[Chronic necrotizing pulmonary aspergillosis treated with itraconazole and inhaled amphotericin B]

A 52-year-old man with chronic necrotizing pulmonary aspergillosis complicated by a residual tuberculous cavity was admitted to the hospital because of fever and a new infiltration shadow in the right lower lobe. Aspergillus was isolated repeatedly from his sputum, though he had been treated with itraconazol for 9 months. Combination therapy with itraconazol (200 mg) and inhaled amphotericin B (AMPC, 10 mg, 4 times a day) was begun. The infiltration shadow gradually resolved. The concentration of AMPC in serum was measured by high-performance liquid chromatography, and was found to be 0.09 micrograms/ml, which is equal to the AMPC concentration obtained with daily oral administration of 2400 mg. This case shows that, contrary to previous opinion, AMPC can be effectively administered by inhalation. We know of no previous reports of similar cases. In addition, itraconazol and inhaled AMPC may have had a synergistic effect in this case.

Expanding intracerebral hematoma from pituitary adenoma: case report

We report the case of a 53-year-old man presenting with a headache of sudden onset and blurred vision secondary to hemorrhage from a nonfunctioning pituitary adenoma, which had been treated 25 years previously by transcranial surgery and postoperative irradiation. The intratumoral and intracerebral hematoma expanded to three times its initial size because of a recurrent hemorrhage that occurred during a 2-day period while the patient awaited surgery. The mechanisms of hematoma expansion and the management strategy in such a case are discussed, and a review of the pertinent literature is presented.

Enhanced migration of fibroblasts derived from lungs with fibrotic lesions

BACKGROUND

The migration and proliferation of fibroblasts may be important in the pathogenesis of pulmonary fibrosis. Considerable data are available on the proliferation of fibroblasts, but very few on their migration.

METHODS

The migratory activity of fibroblasts obtained from lung biopsy specimens from 11 patients with idiopathic pulmonary fibrosis (IPF) was studied using a 96-well chemotaxis chamber. Fibroblasts from eight normal controls, seven patients with interstitial fibrosis associated with a collagen vascular disease (IP-CVD), and 13 patients with sarcoidosis were also examined. Migratory activity was tested in a serum-free medium in the presence and absence of platelet derived growth factor (PDGF), 30 ng/ml, as a chemoattractant.

RESULTS

Migration of fibroblasts from patients with IPF was enhanced in serum-free maintenance medium alone (mean (SD) controls v IPF: 183 (86) v 689 (491) cells/field), and was also enhanced when cells were stimulated by PDGF (controls v IPF: 829 (222) v 1928 (600) cells/field). Fibroblasts from tissues with dense fibrosis had a greater capacity for migration than those from an earlier stage of fibrosis. No correlation was found between migratory activity and proliferative capacity of the individual cells.

CONCLUSIONS

The fact that fibroblasts from fibrotic lungs migrate faster than those from controls suggests that migration is related to the initiation of the pulmonary fibrotic process. These in vitro studies suggest that fibroblasts derived from the lungs of patients with pulmonary fibrosis have a migratory phenotype. Such a change in fibroblast phenotype, if it occurred in vivo, may be important in the context of the pathogenesis of pulmonary fibrosis.

Glucocorticoid receptor expression is down-regulated by Lp(a) lipoprotein in vascular smooth muscle cells

Glucocorticoids have been reported to protect against atherosclerosis and have been used clinically as protective therapy for restenosis after balloon angioplasty. Recently, Lp(a) lipoprotein [Lp(a)] levels have been suggested to be an independent risk factor for atherosclerosis, although its mechanisms of action are still uncertain. To clarify this atherogenic mechanism of Lp(a), we investigated the effects of Lp(a) on glucocorticoid receptor (GR) expression in human vascular smooth muscle cells (SMC). Levels of nuclear GR in SMC began to decrease after 12-h incubation with Lp(a), to 55 +/- 8% of the control value at 48 h; binding affinity did not change. Lp(a) had no effect on estrogen receptor binding in SMC. Moreover, low, very low, and high density lipoproteins had no effect on GR binding in SMC. The effects of Lp(a) on nuclear GR in rat SMC were very similar to those in human SMC; in contrast, Lp(a) did not alter GR or estrogen receptor levels in rat endothelial cells. GR messenger RNA levels in SMC decreased after 1-h treatment with Lp(a) to 23% of the control value after 12 h. Further, the antiproliferative effect of glucocorticoids on SMC was blunted by exposure to Lp(a). We conclude that Lp(a) down-regulates GR gene expression, resulting in a decreased number of GR in SMC. These findings suggest the possibility of a novel atherogenic mechanism of Lp(a) via inhibition of a protective action of glucocorticoids on SMC.

Long-lasting facilitation and depression of periurethral skeletal muscle following acupuncture-like stimulation in anesthetized rats

The effects of acupuncture-like stimulation on the tone of the partially filled bladder and on the periurethral electromyogram (EMG) were examined in urethane-anesthetized rats. Acupuncture-like stimuli were usually applied to the skin and underlying muscles (or other structures), either separately or together, for a period of 1 min; the effects were studied in spinal cord intact and in spinalized animals. Maps have been constructed showing the effects of acupuncture-like stimulation at different sites on the body surface and of similar stimulation applied to individual muscles, the urethra and the testis. When acupuncture-like stimuli were applied to the skin and underlying structures, in the rostral half of the body and the hindpaw, testis or urethra, these stimuli usually induced excitation of periurethral EMG activity. Depression of EMG activity was seen predominantly during stimulation of structures close to the urethra, but not opposed to it. When acupuncture-like stimuli were applied only to structure beneath the skin, depression of EMG activity usually occurred. Acupuncture-like stimulation of the bulbocavernosus, which partly overlies the proximal urethra produced depression of EMG activity in 50% of trials, but the incidence of similar effects from the more distant pubococcygeus, or the dorsal or ventral sacrococcygeal muscles was about 90-100%. Acupuncture-like stimulation for 1 min could produce either excitation or depression of periurethral EMG activity lasting about 5 or 6 min, depending on the site of insertion and rotation of the acupuncture needles. Excitation of short duration (less than 3 min) was consistently observed from areas of the body distant to the bladder, i.e. the nose, forepaw, forelimb, chest, abdominal wall and hindpaw. Longer lasting excitation of EMG activity was often seen from the penile urethra, perineal area and hindlimb. Depression of EMG activity with a duration of more than 3 min was consistently seen from the muscles at the base of the tail (sacrococcygeus) and perineal area (pubococcygeus and bulbocavernosus). The bladder was partially filled in these experiments, so that micturition contractions were never seen; acupuncture-like stimulation of the perineal area induced some increase in bladder tone in 40% of trials. In spinalized animals, the pattern of activity induced by acupuncture-like stimulation was similar to that seen in spinal cord intact animals and the durations of the effects were not significantly different in these two groups. The distribution of sites from which acupuncture-like stimuli can influence the activity of the lower urinary tract is discussed.

[Combination chemotherapy with tegafur-uracil (UFT) and cisplatin (CDDP) for advanced gastric cancer. UFTP Study Group]

An early phase II study of tegafur-uracil (UFT) combined with cisplatin (CDDP) was conducted in patients with advanced gastric cancer. UFT was administered orally for 28 consecutive days at a dose of 400 mg/m2 and CDDP was injected intravenously for 3 day at a dose of 30 mg/m2 over 8 hours every 4 weeks. This treatment cycle was repeated every 4 weeks. Sixteen patients were enrolled in this study and 14 patients could be evaluated for clinical response and toxicity. Based on the results of extramural review, 6 of 14 patients achieved a partial response and the response rate was 42.9%. High grade toxicities (WHO grade 3 or 4), specifically anorexia, nausea and vomiting, diarrhea, and leukocytopenia, were seen in 5, 2, 3 and 2 patients, respectively. The overall median survival time was 347 days (11.4 months) for evaluated patients. Although these results are preliminary, this regimen does appear to be effective in terms of tumor response and survival. Larger patient numbers in a Phase II study and further studies to evaluate survival are awaited.

[Two cases of intrapulmonary lymph node associated with either progressive systemic sclerosis or idiopathic pulmonary fibrosis]

We encountered 2 cases of intrapulmonary lymph node. Case 1 was in a 48-year-old woman who had been given a diagnosis of progressive systemic sclerosis. Case 2 was in a 49-year-old woman with idiopathic pulmonary fibrosis. In each patient, a follow-up chest CT scan showed a pulmonary nodule, which could not be seen on chest X-ray film. Each nodule has an irregular margin and a linear shadow resembling pleural indentation. Histological examination of the open biopsy specimens revealed that these nodules were intrapulmonary lymph nodes surrounded by interstitial pneumonia. Previous case reports and these 2 cases indicate that unless a thoracotomy is done intrapulmonary lymph nodes are difficult to distinguish from lung cancers.

The influence of afferent inputs from skin and viscera on the activity of the bladder and the skeletal muscle surrounding the urethra in the rat

(1) Somato-visceral and viscero-visceral reflex interactions have been studied in the bladder branches of the pelvic nerve and in the electromyographic (EMG) activity of the periurethral skeletal muscles of the anesthetized rat, and by observations of changes in bladder motility. (2) Slow distensions of the bladder caused some elevation of intravesical pressure, and culminated in a micturition contraction. Periurethral EMG activity increased gradually during the bladder distension, and showed an oscillatory marked increase during the bladder contraction. There was a small increase in pelvic nerve efferent activity during slow distension, and there was a substantial increase before, or at the start, of a micturition contraction. (3) Oscillatory bursting activity occurred in recordings of the EMG activity from periurethral skeletal muscle during the rising phase of micturition contraction; this was particularly so during the most rapid rise in intravesical pressure, and periods of electrical silence lasting 80-270 ms alternated with bursts of activity in the periurethral EMG. (4) In the present experiments, the switching mechanism activated by pelvic afferent signals related to intravesical pressure reversed the behavior of a number of reflex pathways. When the bladder pressure was low, nociceptive pinching of the perineal skin usually caused bladder contraction and a rise in pelvic nerve efferent activity and in periurethral EMG activity. When the bladder was full, micturition contractions were present and reduced in size and frequency by pinching of the perineal skin. The pelvic nerve efferent activity was correspondingly reduced, while the EMG activity increased during and following the nociceptive stimulus. Cooling the scrotal skin with ice also decreased the frequency of bladder contractions. (5) When the bladder pressure was low, distension of the anus and colon increased periurethral EMG activity, but did not affect bladder tone. However, when the bladder was full, these stimuli reduced the size and frequency of bladder contractions, associated with a reduction in the pelvic nerve efferent activity. There was usually a simultaneous reduction in the EMG activity in periurethral muscles. Similar results were obtained during distension of the seminal vesicles or vagina, or following injection of 20-60 microliters of saline into the lumen of the vas deferens. Reversal of the responses at extremes of intravesical pressure was observed in every case. (6) Following spinal transection at the upper cervical or thoracic level, micturition contractions were absent at high bladder volumes. However the effects described when the neuraxis was intact and the bladder pressure was low were still observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Induction of differentiation of HL-60 cells by the anti-fungal antibiotic, radicicol

The anti-fungal antibiotic, radicicol, produced in the culture broth of Neocosmospora tenuicristata, was found to induce differentiation of HL-60 cells into macrophages from the following evidence: (1) it caused morphological changes into macrophage-like cells, (2) induced NBT (Nitrobluetetrazolium) reduction activity, (3) induced phagocytosis, and (4) induced alpha-naphthyl acetate esterase activity. The concentration of radicicol required to differentiate HL-60 cells is 50-100 ng/ml, and the incubation time required for commitment of differentiation is 16 hours. Flow cytometry analysis indicated that radicicol blocks the cell cycle of HL-60 cells at the G1 and G2 sites. In addition, radicicol induced reversal of the transformed phenotype of ras-transformed NIH3T3 cells (DT cells) at 25 ng/ml.

Clinorotation inhibits chondrogenesis in micromass cultures of embryonic mouse limb cells

Studies of the response of mammalian chondrocytes to gravitational changes in vivo, in organ culture, and in cell culture show that chondrogenesis is reduced in microgravity or by unloading, and increased by low levels of excess g. To investigate the cellular responses to microgravity using a ground based model, micromass cultures were exposed to simulated weightlessness on two clinostats. For rotation on the large clinostat, cultures were set up in Rose chambers, and cells were videotaped and photographed at several time periods after rotation began. For the smaller clinostat, cultures were set up in T-flasks, and two axes of rotation for clinostated cultures were used. Stationary controls [+1 g, -1 g (upside-down), and sideways] as well as rotation controls were employed. Rotation rate was 30 rpm for both clinostatted cultures and rotation controls. Chondrocyte differentiation was assessed by cartilage specific alcian blue staining. Significantly fewer alcian blue stained nodules were present in clinostatted cultures than in stationary controls or rotation controls. Nodules that did not stain with alcian blue, probably due to unsulfated matrix were present in all cultures. The number of nodules in sideways controls was greater than in any other culture (108% of +1 g controls), probably due to ongoing stimulus of the cell via cytoskeletal components. The results show that chondrocytes in culture respond to changes in the gravity vector in a predictable manner, and that carefully controlled clinostat studies can be useful adjuncts to and predictors for spaceflight experiments.

Effects of short-term administration of alpha-chlorohydrin on reproductive toxicity parameters in male Sprague-Dawley rats

alpha-Chlorohydrin (alpha-CH) was administered orally at doses of 0, 2 or 8 mg/kg/day for 2 weeks to Sprague-Dawley male rats. At the end of the administration period or 2 weeks after withdrawal (one group also treated with 8 mg/kg for 4 weeks), males were mated (treatment with alpha-CH was continued throughout the mating period of 2 weeks) with untreated females, and underwent examination, including assessment of sperm, to determine fertility. No significant treatment-associated changes were observed in terms of body weight, food consumption, or weights of the testes, epididymides or prostate in either the 2 or the 8 mg/kg group. Although there were no significant differences in sperm number, viability or maturation rate between either of the treated groups and the control group, sperm motility in the 8 mg/kg group observed after 2 hours incubation and sperm activity in groups treated with 8 mg/kg observed immediately after collection or after 2 hours incubation, as well as in the 2 mg/kg observed after 2 hours of incubation were significantly decreased. Two weeks after withdrawal (8 mg/kg group only), sperm motility and activity were no longer decreased. Histopathological examination of the testes after 4 weeks of alpha-CH administration disclosed no abnormalities on staining with Hematoxylin-Eosin after fixation in Bouin's solution. All treated male rats copulated with untreated females, but no pregnancy resulted from mating in the 8 mg/kg continuous administration case. There were no significant differences between the control and 2 mg/kg groups in numbers of corpora lutea and implantations in animals becoming pregnant. Two weeks after withdrawal, male rats treated with 8 mg/kg copulated and impregnated females. These findings suggest that evaluation of male fertility is possible within or following a 2-week treatment period for compounds like alpha-CH which have no toxicological, histopathological or sperm morphological effects, and that the use of several parameters for sperm examination is important in determining male fertility.

Glucocorticoid-induced hypertension in the elderly. Relation to serum calcium and family history of essential hypertension

To explore the syndrome of glucocorticoid-induced hypertension in the elderly, we analyzed the clinical findings from 35 patients aged more than 65 years (12 men, 23 women) who received glucocorticoid therapy. Resting blood pressures (BP) were less than 140/90 mm Hg before glucocorticoid therapy, and patients were apparently disease-free apart from the condition for which glucocorticoid therapy was prescribed. Glucocorticoid-induced hypertension is defined as systolic BP more than 160 mm Hg and/or diastolic BP more than 95 mm Hg after glucocorticoid administration. Glucocorticoid-induced hypertension was seen in 13 patients (37.1%); all patients with hypertension [steroid (glucocorticoid)-induced hypertension (SH(+)) group] received more than 20 mg of prednisolone daily, and BP rose rapidly within a week of commencing glucocorticoid administration. The SH(+) group did not differ significantly in terms of age, heart rate, blood count, plasma biochemistry, plasma renin activity, plasma aldosterone, routine urinalysis, or urinary electrolytes from patients who did not show hypertension [SH(-) group]. However, serum total calcium concentrations were significantly lower in the SH(+) group both before and after 2 weeks of glucocorticoid therapy than in the SH(-) group. Furthermore, the SH(+) group showed a significantly higher percentage of patients with a positive family history of essential hypertension than the SH(-) group. In conclusion, although the detailed mechanisms are as yet uncertain, glucocorticoid-induced hypertension occurs often in elderly patients, and is more common in patients with total serum calcium concentrations lower than the normal range, and/or in those with positive family history of essential hypertension.

Lipoxygenase inhibitor-provoked acute asthma in a patient with asthma relieved by aspirin

BACKGROUND

A very small number of patients with asthma show symptomatic improvement after administration of aspirin and other cyclooxygenase inhibitors. The clinical features of such patients with so-called aspirin-relieved asthma are similar to those with aspirin-induced asthma, but the pathogenesis is unclear.

METHODS

We encountered one confirmed aspirin-relieved asthma patient and investigated the effects of cyclooxygenase and lipoxygenase inhibitors on his condition.

RESULTS

Our patient showed a marked improvement of the forced expiratory volume in one second (FEV1) after administration of aspirin and three other cyclooxygenase inhibitors (indomethacin, mefenamic acid, and ketoprofen). A 5-lipoxygenase inhibitor (AA861, Takeda, Japan), however, evoked acute asthma, and repeated administration of this drug resulted in some desensitization, but not complete tolerance.

CONCLUSIONS

These results suggest an altered balance of arachidonic acid metabolism may play a critical role in the pathophysiology of aspirin-relieved asthma.

Leukoencephalopathy in childhood hematopoietic neoplasm caused by moderate-dose methotrexate and prophylactic cranial radiotherapy--an MR analysis

PURPOSE

The main purpose of this study was to determine influential factors related to minor leukoencephalopathy (LEP) caused by moderate-dose methotrexate (MTX) and prophylactic cranial radiotherapy (CRT) in childhood hematopoietic malignancies. We also compared the incidence of LEP following this treatment to that reported in the literature following treatment with high-dose MTX alone.

METHODS AND MATERIALS

Thirty-eight pediatric patients of hematopoietic malignancies (37 acute lymphoblastic leukemias, 1 non-Hodgkin lymphoma) who were given CRT (18-24 Gy) as well as prophylactic intrathecal and per os MTX were studied for leukoencephalopathy by magnetic resonance (MR) imaging. All the patients were free from grave neuropsychiatric disturbances. The data were examined to elucidate the influential ones of five factors (patients' age, doses of intrathecal and per os MTX, dose of CRT, interval between treatment, and MR study) to develop LEP using multiple regression analysis. To compare the effect of moderate-dose MTX and prophylactic CRT on LEP to that of high-dose MTX alone, we conducted literature review.

RESULTS

Seven out of 38 patients (18%) developed LEP. From multiple regression analysis and partial correlation coefficients, the age and CRT dose seemed influential in the subsequent development of LEP. The incidence of LEP following treatment with moderate-dose MTX and prophylactic CRT appears to be less than that reported in the literature following treatment with intravenous high-dose MTX. However, even moderate-dose MTX in combination with CRT can result in a significant incidence of MR-detectable LEP, particularly in children 6 years of age or younger receiving 24 Gy.

CONCLUSION

Leukoencephalopathy was caused by moderate-dose MTX and prophylactic CRT in pediatric patients, probably less frequently than by high-dose MTX treatment alone. The influential factors were patient's age and CRT dose.

Effect of thyrotropin-releasing hormone on serum thyroid hormones: a study in the patients with untreated and treated Graves' disease and subacute thyroiditis

In order to investigate the extrapituitary action of TRH on the thyroid, serum T3, T4, and TSH levels after im administration of TRH were analyzed in 63 patients with untreated hyperthyroid Graves' disease, in 60 euthyroid patients with treated Graves' disease, in 8 patients with subacute thyroiditis, and in 140 healthy subjects. TRH administration in the healthy subjects resulted in a significant increase in serum T3 and T4 levels after 2 h. However, in the patients with untreated hyperthyroid Graves' disease, a significant decrease in serum T3 and T4 levels with undetectable TSH was found 2 h after TRH administration. In the patients with subacute thyroiditis, serum T3 levels also significantly decreased after TRH administration. When a decrease in serum T3 and T4 levels after TRH administration in the patients with hyperthyroid Graves' disease was analyzed in terms of thyroid microsomal antibody and thyroglobulin antibody, a decrease in serum T3 and T4 levels was largest in patients with thyroid microsomal antibody and thyroglobulin antibody. In contrast, an increase in serum T3 and T4 levels in response to TRH in the euthyroid patients with Graves' disease was largest in patients without thyroid autoantibodies. It is concluded that TRH acts directly on the thyroid to suppress the thyroid hormone secreting activity in the absence of circulating TSH and that thyroid autoantibodies affect thyroidal response after TRH administration.

Modulation of somatocardiac sympathetic reflexes mediated by opioid receptors at the spinal and brainstem level

Modulation of somatosympathetic reflexes at the spinal cord and the brainstem was studied by administering opioid receptor agonists into the intrathecal space of the lumbar spinal cord and into the subarachnoid space of the cisterna magna in rats anesthetized with alpha-chloralose and urethane. Somatocardiac sympathetic A- and C-reflexes were elicited by electrical stimulation of myelinated (A) and unmyelinated (C) afferent fibers of the tibial nerve, respectively. Intrathecal administration of the mu-opioid receptor agonist DAMGO selectively depressed the C-reflex in a dose-dependent manner (minimum effective dose 10 ng), whereas the intrathecal injection of the delta-opioid receptor agonist DPDPE and the kappa-opioid receptor agonist U-50,488H only at doses of 10 micrograms and 100 micrograms, respectively, led to a significant depression of the C-reflex. Injection of DAMGO into the cisterna magna enhanced both A- and C-reflexes in a dose-dependent manner (minimum effective dose 1 ng). The administration of neither DPDPE nor U-50,488H into the cisterna magna affected A- or C-reflexes. It is concluded that the activation of mu-opioid receptors is mainly or exclusively responsible for suppressing somatosympathetic C-reflexes at the spinal cord and for enhancing them at the brainstem.

[Efficacy of video thoracoscopic lung biopsy in diffuse lung diseases: comparison with open lung biopsy]

The efficacy and safety of video thoracoscopic lung biopsy (VTLB) and of open lung biopsy (OLB) were compared in patients with diffuse lung diseases. Thirty-three patients who had undergone VTLB were retrospectively studied and compared with 67 patients who had undergone OLB. There were no significant differences in age (52.8 +/- 10.9 vs 53.4 +/- 10.3), in the number of biopsies per patient (2.6 +/- 0.6 vs 2.7 +/- 0.6), or in the rate of diagnosis (94% vs 93%) between the two groups. However, the rate of diagnosis was low when the number of VTLB or OLB performed per patient was low. The patients undergoing VTLB had significantly shorter operative times (VTLB, 100.2 +/- 27.2 min. vs OLB, 119.8 +/- 42.6 min; p < 0.01) and less blood loss (VTLB, 4.7 +/- 14.6 ml vs OLB, 65.7 +/- 77.0 ml; p < 0.001). Complications occurred in 3 of the 33 who underwent VTLB, and in 18 of the 67 who underwent OLB. These results indicate that VTLB is an effective and safe alternative in the diagnosis of diffuse lung diseases.

[Serum phospholipase A2 activity in patients with aspirin-induced asthma]

Urinary excretion of leukotrienes is greater in patients with aspirin-induced asthma (AIA) than in other patients with asthma in remission, and is greater still during an aspirin-induced attack. We therefore hypothesized that increased phospholipase A2 (PLA2) activity leads to increased leukotriene synthesis when non-steroidal antiinflammatory drugs inhibit cyclooxygenase in patients with AIA, and that PLA2 activity increases further during an aspirin induced attack. To test this hypothesis, we measured the serum PLA2 activity in adult asthmatic patients, and compared the activity in those with AIA to the activity in those without AIA. The subjects were 43 patients with asthma in remission, 17 with AIA and 26 without AIA. Serum PLA2 activity was also measured before and after intravenous administration of lysine-aspirin in three patients with AIA and in one without AIA. Serum PLA2 activity was measured by radioimmunoassay. Serum PLA2 activity in patients with AIA, in those without AIA, and in healthy controls was 300.9 +/- 52.9, 294.4 +/- 65.3 and 171.7 +/- 41.8 pmol/ml/min, respectively. Serum PLA2 activity in asthmatic patients was significantly higher than in healthy controls (p < 0.01), but there was no difference between patients with and without AIA. Intravenous lysine-aspirin provoked asthmatic attacks in three patients with AIA. However, intravenous lysine-aspirin did not significantly change serum PLA2 activity in the three patients with AIA or in the patient without AIA. These results indicate that although PLA2 may be involved in the pathogenesis of bronchial asthma, it is not specific to AIA. Thus, the pathophysiology of AIA remains unclear and further investigation is needed.

The inhibitory role of nitric oxide (NO) in the somatocardiac sympathetic C-reflex in anesthetized rats

The role of nitric oxide (NO) in the two somatosympathetic reflex arcs, i.e. A- and C-reflexes, was examined using NO synthase (NOS) inhibitor in anesthetized rats. The A- and C-reflex components were recorded from a cardiac sympathetic efferent nerve and elicited by stimulation of myelinated A and unmyelinated C afferent fibers in the left tibial nerve. NG-nitro-L-arginine methyl ester (L-NAME), a NOS inhibitor, when administered by either intrathecal (i.t.) or into the cisterna magna (i.c.m.) routes, augmented only the C-reflex in a dose-dependent manner. The effective i.t. dose of L-NAME to augment the C-reflex was approximately 1000 times the i.c.m. dose. NG-nitro-D-arginine methyl ester (D-NAME), an isomer of L-NAME, had no effect on either A- or C-reflexes, when administered i.c.m. Neither i.c.m. pre-treatment nor post-treatment with L-arginine, a NOS substrate, influenced either A- or C-reflexes, but i.c.m. pre-treatment with L-arginine abolished the facilitatory effect of L-NAME on the C-reflex. These results suggest that NO, synthesized in the brain stem, plays an inhibitory role in the central modulation of the somatocardiac sympathetic C-reflex. The possibility of movement of L-NAME to the brain stem from the spinal cord is discussed.

Superoxide generation by alveolar macrophages from aged rats: improvement by in vitro treatment with IFN-gamma

Alveolar macrophages (AM) from aged rats show an impaired oxidative response, but it is unclear whether or not this is due to the inability of these cells to be activated. To elucidate this, we investigated the capacity of AM from young (16-week-old) and aged (100-week-old) rats to become primed with recombinant rat interferon-gamma (IFN-gamma) for increased phorbol myristate acetate (PMA)-elicited O2- production, utilizing an MCLA-dependent chemiluminescent assay. We also compared concanavalin A- or Bacillus Calmette Guerin (BCG)-induced IFN-gamma production by the spleen cells of young and aged animals. The data indicated that AM freshly harvested from non-sensitized aged rats produced less O2- than those from young animals. A similar result was obtained in BCG-sensitized rats. However, AM from aged rats were primed with in vitro treatment with IFN-gamma for increased rate of O2- production to an equivalent level of that by AM from young animals. In addition, the ability of spleen cells to produce IFN-gamma was well maintained in aged rats. These results suggest that AM function is suppressed in the lungs of aged animals. Our observation that the decreased AM function in aged rats can be reversed is important because it suggests that appropriate treatment may reduce the incidence and mortality of respiratory infections in the elderly.

Effect of 14-membered ring macrolide therapy on chronic respiratory tract infections and polymorphonuclear leukocyte activity

We studied the efficacy of the long-term administration of 14-membered ring macrolides in treating patients with diffuse panbronchiolitis (DPB) (34 patients) and bronchiectasis (BE) (40 patients). Oral administration of erythromycin (400 or 600 mg), roxithromycin (150 or 300 mg) or clarithromycin (200 or 400 mg) given daily for at least 2 months, was evaluated. The efficacy of erythromycin, roxithromycin, and clarithromycin in DPB was 19/24 (79%), 6/7 (86%), and 2/3 (67%), respectively. Efficacy of these agents in BE exceeded 50%. We determined the effect of these macrolides on the activity of polymophonuclear leukocytes (PMNs) obtained from healthy volunteers. There were no significant differences between the effects of these 14-membered ring macrolides and josamycin, a 16-membered ring macrolide which was previously found to be ineffective in treating DPB. Thus, the effectiveness of the 14-membered ring macrolides in treating DPB appears to depend on mechanism(s) other than alterations in PMN activity.

Somatocardiovascular reflexes in anesthetized rats with the central nervous system intact or acutely spinalized at the cervical level

The effects of noxious mechanical stimulation of various segmental areas on heart rate and mean arterial blood pressure (MAP), as well as cardiac and renal sympathetic nerve activities were examined in anesthetized rats with the central nervous system (CNS) intact or acutely spinalized at the cervical level. In CNS-intact rats, pinching for 20 s applied to any segmental skin area, but particularly that of the paw, produced an increase in heart rate, blood pressure and the sympathetic nerve activities. In acutely spinalized rats, pinching the chest, abdomen and back of the body produced large increases, while hindlimb and perineum stimulation induced only a small increase or no increase in heart rate, blood pressure and the sympathetic nerve activities. Stimulation of the right side produced particularly large responses in heart rate and stimulation of the ipsilateral side produced large responses in cardiac and renal sympathetic nerve activities in spinalized rats. These results suggest the existence of the two types of reflex responses, supraspinal and propriospinal, in the somatocardiovascular reflex. The supraspinal one has characteristics of diffuse reflex organization, while the propriospinal one has strong segmental and lateral organization.

Intracytoplasmic sperm injection using immobilized or motile human spermatozoon

OBJECTIVES

To investigate the efficacy of the treatments for oocyte activation on the results of intracytoplasmic sperm injection using immobilized or motile human spermatozoa.

DESIGN

The protocol of intracytoplasmic sperm injection was divided into four groups according to the states of sperm used for microinjection and the treatment for oocyte activation. In group A, immobilized sperm is used. The oocyte is activated merely by aspiration of the cytoplasm into the pipette. In group B, immobilized sperm is used. Microinjected oocyte is treated with A23187. In group C, immobilized sperm is used. Electroporation is performed on the microinjected oocyte. In group D, motile sperm is used. The oocyte is activated merely by aspiration of the cytoplasm into the pipette.

SETTING

The Obstetrics and Gynecology Hospital, Fukushima Medical College.

PATIENTS

The subjects are the cases that had failed fertilization in standard IVF, cases of severe oligozoospermia, and cases of severe asthenozoospermia.

RESULTS

No difference was found between the groups as to the survival rate and fertilizing rates of oocytes after intracytoplasmic sperm injection. The cleavage rate of oocytes was high in order of group D, C, B, A. The cleavage rate for groups D, C, and B was significantly higher than group A. Cases of pregnancy were found in groups D and B.

CONCLUSION

Using motile sperm rather than immobilized sperm can be expected to produce better results in human ICSI. Activating oocytes positively is needed when immobilized sperm is used.