Marginal ulceration after pylorus-preserving pancreaticoduodenectomy

Marginal ulceration is a serious problem after both standard pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD). The relationship between this complication and the method of reconstruction after PPPD was analyzed in this study. Patients who underwent standard PD (n = 72) or PPPD (n = 28) in the 20-year period from 1978 to 1997 were retrospectively reviewed. After PPPD, 4 patients (14.3%) developed marginal ulceration on the jejunal side of the duodenojejunal anastomosis, while none of the patients had marginal ulceration after standard PD. The marginal ulcer occurred in 3 of 14 patients treated with the Roux-en-Y method, and in 1 of 9 treated with pancreatogastrostomy. In the Roux-en-Y method, the anal jejunal loop anastomosed to the bulb was directly exposed to gastric juice without neutralization by pancreatic juice from the oral jejunal limb. Of the 4 patients with marginal ulceration, 2 of those treated by the Roux-en-Y method required gastrectomy; the other 2 patients were treated medically. Our analysis of the literature showed that the Roux-en-Y method had the highest incidence of marginal ulcerations. The gastrointestinal reconstruction method without a mixture of gastric juice and pancreatic juice may be a causal factor in the marginal ulceration that occurs after PPPD. In reconstruction after PPPD, we should not create a jejunal loop that is exposed to gastric juice alone.

Electrocardiographic changes related to parasympathetic tone during right coronary angioplasty

The role of basal parasympathetic tone in reducing the heart rate and causing electrocardiographic (ECG) changes during right coronary angioplasty was evaluated in 19 patients with angina pectoris. To measure parasympathetic tone, time and frequency domain parameters of heart rate variability were assessed using 24 h of ambulatory ECG data recorded before angioplasty. There was an age-dependent reduction in heart rate. However, no parameters of heart rate variability were responsible for the changes in heart rate. In contrast, the degree of ST segment elevation during angioplasty correlated significantly with the high-frequency component of heart rate variability. Therefore, the increased parasympathetic tone, as assessed by spectral analysis, may augment the early ST segment elevation induced by right coronary occlusion.

Inhibited serum phospholipase A2 activity in hyperbilirubinemia

BACKGROUND/AIMS

Phospholipase A2 activity is reported to be related to the physiology of various disorders, and the activity is modified by deoxycholic acid.

METHODOLOGY

Serum phospholipase A2 activity was measured by counting the radioactivity of 14C-palmitic acid released from L-3-phosphatidylcholine (1-palmitoyl-2-14C-palmitoyl) in 40 patients with hyperbilirubinemia due to malignant neoplasms and benign cholestasis. Phospholipase A2 activity in serum from healthy subjects was also measured after incubation with 5-30 mg of bilirubin per dL or 0.1-5 mM of cholic acid for 60 min at 37 degrees C.

RESULTS

Serum phospholipase A2 activity was significantly lower in patients with hyperbilirubinemia. There were negative correlations between serum phospholipase A2 activity and concentration of total bilirubin (r = 0.668; P < 0.0001) or total bile acids (r = 0.423; P < 0.05) in patients with hyperbilirubinemia. In 12 patients who underwent percutaneous transhepatic biliary drainage, the low serum phospholipase A2 activity was reversed while bilirubin concentrations decreased. Incubation of sera from healthy subjects with more than 3 mM cholic acid significantly reduced phospholipase A2 activity (P < 0.01), whereas incubation with bilirubin had no effect.

CONCLUSIONS

Inhibition of serum phospholipase A2 activity in patients with hyperbilirubinemia may be caused by increased serum cholic acid concentration.

Discovery of novel trans-3,5-disubstituted pyrrolidinylthio-1beta-methylcarbapenems

Novel trans-3,5-disubstituted pyrrolidinylthio-1beta-methylcarbapenems were designed and synthesized to provide J-111,347 (1a) as the first example of an exceptionally broad-spectrum antibiotic, showing activity against methicillin-resistant Staphyloccocus aureus (MRSA) as well as Pseudomonas aeruginosa. Further derivation of 1a afforded J-111,225 (2a), J-114,870 (3a), and J-114,871 (3b). which showed improved safety profiles and retained broad-spectrum antibacterial activities.

Afferent mechanisms of acute responses of renal sympathetic nerve activity to microgravity

Exposure to microgravity is thought to induce an alteration of autonomic function through several afferent pathways. First, a removal of all hydrostatic gradients, which results in a large cephalad fluid shift. The fluid shift may induce an increase in transmural pressure in the cardiopulmonary region, which stimulates cardiopulmonary mechanoreceptors and baroreceptors, and elicits neurogenic responses. Secondly, an alteration of the vestibular input may modify sympathetic output via the vestibulosympathetic reflex. However, there is a lack of direct evidence for the role of cardiopulmonary mechanoreceptors, baroreceptors, and vestibular system in autonomic responses to microgravity. Accordingly, responses of renal sympathetic nerve activity (RNA) to microgravity, produced by free drop, were examined in anesthetized rats. To examine the afferent pathways of the RNA responses, the same experiment was performed in rats that had undergone labyrinthectomy, sinoaortic baroreceptor denervation (SAD), vagotomy, or SAD plus vagotomy.

Acute responses of renal nerve activity to microgravity induced by free drop in anesthetized rats

To examine acute cardiovascular and autonomic responses to microgravity (microG), arterial pressure (AP), aortic flow velocity (AFV), central venous pressure (CVP), and renal nerve activity (RNA) were measured in anesthetized rats during 4.5 s of microG produced by free drop. A smooth and immediate reduction in gravity occurred during free drop, microG being achieved 100 ms after the start of the drop. Acute microG elicited an immediate and striking, but transient, decrease in RNA with no significant change in AP and AFV, but a significant decrease in CVP. The decrease in RNA lasted 2 s, then RNA recovered to the control level despite the G value remaining at < 0.001 for 4.5 s. The RNA decrease was attenuated or completely abolished by sinoaortic denervation, vagotomy, or sinoaortic denervation plus vagotomy. These results suggest that acute microG conditions stimulate sinoaortic and cardiopulmonary mechanoreceptors and suppress RNA.

The roles of platelet-activating factor and endothelin-1 in renal damage after total hepatic ischemia and reperfusion

BACKGROUND

This study was designed to verify the involvement of platelet-activating factor (PAF) in renal damage associated with hepatic ischemia and reperfusion (HIR) injury through the release of endothelin (ET)-1 and to determine the modulating effect of a specific PAF receptor antagonist on these insults in rats.

METHODS

Male rats pretreated with either normal saline as a vehicle (NS group) or intravenous TCV-309, a PAF receptor antagonist (TCV group), were subjected to 120 min of total hepatic ischemia under an extracorporeal portosystemic shunt. Plasma aspartate transaminase, creatinine, blood urea nitrogen, and ET-1 levels and the relative renal wet weight were determined under nonischemic conditions and at 1, 3, and 6 hr of reperfusion after hepatic ischemia. Changes in mean arterial blood pressure and renal tissue blood flow measurements in the kidney were determined throughout the experiment.

RESULTS

Increased plasma aspartate transaminase, creatinine, blood urea nitrogen, and ET-1 levels and the relative renal wet weight after HIR in the NS group were significantly suppressed by TCV-309 pretreatment. Mean arterial blood pressure and renal tissue blood flow after HIR in the TCV group were significantly improved when compared with those in the NS group. These effects resulted in attenuation of structural hepatic and renal damage with the improvement of 7-day survival (62%).

CONCLUSIONS

The present study demonstrates that renal damage as well as critical liver injury is produced after reperfusion following 120 min of total hepatic ischemia. A PAF receptor antagonist may be therapeutically useful to protect against these types of damage via indirect modulation of plasma ET-1 levels.

Role of the vestibular system in sudden shutdown of renal sympathetic nerve activity during microgravity in rats

The purpose of this study was to examine the effect of microgravity (muG) on renal sympathetic nerve activity (RNA) in rats. Additionally, we estimated the participation of the vestibular system in the response of RNA to muG. Eight normal Sprague-Dawley (SD) rats and five chemically and bilaterally labyrinthectomied SD rats were used to measure RNA during free-drop examination (4.5-s duration of muG); arterial pressure (AP) and aortic flow velocity (AFV) were additionally monitored. Although AFV showed no particular change, AP tended to decrease during muG in the later phase. Prior to this AP fall-off, RNA was immediately and markedly attenuated by muG. This attenuation was transient and RNA returned to 1G level within the mu;muG condition. Interestingly, this phenomenon remained even in labyrinthectomied rats. In conclusion, cephalad shift of the body fluid by loading of muG may cause cardiopulmonary low-pressure receptor activation and consequent RNA attenuation, but the participation of the vestibulosympathetic reflex in this phenomenon is not obvious.

Thyroid hypertrophic effect of semotiadil fumarate, a new calcium antagonist, in rats

We studied the effects of semotiadil fumarate (SF), a new calcium antagonist with a unique benzothiazine structure, on the thyroid gland and liver in rats and compared them with those of another calcium antagonist, nicardipine (NCD), a well-known thyroidal hypertrophic agent and microsomal enzyme inducer, phenobarbital (PB), and goitrogen propylthiouracil (PTU). In oral 2-week treatment, SF caused increases in hepatic microsomal protein levels, uridine diphosphate glucuronosyltransferase (UDPGT) activity and an increase in serum thyroid stimulating hormone (TSH) level together with decreases in serum thyroid hormone levels. These results suggest that SF accelerates peripheral disposition of thyroid hormones and subsequently stimulates secretion of TSH from the pituitary gland as a compensatory response. PB and NCD had similar effects on the thyroid gland and the liver. PTU showed obvious thyroid hyperplasia and an increase in relative liver weight. Drastic increase in TSH level was observed in the PTU-treated group together with significant decreases in serum thyroid hormone levels and an increase in hepatic UDPGT activity. Histopathologically, PTU depleted the colloids in follicles, suggesting the inhibition of thyroid hormone synthesis. SF, PB and NCD showed thyroidal hyperplasia, but the extent of the change was far more moderate than that induced by PTU. These results indicate that the effect of SF is similar to those of PB and thyroid hypertrophy seen in the oral 2-week treatment with SF, and may be caused by indirectly elevated TSH levels which resulted from the induction of hepatic UDPGT activity.

The role of ABI3 and FUS3 loci in Arabidopsis thaliana on phase transition from late embryo development to germination

Arabidopsis abi3 and fus3 mutants are defective in late embryo development and their embryos show precocious growth. To understand the function and role of ABI3 and FUS3, we analyzed expression patterns of genes which were normally activated during late embryo development and germination in these mutants. Using the differential display method, both upregulated and downregulated genes were observed in immature siliques of the abi3 fus3 double mutant. Four clones having more abundant expression in the abi3 fus3 double mutant than in wild type were isolated. These genes were activated during wild-type germination, suggesting that some genes that are activated during wild-type germination are precociously activated in the abi3 fus3 mutant during late embryo development. Also, genes that were activated during wild-type germination were isolated and their expression patterns during late embryo development in the wild type and in abi3, fus3, and abi3 fus3 mutants were analyzed. Sixteen such clones were found, and 11 of these showed derepression or precocious activation of gene expression in the mutants. These results indicate that ABI3 and FUS3 negatively regulate a particular set of genes during late embryo development. We also showed that immature fus3 siliques accumulated one-third of the wild-type level of abscisic acid (ABA), but mature fus3 siliques accumulated ABA at a level comparable to that in the wild type. The possible mechanisms of controlling developmental timing in late embryo development as well as collaborative and distinct roles of ABI3 and FUS3 are discussed.

[A patient with advanced gastric cancer who obtained downstaging and underwent radical surgery by neoadjuvant chemotherapy]

The patient was a 74-year-old man with extremely advanced gastric cancer. A CT scan of the abdomen showed enlargement of many huge abdominal para-aortic lymph nodes. Neoadjuvant chemotherapy (NAC) was planned in order to reduce or eliminate the tumor. Two cycles of FLP combination therapy (5-fluorouracil, leucovorin, cisplatin) were given. After NAC, a CT scan revealed marked shrinkage of the No. 16 lymph nodes, and a distal gastrectomy with extended radical lymph node dissection including the No. 16 nodes was performed. The histological effect was judged to be grade 2. There were no viable cancer cells in the No. 16 lymph nodes. The FLP combination therapy as NAC was so effective that it induced downstaging from stage IVb to IIIb.

[The three-dimensional CT angiography findings of ruptured aneurysms hardly detectable by repeated cerebral angiography]

We reported three cases of cerebral aneurysms hardly detectable by cerebral angiography, but easily detected by three-dimensional CT angiography (3D-CTA). These cases were ruptured aneurysms with subarachnoid hemorrhage. After detection of subarachnoid hemorrhage on CT scan, cerebral angiography was performed at first, but aneurysms were not detected. Subsequently 3D-CTA was carried out, and aneurysms were detected. In all cases, cerebral angiography was repeated, after the aneurysms had been found by 3D-CTA. This time aneurysms were all detected by cerebral angiography, but each case needed photographs from special direction. The aneurysms were small by usual cerebral angiography and they were almost invisible behind the artery near which they existed. 3D-CTA was very useful for detection of small aneurysms, but small perforating arteries around the aneurysms were invisible by 3D-CTA. To find these perforating arteries, cerebral angiography was needed.

Studies on the 1,1-diphenyl-2-picrylhydrazyl radical scavenging mechanism for a 2-pyrone compound

The radical scavenging mechanisms for the 2-pyrone compound, 4-hydroxy-3,6-dimethyl-2H-pyrane-2-one (1), and the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical (4) in several solvent systems were evaluated by the quantitative change in compounds detected at 270 nm and subsequent HPLC analyses. The HPLC profile for each condition suggested that the reaction proceeded by a different mechanism in each solvent system. In organic solvents (CHCl3, iso-propanol, and EtOH), 1-[4-(3,4-dihydro-3,6-dimethyl-2,4-dioxo-2H-pyran-3-yl) phenyl]-1-phenyl-2-picrylhydrazine (2) was produced as an adduct of the DPPH radical and 1. On the other hand, the reaction in a buffer solution (an acetate buffer at pH 5.5) gave several degradation products with 1[4-(2,3-dihydro-2,5-dimethyl-3-oxo-fur-2-yl) phenyl]-1-phenyl-2-picrylhydrazine (5), this being structurally elucidated by spectroscopic analyses. The decrease of the DPPH radical in each reaction system suggests that compound 1 could scavenge about 1.5-1.8 equivalents of the radical in organic solvents and about 3.5-3.9 in the buffer solution.

Deep venous thrombosis and pulmonary thromboembolism associated with a huge uterine myoma--a case report

A 51-year-old woman with a large uterine myoma suffered from acute pulmonary thromboembolism. Venography revealed thrombosis in the right common iliac vein and almost complete obstruction of the left common iliac vein. The ascending lumbar vein showed collateral drainage. Treatment was initiated with continuous intravenous heparin sodium, and a Greenfield filter was inserted to prevent the extension of the pulmonary embolism during and after hysterectomy. After a total hysterectomy, venography revealed restoration of patency in the bilateral common iliac veins, and no flow was seen in the ascending lumbar vein. Thorough clinical examinations failed to identify any other prothrombotic conditions. These results suggest that a large uterine myoma compressed veins in the pelvis, and the resulting impaired blood flow caused deep venous thrombosis and pulmonary thromboembolism.

Effects of chlorine, iodine, and quaternary ammonium compound disinfectants on several exotic disease viruses

The effects of three representative disinfectants, chlorine (sodium hypochlorite), iodine (potassium tetraglicine triiodide), and quaternary ammonium compound (didecyldimethylammonium chloride), on several exotic disease viruses were examined. The viruses used were four enveloped viruses (vesicular stomatitis virus, African swine fever virus, equine viral arteritis virus, and porcine reproductive and respiratory syndrome virus) and two non-enveloped viruses (swine vesicular disease virus (SVDV) and African horse sickness virus (AHSV)). Chlorine was effective against all viruses except SVDV at concentrations of 0.03% to 0.0075%, and a dose response was observed. Iodine was very effective against all viruses at concentrations of 0.015% to 0.0075%, but a dose response was not observed. Quaternary ammonium compound was very effective in low concentration of 0.003% against four enveloped viruses and AHSV, but it was only effective against SVDV with 0.05% NaOH. Electron microscopic observation revealed the probable mechanism of each disinfectant. Chlorine caused complete degeneration of the viral particles and also destroyed the nucleic acid of the viruses. Iodine destroyed mainly the inner components including nucleic acid of the viruses. Quaternary ammonium compound induced detachment of the envelope of the enveloped viruses and formation of micelle in non-enveloped viruses. According to these results, chlorine and iodine disinfectants were quite effective against most of the viruses used at adequately high concentration. The effective concentration of quaternary ammonium compound was the lowest among the disinfectants examined.

The novel neuropeptide Y Y(1) receptor antagonist J-104870: a potent feeding suppressant with oral bioavailability

Neuropeptide Y (NPY) is known to induce robust feeding through the action of NPY receptors in the hypothalamus. Among the subtypes of NPY receptors, Y(1) receptors may play a key role in feeding regulation. In the present study, we demonstrated that a novel Y(1) antagonist, J-104870, shows high selectivity and potency for the Y(1) receptor with an anorexigenic effect on NPY-mediated feeding. J-104870 displaced [(125)I]peptide YY (PYY) binding to cloned human and rat Y(1) receptors with K(i) values of 0.29 and 0.54 nM, respectively, and inhibited the NPY (10 nM)-induced increase in intracellular calcium levels (IC(50) = 3.2 nM) in cells expressing human Y(1) receptors. In contrast, J-104870 showed low affinities for human Y(2) (K(i) > 10 microM), Y(4) (K(i) > 10 microM), and Y(5) receptors (K(i) = 6 microM). In rat hypothalamic membranes, J-104870 also completely displaced the binding of [(125)I]1229U91, which is known to bind to the typical Y(1) receptor, with a high affinity (K(i) = 2.0 nM). Intracerebroventricular (ICV) injection of J-104870 (200 microg) significantly suppressed NPY (5 microg)-induced feeding in satiated Sprague-Dawley rats by 74%. Furthermore, ICV and oral administration of J-104870 (200 microg and 100 mg/kg, respectively) significantly suppressed spontaneous food intake in Zucker fatty rats. These findings suggested that J-104870 is a selective and potent nonpeptide Y(1) antagonist with oral bioavailability and brain penetrability. In addition, the anorexigenic effect of J-104870 clearly revealed the participation of the Y(1) receptor in NPY-mediated feeding regulation. The potent and orally active Y(1) antagonist J-104970 is a useful tool for elucidating the physiological roles of NPY in obesity.

J-104129, a novel muscarinic M3 receptor antagonist with high selectivity for M3 over M2 receptors

A new class of 4-acetamidopiperidine derivatives has been synthesized and investigated for human muscarinic receptor subtype selectivity. Introduction of a hydrocarbon chain of appropriate length into the piperidine nitrogen of the racemic N-(piperidin-4-yl)-2-cyclobutyl-2-hydroxy-2-phenylacetamide platform conferred up to 70-fold selectivity for human muscarinic M3 receptors over M2 receptors. Subsequent synthetic derivatizations resulted in highly potent M3 receptor antagonists with selectivity greater than two orders of magnitude for M3 over M2 receptors, from which the analogue 4r was selected. Preparation of both enantiomers of 4r led to the identification of (2R)-N-[1-(4-methyl-3-pentenyl)piperidin-4-yl]-2-cyclopentyl-2-hyd roxy-2-phenylacetamide (J-104129, (R)-4r), which exhibited 120-fold selectivity for M3 receptors (Ki = 4.2 nM) over M2 receptors (Ki = 490 nM). In isolated rat trachea, (R)-4r potently and specifically antagonized acetylcholine (ACh)-induced responses with a K(B) value of 3.3 nM. The highly subtype-selective profile was also seen in isolated rat tissue assays (50-fold) and in anesthetized rats (> 250-fold). Oral administration of J-104129 ((R)-4r) antagonized ACh-induced bronchoconstriction with an ED50 value of 0.58 mg/kg in rats. Thus, J-104129 ((R)-4r) may effectively facilitate bronchodilation in the treatment of obstructive airway disease.

[A case of advanced gastric cancer with abdominal para-aortic lymph node metastasis successfully treated with FLP therapy]

A 73-year-old woman was admitted to our hospital in June 1998, suffering from upper abdominal pain. The upper G-I series and endoscopic examination revealed stenosis of the pylorus and antrum by a type 2 cancer, and a poorly differentiated adenocarcinoma and a signet-ring cell carcinoma were confirmed on endoscopic biopsy. A CT scan showed the enlargement of many regional and abdominal para-aortic lymph nodes. FLP therapy combined with cisplatin (50 mg/m2 drip i.v., day 1-8), 5-fluorouracil (333 mg/m2 drip i.v.) and leucovorin (30 mg/body i.v., day 1-8) was planned for neoadjuvant chemotherapy (NAC) in order to reduce or eliminate the tumor and increase curability. After two cycles of the FLP therapy, the tumor size shrunk remarkably and the enlargement of the para-aortic lymph nodes disappeared. Distal gastrectomy with extended lymphadenectomy and cholecystectomy was performed. The histological findings of the primary tumor and metastatic lymph nodes demonstrated massive cancer cell degeneration such as pycnosis and vacuolation, xanthogranulomatous inflammation and dense fibrosis. The effect of NAC was judged to be grade 2 histologically. FLP therapy is an effective and safe regimen for NAC.

[Effects of intravenous and oral administration of ondansetron hydrochloride on chemotherapy-induced nausea and vomiting in patients with esophageal cancer]

The effects of ondansetron hydrochloride (OND) were studied through 11 courses of chemotherapy, including 70 mg/m2 of cisplatin, in 9 patients with advanced esophageal cancer. During the observation period of 5 days, 4 mg of OND was given intravenously on the day of cisplatin infusion and orally for consecutive 4 days, and nausea was controlled by over 70%. Vomiting was controlled by over 80%. The inhibitory effect of OND on nausea and vomiting was found in 72.7% on the day of cisplatin injection and 88.9% overall. No other side effects of OND except slight increases in total bilirubin and LDH were found in any patient. These findings suggest that intravenous and oral administration of OND may inhibit chemotherapy-induced nausea and vomiting in patients with advanced esophageal cancer.

Combined modality therapy for basaloid squamous carcinoma of the esophagus

A 61 year-old woman came to our hospital with dysphasia that had persisted for 2 months. Endoscopy and barium swallow showed a protruding tumor, about 6.0 cm long, in the midportion of the esophagus. A biopsy specimen showed squamous cell carcinoma of the esophagus. Computed tomography (CT) scan revealed adventitial involvement and lymph node metastases beneath the carina. After 2 courses of chemotherapy with cisplatin (CDDP) 100 mg for 1 day, 5-Fluorouracil (5-FU) 800 mg for 5 days, and leucovorin 30 mg for 5 days, complete regression of the tumor was observed by endoscopy and barium esophagography. Transthoracic esophagectomy with lymph node dissection was performed. Histologically, the muscle layers of the resected esophagus had been replaced by fibrous tissue; however, small foci of basaloid squamous carcinoma (BSC) were found in the submucosa. Six months after surgery, a CT scan revealed a metastatic lymph node around the right main bronchus. Chemotherapy and radiotherapy resulted in the disappearance of the metastasis. The patient has survived for more than 3 years since surgery with a good quality of life.

Double cancer of the gallbladder and common bile duct associated with an anomalous pancreaticobiliary ductal junction without a choledochal cyst: report of a case

We report herein the case of a 37-year-old woman found to have double cancer of the gallbladder and common bile duct associated with an anomalous pancreaticobiliary ductal junction (APBDJ) without a choledochal cyst (CC). Abdominal ultrasonography showed an isoechoic mass in the gallbladder, and percutaneous transhepatic biliary drainage tubography revealed incomplete obstruction in the upper portion of the common bile duct and APBDJ. The patient underwent cholecystectomy, partial hepatic resection, pancreatoduodenectomy, and portal vein reconstruction. Pathological examination of the tumors from the gallbladder and bile duct revealed papillary carcinoma and poorly differentiated adenocarcinoma, respectively, and direct continuity was not observed between the tumors. A review of the literature on six cases of multiple primary carcinoma of the biliary tract associated with APBDJ without CC is presented following this case report. Double cancer of the biliary tract was found synchronously in five patients and metachronously in one. Gallbladder cancer showed subserosal invasion in four patients, while bile duct cancer invaded the pancreas in one patient and reached the serosa in two patients. Considering the potential for cancer to arise in the biliary tract and the difficulties associated with monitoring it, cholecystectomy and resection of the extrahepatic common bile duct may be the most appropriate treatment for patients with an APBDJ without a CC.

Femtosecond time-resolved optical polarigraphy: imaging of the propagation dynamics of intense light in a medium

A time-resolved imaging technique for visualizing ultrafast propagation dynamics of intense light pulses in a medium has been demonstrated. The method probes the instantaneous birefringence induced by a pulse in the medium. Through consecutive femtosecond snapshot images of intense femtosecond laser pulses propagating in air, ultrafast temporal changes in the two-dimensional spatial distribution of the optical pulse intensity were clearly seen.

Purification and further characterization of enteropeptidase from porcine duodenum

Enteropeptidase [EC 3.4.21.9] is a membrane-bound serine endopeptidase present in the duodenum that converts trypsinogen to trypsin. We previously cloned the cDNA of the porcine enzyme and deduced its entire amino acid sequence [M. Matsushima et al. (1994) J. Biol. Chem. 269, 19976-19982]. In the present study, we purified the porcine enzyme approximately 2,200-fold in a 12% yield from a duodenal mucosal extract to apparent homogeneity by an improved procedure comprising four steps of chromatography including benzamidine-Sepharose affinity chromatography. Lectin blotting analysis suggested that the enzyme is glycosylated mainly with N-linked carbohydrate chains of the tri- and/or tetraantennary complex type. The H and L chains of the enzyme were separated into two major bands upon SDS-PAGE under reducing conditions, suggesting that the enzyme mainly comprises two isoforms, a higher molecular weight form and a lower molecular weight form. The enzyme was also separated by lectin affinity chromatography into two major fractions, named isoforms I and II, which corresponded to the higher and lower molecular weight forms, respectively. These two isoforms appeared to be different only in the carbohydrate moiety, having essentially the same enzymatic properties. The enzyme was optimally active at pH 8.0 toward Gly-Asp-Asp-Asp-Asp-Lys-beta-naphthylamide, and was inhibited strongly by various serine proteinase inhibitors. Furthermore, it was also strongly inhibited by E-64 [L-trans-epoxysuccinyl-leucylamide-(4-guanido)-butane], a cysteine proteinase inhibitor. Substrate specificity studies involving various synthetic peptides indicated that acidic residues at the P2, P3, and/or P4 positions are especially favorable for maximal activity, but are not absolutely necessary, at least in the cases of peptide substrates.

Electron microscopic autoradiography: an improved procedure using Aclar film and Grid-sticks

A simple, time saving technique for electron microscopic autoradiography (EMARG) has been developed using both Aclar film and Grid-sticks. Rats were given 3 mg/kg [pyridine5-3H] nicorandil orally. After 15 min, animals were sacrificed, the hearts were removed, and myocardial samples for EMARG were prepared. Silver grains were detected clearly in myofibrils and in mitochondria, all showing well preserved ultrastructure. The use of Grid-sticks in the procedure improves handling of bulk samples.

Serum level of cytokeratin 19 fragment (CYFRA 21-1) indicates tumour stage and prognosis of squamous cell carcinoma of the oesophagus

To determine the clinical efficacy of serum concentration of cytokeratin 19 fragment (CYFRA 21-1), sera from 66 patients with oesophageal squamous cell carcinoma were examined, and 54 surgically resected specimens were immunohistochemically stained for cytokeratin 19 (CK-19). The patients with positive CK-19 staining in the tissues of their carcinomas had significantly higher serum CYFRA 21-1 levels compared with those with negative CK-19 staining. When the cut-off value was defined as 2.0 ng/mL, CYFRA 21-1 had a higher positive ratio than that of either squamous cell carcinoma antigen (SCC-Ag) or carcinoembryonic antigen (CEA). Serum CYFRA 21-1 level increased significantly along with the clinical stages. In addition, serum CYFRA 21-1 level served as a prognostic factor for patients with oesophageal carcinoma after surgery, whilst SSC-Ag and CEA is not connected with the outcome. These findings suggest that the serum CYFRA 21-1 probably originated from the tumour tissue is an important marker for determining the stage and outcome of oesophageal carcinoma.

Emerin and cardiomyopathy in Emery-Dreifuss muscular dystrophy

Emery-Dreifuss muscular dystrophy (EDMD) is an inherited disorder characterized by the clinical triad of life-threatening progressive cardiomyopathy with conduction defect, early onset joint contractures and slow progressive muscle weakness in scapulo-humero-peroneal distribution. Cardiomyopathy in EDMD is usually noticed after the second to third decade of life, and becomes worse with age. Permanent auricular paralysis occurs frequently and is considered a hallmark of EDMD cardiomyopathy. Cardiac involvement may also occur in female carriers. In autopsy cases, enlargement of the atria with remarkable thinning have been observed. Identification of the gene responsible for X-linked EDMD (X-EDMD) and the protein product, emerin, provided a diagnostic clue for EDMD. Since the emerin gene is rather small, the entire sequence can easily be surveyed. Western blot and immunohistochemistry show an absence of emerin in muscle and skin tissues and oral exfoliating cells in male patients with X-EDMD, and a reduction of the protein content with a mosaic expression pattern in female carriers. Emerin anchors at the inner nuclear membrane of cardiac, skeletal and smooth muscles, and interacts with lamins and nucleoplasm, thereby possibly maintaining the mechanical stability of the nuclear membrane of muscle cells that shows rigorous contraction/relaxation. More recently, positive emerin staining at the cardiac demosomes and fasciae adherentes was noticed in addition to the specific localization at the inner nuclear membrane. This localization implies a physiological role for the protein in cardiac conduction.

Distinct regions specify the nuclear membrane targeting of emerin, the responsible protein for Emery-Dreifuss muscular dystrophy

Emery-Dreifuss muscular dystrophy is a neuromuscular disorder that has three characteristics: (a) early contracture of the elbows, Achilles tendons and postcervical muscles; (b) slowly progressive wasting and weakness of skeletal muscle; and (c) cardiomyopathy with severe conduction block. The responsible gene for the X-linked recessive form of this disease encodes an inner nuclear membrane protein named emerin. Although emerin is absent in tissues from patients with this disorder, it remains obscure why the loss of this widely expressed protein affects selectively skeletal muscle, heart and joints. As the first step to address this question, we examined the molecular regions of emerin that are essential for nuclear membrane targeting and stability of the protein. We found that the C-terminal hydrophobic region was necessary, but not sufficient, for nuclear membrane anchoring and stability of the protein. In the absence of this transmembrane domain, the upstream nucleoplasmic domain showed no firm association with the nuclear rim, but showed the tendency to accumulate at the nucleolus-like structures. Furthermore, proper targeting of emerin to the nuclear membrane required the latter half of the nucleoplasmic domain. These characteristics are distinct from those of lamina-associated polypeptide 2. Our findings indicate that emerin has distinct interactions with the inner nuclear membrane components that may be required for the stability and function of rigorously moving nuclei in tissues such as skeletal muscle, heart and joints.

Myocardial distribution and biotransformation in vitro and in vivo of nicorandil in rats, with special reference to mitochondria

This study reports subcellular localization of nicorandil in the myocardium and metabolism in mitochondria after oral dosing of 3 mg/kg nicorandil to rats. In the in vitro experiments, nicorandil, which was incubated with tissue homogenates (liver, kidney, heart, and small intestine), was metabolized to its denitrated compound, SG-86, and unknown substances. In the absence of a NADPH-generating system in the heart, the metabolic activity existed only in the mitochondrial fraction, but not in cytosolic and microsomal fractions. In the presence of the system, the activity in the mitochondrial fraction became much higher. To examine subcellular distribution of nicorandil in the myocardium, [14C]nicorandil was orally given to rats. Fifteen minutes after oral dosing of 3 mg/kg [14C]nicorandil, of which myocardial concentration reached a peak, nicorandil and SG-86 were found in mitochondrial fractions as well as in cytosolic and microsomal ones of the heart. Electron-microscopic autoradiograms, 15 min after oral dosing of 3 mg/kg [3H]nicorandil to rats, also showed the existence of the silver grains (showing radioactivity) in mitochondria of the heart. We conclude that nicorandil given orally is distributed in mitochondria of the heart, being partly transformed into SG-86, and that the myocardial mitochondria may be a potential site of action of nicorandil, an opener of KATP channels, which have been demonstrated to be present in this subcellular particle.

Time integrated spectroscopy of turbid media based on the microscopic beer-lambert law: application to small-size phantoms having different boundary conditions

Continued work on time-integrated spectroscopy (TIS) is presented to quantify absorber concentrations in turbid media. We investigated the applicability of the TIS method to small-size media that have different boundary conditions by measuring two 20×20×50 mm3 cuboid liquid tissue-like phantoms at various absorption levels (absorption coefficients of the phantom from 2.5×10-3 to 4.4×10-2 mm-1 at 782 nm and from 3.1×10-3 to 2.7×10-2 mm-1 at 831 nm). The scattering and absorbing solution was filled into ordinary and black-anodized aluminum containers to provide different boundary conditions. By means of a single equation, the absorber concentrations have been recovered within errors of a few percent in both cases. This demonstrates that the TIS method can quantify absorbers in small-size media having different boundary conditions. © 1999 Society of Photo-Optical Instrumentation Engineers.

Levels of soluble cell adhesion molecules in patients with angiographically defined coronary atherosclerosis

Adhesion molecules on the endothelial cell membrane play an important role in the pathogenesis of atherosclerosis. Levels of soluble forms of cell adhesion molecules are reportedly elevated in patients with peripheral artery vessel disease and in patients with an atherosclerotic aorta. The present study investigated the association of serum levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble intercellular adhesion molecule 1 (sICAM-1), and soluble P-selectin (sP-selectin) with coronary heart disease (CHD) and the extent of coronary atherosclerosis, and examined the influence of serum levels of lipids, lipoproteins and apolipoproteins (apo) in subjects with (n=52, M/F:43/9) and without (controls, n=40, M/F:25/15) angiographically proven coronary atherosclerosis. After controlling for age and gender, levels of sVCAM-1 (least squares mean +/- std error: 565+/-36 ng/ml vs 540+/-41 ng/ml, ns), sICAM-1 (261+/-17ng/ml vs 247+/-19ng/ml, ns), and sP-selectin (142+/-8ng/ml vs 149+/-10 ng/ml, ns) in patients with coronary atherosclerosis were not different from those in controls, as assessed by an analysis of covariance. After also adjusting for body mass index, hypertension, diabetes mellitus, and smoking by a multiple logistic function analysis, the association of sVCAM-1, sICAM-1, and sP-selectin with CHD was still not significant. Levels of sVCAM-1, sICAM-1, and sP-selectin were also not related to the extent of coronary atherosclerosis as judged by the number of stenosed vessels. However, inverse (p<0.05) relationships were observed between sVCAMs and serum levels of HDL3-cholesterol, apo A-II, and lipoprotein containing apo A-I and A-II, between sICAMs and levels of apo A-II and Lp A-I/A-II (Lp A-I/A-II), and between sP-selectin and lipoprotein containing only apo A-I. In conclusion, serum levels of soluble VCAM-1, ICAM-1, and P-selectin were not related to CHD or the extent of coronary atherosclerosis, but were inversely related to serum levels of high-density lipoprotein-related lipoproteins.

The effects of a high dose, short course of interferon on hepatitis C

To shorten the period of interferon (IFN) treatment for chronic hepatitis C, we investigated the clinical efficacy of a regimen using a higher dose and a shorter treatment period. Fifty chronic hepatitis C patients who were hepatitis C virus (HCV)-RNA positive and who were histologically diagnosed as having chronic hepatitis, took part in the study. Virus levels were measured before and 2 weeks after starting the treatment. We administered natural IFNalpha, 10 MU, i.m. daily for 2 consecutive weeks and then three times per week for the subsequent 14 weeks (total dose 560 MU). Patients who were HCV-RNA negative at the completion of the therapy and 6 months later, were evaluated as sustained responders (SR; 32%). Those who were not HCV-RNA negative at the two time points were evaluated as non-responders. Nucleotide and clone differences in the hypervariable region (HVR) and predictive factors for prognosis were also analysed. Low virus level and HCV-RNA genotype 2a/2b were the predictors for good prognosis, whereas the numbers of nucleotide differences and clone differences in HVR were not. Sustained responder patients became HCV-RNA negative 2 weeks after starting the treatment at a significantly higher rate, whereas no non-responder patients were HCV-RNA negative at that time. The SR rate (32%) was equivalent to those reported in previous 24 week treatment studies. This IFN therapy using a higher dose and a shorter period was useful.

Ultrastructural localization of nicorandil in the heart of rats

To examine the intracellular localization of nicorandil in the heart, [14C]nicorandil and [3H]nicorandil (3 mg kg(-1)) were given orally to rats. The maximum concentration (Cmax) of nicorandil in the myocardium was reached 15 min after the oral dosing. At this time subcellular localization of nicorandil was examined. Nicorandil and its denitrated metabolite, SG-86 were found in mitochondrial fractions and in cytosolic and microsomal fractions of the heart. Electron-microscopic autoradiograms recorded 15min after oral dosing of 3 mg kg(-1) [3H]nicorandil to rats also showed the presence of silver grains generated by the radioactive nicorandil or its metabolites in the mitochondria of the heart. We conclude that nicorandil given orally to rats is distributed in mitochondria of the heart.

Pathophysiological appraisal of a rat model of total hepatic ischemia with an extracorporeal portosystemic shunt

BACKGROUND

Animal models of total hepatic ischemia (THI) and reperfusion injury are restricted by concomitant splanchnic congestion. This study was performed to determine the requirement suitable for an extracorporeal portosystemic shunt (PSS) to maintain the intestinal integrity in a rat model of THI.

MATERIALS AND METHODS

Using a polyethylene tube (0.86 or 1 mm i.d.), PSS was placed between the mesenteric and jugular veins. Comparison was done between THI models with or without PSS and a partial ischemia model with hepatectomy of the nonischemic lobes. Well-tolerated hepatic ischemic period, portal pressure after 10 min of hepatic ischemia, portal endotoxin levels at 1 h after reperfusion, histological features of the small bowel just before reperfusion, and local jejunal and ileal blood hemoglobin oxygen saturation index (ISO2) were compared among the models.

RESULTS

Animals without PSS poorly tolerated 30 min of THI. Animals receiving THI with PSS or partial hepatic ischemia tolerated a longer ischemic period (60 min) with a significantly higher small bowel ISO2, lower portal pressure and endotoxin levels (P < 0.01), and less histological damage of the small bowel when compared to those receiving THI without PSS. Portal endotoxin levels after THI with PSS using a 1-mm i.d. tube as well as partial hepatic ischemia were significantly lower than those after THI with PSS using a 0.86-mm i.d. tube.

CONCLUSIONS

THI with PSS using a 1-mm i.d. tube was strikingly similar to partial hepatic ischemia in the pathophysiological profile during hepatic ischemia. PSS with a tube 1 mm or more in inner diameter offers pathophysiological advantages in experiments on THI and reperfusion.

Parasympathetic tone affects electrocardiographic preconditioning during right coronary angioplasty

We investigated whether parasympathetic tone may affect ischemic preconditioning in terms of ST segment alteration during coronary angioplasty. Coronary balloon angioplasty was performed in 19 patients with angina and isolated right coronary artery disease. Parasympathetic tone was assessed by frequency domain parameters of heart rate variability using 24-hour electrocardiographic recordings obtained before angioplasty. Logistic regression analysis showed the high frequency component to be an independent predictor of the change in ST elevation induced by the second balloon inflation. An increase in parasympathetic tone was related to ischemic preconditioning with respect to the electrocardiographic alterations observed in these patients.

[Evaluation of hepatic arterial infusion chemotherapy using reservoir for liver metastases from gastric cancer]

We evaluated the results of hepatic arterial infusion chemotherapy (HAIC) using implantable reservoir for gastric cancer patients with unresectable liver metastases. Twenty-eight patients (19 with synchronous liver metastases, 6 patients with recurrent hepatic tumors, and 3 patients with high risk factors of liver recurrence after curative surgery) were treated with HAIC. The canula was inserted into the hepatic artery during primary surgery for 19 patients and during angiography for 7. The combination of anti-cancer drugs, such as, MMC + 5-FU (6 cases), ADM + 5-FU (14 cases), 5-FU + ADM + MMC (5 cases), and CDDP (3 cases) was administered by the intra-arterial route to out-patients every one or two weeks.

RESULTS

The response rate of the metastatic liver foci in evaluable patients was 32.0% (1 CR + 7 PR/25). The median survival time (MST) of all patients was 294 days, and there were only two 5-year survivors treated to prevent recurrence. The 2-year survival after HAIC was 10.5% for the synchronous liver metastatic group and 53.3% for the metachronous group. The MST of responders was 94 days longer than that of non-responders, but there was no significant difference statistically. The remote survival of the patients whose palliative factors were liver metastases alone was significantly better than that of the patients with hepatic and extrahepatic palliative factors: the MST and 1-year survival was 329 days and 140 days, and 17.9% and 13.3%, respectively (p < 0.05). In conclusion, the clinical effect of HAIC was not sufficient. But the improvement of survival among patients without extrahepatic lesions as a palliative factor, and preventive HAIC was recommended.

Longitudinal follow-up of pulmonary function after lobectomy in childhood - factors affecting lung growth

We examined the changes in pulmonary function values in 27 patients who underwent a lobectomy due to cystic lung disease and compared the results regarding such factors as disease type, age at operation, and preoperative infections. Percent vital capacity (%VC) decreased immediately after lobectomy, but recovered to normal values within 2 postoperative years and remained within or above the normal range. The ratio of residual volume to total lung capacity (RV/TLC) rose temporally with the increase in %VC, but then remained normal after 2 postoperative years. There was no difference in %VC and RV/TLC between diseases, while bronchial atresia showed a significantly lower correlation with percent of forced expiratory volume at 1 s. The older group operated upon at over 4 years of age and the group that had infections before operation showed relatively low %VC and high RV/TLC. Some patients demonstrated extremely low %VC along with funnel chest deformities. Our study suggests that overinflation of the remaining lung compensates VC in the early period after lobectomy while subsequently alveolar multiplication occurs. Factors affecting compensatory lung growth were considered to be operation later than 4 years of age, preoperative infection, and a thoracic deformity.

Insulin-like growth factors - insulin-like growth factor binding protein axis and diabetic control in insulin-dependent diabetes mellitus

There is some evidence that insulin-like growth factors (IGFs) and/or IGF binding proteins (IGFBPs) (IGF-IGFBP axis) may be involved in glucose metabolism. The purpose of this study was to investigate the relationship between the IGF-IGFBP axis and diabetic control in subjects with insulin-dependent diabetes mellitus (IDDM). Thirty-nine subjects with IDDM without major complications (age: 5.8-30.3 years, 13 males and 26 females) participated in this study. In all subjects, the free form of IGF-I (free IGF-I), the total IGF-I (total IGF-I: free plus complexed form of IGF-I) and IGFBP-3 in serum or plasma were measured. The Z-scores of free IGF-I, total IGF-I, and IGFBP-3 were calculated. In 18 young adults with IDDM (age 18.0-30.3 years, 5 males and 13 females), IGFBP-1 in serum was also measured. In all subjects, the diabetic control parameters such as blood glucose (BS) (momentary control), 1,5-anhydro-D-glucitol (1,5 AG) (Ultrashort-term), fructosamine (short term), and glycosylated hemoglobin (HbA1) (long-term) were measured. None of the Z scores for free IGF-I, total IGF-I or IGFBP-3 had a significant correlation with BS. In young adults, IGFBP-I was correlated with BS (r=0.57, P<0.005). None of the Z scores for free IGF-I, total IGF-I or IGFBP-3 had a significant correlation with 1,5 AG, fructosamine or HbA1. In young adults, IGFBP-1 did not correlate with 1,5 AG, fructosamine or HbA1. These data suggested that the IGF-IGFBP axis did not reflect diabetic control in subjects with IDDM under treatment.

Optical quantitation of absorbers in variously shaped turbid media based on the microscopic Beer-Lambert law. A new approach to optical computerized tomography

To determine the concentrations of an absorber in variously shaped turbid media such as human tissue, we propose analytical expressions for diffuse re-emission in time and frequency domains, based on the microscopic Beer-Lambert law that holds true when we trace a zigzag photon path in the medium. Our expressions are implicit for the scattering properties, the volume shape, and the source-detector separation. We show that three observables are sufficient to determine the changes in the concentration and the absolute concentrations of an absorber in scattering media as long as the scattering property remains constant. The three observables are: the re-emission, the mean pathlength or group delay, and the extinction coefficient of the absorber. We also show that our equations can be extended to describe photon migration in nonuniform media. The validity of the predictions is confirmed by measuring a tissue-like phantom.

HDR syndrome (hypoparathyroidism, sensorineural deafness, renal dysplasia) associated with del(10)(p13)

A combination of hypoparathyroidism, sensorineural deafness, and renal dysplasia has been considered to be a new syndrome inherited in an autosomal dominant fashion; we name the condition "HDR syndrome." We describe a Japanese girl who has HDR syndrome associated with de novo del(10)(p13). The chromosome deletion suggests that the putative gene(s) responsible for HDR syndrome is located at a 10pter-->p13 region.

Exposure of fibroblasts derived from keloid patients to low-energy electromagnetic fields: preferential inhibition of cell proliferation, collagen synthesis, and transforming growth factor beta expression in keloid fibroblasts in vitro

We studied the effects of electromagnetic fields (EMFs) on cell proliferation and collagen synthesis in both normal and keloid fibroblasts in vitro. Treatment of keloid fibroblasts with 60-Hz EMFs for 10 days resulted in the inhibition of cell proliferation, whereas no significant change in cell proliferation of normal fibroblasts was observed. EMFs inhibited collagen synthesis in keloid fibroblasts but not in normal fibroblasts without altering the ratio of type III to type I collagen, indicating that EMFs inhibit type I and type III collagen synthesis to the same extent. EMFs also decreased the expression of transforming growth factor beta (TGF-beta) in keloid fibroblasts. These results suggest that EMFs may have a useful therapeutic potential for the treatment of keloid.

Emery-Dreifuss syndrome

Emery-Dreifuss syndrome is a heterogeneous entity characterized by the following clinical triad: early contracture of the elbows. Achilles tendons and postcervical muscles; slowly progressive muscle wasting and weakness with a humeroperoneal distribution early in the course of disease; and a cardiomyopathy usually presenting as an atrioventricular block ranging from sinus bradycardia to complete heart block. As the heart block is the major problem, insertion of a cardiac pacemaker can be life saving. Recent advances through genetic and immunochemical studies have provided valuable clues to the understanding and the early diagnosis of this disease.

Emerin, deficiency of which causes Emery-Dreifuss muscular dystrophy, is localized at the inner nuclear membrane

X-linked recessive Emery-Dreifuss muscular dystrophy (EDMD) is an inherited muscle disorder characterized by the clinical triad of progressive wasting of humero-peroneal muscles, early contractures of the elbows, Achilles tendons and postcervical muscles, and cardiac conduction block with a high risk of sudden death. The gene for EDMD on Xq28 encodes a novel protein named emerin that localizes at the nuclear membrane of skeletal, cardiac and smooth muscles and some other non-muscle tissues. To investigate a possible physiological role for emerin, we examined the ultrastructural localization of the protein in human skeletal muscle and HeLa cells, using ultrathin cryosections. We found that the immune-labeled colloidal gold particles were localized on the nucleoplasmic surface of the inner nuclear membrane, but not on the nuclear pore. Emerin stayed on the cytoplasmic surface of the nuclear lamina, even after detergent treatment that solubilizes membrane lipids and washes out membrane proteins. These results suggest that emerin anchors at the inner nuclear membrane through the hydrophobic stretch, and protrudes from the hydrophilic region to the nucleoplasm where it interacts with the nuclear lamina. We speculate that emerin contributes to maintain the nuclear structure and stability, as well as nuclear functions, particularly in muscle tissues that have severe stress with rigorous contraction-relaxation movements and calcium flux.

[Type III procollagen N-terminal aminopeptide and type IV collagen 7S in pleural effusion fluid]

The mechanism of pleural fibrosis in malignant and inflammatory pleural effusion remains unclear. We measured the levels of type III procollagen N-terminal amino peptide (PIIIP) and type IV collagen 7S in patients who had pleural effusion and lung carcinoma, and in others who had inflammatory diseases (parapneumonic and tuberculous pleuritis). The PIIIP level and the PIIIP/type IV collagen 7S ratio in patients with malignant pleural effusion were significantly lower than those in patients with inflammatory pleural effusion (p < 0.01), but the levels of type IV collagen 7S did not differ. The ratio of PIIIP to type IV collagen 7S was higher in patients with tuberculous pleuritis than in those with parapneumonic pleuritis (p < 0.05). These data indicate that pleural fibrotic adhesion may be accelerated in inflammatory pleural effusion because of elevated production of type III collagen; basement membrane injury in malignant and inflammatory pleural effusion may be caused by similar damage. We conclude that a high level of PIIIP and a high PIIIP/type IV collagen 7S ratio may indicate the presence of inflammatory pleuritis, and that the latter may indicate the presence of tuberculous pleuritis.

Clinical efficacy of interferon therapy for chronic hepatitis C in the Kita-Kyushu District of Japan

The Kita-Kyushu district in Japan is one of the areas known to have a quite high prevalence of HCV infection. We analyzed the results of interferon therapy administered to 50 chronic hepatitis C patients living in this area (33 males and 17 females; ages between 28 and 65 years old). Interferon-alpha (human lymphoblast interferon, HLBI), 6 million units/day, was administered for 24 consecutive weeks. Before the therapy, the HCV levels, HCV-RNA genotype, and sequence of hypervariable region (HVR) of HCV were examined. Patients who were HCV-RNA negative and ALT < or = 30 IU/L at the completion of therapy and in the 6th month after the completion of therapy, were determined as complete responders (CR). In this study, 10 of 50 patients (20%) were CR. Among male patients, there were no CR in each age group, whereas among female patients aged over 40 years old, there were no CR. The number of patients with low virus levels was larger in the genotype 2a/2b cases than in the genotype 1b cases. HVR sequences varied extensively, and had no correlation to interferon efficacy. Multivariate analysis showed that the pre-treatment HCV level is the most important predictor.