A rapid increase in foot tissue temperature predicts cardiovascular collapse during anaphylactic and anaphylactoid reactions

BACKGROUND

Cardiovascular collapse during anaphylactic and anaphylactoid reactions results from release of histamine and other vasoactive substances. Intense arteriolar vasodilation associated with severe allergic reactions is likely to increase convective transfer of heat and peripheral tissue temperature, and finally to provoke cardiovascular collapse. Therefore the authors tested the hypothesis that during anaphylactic and anaphylactoid reactions, an acute increase in peripheral tissue temperature precedes cardiovascular collapse and that the magnitude of the increase correlates with the severity of the reaction.

METHODS

During a 13-yr period, approximately 120,000 patients were screened for clinical evidence of intraoperative anaphylactic and anaphylactoid reactions. Core temperature was measured in the distal esophagus, and "deep" foot tissue temperature was measured on the sole of one foot in all these patients. Otherwise unexplained cardiovascular collapse accompanied by bronchospasm and/or cutaneous signs such as urticaria, flushing, or angioedema occurred in 32 patients who were entered into a prospective diagnostic protocol. Among these, 15 met laboratory criteria for anaphylactic or anaphylactoid reactions. Anaphylaxis was confirmed in nine of them by a positive skin test to the suspected agent, the in vitro leukocyte histamine-release test, or the Praunitz-Küstner test. Reactions were considered anaphylactoid in six others when laboratory evidence did not support anaphylaxis, but plasma histamine or tryptase concentrations were much greater during episodes than 6 weeks later.

RESULTS

Development of anaphylactic and anaphylactoid reactions followed a characteristic pattern: (1) Foot temperature, which was initially 3.3 +/- 1.7 degrees C less than core temperature, increased to within 0.3 degrees C of core temperature 3.2 +/- 1.4 min after drug administration; (2) onset of cardiovascular collapse ensued 1.8 +/- 0.8 min later; and (3) core temperature increased from 34.7 +/- 1.0 degrees C to peak values 37.1 +/- 0.6 degrees C 13 +/- 5 min after drug administration. The most severe reactions were associated with shorter times to comparable core and foot temperatures, faster onset of cardiovascular collapse, and higher maximum core temperatures.

CONCLUSIONS

The normal core-to-peripheral tissue temperature gradient was obliterated several minutes before hemodynamic consequences associated with anaphylactic and anaphylactoid reactions. Further, a rapid increase in deep foot temperature and maximum core temperature correlated with clinical severity.

Expression of CD44 variants in gastric carcinoma with or without Epstein-Barr virus

The significance of CD44 variants in gastric carcinoma has not been fully investigated in terms of the pathological features of the carcinoma, including its association with Epstein-Barr virus (EBV). In this study, a total of 104 primary gastric carcinoma tissues (EBV-associated gastric carcinomas, EBVaGC, and EBV-negative carcinomas) were evaluated by immunohistochemistry. When the immunoreactivity of formalin-fixed, paraffin-embedded sections was graded on a scale of 0-3, the frequencies of grades 0-1, 2 and 3 were, respectively, 77%, 16% and 7% using monoclonal antibody (MAb) 3G5, which recognizes V3-5, and 70%, 14% and 15% with MAb 2F10, which recognizes V6. The expression of CD44 variants is independently correlated with lymph node metastasis and EBV-association in gastric carcinoma. Significant correlations were observed between V3-5 expression and lymph vessel invasion or lymph node metastasis, and between V6 expression and lymph node metastasis. The expression of both variants was significantly correlated with EBV-association. EBV-association and lymph node metastasis contributed independently to CD44 variant expression by multivariate analysis. Thus, the mechanism and significance of CD44 variant-expression are different in gastric carcinomas with or without EBV. EBVaGC is a distinct type of gastric carcinoma which should be considered separately from EBV-negative carcinoma.

Elimination of FK-506 by continuous hemodiafiltration in a liver transplant patient

A liver transplant patient who developed renal failure postoperatively was treated using continuous hemodiafiltration (CHDF). Doses ranging from 0.01 to 0.06 mg/kg/day of FK-506 had been administered intravenously. FK-506 concentrations before and after the filter, and in the ultradiafiltrate were 45.3 +/- 2.9, 56.0 +/- 5.3, and 9.1 +/- 3.1 ng/ml (mean, +/- S.D.), respectively. The filtration rate was 23.6 +/- 6.4%, and extracted FK-506 amounted to 522.0 micrograms (11.3% of administered dose). A part of the FK-506 administered was eliminated through the filter during CHDF.

[Two clinical case of spontaneous hemopneumothorax caused by aberrant vessel]

Spontaneous hemopneumothorax is a rare disease and intrathoracic bleeding reportedly occurs in the detached region of adhesive parietal pleura, aberrant vessel and cystic wall. We experienced two cases of bleeding most likely from the aberrant vessel. One patient was a 25-year-old male who had severe chest pain with dyspnea for four days. Chest X-ray revealed left pneumothorax and mediastinal shift to the right. Approximately 1500 ml of blood was aspirated from the left thoracic cavity. Since bleeding continued, emergency thoracotomy was performed. A restiform structure was noted in the bulla at the apex of the lung and the stump of the structure was considered as the source of bleeding. The other patient was a 29-year-old male who underwent emergency operation 16 hours after the massive bleeding amounting to 1800 ml. At the thoracotomy, a ruptured bulla at the apex of the collapsed lung with restiform structure was encountered. The bleeding point in the stump of the structure was ligated and the ruptured bulla was resected. In the histological study of these patients, an aberrant blood vessel was revealed in the restiform structure, which suggests the etiology of the bleeding. Their postoperative course was uneventful and had no symptom at the discharge. In the management of spontaneous hemopneumothorax, early thoracotomy should be the first consideration taking into account the massive bleeding from the aberrant vessel as in the cases.

Comparison of oxidation products from DNA components by gamma-irradiation and Fenton-type reactions

The four 2'-deoxyribonucleosides were gamma-irradiated or were aerobically treated with Fenton-type-reagents, Fe(II)-EDTA or a renal carcinogen Fe(II)-nitrilotriacetic acid (NTA) under the neutral conditions. The reaction mixtures were immediately analyzed by reverse-phase HPLC. Major products detected were 2-hydroxydeoxyadenosine (2-OH-dA), 8,5'-cyclodeoxyadenosine (cyclo-dA), 8-hydroxydeoxyadenosine (8-OH-dA). 5-formyldeoxyuridine (5-CHO-dU), 5-hydroxydeoxycytidine (5-OH-dC), 8-hydroxydeoxyguanosine (8-OH-dG), 8,5'-cyclodeoxyguanosine (cyclo-dG), and glyoxal and its adduct with dG. Ratio of these oxidized products were dramatically changed depending upon the agents used. For example, 2-OH-dA was a modified nucleoside produced most efficiently by Fe(II)-EDTA, while 5-CHO-dU and 5-OH-dC were the major products by the Fe(II)-NTA treatment and gamma-irradiation, respectively. Glyoxal itself was estimated to be produced most frequently (13 folds of 8-OH-dG) when treated with Fe(II)-EDTA, but its formation was not detected by the treatment with Fe(II)-NTA or by gamma-irradiation. 8-OH-dA was not produced by Fe-EDTA or Fe-NTA but was produced by gamma-irradiation. In contrast, 2-OH-dA was not produced by gamma-irradiation. These results suggest that triphosphates of 2-OH-dA, cyclo-dA, 8-OH-dA, cyclo-dG, 5-CHO-dU, 5-OH-dC, and glyoxal-dG as well as 8-OH-dG may be produced in cells with different ratio by various types of oxidative stress and involved in mutagenesis and carcinogenesis.

Arterialized occipitoparietal osteocutaneous flap

We treated a case of postoperative osteomyelitis and epidural abscess in the left temporal and parietal region. The scalp and skull defect following debridement was reconstructed immediately with an arterialized occipitoparietal osteocutaneous flap that was supplied proximally by the occipital artery and distally by the superficial temporal artery. This method is one of the alternative methods for small to moderately sized skull and scalp defects in the temporal, parietal, and occipital areas without available superficial temporal artery.

Analgesic effect of a herbal medicine for treatment of primary dysmenorrhea--a double-blind study

We evaluated the analgesic effect of Toki-shakuyaku-san (TSS) in women who had a combination of "deficiency," of "Yin," "cold," and "stagnated blood" syndromes, and were suffering from dysmenorrhea. A diagnostic scoring system was used for determination of these conditions. We treated patients with either TSS or placebo during 2 menstrual cycles with a double-blind technique, and we followed them for 2 additional cycles. A significant alleviation of dysmenorrhea was observed in patients treated with TSS as compared to those treated with placebo. Our results suggest that TSS is effective for treatment of dysmenorrhea in patients with the above-mentioned conditions.

Graft damage after a single lung transplantation for pulmonary hypertension in a rat model

The hemodynamic effect and degree of damage in grafts of single lung transplants for pulmonary hypertension were studied in rats with monocrotaline-induced pulmonary hypertension. Inbred male Lewis rats (weight 200-230 g) were divided into two groups. Group 1 (control group, n = 16) underwent isogenic left lung transplantation, while group 2 (n = 15) received an intravenous administration of monocrotaline (80 mg/kg i.v.) and underwent isogenic left single lung transplantation 3 week later. Hemodynamic evaluations were performed prior to transplantation, at 1 h postoperatively, and on days 3 and 7 after transplantation. Mean pulmonary arterial pressure (mPAP) rapidly declined after transplantation in group 2, from 39.3 +/- 8.7 mmHg to 18.5 +/- 3.0 mmHg 1 h after transplantation, and remained stable on day 7 after transplantation. No significant difference in the mPAP between the two groups was observed after transplantation. The extravascular lung water volume (ELWV: dry/wet ratio) in the right lung of group 2 significantly increased on day 3 (0.86 +/- 0.02) (P < 0.01), and subsequently decreased to control levels on day 7 (0.83 +/- 0.02). There was no significant difference in the ELWV in the grafted lungs between the two groups (0.84 +/- 0.03 vs 0.86 +/- 0.04), but there was tendency toward an increase in ELWV in group 2 on days 3 and 7. These data thus demonstrated that a hemodynamic improvement was obtained by single lung transplantation; however the degree of graft damage was remarkable in the pulmonary hypertension group.

Isolated collagen IV retains the potential to form an 18-nm sided polygonal meshwork of the lamina densa

Polygonal meshworks were revealed in the aggregates reconstituted from isolated collagen IV as well as in the lamina densa of mouse pancreas by the quick-freezing and deep-etching technique. Collagen IV solution with acetic acid from the bovine lens capsules and that isolated from the pepsin-solubilized fraction of human placenta reconstituted polygonal meshworks, which were dimensionally similar to the meshwork seen in the lamina densa of mouse pancreas. The average lengths between branching points in the lamina densa, and the meshworks of collagen IV derived from the bovine lens capsules and from the human placenta were 20.1 +/- 7.7 nm (mode = 18 nm), 21.6 +/- 11.3 nm (mode = 14 nm), and 21.6 +/- 9.0 nm (mode = 18 nm), respectively. These observations suggest that collagen IV can, in the absence of other macromolecules including laminins, comprise a skeletal meshwork similar in dimensions to that of the lamina densa.

Response of patients with major depression and silent cerebral infarction to antidepressant drug therapy, with emphasis on central nervous system adverse reactions

BACKGROUND AND PURPOSE

We previously found that silent cerebral infraction (SCI) is present in most patients older than 50 years with major depression. The present study was designed to clarify the response to antidepressant pharmacotherapy in patients with major depression associated with SCI.

METHODS

Using clinical charts, we retrospectively studied patients older than 50 years who were admitted for antidepressant drug therapy. Patients with bipolar affective disorder and those with focal neurological symptoms were excluded. All patients underwent magnetic resonance imaging and were classified as SCI-negative or SCI-positive. The SCI-positive group was subclassified into those with moderate SCI (either perforating area or cortical area) (n = 15) and those with severe SCI (both perforating and cortical areas) (n = 7). Duration of treatment in hospital and the incidence of central nervous system adverse reactions to the antidepressant drugs were compared between the two groups.

RESULTS

The duration of hospital treatment in patients with severe SCI was significantly longer than in those with moderate SCI (P < .01). The percentage of patients with adverse central nervous system reactions to antidepressant drugs was significantly higher in the SCI-positive group than in the SCI-negative group (P < .05). Patients with severe SCI had significantly more adverse reactions than those with moderate SCI (P < .05).

CONCLUSIONS

Depressed patients with severe SCI required longer hospital treatment and had more drug-related adverse reactions of the central nervous system. These findings suggest that the depression associated with severe SCI may be resistant to treatment.

Gelation of the lens capsule type IV collagen solution at a neutral pH

It is known that the type IV collagen extracted from EHS tumor assembles under a physiological condition, but not in a gel form. The EHS type IV collagen requires the other basement membrane components, laminin1, heparansulfate proteoglycan, and/or nidogen for gelation. On the other hand, Muraoka et al. reported that the bovine lens capsule type IV collagen alone gelated under a unique and unexpected condition of 2 M guanidine-HCl and 50 mM dithiothreitol, a condition which is thought to be dissociative for most biological macromolecules, including extracellular matrix [Muraoka, M. et al. (1996) J. Biochem. 119, 167-172]. The present report shows that the bovine lens capsule type IV collagen formed a gel under physiological conditions of pH and ionic environment, though the apparent rigidity of the gel was weaker than that of the gel formed in 2 M guanidine-HCl and dithiothreitol. The rigidity depended greatly on the incubation temperature and NaCl concentration of the type IV collagen solution, as observed in terms of the contractility of gel volume under centrifugal force. the gel formed in 150 mM NaCl and 20 mM phosphate, pH 7.3, at 28 degrees C contracted to 20% of the original volume on centrifugation of 1,800 x g for 10 min, while the gel formed at 4 degrees C, where type I collagen did not gelate at all, retained 90% of the original volume at the same centrifugal force. NaCl concentration was another important factor influencing the mechanical properties of type IV collagen gel. The gel formed at 150 mM showed maximal rigidity in the range of 0 to 300 mM in terms of the contractility on centrifugation. An image of a Pt/C replica of the gelated type IV collagen reconstituted at 4 or 28 degrees C in 20 mM phosphate, pH 7.3, containing 150 mM NaCl showed fine meshworks consisting of rather homogeneous pore sizes, resembling the skeletal structure of basal lamina. Since the condition where the type IV collagen alone formed gels was physiological in terms of ionic strength and pH, the aggregate structure and gel properties might reflect the in vivo type IV collagen supramolecular structure and the property.

Psychosomatic treatment of phantom limb pain with post-traumatic stress disorder: a case report

The successful treatment of severe left lower limb phantom pain is reported. Hypnosis and antidepressant drugs were the basis for the treatment which controlled the phantom limb pain and an associated post-traumatic stress disorder.

Molecular nature of colon tumors in hereditary nonpolyposis colon cancer, familial polyposis, and sporadic colon cancer

BACKGROUND & AIMS

Microsatellite instability (replication error [RER]) is a characteristic of tumors in hereditary nonpolyposis colon cancer (HNPCC), but the mechanism of HNPCC carcinogenesis is not yet understood. To clarify the nature of HNPCC tumors, RER and genetic changes were compared between HNPCC and non-HNPCC tumors.

METHODS

RER and genetic changes were analyzed in 21 HNPCC, 389 familial adenomatous polyposis, and 206 sporadic tumors using polymerase chain reaction, single-strand conformation polymorphism, sequencing, and Southern hybridization. RESULTS. in HNPCC, 95% tumors at all stages showed RER positivity (altered loci, 4.3 of 5). In familial adenomatous polyposis and sporadic tumors, RER positivity (1.7 of 5) was 3% in adenoma and intramucosal carcinoma, 13%-24% in invasive carcinoma, and 35% in carcinoma metastasized to liver. Fifty percent of RER-positive HNPCC tumors had both germline and somatic mutations of hMSH2 or hMLH1 gene, whereas 6% of RER-positive non-HNPCC had somatic mutation. APC, p53, and K-ras-2 mutations and loss of heterozygosity of tumor-suppressor genes were significantly less frequent (P = 0.03 to 0.0006) but transforming growth factor beta type II receptor mutation was significantly more frequent (P = 0.000001) in HNPCC than in non-HNPCC.

CONCLUSIONS

RER positivity occurs from an early stage of carcinogenesis in HNPCC but in later stages in non-HNPCC. Most HNPCC tumors may develop through different genetic changes from those in the adenoma-carcinoma sequence, although a certain percentage develops through APC mutation.

p300 gene alterations in colorectal and gastric carcinomas

Colorectal tumors frequently have loss of heterozygosity on chromosome 22q, suggesting that inactivation of tumor suppressor gene(s) on 22q participates in the tumor development. Neurofibromatosis 2 (NF2) gene and E1A binding protein p300 gene, recently identified on 22q, are thought to be candidates for tumor suppressor genes. In this study, mutation of the NF2 gene in 59 colorectal carcinomas, and mutation of the p300 gene in 27 colorectal and two gastric carcinomas, were analysed using PCR-SSCP, RT-PCR-SSCP and direct sequencing methods. Missense mutations of p300 gene were detected in a colorectal carcinoma, and in a gastric carcinoma, though no mutation of NF2 gene was detected. Both p300 mutations were somatic and coupled to deletion of the second allele of the gene, which suggests inactivation of the p300 gene, in these carcinomas. The mutations are located within the Cys/His-rich regions, which are assumed to play important roles in the function of p300. These are the first cases in which p300 gene has been found to be altered in both alleles, suggesting that inactivation of the p300 gene may be involved in the development of carcinomas, and that this gene may be the target of loss of 22q in carcinomas of the digestive tract.

Differential regulation of intracellular signaling systems by sodium fluoride in rat glioma cells

We investigated the rapid and slow effects of NaF on intracellular signaling systems such as Ca2+ homeostasis and cyclic GMP (cGMP) generation in rat glioma C6 cells, using the Ca2+-sensitive dye fura-2 and cGMP enzyme immunoassay. We found that the following: (a) NaF enhanced cGMP generation in a concentration-dependent manner. This enhancement was abolished by pretreatment with 100 microM BAPTA tetraacetoxymethal ester or in the presence of W-7 in a concentration-dependent manner. N G-Monomethyl-L-arginine (NMMA), a competitive inhibitor or nitric oxide synthase (NOS), also inhibited the NaF-induced generation of cGMP. These results suggest that NaF-induced cGMP generation occurs via a calcium/calmodulin- and NOS-dependent pathway. (b) The basal intracellular Ca2+ concentration ([Ca2+]i) was transiently greater at 1 and 3 h after pretreatment with NaF. W-7 and W-13 antagonized the increase in [Ca2+]i, whereas NMMA had little effect. This suggests that the NaF-induced change in basal [Ca2+] was mediated by a calmodulin-dependent pathway but was independent of a NOS-sensitive pathway. (c) The serotonin (5-HT)-induced intracellular mobilization of Ca2+ was reduced by pretreating the cells with NaF. The reduction in Ca2+ mobilization was antagonized by genistein, a tyrosine kinase inhibitor. W-7, W-5, and H-8 had no effect. Results suggest that NaF differentially regulated the cGMP generation. basal [Ca2+]i, and 5-HT2A receptor function in C6 glioma cells.

Single stage reconstruction of scalp and skull using free muscle flap and titanium mesh in patients with epidural infection

Simultaneous scalp and skull reconstruction using free muscle flap transfer and titanium mesh was performed in two patients with postoperative intracranial infection. The postoperative course in both patients was uneventful. The transferred flap was the latissimus dorsi muscle flap in one and a combination flap with the latissimus dorsi and serratus anterior muscle in another. The titanium mesh afforded satisfactory contour with only mild foreign-body reaction and could be applied simultaneously with the free muscle flap to the infected cranial wound.

A case of double fingernail and ectopic fingernail

Congenital ectopic fingernails are extremely rare and only 22 cases were found in domestic and foreign literature during our investigation. In the 22 ectopic fingernail cases collected, small ectopic fingernails were found along side the normal fingernail (dorsal or palm side), in most cases, and extremely rare double nails, which are as large as normal nails, were found on the palm side opposite the normal fingernail in some cases. We encountered a 4-year-old boy with a double fingernail on the right fifth finger and an ectopic fingernail on the left fifth finger. The nail on the palm side, including the fingernail block and nail matrix, was excised from the right fifth finger and the defect was reconstructed with a palm skin flap.

Suppression of tumorigenicity and invasiveness of colon carcinoma cells by introduction of normal chromosome 8p12-pter

The development of human colon carcinomas is associated with a number of genetic alterations. A high frequency of deletion of the short arm of chromosome 8 at a late stage of colon carcinogenesis was detected by DNA analysis of colon carcinomas, which suggests the presence of a tumor suppressor gene. We therefore, introduced normal human chromosome 8 into colon carcinoma cells that showed allele loss on 8p21, through microcell hybridization. Five clones of hybrid cells were obtained from independent experiments. Three hybrids exhibited morphological alteration and suppressed tumorigenicity in the subcutis of nude mice, but the other two did not. The difference between the two types of hybrids was the region of the introduced normal chromosome 8: Three hybrids exhibiting morphological alteration and suppressed tumorigenicity had the entire region of the introduced chromosome 8, whereas the other two, exhibiting no change, lacked 8p12-pter from the introduced chromosome. Furthermore, the invasiveness of the hybrids with suppressed tumorigenicity was reduced to one-fifth of that of the parental cells. These results indicate that 8p12-pter carries a gene that contributes to suppression of both tumorigenicity and invasiveness of colon carcinomas.

Effect of food intake on the delivery of fluorescein as a model drug in colon delivery capsule after oral administration to beagle dogs

The effect of food on the release time of a model drug, fluorescein (FL), has been studied after oral administration to beagle dogs in colon delivery capsule in comparison to conventional gelatin capsule and enteric capsules. The dose of FL was 30 mg for each animal. After oral administration of each test preparation in fasted or postprandial condition (100 grams of commercial solid food was given at 30 min before drug administration), blood samples were collected and plasma FL concentrations were measured spectrofluorometrically. Pharmacokinetic analysis was performed with plasma FL concentration vs. time data and the following parameters were determined; Tmax (the time when plasma FL concentration reaches to its maximum concentration), Cmax (peak plasma FL concentration), Tlag (the time when FL appeared at first into the systemic circulation), AUC (area under the plasma FL concentration vs. Time curve) and MRT (mean residence time). For gelatin capsule, mean Tmax appeared at 0.83 +/- 0.33 (S.E.) h after administration and MRT was 2.67 +/- 0.21 h in fasted condition. By feeding, Tmax and MRT increased to 1.50 +/- 0.76 h and 3.09 +/- 0.49 h. For two enteric HPMCP and Eudragit S capsules, MRT were 2.90 +/- 0.48 h and 5.24 +/- 0.32 h in fasted condition, and 11.30 +/- 1.10 h and 12.83 +/- 0.34 h in postprandial condition, respectively. Tlag also increased by postprandial administration. As colon delivery capsule, time-controlled release capsule (TCC) and two types of intestinal inner pressure-controlled release capsules (PCC) (#1 is a separate type and #2 is a seamless one) were tested. MRT of TCC was 4.76 +/- 0.29 h and 6.43 +/- 0.66 h in fasted and postprandial conditions, respectively. This capsule did not receive the effect of food intake. For #1 PCC, MRTs were 5.32 +/- 0.22 h and 12.28 +/- 0.26 h in fasted and postprandial conditions, respectively. For #2 PCC, MRTs were 5.51 +/- 0.26 h and 13.36 +/- 0.84 h in fasted and postprandial conditions, respectively. In addition, the effect of two times feedings was studied with two PCCs and longer MRTs, 28.44 +/- 1.39 h and 26.32 +/- 1.64 h, were obtained. The release time of FL from PCCs increased by postprandial administration. As compared to the results on two enteric capsules, these PCCs are thought to disintegrate in the colon. However, TCC is thought to disintegrate in the stomach after postprandial administration.

[Two cases of pleomorphic adenoma of the nasal cavity]

Pleomorphic adenoma in the otorhinolaryngological field is frequently found in the major salivary glands, but is rare in minor salivary glands. Two cases of pleomorphic adenoma of the nasal cavity are reported. Case 1. A 26-year-old female who complained of nasal obstruction had a tumor arising from the right side of the nasal septum. The tumor, 1.5 x 1.5 x 1.2cm in size, was surgically removed utilizing an intranasal approach. Histologically, it was diagnosed as a pleomorphic adenoma of the nasal septum. There has been no recurrence. Case 2. A 51-year-old male had a tumor in the left lateral nasal wall. The tumor, 0.6 x 0.6 x 0.6 cm in size, was surgically removed by the intranasal approach. Histologically, it was diagnosed as a pleomorphic adenoma of the lateral nasal wall. There has been no recurrence. Including the present cases, 59 cases of pleomorphic adenoma arising from the nasal cavity have been reported in Japan. Of these, 51 arose from the nasal septum. Only 8 adenomas had arisen from the lateral nasal wall. Attention has been called especially to differences in the reported incidences of malignant tumors and recurrent tumors. In the present survey, the incidences were unusually low. Four cases (6.8%) have been reported as malignant tumors, and 3 (5.1%) as recurrent tumors.

Gel formation from the type IV collagen isolated from bovine lens capsule in guanidine-HCl and dithiothreitol

Type IV collagen was prepared from bovine lens capsule by acetic acid extraction, followed by purification including DEAE-Sephacel chromatography and dialysis. The type IV collagen solution became viscous and eventually gelated upon dialysis against 2M guanidine-HCl and 10 mM dithiothreitol. Gelation was not observed for heat-denatured type IV collagen, suggesting that collagenous conformation may be required for the gelation. A reducing agent, dithiothreitol, was essential for the gelation of type IV collagen in 2 M guanidine-HCl. An optimal concentration of guanidine-HCl for the gelation lays between 1.5 and 2.5 M: gelation did not occur at 1 M or lower and at 3 M or higher, although the circular dichroism spectrum characteristic of the collagenous triple-helix was not changed in 3 M guanidine-HCl. This suggests that an appropriate change in conformation of the type IV collagen at a region other than the triple-helical region or/and partial dissociation of complexed type IV collagen aggregates may drive intermolecular interactions of the type IV collagen leading to polymerization and eventually to gelation. To our knowledge, this is the first report that the type IV collagen alone has the ability to form a rigid gel. The assembled structure of the type IV collagen in gel form might be related to the skeletal architecture of basement membrane(s).

Addition of lithium to chronic antidepressant treatment potentiates presynaptic serotonergic function without changes in serotonergic receptors in the rat cerebral cortex

The effects of the addition of short-term lithium to long-term administration of antidepressants (clomipramine or citalopram) on the levels of 5-HT and 5-HIAA and serotonergic receptors were studied in the rat cortex. The addition of short-term Li to long-term antidepressant treatment potentiated an increase in 5-HIAA, although Li alone had no effect. On the serotonergic receptors, the addition of short-term Li had no effect. It is speculated that the therapeutic action of Li when added to antidepressants in the treatment of refractory depression may partly have its basis in the further activation of the presynaptic serotonergic system.