[Laser photodynamic therapy for central-type lung cancer]

Laser endoscopic surgery is recognized as an effective treatment for lung cancer. Attention has increasingly been focused on photodynamic therapy (PDT) with dihermatoporphyrin ethers. The Japanese government approved the use of this therapy in October 1995, and reimbursement through the national health insurance system began in April 1996. Over the past decade, 140 patients (283 lesions) with central type lung cancers have been treated at our hospital. Overall complete remission was obtained in 39.6% of 112 lesions, partial remission in 59.4% and no remission in 1.0% The indications for PDT are as follows: 1. Early stage lung cancer curative; among 95 early stage lesions complete remission was obtained in 79 (83.2%), and 71 patients were disease free at 3 to 176 months. 2. Advanced lesions opening of bronchi; overall, "effective" opening of bronchi was achieved in 61 of 81 lesions (75%), in the PDT group, and in 143 of 177 (81%) in the Nd-YAG laser therapy groups. 3. Preoperative laser irradiation to increase operability and reduce the extent of operation; the extent of resectin was reduced, or inoperable lesions were made operable in 21 of 24 patients treated. 4. Multiple primary lung cancer. The success of clinical trials of PDT for treatment of lung cancers bodes well for its future use. More stable, definitive, and successful treatment will become possible with the use of new dyes that distribute more evenly in tumor tissue, and with the deeper tissue penetration made possible by longer-wavelength beams.

Thermolabile beta-2 macroglycoprotein (Hakata antigen) in liver disease: biochemical and immunohistochemical study

Thermolabile beta-2 macroglycoprotein is a novel serum protein that was detected by an autoantibody in sera of a Japanese woman with systemic lupus erythematosus. We developed an enzyme-linked immunosorbent assay for this glycoprotein and measured its serum levels in patients with chronic liver disease. There were significant correlations between serum levels of this glycoprotein and those of albumin and cholinesterase. The serum levels of TL beta 2MG decreased with increasing severity of cirrhosis. Immunohistochemical staining using monoclonal anti-thermolabile beta-2 macroglycoprotein antibody revealed positive staining in the cytoplasm of the hepatocytes. These data strongly suggested that hepatocyte may be one of the production sites of this glycoprotein. Measurement of serum levels of this glycoprotein was useful for evaluation of hepatic function in chronic liver disease.

Differential effect of interleukin-1 alpha on rat hepatic cytochrome P450 monooxygenases

Administration of recombinant human interleukin-1 alpha to adult male rats caused a significant reduction in the levels of hepatic cytochrome P450 and P450 reductase activity at 24 h after the treatment. The mRNAs for cytochrome P450 1A2 and 2E1 were reduced more than 70% at 12 h after administration of interleukin-1 alpha and remained decreased even after 48 h. By contrast, cytochrome P450 2C11 mRNA was reduced only by 30% at 12 h after the treatment and returned to the control levels by 48 h, suggesting that interleukin-1 alpha has a differential effect on the expression of P450 mRNAs. Aniline hydroxylase, benzphetamine N-demethylase and 7-ethoxycoumarin O-deethylase activities were significantly decreased at 24 h after interleukin-1 alpha treatment. The proteins for cytochrome P450 1A2 and 2E1 were reduced by about 50% at 24 h after interleukin-1 alpha treatment.

Immunofluorescence staining of renal biopsy samples in patients with diabetic nephropathy in non-insulin-dependent diabetes mellitus using monoclonal antibody to reduced glycated lysine

This is the first report on immunofluorescence staining of renal biopsy samples in human diabetic nephropathy (DN) using monoclonal antibodies to reduced glycated lysine. In order to detect the localization of glycated lysine in the mesangial matrix and/or the glomerular basement membrane (GBM), we examined immunofluorescence staining using antibodies against reduced glycated lysine in the glomeruli of 16 patients with DN and ten age-matched patients with diffuse mesangial proliferative glomerulonephritis without IgA deposition (DPGN) as controls. In the early stage of DN, immunofluorescence microscopy revealed the presence of intense staining for reduced glycated lysine in the GBM as well as in part of the tubular basement membrane, but not in the mesangial area. In contrast, immunofluorescence microscopy revealed less staining for glycated lysine in the GBM in the advanced stage of DN, and no reaction with any part of the renal tissue in patients with DPGN. It was concluded that detection of reduced glycated lysine in GBM in the early stage of DN might be associated with the initial pathogenesis of this disease.

Ameloblastoma with prominent ossification in the mandible of a dog

A rare case of ameloblastoma with prominent stromal ossification in an 8-year-old female dog was studied. A bony mass recurred rapidly in the right mandible at the first molar region. Histopathologic examination revealed the lesion to be an atypical variant of ameloblastoma. Epithelial cells showed marked cell atypia, and mitotic figures were rather common. The collagenous stroma was abundant, with prominent formation of bone trabecular rimmed by active osteoblasts. The tumor was highly proliferative and aggressive, and thought to be malignant in nature.

Physiologic responses to exchange transfusion with hemoglobin vesicles as an artificial oxygen carrier in anesthetized rats: changes in mean arterial pressure and renal cortical tissue oxygen tension

OBJECTIVES

To evaluate the oxygen transporting capabilities of hemoglobin vesicles by studying the physiologic responses to exchange transfusion with hemoglobin vesicles in anesthetized rats. Exchange transfusions with phosphate buffered saline, hemoglobin vesicles containing methemoglobin (and therefore, deprived of oxygen transporting capabilities), and washed rat red blood cells were used as controls.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Department of Surgery, School of Medicine, Keio University.

SUBJECTS

Twenty-seven male Wistar rats.

INTERVENTIONS

The rats were anesthetized with an intraperitoneal injection of sodium pentobarbital (50 mg/kg). Catheters (PE-20 tubing, outer diameter 0.8 mm, inner diameter 0.5 mm) were introduced into the right jugular vein for infusion and the right common carotid artery for blood withdrawal and mean arterial pressure measurements. The left kidney was exposed by median abdominal incision, and a needle-type polarographic oxygen electrode was placed in the left renal cortex for renal cortical tissue oxygen tension measurements.

MEASUREMENTS AND MAIN RESULTS

Phosphate buffered saline and methemoglobin vesicles were administered as nonoxygen-carrying fluids, and rat red blood cells as oxygen-carrying fluid. Measurements included mean arterial pressure, arterial blood gas analysis, and renal cortical tissue oxygen tension as an indicator of systemic oxygen transport. In the rat red blood cell and hemoglobin vesicles groups, mean arterial pressure was sustained at the end of the exchange transfusion (82.3 +/- 27.5% and 73.5 +/- 11.5%, respectively, from the basal values). However, in the phosphate buffered saline and methemoglobin vesicles groups, mean arterial pressure decreased significantly (p < .05) (33.9 +/- 13.8% and 35.7 +/- 8.2%, respectively). Renal cortical tissue oxygen tension in the rat red blood cell and hemoglobin vesicles groups was sustained at a significantly higher level (p < .05) (83.5 +/- 9.3% and 75.0 +/- 11.9%, respectively) compared with the phosphate buffered saline and methemoglobin vesicles groups (44.9 +/- 12.8% and 58.3 +/- 6.2%, respectively) at the end of the exchange transfusion. Metabolic acidosis was more progressive in the phosphate buffered saline and methemoglobin vesicles groups, manifested as lower pH and base excess values. Platelet counts tended to decrease slightly in the hemoglobin vesicles and methemoglobin vesicles groups, but the changes were not significant.

CONCLUSIONS

Hemoglobin vesicles have an oxygen transporting capability almost equivalent to rat red blood cells and can be considered as a potential artificial oxygen carrier.

Intraglomerular C3 synthesis in human kidney detected by in situ hybridization

Complements 3 and 4 are known to be synthesized in diseased renal tissue and the mRNA of these complements has been demonstrated, using polymerase chain reaction, in renal biopsies from nephritic patients. However, the types of cells producing the complements in intact renal tissue have not been defined. To identify the renal cellular components involved in complement synthesis, we analyzed the expression of C3 mRNA in renal tissues from patients with immune-complex glomerulonephritis by a high-resolution in situ hybridization using digoxigenin-labeled oligonucleotide. Renal tissues from 15 patients with immunoglobulin (Ig) A nephropathy (IgAN), five with lupus nephritis (LN), and five with minimal change nephrotic syndrome (MCNS) were examined. Uninvolved portions of surgically removed kidney with tumors served as normal controls. C3 mRNA was detected in mesangial cells, glomerular epithelial cells, and Bowman's capsule in IgAN and LN. In the interstitium, some tubules and some infiltrating mononuclear cells were positively stained for C3 mRNA. C3 mRNA was not detected in MCNS and control tissues. Our results confirm that the glomerular resident cells can synthesize C3 in immune-mediated glomerulonephritis and suggest that locally synthesized complement may be involved in tissue injury in glomerulonephritis.

Allosteric activation of L-lactate dehydrogenase analyzed by hybrid enzymes with effector-sensitive and -insensitive subunits

Subunit-hybrid enzymes of mutant tetrameric L-lactate dehydrogenases from Bifidobacterium longum were studied in an examination of the mechanism of allosteric activation by fructose 1,6-bisphosphate. We earlier developed an in vivo method for subunit hybridization in Escherichia coli and the hybrids formed were a mixture with different subunit compositions. The B. longum hybrids were separated by anion-exchange chromatography with a mutational tag. Hybrids formed between fructose 1,6-bisphosphate-desensitized subunits and wild-type subunits and also between fructose 1, 6-bisphosphate-desensitized subunits and catalytically inactive subunits. Kinetic analyses of the hybrid enzymes showed that (i) those residues from two symmetrically related subunits that constituted the fructose 1,6-bisphosphate-binding site could bind fructose 1,6-bisphosphate and activate the enzyme only if intact, (ii) hybrids with only one functional fructose 1, 6-bisphosphate-binding site were fully sensitive to fructose 1, 6-bisphosphate, but the allosteric equilibrium had shifted partially, and (iii) activation by fructose 1,6-bisphosphate at the fructose 1, 6-bisphosphate-binding site was transmitted to the active sites through a quaternary structural change, not through direct conformational change within a subunit. These results are evidence of the validity of the concerted allosteric model of this enzyme based on T- and R-state structures in the same crystal lattice proposed earlier.

Comparison of serodiagnostic tests and ultrasonography for cystic hydatidosis in an epidemiological study of rural Uruguay

Cystic hydatidosis (CH) caused by Echinococcus granulosus is an important zoonosis worldwide. Several serodiagnostic and ultrasound tests are currently used for screening asymptomatic CH. The sensitivity of the serodiagnostic tests has been demonstrated by several groups to be lower than ultrasonography (US). To explain the mechanism of the difference in sensitivity, a large-scale US survey combined with an IgG4-enzyme-linked immunosorbent assay test was conducted in Uruguay. Our results suggest that certain cyst images, e.g., multivesicular cysts, may be closely associated with a high antibody response regardless of the cyst size, whereas other hydatid lesions, e.g., solid images with/without rolled parasite membranes, have lower antibody responses with a close relationship to cyst size. Seropositivity of subjects who had been treated surgically for removal of hydatid cysts in the last 5 yr was closest to that of actual CH patients, albeit free from CH by US. These findings are important for the proper use of serodiagnostic tests and US for community-based epidemiological studies.

Inhibitory effect of 1 alpha,25-dihydroxyvitamin D3 on mast cell proliferation and A23187-induced histamine release, also accompanied by a decreased c-kit receptor

Using mouse peritoneal mast cells, we investigated the effects of 1 alpha,25-dihydroxyvitamin D3 (calcitriol) on mast cell proliferation and histamine release. Calcitriol did not affect IL-3/IL-4-dependent mast cell proliferation, but it selectively inhibited stem cell factor-dependent mast cell proliferation and colony formation. Immunohistochemical and immunoblot analyses revealed that calcitriol treatment reduced expression of purified peritoneal mast cell c-kit protein. Using a mast cell line, MC/9, both c-kit protein and c-kit mRNA transcript were seen to be reduced following calcitriol treatment. Calcitriol also reduced histamine release induced by calcium ionophore A23187. In contrast, anti-IgE antibody-dependent histamine release was not affected by calcitriol. Our results indicate that calcitriol inhibits mast cell proliferation and A23187-induced histamine release that might be associated with a decreased expression of c-kit receptor.

Effect of cetirizine on antigen-induced tracheal contraction of passively sensitized guinea pigs

BACKGROUND

Cetirizine dihydrochloride (cetirizine), a potent histamine H1-receptor antagonist, has been developed as an anti-allergy drug.

OBJECT

The anti-allergic effects and mechanism of cetirizine were studied using in vitro assay systems.

METHODS

We investigated the effect of cetirizine on antigen-induced contractions of isolated tracheal strips and on chemical mediator release from antigen-stimulated lung chips taken from passively sensitized guinea pigs. We examined the antigen-induced mobilization of Ca2+ in MC/9 mast cells sensitized with IgE.

RESULTS

Cetirizine inhibited the antigen-induced contraction of isolated guinea-pig trachea concentration dependently. Pyrilamine, another histamine H1-receptor antagonist, delayed the response but did not change the maximum amplitude. Cetirizine at the concentration of 3 microM also inhibited the antigen-induced release of histamine, leukotriene D4, and leukotriene E4 from guinea pig lung chips. Furthermore, it inhibited the antigen-induced Ca2+ increase in MC/9 mast cells, whereas pyrilamine did not.

CONCLUSION

These findings suggest that one anti-allergic mechanism of cetirizine may inhibit mediator release which is, at least partially, mediated by a decrease in the transient Ca2+ influx in mast cells.

Long-term evaluation of recombinant human bone morphogenetic protein-2 induced bone formation with a biologic and synthetic delivery system

The efficacy of microspheres made of polylactic acid polyglycolic acid copolymer mixed with blood clot as a delivery system for recombinant human bone morphogenetic protein-2 (rhBMP-2) was evaluated and the long term behaviour of rhBMP-2 in rats was studied. Twenty micro grams of rhBMP-2 in 200 microliter carrier (blood coagulum and polylactic acid polyglycolic acid porous microspheres) were implanted subcutaneously over both sides of the chest muscles in 40 5-week-old male Long Evans rats. The control group were implanted with carrier alone. Specimens were retrieved after 3 days and weekly for 9 weeks. Outcome was measured by signs of bone formation on low power radiographs, and signs of bony growth on histological examination. There were no signs of foreign body or inflammatory reactions to the carrier in either group. In the experimental group signs of bone formation had started to appear by the end of the first week, and there was a gradual increase in both radio-opacity and size during the observation period. Histologically the bony growth was beginning to mature by 4 weeks and was fully mature by 7-9 weeks. In contrast there was no sign of cartilage or bone formation in the control group and the carrier had resorbed by 4-6 weeks. It is concluded that rhBMP-2 implanted in a carrier consisting of blood clot and porous microspheres made of polylactic acid polyglycolic acid induces rapid proliferation of mesenchymal cells that lead to formation of cartilage and bone by 7 days which had matured by 9 weeks. rhBMP-2 in this carrier may be useful clinically because of its capacity to induce early formation of bone.

Ring chromosome 15 syndrome in an adult female

In this paper, the authors present the case of a 24-year-old female with ring 15 chromosome syndrome. Upon examination, the patient presented with severe mental retardation, dwarfism and microcephaly, along with other minor dysmorphic stigmata. We compared this case with three other adult female cases with this chromosomal aberration. As a result, the authors observed a somewhat dysharmonious profile between the level of mental retardation and behavioural findings in the four women, while sexual development and gonadal function seemed to be normal in all four cases.

A case of Sézary syndrome associated with cutaneous transformation

Sézary syndrome is a leukemic variant in the spectrum of cutaneous T cell lymphomas. In some cases of cutaneous T cell lymphoma, the skin tumors or lymph nodes show morphologic changes indistinguishable from those of a large-cell lymphoma; this has been termed transformation. We report a case of Sézary syndrome who developed multiple skin tumors that showed transformation, loss of multiple pan T-cell markers (CD3, 4, 5, 7, 8), and a concomitant expression of CD30 during the course of the disease. Some of the tumors spontaneously regressed following incisional biopsy or traumatic wounds. The patient died of pneumonia five years following the transformation.

Age-related and dexamethasone-induced changes in cathepsins E and D in rat thymic and splenic cells

Age-related and dexamethasone (DEX)-induced changes in the cellular levels, distributions, and molecular forms of two distinct intracellular aspartic proteinases, cathepsin E (CE) and cathepsin D (CD), were investigated in rat thymus and spleen by immunohistochemical and quantitative analyses. In the thymus, CE was predominantly restricted to thymocytes and macrophage-like cells, whereas CD was associated mainly with the stromal cells. The increased thymic CE level observed in young rats up to 8 weeks of age was markedly decreased in aged rats (78-80 weeks of age), in accordance with the involution of the thymus, while there was little difference in the thymic CD level between young and aged rats. Subcutaneous administration of DEX also caused a marked decrease of the thymic CE level in response to the depletion of thymocytes. In contrast, a great accumulation of CD occurred in the thymic stromal cells after DEX treatment. Immunoblotting analyses revealed that CE in thymocytes isolated from young rats consisted predominantly of a 46-kDa proform which was greatly converted into a 42-kDa mature form in DEX-treated thymocytes. This conversion, however, was scarcely observed during the normal aging process. In the spleen, CE was also abundant in macrophage-like cells and lymphocytes and its level was not significantly changed between young and aged rats. However, DEX treatment caused a marked decrease of the splenic CE and CD levels in accordance with the depletion of the white pulp. Among the lymphoid cell types examined, splenic B cells were the most abundant in CE. The CE level in thymocytes and splenic T-cells was more than twice that in circulating lymphocytes. We concluded that CE is related to the process of activation-induced lymphocyte depletion.

[Gastrointestinal metastasis from lung cancer]

Metastasis of lung cancer to the digestive tract (excluding the esophagus) was confirmed by surgery or autopsy in 30 of the 1635 lung-cancer patients admitted to this Center during the 17-year period since 1977. The diagnosis was made before death in 7 and after death in 23. Metastasis of large cell carcinoma was the most common (3.7%), followed by adenocarcinoma (2.4%), small cell carcinoma (1.7%), and squamous cell carcinoma (0.7%). Metastasis to the stomach occurred in 0.4%, to the small intestine in 1.1% and to the colon in 0.5%. The overall percentage of metastasis to the digestive tract was 1.8%. Among the 298 cases diagnosed at autopsy, metastasis to the digestive tract occurred in 9.7%; stomach, 2.6%; small intestine, 5.7%; and colon, 3.0%. Eleven of the patients in whom the diagnosis was made at autopsy had abdominal symptoms while they were alive. In 11 cases diagnosed at autopsy, occult blood was positive in 9, but 6 of those 9 patients were asymptomatic. The occult-blood test is considered to be helpful as a supplementary diagnostic method in detecting metastasis of lung cancer to the digestive tract. Among the cases diagnosed while the patients were alive, metastasis was observed in the small intestine in 6 and in the colon in 1. The major manifestations were melena, ileus, intussusception, and perforation; 4 patients required emergency surgery. The prognosis was poor: the mean survival period from the onset of symptoms was 49 days. The direct cause of death was metastasis to the digestive tract in 5 cases. The possibility of metastasis to the digestive tract is high when progressive abdominal symptoms are observed and the stool is persistently positive on occult-blood tests.

Establishment and characterization of choroid plexus carcinoma cell lines: connection between choroid plexus and immune systems

Murine choroid plexus cell lines were produced from choroid plexus carcinoma generated in transgenic mice harboring the viral oncogene simian virus 40 large tumor antigen under transcriptional control of an intronic enhancer region from the human immunoglobulin heavy chain (IgH) gene. Two morphologically distinct cell lines have been cloned. These established cell lines retained the characteristics of choroid plexus cells in that they expressed such choroid plexus cell marker or related proteins as transthyretin and alpha2-macroglobulin. They were tumorigenic in nude mice. In the cell lines, the muA and muB (HE2) motifs within the IgH intronic enhancer were active and we also demonstrated the existence of the proteins binding to these motifs, suggesting a potential link between the choroid plexus and immune systems. It is considered that these binding proteins act as trans-activators for the enhancer and may belong to the class of ETS-related proteins. These cell lines and xenografts should be useful materials for analyses of choroid plexus functions.

A safe clinical system for nitric oxide inhalation therapy for pediatric patients

A safe clinical system for nitric oxide (NO) inhalation therapy was developed. The system consists of three parts: a NO controller, a NO monitor, and a patient circuit. NO gas flow and carrier gas flow are controlled by a special rust-proof thermal mass flowmeter. Standard gas quality NO gas (10,000 ppm, balance nitrogen) is used. The outlet of the NO gas tank is connected to the distal end of a heated humidifer that is very close (12 mL) to the patient, to decrease acidic water precipitation and decrease contact time between NO and oxygen (O2). Fail-safe mechanisms to prevent the delivery of a hypoxic mixture or excessive NO concentration are incorporated. Inspiratory NO concentration is continuously monitored by a modified electrochemical NO meter. The patient circuit consists of a breathing circuit and a ventilator with a scavenging unit. A modified Mapleson D type circuit is used. Fresh gas, humidified and mixed with NO, is introduced to the patient connection port. A mechanical ventilator, either of conventional or of high-frequency oscillation type, is connected to the expiratory limb of the Mapleson D circuit. A coaxial scavenging unit including activated charcoal is placed in between the expiratory limb and the ventilator. The adjustment of inspiratory NO concentration (y) was accurate over a wide range (1-80 ppm) of concentrations (x) (y = 0.36 + 0.96x, R2 = 0.999, n = 45) and showed good agreement with the chemiluminescence method. Inspiratory nitrous oxide (NO2) concentration was less than 0.3 ppm, and acidic water accumulation as measured by NO2- and NO3- was less than 5 ppm, even at an extremely high NO concentration of 80 ppm with an FiO2 of 1.0 and 10 L/min of fresh gas flow. Environmental NO and NO2 concentrations in the ICU remained below 0.005 and 0.05 ppm, respectively. This system was used clinically on 214 pediatric patients and proved to be accurate, safe, and useful.

[Clinical study of serum antibodies specific to Chlamydia trachomatis in patients with chronic nonbacterial prostatitis and prostatodynia]

The etiological role of Chlamydia trachomatis in chronic nonbacterial prostatitis is controversial. To assess whether C. trachomatis relates to chronic nonbacterial prostatitis, we investigated the serum levels of immunoglobulin G (IgG) and IgA antibodies specific for C. trachomatis in 41 patients with chronic nonbacterial prostatitis and 47 patients with prostatodynia. The positive rates of the IgG antibody were 29% and 28% in patients with chronic nonbacterial prostatitis and prostatodynia, respectively. There was little difference in the positive rates of the IgG and IgA antibodies for C. trachomatis, between patients with chronic nonbacterial prostatitis and prostatodynia. Also, there was no significant difference in the positive rate of the IgG antibody between 51 patients complaining of urinary symptoms and 25 complaining of referred pain. However, a high positive rate of the IgG antibody (80%) was observed in patients with hematospermia. Our findings suggest that C. trachomatis could not be etiologically responsible for chronic nonbacterial prostatitis, but that it may be related to hematospermia.

Differential mRNA expression of phospholipase D (PLD) isozymes during cAMP-induced differentiation in C6 glioma cells

GTP gamma S-dependent phospholipase D (PLD) activity time-dependently increased during differentiation of rat C6 glioma cells to astrocytic phenotypes induced by dibutyryl cyclic AMP (dbcAMP)/theophylline. The changes in PLD mRNA level were examined by reverse transcriptase-polymerase chain reaction (RT-PCR) method using the degenerate primers designed based on two conserved amino acid sequences in PLDs of human and yeast. The amplified three DNA fragments (tentatively termed as rPLDa, b, and c) contained the conserved regions present in PLDs of various organisms. RT-PCR using non-degenerate primers showed that rPLDa mRNA increased within 12h following treatment with dbcAMP, reaching a broad plateau and then returned to the initial level at 48h. In contrast, the level of rPLDb mRNA showed a concurrent decrease. rPLDc decreased in a time-dependent manner. These results suggest that the expression of PLD mRNAs are differentially regulated during differentiation in C6 glioma cells.

[Surgical treatment of pericostal tuberculosis]

The following two points must be considered on treating pericostal tuberculosis: the first is the appropriate time to treat pericostal tuberculosis surgically when the medical therapy fails to induce a remission, and the second is how to prevent postoperative relapse. In the present study, we investigated these two points by examining seven patients who underwent surgery at the department of thoracic surgery (Osaka Red Cross Hospital), during a 10 years period from January 1985 to December 1994. Antituberculotics were administered to these patients for an average of 3.9 months before surgery, but in vain. Therefore, they were surgically treated. In all cases, the incision was closed at once, and there were no severe complications. The signs and symptoms disappeared soon after surgery. It has been reported that the medical treatment leads to recovery or tendency to recovery within three months of drug administration. The conditions of pericostal tuberculosis patients during this period can be used as indicators to decide whether or not to carry out surgical treatment. Also, by active excision of the rib and tumor as one mass, and by administering antituberculotic for 13.1 months after surgery, no relapse took place during the follow-up period (average 37.4 months). And the postoperative respiratory functions did not decrease compared to those before surgery.

Widespread pruritic plaques in a patient with subacute cutaneous lupus erythematosus and hypocomplementemia: response to dapsone therapy

We describe a patient with subacute cutaneous lupus erythematosus, widespread pruritic papulosquamous plaques, and hypocomplementemia. Skin biopsy specimens revealed liquefaction degeneration and colloid bodies and dyskeratotic cells in basal and suprabasal layers. An immunofluorescence study revealed deposits of IgG, IgM, and C3 at the dermalepidermal junction in a bandlike pattern, and particulate IgG deposition in the basal and suprabasal layers. Treatment with prednisolone (15 mg/day), chloroquine phosphate (200 mg/ day), cyclosporine (5 mg/kg daily), and gold (10 mg/day) failed to reduce pruritic plaque formation, and pulse methylprednisolone therapy led to only a transient remission. Clinical exacerbations correlated with a decrease in complement levels. The disease was successfully controlled with dapsone (75 mg/day) and prednisolone (25 mg/day).