[Angiotensin I-converting enzyme gene polymorphism and renal disease]

ACE inhibitor is known to have a therapeutic efficacy in renal diseases by reducing proteinuria and maintaining renal function. However, the relationship between ACE gene polymorphism and renal disease has not been fully elucidated. In this study, a 287 base pair(bp) I/D polymorphism of the ACE gene was examined with polymerase chain reaction(PCR) in 100 healthy subjects, 34 patients with chronic glomerulonephritis(CGN), 29 with chronic renal failure(CRF) and 25 with diabetes mellitus(DM) with(13) and without(12) nephropathy. We also measured serum ACE activity of these patients. ACE genotype and derived allele frequencies in each disease group did not differ significantly from those in healthy subjects. In all disease groups, values of serum ACE activity were higher in genotype DD than in genotype II. These findings suggest no significant association between I/D polymorphism of the ACE gene and renal disease. Further studies are needed to clarify these findings, considering renal function and type of renal disease.

Effects of escins Ia, Ib, IIa, and IIb from horse chestnut, the seeds of Aesculus hippocastanum L., on acute inflammation in animals

We investigated the effects of escins Ia, Ib, and IIb isolated from horse chestnut, the seeds of Aesculus hippocastanum L., and desacylescins I and II obtained by alkaline hydrolysis of escins on acute inflammation in animals (p.o.). Escins Ia, Ib, IIa, and IIb (50-200 mg/kg) inhibited the increase of vascular permeability induced by both acetic acid in mice and histamine in rats. Escins Ib, IIa, and IIb (50-200 mg/kg) also inhibited that induced by serotonin in rats, but escin Ia didn't. Escins Ia, Ib, IIa, and IIb (200 mg/kg) inhibited the hind paw edema induced by carrageenin at the first phase in rats. Escin Ia (200 mg/kg) and escins Ib, IIa, and IIb (50-200 mg/kg) inhibited the scratching behavior induced by compound 48/80 in mice, but escin Ia was weakest. Desacylescins I and II (200 mg/kg) showed no effect. With regard to the relationship between their chemical structures and activities, the acyl groups in escins were essential. Escins Ib, IIa, and IIb with either the 21-angeloyl group or the 2'-O-xylopyranosyl moiety showed more potent activities than escin Ia which had both the 21-tigloyl group and the 2'-O-glucopyranosyl moiety.

Cholecystokinin antagonistic activities of loxiglumide

Cholecystokinin (CCK) antagonistic activities of loxiglumide ((+/-)-4-(3,4-dichlorobenzamido)-N-(3-methoxypropyl)-N-pentylgl utaramic acid, CR1505, CAS 107097-80-3) were investigated in the gastrointestine and gallbladder in vivo. Intravenous administration of loxiglumide antagonized the CCK-induced reduction of gastric emptying in rats, acceleration of intestinal transport in mice, increase in ileal motility in rabbits, gallbladder contraction in guinea pigs and acceleration of gallbladder emptying in mice. Orally administered loxiglumide also antagonized the CCK-induced gallbladder emptying in mice. Furthermore, egg yolk-stimulated gallbladder emptying in mice was also inhibited by loxiglumide, indicating that this agent antagonizes not only exogenous but also endogenous CCK. These results demonstrate that loxiglumide is an intravenously and orally effective, potent CCK antagonist.

[Bioactive constituents of Chinese natural medicines. III. Absolute stereostructures of new dihydroflavonols, hovenitins I, II, and III, isolated from hoveniae semen seu fructus, the seed and fruit of Hovenia dulcis THUNB. (Rhamnaceae): inhibitory effect on alcohol-induced muscular relaxation and hepatoprotective activity]

The methanol-soluble fraction from a Chinese natural medicine Hoveniae Semen Seu Fructus, the seed and fruit of Hovenia dulcis THUNB. (Rhamnaceae) was found to show an inhibitory effect on the alcohol-induced muscular relaxation and a protective activity on the D-galactosamine/lipopolysaccharide or carbon tetrachloride-induced liver injury. Through bioassay-guided separation using a traction performance test, three new dihydrofravonols named hovenitins I, II, and III were isolated from Hoveniae Semen Seu Fructus together with four known flavonoids, (+)-ampelopsin, laricetrin, myricetin, and (+)-gallocatechin. The absolute stereostructures of hovenitins I, II, and III were determined on the basis of chemical and physicochemical evidence to be (2R, 3R)-5,7,4',5'-tetrahydroxy-3'-methoxydihydroflavonol, (2R,3S)-5,7,4',5'-tetrahydroxy-3'-methoxy-dihydroflavonol, and (2R, 3S)-5,7,3',4',5'-pentahydroxydihydro-flavonol, respectively. Hovenitin I and (+)-ampelopsin, both of which were principal ingredients of the active fractions from this natural medicine, were found to show an inhibitory activity on the ethanol-induced muscle relaxation in rats. In addition, hovenitin I showed a protective activity on the liver injury induced by D-galactosamine/lipopolysaccharide or carbon tetrachloride in mice.

[Clinical efficacy of imipenem/cilastatin sodium for respiratory infections in patients with lung cancer]

Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer. Patients with other serious diseases were excluded and a total of 73 patients were enrolled. They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group). IPM/CS was effective in 75% of the patients, both with and without surgery. The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion. IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater. Thus, IPM/CS treatment achieved good results. Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated. Safety was evaluated in all patients. Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy. In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.

The significance of esophageal variceal pressure in patients with cirrhosis

We measured the portal circulatory hemodynamic parameters in 10 cirrhotic patients with portal hypertension and esophageal varices to determine the significance of esophageal variceal pressure. In 4 patients (group I), the temporary portal vein occlusion produced significant elevations in both the esophageal variceal pressure and the portal venous pressure. The results of the portal circulatory hemodynamic assessment in this group were consistent with the predominance of the backward flow mechanism. In the remaining 6 patients (group II), however, portal vein clamping resulted in a slightly increased esophageal variceal pressure with an enormous increase in the portal pressure. The forward flow mechanism thus appeared to be predominant in group II. In other words, the results of the pressure measurements were consistent with the functional separation of the hemodynamics in the esophageal varices and portal trunk in group II and the functional hemodynamic continuity in group I. This functional separation between the esophageal varices and the portal trunk in group II might therefore have resulted from the increased blood flow in the lesser splanchnic region.

A new sealing device (Sandwich-disc) for rapid recreation of pneumoperitoneum during laparoscopic assisted surgery

We have developed a new device which enables rapid sealing of a minilaparotomy during laparoscopic assisted surgery to recreate an airtight condition. This device consists of a center rod and two discs (7 cm in diameter) which form an airtight condition by compressing the inner and outer surfaces of the abdominal wall. Advanced laparoscopic procedures requiring both pneumoperitoneum and minilaparotomy are facilitated with the use of this device. This new device is called the Sandwich-disc: Takasago Medical Industry Co., Ltd.

Laparoscopic splenectomy

Laparoscopic splenectomy was carried out for the treatment of patients with splenic disorders; 20 idiopathic thrombocytopenic purpura, 1 hamartoma and 3 hereditary spherocytosis. With the patients in the right lateral position, four trocars were used. Under CO2 pneumoperitoneum with a pressure of 10 mmHg, the surrounding ligaments were divided with electrocautery. At the splenic hilum, the splenic artery and vein were exposed using ultrasonic dissector. After double ligation of these vessels, the spleen was dissected with an autostapler. The resected spleen contained in a nylon bag was fragmented with finger-fracture method and extracted through a port site extended up 2 or 3 cm in length. All the patients tolerated the procedure and no blood transfusion was required. Laparoscopic splenectomy is the preferred choice to resect the spleen because of the short hospital stay, less pain and good cosmesis.

Removal of the preputial glands alters the individual odors of male MHC-congenic mice and the preferences of females for these odors

Inbred mice of MHC-congenic strains prefer to mate with mice of different MHC types. Mate selection based on MHC-type occurs through the urinary odors specific to each MHC-congenic mouse strain. Both urine and preputial gland odors of male mice have been postulated to act as female attractants and the present study examined the attraction of MHC-congenic female mice (C57BL/6J and B6-AKR.H-2k) to the urine and preputial gland odors of males. Females of both strains showed a greater attraction to the urine odors of intact males of the other MHC type, but did not show a preference for the urine odors of these males after their preputial glands were removed. There was, however, a preference for the preputial fluid of males of the other MHC type. These results indicate that the MHC-specific urinary odors of mice may arise from the preputial glands, and that it is the MHC-specific preputial gland odors of MHC-conspecific males that are used for mate selection by females.

[Plasma fatty acids, lipids, lipoprotein and macroangiopathy]

Epidemiological studies have elucidated that diabetes mellitus (DM) is one of the risk factors of coronary heart disease and that DM often accompanies dyslipidemia. Dyslipidemia in DM can be classified as either quantitative or qualitative. Although dyslipdemia in DM is affected by the type of DM and glycemic conditions, the characteristics of dyslipidemia in DM, especially in NIDDM are the increase in triglycerides accompanied by the decrease in HDL-cholesterol level. Recently, new commercial kits for measurement of atherogenic lipoproteins which increase in DM are clinically available. The usefulness of these kits in DM was reviewed. Polyacrylamide electrophoresis can detect IDL and Lp(a) qualitatively. It has also become possible to estimate Lp(a) quantitatively by ELISA, TIA and LIA methods. Remnant lipoprotein can be measured in the fraction unbound to anti-apo A1 and anti-apo B100 antibodies by immunoaffinity gel analysis. Apoproteins, apoprotein E phenotype, post-heparin lipoprotein lipase, and Lp AI (HDL with apo AI and without apo AII) can be measured by the commercially available kits. Modified LDLs (glycated, oxidative) increase in DM, but their measurements remain complicated at the moment. Analysis of plasma fatty acids by gaschromatography is useful for dietary assessment. The measurement of these new markers seems to be useful to assess the extent of atherogenic risk in DM.

Successful treatment of chronic necrotizing pulmonary aspergillosis with intracavitary instillation of amphotericin B--a case report

We present an unusual case of 30-year-old man who was admitted to our hospital with dysesthesia of the limbs and skin eruptions. Polyarteritis nodosa was diagnosed based on the histopathological examination of sural nerve and renal biopsies. A month after initiation of corticosteroid therapy, a small infiltrative shadow was detected in the right mid-lung field by chest X-ray. Aspergillus infection was suspected based on a culture of bronchial lavage fluid. Despite intravenous administration of the antifungal agents, miconazole and fluconazole, a thin-walled cavity with a fungus ball gradually formed in the infiltrative lesion. The patient's clinicopathological findings were consistent with a diagnosis of chronic necrotizing pulmonary aspergillosis, a rare aspergillus infection in the lung. Treatment with intracavitary instillation of amphotericin B proved effective.

Extracellular proteolytic activity of Cryptococcus neoformans

Eight strains of Cryptococcus neoformans var. neoformans isolated from AIDS patients in the Infectious Disease Institute, University of Turin, Italy, were examined for growth and extracellular proteolytic activity in culture with solid and liquid media. All of the strains grew well on Yeast Carbon Base (YCB) agar medium supplemented with both 0.1% (w/v) bovine serum albumin (BSA) and 0.01% (w/v) polypeptone (Pp), and produced a clear proteolytic zone around their colonies, whereas they exhibited less growth and proteolytic activity on YCB medium supplemented with BSA alone. Strain #8 with a strong proteolytic activity was cultured in three different liquid media. Its growth was limited in YCB medium supplemented with 0.1% BSA, but was moderate in that with 0.01% Pp. Enhanced growth was supported by the addition of both BSA and Pp to the YCB medium. The relative value of the final cellular yields obtained with the above YCB-0.1% BSA, YCB-0.01% Pp and YCB-0.1% BSA-0.01% Pp media was approximately 1:10:20. In the culture with YCB medium containing both BSA and Pp, a rapid decrease in the amount of BSA was demonstrated by a spectrophotometric assay and gel electrophoresis of the culture supernatant after the log-to-stationary phase. The proteolytic activity in the culture supernatant became detectable after the log phase when tested with skim milk agarose plates. These results allowed us to conclude that Cr. neoformans var. neoformans is able to secrete protease and to utilize protein as a source of nitrogen.

Cost effectiveness of radiofrequency catheter ablation versus medical treatment for paroxysmal supraventricular tachycardia in Japan

This study evaluated the cost of performing radiofrequency catheter ablation in Japanese patients with paroxysmal supraventricular tachycardia refractory to antiarrhythmic drug therapy in comparison with the cost of continuing pharmacologic treatment. Twenty patients (mean age 44 +/- 14 years) underwent successful ablation: 15 patients with Wolff-Parkinson-White syndrome and five with atrioventricular nodal reentrant tachycardia. The mean duration of symptoms was 77 +/- 60 months. The patients had been treated with 2.6 +/- 1.7 antiarrhythmic drugs before undergoing ablation. Charges derived from hospital bills were compared with the outpatient charges for the year before ablation. The mean hospital stay for the ablation procedure was 4.3 +/- 0.5 days. The mean total charge for ablation was 982,806 yen +/- 103,195, and 5.7 +/- 0.7 times the outpatient charges in the previous year. The majority of radical cure charges were the costs of the electrode catheters used in the ablation procedure. All patients had a successful outcome and required no additional antiarrhythmic drug therapy. If medical treatment were continued without ablation, the mean total life-expectancy charges were estimated at 7,064,726 yen +/- 3,116,621, 41.0 +/- 19.2 times the outpatient charges. The total life charges of medical treatment were significantly more than the total ablation charges (p < 0.001). This study suggests that radiofrequency catheter ablation is of clinical benefit in treating paroxysmal supraventricular tachycardia, and markedly reduces the cost of definitive therapy. This strategy appears to be more economical than pharmacologic treatment.

Complete atrioventricular block during left heart catheterization

A 75-year-old male underwent cardiac catheterization for frequent ventricular premature contractions and reduced left ventricular function. ECG on admission showed complete right bundle branch block (RBBB) and left anterior hemiblock. Right heart catheterization was performed uneventfully, but complete atrioventricular block (CAVB) occurred suddenly when a pig-tail catheter was inserted into the left ventricle. Electrophysiological study identified this CAVB as HV block, and demonstrated HV prolongation in sinus rhythm. The coronary angiogram revealed no obstructive lesion or spasm with ergonovine. The reproducibility of the CAVB was demonstrated. The final CAVB developed and persisted for more than one week, requiring the implantation of a permanent pacemaker (DDD). Complete atrioventricular block induced during left heart catheterization is very rare. Pre-existing RBBB with left anterior or posterior hemiblock and reduced left ventricular function may be common factors in patients with this condition. Emergency pacing equipment should always be on-line when left heart catheterization is conducted in such patients.

Relation between the size of lesions and arrhythmias produced by microwave catheter ablation with a special electrode device

The purpose of this study was to examine the effects of microwave catheter ablation of ventricular myocardium. Microwave energy with a frequency of 2450 MHz was delivered via a coaxial catheter with an electrode ball tip. Microwave energy was applied to canine isolated left ventricular endocardium in vitro and to 6 anesthetized dogs in vivo at 50 watts for 15-150 sec. Ventricular arrhythmia was not observed during ablation in any of the dogs when microwave energy was applied for less than 45 sec. When the duration of microwave ablation was greater than 45 sec, ventricular premature contractions were observed in all of the dogs. Nonsustained ventricular tachycardia developed when the duration of microwave delivery was greater than 90 sec. After the cessation of ablation, ventricular arrhythmias did not occur and ventricular programmed stimulation did not induce ventricular tachycardia in any of the dogs. Except for ventricular arrhythmia, no declines in the hemodynamic status were observed in any of the 6 dogs. The size of the ablated lesion was significantly greater as the duration of ablation was increased (p < 0.05). When ablation lasted for more than 120 sec, the coagulation layer was extended to the epicardium in all 6 dogs. The results of this study suggest that microwave ablation is feasible for the treatment of tachyarrhythmias from deep focus of ventricular myocardium with relatively small proarrhythmic effects.

[An experimental study of catheter ablation using microwave energy via coaxial electrode catheter]

The purpose of this study was to examine the efficacy, arrhythmogenicity, and the size of ablated lesions of catheter ablation with microwave energy. Microwave energy generated by a device with a frequency of 2450 MHz, was delivered via a bipolar electrode coaxial catheter with an electrode ball tip. Microwave ablation was applied (50 watts for 15-150 sec.) on the left ventricular endocardium in 6 dogs. No ventricular arrhythmia occurred during ablation in any of the dogs when microwave catheter ablation was applied for less than 45 sec. However, when the duration of microwave catheter ablation was longer than 45-60 sec, ventricular premature contractions were observed in all 6 dogs. When ablation time was set for a longer time, the dogs developed nonsustained ventricular tachycardias. Nevertheless, ventricular arrhythmias after ablation did not occur in all dogs. Ventricular programmed stimulation after ablation did not induce ventricular tachycardia in any of the dogs. When ablation time lasted more than 120 sec, the coagulation layer was extended to the epicardium in all 6 dogs. The results of this study suggest that microwave ablation is feasible for the treatment of tachyarrhythmias from a deep focus of the ventricular myocardium.

[Lower lung field tuberculosis]

Lower lung field tuberculosis has been considered as rare disease, but it was observed about ten percent in the literature. It seemed that the important problems in lower lung field tuberculosis are delay and difficulty of diagnosis. The materials for this report was accumulated over a period of 10 years, from January 1983 to December 1992 at the National Sanatorium Fukuoka-Higashi Hospital. The criteria for lower lung field tuberculosis are: (1) disease confined to lower lobe except for S6a, middle lobe and lingular segment, (2) bacteriologically and/or histologically proved diagnosis of tuberculosis, (3) clinically considered as tuberculosis for which improved by only anti-tuberculous drugs. During this period, 672 new patients suffering from active pulmonary tuberculosis were admitted to the sanatorium. Of the total of 672 patients, 57 patients were selected as the criteria for lower lung field tuberculosis. The incidence of them was 8.5 percent of the total new admissions. Of these 57 patients, 30 were females and 27 males. The mean age of these 57 patients was 59.4 years ranging between 19 and 86 years. The incidence of them obtained through ten years did not show any tendency to increase or decrease. The respiratory and general symtoms most commonly observed were cough and chest pain. The average duration of used for diagnosis of the lower lung field tuberculosis over 65 years old was 71.7 days and it seemed to show the delay and difficulty of diagnosis.

Optimal frequency of radiofrequency catheter ablation in vitro and in vivo for treating ventricular tachycardias--a study using various frequencies

The purpose of this study was to determine the optimal frequency for radiofrequency catheter ablation of ventricular tachycardias. A radiofrequency current was delivered from a 6F bipolar electrode catheter with a tip electrode width of 4 mm. Ablation was performed for a pulse duration of 10 sec at 20 watts (50 V and 0.4 A) at seven different frequencies between 10 and 500 kHz. We used 35 canine isolated left ventricular endocardial sites in vitro and 14 anesthetized dogs in vivo. The lesions which were ablated at frequencies of 200 and 300 kHz were significantly larger than those at other frequencies, with a mean surface areas of 78.5 and 76.3 mm2, and mean depths of 4.0 and 4.1 mm, respectively (p < 0.05). The appearance of ventricular arrhythmias during ablation increased as the frequency decreased. One dog, to which a frequency of 100 kHz was applied, developed spontaneous ventricular fibrillation and died. All of the dogs which received a current with a frequency under 50 kHz exhibited muscle cramping during ablation. Ventricular stimuli applied after ablation did not induce ventricular tachycardia. These results suggest that the optimal frequency for ablating a large lesion is between 200 and 300 kHz. To avoid inducing malignant ventricular arrhythmia during ablation, the frequency must exceed 200 kHz. Furthermore, a frequency below 100 kHz should not be used in radiofrequency catheter ablation because of the risk of arrhythmias and muscle cramping.

[Borderline values of laboratory data in patients with hyperlipidemia]

In Japanese, serum cholesterol levels have been increasing. This seems to be due to changes in life style, mainly the increase in dietary fat. Epidemiologic studies in the United States and Europe have shown that patients with hypercholesterolemia have a high risk of ischemic heart disease. Some guidelines for the management of hyperlipidemia have been developed in the United States, Europe, and Japan. The National Cholesterol Education Program (NECP) in the United States divides serum cholesterol level into three grades (desirable: below 200 mg/dl, borderline: between 200 mg/dl and 240 mg/dl, hypercholesterolemia: over 240 mg/dl). Borderline serum cholesterol is also a risk, especially in people complicated by other risk factor(s). As most borderline serum cholesterol seems to be due to polygenic hypercholesterolemia, an attempt to change the diet should be the first recommendation for treatment.