[Complete eradication by endoscopic injection sclerotherapy reduces the recurrence of esophageal varices]

Endoscopic intravariceal injection sclerotherapy (EIS) using sclerosant mixed with contrast medium was done in 100 patients without hepatocellular carcinoma. They were followed longer than 12 months (mean; 58 +/- 29 months) after EIS. The recurrence rate of esophageal varices in cases with complete eradication (n = 79) and cases with incomplete eradication of (n = 21) was 8.9% and 85.7%, respectively (p < 0.01). In 21 cases, complete eradication was achieved by intravariceal injection and additional therapy using paravariceal injection was not performed. The recurrence rate of this group was only 4.8%. Endoscopic varicealography during injection sclerotherapy were evaluated in 91 cases. At final session of EIS, narrowing of diameter (less than 1 mm) and irregularity of vessel walls were observed in small vessels (devastated vessels). Appearance rate of devastated vessel in 75 cases with completely eradicated esophageal varices was 65.3%. In contrast, among 16 cases with incomplete eradication of varices, devastated vessels were seen only in 6.3% (p < 0.01). It is concluded that the important point in preventing the recurrence of esophageal varices after EIS was the complete eradication of esophageal varices by intravariceal injection sclerotherapy resulting in the eradication of the routes to esophageal varices from port-splenic venous system. For the sake of accomplishment of this treatment, appearance of devastated vessel is very useful.

[A case of recurrent breast cancer responding to combination therapy with mitoxantrone (MIT), 5'-deoxy-5-fluorouridine (5'-DFUR) and medroxyprogesterone acetate (MPA)]

The patient was a 50-year-old woman who had undergone left standard radical mastectomy who had undergone left standard radical mastectomy on June 1, 1986. She showed multiple liver metastases with elevation of CEA level in July, 1991, and 5'-DFUR plus MPA combination therapy was started. The daily dosages were: 800 mg/body and 1,200 mg/body, respectively. After intra-arterial infusion of pirarubicin and Lipiodol, bilateral oophorectomy was performed and an implantable reservoir for intra-arterial infusion chemotherapy was implanted via the proper hepatic artery. Then she was treated by arterial-infusion of mitoxantrone 10mg/body intermittently every two weeks. The metastatic foci responded to this therapy and her CEA level decreased.

[Factors related to demand for cancer mass screening]

The demand for cancer mass screening was studied by a survey conducted in a city of Gifu Prefecture using a mailed self-administered questionnaire. Subjects (n = 300) were randomly selected by age groups from among residents aged 40 years or over, and the response rate was 65.1% (n = 192). Eight subjects were excluded from analysis because of missing data. The demand for mass screening was much lower in both sexes in the age groups 70 years old or over (stomach: 51.6%, lung: 45.2%, colon: 41.9%) than in younger age groups (stomach: 85.8%, lung: 77.8%, colon: 80.8%). Demand level of housewives and persons without regular occupation were lower than those in other occupational groups. Persons with prior experience of receiving screening at their work-site had higher demand for screening than others. A multivariate analysis of screening for stomach cancer showed that prior experience of screening is the most important factor predicting demand for the next screening.

Risk analysis of carcinogenesis in the remnant stomach with measurement of ornithine decarboxylase activity

Gastric ornithine decarboxylase (ODC) activity was measured as a biomarker of tumor-promoting activity in the remnant stomach of rats and humans. Gastrectomy of Wistar rats utilizing the Billroth I method caused a significantly high induction of ODC, and use of the Billroth II method caused a significantly higher induction of ODC than the Billroth I method. In humans, ODC activity of remnant gastric cancer tissue, normal-appearing mucosa of remnant gastric cancer patient, and remnant gastric mucosa without cancer after the Billroth II method were significantly higher than that of normal gastric mucosa without gastrectomy. ODC activity of remnant gastric mucosa without cancer after the Billroth II method was significantly higher than that after the Billroth I method. Risk of carcinogenesis was high in the remnant stomach, especially after the Billroth II method.

Identification of the lipopolysaccharide core region as the receptor site for a cytotoxin-converting phage, phi CTX, of Pseudomonas aeruginosa

A temperate phage, phi CTX, is a cytotoxin-converting phage of Pseudomonas aeruginosa. In this study, we characterized the lipopolysaccharide (LPS) structures of phi CTX-resistant mutants derived from phi CTX-sensitive strains. phi CTX infectivity was neutralized by LPS preparations derived from sensitive strains but not by those from resistant strains. phi CTX-resistant mutants had lower-molecular-weight rough (R)-type LPS than the parental strains and lacked the reactivity of some anti-LPS core monoclonal antibodies. Some LPS core components were lacking or significantly decreased in the resistant mutants. These results suggested that a receptor site of the cytotoxin-converting phage phi CTX was the LPS core region and that especially L-rhamnose and D-glucose residues in the outer core were involved in phage binding. The host range of phi CTX was nearly O-serotype dependent, probably because of the diversity of the LPS core structure among P. aeruginosa strains. phi CTX bound to most strains of Homma serotypes A, G, and I but not to strains of serotypes B and E. Furthermore, we found that a genetic locus specifying phi CTX sensitivity (and consequently participating in the biosynthesis of part of the LPS core) existed in or near the locus participating in the determination of O-serotype specificity (somA), which has been mapped between leu-10 and eda-9001. phi CTX, as well as anti-LPS core monoclonal antibodies, will be a good tool for structural characterization of the P. aeruginosa LPS core region.

Identification and characterization of IL-2 hyper-responsive NZB/WF1 CD5- B cells

The responsiveness of CD5- and CD5+ B cells of BALB/c and NZB/WF1 mice to various cytokines was examined with respect to their growth and differentiation. BALB/c splenic CD5- B cells required longer incubation with IL-2 or pretreatment with IL-4 to respond to IL-2 by DNA synthesis, whereas NZB/WF1 CD5- B cells were highly competent to IL-2. Flow cytometric analysis demonstrated that NZB/WF1 and BALB/c CD5- B cells had higher and intermediate proportions of B cells positive for IL-2R beta, respectively. On the other hand, BALB/c and NZB/WF1 splenic CD5+ B cells consisted of lower proportion of B cells positive for IL-2R beta than did their corresponding CD5- B cells and grew meagerly in response to IL-2. Peritoneal exudative CD5+ B cells of NZB/WF1 mice lacked IL-2R beta mRNA expression and failed to respond to IL-2. Although both BALB/c and NZB/WF1 CD5- B cells pretreated with anti-IgM, IL-4, and IL-5 responded to IL-2 by DNA synthesis, only BALB/c CD5- B cells developed into IgM-producing cells. Furthermore, BALB/c, but not NZB/WF1 CD5-, B cells pretreated with anti-IgM and IL-5 responded to IL-2 by IgM production without DNA synthesis. Thus, cross-talk between IL-4 and IL-2 operated in the growth responses of both BALB/c and NZB/WF1 splenic CD5- B cells, whereas cross-talk between IL-5 and IL-2 operated only in the differentiation of BALB/c CD5- B cells, providing us with another intriguing functional abnormality of NZB/WF1 B cells.

Identification and characterization of IL-2 hyper-responsive NZB/WF1 CD5- B cells

The responsiveness of CD5- and CD5+ B cells of BALB/c and NZB/WF1 mice to various cytokines was examined with respect to their growth and differentiation. BALB/c splenic CD5- B cells required longer incubation with IL-2 or pretreatment with IL-4 to respond to IL-2 by DNA synthesis, whereas NZB/WF1 CD5- B cells were highly competent to IL-2. Flow cytometric analysis demonstrated that NZB/WF1 and BALB/c CD5- B cells had higher and intermediate proportions of B cells positive for IL-2R beta, respectively. On the other hand, BALB/c and NZB/WF1 splenic CD5+ B cells consisted of lower proportion of B cells positive for IL-2R beta than did their corresponding CD5- B cells and grew meagerly in response to IL-2. Peritoneal exudative CD5+ B cells of NZB/WF1 mice lacked IL-2R beta mRNA expression and failed to respond to IL-2. Although both BALB/c and NZB/WF1 CD5- B cells pretreated with anti-IgM, IL-4, and IL-5 responded to IL-2 by DNA synthesis, only BALB/c CD5- B cells developed into IgM-producing cells. Furthermore, BALB/c, but not NZB/WF1 CD5-, B cells pretreated with anti-IgM and IL-5 responded to IL-2 by IgM production without DNA synthesis. Thus, cross-talk between IL-4 and IL-2 operated in the growth responses of both BALB/c and NZB/WF1 splenic CD5- B cells, whereas cross-talk between IL-5 and IL-2 operated only in the differentiation of BALB/c CD5- B cells, providing us with another intriguing functional abnormality of NZB/WF1 B cells.

Biosynthesis of human endothelins in transformants expressing cDNAs for human prepro-endothelins

To understand the biosynthesis of the human ET family, three kinds of cloned cDNA for human prepro-endothelin-1 (prepro-ET-1), prepro-ET-2, and prepro-ET-3 were stably expressed in Chinese hamster ovary cells (CHO-K1). Immunoreactive (ir-) ET polypeptides in the culture media of the transformants were purified by reverse-phase high-performance liquid chromatography (HPLC) coupled with sandwich-type enzyme immunoassay (EIA). Amino acid sequencing and FAB mass spectrometry of the purified ir-ET polypeptides revealed the presence of human big ET-1 (1-38), big ET-2 (1-38), and big ET-3 (1-41)NH2 as intermediate forms. These results directly revealed the biosynthetic pathways of three human ETs at the peptide level.

Characteristics of anemia in patients with nephrotic syndrome

Primary nephrotic syndrome can, although infrequently, cause severe anemia. However, the mechanisms of the anemia remain unknown. We investigated the mechanism of anemia in nephrotic syndrome by measuring parameters of nephrotic syndrome and anemia in 44 nephrotic patients (male: female; 21:23, average age; 43.6 +/- 20.3 years). Nephrotic patients had significantly lower hematocrits than did healthy controls (43.3 +/- 3.7 vs. 46.8 +/- 3.4% in males, 37.4 +/- 3.5 vs. 40.8 +/- 2.8% in females). Serum erythropoietin (Epo) concentrations were correlated inversely with hemoglobin (Hb), hematocrit (Hct), and red blood cell corpuscle (RBC) counts. Furthermore, serum Epo correlated with the serum iron concentration, but not with the other parameters, such as reticulocytes, serum protein and proteinuria. However, the maximum Epo concentration was less than 100 mU/ml in spite of severe anemia, and this was thought to be inappropriate. On the contrary, urine Epo was not detected by the same method of serum Epo determination in spite of aggressive dialysis with distilled water. When four patients with severe anemia were subcutaneously administered recombinant Epo 6,000 unit two times a week, they showed marked improvement in Hb/Hct/RBC. The precise mechanism of anemia in NS was not elucidated by this investigation, but further study should clarify the causes of the inappropriately low concentration of serum Epo in patients with primary nephrotic syndrome.

[Treatment modalities and hypothalamo-pituitary-adrenal (HPA) axis suppression in Japanese patients with asthma]

We examined HPA axis function using a short tetracosactrin test in 94 asthmatics treated with three different modalities. The first group, (B + S), consisted of 41 patients taking BDP (910 +/- 320 micrograms, daily) plus a short term burst of oral steroids (20-40 mg daily, 3-7 days/course, 1-18 courses/year). The second group, (B + R), consisted of 19 patients taking BDP (1076 +/- 410 micrograms, daily) plus continuous oral steroids (2.5-20 mg/day for 1.8-24 years). The third group, (B alone), consisted of 34 patients taking BDP only (615 +/- 258 micrograms, daily). All patients had been inhaling BDP for more than 1 year. The rise in cortisol in response to tetracosactrin in B + S, B + R, and B alone was 12 +/- 4.3 micrograms/dl, 7.0 +/- 5.0 micrograms/dl and 14 +/- 4.5 micrograms/dl, respectively, and achieved cortisol was 21 +/- 4.5 micrograms/dl, 12 +/- 7.2 micrograms/dl and 23 +/- 4.2 micrograms/dl;, respectively. Both values were significantly lower in the B + R group than in either B + S or B alone. However, there was no difference between B + S and B alone, although the BDP dose was significantly larger in the B + S group. Significant HPA axis suppression (rise in cortisol < 7 micrograms/dl and achieved cortisol < 18 micrograms/dl) was seen in 7 patients. Although HPA axis suppression was more frequently seen in B + R (10/19), no significant difference was seen between B + S and B alone (4/41 and 1/34, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of oesophageal and forestomach carcinomas in rats by reflux of duodenal contents

A study was designed to determine whether oesophageal carcinomas can be induced through reflux of duodenal contents. Male Wistar rats weighing 230-250 g were divided into three groups according to the surgical procedure performed: (1) the duodenal contents were directed into the forestomach through a stoma (duodeno-forestomach reflux); (2) the duodenal contents were regurgitated into the forestomach through the glandular stomach (duodeno-glandular-forestomach reflux); and (3) a sham operation was performed as a control. Animals were fed standard CRF-1 solid food and tap water that was not exposed to carcinogens and were sacrificed 50 weeks post-operatively. While no neoplasia was observed in any of the 32 control rats, 4/11 (36%) with duodeno-forestomach reflux and 3/18 (17%) animals with duodeno-glandular-forestomach reflux developed carcinomas in the lower oesophagus and forestomach. The incidence in each group was significantly higher than in the controls (P < 0.01 and P < 0.05 respectively). Six of the seven lesions consisted of squamous cell carcinomas, and one was a mucinous adenocarcinoma. Oesophageal columnar epithelial metaplasia was observed in two (18%) of the animals with duodeno-forestomach reflux. Carcinomas were always surrounded by chronic inflammatory changes, including regenerative thickening, basal cell hyperplasia and dysplasia. Additional well-differentiated adenocarcinomas were observed in the prepyloric antrum of 6/18 (33%) animals with duodeno-glandular-forestomach reflux. These findings indicate that chronic reflux of duodenal contents may cause oesophageal carcinoma.

Inositol trisphosphate and energy-force coupling in rabbit aorta

Five-minute exposures of aortic smooth muscle to 15 microM norepinephrine (NOR) under normoxia resulted in significant increases in inositol 1,4,5-trisphosphate [Ins(1,4,5)P3] (152%), inositol 1,4-bisphosphate [Ins(1,4)P2] (171%) and inositol 4-phosphate [Ins(4)P] (203%) contents compared with values measured in unstimulated muscle but no changes in inositol 1,3,4-trisphosphate [Ins(1,3,4)P3], inositol 1,3,4,5-tetrakisphosphate [Ins(1,3,4,5)P4] inositol 1/3-phosphate [Ins(1/3)P] or inositol 1,3/3,4-bisphosphate [Ins(1,3/3,4)P2] contents. Increases in Ins (1,4,5)P3 content and the contents of its by-products persisted or increased for at least 20 min of NOR exposure during normoxia. After a rapid decrease in Po2 at 5 min of NOR exposure, there were parallel decreases in Ins(1,4,5)P3 and Ins(1,4)P2 contents and in force. Ins(1,4,5)P3 and Ins(1,4)P2 contents were significantly decreased to 85 +/- 4.3% and 70 +/- 9.4% of control, respectively, at a time just after onset of relaxation. At near-maximal relaxation, Ins(1,4,5)P3 and Ins(1,4)P2 contents were decreased to 36.5 +/- 5.8% and 59.2 +/- 16.8%, respectively, of control normoxia values (P < .05). After readmission of O2 to the bubbling gas, Ins(1,4,5)P3 and Ins(1,4)P2 contents rapidly increased. Comparing decreased PO2-evoked [PCr] and [ATP] (phosphocreatine and adenosine triphosphate) decrements (measured previously; Coburn et al., 1992) with our present data, threshold [PCr] and [ATP] for a decrease in Ins(1,4,5)P3 content were shown to be 0.5 and 0.8 mM, respectively, and [PCr] and [ATP] at the time of 50% decrease in Ins(1,4,5)P3 content were 0.3 and 0.7 mM, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of ultraviolet C on in vitro nucleosome assembly and stability

The effects of ultraviolet C (UVC) irradiation on nucleosome assembly and its stability were investigated quantitatively using an in vitro nucleosome assembly system comprising a plasmid DNA of pBR322 and core histones isolated from rat ascites hepatoma cells. Nucleosomal formation was estimated by analyzing the resulting DNA supercoils. When UVC-irradiated (3000 J/m2) DNA was used as a substrate for the nucleosome assembly system, the nucleosomal formation efficiency was reduced by half compared with nonirradiated DNA. On the other hand, when the reconstituted nucleosomes (minichromosomes) on the nonirradiated DNA were irradiated with UVC (3000 J/m2), about half each were disrupted and retained. These results indicate that it is difficult for UV-damaged DNA regions to supercoil around the histone octamers to form nucleosomes and that the histone octamers in the UV-damaged nucleosomes tend to be dissociated from DNA.

Reflection-grating self-pumped phase conjugation with optical feedback free of input conditions

A reflection-grating self-pumped phase-conjugate mirror is demonstrated with a photorefractive KNbO(3) crystal in a novel ring configuration. The feedback beam in the ring configuration is made to track the input probe beam automatically so that the phase conjugation is sustained without readjustment of the optical feedback loop when the angle or the position of the input probe beam is changed. The tracking feedback is realized by means of a simple three-lens erect imaging system. The angular and the positional acceptances for a tightly focused input beam of 50-µm diameter are Δθ(x). = 55 mrad, Δθ(y), = 67 mrad, and Δ(x) = 2.1 mm, Δ(y) = 4.2 mm, respectively.

Experimental study of bioactive polyurethane sponge as an artificial trachea

An artificial trachea that has tissue reconstructive activity and elasticity that matches a biologic trachea was fabricated using a polyurethane sponge (PS). The inner surfaces of the PS were modified by immobilizing collagen, fibronectin, RGD peptide, a coating of collagen, and apatite. Two PS pore sizes were prepared, 150 to 350 microns (small pore) and 350 to 710 microns (large pore). When they were implanted in the subcutaneous tissue of rats, study of the implantation showed severe inflammatory cell infiltration with the treated PS, especially with collagen and collagen coating. Infiltration and maturity of fibroblasts inside the PS were noted with fibronectin. Infiltration of inflammatory cells and fibroblasts was noted with small pore PS compared with large pore PS. Partial tracheal defects were patched with PS. Better epithelization of PS patches was observed with fibronectin and apatite compared with the others. The artificial trachea made of PS was transplanted into the tracheas of dogs. No separation of the anastomosis and tissue reconstruction of the artificial trachea wall were observed; however, sputum absorption and tracheal granulation were seen.

[Pregnancy and delivery in patients with lupus nephritis]

To investigate some of the problems associated with pregnancy and delivery in lupus nephritis, 13 pregnancies in 7 patients with inactive lupus nephritis and 5 pregnancies in one patient with primary antiphospholipid syndrome (PAPS) were compared with 36 pregnancies in 22 patients with primary nephrotic syndrome (NS). Furthermore, a follow-up survey during 0-8 years was made with 12 babies born to mothers with lupus nephritis. Some pregnancies during lupus nephritis were accompanied by disease exacerbation and worsening of renal function. There was a higher incidence of babies born with a low birth weight, and the incidences of fetal loss or premature birth and toxemia were higher in lupus nephritis than in NS. The number of babies with a low birth weight was significantly higher in patients with pregnancy-induced hypertension or skin lesion due to lupus erythematosus. The presence of antibodies against SSA/RO in the mother was associated with the occurrence of congenital heart block. Birth weight of babies born to mothers with lupus nephritis was low, but there were no statistical differences in the growth of babies after 6 months of age compared with babies born to normal women.

[Identification of an unusual stabbing weapon based on the shape of injuries of the kidney and humerus]

The body of a 38-year-old man was found buried. The first step of the discovery was an anonymous telephone call. The body had 5 stab wounds (3 in the back, 1 in the left upper arm and 1 in the right leg). The cause of death was considered to be loss of blood due to a stab wound in the lung. The wounds in the kidney and the left humerus had peculiar shapes. The wound on the kidney was 1.1 cm long and had notches in the center of both margins of the wound. A V-shaped nick was noted on the humerus. Based on the above findings it was assumed that the murder weapon was a tapering 4-edged instrument. Later, based on the confession of the assailants, a pickaxe with the above-mentioned characteristics was discovered in a river. The victim was a member of a gang (Bohryoku-dan) and the assailants were members of another one. The present situation of gangs in Japan is briefly outlined.

Surgical results of performing R4 gastrectomy for gastric cancer located in the upper third of the stomach

Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach.

[Mutagenicity of gastric and duodenal juice on gastric carcinogenesis in rats with duodenal reflux]

A mutagenicity of gastric and duodenal contents in regard to gastric carcinogenesis was estimated in animals with duodenogastric reflex. Male Wistar rats were subjected to one of following four types of operative procedures: 1) Reflux through the pylorus (DGR), b) DGR + truncal vagotomy (DGR + V), 2) Control group; a) sham operation treated with gastrotomy (SO), b) SO + truncal vagotomy (SO + V). No carcinogens were given to animals, and they were killed 50 weeks after surgery. No cancers were detected in any of 25 animals in the control group, but nine (41%) of 22 animals in the reflux group had gastric adenocarcinoma. The count of nitrate-reducing bacteria of gastric juice was increased in DGR + V and SO + V groups, and that of duodenal juice was increased in DGR and DGR + V groups. The mutagenicity according to umu test was detected in DGR and DGR + V in both gastric and duodenal juice, but no mutagenicity was observed in the control group. These results suggested that the gastric and duodenal juice in animals with duodenogastric reflux have potent mutagenic activity. The carcinogen is likely to be produced not only in the stomach but also in the duodenum, and its production may be associated with overgrowth of nitrate-reducing bacteria.

Effects of aminoguanidine on insulin release from pancreatic islets

Aminoguanidine (AG) is a potential therapeutic agent for preventing the generation of advanced glycation end products in diabetes mellitus. In this study, the effect of AG on insulin secretion was investigated in in vitro rat pancreatic islets. The islets were aseptically isolated and cultured in tissue culture medium 199 for 48 h with or without AG. After the culture, batches of 10 islets were incubated in Krebs-Ringer bicarbonate buffer containing 3.3 mM or 16.7 mM glucose. Islets previously exposed to 0.18 mM AG or 0.45 mM AG showed similar insulin release to control islets at a 16.7 mM glucose concentration, but high glucose-stimulated insulin release was inhibited in the islets exposed to 1.8 mM. In the perifusion experiment, insulin release caused by 16.7 mM glucose from the islets previously exposed to 1.8 mM AG was not significantly different from that of the control islets. However, culture of the islets with higher AG concentrations, 4.55 mM and 9.1 mM, significantly inhibited glucose-stimulated insulin release (< 0.02 and 0.002, respectively). These results suggest that AG at high concentrations impairs pancreatic B-cell response to a high concentration of glucose.

[Can patients with chronic asthma discontinue inhaled corticosteroid?]

As an initial investigation to determine whether or not inhaled corticosteroids can be discontinued, we evaluated the results of discontinuation in patients who had been well controlled with inhaled corticosteroids for more than one year prior to this study. The average dose of BDP which the patients had been inhaling at the start of this study was 365 micrograms/day. To determine the effect of discontinuing inhaled corticosteroids, we compared the patients' peak expiratory flow rates and the frequency of beta-agonist use between the 4-week observation period and follow-up periods of varying duration. Only three out of twenty patients enrolled were able to maintain their discontinuation of BDP, while the remaining seventeen patients restarted after a mean period of 30.8 days. Mean peak flow values began to fall during the first week after discontinuation, and decreased morning peak flow values became significant in the 2nd, 3rd and 4th weeks. The mean peak flow value during the observation period was 85.2% of each patient's personal best, but had dropped to 68.8% of this level just before restarting inhaled corticosteroid. The frequency of beta-agonist use during the study period (2.99 +/- 3.39 times a day) was significantly higher than during the observation period (1.94 +/- 2.95 times a day). This finding strongly suggests that the patients' asthmatic conditions had become unstable during the study period. These results suggest that any decision to discontinue the use of inhaled corticosteroid, even in well controlled patients with chronic asthma, should be taken with great care.