[A comparative study of caregivers of the elderly with dementia between 1982 and 1991]

The purpose of this study is to clarify the changes of the caregivers'status with comparison of two cross-sectional studies. The subjects were 658 (primary, in 1982) and 705 (secondary, in 1991) group members of "The Association of Families Caring for Elderly Persons with Dementia". The summary of results are as follows: 1) The mean life span of a person suffering dementia was found to be longer in 1991 than 1992. 2) In 1991, about 30 percent of the patients in all age groups were hospitalized and about 70 percent of the patients were treated at home. These facts indicated that the medical facilities had expanded their capacities during the 9 year period for receiving the elderly with dementia. 3) Family members who wished to live independently supported the idea that care should be given by a decreased number of individuals within the family. In that sense, the family's power of caregiving was decreased. 4) The range of main caregivers' informal social-support-network was remarkably expanded. 5) The more the service were expanded, the more the service were utilized by the caregivers. However, the quality and the quantity of the services provided are still not sufficient to meet the caregivers' need. 6) In balance, the difficulties caregivers used to face, seemed to be decreased in 1991.

IL-6 cytokine family and signal transduction: a model of the cytokine system

The interleukin 6 (IL-6) cytokine family, which includes IL-6, leukemia inhibitory factor (LIF), oncostatin M (OSM), ciliary neurotrophic factor (CNTF), IL-11 and cardiotrophin-1 (CT-1), exhibits pleiotropy and redundancy in biological activities. The IL-6 family cytokines exhibit a helical structure. Their receptors belong to the type 1 cytokine receptor family. The receptors of the IL-6 family cytokines share a receptor subunit, which explains one of the mechanisms of functional redundancy. In this review, we describe the general features of the IL-6 cytokine family and its signal transduction mechanisms. Many functional properties of the IL-6 family of cytokines and their receptors are general features of the cytokine system.

Intraindividual variations in lipoprotein (a) levels and factors related to these changes

Lp(a) levels are genetically determined and remain stable without major changes throughout lives. However, when an individual's Lp(a) levels are observed over a one-year period, they show spontaneous variation. The rate of intraindividual variation in Lp(a) was observed in 16 patients with hypertension, hyperlipidemia and/or glucose intolerance in a chronic stable state who regularly visited the hospital clinic once a month, at least 10 times during the year, and in whom a total of 42 blood and clinical chemistry tests including serum lipids, Lp(a) and apoproteins were performed. The rate of annual intraindividual variation of Lp(a) averaged out as 16.6%. The rate was 18.8% for isoform S4 (n = 10), 18.6% for S3 (n = 3), and although small in number of subjects, other isoforms showed minor variation rates. There was a significant negative correlation between the rate of variation (y%) and LP(a) level (xmg/dl) r = -0.605, p < 0.05, y = -0.461 x +29.8). Therefore, when Lp(a) was high, the rate of variation (SD%) was low. This was consistent with the finding that the rates of variation were low for isoforms S2, S3S4 and F, whose molecular weights were low, accompanied by high Lp(a) levels. On the other hand, when the relationship between Lp(a) level and the amount of variation (SD mg/dl) was examined, there was no correlation between the two, since the amounts of variation were almost constant at a level of 3.8 mg/dl, regardless of Lp(a) level. The annual variation of Lp(a) level was found to be related to three groups of factors based on comparison of the variations among WHO phenotypes of hyperlipidemias, univariate correlation analysis with the clinical parameters tested, and multivariate analysis: the first group of factors was related to structure and metabolism of very low-density lipoprotein such as triglycerides, phospholipids, apo C-II, C-III, E, A-II and uric acid; the second group was related to thrombosis centering on platelets; and the third group involved those in the acute phase reactions represented by 1 hr and 2 hr erythrocyte sedimentation rates.

Impairment of regional fatty acid uptake in relation to wall motion and thallium-201 uptake in ischaemic but viable myocardium: assessment with iodine-123-labelled beta-methyl-branched fatty acid

In coronary artery disease, discrepancy in the uptake of thallium-201 and of methyl-branched fatty acid at rest has been described. The purpose of this study was to evaluate iodine-123 labelled beta-methyl-branched fatty acid (BMIPP) myocardial uptake and wall motion at rest in segments with stress-induced ischaemia identified by stress 201Tl tomography in patients with chronic coronary artery disease. 123I-BMIPP myocardial tomography was performed at rest and was compared with the findings of exercise-reinjection 201Tl tomography in 45 patients with chronic coronary artery disease. Regional wall motion was evaluated by contrast left ventriculography in 36 patients. Among 237 segments with reversible 201Tl defects, equally decreased uptake on both reinjection 201Tl and BMIPP images was observed in 93 (39%), more severely decreased uptake of BMIPP in 118 (50%) and more severely decreased uptake of reinjection 201Tl in 26 (11%). On the other hand, among 90 segments with non-reversible 201Tl defects, each pattern was observed in 71 (79%), 6 (7%) and 13 (14%) segments, respectively. When comparing the ischaemic segments with and without more severely reduced uptake of BMIPP than of reinjection 201Tl, wall motion was impaired to a greater extent in the segments with more severely reduced uptake of BMIPP than of reinjection 201Tl [severe hypo- or dyskinesis was present in 64 (70%) of 91 segments and in 24 (22%) of 110 segments, respectively, P<0.005]. In patients with chronic coronary artery disease, resting fatty acid uptake was frequently more reduced than reinjection 201Tl in the segments with stress-induced ischaemia, while in most of the fixed perfusion defects BMIPP and reinjection 201Tl uptake decreased concordantly. In ischaemic myocardium, wall motion was impaired to a greater extent in those segments which showed more severely reduced uptake of BMIPP than of reinjection 201Tl. In ischaemic but viable myocardium, discordant BMIPP uptake less than reinjection 201Tl uptake may indicate metabolic alterations and wall motion abnormality at rest independent of perfusion abnormalities. In conclusion, the combination of resting BMIPP and stress-reinjection 201Tl imaging may provide information on metabolic alterations and wall motion abnormality at rest independent of perfusion abnormalities.

Development of near-field optic/atomic force microscope for biological materials in aqueous solutions

This paper reports improvements of optical fiber cantilevers and the scanning near-field optical microscopy imaging of biological materials in liquid. In our scanning near-field optical/atomic-force microscope (SNOAM), the scanning of an optical fiber cantilever over the specimen was controlled by dynamic mode AFM to reduce damage to the probe and soft specimens. The typical resonant frequency of the optical fiber cantilever was 19.5 kHz, while it was 23.0 kHz in air. The Q-factor of the cantilever depended on the vibration amplitude and was typically 260-600 in air and 40-240 in water. The relationship between the vibration amplitude and the average sample-probe separation indicated that the cantilever worked in the non-contact mode in water, while it worked in the cyclic-contact mode in air. Cultured cells in aqueous solutions were visualized by the SNOAM, indicating that the SNOAM is suitable to observe soft specimens.

Laparoscopic mesenterioadhesiotomy and Tenckhoff catheter placement in patients with predisposing abdominal surgery

Peritoneoscopic surgery has been performed widely for a variety of abdominal surgical diseases. We describe here a safe and reliable technique of laparoscopic-assisted mesenterioadhesiotomy and peritoneal Tenckhoff catheter placement in patients who have previously undergone abdominal surgery. Five patients suffering from end-stage renal failure previously underwent single and/or polyabdominal surgery. The surgical procedures included hysterectomy, ovarian resection, appendectomy, and transabdominal right nephrectomy. Under general endotrachial anesthesia, a laparoscope was placed down through a direct cut made using a trocar. After CO2 gas insufflation, another one or two trocars were put in place for surgical procedures. To avoid intestinal injury, mesenterioadhesiotomy was performed carefully using a high-frequency hook electrode, forceps, and scissors forceps, and the Tenckhoff catheter was subsequently inserted with forceps directly into Douglas' fossa. Peritoneal equilibration tests performed 30-70 days after the initiation of continuous ambulatory peritoneal dialysis (CAPD) treatment revealed moderate to good peritoneal effectiveness. This procedure permits the surgeon to perform safe and exact catheter placement into Douglas' fossa even when there is a possibility that peritoneal and mesenterial adhesion are present. We believe that this technique of catheter placement may extend the indication for CAPD treatment in patients with predisposing lower abdominal surgery.

Analysis of influenza A virus reinfection in children in Japan during 1983-91

The epidemiology of influenza A in Japan was studied during 1979-91 and viruses isolated from reinfections during 1983-91 were analysed. Of 2963 influenza viruses isolated from reinfections during 1983-91 were analysed. Of 2963 influenza viruses isolated during this period, 922 and 1006 were influenza A(H1N1) and A(H3N2) viruses respectively; the others were influenza B viruses. Influenza A(H1N1) and A(H3N2) caused 5 and 6 epidemics respectively, most accompanied by antigenic drift. Seventeen reinfections with H1N1 and 17 with H3N2 were detected during our study. The primary and reinfection strains isolated from 7 H1N1 and 10 H3N2 cases were studied by haemagglutination-inhibition, and amino acid and nucleotide sequences of the HA1 region of the haemagglutinin. Most of the primary and reinfection strains were antigenically and genetically similar to the epidemic viruses circulating at that time. However, in 4 out of 10 cases of reinfection with influenza H3N2 virus, reinfection strains were genetically different from the epidemic viruses.

Radiofrequency capacitive hyperthermia combined with irradiation or chemotherapy for patients with invasive bladder cancers

To assess the immediate therapeutic clinical efficacy and long-term outcome, hyperthermia in combination with irradiation or chemotherapeutic agent was used in 46 patients with invasive bladder cancer. Radiohyperthermia (RH) was employed in 19 cases and chemohyperthermia (CH) in 27 cases. Complete response (CR) was obtained in 5 and partial response (PR) in 15 of the 46 cases. One-year survival rates by the Kaplan-Meier method were 65.0% in the CR/PR group and 46.2% in the no change (NC)/progressive disease (PD) group. Five-year survival rates were 43.8% and 18.3%, showing no difference in survival rate between the CR/PR group and the NC/PD group The overall median survival period for the CR/PR group without metastasis was 61.6 months compared to 32.3 months for the NC/PD group without metastasis (P < 0.05).

Utility of iodine-123-BMIPP in the diagnosis and follow-up of vasospastic angina

Myocardial damage caused by vasospastic angina (VSA) may be detected by [123I]BMIPP, a beta-methyl-branched fatty acid. We investigated whether BMIPP could be used in the diagnosis and follow-up of patients with VSA.

METHODS

Thirty-two patients with VSA were studied with resting BMIPP-SPECT in comparison to stress perfusion imaging with either 201Tl or 99mTc-MIBI. During coronary arteriography, spasm was induced by provocative testing with acetylcholine or ergonovine, and only total or subtotal occlusion was considered positive. Decreased BMIPP uptake was semiquantitatively evaluated segmentally aided by polar map display.

RESULTS

Reduced BMIPP uptake was observed in 25 of 32 patients (78%), with complete or partial agreement between the BMIPP abnormality and coronary territory seen in 23 patients (72%). In contrast, a perfusion abnormality was seen in only 10 patients (31%). In the repeat BMIPP study (n = 23) during the follow-up period (average 206 days), 11 of 14 patients who showed BMIPP improvement also had improved angina attacks. Conversely, two of nine patients with nonimproved BMIPP showed improved symptoms (p < 0.05).

CONCLUSION

BMIPP can detect myocardial injury associated with VSA and may be useful in monitoring response to treatment.

Comparison of 99Tcm-sestamibi and 201Tl-chloride to estimate right ventricular overload in children

To evaluate right ventricular overload in paediatric patients with congenital cardiac disease (n = 25), the uptakes of 201Tl and 99Tcm-sestamibi (99Tcm-MIBI) were compared. 99Tcm-MIBI showed a clearer myocardial border and better contrast between the myocardium and ventricular cavity. Although hepatic activity may influence right ventricular myocardial activity, it did not have a significant effect on the quantitative data of myocardial uptake. The right ventricle-to-background (RV/BG) ratio and left ventricle-to-background (LV/BG) ratio were lower with 99Tcm-MIBI than with 201Tl, and the RV/LV count ratio was also significantly lower in the 99Tcm-MIBI study. The parameters of the RV/LV count ratios showed good correlations between the 201Tl and 99Tcm-MIBI studies. The RV/LV pressure ratio was estimated using the formula: RV/LV pressure ratio = 0.99 (RV/LVav) + 0.02 (R = 0.90, P < 0.0001). To estimate RV overload or the RV/LV pressure ratio scintigraphically, we conclude that 99Tcm-MIBI be used instead of 201Tl. 99Tcm-MIBI studies are a good adjunct to perfusion studies when estimating RV pressure.

Effect of temporary occlusion of the hepatic vein on dual blood in the liver: evaluation with spiral CT

PURPOSE

To evaluate the contribution of hepatic veins to the dual blood supply in the liver under temporary hepatic venous occlusion.

MATERIALS AND METHODS

Selected hepatic veins in 23 patients with liver tumors were temporarily occluded with a balloon catheter. Computed tomography (CT) arteriography, CT during arterial portography (CTAP), or both were performed with a spiral technique with and without temporary occlusion of a hepatic vein.

RESULTS

After hepatic vein occlusion, a well-demarcated, wedge-shaped area of hypoattenuation was seen at CTAP and/or hyperattenuation was seen at CT arteriography in the following regions: left lobe (left hepatic vein), ventral part of the anterior segment and the medial segment except for the ventromedial part (middle hepatic vein), dorsal part of the anterior segment and the ventral part of the posterior segment (right hepatic vein), and dorsocaudal part of the right lobe (inferior right hepatic veins).

CONCLUSION

After hepatic venous occlusion, the portal veins become draining veins and the occluded area is supplied with arterial blood alone.

[Remnant-like particles-cholesterol (RLP-C) assay and its clinical application to lipid tests in a postprandial as well as fasting state]

It was during the past few years that postprandial hyperlipidemia is believed to be more closely related to a risk for coronary artery disease. However, the high variability in the postprandial triglyceride (TG) levels could have made overlooked such diagnostic value in estimating an individual's risk for coronary artery disease. To minimize the impact of such variability, the remnant lipoproteins, TG-rich lipoproteins, might be measured in cholesterol using remnant-like particles (RLP-C) assay as a more reliable marker. In place of the previous cholesterol reagent (CHOD-Iodine) in RLP-C assay, the RLP-C assay was improved by employing a new cholesterol reagent (POD-EMSE). The correlation between these two assays was high (r = 0.978). The variations in RLP-C levels in healthy normolipidemic subjects was within 7.5mg/dl in a day. In oral-fat loading test, the variations of RLP-C levels in healthy subjects were also within 7.5mg/dl. However, patients with coronary artery disease showed much higher levels (over 7.5mg/dl) of RLP-C during the test. In conclusion the RLP-C assay can be used for the measurement of remnant lipoproteins in serum prepared from the fasting as well as postprandial states for predicting subjects who may be at risk of coronary artery disease.

ERM, a PEA3 subfamily of Ets transcription factors, can cooperate with c-Jun

A human cDNA clone for ERM, a member of the ets gene family, has been obtained by polymerase chain reaction with degenerate primers corresponding to highly conserved regions within an Ets DNA binding domain. ERM mRNA is expressed ubiquitously. The gene was mapped to chromosome 3q27. In in vivo transient-expression assays, ERM induced transcription more efficiently from a synthetic element containing both an ets-binding site (EBS) and a cyclic AMP response element (CRE) than from one containing an EBS alone. The activation of a synthetic EBS-CRE site by ERM was likely to involve a leucine zipper protein capable of dimerizing with CRE-BP1 leucine zipper. Indeed, ERM and c-Jun synergistically activated the EBS-CRE without making an apparent ternary complex. The synergy between c-Jun and ERM may be attributed to the enhancing effect of c-Jun on the transcription activity of ERM, because c-Jun increased ERM transcription activity by more than 20-fold in an assay system using a variety of fusion proteins between a Gal4 DNA-binding domain and a portion of ERM. This enhancing effect of c-Jun required the amino-terminal portion of ERM.

Body stalk anomaly: prenatal diagnosis

Body stalk anomaly is a severe body wall defect, with maldevelopment of the hindgut and the presence of a very rudimentary umbilical cord. A case of prenatally-diagnosed body stalk anomaly is presented along with the discussion of the prenatal diagnosis and its management. Autopsy of the fetus showed abnormalities compatible with the maldevelopment of embryonic body folding. Prenatal ultrasonographic diagnosis of body stalk anomaly would permit the early termination of pregnancy or avoidance of surgical intervention.

Hemorheological and hemodynamic analysis of hypervolemic hemodilution therapy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage

BACKGROUND AND PURPOSE

Hypervolemic hemodilution therapy is effective for treating neurological deficits due to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). We monitored various hemorheological and hemodynamic parameters to assess the effects of hypervolemic hemodilution therapy in SAH patients with cerebral vasospasm.

METHODS

Ninety-eight patients who underwent early craniotomy for aneurysm clipping surgery after SAH were studied. Fifty-one patients (52.0%) developed symptomatic vasospasm. The hematocrit level and red blood cell aggregability were measured daily from day 1 to day 14, whereas the circulating blood volume and cerebral blood flow were measured periodically. Cardiac output and pulmonary capillary wedge pressure were also measured using a Swan-Ganz catheter.

RESULTS

The hematocrit level was decreased significantly to 29% to 32% by hypervolemic hemodilution therapy. Red blood cell aggregability increased until day 6 but was significantly reduced by therapy. Hypovolemia tended to develop after SAH. However, patients receiving hypervolemic hemodilution therapy became normovolemic to hypervolemic, with a significant increase of cardiac output and pulmonary capillary wedge pressure. At the onset of vasospasm, cerebral blood flow was significantly lower on the operated side than on the contralateral side, and it increased on both sides with therapy.

CONCLUSIONS

Patients with SAH develop hypovolemia, hemodynamic depression, and increased red blood cell aggregability. Hypervolemic hemodilution therapy decreases hematocrit level and red cell aggregability while increasing cardiac output. Improvement of hemorheological and hemodynamic parameters by this therapy can reverse neurological deterioration due to cerebral vasospasm.

Characteristics and clinical significance of a stabilization assay to detect specific antibodies to reverse transcriptase of human immunodeficiency virus

Antibodies against reverse transcriptase (RT) of human immunodeficiency virus type 1 (HIV-1) have been detected in seropositive subjects by immunoprecipitation, Western immunoblotting, and neutralization assay. Recently, we noticed that the antibodies against RT stabilized RT upon heat inactivation, and we have developed a stabilization assay of RT antibody. Briefly, the RT of HIV-1 is completely inactivated by incubation at 56 degrees C for 20 min, but this inactivation is inhibited in the presence of a specific antibody directed against this molecule. We examined the specificity and clinical significance of this stabilization assay. HIV-1 antibody-positive sera stabilized HIV-1 RT but not HIV-2 RT, whereas half of these sera cross-neutralized HIV-2 RT. Antibody titers against RT determined by the neutralization assay and the stabilization assay were compared with clinical characteristics. Antibodies against HIV-1 RT were much more frequently detected by the stabilization assay than by the neutralization assay. Statistically significant associations were found between stabilizing antibody titer and CD4+ cell number in peripheral blood of patients and also between antibody titer and CD4+/CD8+ ratios. These results indicate that our new stabilization assay to detect specific antibodies against RT of HIV-1 is useful as a clinical marker of infection and progress of the disease.

Effects of lansoprazole on pharmacokinetics and metabolism of theophylline

The effect of the new substituted benzimidizole proton pump inhibitor, lansoprazole, on pharmacokinetics and metabolism of theophylline has been studied in healthy adults given oral lansoprazole 30 mg once daily for 11 days. On Days 4 and 11 of 300 mg aminophylline was simultaneously administered orally and blood samples for theophylline analysis were taken over 24 h. Urine samples were collected for up to 24 h and were assayed for theophylline and its major metabolites 1,3-dimethyluric acid (1,3-DMU), 1-methyluric acid (1-MU) and 3-methylxanthine (3-MX). The pharmacokinetic parameters of theophylline were determined, and the urinary recovery of unchanged theophylline and its major metabolites were calculated. After administration of lansoprazole for 4 days, no significant alteration in the terminal elimination half-life (t1/2beta) or the mean resistance time (MRT) was detected. However, there was a significant decrease of about 13% in the area under the plasma concentration-time curve (AUC) and a significant increase of about 19% in the apparent clearance (CLapp). Lansoprazole treatment for 11 days caused a significant decrease of approximately 12% in t1/2beta and about 10% in the MRT of theophylline, although neither AUC nor CLapp showed a significant alteration. The excretion of 3-MX in the urine was significantly increased by about 20% after lansoprazole treatment for 4 and 11 days, although there was no significant alteration in the excretion of unchanged theophylline, 1,3-DMU or 1-MU. The results indicate that repeated administration of lansoprazole to humans induces the hepatic microsomal P-450-dependent drug oxidation system that mediates N-1-demethylation of theophylline, consequently increasing its metabolism.

[Effect of scatter correction on quantification of myocardial SPECT and application to dual-energy acquisition using triple-energy window method]

Triple-energy window (TEW) method is a simple and practical approach for correcting Compton scatter in single-photon emission tracer studies. The fraction of scatter correction, with a point source or 30 ml-syringe placed under the camera, was measured by the TEW method. The scatter fraction was 55% for 201Tl, 29% for 99mTc, 57% for 123I. Composite energy spectra were generated and separated by the TEW method. Combination of 99mTc and 201Tl was separated well, and 201Tl and 123I were separated within an error of 10%; whereas asymmetric photopeak energy window was necessary for separating 123I and 99mTc. By applying this method to myocardial SPECT study, the effect of scatter elimination was investigated in each myocardial wall by polar may and profile curve analysis. The effect of scatter was higher in the septum and the inferior wall. The count ratio relative to the anterior wall including scatter was 9% higher in 123I, 7-8% higher in 99mTc and 6% higher in 201Tl. Apparent count loss after scatter correction was 30% for 123I, 13% for 99mTc and 38% for 201Tl. Image contrast, as defined myocardium-to-left ventricular cavity count ratio, improved by scatter correction. Since the influence of Compton scatter was significant in cardiac planar and SPECT studies; the degree of scatter fraction should be kept in mind both in quantification and visual interpretation.

Calcitonin-like polypeptides without apparent biological activity in a patient with recurrent medullary thyroid carcinoma

A 51-year-old male with a recurrent medullary thyroid carcinoma (MTC) showed high serum levels of calcitonin (CT) and carcinoembryonic antigen (CEA) but with concomitant normocalcemia. The CT activities of the patient's serum in vivo (hypocalcemic activity in rats) and in vitro (cyclic AMP-increasing activity in cultured human mammary tumor, T47D) were much lower than those expected from the patient's CT level. High performance liquid chromatography (HPLC) with radioimmunoassay (RIA) detection gave a broad spectrum of molecular weights of CT-like polypeptides in the 3 kDa to 200 kDa range with separation from CEA, suggesting that the mechanism for CT production in MTC is an obscure one.

Radiofrequency capacitive hyperthermia combined with irradiation or chemotherapy for patients with invasive bladder-cancer

The immediate therapeutic clinical efficacy and long-term outcome of hyperthermia in combination with irradiation or chemotherapeutic agent was evaluated in 46 patients with invasive bladder cancer. Radiohyperthermia was performed in 19 cases and chemohyperthermia in 27 cases. Complete response (CR) was obtained in 5 and partial response (PR) in 15 of the 46 cases. Five-year survival rates by the Kaplan-Meier method were 43.8% in the CR/PR group and 18.3% in the no change (NC)/progressive disease (PD) group, showing no difference of survival rate between the CR/PR group and the NC/PD group. The overall median survival period for the CR/PR group without metastasis was 61.6 months compared to 32.3 months for the NC/PD group without metastasis (P<0.05).