Emergency colonoscopy for the diagnosis of lower intestinal bleeding

During the past 8 years, we performed emergency colonoscopy in 206 patients in whom severe bloody stools suggested bleeding of the lower digestive tract. The site of hemorrhage could be determined in 184 patients (89.3%). In cases with severe hemorrhage, the causes were stercoral rectal ulcer and bleeding from the small intestine or the upper GI tract. The bleeding tended to be mild in patients with other colon diseases. Determination of the bleeding site was impossible or difficult when a large amount of blood was present in the intestinal lumen or the blood was completely discharged. These observations suggest that emergency colonoscopy is effective for determination of the site of GI bleeding, but improvements are considered to be needed especially in the preparation for the examination in patients in critical condition.

Comparison of beta-cell function after long-term treatment with either insulin, insulin plus gliclazide or gliclazide in neonatal streptozotocin-induced non-insulin-dependent diabetic rats

There are no definite guidelines in the treatment of non-insulin-dependent diabetes mellitus (NIDDM) as to whether the treatment of choice is insulin, a sulfonylurea or a combination of insulin and sulfonylurea. We have therefore tried to evaluate the long-term effects of these treatments on beta-cell function in a rat model of NIDDM. NIDDM rats were prepared by the injection of streptozotocin (60 mg, i.p.) on the 5th day after birth. At 10 weeks, an oral glucose tolerance test (2 g/kg) was performed and rats were divided into 4 groups, each of which had the same mean glucose tolerance. The treatment of each group with either NPH insulin (4 U/kg/day), or oral gliclazide (10 mg/kg/day by a stomach cannula), or a combination of the above two, or a control (vehicle for gliclazide) was started from 12 weeks of age and continued for 6 months. Rats were fed ad libitum with standard rat chow. The weight gain of diabetic rats treated with gliclazide alone and of the vehicle-treated diabetic rats during 6 months was less than that of the other groups receiving insulin. The fasting plasma glucose of the insulin-only treated group stayed at the initial level for 6 months, but that of the other groups increased gradually. The frequency of deterioration of glucose tolerance for oral glucose loading (2 g/kg) in the insulin-only treated group was smaller than that in the other diabetic groups at 3 at 6 months after the start of treatment. The increase in plasma IRI after the oral glucose loading of the insulin-only treated group was the largest among the 4 groups at 6 months. In the pancreas perfusion experiment, the insulin response to glucose in the insulin-only treated group was more preserved than that in the other groups of diabetic rats after 6 months of treatment. These results suggest that treatment with insulin is effective in preserving beta-cell function in a rat model of NIDDM, whereas treatment with a sulfonylurea agent is not only ineffective but might negate the protective effect of insulin because the insulin-plus-gliclazide treated group elicited results similar to those of the gliclazide-only treated group except for the weight gain.

Induction of heat shock proteins and their implication in protection against ethanol-induced damage in cultured guinea pig gastric mucosal cells

The induction of heat shock proteins in cultured guinea pig gastric mucosal cells was investigated to assess their role in gastric cytoprotection. In response to sublethal heat stress at 43 degrees C for 1 hour, the cells synthesized a 72-kilodalton protein and increased the synthesis of 74- and 90-kilodalton proteins, which were detected using gel electrophoresis after [35S]methionine labeling of the cells. Immunoblot analysis indicated that the 72- and 74-kilodalton proteins were members of the heat shock protein 70 family. Northern blot analysis showed the induction of a 2.6-kilobase messenger RNA of heat shock protein 70 gene only with heat treatment. Furthermore, with heat treatment, there was significant reduction of damage after ethanol treatment. This reduction was blocked with a protein synthesis inhibitor, cycloheximide, and was associated with inhibition of synthesis of heat shock proteins. These results strongly suggest that synthesis of heat shock proteins plays an important role in the intracellular mechanism of gastric protection against ethanol.

[Steroid induced early changes of the femoral head in man--histological study of autopsied cases]

High dose corticosteroid therapy constitutes one of major causes of osteonecrosis of the femoral head. To examine the early changes of the femoral head induced by corticosteroid therapy, 20 femoral heads were obtained at autopsy and the other 19 femoral heads without having been on steroid were served as controls. Histological examination from steroid treated group revealed that in areas of subchondral bone there were observed necrotic changes of osteocytes. The nucleus was so pressed to one side of the cell as to assume crescent like aspect. When stained with Sudan IV, fat positive materials were found in the osteocyte lacunae. Electron micrographic examination revealed intracellular fat as low electron dense droplets in these degenerative osteocytes. Examination of bone marrow showed an increase of the number of fat cells in steroid treated group. These changes in man may represent some failure in lipid metabolism, although it is unknown whether these events may produce osteonecrosis of the femoral heads.

Ketone body utilization and its metabolic effect in resting muscles of normal and streptozotocin-diabetic rats

By using an in situ rat hindquarter perfusion, we evaluated ketone body utilization and its metabolic effects in the resting muscle of 24 h fasted normal and streptozotocin (STZ)-diabetic rats. Under the perfusion with ketone body-supplementation (1 mM each of acetoacetic acid (AcAc) and 3-hydroxybutyric acid (3-OHB], the AcAc and 3-OHB uptake of STZ-diabetic rats was significantly (P less than 0.05) smaller than that of normal rats. This might be explained by the low enzyme activity of 3-oxoacid CoA transferase demonstrated in the hindlimb muscles of STZ-diabetic rats and this reduced ketone body uptake would be one of the causes of the development of diabetic ketoacidosis. The glucose uptake and the phosphofructokinase (PFK) activity of normal rats were significantly (P less than 0.05) higher than those of STZ-diabetic rats. In both normal and STZ-diabetic rats, the glucose utilization and PFK activity of the muscles in the ketone body-supplemented condition were significantly (P less than 0.05) lower than those in the non-supplemented condition. This inhibition of glucose utilization by ketone bodies should be due to the mechanism by which the oxidation of ketone bodies inhibits PFK in the muscle.

[A case of inflammatory breast cancer well treated with intraarterial infusion chemotherapy-- evaluation of therapy by contact thermography]

A case of inflammatory breast cancer, for which an intra-arterial infusion chemotherapy was reported that it was effective. A 63 year-old woman was admitted with the complaint of left breast mass and reddish skin. Clinically it was diagnosed to be inflammatory breast cancer and was treated with an intra-arterial infusion. Contact thermography was employed for the efficacy of the treatment. Three weeks after the chemotherapy the temperature of the tumor site was decreased with a reduction of the tumor size. But, the opposite symptoms appeared before the tum or size increased. Contact thermography seemed to be useful for an evaluation of the preoperative chemotherapy for inflammatory breast cancer.

Lipid A and related compounds. XXVI. Syntheses of biologically active penta-O-acetyl-N-glycoloylneuraminyl- and penta-O-acetyl-3-deoxy-D-galacto-2- nonulopyranosonic acid-(alpha 2----6)-D-glucosamine-4-phosphate analogs of lipid A

The syntheses of novel penta-O-acetyl-N-glycoloylneuraminyl- and penta-O-acetyl-3-deoxy-D-glycero-D-galacto-2-nonulopyranosonic acid-(alpha 2----6)-D-glucosamine-4-phosphate analogues of lipid A containing sialic acid in place of 3-deoxy-D-manno-2-octulosonic acid are described. Preliminary examination of the biological activity revealed that two synthetic disaccharides showed mitogenic activities and weak antitumor activities.

A strategy for the study of cerebral amino acid transport using iodine-123-labeled amino acid radiopharmaceutical: 3-iodo-alpha-methyl-L-tyrosine

We examined the brain accumulation of iodine-123-iodo-alpha-methyl-L-tyrosine (123I-L-AMT) in mice and rats. I-L-AMT showed high brain accumulation in mice, and in rats; rat brain uptake index exceeded that of 14C-L-tyrosine. The brain uptake index and the brain slice studies indicated the affinity of I-L-AMT for carrier-mediated and stereoselective active transport systems, respectively; both operating across the blood-brain barrier and cell membranes of the brain. The tissue homogenate analysis revealed that most of the accumulated radioactivity belonged to intact I-L-AMT, an indication of its stability. Thus, 123I-L-AMT appears to be a useful radiopharmaceutical for the selective measurement of cerebral amino acid transport.

Induction of cutaneous graft-versus-host disease by local injection of unprimed T cells

The skin is a major target organ in human graft-versus-host disease (GVHD) after bone-marrow transplantation. GVHD can be induced in mice by i.v. injection of T cells into unirradiated semi-allogeneic or lethally irradiated allogeneic recipients. However, in the murine systemic GVHD model, cutaneous lesions occur only in lethally irradiated recipients. Since lethal irradiation itself might induce the epidermal cell damage, several investigators have employed another murine model of cutaneous GVHD, in which cutaneous lesions were induced by intradermal injection of alloreactive T cell clones. Using this system, it has been reported that both MHC class I- and II-reactive T cell clones can induce cutaneous GVHD in non-irradiated or sublethally irradiated recipients. However, it has remained unknown whether or not freshly prepared T cells are able to induce cutaneous GVHD after local injection into non-irradiated recipients. We show that unprimed T cells can induce cutaneous GVHD after local injection into unirradiated MHC class II- or I + II-disparate recipients. In contrast to alloreactive T cell clones, unprimed T cells could elicit only mild cutaneous lesions in MHC class I-disparate recipients. Since sublethal irradiation of MHC class I-disparate recipients did not result in the manifestation of cutaneous lesions after injection of unprimed T cells, host anti-donor responses by radiosensitive cells could not be responsible for this phenomenon. This experimental system provides a useful model for analysis of the regulation mechanisms in the induction of GVHD by unprimed T cells.

Quantum chemical study for genotoxic and antitumor activities of hydroxyanthraquinones

For anthraquinone and its mono- and dihydroxyl derivatives, and for their semiquinone anion radicals, semiempirical MNDO (moderately neglected differential overlap)/H calculations were performed and an attempt was made to correlate the calculated quantum quantities with the genotoxic and the antitumor activities. From these calculations, it was found that the electrophilic frontier electron densities (fE beta) on the beta position in anthraquinones were distinctly correlated with the genotoxic activity. On the other hand, calculations for the semiquinone anion radicals revealed the great stabilizations by the intramolecular hydrogen bond of the carbonyl group with alpha-hydroxyl groups. It has been suggested that this type of stabilization may be associated with the antitumor activity of several hydroxylanthraquinone derivatives.

Combined effects of inversed ratio ventilation (IRV) with positive end-expiratory pressure ventilation (PEEP) on cardiorespiratory function in acute respiratory failure

Combined effects of inversed ratio ventilation (IRV) with positive end-expiratory pressure (PEEP) on cardiorespiratory function were examined in 24 patients with acute respiratory failure. Patients were divided into two groups: the IRV group (n = 12) who showed no significant increase in Pa(O)(2) with a 6 cmH(2)O of PEEP and PEEP group (n = 12) who were ventilated mechanically with PEEP only at maximum level of 10 cmH(2)O. In IRV group step-wise prolongation of the I : E ratio from 1 : 1.9 to 2.6 : 1 or 4 : 1 was applied as a Pa(O)(2) was improved and in PEEP group also level of PEEP was increased from 0, 5 to 10 cmH(2)O after one hour period irrespective of Pa(O)(2). Inversed ratio ventilation and PEEP increased significantly Pa(O)(2)/F i(O)(2), the increase being observed 6 hrs (I : E = 2 : 1) and 2 hrs (10 cmH(2)O) after starting IRV or PEEP. Further improvement of oxygenation was not observed in IRV even if I : E ratio was prolonged up to 2.6 : 1 or 4 : 1. These results suggested that combinations of IRV with PEEP were effective and an I : E ratio of 2 : 1 may be optimal, and IRV is advantageous compared to PEEP, but will take more long time to improve oxygenation than PEEP.

[The prediction of the need for postoperative mechanical ventilation in patients with myasthenia gravis undergoing transsternal thymectomy]

During a sixteen-year period, 51 patients with myasthenia gravis underwent trans-sternal thymectomy including extended resection of the adipose tissue around thymus. Using the criteria of risk factors described by Leventhal and Kimura, a predictive score was assessed for our 51 patients. Leventhal's scoring system achieved an accuracy of 54.3%, a sensitivity of 20.0% and a specificity of 63.9%. And, Kimura's scoring system achieved an accuracy of 75.0%, a sensitivity of 81.8% and a specificity of 73.0%. From this study it was concluded that Kimura's scoring system is statistically more adaptive for Japanese than Leventhal's scoring system, and the Leventhal's accuracy may have increased by adding "bulbar symptoms" and "preoperative crisis" as other risk factors and by decreasing "points" for "duration of myasthenia" and "pyridoxamine dosage", and the "Kimura's " accuracy may have increased by decreasing "7 points" for preoperative crisis. Consequently, patients who received postoperative ventilation were compared with the group who did not, with respect to the 19 factors. Evidence is that Osserman's type, bulbar symptoms, preoperative crisis and preoperative % VC were influenced to require the postoperative ventilation, but sex, age, thymic histology, duration of myasthenia and pyridoxamine dosage were not any influenced to require the postoperative ventilation.

Cytotoxic effects of myelin basic protein-reactive T cell hybridoma cells on oligodendrocytes

Cells of a rat/mouse T cell hybridoma reactive to the encephalitogenic peptide of myelin basic protein (MBP) was found to be cytotoxic to 51Cr-labelled rat oligodendrocytes (oligos) inducing 52 +/- 5% 51Cr release vs. 28 +/- 2% spontaneous 51Cr release from replicate oligos. The hybridoma cells were not toxic for rat astrocytes or concanavalin A-stimulated lymphoblasts. Hybridoma T cells reactive to an experimental allergic encephalomyelitis-irrelevant antigen (ovalbumin) were not cytotoxic to oligos. The cytotoxic reaction required cell-cell contact but did not require the in vitro presence of antigen-presenting cells MBP. The target antigen on the oligos is not yet defined. These studies suggest that MBP-reactive T cells can be directly cytotoxic to oligos in the absence of other cell populations.

[Enzyme immunoassay for secretory immunoglobulin A on skin surface and in sweat]

Recently secretory IgA (S-IgA) was found to be secreted from the eccrine gland. By using a sandwich enzyme immunoassay, we measured the concentration of S-IgA 1) in sweat (sweat S-IgA) and 2) in the extract buffer obtained by pipetting++ on the skin (skin surface S-IgA). Skin surface hydration and skin surface lipid were measured at the sites where the samples of skin surface S-IgA were collected. (These measurements were taken immediately after the buffer was pipetted). The quantity of both sweat S-IgA and skin surface S-IgA differed according to the sites where they were collected. Sites in order of decreasing sweat S-IgA level: face, chest, forearm. Sites in order of decreasing skin surface S-IgA level: face, chest, palm, forearm, sole. (Skin surface S-IgA levels on palm and forearm were approximately equal). Although the amount of skin surface S-IgA was not related to the skin surface hydration, there was a significant correlation between skin surface S-IgA and skin surface lipid.

Family studies of the LDL receptor gene of relatively severe hereditary hypercholesterolemia associated with Achilles tendon xanthomas

To assess the relationship between relatively severe hereditary hypercholesterolemia with Achilles tendon xanthomas and the defect of the low density lipoprotein (LDL) receptor gene, family studies were carried out in 17 hypercholesterolemic families. In 16 out of the 17 families, hypercholesterolemia co-segregated with four different gross rearrangements, six different restriction fragment length polymorphism (RFLP) haplotypes, or an abnormal TaqI band of the LDL receptor gene. These findings are compatible with the interpretation that hypercholesterolemia is caused by defective LDL receptor genes, and that the origin of the mutant LDL receptor genes in Japanese generally differs among different pedigrees. In the remaining family, the proband and his sibling, both having relatively severe hypercholesterolemia and Achilles tendon xanthomas, shared an RFLP haplotype, although the proband's other sibling with moderate hypercholesterolemia but without Achilles tendon xanthomas did not. The mutant gene for familial defective apolipoprotein B-100 was not detected in the 17 probands. These data suggest that most, if not all, of the relatively severe hereditary hypercholesterolemia associated with Achilles tendon xanthomas is caused by a defect of the LDL receptor gene.

[Pathological findings as determinant factors of prognosis of renal cell carcinoma]

Clinicopathological studies were made on 105 patients with renal cell carcinoma who visited us from January 1978 to August 1989. The results were as follows: 1. Overall 3, 5 and 10-year survival rates were 60.4%, 49.8% and 44.5%, respectively. 2. Patients in Robson stage I survived longer than those in stage III, and patients in stage II survived longer than those in stage IV with a significant difference. 3. A significant difference did not exist between patients in stages lower than pT2 and those in pT3a, while patients in pT3a survived longer than those in stages higher than pT3b. 4. Patients with grade 1 tumors survived longer than those with grade 2 tumors, and patients with grade 2 tumors survived longer than those with grade 3 tumors with a significant difference. 5. Patients with clear cell subtype survived longer than those with granular cell subtype and mixed subtype with a significant difference, while a significant difference did not exist between patients with granular cell subtype and those with mixed subtype. 6. Patients with INF alpha tumors survived longer than those with INF beta tumors with a significant difference. There was the same significant difference in patients with grade 2 tumors.

[A case-control study of ulcerative colitis]

In order to evaluate the epidemiological characteristics of ulcerative colitis, we conducted a matched case-control study of ulcerative colitis. Fifty patients with ulcerative colitis diagnosed at three hospitals in Kyoto, Osaka and Hyogo Prefectures in Japan during 1984 and 1987 were interviewed about their habitual and pre-illness diets, personal habits, past histories and family histories. The results were compared to those for fifty healthy controls who were matched for sex and age (+/- 2 years) and participated in health-screening examinations in Kyoto or Osaka during the same period. Frequent intake of rice (4 or more bowls a day), bread (3 or more times a week), and green tea (7 or more cups a day) significantly increased the relative risk of ulcerative colitis. However, a past history of appendectomy was negatively correlated with the disease. There were no relationships between ulcerative colitis and consumption of animal foods and tobacco.

[Immunochemical quantification of the airborne chironomid allergens]

We collected airborne particles in the air using a high-volume air sampler, and measured chironomid allergen in the air-filter extract by use of RAST inhibition assay. The results obtained were as follows: 1) The assay revealed the presence of chironomid allergen in the air varying from 6.8 to less than 0.3 ng/m3. 2) In Toyama, seasonal fluctuations of airborne chironomid allergen demonstrated some large peaks in summer (June to August), and showed a tendency to decrease in winter. 3) There were significant correlations between airborne chironomid allergen and dry weight of chironomid midges, collected by using light traps, in all period of a week just before, 1 to 2 weeks before, 2 to 3 weeks before, or 3 to 4 weeks before air sampling. There were not significant correlations between airborne chironomid allergen and weathers (temperature, wind speed and precipitation) during or just before air sampling. 4) In Toyama, the frequency of asthma attacks in the asthmatic children with positive C.p. RAST was much increased in summer compared with that of the negative, in which the amount of airborne chironomid allergen was increased. These results show that there is large amount of chironomid allergen in the air from spring to autumn, especially large in summer, and it is related for some asthmatics to the increase of the frequency of asthma attack.