lovastatin had an inhibitory effect on mesangial and aortic smooth muscle cell proliferation, and mevalonate was essential for DNA replication in both types of cells. Lovastatin may reduce glomerular and atherosclerotic injury through an anti-proliferative effect on mesangial and vascular smooth muscle cells, in addition to lowering circulating lipids.

Acute pyelonephritis focusing on perfusion defects on contrast enhanced computerized tomography(CT) scans and its clinical outcome

OBJECTIVES

Many cases of acute pyelonephritis show renal perfusion defects on contrast enhanced computerized tomography (CT) imaging studies. The purpose of this study is to show the frequency of renal perfusion defects in uncomplicated acute pyelonephritis and to compare the clinical responses of patients who had perfusion defects or not.

METHODS

We studied patients who had symptoms and signs of acute pyelonephritis through CT examinations with contrast enhancement. We identified 21 cases who had perfusion defects among 35 patients who had undergone CT imaging studies and compared the clinical data in the two groups of patients who had perfusion defects on CT (group 1) and who had not (group 2).

RESULTS

Nearly all patients had typical symptoms and signs of acute pyelonephritis such as high fever and chill, flank pain and costovertebral angle tenderness. Combined clinical problems were septic shock (one case, 4.8%) and disseminated intravascular coagulation (DIC) (one case, 4.8%) in group 1. Laboratory findings were not different between the two groups. All patients were treated with antibiotics and had successful recoveries. The duration of recovery of pyuria in group 1 (5.2 +/- 9.6 days) was not longer than that in group 2 (3.1 +/- 2.9 days) (p > 0.05). The length of defeverscence in group 1 (7.0 +/- 4.6 days) was longer than in group 2 (3.5 +/- 2.7 days) (p < 0.05). There were no differences between group 1 and group 2 in the rate of predisposing factors. Thirteen of 21 cases (61.9%) in group 1 and five of 14 cases (35.7%) in group 2 had positive urine culture results which are relatively low probably due to the administration of antibiotics prior to our emergency room visit. Perfusion defects on CT were very frequent findings (60.0% of the clinical acute pyelonephritis patients). We classified CT findings of group 1 as focal unilateral (2 cases, 9.5%), multifocal unilateral (14 cases, 66.7%) and multifocal bilateral (5 cases, 23.8%), and there were no differences between the subgroups of group 1 in the duration of defeverscence.

CONCLUSION

Those patients who had perfusion defects on CT showed relatively severe clinical courses but responses to early antibiotics were very good. Contrast enhanced CT scans may be very sensitive for the detection of acute renal parenchymal inflammatory disease and for defining the extent of disease, but it is clinically not essential to perform in the early uncomplicated acute pyelonephritis because CT diagnosis does not change management. Clinical use of contrast enhanced CT scan may be appropriate in case of persistence of fever and leukocytosis for more than seven days despite antibiotic treatment.

Post-transplantation diabetes is better controlled after conversion from prednisone to deflazacort: a prospective trial in renal transplants

It is well known that long-term use of steroids plays a decisive role in the development of glucose intolerance and diabetes mellitus (DM). Deflazacort, an oxazoline derivative of prednisolone, has been introduced as a potential substitute for conventional steroids in order to ameliorate glucose intolerance. We initiated a randomized study of conversion from prednisone to deflazacort in kidney transplantation (Tx) recipients presenting with pre-Tx or post-Tx DM to ascertain whether or not the switch to deflazacort would ameliorate the diabetic state. Forty-two recipients in the conversion group were compared with 40 patients on prednisone (the control group) in a prospective manner. The dose reduction of insulin or oral blood glucose-lowering agents, the adequacy of glucose control, and the development of side effects were the criteria for evaluating outcome. In the conversion group, patients were switched to a deflazacort at a dose ratio of 6 mg deflazacort to 5 mg prednisone. During the mean follow-up period of 13.2 months, neither graft dysfunction nor acute rejection developed in the conversion group. Improvement in blood glucose control in the conversion group was noted. When the conversion group was stratified into pre- or post-Tx DM, promising effects were clearly evident in the post-Tx DM patients. More than 50% dose reduction of blood glucose-lowering agents was possible in 42.3% of post-Tx DM patients. In conclusion, it was readily possible to control blood glucose better in post-Tx DM recipients without seriously affecting the immunosuppressive activity after conversion to deflazacort.

Influence of nutritional status on CAPD peritonitis

To investigate the effect of nutritional status of continuous ambulatory peritoneal dialysis (CAPD) patients on the development of peritonitis, a cross-sectional study of the nutritional status of 79 CAPD patients and a retrospective study on the incidence of peritonitis in these patients were done. The incidences of peritonitis were compared according to the nutritional status of these patients on CAPD. Protein-caloric malnutrition assessed by a score system based on triceps skinfold thickness, mid-arm circumference, serum albumin level and relative body weight was demonstrated in 27 patients (34%) among 79 total CAPD patients. The incidence of peritonitis was significantly higher in poor nutritional status patients, with 1.09 +/- 0.86/patient-year, than that in normal nutritional status patients with 0.64 +/- 0.72/patient-year (p less than 0.05). In patients with the same nutritional status, patients using Dianeal solution had a trend of a lower incidence of peritonitis than those using Peritosol solution. In conclusion, the nutritional status and possibly the type of CAPD solution may influence CAPD peritonitis as risk factors.

Synthesis and cytotoxic effects of deoxy-tomentellin

Cannabigerol (1, CBG), methyl 4-[(2E)-3,7-dimethyl-2,6-octadienyl)oxy]-3-methoxybenzoate (2, DTM), 5-fluorouracil (3, FU) as a reference, and cannabidiol (4, CBD) were tested for their growth inhibitory effects against KB(ATCC NO, OCL 17) cell lines using two different assays, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazoliumbromide (MTT) assay and the sulforhod-amine B protein (SRB) assay. These compounds showed inhibitory activity in vitro in the micromolar range against KB cell lines. In general, the antitumor activities of these compounds (1, 2, 3 and 4) were dose-dependent over the micromolar concentration range of 1 to 100 M. The comparison of IC50 values of these compounds in tumor cell lines showed that their susceptibility to these compounds decreases in the following order: DTM > CBD > 5-FU > CBG by MTT assay and DTM = CBD > 5-FU > CBG by SRB assay. CBG 1, DTM 2, 5-FU 3, and CBD 4 were tested for their cytotoxic effects on NIH 3T3 fibroblasts using two different assays, the MTT assay and SRB assay. These compounds exhibited potent cytotoxic activities in vitro in the micromolar range against NIH 3T3 fibroblasts. In general, the cytotoxic activities of these compounds (1, 2, 3 and 4) were dose-dependent over the micromolar concentration range of 1 to 100 M. The comparison of CD50 values of these compounds in NIH 3T3 fibroblasts shows that their susceptibility to these compounds in decreases the following order(:) CBD > 5-FU > DTM > CBG by MTT assay, CBD > 5-FU > CBG > DTM by SRB assay. These results suggest that DTM 2 has the most growth-inhibitory activity against KB cell lines.

Hepatitis G virus infection in hemodialysis and continuous ambulatory peritoneal dialysis patients

To determine the prevalence and clinical relevance of HGV infection in dialysis patients, we performed a cross-sectional study of 61 HD patients and 79 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. HGV-RNA was identified by reverse-transcription (RT) polymerase chain reaction (PCR) assay with primers from the 5'-untranslated region of the viral genome. The prevalence of HGV infection was similar in HD and CAPD patients (9.8% vs. 12.7%), while that of HCV infection was significantly higher in HD patients compared to CAPD patients (16.4% vs. 1.3%, p < 0.05). The mean age (49.2 +/- 13.4 vs. 46.7 +/- 13.0 years), male to female ratio (2.4:1 vs. 1.3:1), history of transfusion (62.3% vs. 49.4%), history of hepatitis (27.9% vs. 26.6%), mean ALT level during the previous 6 months (22.4 +/- 37.9 vs. 14.0 +/- 7.4 IU/L), and the prevalence of HBsAg (8.2% vs. 6.3%) showed no difference between HD and CAPD patients. In both HD and CAPD patients, the presence of HGV RNA was not related to age, sex, duration of dialysis, history of transfusion, history of hepatitis, or to the presence of HBV or HCV markers. There was no significant difference in the clinical and biochemical data between patients with isolated HGV infection (n = 12) and patients without viremia (n = 106). The clinical feature of patients coinfected with HGV and HBV (n = 2), or HGV and HCV (n = 2) seemed to be similar to those of patients with isolated HBV (n = 8) or HCV (n = 9) infection. In conclusion, the prevalence of HGV infection was not different between HD and CAPD patients, and HGV infections did not seem to be associated with clinically significant hepatitis. The routes of HGV transmission, other than transfusion or contamination during HD procedure, were suspected.

Negative conversion of antimitochondrial antibody in primary biliary cirrhosis: a case of autoimmune cholangitis

Autoimmune cholangitis is a clinical constellation of chronic cholestasis, histological changes of chronic nonsuppurative cholangitis and the presence of autoantibodies other than antimitochondrial antibody (AMA). It is uncertain whether this entity is definitely different from AMA positive primary biliary cirrhosis (PBC), though it shows some differences. We report a case of autoimmune cholangitis in a 59-year-old woman, who had been previously diagnosed as AMA-positive PBC associated with rheumatoid arthritis, has been converted to an AMA-negative and anticentromere antibody-positive PBC during follow-up. The response to ursodeoxycholic acid treatment is poor except within the first few months, but prednisolone was dropping the biochemical laboratory data.

Control of renin secretion by Ca2+ and cyclic AMP through two parallel mechanisms

The cellular mechanism of action of cyclic AMP (cAMP) mediating the beta-adrenergic stimulation of renin secretion was studied, with special reference to its interactions with the inhibitory pathway of renin secretion by Ca2+ calmodulin. Forskolin, a potent stimulator of adenyl cyclase that bypasses the hormone-receptor interactions, stimulated renin secretion in vitro from rabbit renal cortical slices in a concentration-dependent manner. Renin secretion stimulated by submaximal concentration of forskolin was partly or completely antagonized or blocked by raising intracellular Ca2+ concentration by incubating slices in a high-K+ depolarizing medium, but renin secretion stimulated by the maximal effective concentration of forskolin was not inhibited by Ca2+. In addition, the maximal effective concentration of forskolin (10(-5) M) increased renin secretion by a fixed amount independent of medium (by inference, intracellular) Ca2+ concentration in the range of 10(-8) to 10(-6) M in a high-K+ medium. Furthermore, the degree of stimulation of renin secretion by forskolin was greater with greater removal of the inhibitory effect of Ca2+ calmodulin pathway on renin secretion with use of potent calmodulin antagonists, suggesting that the stimulatory effect of cAMP on renin secretion may be maximal in the absence of the inhibitory influence of Ca2+. These results are consistent with the hypothesis that cAMP (by inference, the beta-adrenergic stimulus) stimulates renin secretion through a cellular mechanism independent of that through the Ca2+ -calmodulin pathway.

Stomach hanging technique using gauze during laparoscopic gastrectomy

INTRODUCTION

Lifting the stomach using laparoscopic instruments during laparoscopic gastrectomy is difficult and increases the risk of crushing the tumor. In this study, we present a stomach hanging technique using gauze pieces that reduces the risk to the tumor.

MATERIALS AND SURGICAL TECHNIQUE

After a partial omentectomy and the opening of the lesser sac, the antrum was wrapped with a 15-20-cm gauze piece. Next, a straight needle with 2-0 monofilament suture material pierced the abdominal cavity through the right subcostal area on the mid-clavicular line, and the gauze was then sutured twice in a figure of eight manner. The needle was removed percutaneously through the right middle quadrant of the abdomen. Another suture was applied to wrap the left side of the stomach. The stomach was easily lifted and positioned by pulling the four suture strings in different directions. After the suture materials were fastened to the abdominal wall using hemostat forceps, the surgical field was sufficiently exposed, facilitating lymph node dissection on the superior surface of the pancreas. This method freed the assistant from holding the stomach and enabled this individual to assist the operation in other ways.

DISCUSSION

This stomach lifting technique using gauze is a good option for exposing the surgical field, enables the assistant to perform other tasks, and reduces the risk of crushing the tumor during laparoscopic gastrectomy.

Prognostic factors and renal survival rates in IgA nephropathy

A retrospective study of 223 patients with IgA nephropathy (IgAN) was performed to clarify the prognostic factors and the renal survival rates of the disease. One hundred twenty-two patients were followed-up for more than 6 months after their renal biopsy (mean follow-up duration: 43.0 months), and 20 of them (16.4%) had progressed to end-stage renal disease (ESRD). Using univariate analysis, 8 risk factors (2 clinical and 6 histopathological findings) for developing ESRD were identified: renal insufficiency at initial presentation (serum creatinine > or = 1.5 mg/dl); heavy proteinuria (> or = 3.5 gm/day); moderate to severe histopathologic findings such as class IV/V lesions by W.H.O. classification, mesangial hypercellularity, glomerular sclerosis, interstitial infiltration, interstitial fibrosis, and tubular atrophy. In multivariate regression analysis, class IV/V lesions and renal insufficiency at initial presentation were the independent prognostic factors of IgAN. The renal survival rates were 100% at 1 year, 97.0% at 3 years, and 78.9% at 5 years. In conclusion, it seems that about 20% of IgAN patients have a risk to progress to ESRD within 5 years, and a careful follow-up is recommended especially in patients who have either renal insufficiency at the time of presentation or severe renal pathology (class IV/V lesions).

Combination chemotherapy of oral 5'-deoxy-5-fluorouridine and cisplatin in advanced gastric cancer: a phase II study

This study was designed to test the activity and feasibility of 5'-deoxy-5-fluorouridine (5'-DFUR) and cisplatin combination therapy in the treatment of advanced gastric cancer. Nineteen patients with inoperable and/or metastatic gastric cancer, which was histologically proven, were orally administered 5'-DFUR 1,200 mg/m2 on days 1 to 4 and days 15-18 combined with 70 mg/m2 of cisplatin being repeated every 4 weeks. Five partial responses (PRs) were achieved. Seven patients had stable disease and 6 progressed on therapy. The overall response rate was 27.7% (95% confidence interval: 9.69% to 53.5%). The median survival duration of all 18 patients was 25 weeks (9-64). The majority of patients had WHO grade I/II toxicity, but there was no treatment-related death. These data support that the combinations of oral 5'-DFUR and cisplatin are well tolerable and have a moderate activity with low toxicity in the treatment of advanced gastric cancer.

A case of Behçet's syndrome with supeior vena cava syndrome

Behçet's syndrome is a multi-systemic and chronic disorder that affects many organs. It has been suggested that the diagnosis was based on the presence of the 'major' and 'minor' clinical criteria. When thromobophlebitis, arthritis, central nervous system or gastrointestinal lesions are also present. Behçet's syndrome will be thought to be present in the appropriate geographic area. We report a case of superior vena cava syndrome caused by Behçet's disease in a 40-year-old man with recurrent oral aphthous ulcers and skin rashes on the anterior chest wall. There were multiple thrombosis of the superior vena cava, innominate and subclavian veins. This patient also had a solitary cecal ulcer with an ileocecal fistula and downhill varix. The chest CT, veno-cavography, pulmonary angiography and colon study were taken and follow-up was performed.

Comparative study of hepatitis C virus antibody between hemodialysis and continuous ambulatory peritoneal dialysis patients

We have done cross sectional and prospective studies to determine the prevalence and the clinical significance of antibodies to the hepatitis C virus (Anti-HCV) in 54 hemodialysis (HD) patients and 227 continuous ambulatory peritoneal dialysis (CAPD) patients. Fifteen patients (27.8%) were anti-HCV (+) among the HD group, and twelve patients (5.3%) were anti-HCV (+) among the CAPD group. In the HD group, the positivity of anti-HCV correlated with the duration of HD, but there was no significant correlation with the history of transfusion, the amount of transfusion and abnormal alanine aminotransferase (ALT). At the follow-up study in 164 cases (HD 50 cases, CAPD 114 cases) after 6 months, one of 14 anti-HCV (+) CAPD patients was converted to anti-HCV (-) and two of 35 anti-HCV (-) HD patients were converted to anti-HCV (+). In conclusion, the prevalence of anti-HCV was significantly higher in HD patients compared to CAPD patients, and the positivity for anti-HCV in HD patients correlated with the duration of HD. A regular follow-up of anti-HCV and isolation of anti-HCV (+) HD patients with a separate machine may be needed to prevent the transmission of the hepatitis C virus during hemodialysis.

Hepatitis C infection in hemodialysis units

We performed an epidemiological study of the hepatitis C infection on 112 patients of 3 urban hemodialysis units using a recently developed anti-HCV recombinant based assay. Eleven patients (9.8%) were positive for anti-HCV. Among them, 8 (72.7%) were positive for anti-HBc, one of whom was HBsAg positive and 6 of whom were also anti-HBs positive. Surprisingly, all of the anti-HCV (+) patients were normal alanine aminotransferase. The mean age of the anti-HCV (+) patients was 50.7 +/- 3.3 (mean +/- SE) and that of the anti-HCV (-) was 47.6 +/- 1.3. The mean duration (month) of hemodialysis of the anti-HCV (+) and anti-HCV (-)groups were 52.7 +/- 7.2 (mean +/- SE) and 60.9 +/- 9.7, respectively. The prevalence of anti-HCV among anti-HBc positive subjects was 9.5% and that among anti-HBc negative subjects was 17.6%. This didn't have any statistical significance according to the criteria of the study (p = 0.308). The prevalence of anti-HCV among the transfusion positive group was 11.0% and that of the transfusion negative group was 7.7%. This data showed the tendency for a higher prevalence of anti-HCV among the transfusion positive group, but this also didn't reach statistical significance (p = 0.424). Of the 40 normal controls, none were anti-HCV positive. The prevalence of HBsAg in our hemodialysis units was 12.5%. This rate was not so much higher than the average population in Korea. The prevalence of anti-HCV and previous hepatitis B virus infection also had no significant relationship.(ABSTRACT TRUNCATED AT 250 WORDS)