Effect of serum concentration on hypothermic preservation of cardiac myocytes isolated from neonatal rat ventricle

The purpose of the present study was to evaluate the functional and biochemical effects of serum concentrations on hypothermic preservation of cardiac myocytes. Myocytes were isolated from neonatal rat ventricles and cultured for 4 days, and then incubated for 24 hrs at 4 degrees C in media containing 0, 2, 5, 10, and 20% fetal calf serum (FCS). The myocytes were then cultured for an additional 24 hrs at 37 degrees C to evaluate the recovery of myocyte beating rate. The recovery ratio of myocyte beating rate after hypothermic incubation was 25.3 +/- 14.2 percent of control in the serum-free, 33.0% in 2% FCS, 30.7% in 5% FCS, 22.3% in 10% FCS, and 24.3% in 20% FCS groups. Serum-free, 10% and 20% FCS groups had lower recovery ratios compared to the other two groups. The release of CPK and LDH after hypothermic incubation were similar in the serum-free, 2% and 5% FCS groups, however, significant increases were observed for the 10% and 20% FCS groups. It is suggested that fetal calf serum at high concentrations (> 10%) might be injurious to immature myocardium under hypothermic preservation, and that the optimum concentration of FCS is two percent or less.

Evaluation of immature cardiac myocyte viability after 24 hours of hypothermic preservation

In this study, we evaluated cardiac myocyte viability and function under hypothermic conditions using three types of storage solutions; saline solution (SS), Euro-Collins solution (ECS) and MCDB 107 medium (MM). Cardiac myocytes were isolated from neonatal rat ventricles by collagenase dispersion and cultured for 4 days with MCDB 107 medium. A total of 12.5 x 10(5) myocytes/culture dish were used and the myocytes were incubated at 4 degrees C for 6, 12, 18 and 24 hrs in the various storage solutions. After each incubation time, CPK and LDH were measured in the storage solutions. The myocytes were then cultured in MCDB 107 medium and incubated for 24 hrs at 37 degrees C to evaluate the recovery of the myocyte beating rate. In group MM (n = 7), the recovery ratio of the myocyte beating rate was 99.2 percent of control (beating rate prior to hypothermic incubation) at 6 hours, 104.6% at 12 hrs and 44.8% at 24 hrs. Groups SS and ECS (n = 7 each) had significantly lower recovery ratios than the MM group (at 6 hrs: 74.3, 34.0; at 12 hrs: 61.0, 32.2; at 24 hrs: 0.0, 0.0 percent of control, respectively). Release of CPK and LDH in the MM group gradually increased and at 24 hrs was 28.6 IU/l and 93.6 IU/l, respectively. However, the SS group had significantly increased CPK and LDH values at 24 hrs (CPK: 66.9, LDH: 164.2). The ECS group showed the greatest increase in both markers (CPK: 317.5, LDH: 421.2). In summary, saline solution showed a beneficial effect on recovery of myocyte viability at 12 hours compared to Euro-Collins solution, however, MCDB 107 medium had the best overall protective effect on cultured myocytes. Accordingly, alternate hypothermic storage solutions, such as cell-culture medium, may have protective characteristics that are suitable for cardiac preservation.

[Relationship of public health and sexuality of the elderly]

Senior citizens were surveyed with respect to their sexual lives, their views of the things that give meaning to their lives, and their health. At the same time, approaches to providing sex education for the elderly were considered. Given the social sensitivity ascribed to the subject of sexual activity among the elderly, in order to obtain an accurate unbiased picture, the problem of methodology had to be addressed initially. Two methods were employed in a given region: interviews of senior citizens were conducted and a written questionnaire survey was administered on members of senior citizens' clubs or groups. Through this process the advantages and disadvantages of each method could be evaluated and a more concrete grasp of conditions governing Sexual activity among the aged was obtained. Results of this study showed that a sense of fulfillment in sexual life of a subject was associated with more meaning in life and better subjective health. Therefore the existence of an interrelationship between sexual activity, a sense of meaning in life, and personal health was confirmed. With regard to sex education for the elderly, warm, close physical contact was an aspect of sexual life which was stressed regardless of sex, age, or physical condition. Since frequency of impotence and concern with this problem were high among the men surveyed, including of a detailed discussion of this subject is considered necessary in the sex education program. This study indicated that, in addition to the current emphasis of nutrition, exercise, and rest in the health of senior citizens, sexual activity needs to also be considered as a key element.

Nationwide randomized comparative study of daunorubicin and aclarubicin in combination with behenoyl cytosine arabinoside, 6-mercaptopurine, and prednisolone for previously untreated acute myeloid leukemia

Aclarubicin was evaluated in combination chemotherapy for adult acute myeloid leukemia in a randomized trial involving 58 institutions throughout Japan. Behenoyl cytosine arabinoside (BH-AC).daunorubicin, 6-mercaptopurine, and prednisolone (DMP) was compared with BH-AC.aclarubicin, 6-mercaptopurine, and prednisolone (AMP). In the 360 evaluable cases among the 433 cases enrolled, complete remission (CR) rates were 63.7% (116/182) for BH-AC.DMP and 53.9% (96/178) for BH-AC.AMP (P = 0.0587). Median survival periods and 7-year survival rates were 15.8 months and 19.3% for BH-AC.DMP and 9.5 months and 20.2% for BH-AC.AMP (P = 0.0091 according to the generalized Wilcoxon test [GW], P = 0.196 according the log-rank test [LR]). Median disease-free survival periods were 15.4 months for BH-AC.DMP and 14.1 months for BH-AC.AMP (P = 0.851 by GW, P = 0.439 by LR). Among the 346 cases of extramurally confirmed FAB subtypes, CR rates were 67.9% (19/28) with BH-AC.DMP and 31.8% (7/22) with BH-AC.AMP for subtype M3 (P = 0.011) and 63.3% (93/147) with BH-AC.DMP and 56.8% (84/148) with BH-AC.AMP (P = 0.254) for subtypes M1, M2, M4, and M5. Diarrhea, ileus, pneumonia, and renal failure were more frequent with BH-AC.AMP than with BH-AC.DMP. The results indicate, at least on the basis of the long-term outcome, that BH-AC.AMP has antileukemic effects on subtypes M1, M2, M4, and M5 that are comparable with those of BH-AC.DMP.

Nation-wide randomized comparative study of doxorubicin, vincristine and prednisolone combination therapy with and without L-asparaginase for adult acute lymphoblastic leukemia

A randomized clinical trial of combination chemotherapy for adult acute lymphoblastic leukemia (ALL) with doxorubicin, vincristine and prednisolone with and without L-asparaginase (AdVP vs L-AdVP) was conducted, involving 58 institutions throughout Japan. After reaching complete remission (CR), patients were treated with the same regimen for more than 2 years. Among 166 evaluable cases of the 198 cases enrolled, CR rates were 63.1% (53/84) with AdVP and 64.6% (53/82) with L-AdVP (P = 0.837). Median survival times and 7-year survival rates were 12.7 months and 21.2% with AdVP, and 16.0 months and 22.3% with L-AdVP (P = 0.955 by generalized Wilcoxon test [GW], P = 0.952 by log-rank test [LR]). Median disease-free survival times and 7-year survival rates were 13.5 months and 23.8% with AdVP and 17.0 months and 30.6% with L-AdVP, showing some increments for L-AdVP but no statistical significance (P = 0.141 by GW, P = 0.300 by LR). Among the cases of extramurally confirmed FAB subtypes, CR rates were 75.9% (63/83) for the L1 subtype and 51.3% (39/76) for the L2 subtype (P = 0.001). As to adverse effects, pancreatitis was complicated more frequently in L-AdVP than in AdVP (P = 0.039). Other side effects such as hyperbilirubinemia, diabetes mellitus, diarrhea and hypofibrinogenemia were observed more frequently with L-AdVP, but with no statistical significance. Thus, addition of a single course of L-asparaginase in the induction phase of combination chemotherapy with doxorubicin, vincristine and prednisolone did not significantly enhance the effect of antileukemic treatment of adult ALL.

Cardiac myocyte functional and biochemical changes after hypothermic preservation in vitro. Protective effects of storage solutions

In this study, we evaluated cardiac myocyte viability and function under hypothermic conditions with four types of storage solutions, saline solution, Euro-Collins solution, University of Wisconsin solution, and MCDB 107 medium. Cardiac myocytes were isolated from neonatal rat ventricles by collagenase dispersion and cultured for 4 days with MCDB 107 medium. A total of 12.5 x 10(5) myocytes per culture dish was used and the myocytes were incubated at 4 degrees C for 6, 12, 18, and 24 hours in the various storage solutions. After each incubation time, creatine kinase and lactate dehydrogenase were measured in the storage solutions. The myocytes were then incubated for 24 hours at 37 degrees C to evaluate the recovery of the myocyte beating rate. In the MCDB 107 group (n = 7), the recovery ratio of myocyte beating rate was complete by 12 hours, then decreased to 44.8% of control (beating rate before hypothermic incubation) at 24 hours. The saline, Euro-Collins, and University of Wisconsin groups (n = 7 each) had significantly lower recovery ratios than the MCDB 107 group (at 12 hours: 61.0%, 32.2%, and 48.9%; at 18 hours: 0.0%, 5.5%, and 15.1% of control, respectively). Release of creatine kinase and lactate dehydrogenase in the MCDB 107 group gradually increased and at 24 hours was 143.2 mIU/flask and 486.2 mIU/flask, respectively. However, the saline and University of Wisconsin groups had significantly increased creatine kinase and lactate dehydrogenase values at 24 hours (creatine kinase: 334.6 and 319.6 mIU/flask; lactate dehydrogenase: 821.6 and 654.4 mIU/flask, respectively). The Euro-Collins group showed the greatest increase in both markers (creatine kinase: 1587.5, lactate dehydrogenase: 2106.9 mIU/flask). In summary, saline and University of Wisconsin solutions showed a beneficial effect on recovery of myocyte viability at 12 hours compared with Euro-Collins solution, however MCDB 107 medium had the best overall protective effect on cultured myocytes. Accordingly, alternate hypothermic storage solutions, such as cell-culture medium, may have protective characteristics that are suitable for cardiac preservation.

[In vitro evaluation of prostaglandin I2 analogue on hypothermic injury to immature myocytes]

We evaluated the functional and biochemical effects of prostaglandin I2 analogue (PGI-A) on cardiac myocytes incubated under hypothermic conditions. Myocytes were isolated from neonatal rat ventricles and cultured for 4 days. Then, myocytes (12.5 x 10(5) myocytes/flask) were incubated at 4 degrees C for 24 hrs in media with PGI-A as follows; O M PGI-A (group C: control), 10(-9) M (group P1), 10(-8) M (group P2), 10(-7) M (group P3), 10(-6) M (group P4). After hypothermic incubation, CPK and LDH were measured. The myocytes were then cultured for 24 hrs at 37 degrees C to evaluate the recovery of myocyte beating rate. For the beating rate, group P2 showed significantly increased recovery compared to the control (P2: 47.9, p < 0.025, C:18.1 percent of control; ie, beating rate prior to hypothermic incubation). The release of CPK and LDH was significantly suppressed in group P2 compared to the control (P2:57.7, p < 0.05, 275.1, p < 0.025; C:96.8 mIU/flask, 439.6 mIU/flask, respectively). In conclusion, prostaglandin I2 has direct cytoprotective characteristics for immature myocytes that may be suitable for cardiac preservation.

[The relation between the time and the fatigue of skeletal muscle ventricle]

It is generally recognized that if skeletal muscle is stimulated corresponding with the heart rate to assist the cardiac performance, the contraction power of the skeletal muscle decreases in a few minutes. It becomes necessary that the skeletal muscle is electrically stimulated in 6-9 weeks to lead into the transformation or that the muscle is laid without working after operation in 6-9 weeks to wait for growing of the collateral vessels. The observation time of the fatigue phenomenon in many studies is, however, short and it is not understandable that the contraction power decreases near to zero although the type I fibers remain. So we studied the relationship between the time and the pressure assist of the skeletal muscle ventricle (SMV). It was concluded that 1) the cause of the power decrease is not only the fatigue but the operative invasion. 2) in our setting, when SMV was stimulated in the ratio of 1:4 or 1:10 to the heart rate, the power recovered within 3 hours. 3) if the initial setting of the drive is light enough, the preconditioning or the vascular delay will be unnecessary and the working transformation or the in situ training will practicable.

Modulation of cardiac myocyte beating rate and hypertrophy by cardiac fibroblasts isolated from neonatal rat ventricle

We evaluated the in vitro modulation of cardiac myocyte beating rate and growth hypertrophy in the presence or absence of cardiac fibroblasts. Cardiac myocytes and fibroblasts were isolated from neonatal rat ventricles, and cultures of either myocytes alone or of myocytes in co-culture with fibroblasts were established and observed for 21 days. The beating rate in control myocytes increased rapidly, reached peak values on day 5 (266.2 +/- 58.2 beat/min), and then decreased by day 21. The beating rate of myocytes which were co-cultured with fibroblasts in group 2-1 (2-1 ratio of myocytes to fibroblasts, 6.0 x 10(5) total cells/well) was significantly lower than that in control myocytes, and showed a decreased peak value on day 7 (135.1 +/- 46.4). The beating rate in group 1-1 was significantly less than that of group 2-1, with a peak value on day 7 (85.9 +/- 24.9). Group 1-2 myocytes did not show a beating rate increase. Myocyte hypertrophy was measured after three days of culture. The surface area of myocytes which had been co-cultured with fibroblasts was significantly increased, as compared to that of control myocytes. In addition, myocyte surface area increased with increasing numbers of fibroblasts (mean myocyte surface areas in group 2-1, 1-1 and 1-2 were 143 +/- 21, 163 +/- 33, 206 +/- 38% of control, respectively). In conclusion, suppression of the myocyte beating rate and acceleration of myocyte hypertrophy are characteristic expressions of myocyte differentiation and growth during the neonatal period The present results suggest that fibroblasts play an important role in controlling myocyte development.

[Granisetron oral phase III clinical trial--study on the inhibitory effect of granisetron for nausea/vomiting induced by chemotherapy for tumors in the hematopoietic organs]

The efficacy and safety of oral granisetron against nausea and vomiting induced by chemotherapy for tumors in the hematopoietic organs were investigated. Depending on the day of anticancer drug administration, single administration or 2 to 6-day repeated administration of granisetron at 2 mg once daily was conducted. The clinical efficacy rate against nausea and vomiting was 91.6% on the first day of administration of anti-cancer drugs and 90% or over on and after the second day of administration. Compared with the status at the previous chemotherapy, a significant decrease in vomiting frequency was observed during the present trial. Adverse events which were suspected to be related to granisetron included 1 case of mild feeling of residual urine and another demonstrating very mild eosinophilia. From the above results, it was confirmed that granisetron was a safe and effective antiemetic against nausea and vomiting induced by anticancer drug administration.

In vitro evaluation of diltiazem on hypothermic injury to immature myocytes

The purpose of the present study was to evaluate the functional and biochemical effects of diltiazem (DTZ) on cardiac myocytes incubated under hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days with MCDB 107 medium. Then, myocytes (12.5 x 10(5) myocytes/flask) were incubated at 4 degrees C for 24 hours in media with or without DTZ at concentrations of 0 M (group C), 10(-7) M (Group D1), 10(-6) M (group D2), 10(-5) M (group D3), or 10(-4) M (group D4). After 24 hours at 4 degrees C, CPK and LDH were measured. The myocytes were then cultured for 24 hours at 37 degrees C to evaluate the recovery of the myocyte beating rate. In group C (n = 7), the recovery ratio of the myocyte beating rate was 29.9% of control (beating rate prior to hypothermic incubation). Groups D1 and D2 (n = 7 each) had approximately the same recovery ratios as group C (24.0% and 24.7%, respectively); however, groups D3 and D4 (n = 7 each) showed no beating rate recovery. Release of CPK and LDH in group C was 112.3 mIU/flask and 457.4 mIU/flask, respectively. Groups D1 and D2 showed no significant differences in both enzymes compared to group C. However, the levels of CPK were significantly higher in group D4 (203.3, p < 0.05), and LDH levels were significantly higher in groups D3 and D4 (669.3, p < 0.05; 883.4, p < 0.02). In conclusion, DTZ showed no protective effects on hypothermic injury to immature cardiac myocytes; moreover, it accelerated cellular injury at the concentrations of 10(-5) and 10(-4) M both functionally and biochemically. Therefore, diltiazem may not be suitable for cardiac preservation during the neonatal period.

Evaluation of oral aclarubicin treatment for tumors of the gastrointestinal track

Aclarubicin (ACR), a drug useful for the treatment not only of tumors of the hematopoietic system but also of those of the gastrointestinal tract, has been administered invariably by the intravenous route. We attempted oral administration of ACR to increase its specificity in the treatment of gastrointestinal tumors. Oral administration resulted in a much higher intratumor concentration but lower peripheral blood cell or bone marrow cell concentration of the drug as compared with intravenous administration. The reduced peripheral cell inhibition and bone marrow suppression permits the administration of the drug in higher doses, and the absence of the drug in the plasma suggests a reduced likelihood of myocardial cell injury and hepatocyte impairment. These favorable findings are considered to warrant early clinical trial of the treatment.

[Clinical study of patients with deep-seated fungal infection associated with hematological diseases]

An assessment has been made regarding usefulness of measuring beta-D-glucan (beta-glucan) as fungal serodiagnosis in 50 cases of fungal infection with hematological diseases. Further, an assessment has been made regarding relation between hematological findings and therapeutic effect by administering miconazole, an antifungal agent (MCZ: Florid, clinically to the subjects. Positivity of beta-glucan (beta-glucan > or = 10 pg/ml) was observed in 54.5% (24/44), and the effective rate of MCZ in the positive cases was 75.0% (18/24). In the cases in whom fungus was detected, beta-glucan-positive rate was 50.0% (8/16), and MCZ-effective rate in beta-glucan-positive cases was 62.5% (5/8). The total effective rate of MCZ was 80% (40/50). Side effects were observed in 3 cases, but continual administration of MCZ was possible in all of the 3 cases. By the assessment regarding the relation between hematological findings and therapeutic effect of MCZ, it was found that the effective rates in the cases who underwent a transition with neutrophil and lymphocyte counts less than 500/microliters during the period of MCZ administration were 64.7% (11/17) and 50% (5/10), respectively, and large effects were observed in the cases who underwent a transition with the neutrophil and lymphocyte counts more than 500/microliters was 86.7% (19/22) and 91.7% (22/24), respectively. These results suggested that lymphocytes rather than neutrophils had an important role in the morbidity of fungal infection. It was noteworthy that MCZ was effective for the treatment of deep seated mycosis and significant effective rate was obtained in the group of patients who had neutrophils and lymphocytes less than 500/microliters.

A randomized study of alfacalcidol in the refractory myelodysplastic anaemias. A Japanese cooperative study

A multi-institutional randomized trial of alfacalcidol (1 alpha hydroxyvitamin D3) was performed to determine the therapeutic effect of alfacalcidol in patients with refractory myelodysplastic anaemias. Twenty-three evaluable patients were randomized to receive either a single daily oral dose of 6 micrograms of alfacalcidol or only supportive care as a control. Treatment was continued, whenever possible, for a period of 6 months. Response was assessed by weekly blood counts, clinical course and repeated marrow examinations. No significant difference was noted between the alfacalcidol and control groups. Three of the 13 patients in the alfacalcidol group, and two of the 10 patients in the control group, suffered a progression of their disease. One patient with refractory anaemia showed a good response to alfacalcidol in all three haematopoietic cell lineages; the response, however, could not be maintained, because discontinuation of the drug resulted in a worsening of pancytopenia which was refractory to a second course of alfacalcidol therapy. Hypercalcaemia was the major toxic side-effect of alfacalcidol therapy. The results indicate that alfacalcidol therapy, when used alone, does not induce a beneficial effect in patients with refractory myelodysplastic anaemias.

Re-analysis of prognosis in refractory anemia alone, with ring sideroblasts, and with excess of blasts

Based on 473 primary cases of refractory anemia (RA), RA with ring sideroblasts (RARS), or with an excess of blasts (RAEB), new staging systems for overall survival, leukemic transformation, and nonleukemic death were developed. The reproducibility of these new staging systems, our former staging systems for leukemic transformation and nonleukemic death, and that for overall survival provided by Sanz et al. (Blood 1989;74:395-408), were estimated using a total of 132 patients with RA, RARS, or RAEB (test sample). The correlation of risk ratios of the test sample from our system and that of Sanz et al. was poor (tau = 0.24; Kendall rank correlation). Our risk ratio was a significant (p = 0.0012) continuous covariate of the Cox model life-table analysis in the test sample but that of Sanz et al. was not. The new and previous staging systems for leukemic transformation were highly similar (tau = 0.7) and risk ratios of both systems were significant in the test sample (p = 0.00046 and 0.0017, respectively). Based upon the new system, patients at high risk for leukemic transformation RA or RARS were identified as males, with bone marrow myeloblasts higher than 2.5%, abnormal granules in the granulocytes, and circulating erythroblasts. Their cumulative leukemic transformation rate exceeded 50% within 2 years from presentation. The new and previous systems for nonleukemic death were moderately correlated (tau = 0.47). The risk ratios of both systems were significant in the test sample (p = 0.00012 and 0.000024, respectively) but failed to stratify test sample patients into three distinct risk groups. In conclusion, our new staging systems for overall survival and leukemic transformation were reproducible in RA, RARS, or RAEB patients and will be useful especially in identifying high-risk patients with RA or RARS, who are considered to be at lower risk by the FAB classification.

Prevention of postischemic reperfusion injury: the improvement of myocardial tissue blood flow after ischemia by terminal nicorandil-Mg cardioplegia

We evaluated the preventive effect of postischemic reperfusion injury by Nicorandil-Mg cardioplegia given just prior to reperfusion as "terminal cardioplegia." Twenty seven dogs were placed on cardiopulmonary bypass and the aorta was cross-clamped for 90 min under hypothermic (17-19 degrees C) cardioplegic arrest. The canine hearts were divided into three groups: in group A (n = 10) the hearts reperfused without any treatment; in group B (n = 9) the hearts received coronary perfusion with Nicorandil-Mg solution (Nic, 8 mg/l; Mg, 20 mEq/l; glucose, 50 g/l) for 2 min just prior to reperfusion; and in group C (n = 8) the hearts received coronary perfusion with Nicorandil-Mg free solution (glucose, 50 g/l). During and after ischemia, the myocardial tissue PCO2 (t-PCO2) was continuously monitored by an ion-sensitive field effective transistor (ISFET) sensor. In addition, the myocardial tissue blood flow (TBF), oxygen consumption, and lactate flux were then calculated at 5, 10, 20, and 40 min of reperfusion. In the initial reperfusion period, Group B showed an improved TBF compared to group A and C (at 5 min, group B was 42.7 +/- 11.9; group A was 29.4 +/- 11.2, P < 0.025; and group C was 33.9 +/- 9.2% of the preischemic control level, P < 0.05). T-PCO2 in group B was significantly decreased at 5 min of reperfusion (group B, 127.5 +/- 22.5-->42.5 +/- 9.7; group A, 117.5 +/- 23.0-->85.2 +/- 17.4, P < 0.001; group C, 122.3 mmHg-->68.2 +/- 18.7 mmHg, P < 0.01), and group B had a better metabolic recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of small adenocarcinoma of the lung with giant bullae]

A 52-year-old male underwent right upper lobectomy for giant bullae which involved almost half of thoracic cavity and covered over the right upper lobe. Postoperative histopathological examination revealed emphysematous bullae of right upper lobe and adenocarcinoma (6 mm in diameter) was found in the bullae wall under the pleura. Since there was no metastasis in bronchial lymph nodes of upper lobe, additional procedure for lymph node dissection was not performed. Patient has been healthy for eight years after operation and there is no evidence of recurrent tumor. It is difficult to define the small lesion of neoplasma with giant bullae of lung. Therefore, the patient involved with bullae may require preoperative and intraoperative attentive investigation for possible malignant lesions.

Report of a patient with POEMS/Takatsuki/Crow-Fukase syndrome associated with focal spinal pachymeningeal amyloidosis

The authors present the results of an autopsy of a 67-year-old Japanese man with POEMS/Takatsuki/Crow-Fukase syndrome (P/T/CFS) diagnosed in 1972. Each component of the syndrome was gradually recognized after the resection of lumbar vertebral solitary plasmacytoma in 1967. The patient died in 1989 of generalized infection and renal failure. Autopsy revealed in the vertebral canal between the fifth and seventh thoracic vertebrae dorsal pachymeningeal fibrosis, with prominent amyloid deposition that oppressed the spinal cord. This condition was consistent with the final neurologic manifestation of the patient, bilateral motor and sensory disturbance below the sixth thoracic level. Myelopathy remained clinically unnoticed because neurologic disturbance had begun as peripheral polyneuropathy. Normocellular marrow with heterogeneously scattered lambda light chain-positive plasma cells and degeneration of the myelinated fibers of sciatic nerve also were observed. This is the first report of focal spinal amyloidosis associated with P/T/CFS.

Clinical features of long-term survivors of refractory myelodysplastic anemias. A Japanese cooperative study

Eighty-one of 473 patients with refractory myelodysplastic anemias registered by the Japanese Cooperative Study Group prior to January 1987 survived more than 5 years. At presentation, most patients had mild cytopenia, a less aggressive form of the disease (48 with refractory anemia, 23 with refractory anemia with ring sideroblasts, 10 with refractory anemia with excess of blasts), less blast cells in the marrow and blood, and onset at younger ages. Their clinical profiles 5 years after presentation showed no significant improvement. The results suggest that the long-term survivors were found in a subpopulation of patients with a favorable prognosis and that it is a part of the natural course rather than the results of treatment.

[A successful treatment of coronary arteriovenous fistula with Symbas procedure]

A successful treatment of coronary arteriovenous fistula with intraoperative echocardiogram and Symbas procedure is presented. The patient, a 2-year-old male, had been suffering from concealed congestive heart failure from his birth. The cardiac catheterization and angiogram revealed coronary arteriovenous fistula from LAD to right ventricle with large coronary aneurysm. In the operation, no fistula vessels were noted on the cardiac surface. Then, the intraoperative echocardiography was performed, and the fistula pour into right ventricle with aneurysm was found in the myocardium. The fistula was closed with Symbas procedure, and excellent closure could be checked with the intraoperative echocardiogram, too. After this operation, he got well under anticoagulant treatment with "ticlopidine".

Antibody removal therapy used successfully at delivery of a pregnant patient with Glanzmann's thrombasthenia and multiple anti-platelet antibodies

A 31-year-old Japanese woman with Glanzmann's thrombasthenia became pregnant voluntarily. She had had transfusions with more than 60 units for severe bleeding. She had multiple antibodies against HLA antigens and platelet glycoprotein IIb/IIIa. No compatible platelets were available. To prevent serious hemorrhage during her delivery, antibody removal therapy was carried out three times. Large molecules including immunoglobulins were removed from more than 3 liters of plasma each time. After the titer of antiplatelet antibodies had decreased in the patient's blood, antihuman globulin-lymphocyte cytotoxicity test compatible platelets were transfused. Her bleeding time improved and delivery was induced successfully despite atonic hemorrhage of about 2,000 g of blood. Her infant had no bleeding problems. This patient is the first with Glanzmann's thrombasthenia to receive antibody removal therapy at delivery.

The neuronal organization of horizontal semicircular canalactivated inhibitory vestibulocollic neurons in the cat

1. The somatic location and axonal projections of inhibitory vestibular nucleus neurons activated by the horizontal semicircular canal nerve (HCN) were studied in anesthetized cats. Cats were anesthetized with ketamine hydrochloride and pentobarbital sodium. 2. Intracellular recordings were obtained from 11 neck extensor motoneurons which were identified by antidromic activation from the dosal rami (DR) in the C1 segment. Stimulation of the ipsilateral (i-) HCN and the ipsilateral abducens (AB) nucleus evoked IPSPs in the motoneurons. These IPSPs were fully or partially occluded when they were evoked simultaneously. 3. Intracellular recordings were obtained from 8 AB motoneurons. Stimulation of the i-HCN and the i-C1DR motoneuron pool evoked IPSPs in the AB motoneurons. These IPSPs were also partially occluded when they were evoked simultaneously, which implied that some HCN-activated neurons inhibit both i-AB motoneurons and ipsilateral neck motoneurons. 4. Unit activity was extracellularly recorded from 30 vestibular neurons that were activated monosynaptically by i-HCN stimulation. Their axonal projections were determined by stimulating the i-AB nucleus and the i-C1DR motoneuron pool. Eight neurons were activated by both stimuli, and were termed vestibulooculo-collic (VOC) neurons. Their axonal branching was examined by means of local stimulation in and around the i-AB nucleus and the i-C1DR motoneuron pool. Eighteen neurons were antidromically activated from the i-C1DR motoneuron pool but not from the i-AB nucleus. These were termed vestibulo-collic (VC) neurons. Four neurons were activated from the i-AB nucleus but not from the ventral funiculus in the C1 segment, and were termed vestibulo-ocular (VO) neurons.(ABSTRACT TRUNCATED AT 250 WORDS)

Lower lumbar branching of caudal medullary expiratory neurons of the cat

Extracellular spike activities of medullary expiratory (E) neurons in the caudal ventral respiratory group were recorded in cats anesthetized with sodium pentobarbital. The majority of E neurons extended their axons in the lower lumbar or the sacral segments and distributed collaterals in L5-L7. These results suggest that E neurons are involved not only in respiratory activities but also in the respiratory modulated motor activities of the lower lumbar segments.

[Clinical effect of miconazole gel against upper digestive tract mycosis]

A total of 43 patients, comprising 41 patients with oral candidiasis and 2 with esophageal candidiasis, were treated with miconazole (MCZ) gel to assess its efficacy and safety in treating upper digestive tract mycosis. The efficacy of the drug was evaluable in 33 of them, consisting of 32 patients with oral candidiasis and 1 with esophageal candidiasis. The clinical efficacy rate of the drug against oral candidiasis was 87.5% (28/32 patients), and the clinical response was good in the 1 evaluable patient with esophageal candidiasis. The safety of the drug was assessed in 40 patients. In 3 (7.5%) of them, nausea occurred as an adverse event, but was not particularly serious in any of them. No abnormal laboratory test values caused by the drug were observed. The results suggested that MCZ gel would be a very useful drug in treating oral and esophageal candidiasis.

[The effect of long-term group education for obese women in a public health center]

In order to improve maintenance of weight reduction, a long-term (5 month) weight reduction class for obese women consisting of repeated group learning three times a month in areas of dietary regimen and practice of physical exercise, and self-help group activities was conducted at a health center. Maintenance of achieved weight reduction was studied six months and one year after completion of the class. The results are as follows. 1) Among 30 alumni, percentages of rebound, regaining weight of more than half of reduction during the class, were 18% at six months and 48% at one year after the class. These results appear to indicate the difficulty in maintaining weight loss. 2) However, when changes were studied in terms of fat mass and lean body mass, rebound of fat mass, regaining fat mass of more than half of reduction, was very small--only 5%, through the follow-up periods--while lean body mass increased gradually. These results indicate very good maintenance of fat mass reduction, and from the view point of the objective of weight reduction which is principally fat mass reduction, this objective was supported. 3) The attendees were divided into two groups, diet group and exercise group. There were almost no differences in the follow-up results for weight maintenance between the two groups. This can be attributed to the fact that since the combination of dieting and exercise was emphasized in both groups, with moderate energy restriction and balanced food intake in the dietary regimen and aerobic walking for exercise in addition to the classroom learning, instructions for lifestyle changes were rather similar for both groups.

Participation of a dominant cytotoxic T cell population defined by a monoclonal antibody in syngeneic anti-tumor responses

Cytotoxic T lymphocyte (CTL) clones against a syngeneic Friend virus-induced erythroleukemia (FBL-3) were generated in C57BL/6 (B6) mice. A monoclonal antibody (mAb, N9-127) was then raised from spleen cells of a B6 mouse immunized syngenically against one of these CTL clones. This mAb detected the epitope (127Ep) of the T cell antigen receptor (TcR) on the immunizing CTL clone in tests of immunoprecipitation, specific blocking and proliferation, and induction of TcR-mediated nonspecific lysis of the clone. In addition, more than 10% of the FBL-3-specific CTL clones isolated independently from B6 mice were 127Ep+. Further investigations revealed that up to 30% of B6 anti-FBL-3 T cell blasts from mixed lymphocyte tumor cell cultures were positive for this epitope, and that its expression was confined to CD8+ T cells. This epitope was not detected in naive lymphoid cells from the spleen, lymph nodes or thymus or in T cell clones specific for tumors other than FBL-3. The FBL-3-specific CTL clones were next grouped into 127Ep+ and 127Ep- clones. Sequence analyses of the CTL clone used for immunization showed the rearrangements of V alpha 1J alpha 112-2 and V beta 10D beta 2.1J beta 2.7. Southern blot analysis of all the 127Ep+ CTL clones examined showed the same DNA rearrangement bands of both the TcR alpha and beta genes. These findings suggested that mAb N9-127 recognized the shared determinant of the TcR molecule which was expressed by the dominant CTL population in the response to FBL-3.

Interleukin-2 receptor beta-chain (p70-75) expressed on leukemic cells from adult T cell leukemia patients

To determine whether the interleukin-2 receptor (IL-2R) beta-chain (p70-75) is expressed on leukemic cells from patients with adult T cell leukemia (ATL) as well as alpha-chain (p55, Tac), we performed radiolabeled interleukin-2 (IL-2) binding assay, chemical crosslinking of radiolabeled IL-2 and flow cytometric analysis using a newly-developed anti-IL-2R beta-chain antibody. The results showed that leukemic cells from all the 12 ATL patients we examined expressed the IL-2R beta-chain together with the alpha-chain whereas there was no detectable beta-chain expression on unstimulated peripheral blood CD4(+) T cells from healthy volunteers. Southern blot analysis revealed that this abnormal expression was not caused by the structural change of IL-2R beta-chain gene. Though leukemic cells from all ATL patients examined expressed high-affinity IL-2Rs, leukemic cells from only 25% of all ATL patients proliferated in response to IL-2. These results showing abnormal expression of IL-2R beta-chain on leukemic cells from ATL patients (ATL cells) suggest a close association between HTLV-I infection and abnormal beta-chain expression as well as alpha-chain expression.

[Evaluation of photodynamic therapy using pheophorbide-a as a photosensitizer]

Intra-tumoral concentrations of pheophorbide-a, a new photosensitizer, were measured by high-performance liquid chromatography after administration of pheophorbide-a to nude mice (BALB/c-nu) that had been implanted with human hepatocellular carcinoma. The results were as follows: 1) 0.009 +/- 0.007 microgram/g tissue in 1 mg/kg body p.o. administration group, 2) 0.22 +/- 0.06 microgram/g tissue in 250 mg/kg body p.o. administration group, 3) 0.85 +/- 0.14 microgram/g tissue in 5 mg/kg body intra-peritoneal administration group, 4) 3.42 +/- 2.84 microgram/g tissue in not-injected side, and 116 +/- 24 microgram/g tissue in injected side of 200 micrograms intra-tumoral administration group. Tumors in each group were irradiated using an Nd:YAG laser (Q-switch; mean power 0.5 W, duration 10 min.). Areas of tumor necrosis were larger than in the control group only in the intra-tumoral administration group. These results suggest that no photodynamic reaction occurs if the intra-tumoral pheophorbide-a concentration is less than 0.85 microgram/g tissue.

Induction of tumor necrosis factor-alpha and its receptors during differentiation in myeloid leukemic cells along the monocytic pathway. A possible regulatory mechanism for TNF-alpha production

We examined the characteristics of tumor necrosis factor (TNF) receptors expressed on immature mouse myeloid leukemic cells (M1), M1 cells induced to differentiate into macrophages, and macrophage cells (Mm1 cells) by binding studies with radioiodinated TNF. Scatchard analysis of TNF binding revealed that a single class of high affinity receptor was present and that 750-1,100 receptors were expressed on each immature M1 cell. The number of TNF receptors was increased 1.5-2-fold on differentiated M1 cells and 4-5-fold on Mm1 cells with no change in affinity. The addition of interferon-gamma (IFN-gamma) up-regulated the expression of TNF receptors in differentiated M1 cells and Mm1 cells, while immature M1 cells were insensitive to IFN-gamma. The number of TNF receptors on the differentiated cells was increased 4-5-fold by the treatment with IFN-gamma with no change in the binding constant. The affinity of TNF receptors to human TNF-alpha (Kd = 1.7-2.8 nM) was lower than that to murine TNF-alpha (Kd = 0.2-0.7 nM). The assays for cell growth and [3H]thymidine incorporation suggested that no relation exists between the sensitivity of the cells to TNF-alpha and the number of TNF receptors. Enhancement of TNF-mediated cytotoxicity by the treatment with IFN-gamma did not correlate with increases in the number of TNF receptors. Cytolytic assays using L929 cells demonstrated that the amount of constitutive and lipopolysaccharide (LPS)-induced secretion of TNF-alpha was markedly increased during differentiation. Both the constitutive expression and IFN-gamma-mediated superinduction of TNF receptors, and the constitutive and LPS-induced secretion of TNF-alpha were closely related to the extent of cellular differentiation along the monocytic pathway. The time course of LPS-induced TNF-alpha activity showed a rise-and-decline profile with a peak at 2 h. On the other hand, the time course of the number of cell surface TNF receptors showed a decline-and-rise profile, a mirror image of the TNF-alpha activity time course profile in the supernatant. Anti-TNF-alpha antibody treatment blocked the LPS-induced down-regulation of TNF receptors and increased TNF-alpha mRNA accumulation. We discussed "an autoinhibitory system" in which an internalization of secreted TNF-alpha mediated by its own receptors is involved not only in decreasing TNF-alpha activity in the supernatant but also in reducing TNF-alpha mRNA expression.

[Evaluation of the efficacy of photodynamic therapy on experimental hepatocellular carcinoma--using local injection of photosensitizer]

The effect on photodynamic therapy (PDT) of using pheophorbide-a as a photosensitizer and Nd: YAG laser (Q-switch) was evaluated. Two hundred micrograms (0.1 ml) of pheophorbide-a was injected into tumors that had been subcutaneously implanted into the backs of nude mice (BALB/c-nu). Interstitial Nd: YAG laser irradiation (Q-switch; mean power 0.5 W, duration 10 min.) was performed 72 hours after pheophorbide-a injection. Forty-eight hours after laser irradiation, the areas of tumor necrosis were measured; these were larger in the group with the injection of pheophorbide-a than in those without. The areas of tumor necrosis after Nd: YAG laser irradiation at a higher mean power (Q-switch; mean power 2 W, control temperature 43-43.5 degrees C, duration 10 min.) were also measured. Again, the areas were larger in the group injected with pheophorbide-a. These results show that the injection of pheophorbide-a and interstitial irradiation using Nd: YAG laser induce a photodynamic reaction, and that this combination is useful in the treatment of deep-seated tumors.

[Portal hemodynamic changes from partial hepatectomy--quantitative analysis of portal flow before, during and after hepatectomy, using an Doppler ultrasound system]

We investigated portal hemodynamic changes in 86 patients with hepatic tumors who underwent partial hepatectomy. Portal blood flow was measured using a sector type Doppler ultrasound system before, during and after operation. In the intraoperative studies, the portal flow in patients who underwent massive liver resection decreased significantly. On the other hand, the portal flow in patients with minor liver resection tended to increase, but not significantly. Overall, portal flow per unit of cardiac out put decreased significantly; it also decreased significantly in patients who underwent massive or major liver resection, in patients with liver cirrhosis, and in patients whose post operative clinical course was satisfactory. In the post-operative studies (10-12 days after surgery), the portal blood flow decreased significantly in patients who manifested a severe post-operative clinical course; it showed no significant change in other patients. It is thus essential to monitor the portal hemodynamics of partial-hepatectomy patients. This is most readily realized using Doppler ultrasound.

Relationship between splenic and superior mesenteric venous circulation

We took advantage of routine hemodynamic examinations to determine the relationship between splenic and intestinal circulation by infusing prostaglandin E1 into the superior mesenteric artery and observing the portal hemodynamic changes in patients with chronic liver disease. Relative blood flow rate in various vessels of the portal system were measured percutaneously using an ultrasonic duplex system, while portal venous pressure was measured directly using a transducer. The superior mesenteric venous blood flow increased significantly as did the portal venous blood flow and pressure, though the degree of change of portal venous blood flow was less than was expected from the change of portal venous blood flow in the superior mesenteric venous blood flow. Splenic venous blood flow decreased significantly. This decrease is perhaps due to a mechanism that acts to compensate for the increase induced in the superior mesenteric venous blood flow to maintain portal flow at approximately the same level. The measured changes suggest a relationship between splenic and intestinal blood flows that is regulated according to the hepatic circulatory condition. The regulatory mechanism should be considered when designing the treatment of portal hypertension.

Deficient elevation of the cytoplasmic calcium ion concentration by epinephrine in epinephrine-insensitive platelets of patients with myeloproliferative disorders

Elevation of the cytoplasmic Ca2+ concentration ([Ca2+]i) by epinephrine and epinephrine-induced inhibition of prostaglandin E1 (PGE1)-stimulated cyclic adenosine monophosphate (cAMP) accumulation were assessed in platelets from three groups of subjects; normal controls (NS, n = 11) and patients with myeloproliferative disorders whose platelets were either sensitive (ES, n = 9) or specifically insensitive (El, n = 7) to the aggregatory effect of epinephrine. The inhibition by epinephrine of cAMP accumulation in the platelets exposed to 500 nM PGE1 was not significantly different between the three groups. Therefore, despite the defective aggregation response to epinephrine, platelets from the El group seemed to retain normal response, which was attained through alpha 2-adrenergic receptors, guanine nucleotide binding regulatory protein, and the adenylate cyclase system. However, in aequorin-loaded, washed platelets, the epinephrine-stimulated rise in [Ca2+]i showed significant decrease in the El group compared with the other groups (P less than 0.01). Thus the mechanism for the impaired aggregation response to epinephrine in platelets from the El group could include the defect that exists in the pathway from receptor binding of epinephrine to the aggregation response through [Ca2+]i elevation.

Clinical usefulness of vinca alkaloid slow infusion in the treatment of chronic refractory idiopathic thrombocytopenic purpura: a multicenter cooperative study

Thirty-eight patients with chronic refractory idiopathic thrombocytopenic purpura (ITP) were treated with weekly slow infusions of vincristine (0.02 to 0.04 mg/kg) or vinblastine (0.1 to 0.2 mg/kg). Twenty-two patients showed good to excellent responses after one to eight infusions. These responses were generally short, and lasted only in six patients after discontinuance of the therapy. The efficacy was comparable between vincristine and vinblastine. Neither the age, sex, duration of the disease, prior splenectomy nor combined use of adrenocortical steroids was likely to have influenced the therapeutic effect. Side effects such as peripheral neuropathy, alopecia, gastrointestinal symptoms and leukopenia occurred in 34 patients, and necessitated discontinuance of the therapy in eight patients. Slow infusions of vinca alkaloids can be an effective means of inducing platelet response in patients with chronic refractory ITP, but frequent side effects limit its clinical usefulness.

Myelodysplastic syndrome (MDS)-associated inhibitory activity on haemopoietic progenitor cells

We studied MDS-associated inhibitory activity, which inhibited colony formation in vitro of granulocyte-macrophage progenitors (CFU-GM). Macrophages obtained from MDS bone marrow mononuclear cells (BM-MNC) when pretreated with granulocyte-macrophage colony stimulating factor (GM-CSF) suppressed the growth of normal CFU-GM. These macrophages were designated as 'MDS-derived inhibitory macrophages'. Media conditioned by MDS-derived inhibitory macrophages (MDS-CM) also suppressed the growth of normal CFU-GM. In the MDS-CM, high levels of prostaglandin E2 (PGE2) and ferritin were found. However, MDS-CM did not contain detectable levels of tumour necrosis factor (TNF) or gamma-interferon (gamma-IFN). Antiserum against human placental ferritin and/or against PGE2 blocked the haemopoietic inhibitory activity to some extent. These results suggest that inhibitory macrophages may be responsible for the suppression of granulopoiesis in patients with MDS and that the suppression may be mediated by soluble factors including PGE2 and ferritin.

[Prognostic factors in aplastic anemia. A statistical analysis of 105 cases]

We analyzed 105 cases of aplastic anemia diagnosed between 1958 and 1985 to clarify the variables that are related to prognosis. The most significant variable at diagnosis was reticulocyte count, followed in order by percent bone marrow lymphocyte, red cell turnover rate, T-score severity grade, iron utilization and aplastic anemia study group (AASG) severity grade. Reticulocyte count was the single significant variable in multivariate analysis. Three months after diagnosis, the most significant variable was still the reticulocyte count, followed by AASG severity grade. Changes of variables during the 3 months were not correlated to prognosis. Our result reconfirmed that reticulocyte count was the most important variable related to prognosis.

Selective expression of the p70 subunit of the interleukin-2 receptor on lymphocytes from patients with infectious mononucleosis

The lymphocytosis manifested in infectious mononucleosis (IM) during acute phase is ascribed to a reactive expansion of CD8+ T lymphocytes caused by Epstein-Barr virus (EBV)-infected B lymphocytes. Expression of HLA-DR antigen on IM lymphocytes suggests that these T lymphocytes are somehow activated in vivo. In the present study, we analyzed the interleukin-2 (IL-2) receptor expression on lymphocytes from six patients with acute IM. Radiolabeled IL-2 binding assay revealed that IM lymphocytes from all patients examined had a considerable number of IL-2 binding sites with an intermediate affinity, although they did not express the IL-2 receptor recognized by anti-Tac antibody (p55). The number of binding sites (1,070 to 4,600 sites per cell) was larger than that of a normal, resting T lymphocyte-enriched population (650 sites per cell). Furthermore, IM lymphocytes showed marked proliferative responses to higher concentrations of IL-2, which were almost completely blocked by an anti-p70 IL-2 receptor antibody, indicating that their IL-2 receptor is a functional receptor. The results of an affinity cross-linking study seem to indicate that the IL-2 receptor expressed on IM lymphocytes is p70, the second chain of the IL-2 receptor distinct from p55. Flow cytometric analysis following immunofluorescent staining with anti-p70 IL-2 receptor antibody confirmed p70 expression on CD8+ HLA-DR+ lymphocytes. These data suggest that p70 IL-2 receptor expression is involved in the immune response triggered by EBV infection.

[Flow cytometric analysis of nuclear DNA contents in human hepatocellular carcinoma]

The nuclear DNA contents in fresh surgical specimens in cases of 34 hepatocellular carcinoma were measured by flow cytometry. The frequency of aneuploid and relation of ploidy with degree of malignancy (stage and portal vein thrombosis, etc.) were examined. The incidence of aneuploidy of human hepatocellular carcinoma was 53%, these cases were at a significantly higher stage than the diploid cases (P less than 0.05). Among aneuploid cases, 61% (11 out of 18 cases) were associated portal vein thrombosis, this incidence was also significantly higher than the 6% (one of 16 cases) for the diploid cases (P less than 0.01). These findings demonstrated flow cytometric analysis are not only useful to diagnose to hepatocellular carcinoma, but useful to evaluate the prognosis.

Role of alpha chain-IL-2 complex in the formation of the ternary complex of IL-2 and high-affinity IL-2 receptor

Using anti-Tac (anti-alpha chain) and 2R-B (anti-beta chain) antibodies, we studied the roles of IL-2 receptor subunits (alpha and beta chains) in the formation of IL-2 and high-affinity IL-2 receptor complex, which is the initial event of IL-2 induced T cell growth. High-affinity IL-2 binding which was undetectable in the presence of 2R-B antibody at 4 degrees C became fully detectable when examined at 37 degrees C, which explained the lack of inhibition by 2R-B antibody of IL-2-induced proliferation of the cells expressing high-affinity IL-2 receptor. We further studied the mechanism of the 'reappearance' of high-affinity IL-2 binding in the presence of 2R-B antibody. The addition of IL-2 to the cells preincubated with radiolabeled or fluorescence-labeled 2R-B antibody resulted in a marked decrease in the antibody bound to the cells expressing high-affinity IL-2 receptor at 37 degrees C. This decrease was blocked by the presence of anti-Tac antibody, which inhibited IL-2 binding to alpha chain, but not by 7G7/B6 antibody, which recognized a non-IL-2 binding site of its chain. Furthermore, the decrease in cell-bound 2R-B antibody was not due to the internalization of beta chain-2R-B antibody complex, because the amount of cell-bound Mik-beta3 antibody recognizing a non-IL-2 binding epitope of beta chain remained unchanged, nor to the inhibition by simple competitive binding of IL-2 molecules to beta chain as judged from comparative studies of competitive binding inhibition. Taking these data together, the reappearance of high-affinity IL-2 binding was considered to be caused by the replacement of 2R-B antibody at the IL-2 binding site of beta chain by alpha chain-mediated IL-2, and it was strongly suggested that alpha chain-IL-2 complex has a key role in the formation of the ternary complex of IL-2 and high-affinity IL-2 receptor. alpha chain may function as a dimension converter of IL-2 to effectively deliver IL-2 molecules to a relatively small number of beta chains in the dynamics of the formation of high-affinity IL-2 binding in T cells.

[Therapeutic evaluation of combination therapy using C-425, human native immunoglobulin liquid preparation for i.v. administration, with antibiotics in severe infections in the field of internal medicine]

A novel human native immunoglobulin liquid preparation for intravenous injection, C-425, was used in combination with antibiotics to study its efficacy, safety, and usefulness in 262 patients with severe infections which had not responded to antibiotic therapy of 3-day or more duration. As a result of the Committee judgement, 12 of the 262 patients were excluded from this study; 87 were included only in safety analysis; 163 (62.2%) were included in efficacy, safety, and usefulness analyses (complete inclusion). The complete analysis of 163 patients consisted of 93 patients (57.1%) with suspected septicemia, 33 (20.2%) with pneumonia, and 18 (11.0%) with septicemia. Eighty percent or more of the patients had severe underlying diseases such as leukemia and malignant lymphoma. Clinical efficacy of C-425 was judged by the doctors in charge to be "excellent" or "good" in 49.1% of the total cases. The rate of effectiveness was calculated at 74.8% when "excellent", "good" and "fair" cases were all included. Similarly, the rate of effectiveness calculated from the results of Committee judgment was 53.4% when "excellent" and "good" cases were included, and 68.7% when "excellent", "good" and "fair" cases were included. Microbiological assessment was conducted in 19 patients. Causative organisms were eliminated in 11 patients, decreased in number in 1, persisted in 5, and replaced in 2. The rate of elimination was 57.9%. Side effects appeared in 6 of 250 patients (2.4%). It was judged that 3 patients (1.2%) of the 6 were affected by the drug or suspected to be affected, but they were not considered clinically important. Hepatic disfunction was found in 4 patients (1.6%) of the 250; but it was not clarified whether this was related to the drug. From these results, C-425 was considered to be an effective and very safe drug for treating severe internal infections.

Prognosis of refractory anemias

Several aspects of prognosis of myelodysplastic syndromes were reviewed with special attention to refractory anemia (RA). The median survivals were 14 months in chronic myelomonocytic leukemia, 16 months in RAEB, 42 months in RA, and 58 months in RA with ring sideroblasts (RARS). Cumulative leukemia-free rates at 5 years were 31% in RAEB, 80% in RA, and 92% in RARS. The proportion of cases having very low hazards for leukemic transformation or for nonleukemic death was 92% (RARS), 73% (RA), and 26% (RAEB) for leukemic transformation and 23% (RA) and 29% (RAEB) for nonleukemic death. All RARS cases had hazard for nonleukemic death. In RA, the annual mortality rate was about 5 to 11 times higher than that of age-and sex- matched general population up to 6 years. After which no failure was found in RA cases with survival rate of 33% up to 14 years. The relative importance of hazard from leukemic transformation to nonleukemic death in RA was about one half at presentation, but this declined to less than 10% after 10 years.

[Evaluation of the relationship between esophageal varices and azygos vein using percutaneous transhepatic cine-portography]

To evaluate the relationship between esophageal varices and the azygos vein--which is generally considered to drain the major part of the esophageal variceal blood--we examined 36 patients with portal hypertension using percutaneous transhepatic cine-portography. The patients were classified into three groups (azygos, cervical and combined) according to the amount of blood to be considered drained by the azygos vein. Eighteen patients (50%) fell into the azygos type group, five (14%) into the cervical, and 13 (36%) into the combined. Highly developed esophageal varices were recognized endoscopically in all patients in the combined and cervical type groups while some of the patients in the azygos type group had less well developed varices. In the azygos type group, there was a tendency for the varices to be increasingly severe the higher the part of the azygos vein they drained into. Because it helps us to fully comprehend the significance of the azygos venous blood flow and the occasionally uncertain effect of endoscopic injection sclerotherapy for esophageal varices, it is important to evaluate the drainage route of esophageal varices in vivo and in detail. Percutaneous transhepatic cine-portography is the useful method for this purpose as it enables us to visualize even the most minute blood stream.

Characterization of a CD4(L3T4)-positive cytotoxic T cell clone that is restricted by class I major histocompatibility complex antigen on FBL-3 tumor cell

An L3T4(CD4)+ CTL clone specific for Friend virus-induced tumor FBL-3 was isolated, characterized and compared with a conventional Lyt-2(CD8)+ CTL clone. This clone L3.1 was obtained from the limiting dilution culture of splenic MLTC cells from a CB6F1 mouse whose CD8+ T cells had been suppressed by an in vivo injection of anti-Lyt-2.2 mAb. The phenotype of clone L3.1 was sIg-, Thy-1.2+, L3T4(CD4)+, Lyt-2 (CD8)-, and Ia- as determined by flow-cytometry. Northern blot analysis also confirmed that mRNA for L3T4(CD4), but not for Lyt-2 (CD8) was present in the total RNA of L3.1. The FBL-3-specific killing activity of L3.1 was inhibited by anti-H-2D6 mAb, and the tumor cells did not express class II MHC antigen, indicating that the recognition of tumor antigen by this CD4+ CTL clone was restricted by the class I MHC molecule on the tumor cells. Furthermore, the finding that anti-L3T4(CD4) mAb GK1.5 inhibited the specific and lectin-dependent non-specific cytotoxicity of L3.1 suggested that CD4 molecules on this CTL clone are not ligand (MHC class II)-binding proteins, but are involved in signal transduction.