Milrinone decreases both pulmonary arterial and venous resistances in the hypoxic dog

We have studied the effect of milrinone on pulmonary vascular resistance (PVR) in dogs with hypoxic pulmonary vasoconstriction (HPV). Using a pulmonary arterial occlusion method, we measured effective pulmonary capillary pressure (Pcap) by which total PVR was partitioned into arterial (PVRa) and venous (PVRv) components. Hypoxic ventilation (FIO2 = 0.11-0.13) produced significant increases in mean pulmonary arterial pressure (PAP) and Pcap (P < 0.01) associated with increases in PVRa and PVRv (P < 0.01). During the hypoxic period, milrinone significantly decreased mean PAP and Pcap (P < 0.01), reflected in decreases in PVRa and PVRv (P < 0.01). The longitudinal distribution of PVR (PVRa/PVRv) remained unchanged throughout the experiment, indicating that HPV occurred equally in the arterial and venous segments and that milrinone-induced vasodilatation occurred equally in both segments. During hypoxia, milrinone did not produce an increase in cardiac output or a decrease in PaO2. Milrinone also produced significant decreases in mean systemic arterial pressure (P < 0.01) and systemic vascular resistance (P < 0.05) to a similar extent to the decreases in mean PAP and PVR, suggesting no selective dilating effect of milrinone on the pulmonary vasculature. These results indicate that in HPV, milrinone decreased the vascular tone of both pulmonary arterial and venous segments without increasing cardiac work or impairing pulmonary oxygenation. This suggests a potential for use in patients suffering from hypoxic pulmonary hypertension.

[Pulmonary cryptococcosis exhibiting diffuse multiple nodular shadows]

We report a case of pulmonary cryptococcosis showing diffuse multiple nodular shadows in all lung fields. A 39-year-old woman with no immunological abnormalities was admitted with complaints of cough and sputum. She had experienced measles 4 weeks prior to admission. Chest x-ray films revealed diffuse nodular opacities throughout the lung fields, a finding suggestive of metastatic lung cancer. Detailed examinations, including transbronchial lung biopsy, were not conclusive. A diagnosis of pulmonary cryptococcosis was made on the basis of findings from video-assisted thoracoscopic biopsy. Primary pulmonary cryptococcosis usually appears as a solitary nodule or limited infiltration. Immunologically compromised hosts commonly demonstrate various abnormal shadows, such as the multiple nodular shadows observed in our patient. It has been reported that measles infection can cause temporary immune suppression. Secondary immunodeficiency resulting from the preceding infection with measles could explain the unusual chest x-ray findings in this case.

[Lung collapse during one lung ventilation does not change low frequency respiratory mechanics]

The present study was carried out to clarify the effects of lung collapse for one lung ventilation on respiratory system impedance during thoracic surgery. We measured the impedances of respiratory system (RS) in eight paralyzed subjects under anesthesia employing a pseudorandom noise forced volume oscillation technique. These measurements were performed before and after the one lung ventilation. The impedance values were fitted to a mathematical model consisting of a single conduit connected with a viscoelastic parenchyma. Lung collapse did not affect resistance and reactance in RS after the re-expansion. The mathematical modeling showed no significant effect of one lung ventilation on all the parameters of airway and parenchyma. There was no difference in model fit of the parameters, indicated by the presence of the goodness-of-fit parameter (chi 2), before and after lung collapse. In conclusion, lung collapse during one lung ventilation does not change low frequency respiratory mechanics.

Dry condition affects desquamation of stratum corneum in vivo

We examined whether a dry condition actually induces scaly skin in vivo. Hairless mice were kept in a high humidity condition or a low humidity condition and skin changes were examined. Scales appeared on the backs of mice kept for 3 days under the dry condition. The weight of stratum corneum (SC) was increased at this point, and these alterations were not accompanied with hyperproliferation of the nucleated cell layer of the epidermis. A decrease of desmosomal degradation was observed, though, desquamation-related enzyme activity was not altered. The regulation mechanism of desquamation is not yet clear, however, in vitro experiments suggest that the water content in SC is an important factor. The water content of SC was decreased in the dry condition. These results indicate that a dry environment perturbs desmosome degradation in intact SC by decreasing the water content of SC, and the consequent impairment of desquamation in normal skin in vivo may lead to the induction of a scaly skin surface.

Continuous monitoring of hematocrit values during apheresis for allogeneic peripheral blood stem cell collection

Rapid changes in the circulating blood volume or hemoglobin level during apheresis may pose a risk for healthy individuals donating allogeneic PBSC. In this study, a real-time noninvasive monitor CRIT-LINE was used for continuous monitoring of hematocrit values in a total of 16 aphereses performed in 4 adult (median age 30 years) and 4 pediatric donors (4 years). Donors received recombinant G-CSF (10 microg/kg s.c. for 5 days) for mobilization of PBSC. A CS3000 plus blood cell separator (Baxter) was used in two different procedures. Adults donors were subjected to modified program 1-120 using a combination of the granulocyte chamber and the small volume collection chamber (SVCC), and pediatric donors were subjected to specialized program 4 with a combination of the newly developed small volume separation chamber holder (SVSCH) and SVCC. In all of the procedures for children, the extracorporeal line was primed with 400 ml leukocyte-depleted allogeneic RBC or 200 ml autologous RBC after regular priming with normal saline, whereas none of the adult donors received this treatment. We found a marked contrast in the hematocrit kinetics during apheresis in the two cohorts/procedures. In adults, the initiation of apheresis was followed by an immediate decline in the hematocrit value over the initial 10 min until a stable plateau level was reached (7% decrease). In children, the values decreased slowly but progressively throughout the entire procedure to finally reach a 9% decrease at the completion of apheresis. These data may suggest that the use of SVSCH plus SVCC or priming with RBC can eliminate the abrupt decline in blood hemoglobin levels that occurs during apheresis.

Low humidity stimulates epidermal DNA synthesis and amplifies the hyperproliferative response to barrier disruption: implication for seasonal exacerbations of inflammatory dermatoses

Although seasonal changes in humidity are thought to exacerbate various skin diseases, whether these flares can be attributed to prolonged exposure to extremes in environmental humidities has not been studied systematically. We recently showed that prolonged exposure to high versus low humidities induced profound changes in epidermal structure and permeability barrier homeostasis. Therefore, we asked here whether comparable extremes in humidity could initiate not only homeostatic, but also potentially pathophysiologic alterations. We showed first that exposure to low humidity increases epidermal DNA synthesis in normal murine epidermis. Moreover, exposure to a low humidity for 48 h further amplifies the DNA synthetic response to barrier disruption, resulting in marked epidermal hyperplasia. Additionally, exposure to a dry environment for 48 h prior to barrier disruption results in dermal mast cell hypertrophy, degranulation, as well as histologic evidence of inflammation. To demonstrate the role of changes in external moisture on these phenomena, we applied either an occlusive, water-impermeable plastic membrane, Petrolatum, or a nonocclusive humectant, both to nonperturbated and to perturbed skin. All three forms of treatment prevented the epidermal hyperplasia and dermal mast cell hypertrophy and degranulation induced by exposure to low humidity. These studies indicate that (i) exposure to changes in environmental humidity alone induces increased keratinocyte proliferation and markers of inflammation, and (ii) that these changes are attributable to changes in stratum corneum moisture content. Finally, these studies provide evidence that changes in environmental humidity contribute to the seasonal exacerbations/amelioration of cutaneous disorders, such as atopic dermatitis and psoriasis, diseases which are characterized by a defective barrier, epidermal hyperplasia, and inflammation.

Loss of water from the stratum corneum induces epidermal DNA synthesis in hairless mice

Many clinical studies have shown that low humidity has a deleterious effect on skin, but the mechanisms involved are poorly understood. To clarify the changes that occur in skin, we examined epidermal cell proliferation in mice kept in a dry (relative humidity < 10%) or a moist (relative humidity > 90%) environment. In animals exposed to low humidity, epidermal DNA synthesis started to increase within 12 h, reaching twice the original level, and the increased level was maintained for up to 5 days. The transepidermal water loss (TEWL) of mice kept for 12 h in the dry environment was the same as that of mice kept in the moist environment, but the skin conductance was lower. The increase in epidermal DNA synthesis following exposure to the dry environment was inhibited by topical application of petrolatum. It is concluded that loss of water from the stratum corneum induces epidermal cell proliferation within 12 h, and this change occurs in the absence of apparent cutaneous barrier dysfunction.

Clinically applicable bulk isolation of blood CD34+ cells for autografting in children

CD34+ cells were purified in bulk from apheresis-collected cells of children with cancer using monoclonal antibody (MoAb) and magnetic beads (Baxter ISOLEX system). To improve the purity of the final product for possibly better tumor cell purging and to make the manufacturer's original procedure more cost-effective, we incubated the cells for 30 min with l-phenylalanine methylester hydrochloride (PME) to reduce the cell number by removing contaminating granulocytes and monocytes in the initial step before incubation with MoAb. Our modification prevented nonspecific interactions between MoAb and magnetic beads, and thereby saved expensive materials for purification. A total of 40 purifications were performed with samples containing a mean of 3.1 x 10(9) blood cells mobilized from 15 children by chemotherapy plus granulocyte colony-stimulating factor (G-CSF). The entire purification procedure, from the end of apheresis to storage, was completed within 5h. After incubation with PME and double-layered (40/60%) Percoll separation, the number of CD34+ cells was reduced to 48+/-29%, which suggests the possibility that half of the CD34+ cells in the inoculum were nonclonogenic in the hematopoietic progenitor assay. PME/Percoll-treated cells were then subjected to a final isolation procedure with MoAb according to the manufacturer's suggestions, and 52+/-42% and 32+/-22%, respectively, of the CFU-GM and CD34+ cells present in the initial bag inoculums were recovered. The recovery rates were, respectively, 54% and 67%, when the calculation was limited to the isolation procedure with MNoAb. The purity of isolated CD34+ cells and the plating efficiency in methylcellulose culture were, respectively, 77+/-24% and 33+/-13%. Fourteen children were subsequently autografted with purified CD34+ cells after marrow ablative chemotherapy. The median number of days to achieve an ANC of 0.5 x 10(9)/l was 12 and that to achieve a platelet count of 50 x 10(9)/l was 22.5, which were comparable to those in our historical group of 55 patients who underwent transplant with unmanipulated blood cells (13 and 16 days). These results suggest that our modified purification procedure with PME is useful for the initial reduction of cell numbers to save costly materials, and that cells isolated by this procedure can be directly used in clinical transplantation procedures.

[Interstitial pneumonia preceding systemic sclerosis]

We describe a 57-year-old man with interstitial pneumonia associated with systemic sclerosis. About 3 years prior to the appearance of distinctive signs of systemic sclerosis, he was admitted to our hospital with a chronic dry cough. A chest roentgenogram on admission revealed reticulonodular shadows in both lung fields. There were no abnormal laboratory findings. Open lung biopsy specimens revealed patterns indicative of usual interstitial pneumonia, and myxomatous connective tissue within the lumen of the airways. Skin biopsy specimens showed heightened levels of collagen in the dermis, a finding consistent with systemic sclerosis. The patient was given a diagnosis of lung involvement preceding systemic sclerosis despite the absence of concurrent skin symptoms.

Recessive x-linked ichthyosis: role of cholesterol-sulfate accumulation in the barrier abnormality

Cholesterol sulfate is a multifunctional sterol metabolite, produced in large amounts in squamous keratinizing epithelia. Because patients with recessive x-linked ichthyosis display not only a 10-fold increase in cholesterol sulfate, but also a 50% reduction in cholesterol, we assessed here whether cholesterol sulfate accumulation and/or cholesterol deficiency produce abnormal barrier function in recessive x-linked ichthyosis. Patients with recessive x-linked ichthyosis display both an abnormal barrier under basal conditions, and a delay in barrier recovery after acute perturbation, which correlate with minor abnormalities in membrane structure and extensive lamellar-phase separation. Moreover, both the functional and the structural abnormalities were corrected by topical cholesterol. Yet, topical cholesterol sulfate produced both a barrier abnormality in intact skin and extracellular abnormalities in isolated stratum corneum, effects largely reversed by coapplications of cholesterol. Together, these results suggest that cholesterol sulfate accumulation rather than cholesterol deficiency is responsible for the barrier abnormality. Despite the apparent importance of cholesterol sulfate-to-cholesterol processing for normal barrier homeostasis, neither steroid sulfatase activity nor mRNA levels are upregulated following acute perturbations. These results demonstrate both a potential role for cholesterol sulfate-to-cholesterol processing in normal permeability barrier homeostasis, and that basal levels of steroid sulfatase are sufficient to accommodate acute insults to the permeability barrier.

Exposure to a dry environment enhances epidermal permeability barrier function

Previous studies have suggested that transepidermal water movement may play an important role in epidermal homeostasis and barrier repair. Here we analyzed cutaneous barrier function, epidermal morphology, and lipid content of the stratum corneum in hairless mice maintained in a high relative humidity (RH > 80%) versus low humidity (RH < 10%) environment for 2 wk. Basal transepidermal water loss was reduced by 31% in animals maintained in a dry versus humid environment. Moreover, the number of lamellar bodies in stratum granulosum cells, the extent of lamellar body exocytosis, and the number of layers of stratum corneum increased in animals kept in a dry environment. Furthermore, the dry weight of the stratum corneum and the thickness of the epidermis also increased in a dry environment. In addition, total stratum corneum lipids increased but lipid analysis revealed no significant differences in lipid distribution. Lastly, barrier recovery following either acetone treatment or tape stripping was accelerated after prolonged prior exposure to a dry environment, while conversely, it was delayed by prior exposure to a humid environment. These studies demonstrate that environmental conditions markedly influence epidermal structure and function, and suggest mechanisms by which the environment could induce or exacerbate various cutaneous disorders.

Psychological and physiological changes during isolation and confinement: I. Group dynamics and member interaction

The isolated and confined environment of a laboratory setting was used as one of the analogous environments of long-term manned spaceflight. This setting has more advantages than the natural one in that the behavioral variables can be easily controlled. Thus, a hyperbaric chamber was used in this experiment. The subjects were five men from 22- to 26-years old who had never met before the experiment. Over a total 5-day isolation and confinement period as well as 2-day pre- and post-isolation periods, the subjects were given different kinds of physiological and psychological tasks. During these periods their behavior and communications were recorded in order to observe when the formation of a group begins and how it forms and functions. The formation of a sub-group of three men was observed on the third day of isolation, showing strong reciprocal connections among these subjects who developed bonds that were quite stable. It is, however, not known how this sub-group functioned within the large group, since the experimental period was possibly too short.

Intra-apheresis recruitment of blood progenitor cells in children

BACKGROUND

Determination of the optimal duration of apheresis requires a careful examination of blood progenitor cell (BPC) kinetics during apheresis. Intra-apheresis recruitment of BPCs should be evaluated.

STUDY DESIGN AND METHODS

Twenty-six apheresis procedures were performed in 13 children with various malignant disorders (ages, 10 months to 17 years; median, 7 years) to collect BPCs for autologous transplant, using a blood cell separator with 2 to 5.2 blood volumes processed. The subjects were divided into three groups according to age: below 1 year (n = 4), 2 to 10 years (n = 5), and 11 to 20 years (n = 4). BPCs were mobilized by a combination of chemotherapy and granulocyte-colony-stimulating factor (G-CSF; 2-7.5 micrograms/kg/day intravenous drip). The levels of circulating CD34+ cells and colony-forming units-granulocyte-macrophage (CFU-GM) were monitored to examine intra-apheresis recruitment. For every 50 mL per kg or 2 L of processed blood, 5-mL blood samples were collected via a central line.

RESULTS

In the first apheresis procedure, more CD34+ cells were mobilized by the procedure itself in the infant group than in the older groups, and the number of cells decreased with the subject's age. When the same analysis was made during the second apheresis procedure, performed 1 day later, the levels of both CD34+ cells and CFU-GM had decreased to below the preapheresis values in all of the populations. Cell yields in the second apheresis procedure were significantly lower than those in the first.

CONCLUSION

Although several factors prevent a reliable analysis, the data suggest that the intra-apheresis recruitment of BPCs may be age-specific; the continuous and prolonged supply of cells from the bone marrow to peripheral blood that occurs during apheresis is more predominant in infants, which leads to the collection of proportionately more BPCs in younger children than in their older counterparts.

Endogenous asymmetrical dimethylarginine and hypertension associated with puromycin nephrosis in the rat

1. The present experiments were designed to investigate the role of asymmetrical NG,NG-dimethyl-L-arginine (ADMA) in causing hypertension associated with the focal and segmental glomerulosclerosis (FSGS) produced by a single bolus of puromycin aminonucleoside (PAN) and successive injection of protamine for 7 days in rats which had undergone unilateral nephrectomy. 2. After the unilateral nephrectomy, and administering PAN and protamine, histological examinations of the kidney revealed a typical FSGS, that is, evident abnormalities including segmental mesangial proliferation, obliteration of glomerular capillary lumens and adhesions between the glomerulus and Bowman's capsule could be observed. Changes in the glomerular epithelial cells consisted of the swelling with bleb formation. 3. In the FSGS rats, urine volume and urinary protein were significantly (P<0.05 and P<0.005) increased throughout 4-week experimental period, while the creatinine clearance was significantly (P<0.005) and transiently decreased, and recovered 4 weeks later. These changes were associated with the sustained elevation of the systolic blood pressure. 4. ADMA levels in aortic endothelial cells, plasma and urine were significantly (P<0.05 and P<0.005) increased in the FSGS rats, but the level in the kidney remained unchanged. 5. The basal level and net production of cyclic GMP in the aortic vessel wall with endothelium when stimulated by norepinephrine and acetylcholine were significantly (P<0.05 and P<0.01) attenuated in the FSGS rats. 6. There were significant and positive correlations between systolic blood pressure (y) and ADMA levels (x) in endothelial cells (y=4.43x+122.2, r=0.979, P<0.0001), plasma (y=0.10x+71.9, r=0.921, P<0.001) and urine (y=0.48x+126.9, r =0.699, P<0.005), but not significant in the kidney (y=0.06x+102.7, r=0.252, NS). 7. These findings suggest that ADMA as an endogenous inhibitor of NO synthesis may play an important role for the pathogenesis in the hypertension associated with the experimental FSGS in the rat.

Evidence of idiotypic modulation in the immune response to gp43, the major antigenic component of Paracoccidioides brasiliensis in both mice and humans

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, with a high prevalence in Brazil, Argentina, Colombia and Venezuela. The aetiologic agent of disease is a thermal dimorphic fungus, Paracoccidioides brasiliensis. A glycoprotein of 43,000 D (gp43) is the major antigen of P. brasiliensis. Antibodies directed to this antigen are detected in the sera of all patients with PCM. Gp43 binds to laminin, thus participating in adhesion, invasion and pathogenesis of the fungus. As the role of antibodies in PCM is not fully understood, we decided to investigate the outcome of mice immunization with three distinct anti-gp43 MoAbs (17c, 8a and 24a) coupled with keyhole limpet haemocyanin (KLH). Results show not only the expected presence of anti-Id (AB2) antibodies in the sera of these animals but also a spontaneous and increasing amount of anti-anti-Id (AB3) antibodies after the third course of immunization. Hybridomas producing both AB2 and AB3 MoAbs were obtained using spleen cells from mice immunized with MoAb 17c. AB3 MoAbs were also obtained with spleen cells of mice immunized with MoAbs 8a and 24a. It was also shown that human PCM patients' sera with high titres of anti-gp43 antibodies generate anti-Id antibodies. These data suggest that the immune response to P. brasiliensis can be spontaneously modulated by the idiotypic network.

Genetic instability and chromosomal aberrations in colorectal cancer: a review of the current models

Our understanding of the pathogenesis of cancer has undergone a revolution over the past decade. Tumors develop by the accumulation of damage to genes that regulate cell growth. Many of the genes responsible for disregulation of cell growth have been identified, as have the processes that lead to the genetic damage. One of the most important concepts that has facilitated our understanding of carcinogenesis is that of genetic or "genomic" instability, which is required to permit a sufficient amount of genetic damage to accumulate to permit the neoplastic phenotype to emerge and evolve. Two mechanisms that lead to genomic instability--one of which involves the loss of chromosomal fragments from the nucleus, and a second which is characterized by microsatellite instability--are discussed.

Endoscopic diagnosis of lower intestinal lesions of leukaemia and malignant lymphoma

There have been only a few endoscopic studies with respect to lower intestinal lesions of leukaemia and malignant lymphoma, although there have been many autopsy studies of these lesions. The aim of this study was to clarify these lesions using endoscopy. Colonoscopy was performed on 11 of 341 patients with leukaemia and on 32 of 105 patients with malignant lymphoma for frequent diarrhoea, anal bleeding or abnormal findings on barium enema examination, between April 1984 and September 1994. In eight of the 11 patients with leukaemia on whom endoscopy was performed, nine lesions were found; aphthoid ulcers, small ulcers or large tumours due to leukaemic infiltration were found in five, and colorectal adenoma was found in only one patient. Antibiotic-associated haemorrhagic colitis or pseudomembranous colitis was found in one patient each. In 10 of the 32 patients with malignant lymphoma, 11 lesions were found. The following were found in one patient each: large lymphomatous tumours, a large lymphomatous ulcer, multiple small polypoid lesions, multiple lymphomatous polyposis; and colorectal cancer or adenoma in six patients. However, the autopsy findings in patients with both diseases were mostly pseudomembrane formation or ulcers due to fungal and/or bacterial infection. It is concluded that accurate endoscopic diagnosis of lower intestinal lesions in patients with leukaemia or malignant lymphoma is essential for staging and treatment of these diseases and for determining their prognosis. Most lesions in leukaemia are aphthoid and small ulcers are due to leukaemic infiltration or antibiotics; most lesions in malignant lymphoma are elevated lesions such as cancer, adenoma or lymphomatous lesions as determined by endoscopy. This is in contrast to pseudomembrane formation or ulcers due to fungal and/or bacterial infection which are detected at autopsy.

Cholesterol sulfate inhibits proteases that are involved in desquamation of stratum corneum

We previously reported that desmosomes play a key role in the adhesion of corneocytes, and their digestion by two types of serine proteases leads to desquamation. Patients with recessive X-linked ichthyosis show hyperkeratosis attributable to desmosomes, associated with an increased content of cholesterol sulfate (CS) and an increased thickness of stratum corneum. In this study, therefore, we examined the possibility that CS provokes the abnormal desquamation, acting as a protease inhibitor. Scaling was induced on mice after topical application of chymostatin and leupeptin. Visible scale was also observed on mice after topical application of CS. We found that the stratum corneum thickness of CS-treated mice was increased in comparison with that of vehicle-treated mice. The thickness of the epidermis and the labeling index with proliferating cell nuclear antigen from CS-treated mice was almost the same as that from vehicle-treated mice. Moreover, in the stratum corneum of CS-treated mice, the content of desmosomes was higher than that in vehicle-treated mice. CS also inhibited the protease-induced cell dissociation of human stratum corneum sheets. In vitro, CS competitively inhibited both types of serine protease: the Ki for trypsin was 5.5 x 10(-6) M and that for chymotrypsin was 2.1 x 10(-6) M. These results indicate that CS retards desquamation by acting as a protease inhibitor. Thus, accumulation of stratum corneum in recessive X-linked ichthyosis may be a result of the inhibition by excessive CS of proteases involved in the dissolution of desmosomes, required for desquamation of the stratum corneum.

Tc-99m leukocyte imaging for evaluating disease severity and monitoring treatment response in ulcerative colitis: comparison with colonoscopy

The diagnostic value of Tc-99m leukocyte imaging for evaluating disease activity and monitoring treatment response in ulcerative colitis was compared with that of colonoscopy. A total of 48 studies were performed in 28 patients with ulcerative colitis. Forty-six studies had both Tc-99m leukocyte imaging and colonoscopy within 2 weeks of each other, and the remaining two studies had only Tc-99m leukocyte imaging. In 46 studies, semiquantitative grading of colonic radioactivity by comparison with iliac crest marrow activity on radionuclide imaging correlated well with macroscopic grading based on Matts' criteria on colonoscopy. Fourteen (82%) of 17 studies with slight colonoscopic change showed a negative result on the radionuclide image. In 15 patients treated with glucocorticoids or leukapheresis, radionuclide imaging showed nearly the same statistical results as colonoscopy in monitoring treatment response. Tc-99m leukocyte imaging could be used as an alternative to colonoscopy to evaluate the disease activity of ulcerative colitis or to monitor the treatment response, although it is insensitive for detecting disease with only slight macroscopic changes.

[Transformation of myelofibrosis into acute myelogenous leukemia (M0) with multiple tumor emboli]

A 60-year-old woman was admitted in August 1995 complaining of abdominal pain. A diagnosis of essential thrombocythemia had been made in 1987, and myelofibrosis developed in the patient thereafter. Physical examination revealed massive hepatosplenomegaly, and the peripheral blood showed leukoerythroblastosis with chromosomal abnormalities in peripheral blood cells. In May, 1996, blastic transformation occurred. Based on the findings of surface marker analysis, the blasts met the diagnostic criteria for acete myelogenous leukemia because they were negative for peroxidase and positive for CD13. In June, the patient died of multiple organ failure. Postmortem examination revealed multiple tumor emboli.

Inhalation anaesthetics produce asynchronous reversal of ventilation inhomogeneity and increased lung resistance in a canine model of bronchial asthma

Bronchial asthma is characterized by not only an increase in lung resistance but also inhomogeneous ventilation. We aimed to investigate how two inhalation anaesthetics, isoflurane and sevoflurane, relieve ventilation inhomogeneity and reduce lung resistance in the bronchoconstricted lung. We provoked bronchoconstriction in dogs by a continuous i.v. infusion of methacholine, then administered either isoflurane or sevoflurane. Ventilation inhomogeneity was quantified by the difference in respiratory phases between the regional alveolar pressures measured at two distinct lobes. We constructed a mathematical model that simulated our experimental results. Both anaesthetics decreased lung resistance (P < 0.01). Isoflurane significantly reduced the indices of inhomogeneity (P < 0.01). Sevoflurane exerted only a tendency to reduce uneven ventilation. Our model simulation suggested that the anaesthetics reduced ventilation inhomogeneity in preference to lung resistance when the dogs suffered from severe bronchoconstriction.

Intramuscular 3-hydroxybutyrate levels after 60 tetani/min contraction in diabetic and non-diabetic rats

Post-exercise hyperketonemia in poorly-controlled diabetic patients is a well recognized phenomenon, but because studies concerning changes in ketone body metabolism in muscle during and/or after exercise are scarce, we measured the intramuscular 3-hydroxybutyrate (3-OHBA) and lactate concentrations in 12 diabetic (streptozotocin-induced; 60 mg/kg, ip) and 13 non-diabetic control rats before and after a 1-h muscle contraction. One thigh tetanic contraction was elicited at a tetanic frequency of 60 tetani/min and the other thigh was kept resting. We used a microdialysis technique in both quadriceps muscles, vastus lateralis, and the right jugular vein. Blood flow in both femoral muscles was also monitored before and after contraction. Dialysate 3-OHBA and lactate levels in contracting and non-contracting muscles and in blood showed a significant increase after contraction (P<0.05) in diabetic rats. In control rats there was no significant change in dialysate 3-OHBA or the lactate concentration in contracting and non-contracting muscles or in blood before and after contraction. A significant increase in contracting muscle blood flow was observed only for the first 5 min after contraction in diabetic and control rats. These results suggest that 3-OHBA uptake in contracting muscle is reduced, and that this phenomenon may play a role in post-exercise ketosis in diabetes.

[Clinical study on prostate cancer initially presenting with disseminated intravascular coagulation syndrome]

We experienced five patients with prostate cancer with disseminated intravascular coagulation syndrome (DIC) at the first presentation at Gunma University Hospital and affiliated institutions between 1991 and 1997. Their average age was 68 years, average DIC score at the first presentation was 10 and prostate specific antigen (PSA) level was more than 700 ng/ml. All of them had multiple bone metastases. The therapy for DIC and hormonal therapy for prostate cancer were simultaneously started at the first presentation before prostate needle biopsy, but all patients died. The average number of days from the start of DIC to death was 685 days. The patients initially showed a good response to therapy, but their conditions soon aggravated. The prognosis was extremely poor, but some proper therapies lead to the prognosis which was equal to that of prostate cancer in Stage D2 without DIC.

[A case of hepatocellular carcinoma with reduction of primary tumor and disappearance of multiple lung metastasis]

A 56-year-old male had suffered from hepatocellular carcinoma treated by operation, PHoT and TAE since 1994. In December 1995, he had multiple metastases of lung in addition to recurrence of primary hepatic lesions. We discontinued treatment of TAE and decided to administer UFT (400 mg/day) orally as an outpatient. After seven months, the primary hepatic lesions were decreased in size, and metastatic lesions of lung were completely eliminated with reduction of AFP level. Generally, hepatocellular carcinoma with metastasis is refractory to treatment. However, this result suggests that UFT is one of the effective treatments for such advanced cases as having lung metastasis.

Solitary fibrous tumor of the parotid gland extending to the parapharyngeal space

Solitary fibrous tumors (SFT) arise in the pleura and less commonly in extrapleural sites. Head and neck regions have included the nose and paranasal sinuses, soft palate, epiglottis, thyroid, parotid and submandibular glands, as well as the infratemporal fossa and parapharyngeal space. We report a case of SFT arising from the parotid gland and extending to the parapharyngeal space. To our knowledge, this is the fourth case of SFT originating from the parotid gland and is the largest of its kind among the extrapleural lesions described. The characteristics revealed by computed tomography and magnetic resonance imaging are presented.

[PSA-doubling time immediately before the diagnosis of prostate cancer]

PSA-doubling time (PSA-DT) immediately before the diagnosis of prostate cancer was calculated in 8 prostate cancer patients in whom PSA was checked three or more times with the same kit during a period of 6 months or more. The correlation between PSA-DT and clinical stage or pathological differentiation was analyzed. In most patients, PSA correlated well showing a straight regression line to the observation period on a hemi-logarithmic scale. The correlation coefficient was high, almost 0.9 or more except in one patient. PSA-DT ranged from 5.1 to 64.9 months, averaging 23.1 months. There was no significant correlation between clinical stage or pathological differentiation and PSA-DT. However, PSA-DT in stage D patients tended to be shorter than that of stage B + C patients. One patient who had stage D poorly differentiated carcinoma died of cancer recurrence. In this patient, PSA-DT was short (5.1 months).

[Simple kinetic analysis of 99mTc-GSA by direct integral linear least square regression method: calculation of hepatic blood flow and receptor index based on three-compartment model]

To obtain both hepatic blood flow and an index of asialoglycoprotein receptor amount by simple calculation in the asialoglycoprotein receptor imaging with 99mTc-DTPA-Galactosyl Human Serum Albumin (99mTc-GSA), we have tested the applicability of the direct integral linear least square regression (DILS) method based on a linear 3-compartment model (Bronqvist, 1984) to the kinetic analysis of 99mTc-GSA scintigraphy. DILS method can provide hepatic blood flow (k1) and the product of receptor amount and forward binding rate constant (k1k3/k2) as a receptor index, without requiring iterative calculation and initial estimates of the parameters. To compare DILS method with nonlinear least square regression (NLS) method as a standard, data from 35 patients with liver dysfunction were analyzed by both methods. The effect of the data noise to parameter estimate were simulated, and both DILS and NLS method could provide reliable parameter estimate which is relatively insensitive to the data noise. In estimated model parameters, both hepatic blood flow (k1) and the receptor index (k1k3/k2) showed significant correlation between 2 methods (r2 = 0.96, p < 0.0001; r2 = 0.99, p < 0.0001, respectively). We concluded that DILS method was comparable to NLS method in determination of the model parameters and could be useful in the asialoglycoprotein receptor imaging.

Effect of insulin on intramuscular 3-hydroxybutyrate levels in diabetic rats

It has been shown that inhibition of lipolysis and ketogenesis by insulin is more sensitive than suppression of hepatic glucose production and stimulation of tissue glucose uptake. Clinically, on the other hand, blood glucose concentrations fall much more quickly than blood ketone concentrations. Therefore, during continuous insulin infusion at a rate of 3.0 mU/kg B.W./min over a period of 150 min we monitored blood glucose and 3-hydroxybutyrate (3-OHBA) concentrations and muscle 3-OHBA levels using the microdialysis technique in streptozotocin-induced diabetic rats. Blood glucose concentrations decreased rapidly after insulin infusion. However, significant reduction in blood-3-OHBA concentration was found for the last 30 min. In muscle dialysate 3-OHBA concentrations and muscle local blood flow there was no significant change throughout the study. These results suggest that one possible mechanism of delayed improvement in ketonemia is a reduction in muscle removal capacity.

Nitric oxide relaxes bovine ciliary muscle contracted by carbachol through elevation of cyclic GMP

It is generally accepted that nitric oxide relaxes vascular smooth muscles by activating guanylyl cyclase, which in turn increases cyclic 3':5' guanosine monophosphate level. Despite the physiological significance of nitric oxide, very few studies have attempted to characterize the mode of action of this mediator in ciliary muscles. Therefore, the present experiments were designed to investigate whether or not the relaxation induced by sodium nitroprusside as a donor of nitric oxide is accompanied by the increase in cyclic 3':5' guanosine monophosphate level in the bovine ciliary muscle, and these responses are affected by methylene blue as an inhibitor of guanylyl cyclase and 3-isobutyl-1-methylxanthine as an inhibitor of phosphodiesterases. The relaxation activity of exogenous 8-bromo-cyclic 3':5' guanosine monophosphate was also determined. Sodium nitroprusside produced a concentration-dependent relaxation in the bovine ciliary muscle strips which had been contracted by carbachol as a cholinergic agonist. Relaxation in response to sodium nitroprusside was accompanied by a significant (P<0.05 and P<0.005) increase in cyclic 3':5' guanosine monophosphate level. The relaxation response and the increase in cyclic 3':5' guanosine monophosphate caused by sodium nitroprusside were significantly (P<0.01 and P<0.05) augmented by the pretreatment with 3-isobutyl-1-methylxanthine, and were significantly (P<0.005 and P<0.05) attenuated in the presence of methylene blue. The exogenously applied 8-bromo-cyclic 3':5' guanosine monophosphate relaxed the ciliary muscle strips in a concentration-dependent manner. These results suggest that nitric oxide causes relaxation of the bovine ciliary muscle through the activation of guanylyl cyclase and an increase in cyclic 3':5' guanosine monophosphate level.

Starvation and diabetes increase the amount of pyruvate dehydrogenase kinase isoenzyme 4 in rat heart

This study investigated whether conditions known to alter the activity and phosphorylation state of the pyruvate dehydrogenase complex have specific effects on the levels of isoenzymes of pyruvate dehydrogenase kinase (PDK) in rat heart. Immunoblot analysis revealed a remarkable increase in the amount of PDK4 in the hearts of rats that had been starved or rendered diabetic with streptozotocin. Re-feeding of starved rats and insulin treatment of diabetic rats very effectively reversed the increase in PDK4 protein and restored PDK enzyme activity to levels of chow-fed control rats. Starvation and diabetes also markedly increased the abundance of PDK4 mRNA, and re-feeding and insulin treatment reduced levels of the message to that of controls. In contrast with the findings for PDK4, little or no changes in the amounts of PDK1 and PDK2 protein and the abundance of their messages occurred in response to starvation and diabetes. The observed shift in the relative abundance of PDK isoenzymes probably explains previous studies of the effects of starvation and diabetes on heart PDK activity. The results indicate that control of the amount of PDK4 is important in long-term regulation of the activity of the pyruvate dehydrogenase complex in rat heart.

New consecutive high-dose chemotherapy modality with fractionated blood stem cell support in the treatment of high-risk pediatric solid tumors: a feasibility study

For the treatment of childhood solid tumors, we performed a pilot feasibility study of consecutive high-dose therapies, in which each course was followed by transplantation with granulocyte colony-stimulating factor-mobilized peripheral blood cells which had been separated into CD34-positive and -negative fractions by an Isolex system (Baxter). Positive selection of CD34+ cells has been associated with inevitable cell loss. To overcome this loss, CD34+ cells that had migrated into the negative fraction were saved and used for the first transplant, which was followed by a second transplant after a 3- to 5-month interval. In this phase I feasibility study, the results in six children were evaluated for safety and engraftment. Multi-drug cytoreductive regimens using ranimustine (MCNU), melphalan, thiotepa, carboplatin, cyclophosphamide or VP-16 were comparable between the two transplant procedures in terms of their intensity. The number of CD34+ cells in the 'CD34(+) fraction' was 3.31 x 10(6)/kg (0.63-4.3 x 10(6)/kg), while this number in the 'CD34(-) fraction' could not be evaluated correctly due their scarcity (<0.1%). The median numbers of infused MNC and CFU-GM were, respectively, 4.2 x 10(6)/kg and 1.75 x 10(5)/kg in the CD34(+) fraction, and 4.8 x 10(8)/kg and 3.35 x 10(5)/kg in the CD34(-) fraction. The number of days required to achieve an ANC >0.5 x 10(9)/l and a platelet count >20 x 10(9)/l and >50 x 10(9)/l were, respectively, 14.5, 15.0 and 19.5 in the first transplant with CD34- cells, and 13.5, 18.0 and 25.0 in the second transplant with CD34+ cells, with no essential difference between the two treatments. Although the small number of patients, the variation in clinical status and treatment, and the short follow-up invalidate any evaluation of the therapeutic benefit of this strategy, the encouraging results support the feasibility of this strategy, which enables an escalation of dose intensity with an improved cost/benefit ratio.

Significance of measurement of prostate specific antigen (PSA) in familial prostate cancer lines

The concentration of prostate specific antigen (PSA) in serum was measured in 20 brothers or sons in 10 families in which the father and son or brothers had prostate cancer using the E test TOSOH IIPA. The patients were between 32 and 70 years old with a mean age of 48.2 years. The PSA value was between 0.4 and 19.5 ng/ml with a mean value of 3.4 ng/ml. Five patients (25%) had PSA values exceeding the cut-off value of 4.0 ng/ml. After obtaining their consent, systematic prostate needle biopsy by transrectal ultrasonography was performed on 3 patients (15%). Prostate cancer was detected in all of them. Among them 2 patients were brothers, and since the other two brothers already had prostate cancer, all four brothers were confirmed to have prostate cancer. This is the first report of a familial prostate cancer in four brothers in Japan. In the western countries where the incidence of prostate cancer is higher than that in Japan, studies have been performed on the risk factors. Family history is one of the most important risk factors. In Japan, the incidence of prostate cancer is increasing rapidly. Moreover, patients with a prostate cancer family history are expected to increase. In such cases, prostate cancer screening should be performed aggressively from a young age.

The mechanism of myometrial contractions induced by endothelin-1 in rat

Experiments were performed to characterize endothelin-1-induced contractions and the role of endothelin (ET) receptor subtypes in rat myometrium. The binding sites of [(125)I]-ET-1 were saturable with high affinity. Scatchard plot analysis revealed that ET-1 binding sites in the myometrium constituted a single population. The dissociation equilibrium constant (Kd) and the maximum binding sites (Bmax) were determined to be 48.9+/-3.0 pM and 1364.0+/-210.3 fmol/mg protein respectively. Specific [(125)I]-ET-1 binding was inhibited completely by unlabelled ET-1 and Ro 46-2005 (mixed-type ET receptor antagonist), but not fully (90.7+/-1.4%) by BQ 123 (a selective ETA receptor antagonist), and not at all by RES 701-1 (a selective ETB receptor antagonist). ET-1 induced myometrial contractions were composed of two types, an increase in resting tone and rhythmic contractions. These contractions were inhibited by BQ 123 and Ro 46-2005, but not by RES 701-1. ET-1-induced contractions were greatly reduced in Ca2+-free Krebs' solution. Nifedipine abolished the rhythmic contractions without affecting the increase in resting tone. These results suggest that ETA receptors are predominantly localized in rat myometrium and that excitation of ETA receptors evokes two types of contractions by increasing the cytoplasmic Ca2+ concentration.

[Guided tissue regeneration around dental implants in immediate extraction sockets: comparison of resorbable and nonresorbable membranes]

OBJECTIVE

This study was performed to compare the efficacy of guided tissue regeneration (GTR) around dental implants immediately placed into extraction sockets by resorbable or nonresorbable membranes.

METHODS

Mandibular P2, P3, and P4 of four adult beagle dogs were extracted bilaterally, and buccal standard defects were created and measured. Eighteen commercially pure titanium Steri-Oss implant fixtures were placed into the fresh extraction sockets. Four untreated implants were as controls, four implants received polytetrafluoroethylene (e-PTFE, Gore-Tex) membranes, five implants received collagen membranes, and five implants received polyglactin 910 mesh. After 14 weeks, clinical measurements were taken and the dogs were sacrificed and all specimens retrieved for histologic and histomophometric evaluation.

RESULTS

The average gain in bone height was 2.1 mm for untreated control sites, 3.3 mm for Gore-Tex sites, 3.8 mm for collagen sites, and 1.3 mm for polyglactin 910 sites.

CONCLUSION

The results of this study indicated that Gore-Tex and collagen membrane produced good results for GTR around implants. Collagen membrane can be a valid alternative to Gore-Tex membrane to improve bone regeneration around dental implants, while polyglactin 910 mesh seemed not suitable to be used as GTR membrane in immediate implantation for its high infection rate.

[Cleidocranial dysplasia: a case report]

A 3-month-old female infant who presented with patent sagittal suture and loss of weight is described. Physical examination revealed a large sagittal and metopic suture showing delayed closure, a high-arched palate, saddle nose, hypertelorism and nonpalpable edges of the bilateral clavicles. The clavicles also showed undue mobility. Radiological investigations of the cranial skeletal abnormalities revealed enlargement of the sagittal and metopic sutures, and the anterior and posterior fontanelles. A chest radiograph showed a small, bell-shaped thoracic rib cage with partial aplasia of both clavicles. On the basis of the clinical findings, cleidocranial dysplasia was diagnosed. Cleidocranial dysplasia is an uncommon generalized skeletal disorder which, as its name implies, shows striking involvement of the cranial vault and clavicles. The clinical features reflect a generalized defect of both membranous and endochondral bone formation. It is characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, delayed deciduous dentition, and hereditary characteristics. The amount of calvarial growth is generally small, and the shape remains nearly unaltered. In all cases, calvarial bone thickness increases with age, but in the midline, the fontanelle area, which is shown to be defective at the first examination, remains open in all cases. The midfrontal area is poorly developed and exhibits a groove in many patients. It is inherited as an autosomal dominant trait, with wide variability of expression but a high degree of penetrance. Cytogenetic abnormalities involving chromosome 6p21 have been reported with a cleidocranial dysplasia phenotype. Although psychosocial disorders associated with the abnormal facial and body features may occur, patients have a good overall prognosis and life expectancy. Skull deformity, and delayed closure of the fontanelles and cranial sutures are the most important problems for neurosurgeons. The postero-lateral fontanelle closes before adulthood, whereas the opening in the midfrontal sutural area may persist. Many children with cleidocranial dysplasia whom we have encountered have persisting fontanelles and patent sutures, but this does not seem to predispose them to an abnormal calvarial growth pattern, at least in the age groups investigated. Congenital midface retrusion in the presence of relative or absolute mandibular prognathism is also a major deformity. Care is supportive, including attention to neurosurgical, orthopedic, pediatric and dental problems.

[Prostate cancer associated with long-term intake of patent medicine containing methyltestosterone: a case report]

An 81-year-old man, admitted with lumbago and pollakisuria, was diagnosed to have stage D2 prostate cancer (T3N2M1). Although the serum level of prostate specific antigen (PSA) was 3,560 ng/ml, serum testosterone (55.6 ng/dl) and luteinizing hormone (LH, 0.8 mIU/ml) levels were very low. Detailed inquiry of the patient revealed a daily intake of patent medicine containing 6-9 mg methyltestosterone for the past 30 years. He was treated by surgical castration and oral chlormadinone acetate. We advised him not to take such androgenic drugs. The disease has been well controlled for 7 months. We stress the importance of checking medication habits of patients with prostate cancer, especially androgen-containing drugs which can be purchased without a physician's prescription. A low serum LH level may be an important finding indicating the intake of androgenic drugs.

Urine N-acetyl-beta-D-glucosaminidase activity in healthy cattle

OBJECTIVE

To measure urine N-acetyl-beta-D-glucosaminidase (NAG) activity of healthy cattle, using 3 substrates (4-methylumbelliferyl-N-acetyl-beta-D-glucosaminide, sodio-m-cresolsulfonphthaleinyl-N-acetyl-beta-D-glucosaminid e, and p-nitrophenyl-N-acetyl-beta-D-glucosaminide), and to determine the relations between the obtained values and age and sex of cattle.

ANIMALS

50 healthy lactating Holstein-Friesian cows and 10 healthy Holstein-Friesian steers.

PROCEDURE

Untimed urine samples were collected, and urine NAG activity was measured, using the 3 aforementioned methods. Urine creatinine concentration also was measured, and NAG activity was expressed as units per gram of creatinine (NAG index). Correlations between urine NAG activity and age and sex of cattle were investigated. Furthermore, correlations among data obtained by each of the 3 methods were determined.

RESULTS

Urine NAG activity in cows measured by each of the 3 methods was < 3.0 U/L. Urine NAG activity in steers was significantly higher than that in cows. However, there was no significant difference between the sexes in NAG index. There were no significant differences in mean values of NAG activity and index among cows of various age groups. Individual values of urine NAG activity determined by each method correlated significantly with each other.

CONCLUSIONS AND CLINICAL RELEVANCE

Urine NAG activity and NAG index of healthy cattle will be useful for determining diagnostic criteria of renal disease in cattle.

Discordant splenic uptake of Tc-99m colloid and Tc-99m denatured RBC in candidiasis-endocrinopathy syndrome

We report discordant splenic uptake of Tc-99m colloid and Tc-99m heat-denatured red blood cells (RBC) which occurred in a 21-year-old female with candidiasis-endocrinopathy syndrome. Tc-99m colloid liver-spleen imaging showed no splenic uptake, suggesting the presence of functional asplenia. A subsequent Tc-99m heat-denatured RBC study clearly revealed a small spleen with preserved sequestrating function. These results may demonstrate that the qualitative dissociation of splenic functions in processing colloid and denatured RBC in functional asplenia: the sequestration function remains while the reticuloendothelial system is impaired.

Studies on the regulation of the mitochondrial alpha-ketoacid dehydrogenase complexes and their kinases

Five mitochondrial protein kinases, all members of a new family of protein kinases, have now been identified, cloned, expressed as recombinant proteins, and partially characterized with respect to catalytic and regulatory properties. Four members of this unique family of eukaryotic protein kinases correspond to pyruvate dehydrogenase kinase isozymes which regulate the activity of the pyruvate dehydrogenase complex, an important regulatory enzyme at the interface between glycolysis and the citric acid cycle. The fifth member of this family corresponds to the branched-chain alpha-ketoacid dehydrogenase kinase, an enzyme responsible for phosphorylation and inactivation of the branched-chain alpha-ketoacid dehydrogenase complex, the most important regulatory enzyme in the pathway for the disposal of branched-chain amino acids. At least three long-term control mechanisms have evolved to conserve branched chain amino acids for protein synthesis during periods of dietary protein insufficiency. Increased expression of the branched-chain alpha-ketoacid dehydrogenase kinase is perhaps the most important because this leads to phosphorylation and nearly complete inactivation of the liver branched-chain alpha-ketoacid dehydrogenase complex. Decreased amounts of the liver branched-chain alpha-ketoacid dehydrogenase complex secondary to a decrease in liver mitochondria also decrease the liver's capacity for branched-chain keto acid oxidation. Finally, the number of E1 subunits of the branched-chain alpha-ketoacid dehydrogenase complex is reduced to less than a full complement of 12 heterotetramers per complex in the liver of protein-starved rats. Since the E1 component is rate-limiting for activity and also the component of the complex inhibited by phosphorylation, this decrease in number further limits overall enzyme activity and makes the complex more sensitive to regulation by phosphorylation in this nutritional state. The branched-chain alpha-ketoacid dehydrogenase kinase phosphorylates serine 293 of the E1 alpha subunit of the branched-chain alpha-ketoacid dehydrogenase complex. Site-directed mutagenesis of amino acid residues surrounding serine 293 reveals that arginine 288, histidine 292 and aspartate 296 are critical to dehydrogenase activity, that histidine 292 is critical to binding the coenzyme thiamine pyrophosphate, and that serine 293 exists at or in close proximity to the active site of the dehydrogenase. Alanine scanning mutagenesis of residues in the immediate vicinity of the phosphorylation site (serine 293) indicates that only arginine 288 is required for recognition of serine 293 as a phosphorylation site by the branched-chain alpha-ketoacid dehydrogenase kinase. Phosphorylation appears to inhibit dehydrogenase activity by introducing a negative charge directly into the active site pocket of the E1 dehydrogenase component of the branched-chain alpha-ketoacid dehydrogenase complex. A model based on the X-ray crystal structure of transketolase is being used to predict residues involved in thiamine pyrophosphate binding and to help visualize how phosphorylation within the channel leading to the reactive carbon of thiamine pyrophosphate inhibits catalytic activity. The isoenzymes of pyruvate dehydrogenase kinase differ greatly in terms of their specific activities, kinetic parameters and regulatory properties. Chemically-induced diabetes in the rat induces significant changes in the pyruvate dehydrogenase kinase isoenzyme 2 in liver. Preliminary findings suggest hormonal control of the activity state of the pyruvate dehydrogenase complex may involves tissue specific induced changes in expression of the pyruvate dehydrogenase kinase isoenzymes.

Guided tissue regeneration around dental implants in immediate extraction sockets: comparison of resorbable and nonresorbable membranes

This study was performed to compare the efficacy of guided tissue regeneration (GTR) around dental implants immediately placed into extraction sockets by resorbable of nonresorbable membranes. Mandibular P2, P3, and P4 of four adult beagle dogs were extracted bilaterally, and buccal standard defects were created and measured. Eighteen commercially pure titanium Steri-Oss implant fixtures were placed into the fresh extraction sockets. Four implants were untreated controls, four implants received polytetrafluoroethylene (e-PTFE, Gore-Tex) membranes, five implants received collagen membranes (ParaGuide), and five implants received polyglactin 910 mesh (Vicryl). After 14 weeks, clinical measurements were taken and the dogs were sacrificed and all specimens retrieved for histologic and histomorphometric evaluation. The average gain in bone height was 2.1 mm for untreated control sites, 3.3 mm for Gore-Tex sites, 3.8 mm for collagen sites, and 1.3 mm for polyglactin 910 sites. The greatest gain in bone height and volume was seen for two sites that received Gore-Tex membranes and remained covered for the entire evaluation interval. The results of this study indicate that Gore-Tex and collagen membrane produced good results for GTR around implants immediately placed into extraction sockets. Since collagen membrane does not cause obvious infection and does not need the surgical reentry for membrane removal, it can be a valid alternative to Gore-Tex membrane to improve bone regeneration around dental implants, while polyglactin 910 mesh seems not suitable to be used as GTR membrane in immediate implantation for its high infection rate.

Analysis of bile acids in colon residual liquid or fecal material in patients with colorectal neoplasia and control subjects

Bile acids are believed to play a role in the etiology of colorectal cancer. To examine the relationship between bile acids and colorectal neoplasia, bile acids in colon residual liquid or fecal material were analyzed in 18 patients with colorectal adenoma, 12 patients with colorectal cancer, and 18 healthy control subjects. High-performance liquid chromatography combined with immobilized 3 alpha-hydroxysteroid dehydrogenase in column form showed a significant elevation in the proportion of deoxycholic acid (P < 0.05), lithocholic acid (P < 0.05), secondary bile acids (deoxycholic acid plus lithocholic acid) (P < 0.02), and the chenodeoxycholic acid-lithocholic acid family (chenodeoxycholic acid plus lithocholic acid) (P < 0.05) in the colon residual liquid or fecal material of the patients with colorectal adenoma compared with proportions in the control subjects. A similar trend was noted in the patients with colorectal cancer compared to the control subjects. These findings suggested that an increase in the proportion of secondary bile acids, in particular, of lithocholic acid, was closely related to the pathogenesis of colorectal neoplasia.

Effect of nicotine on the intimal hyperplasia after endothelial removal of the rabbit carotid artery

1. The present experiments were designed to investigate the effect of long-term oral nicotine (10 mg/200 ml/kg/day for 7 weeks) on the intimal hyperplasia after endothelial removal of the rabbit carotid artery. 2. The plasma concentrations of nicotine were determined to be 11.7-12.5 ng/ml during the term of administration and corresponded to the plasma levels in human smokers. 3. Six weeks after the endothelial removal, light microscopy revealed a marked intimal hyperplasia. Administration of nicotine tended to accelerate the intimal hyperplasia, which was estimated by comparing the histological findings, DNA content and wet weight of the vessel wall. 4. Acetylcholine- and A23187-induced endothelium-dependent relaxations were greatly impaired in the hyperplastic artery strips. The impairment of relaxations tended to be accelerated in the nicotine group. Sodium nitroprusside-induced relaxation was not different between the control and the hyperplastic artery strips and remained unaffected in the nicotine group. 5. The concentrations of endogenous nitric oxide (NO) synthesis inhibitors, NG-monomethyl-L-arginine (L-NMMA) and asymmetrical NG,NG-dimethyl-L-arginine (ADMA) were significantly more increased in the regenerated endothelial cells compared with those in the control endothelial cells. The concentrations of L-NMMA and ADMA in the regenerated endothelial cells were significantly increased by as much as 1.3 x 10(-6) and 5.6 x 10(-7) M, respectively, in the nicotine group. 6. Immunoreactive endothelin-1 was significantly increased in the hyperplastic vessel wall (2.4 times that of the control) in 6 weeks. Administration of nicotine tended to increase the level. 7. It seems possible to assume from these results that, although, under the present experimental conditions, nicotine exhibited a tendency to accelerate the intimal hyperplasia after endothelial removal, the longer exposure to nicotine or a higher dose of the agent or both would significantly accelerate the intimal hyperplasia through the enhanced impairment of endothelium-derived relaxing factor/ NO production, which might be brought about by the enhanced increases in L-NMMA and ADMA concentrations, and the enhanced increase in endothelin-1 in the vessel wall.

A possible role of endogenous inhibitor for nitric oxide synthesis in the bovine ciliary muscle

The present experiments were designed to investigate the possible role of endogenous methylarginine derivatives such as NG-monomethyl-L-arginine, asymmetrical NG,NG-dimethyl-L-arginine and symmetrical NG,N'G-dimethyl-L-arginine for the nitric oxide synthesis in the bovine ciliary muscle. The contents of asymmetrical NG,NG-dimethyl-L-arginine and symmetrical NG,N'G-dimethyl-L-arginine in the bovine ciliary muscle were determined to be 370.2 +/- 27.6 (n = 5) and 182.4 +/- 22.9 (n = 5) pmoles g-1 wet weight, respectively by means of the automated high-performance liquid chromatography. NG-Monomethyl-L-arginine was below the assay limits. On the basis of the total tissue water content (0.792 +/- 0.006 ml g-1 wet weight, n = 14), the concentrations of asymmetrical NG,NG-dimethyl-L-arginine and symmetrical NG,N'G-dimethyl-L-arginine were tentatively estimated to be (4.7 +/- 0.3) x 10(-7) M (n = 5) and (2.3 +/- 0.3) x 10(-7) M (n = 5), respectively. A23187 (10(-7)-3 x 10(-4) M) produced a concentration-dependent relaxation of the ciliary muscle strips which had been contracted with 10(-5) M carbachol. Authentic asymmetrical NG,NG-dimethyl-L-arginine (3 x 10(-6)-3 x 10(-4) M), but not symmetrical NG,N'G-dimethyl-L-arginine (3 x 10(-4) M), inhibited the 10(-6) M A23187-induced relaxation in a concentration-dependent manner. The inhibition with asymmetrical NG,NG-dimethyl-L-arginine (10(-4) M) was reversed by an addition of 3 x 10(-3) M L-arginine, but not by 3 x 10(-3) M D-arginine. The A23187 (10(-6) M)-induced relaxation was enhanced by 3 x 10(-3) M L-arginine or superoxide dismutase (50 U ml-1), whereas it was inhibited by carboxy-PTIO (3 x 10(-4) M), a scavenger of nitric oxide, or methylene blue (10(-5) M), an inhibitor of guanylate cyclase. The carbachol-induced contraction was enhanced by asymmetrical, NG,NG-dimethyl-L-arginine (10(-5) M) and inhibited by 3 x 10(-3) M L-arginine. Any effect of prostanoid formation during the A23187-induced relaxation was ruled out by using indomethacin (10(-5) M). Sodium nitroprusside (10(-5) M), a donor of nitric oxide, also produced a relaxation, which was inhibited by methylene blue (10(-5) M) or carboxy-PTIO (3 x 10(-4) M) and was augmented by superoxide dismutase (50 U ml-1), but unaffected by asymmetrical NG,NG-dimethyl-L-arginine (3 x 10(-4) M) or L-arginine (3 x 10(-3) M). These results lead us to speculate that the nitric oxide synthesized endogenously from L-arginine may play a role for mediating relaxation of the bovine ciliary muscle and that the endogenous asymmetrical NG,NG-dimethyl-L-arginine may be involved in inhibiting the biosynthesis of nitric oxide when there are increased intracellular concentrations of the methylarginine under certain circumstances.