[Mitral prosthetic valve replaced twice due to repeated prosthetic valve endocarditis: a case report]

A 38-year-old man was admitted to our hospital for detailed examination of fever, cough and yellow sputum. At the age of 32, be had mitral prosthesis for the first time, because of mitral regurgitation due to mitral valve prolapse. Four years previously, he had again undergone mitral prosthetic valve replacement due to prosthetic valve endocarditis due to staphylococcus epidemidis. This occasion, staphylococcus aureus was isolated by arterial blood culture. Transesophageal echocardiography detected vegetation attached to the mitral prosthetic valve and paravalvular leakage. The diagnosis was prosthetic valve endocarditis. He underwent a third mitral prosthetic valve replacement. Detection of the source of infection was difficult only by transthoracic echocardiography, and immediate transesophageal echocardiography seemed mandatory to diagnose bacterial endocarditis.

[A case of fluminant septic shock due to Streptococcus agalactiae in a patient with MPO-ANCA related glomerulonephritis]

Recently group A Streptococcus toxic shock like syndrome (TSLS) has been reported, but as for group B streptococcus (S. agalactiae) infection, there have been little documentation in the literature. We report a case of fluminant septic shock due to Streptococcus agalactiae (S. agalactiae). A 72-year-old male was admitted to our hospital because of general fatigue and azotemia. He was diagnosed as having MPO-ANCA related glomerulonephritis and treated with steroid therapy. Gradually he was doing well. On the 228th hospital day, he suddenly had tachypnea, transient conscious disturbance, and profound hypotension. About 16 hours later, he died despite intensive treatment. S. agalactiae was isolated from the blood. Autopsy revealed bilateral bronchopneumonia and shock liver. To our knowledge, this is the first report of septic shock caused by S. agalactiae.

Life-threatening cardiac involvement throughout life in a case of Costello syndrome

Costello syndrome is characterized by poor postnatal growth, mental retardation, curly hair, coarse face, loose skin of the hands and feet, and nasal papillomata. Patients with Costello syndrome have a high incidence of cardiac involvement, such as arrhythmias, hypertrophic cardiomyopathy, or congenital anomalies. The importance of cardiac involvement in Costello syndrome has not been strongly emphasized thus far, although arrhythmia and hypertrophic cardiomyopathy are both serious forms of cardiac involvement. We report the case of a Japanese girl with Costello syndrome, who experienced life-threatening cardiac involvement throughout her life.

[A 66-year-old woman with a patent ductus arteriosus and no significant progression of pulmonary arterial pressure over 17 years]

We report the case of a 66-year-old woman with a patent ductus arteriosus and no significant progression of pulmonary arterial pressure over 17 years. She was admitted to our hospital in 1978 because of palpitations on exertion and chest discomfort. Cardiac catheterization was done, and she was given a diagnosis of patent ductus arteriosus. Because the left-to-right shunt was small (15%) and because there was no evidence of pulmonary hypertension (38/18 mmHg), she was treated medically. In 1995 she was admitted again, to determine the cause of a cerebral infarction. The cerebral infarction was believed to have been caused by an embolism due to atrial fibrillation. She underwent cardiac catheterization again. The left-to-right shunt had increased to 41%, but the pulmonary artery pressure had not changed (27/14 mmHg). Intravascular ultrasound imaging was used to evaluate the ductus arteriosus. The diameter of the ductus was 4.4 mm and calcification was not observed. During the 17 years of follow-up, heart size increased slightly, but pulmonary artery pressure did not change. In addition, intravascular ultrasound was very useful for evaluating the condition of the ductus arteriosus.

Ossifying fibromyxoid tumor of soft parts of the back

We report a first case of ossifying fibromyxoid tumor of soft parts of the back, a 10 x 9.5 x 6 cm well-circumscribed elevated subcutaneous tumor demarcated by an incomplete fibrous capsule with bone formation at its base. The tumor was composed of both myxomatous areas with spindle tumor cells and pseudoalveolar structures with oval tumor cells. The tumor cells had evenly sized, oval nuclei without atypia and slightly eosinophilic cytoplasm with intracellular vacuoles. Immunohistochemical studies revealed positivity for vimentin and focal positivity for S-100 protein. Ultrastructural examination revealed a few filopodia-like processes, discontinuous basal lamina and a few primitive cell junctions. Based on these immunohistochemical and ultrastructural results, this tumor may be related to Schwann's cells. There has been no recurrence 5 years after wide local excision.

Effect of continuous passive motion on the results of TMJ meniscectomy. Part I: Comparison of chewing movement

In order to evaluate the therapeutic effect of continuous passive motion (CPM) on the outcome of TMJ meniscectomy, chewing movement was analyzed before surgery and six months after surgery in 31 patients receiving CPM (CPM group), 26 patients without CPM (non-CPM group), and in ten normal subjects. The surgical procedure consisted of either total meniscectomy or partial meniscectomy with disk repair. It was found that chewing in patients receiving CPM was closer to the normal range than for patients in the non-CPM group. The results from the CPM group demonstrated chewing parameters for patients with partial meniscectomy returning to the normal range. However, for the patients with total meniscectomy, some parameters remained out of the normal range. From these results, we conclude that CPM has a positive influence on the outcome of TMJ surgery.

Experimental infusion phlebitis: importance of titratableacidity on phlebitic potential of infusion solution

The titratable acidity of infusion solutions has never been taken into account in infusion phlebitis. This study aims to clarify the importance of titratable acidity on the phlebitic potential of infusion solutions. Solutions with different titratable acidity (from 0.16 to 12 mEq/L) were infused into the ear veins of 6 rabbits for 6 h at 10 mL/kg/h, and the veins were later examined histopathologically. Even at pH 4.0, a commercial 10% glucose solution scarcely caused any changes because of its very low titratable acidity (0.16 mEq/L). A 10% glucose solution with its titratable acidity adjusted to 3 mEq/L (pH 4.3) with citrate and NaOH, however, caused phlebitic changes in all 6 rabbits, and adjusting the titratable acidity to 12 mEq/L (pH 4.4) increased the degree of phlebitis. On the other hand, a 10% glucose solution with a pH of 5.4 and a titratable acidity of 6 mEq/L caused slight phlebitic changes in half the rabbits. These results suggest that 1) the titratable acidity of infusion solutions is important to the phlebitic potential when the pH is low, 2) when the pHs are similar, the phlebitic potential of infusion solutions depend on the titratable acidity, and 3) the phlebitic potential of infusion solutions can not be estimated by pH or titratable acidity alone.

Detection of Bacteroides fragilis by PCR assay targeting the neuraminidase-encoding gene

Oligonucleotide primers were designed on the basis of the sequence of the neuraminidase-encoding gene (nanH) of Bacteroides fragilis and used for the specific detection of this anaerobe by the nested PCR assay. Fifty-nine of 60 representative strains of Bact. fragilis were detected, while none of 45 strains of other species generated visible PCR products. The detection limits of Bact. fragilis cells and DNA by the nested PCR were 10 colony-forming units and 10 fg of chromosomal DNA, respectively. The PCR assay targeting the nanH gene has the potential for the detection of Bact. fragilis.

[A case of selective IgM deficiency associated with systemic lupus erythematosus]

We report a case of selective IgM deficiency associated with systemic lupus erythematosus (SLE). A 34-year-old female suffering from SLE was admitted with proteinuria and general fatigue. Laboratory findings revealed a very low serum IgM level, almost lower than 12 mg/dl. Renal biopsy findings showed diffuse proliferative lupus nephritis (DPLN). In immunofluorescent microscopy, IgG was the most strongly stained followed by IgA, but IgM staining was only faint. As for the immunophenotype of the T cells, the OKT4/OKT8 ratio was normal. Response to both phytohemagglutinin (PHA) and concanavalin A (ConA) was normal. However, responses of B cells to both pokeweed mitogen (PWM) and Staphylococcus aureus Cowan strain I (SAC) were significantly reduced. Surface IgM-positive B cells were decreased. These results indicate that the patient had B cell dysfunction, involving impairment of B cell differentiation. In this report, we discuss selective IgM deficiency and SLE documented in the literature.

[Familial hypertrophic cardiomyopathy generating a marked left ventricular pressure gradient in an 82-year-old woman]

Familial nonobstructive hypertrophic cardiomyopathy in 78-year-old woman was diagnosed in 1988. Since then she has been treated with a beta-blocking drug and a calcium antagonist. Her clinical condition was NYHA I or II for several years. Echocardiography revealed asymmetric septal hypertrophy in 1988 (interventricular septal thickness = 21 mm, posterior wall thickness = 10 mm). Systolic anterior motion of the mitral valve was first observed at the end of 1992. The left ventricular pressure gradient also gradually increased; it was about 138 mmHg in 1993 (age 82 yrs). The left ventricular ejection time index increased from 376 msec in May, 1992 to 459 msec in May, 1994. In September, 1994, the patient's condition gradually deteriorated (NYHA IV), and she was admitted to our hospital. To attenuate the left ventricular pressure gradient, 150 mg of disopyramide was administered. Her condition markedly improved: the left ventricular pressure gradient decreased from 180 mmHg to 76 mmHg, and the left ventricular ejection time index decreased from 485 msec to 419 msec. These results indicate that a left ventricular pressure gradient can be generated rapidly even in a very old patient, and that disopyramide may be useful to attenuate the left ventricular pressure gradient.

The influence of postoperative treatment on the results of TMJ meniscectomy. Part II: comparison of chewing movement

In order to evaluate the influence of different types of postoperative treatments on the results of TMJ surgery, chewing movement recorded postoperatively was compared in 32 patients with unilateral total meniscectomy, 42 patients with partial meniscectomy with disk repair, and 10 normal subjects. Postoperative treatment was of three different types depending on its strategy. It was found that postoperative treatment had a significant positive effect on the results of both total and partial meniscectomy. Postoperative treatment which included both physical medicine modalities and dental treatment demonstrated better results than only dental treatment or no postoperative treatment. However, none of these studied techniques could recover chewing movement to the normal range.

Characteristic chewing parameters for specific types of temporomandibular joint internal derangements

In order to determine if there are characteristic chewing patterns for specific types of TMJ internal derangements, chewing was analyzed in 210 TMD patients with unilateral internal derangement (MDR early, 40; MDR late, 41; MD, 80; MDP, 49), and in 94 TMD patients without internal derangement, and 10 asymptomatic subjects with normal TMJ imaging. Each internal derangement subgroup demonstrated a significantly restricted envelope of motion and a reduced chewing velocity especially when they chewed on their normal TMJ side. Comparing different types of internal derangement, the MDR early group demonstrated relatively normal chewing, while the MDR late, MD and MDP groups showed severely impaired chewing movements. Among these three groups, the MD group demonstrated the most impairment, followed by the MDP and the MDR late groups. These results demonstrate that different types of internal derangement have specific impairments upon chewing, suggesting use of this analysis as a diagnostic tool.

Intraglomerular deposition of intact cross-linked fibrin in IgA nephropathy and Henoch-Schönlein purpura nephritis

To investigate the significance of intraglomerular coagulation and fibrinolysis in IgA nephropathy (IgA-N) and Henoch-Schönlein purpura nephritis (HSPN), the distribution of intact cross-linked fibrin (XFb) modulated by plasmin activity was examined in 25 patients with IgA-N and in 12 with HSPN. In addition to the conventional method detecting fibrin-related antigen (FRA) with an antibody against fibrinogen, the enhanced intensity of immunoreactivity of cross-linked FRA (KL-FRA) using the monoclonal antibody DD3B6/22 after plasmin exposure was evaluated to assess intraglomerular deposition of intact XFb. Also, intraglomerular invasion of macrophages was detected using the monoclonal antibody KP1 against CD68. Sixteen of a total of 37 specimens (43%) showed increased intensity of XL-FRA staining after plasmin treatment which is considered to reflect the distribution of intact XFb. Increases in the intensity of XL-FRA staining were observed mainly in mesangium and partially along glomerular capillary loops and also in a few cases in the crescents. The incidence (67%) of increases in XL-FRA staining after plasmin exposure in HSPN specimens was significantly higher than that in IgA-N specimens (32%; p < 0.05). In the group positive for XL-FRA after plasmin exposure, the numbers of macrophages per glomerulus were significantly higher (n = 15; mean +/- SD = 1.6 +/- 0.9) than in the negative group (n = 6; 0.5 +/- 0.6; p < 0.01). In HSPN, the number of macrophages per glomerulus (n = 8; 1.9 +/- 1.0) was higher than that in IgA-N (n = 13; 0.9 +/- 0.9; p < 0.05). Based on these results, we conclude that XFb is often produced and distributed in intact form in the glomeruli both in IgA-N and HSPN, associated with a relatively low intraglomerular plasmin activity, and that intraglomerular coagulation may progress in accordance with macrophage infiltration, especially in HSPN.

[Bladder cancer in spinal cord injury patient. A case report]

A case of bladder cancer following spinal cord injury is reported. A 57-year-old male with L1 incomplete paraplegia was referred to our hospital under the diagnosis of bladder tumor with gross hematuria in November, 1994. Radical cystectomy, rt nephroureterectomy (nonfunctioning kidney) and lt ureterocutaneostomy were carried. Histopathological study revealed squamous cell carcinoma (well differentiation) and transitional cell carcinoma (G3), stage pT3b. He has been doing well without recurrence for 4 months after operation.

Ionotropic mechanisms involved in postsynaptic inhibition by the endothelins of ganglionic transmission in dog cardiac sympathetic ganglia

We investigated the effects of endothelin-1 and endothelin-3 (ET-1, ET-3) on the ganglionic transmission of cardiac sympathetic ganglia in vivo by the direct administration of agents to the ganglia through the right subclavian artery while monitoring the heart rate (HR) as an indicator of the ganglionic function in spinal dogs. The positive chronotropic responses to dimethylphenylpiperazinium (DMPP) and McN-A-343 administered to the ganglia were similarly inhibited by ET-1 (0.05-0.2 microg) and ET-3 (0.5-2 microg), but ET-1 was approximately 10 times more potent than ET-3. The inhibition induced by ETs was antagonized by endothelin ETA receptor antagonist BQ-123 (20 microg). This inhibition was unaffected by pretreatment with indomethacin given intravenously (i.v.), ruling out the possible involvement of endogenous prostaglandins production. The voltage-sensitive Ca2+ channel antagonist nifedipine had no effect on inhibition. However, the inhibition was antagonized by pretreatment with the low conductance Ca2+-activated potassium channel antagonists, such as apamin (20 microg intraarterially, i.a.), scyllatoxin (10 mug i.a.) and D-tubocurarine (0.6 mg i.a.). On the other hand, the voltage-sensitive K+ channel antagonist 4-aminopyridine (4-AP), ATP-dependent K+ channel antagonist, glibenclamide, and high-conductance Ca2+-activated K+ channel antagonists iberiotoxin and charybdotoxin failed to affect the inhibition by ETs. The results suggest that ETs inhibit the nicotinic and muscarinic ganglionic transmission through the ETA receptor-operated low-conductance Ca2+-activated potassium channel at postganglionic sites.

Young borderline hypertensives are hyperreactive to mental arithmetic stress: spectral analysis of R-R intervals

To investigate whether sympathetic tone and its reactivity to stress are increased in borderline hypertension, we compared pressor and autonomic nervous responses to mental arithmetic stress in male borderline hypertensives (BH) and normotensive volunteers (NT). Three age groups, 30, 40 and 50-year-old groups, which included 30 to 39, 40 to 49 and 50 to 59-year-old subjects, were studied. Fractional LF (%LF), fractional HF (%HF) and L/H, obtained from the power spectrum of R-R intervals, were used as indices of autonomic nervous function. Baseline autonomic nervous indices did not differ between NT and BH of any age group. Blood pressure rose higher during mental arithmetic stress in 50 than in 30-year-old NT but not in comparable age groups of BH. Pressor responses were augmented in BH compared to NT only in the 30-year-old group. However, the differences were not significant when pressor responses were expressed as percent increases in blood pressure. Both %L and L/H increased during arithmetic stress. The increase in %L did not differ between NT and BH but that in L/H (% delta L/H) was larger in 50 than in 30-year-old NT. % delta L/H was larger in BH than in NT only in the 30-year-old group. These findings suggest that both pressor and autonomic nervous responses to metal arithmetic stress were altered by aging and augmented in BH compared to NT in the 30-year-old group.

Warfarin-induced eosinophilic pleurisy

A 51-year-old man was admitted to our hospital because of dry cough and low grade fever with right-sided pleural fluid and blood eosinophilia. Warfarin had been prescribed following coronary artery bypass grafting. After the discontinuation of warfarin the clinical and chest X-ray findings improved; readministration of the drug caused recurrent blood eosinophilia and pleural effusion in the other lung. Since no other specific etiologies for eosinophilia and pleural effusion were determined by extensive evaluation, warfarin seemed to be associated with his illness. This is the first report of warfarin-induced eosinophilic pleurisy.

[A case of systemic arterial supply to the normal left basal segments with anomalous return of the left inferior pulmonary vein]

A 38-year-old man was admitted to Yatsushiro General Hospital because of an abnormal shadow on chest X-ray film. Chest X-ray film showed a tumorous shadow in the left posterior basal segment (S10). Chest CT scan showed that this shadow was consisted of torutuous vessels and was connected to the descending thoracic aorta. Angiographic examinations showed that there was no normal left basal trunk of the pulmonary artery, and revealed an anomalous arterial supply to the basal segments from the descending thoracic aorta, with an anomalous left inferior pulmonary vein. The left bronchial tree appeared normal during fibroptic bronchoscopy (confirmed by post-operative bronchography). From these findings, we determined that this patient had an systemic arterial supply to the normal basal segments. Furthermore, this patient had an anomalous left inferior pulmonary vein, which took a peculiar route to the left atrium. The left lower lobe and the anomalous systemic artery were resected. In the resected specimen, the bronchi of the left lower lobe had a normal structure and showed a normal pattern of distribution. This anomalous systemic artery had an elastic component.

Chewing pattern analysis in TMD patients with unilateral and bilateral internal derangement

In order to evaluate chewing in temporomandibular disorder (TMD) patients with unilateral and bilateral internal derangement of the temporomandibular joint (TMJ), the envelope of motion and velocity of chewing were analyzed in 103 TMD patients with unilateral internal derangement, 42 patients with bilateral internal derangement and 10 normal subjects. It was found that patients with bilateral internal derangement demonstrated a significantly restricted range of motion and reduced velocity than patients with unilateral internal derangement or normal subjects. The analysis of chewing patterns in the frontal and sagittal planes revealed that patients with bilateral internal derangement had no specific pattern while patients with unilateral internal derangement demonstrated a specific pattern. The analysis of chewing velocity pattern suggested that opening and closing patterns without any obvious peak velocity was significantly more frequent in patients with bilateral internal derangement than patients with unilateral internal derangement or normal subjects.

Nucleotide sequence of the gene encoding beta-isopropylmalate dehydrogenase (leuB) from Bacteroides fragilis

The complete nucleotide sequence of the gene (leuB) coding for beta-isopropylmalate dehydrogenase of Bacteroides fragilis was determined. An open reading frame of 1,061 nucleotides was detected that could encode a polypeptide of 353 amino acid residues with a calculated molecular mass of 39,179 Da. The deduced amino acid sequence of the beta-isopropylmalate dehydrogenase from B. fragilis showed substantial sequence similarity with the beta-isopropylmalate dehydrogenases from other bacteria.

Chewing pattern analysis in TMD patients with and without internal derangement: Part II

In order to investigate the chewing movement of temporomandibular disorders (TMD) patients with and without internal derangement of the temporomandibular joint (TMJ), the velocity of chewing movement was analyzed in 103 TMD patients with unilateral internal derangement (D group), 94 TMD patients without internal derangement (NID group) and 10 normal subjects (normal group). The ID group showed a significantly reduced maximum opening velocity, a significantly smaller standard deviation for the velocity and a significantly frequent opening velocity pattern with a deceleration in the middle of opening compared to the NID or the normal groups. The NID group demonstrated significantly frequent opening velocity patterns without any velocity peak compared to the ID or normal groups.

Activation of endogenous thromboxane A2 biosynthesis mediates presynaptic inhibition by endothelin-3 of dog stellate ganglionic transmission

Effects of endothelin-3 on ganglionic transmission were investigated in dog cardiac sympathetic ganglia. Positive chronotropic responses to preganglionic stellate stimulation were inhibited by endothelin-3 (0.5-2 micrograms) given directly to the ganglia through the artery. To find possible inhibitory effects of the peptide at presynaptic sites, acetylcholine released from the isolated stellate ganglia was determined. The amount of acetylcholine released during preganglionic stimulation was reduced by exposure to endothelin-3 (10(-9) to 10(-6) M). A similar reduction of acetylcholine release was observed after application of a stable thromboxane A2, a thromboxane A2/prostaglandin H2 receptor agonist, U-46619, and prostaglandin E2 at concentrations from 10(-8) to 10(-4) M, but not by the same concentrations of prostaglandins F2 alpha and I2. The reduction elicited by endothelin-3 was unaffected by a phospholipase C inhibitor, neomycin, or a protein kinase C inhibitor, H-7, but was antagonized by pretreatment with phospholipase A2 inhibitors, dexamethasone or methylprednisolone, and by cyclooxygenase inhibitors, aspirin and indomethacin. In addition, the reduction also was antagonized by pretreatment with a thromboxane A2 synthetase inhibitor, OKY-046, and a specific thromboxane A2 receptor antagonist, S-145, but not by a specific prostaglandin E2 receptor antagonist, SC-19220. Furthermore, endothelin-3 (10(-7) M) stimulated the OKY-046- and indomethacin-sensitive formation of thromboxane A2 in the ganglia. These results indicate that endothelin-3 inhibits the sympathetic ganglionic transmission by reducing acetylcholine release at preganglionic terminals and that this inhibition seems to involve activation of endogenous thromboxane A2 production.

Chewing pattern analysis in TMD patients with and without internal derangement: Part I

In order to investigate the chewing movement of temporomandibular disorders (TMD) patients with and without internal derangement of the temporomandibular joint (TMJ), analysis of the envelope of motion during chewing was performed in 103 TMD patients with unilateral internal derangement (ID group), 94 TMD patients without internal derangement (NID group) and 10 normal subjects (normal group). The analysis of numeric parameters revealed that the ID group demonstrated a significantly restricted range of motion compared to the NID or normal groups, and the NID group demonstrated significant irregularity of chewing compared to the ID or normal groups. The analysis of chewing also demonstrated that the chewing pattern for the ID group demonstrated more frequent deviation of the turning point to the nonchewing side in the frontal plane and a narrow anteroposterior pattern in the sagittal plane compared to the other groups. No characteristic chewing patterns were identified for the NID group.

The influence of postoperative treatment on the results of temporomandibular joint menisectomy. Part I: Comparison of mandibular opening and closing movements

In order to evaluate the influence of postoperative treatment on the results of temporomandibular joint (TMJ) menisectomy, the maximum voluntary opening and closing movements of 67 patients who underwent either total menisectomy or partial menisectomy with disk repair were analyzed and compared to those of 10 normal subjects. The postoperative treatment was classified into three different types depending on its strategy. It was observed that postoperative treatment which emphasized physical medicine modalities could produce opening and closing movements of the mandible closer to the normal range. The effect of the postoperative treatment on the results of total menisectomy was more significant than that on the results of partial menisectomy with disk repair. Partial menisectomy with disk repair resulted in better opening and closing movement than total menisectomy.

Determination of bromate in bread by capillary gas chromatography with a mass detector (GC/MS)

A sensitive method was developed for the determination of bromate in bread by capillary gas chromatography with a mass detector (GC/MS). Bromate was extracted with water from bread samples. After centrifugation, the supernatant was filtered and Cl- was removed by an OnGuard-Ag cartridge column. The mixture was absorbed on a DEA solid phase extraction column and washed with water. Bromate was then eluted with 3 M potassium chloride solution. Two ml of 4 x 10(-3) M styrene monomer solution (washed with 1% sodium hydroxide solution before use), 1 ml 0.01 M potassium bromide solution and 1 ml sulphuric acid were added to the eluent and shaken vigorously. The styrene bromo derivative (alpha-bromomethyl-benzenemethanol[2-bromo-1-phenylethanol]) was extracted with 2 ml n-hexane, and determined by GC/MS. Recoveries of bromate from breads were in the range 91.3-98.1% (0.03-0.50 micrograms/g), and the limit of detection was 0.03 microgram/g. Pullman and open top types of white bread, produced by a sponge and dough method and a short process method respectively, were prepared in our laboratory for measurement of residual bromate. When 30 micrograms/g or less bromate as HBrO3 (pullman type), and 75 micrograms/g bromate or less as KBrO3 (open top type), was added to flour, no residual bromate was detected in either type of bread.

[Clinical effects and safety of granisetron administration against CDDP chemotherapy in lung cancer. Lung Cancer Study Group]

Granisetron (3 mg/body) was administered immediately before single CDDP administration (80 mg/m2 or more) to 53 patients with lung cancer. This chemotherapy was performed a total of 73 times. Concerning Grade 2 or 3 nausea and vomiting, good conditions were observed on day 1 (day of treatment), most marked aggravation on day 2, and initiation of improvement on day 4. Vomiting was slight on day 1, most aggravated on day 2, but began to improve on day 3; good results were generally observed thereafter. Decreased appetite was slight on day 1, but was most aggravated on day 3 and 4; its recovery was delayed even until day 7. In the treatment for delayed emesis, comparison was made among the group treated with granisetron alone who did not require treatment for delayed emesis, the group with delayed emesis treated with granisetron, and the group with delayed emesis treated with drugs other than granisetron. Slightly better results were observed in terms of nausea, vomiting, and the frequency of vomiting in the group treated with granisetron alone on days 2 and 3. However, no significant difference was observed in decreased appetite among the 3 groups. Granisetron had no side effects and was safe. It inhibited vomiting, but measures to improve decreased appetite are needed.

A retrospective study on the clinical results of temporomandibular joint surgery

A retrospective study on the results of temporomandibular joint (TMJ) surgery was performed in 74 patients with total menisectomy, 90 patients with partial menisectomy with disk repair, and 66 patients with arthroscopic lysis of adhesion and lavage of the joint space. TMJ pain during jaw movement, TMJ noise and maximum jaw opening was evaluated one year after surgery. TMJ pain and TMJ noise were significantly reduced by all three procedures. However, TMJ clicking was more significantly observed in patients with arthroscopy. Maximum jaw opening was significantly increased by all three procedures. However, maximum opening of patients with total menisectomy was significantly smaller than in the other two procedures.

Malignant pheochromocytoma accompanied by microangiopathic hemolytic anemia: a case report

A 63-year-old woman was in hospital for persistent backache. Four months prior to admission she had been pointed out as having hypertension for the first time. On admission, she had anemia (hemoglobin 7.0 g/dl) with reticulocytosis, and a blood smear showed fragmented erythrocytes. A bone marrow aspirate disclosed erythroid hyperplasia and invasion of cancer cells. The chest roentgenogram showed a coin-lesion of the right lung and left pleural effusion. A diagnosis of microangiopathic hemolytic anemia (MAHA) associated with carcinomatosis was made, but the primary site of the cancer was unknown. Respiratory failure developed and the patient died a month later. Surprisingly, the autopsy revealed a malignant pheochromocytoma arising from the right adrenal gland with massive metastases to the lungs, liver, lymph nodes and systemic bones, and also disseminated intravascular coagulation (DIC). The DIC would probably account for the MAHA in this case. To our knowledge, this is the first reported case of malignant pheochromocytoma accompanied by MAHA.

Effect of malocclusion on mandibular movement during speech

To investigate the effect of malocclusion on mandibular movement during speech, the Sirognathograph Analyzing System was used to analyze the form of the envelope of motion during speech, as well as the relationship between the envelope of motion and eccentric movement paths, in 10 normal subjects and 60 subjects having malocclusion. Location of the envelope of motion, and the relationship between the envelope of motion and eccentric movement paths, were closely related to specific malocclusions. It is suggested that analysis of the envelope of motion during speech has diagnostic value in speech function assessment and that its detailed analysis offers valuable information for diagnosis and initiation of dental treatment.

Effects of an anti-platelet drug (dilazep) in IgA nephropathy: comparison of clinical effects with renal biopsy findings

To investigate renal biopsy findings arising in response to treatment with an anti-platelet drug in IgA nephropathy, 46 patients were treated with dilazep dihydrochloride (Dilazep), and a retrospective comparison was performed between the clinical effects and renal biopsy findings. After 6 months of treatment, 18 patients (39%) were judged to be improved if their proteinuria was ameliorated by a 25% or greater decrease with improved or persistent renal function. The group of improved patients exhibited mean decreased levels of urinary proteins in the range from 1.9 to 0.8 g/day after treatment (p < 0.01). By contrast, the unimproved group showed increased urinary proteins in the range from 1.2 to 2.0 g/day (p < 0.05). The improved group showed histological findings with fewer glomeruli exhibiting sclerosis and/or cellular crescents, with a lesser increase in mesangial matrix and with smaller tubulo-interstitial lesions than the unimproved group. By immunofluorescence, the improved group was found to have smaller amounts of glomerular IgA and IgG deposits. These findings suggest that an anti-proteinuric effect of Dilazep administration can be expected in patients with IgA nephropathy with relatively mild glomerulo-sclerotic lesions.

Protein kinase inhibitor H-7 differentially affects early and delayed nerve growth factor responses in PC12 cells

The effects of the protein kinase inhibitor H-7 on early and delayed responses to nerve growth factor (NGF) were investigated in PC12 cells. H-7 reduced the NGF-induced expression of c-Fos in a dose-dependent manner without affecting the time course of c-Fos appearance. Conversely, H-7 potentiated delayed NGF effects, i.e., neurite outgrowth and Ca2+/phospholipid-dependent protein kinase (PKC) induction, but not choline acetyltransferase induction. Long-term treatment with NGF resulted in an increase of at least four tyrosine-phosphorylated protein bands with molecular masses between 39 and 48 kDa, which was also potentiated by H-7. In the absence of NGF, H-7 had no significant effect on c-Fos expression, tyrosine phosphorylation of the 45 kDa protein, or choline acetyltransferase activity. However, 4 days of exposure to H-7 alone induced PKC activity and tyrosine phosphorylation of the 39-kDa protein. The action of H-7 derivatives on neurite outgrowth did not correlate with their inhibition profile of cyclic nucleotide-dependent protein kinases. Down-regulation of PKC activity by prolonged exposure to phorbol ester did not completely abolish the effects of NGF and H-7 on induction of c-Fos, choline acetyltransferase activity, and neurite outgrowth, indicating that PKC-independent pathways contribute to these actions. These results suggest that additional pathway(s) sensitive to H-7 may exist, which induce immediate early gene expression and suppress neuronal differentiation of PC12 cells.

Increase of acetylcholine release by nebracetam in dog cardiac sympathetic ganglion

The effects of nebracetam (4-aminomethyl-1-benzylpyrrolidine-2-one hemifumarate, WEB 1881FU), a potential cognitive enhancer, on acetylcholine release from the preganglionic nerve terminals were investigated in the isolated dog stellate ganglia. Acetylcholine release from the isolated ganglia by preganglionic stimulation (5 Hz) was enhanced in the presence of nebracetam, 10(-7) to 10(-5) M. The release was decreased to a certain extent by bethanechol, 10(-5) M, and this decrease was completely antagonized by AFDX-116 (10(-5) M), a selective M2 muscarinic antagonist, but was unaffected by nebracetam (10(-6) M). Under the depleted condition of acetylcholine induced by pretreatment with hemicholinium-3 (10(-5) M) in combination with prolonged preganglionic stimulation, the release was increased to a degree by nebracetam or choline alone and was markedly increased in the presence of both nebracetam and choline. Nebracetam did not directly act on choline acetyltransferase activity, but acetylcholine formation was stimulated in the isolated ganglion incubated with the agent at 10(-6) M and in the ganglion isolated from the dog to which nebracetam, 5 mg/kg, was previously administered i.v. Uptake of choline in the isolated ganglia was not altered by nebracetam (10(-6) M) but was enhanced under the depleted conditions. These findings suggest that nebracetam enhances acetylcholine release from presynaptic sites of dog stellate ganglia not by blocking presynaptic M2 muscarinic autoreceptors but by accelerating acetylcholine formation, and by increasing choline uptake when acetylcholine is depleted.

Alteration of response to neuropeptide Y in the nucleus tractus solitarius of spontaneously hypertensive rats

In normotensive rats, microinjections of neuropeptide Y (2.5 to 25 pmol) into the unilateral nucleus tractus solitarius elicited dose-dependent vasodepressor and bradycardiac responses accompanied by an inhibition of sympathetic nerve firing. After microinjections of the alpha 2-adrenergic receptor antagonist yohimbine (100 ng) into the nucleus tractus solitarius, the depressor and bradycardic responses to the injection of neuropeptide Y (25 pmol) into the nucleus tractus solitarius were significantly attenuated. In contrast, pretreatment with the alpha 1-adrenergic receptor antagonist doxazosin (200 ng) injected into the nucleus tractus solitarius did not alter these responses. In spontaneously hypertensive rats, microinjections of neuropeptide Y (25 pmol) into the nucleus tractus solitarius also elicited depressor and bradycardic responses that were significantly less than those of normotensive Wistar-Kyoto rats. However, pretreatment with yohimbine (100 ng) in the nucleus tractus solitarius did not diminish these depressor responses in spontaneously hypertensive rats. Depressor responses to neuropeptide Y, which was administered after yohimbine pretreatment, were also less in Wistar-Kyoto rats than in spontaneously hypertensive rats. The results suggest that the depressor and bradycardic responses elicited by neuropeptide Y were accompanied by the inhibition of sympathetic nerve activity. These responses may be mediated in part by alpha 2-adrenergic receptor in the nucleus tractus solitarius. The impairment of alpha 2-adrenergic receptor-mediated responses to neuropeptide Y in spontaneously hypertensive rats may contribute to the development of hypertension.

The relationship between the mandibular movements during speech and specific types of malocclusions

To investigate the effect of malocclusion on mandibular movements during speech, the location, width and height of the envelope of motion during speech were analyzed in 25 normal subjects and 60 subjects with malocclusion using the Sirognathograph Analyszing System. Location of the envelope of motion was closely related to the specific types of malocclusions. It is suggested that the analysis of the envelope of motion during speech has diagnostic values in speech function and dental treatments.

Species specificity of pharmacological characteristics of CCK-B receptors

Novel CCK-B receptor antagonists, tetronothiodin and L-156,586, showed different affinities for CCK-B receptors in brain membranes from human, rat, guinea pig and mouse. [125I]CCK-8 bound to these membranes with a similar affinity. However, tetronothiodin was most potent in rat (IC50 = 3.6 nM), followed by guinea pig (96 nM), human (210 nM) and mouse (280 nM). L-156,586 bound with highest affinity to membranes from guinea pig (11 nM), and with lowest affinity to membranes from mouse (220 nM). These results suggest the existence of species specificity of CCK-B receptors, and that these two compounds are useful tools for discrimination between these receptors.

Serial changes in serum alpha-fetoprotein prior to detection of hepatocellular carcinoma in liver cirrhosis

In 49 liver cirrhosis patients with hepatocellular carcinoma in which the hepatocellular carcinoma nodule was smaller than 30 mm in size, serial changes in serum alpha-fetoprotein levels prior to the detection of the hepatocellular carcinoma were studied retrospectively, and compared with those of 70 cirrhotic patients with no hepatocellular carcinoma. The changes in alpha-fetoprotein levels were classified into the 4 types normal, low plateau, high plateau and spiky type. The spiky type (spiky elevation during a short period) was more frequently noted in the patients with hepatocellular carcinoma than in those with liver cirrhosis. In a prospective analysis of 39 patients with liver cirrhosis, hepatocellular carcinoma was detected in 6, and was also more frequently noted in the spiky type than the other types. Moreover, in the hepatocellular carcinoma patients with the spiky type of alpha-fetoprotein, hepatocellular carcinoma was suspected, on the basis of the tumor doubling time, to exist at the time of the first elevation of alpha-fetoprotein. These results suggest that the liver cirrhotics with the spiky type of alpha-fetoprotein may be considered to be a high-risk group of hepatocellular carcinoma.

[Delayed vasospasm complicated with the postoperative stage of the meningioma: a case report]

Though it has been reported infrequently that delayed vasospasm may appear in head-injured patients, it is rather rarer to see it as a complication arising from tumor removal. Such a case was presented and gave rise to speculation of a possible underlying pathophysiology. A 46-year-old female patient was admitted to our neurosurgical service, complaining of aching pain in the forehead. No neurological deficits were elicited on admission. CT scans as well as MR imagings confirmed the existence of a left sphenoid wing meningioma whose gross total removal was accomplished. She was doing well till the 3rd postoperative day, when she developed transcortical motor aphasia. 123I-IMP SPECT revealed low perfusion over the left middle cerebral artery territory, and CT scans also showed low density areas in the same region, including the putamen, corona radiata and temporal lobe on the left side. Left carotid angiography disclosed diffuse arterial narrowings involving C1, C2, A1 and M1 portions. The authors suspect that indirect injury to those arteries and/or some kind of inflammatory process might have played a role.

Activation of CCK-B receptors elevates cytosolic Ca2+ levels in a pituitary cell line

Cytosolic Ca2+ levels ([Ca2+]i) in GH3 cells, a rat anterior pituitary tumor cell line, were monitored with fura-2 by fluorescence measurements. Cholecystokinin octapeptide (CCK-8) produced a transient elevation of [Ca2+]i. The elevation of [Ca2+]i by CCK-8 was inhibited by L-365,260, but not by devazepide. It was still observed when extracellular Ca2+ was eliminated, indicating that CCK-8 mobilizes Ca2+ from intracellular storage sites after interaction with CCK-B receptors. Cholecystokinin octapeptide increased the turnover of phosphatidylinositol, but it did not affect cyclic AMP levels. A possible involvement of phosphatidylinositol breakdown and calcium mobilization in the transduction system of CCK-B receptors in GH3 cells is suggested.

Biochemical and immunochemical study of seven families with 3-ketothiolase deficiency: diagnosis of heterozygotes using immunochemical determination of the ratio of mitochondrial acetoacetyl-CoA thiolase and 3-ketoacyl-CoA thiolase proteins

The possibility of identifying heterozygotes of 3-ketothiolase deficiency, an inborn error of metabolism caused by a defect of mitochondrial acetoacetyl-CoA thiolase (T2), was tested in seven unrelated families by using enzymatic assay of thiolase activity and immunoblot analysis. The ratio of acetoacetyl-CoA thiolase activities, in the presence and absence of K+ ion (+K/-K ratio), in fibroblasts from 15 normal controls was around 2.0 (1.8 to 2.4), whereas the +K/-K ratio in eight patients was always 1.0. The ratio for the 13 obligate carriers ranged from 1.4 to 1.9, causing a minor overlap with control. Identification of heterozygote cells by immunoblot analysis, using anti-T2 antibody alone as a probe, was difficult, as previously reported. We therefore carried out immunoblot analysis, using as probes a mixture of anti-T2 antibody and the antibody against mitochondrial 3-ketoacyl-CoA thiolase (T1), another mitochondrial thiolase, and determined the ratio of the intensities of the T2 and T1 bands (T2/T1 ratio) using a densitometer. When the T2/T1 ratio was calculated, there was no overlap between the heterozygotes and normal controls. Hence, the heterozygotes can be unambiguously identified using this method. The thiolase activities and T2/T1 proteins in immunoblotting were detectable in peripheral lymphocytes, rectal mucosa, amniocytes, and liver. Thus, the postnatal diagnosis of 3-ketothiolase deficiency can be readily made using lymphocytes or rectal mucosa. The applicability of these methods in amniocytes indicates that prenatal diagnosis of this disease should be possible.

GH3 cells, an anterior pituitary cell line, express CCK-B receptors

We found that GH3 cells, a rat anterior pituitary tumor cell line, expressed a single class of high-affinity binding sites for radiolabeled cholecystokinin octapeptide (CCK-8) with a Kd of 48 pM. The binding sites had high affinity for CCK-8, CCK-4, gastrin I, and L-365,260 (CCK-B antagonist), and had low affinity for devazepide (CCK-A antagonist), indicating that the binding sites are CCK-B receptors. GTP and its stable analogues inhibited radiolabeled CCK-8 binding to GH3 cell membranes, suggesting a coupling of CCK-B receptors to a G-protein.

[An elderly case of thrombotic thrombocytopenic purpura]

A 78-year-old woman was admitted to our hospital because of disorientation and fever on January 21, 1992. Two days before admission she experienced vomiting, anorexia and general malaise. Laboratory examinations on admission disclosed a hemoglobin level of 11.1 g/dl and a platelet count of 8,000/microliters. The peripheral blood smear revealed anisocytosis with numerous schistocytes and poikilocytes. Polychromatophilic and nucleated red blood cells were also seen, and the reticulocyte count was 38/1000. Her serum lactate dehydrogenase (LDH) value was 2,977 WU and the total serum bilirubin level was 3.5 mg/dl with 2.7 mg/dl indirect reacting fraction. Serum creatinine was 4.7 mg/dl. Her consciousness became semicomatose after a systemic seizure which lasted approximately 15 seconds and her hemoglobin level decreased to 8.5 g/dl on hospital day 2. Therefore, we diagnosed her as having thrombotic thrombocytopenic purpura (TTP) because of the presence of all 5 features, that is, thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic abnormalities, renal dysfunction and fever. A plasmapheresis with fresh frozen plasma (FFP) replacement was begun on that day. She was also treated with anti-platelet agents, 80 mg/day aspirin, and 300 mg/day dipyridamole. Moreover, packed red blood cells (PRC) were infused. While also receiving diphenylhydantoin and phenobarbital to prevent convulsions, status epilepticus developed on day 3. Because of inhibited spontaneous respiration which was an adverse effect derived from diazepam and sodium thiamylal administered intravenously to treat the status epilepticus, an artificial respiration was initiated.(ABSTRACT TRUNCATED AT 250 WORDS)