[A questionnaire survey of surgical lung biopsy in patients with diffuse lung diseases]

A nationwide questionnaire survey was conducted to investigate the indications, diagnostic yield, complications, outcome, and benefit of surgical lung biopsy for diffuse lung diseases. Surgical lung biopsies were performed in 410 patients at 132 institutes in 1998, 94% of them as video-assisted thoracoscopic surgery (VATS). Interstitial lung diseases of unknown etiology formed the largest diagnostic group, and consisted of 194 patients. The clinical diagnosis prior to lung biopsy was inconsistent with the final diagnosis in 32.8%. Complications were seen in 32 patients, and mortality was 1.2%. Acute exacerbation of the underlying disease was seen in 9 patients, four of whom died. Patients with nonspecific interstitial pneumonia and even usual interstitial pneumonia who were treated following biopsy showed better outcomes than those untreated. The physician in charge judged that 82.2% of the patients received clinical benefits from the biopsy procedure. We concluded that VATS lung biopsies are indicated in more cases to confirm diagnoses and as a reference for treatments in patients with diffuse lung disease.

[Gastroesophageal reflux and respiratory diseases]

There is a relationship between gastroesophageal reflux and respiratory diseases. Reflux may trigger and aggravate respiratory diseases especially bronchial asthma. Both clinical and experimental observations suggest that the pathogenic mechanisms may be a vagal reflex and/or microaspiration of gastric acid into the trachea. General measures to avoid reflux and proton pomp inhibitor together with inhaled corticosteroid are the choice for treatment of asthma associated with gastroesophageal reflux. Xanthine derivatives and beta 2 adrenergic agonist might be withheld in these patients. A laparoscopic surgical treatment may be an option for patients with persistent symptoms.

Effects of neutral endopeptidase inhibition in the rat remnant kidney model

The orally active neutral metalloendopeptidase (NEP) inhibitor SCH34826 was given by oral gavage in a dose of 90 mg/kg twice daily for 3 days to rats with subtotal nephrectomy (n = 7) and effects were compared to a placebo group receiving phosphate buffer (n = 5). Inhibition of neutral endopeptidase in the remnant kidney was measured by in vitro autoradiography using the specific radioligand [125I]-SCH 47896. Treatment with the NEP inhibitor SCH34826 caused a 60% reduction in the neutral endopeptidase radioligand-binding site density in the kidneys of the SCH34826-treated animals compared to the placebo group (81.6+/-3.7 versus 214.5+/-4.2 dpm/mm2, p<0.01). This was associated with a marked increase in urinary atrial natriuretic peptide (ANP) from 3,930+/-295 to 9,094+/-1,089 pg/24 h in the SCH34826-treated group (p<0.01). Concomitantly there was a transient increase in natriuresis in the SCH34826-treated group [baseline 2.03+/-0.55 to 3.77+/-0.58 mmol/24 h on treatment day 1 (p = 0.02) and 2.58+/-0.19 mmol/24 h on treatment day 3 (p = 0.09)] which was not observed in the placebo group. Urinary protein excretion, glomerular filtration rate (determined by 99mTc-DTPA clearance), systemic blood pressure, plasma ANP concentration and urinary cyclic GMP excretion were not changed by SCH34826 treatment. These results suggest that oral administration of the NEP inhibitor SCH34826 inhibits renal neutral endopeptidase, increases urinary ANP and modulates natriuresis without alteration of systemic blood pressure, plasma ANP and renin level, glomerular filtration or protein excretion.

Sucrose-diet feeding induces gene expression of heat shock protein in rat brain under stress

Stress-induced hyperphagia is enhanced in the presence of sweets, particularly sucrose, which may act to attenuate stress. Recently, it was also reported that heat shock protein (HSP) may be involved in the defense against stress. To explore whether sucrose alters gene expression of HSP under stress, we determined the HSP mRNA levels in the hypothalamus, cerebellum, and cerebral cortex after restraint stress in sucrose-diet-fed rats. Competitive RT-PCR revealed that gene expressions of HSP27 in the cerebral cortex and cerebellum and of HSP70 in the cerebral cortex, hypothalamus, and cerebellum were induced by restraint stress under a sucrose-diet-fed condition. However, restraint stress by itself or sucrose diet alone did not induce expression of HSP27 or HSP70 mRNA in any of the three anatomical parts. It is suggested that sucrose facilitates the gene expression of HSP27 and HSP70 in brain after restraint stress, which may attenuate stress.

Respiratory gated irradiation system for heavy-ion radiotherapy

PURPOSE

In order to reduce the treatment margin of the moving target due to breathing, we developed a gated irradiation system for heavy-ion radiotherapy.

METHODS AND MATERIALS

The motion of a patient due to respiration is detected by the motion of the body surface around the chest wall. A respiratory sensor was developed using an infrared light spot and a position-sensitive detector. A timing signal to request a beam is generated in response to the respiration waveform, and a carbon beam is extracted from the synchrotron using a RF-knockout method. CT images for treatment planning are taken in synchronization with the respiratory motion. For patient positioning, digitized fluoroscopic images superimposed with the respiration waveform were used. The relation between the respiratory sensor signal and the organ motion was examined using digitized video images from fluoroscopy. The performance of our gated system was demonstrated by using the moving phantom, and dose profiles were measured in the direction of phantom motion.

RESULTS

The timing of gate-on is set at the end of the expiratory phase, because the motion of the diaphragm is slower and more reproducible than during the inspiratory phase. The signal of the respiratory sensor shows a phase difference of 120 milliseconds between lower and upper locations on the chest wall. The motion of diaphragm is delayed by 200 milliseconds from the respiration waveform at the lower location. The beam extraction system worked according to the beam on/off logic for gating, and the gated CT scanner performed well. The lateral penumbra size of the dose profile along the moving axis was distinguishably decreased by the gated irradiation. The ratio of the nongated to gated lateral fall-off was 4.3, 3.5, and 2. 0 under the stroke of 40.0, 29.0, and 13.0 mm respectively.

CONCLUSION

We developed a total treatment system of gated irradiation for heavy-ion radiotherapy. We found that with this system the target margin along the body axis could be decreased to 5-10 mm although the target moved twice or three times. Over 150 patients with lung or liver cancer had already been treated by this gated irradiation system by the end of July 1999.

[A questionnaire survey on the self-assessment to the asthmatic treatment in Saitama Prefecture: results from 2825 cases]

The aim of this study was to survey the self-assessment to the treatment of adult bronchial asthmatics in Saitama prefecture. A questionnaire on daily symptoms and medications was distributed to 2825 adult asthmatic subjects who were treated at 125 hospitals/clinics in Saitama prefecture between September 15th and October 30th 1998. More than half (52.7%) of patients described that their general condition of asthma was poorly controlled. Even among the patients described that their condition was good or fair, 30.2% of them had some asthmatic symptoms such as shortness of breath or nocturnal awakening. Although inhaled corticosteroids were used in 66.2%, the ratio of patients who used spacer and kept drug compliance as prescribed were 59.6% and 45.8%, respectively. According to the physician's reports, cysteinyl leukotriene antagonist was used in 35.7%, which was comparable to the total of another anti-allergic drugs (37.3%). These results suggest that more than half of asthmatic patients in Saitama prefecture were not satisfied with their conditions of the disease control. Furthermore, more thorough education on the technique and compliance of inhaled corticosteroids would be required.

Immunohistochemical and chemical changes of beta-citryl-L-glutamate in the differentiation of bovine lens epithelial cells into lens fiber cells

Beta-citryl-L-glutamate (beta-CG) concentration was determined by HPLC during the differentiation of bovine lens epithelial cells into lens fiber cells in culture. beta-CG increased from 1 to 4 weeks of culture and then decreased slightly, while alpha-crystallin, a marker of lens cell differentiation, increased rapidly 4 weeks after the culture and continued to increase gradually until week 11. In addition, the localization of beta-CG was immunohistochemically examined using anti-beta-CG antibody. Cells around lentoid bodies were stained with anti-beta-CG antibody, whereas cells in the bodies were stained strongly with anti-gamma-crystallin antibody. These findings suggest that beta-CG accumulated immediately before the differentiation of the bovine lens epithelial cells into lens fiber cells and may play a role in regulating the differentiation of lens cells.

Cardiac infarcts increase sodium transporter transcripts (rBSC1) in the thick ascending limb of Henle

BACKGROUND

Enhanced expression of the kidney-specific sodium transporter, rBSC1, in the thick ascending limb of Henle (TAL) and of the renal water channel, aquaporin-2 (AQP2), in collecting duct has been identified in rats with congestive heart failure (CHF) as a cause for enhanced sodium and water retention in this condition. However, the mechanism of impaired urinary sodium excretion observed even in rats with mild cardiac dysfunction remains unknown.

METHODS

Male Sprague-Dawley rats with myocardial infarctions measuring 15 to 30% of the left ventricular circumference with no overt CHF were prepared. We measured the amount of rBSC1 or AQP2 mRNA using competitive polymerase chain reaction (PCR) by inducing a point mutation at the middle of the PCR product for rBSC1 or by deleting 180 bp from the 760 bp PCR product for AQP2, respectively. The results were confirmed by in situ hybridization. rBSC1 protein expression was examined by immunohistochemistry and Western blot analysis using a specific antibody against rBSC1.

RESULTS

Although plasma renin activity was slightly elevated in rats with myocardial infarction (MI), no significant differences in lung weight or plasma concentrations for aldosterone and atrial natriuretic peptide were observed between control rats and MI rats. Competitive PCR showed a significant increase in rBSC1 mRNA in the renal outer medulla and cortex of MI rats, which was confirmed by in situ hybridization. However, the AQP2 mRNA of these rats remained unchanged throughout the kidney. Renin-angiotensin II blockade by oral captopril administration did not influence the alteration in rBSC1 mRNA induced by myocardial infarction. Immunohistochemistry and Western blots showed the enhanced expression of rBSC1 protein in TAL of rats with small to moderate cardiac infarcts.

CONCLUSIONS

rBSC1 is up-regulated even in rats with small to moderate myocardial infarctions, which may enhance the sodium transport in the TAL in this pathophysiologic condition.

Identification of two novel mutations of the carnitine/acylcarnitine translocase (CACT) gene in a patient with CACT deficiency

Carnitine/acylcarnitine translocase (CACT) transports acylcarnitines into mitochondria in exchange for free carnitine, and is therefore an essential component within the fatty acid beta-oxidation pathway. CACT deficiency is an autosomal recessive disease caused by a mutation of the CACT gene. We have identified two novel mutations of the CACT gene in a patient with CACT deficiency. The first, a deletion mutation (146 del T), leads to premature termination and results in a very immature CACT protein. The second, a splicing mutation (261-10T > G), results in either skipping of exons 3 and 4, or of exon 3 alone, and leads to truncation of the protein. Each of these mutations is hypothesized to destroy the function of the CACT protein. We propose that each of these mutations of the CACT gene play a causative role in the disease.

Importance of interleukin-8 in the development of reexpansion lung injury in rabbits

Reexpansion of a collapsed lung induces increased microvascular permeability leading to reexpansion pulmonary edema (REPE). This study was designed to prove the hypothesis that local overproduction of interleukin-8 (IL-8) induces inflammatory cell accumulation which leads to the induction of REPE. Initially, we examined the detailed characteristics of a rabbit model of REPE in association with IL-8 production and its mRNA expression. The lung tissue to plasma ratio of radiolabeled albumin (T/P ratio), the lung wet to dry ratio, and bronchoalveolar lavage (BAL) neutrophil counts were significantly increased in the reexpanded lung. IL-8 concentrations and mRNA expression were significantly increased in the reexpanded lung homogenate. Immunohistochemically, alveolar macrophages (AMs) and epithelial cells in the reexpanded lung and AMs in the collapsed lung were positive for IL-8. Second, we examined the effect of pretreatment with a specific monoclonal anti-IL-8 antibody (Ab) or control IgG on the development of REPE. The T/P ratio and BAL neutrophil counts were conspicuously decreased by pretreatment with anti-IL-8 Ab, but not with control IgG. On a histopathological study, lung injury and leukocyte infiltration were attenuated by the pretreatment with anti-IL-8 Ab. In conclusion, IL-8 production is enhanced in the reexpanded lung, and contributes to the development of REPE. The pretreatment with anti-IL-8 antibody may be useful as a novel protective therapy for this disease.

Renal-protective effect of nondepressor dose of cicletanine in diabetic rats with hypertension

We assessed the renal and cardiac benefits of cicletanine (CIC), a furopyridine derivative drug with diuretic and antihypertensive properties, in diabetic spontaneously hypertensive rats with renal impairment. Uninephrectomized streptozotocin (STZ)-diabetic spontaneously hypertensive Izmo rats (SHRIzm) (10 weeks old) were randomly assigned to receive vehicle or CIC (100 mg/kg/day, orally), and age-matched, uninephrectomized STZ diabetic Wistar-Kyoto Izmo rats (WKYIzm) were assigned to receive vehicle for up to 12 weeks. Blood pressure increased progressively in diabetic SHRIzm but not in diabetic WKYIzm. Urinary albumin excretion increased significantly in both diabetic SHRIzm and diabetic WKYIzm throughout the experiment. The antihypertensive effect of CIC was not significantly observed in diabetic SHRIzm. However, the subdepressor doses of CIC significantly decreased urinary albumin excretion, serum creatinine, and blood urea nitrogen in diabetic SHRIzm. These results were confirmed by morphological analysis of kidneys in each group of rats. The index of focal glomerular sclerosis (FGS) in diabetic SHRIzm was significantly higher than that in diabetic WKYIzm. The CIC treatment significantly and effectively protected against an increase in the index of FGS in diabetic SHRIzm. Moreover, CIC treatment significantly attenuated the increase in the heart weight to body weight ratio in diabetic SHRIzm. Treatment with CIC did not affect urinary and blood glucose concentrations at this dose. These results suggest that CIC has a renal-protective action, which is not related to improvement of diabetes or improvement of high blood pressure in diabetic rats with hypertension. The action might be due to the reduction of intraglomerular capillary pressure or protection of the renal glomerular vascular endothelial cell injury and mesangial cell injury through stimulation of PGI2 generation or elimination of free radicals, although the mechanism remains to be further investigated.

Evaluation of cytotoxicity of UHMWPE wear debris

We established a novel method to investigate the phagocytosis of ultra high molecular weight polyethylene using primary macrophage cells by an inverted cell culture method. Abundant wear debris derived from implant materials are generated in aseptic loosening and are deposited in periprosthetic tissues in which they are phagocytized by mono- and multi-nucleated macrophage like cells. Ultra-high-molecular-weight-polyethylene wear debris generated from different sources namely, from laboratory test wear machine, in vivo methods and from knee and hip simulator were mainly used in this investigation. The cytotoxicity index of the different UHMWPE particles obtained from various sources were compared with that of the PE beads and the control without particles by Alamar Blue and Neutral Red assays. The results showed that the cytotoxicity index was significantly lower for the wear debris from the in vivo experiments than that for other particles. SEM analysis were also done to understand the morphology of the wear debris and polyethylene beads and to confirm the phagocytosis process. The mean diameter of the wear debris obtained from the in vivo experiments as estimated from the imaging analysis of the SEM photographs was found to be the least. The inverted cell culture method may be regarded as one of the good methods to study the phagocytosis of UHMWPE by macrophage cells.

Abnormal visceral perception in patients with functional dyspepsia: use of cerebral potentials evoked by electrical stimulation of the oesophagus

Altered visceral perception is thought to be included in the pathogenesis of functional dyspepsia. However, in previous studies, the assessment of visceral perception has been based solely on patients self-reported symptoms. Cerebral evoked potential (EP), either by mechanical or electrical stimulation (ES) of the visceral organ, is used to evaluate visceral perception via afferent neural pathways. In this study, we investigated the visceral perception in patients with functional dyspepsia by EP to eliminate the possibility of self-reported bias. EP responses were recorded by oesophageal ES at 37 cm from the nostril in 14 patients with functional dyspepsia and 14 normal healthy control subjects. Threshold levels of perception, peak latencies and peak-to-peak amplitudes of EP were evaluated. There was no difference in the sensory threshold between the dyspeptic patients and the control subjects (median 6 mA, range 2-12 mA, vs. 8 mA, range 6-14 mA; P= 0.09). There was a strong trend towards a decreased discomfort threshold in the patients when compared to the control subjects (median 14 mA, range 6-24 mA vs. 20 mA, range 14-26 mA; P = 0.05). The latency of the later EP peak (N2) among the patients (154 ¿ 4 ms) was significantly shorter than that of the control subjects (171 ¿ 3 ms, P < 0.01) although there was no difference between the earlier peaks (Ni and P1). There was also no difference in the amplitudes (Ni/Pi and P1/N2) of EP between the patients and the control subjects. Half of the patients (seven out of 14) complained of nausea during ES but the control subjects were unaffected. The latency of the first EP peak (Ni) in the patients with nausea was significantly shorter (66 ¿ 3 ms) than that of the patients without nausea (79 ¿ 4 ms, P 0.05) or among the control subjects (80 ¿ 3 ms, P < 0.05). These results suggest that dyspeptic patients may recruit a greater number of fast conducting myelinated nerve fibres that convey visceral afferent impulses to the brain and/or that dyspeptic patients may have an altered central processing of the visceral perception. We conclude that EP recording by oesophageal ES provides an objective measurement of altered visceral perception in patients with functional dyspepsia.

17Beta-hydroxysteroid dehydrogenase type 1 and type 2 in human breast carcinoma: a correlation to clinicopathological parameters

The expression of 17beta-hydroxysteroid dehydrogenase (17beta-HSD) type 1 and type 2 was examined immunohistochemically in 111 invasive ductal carcinomas, and correlated with various clinicopathological parameters. This study investigates local regulatory mechanisms of oestrogens in human breast carcinoma. 17Beta-HSD type 1 was immunolocalized in carcinoma cells of 68 out of 111 invasive ductal carcinoma cases (61.3%). 17Beta-HSD type 2 immunoreactivity was not detected in all cases examined. A significant inverse correlation was observed between the immunohistochemical expression of 17beta-HSD type 1 and histological grade of the carcinoma (P < 0.02). There was a significant correlation between 17beta-HSD type 1 and oestrogen receptor (ER) labelling index (LI) (P < 0.05). In addition, carcinoma cells expressing immunoreactive 17beta-HSD type 1 were frequently positive for ER. 17Beta-HSD type 1 was also correlated with progesterone receptor (PR) LI (P < 0.05). There was a significant inverse correlation between 17beta-HSD type 1 and Ki-67 LI (P < 0.0001). No significant correlations were detected between 17beta-HSD type 1 and other clinicopathological parameters, including patient age, menopausal status, stage, tumour size, lymph node status and prognosis. This study suggests that 17beta-HSD type 1 plays an important role in the regulation of in situ oestradiol production in hormone-dependent breast carcinomas.

Quantitative analysis of cell allocation during liver development, using the spf(ash)-heterozygous female mouse

Mosaicism of ornithine transcarbamylase (OTC) expression in hepatocytes was quantitatively analyzed during liver development of the spf(ash)-heterozygous female mouse. Because the mosaic patterns depend on cell migration and cell mixing, such analysis could give insights on the growth pattern or allocation pattern of hepatocytes during liver development. Complex mosaic patterns of OTC-positive and -negative hepatocytes were observed in sections of fetal and postnatal livers. Sizes of patches, which were aggregates of OTC-positive or -negative hepatocytes, increased during development. Patches were slender and comparatively simple in 15.5- and 17.5-day fetal and neonatal livers. Quantitative analysis of patch shapes demonstrated that undulation of patches was maximal at 7 postnatal days. Patches with nodular shapes also started to increase in number at this stage. Isolated patches in sections of fetal livers and postnatal livers three-dimensionally connected with one another. However, especially in fetal livers, in which OTC-positive patches were minor, due to the presence of abundant hemopoietic cells, isolated three-dimensional patches consisting of approximately 5 to 70 cells were often found. They were shaped like slender branching or zigzag-shaped cords, but no definite orientation such as portal-central was observed in them at any stage. These results suggest that hepatocytes contiguously allocate their daughter cells as zigzag-shaped or branching cords at younger stages. Some hepatocytes grow with nodular formation after 7 postnatal days. Migration and mixing of hepatocytes appear to be more extensive at fetal stages than in the adult liver. Immunohistochemical analysis of intercellular junction proteins (E-cadherin, connexins 26 and 32, occludin, and ZO-1) also revealed that their expression and distribution changed in hepatocytes during development, which may be correlated with the OTC mosaic patterns.

Changes in neoplastic cell features and sensitivity to mitotane during mitotane-induced remission in a patient with recurrent, metastatic adrenocortical carcinoma

A 58-year-old man had adrenocortical carcinoma in the right adrenal gland. The tumour secreted excessive cortisol and dehydroepiandrosterone-sulphate (DHEA-S), and had invaded the right hepatic lobe and vena cava. Eleven months after surgical tumour resection, the serum DHEA-S levels again increased. Local tumour recurrence and a metastasis was found in the lung. Eleven months after surgery chemotherapy with mitotane (o,p'-DDD) was initiated. Twelve weeks of mitotane reduced serum DHEA-S levels and caused these tumours to disappear. The patient was then treated with low-dose mitotane (1.5-2.0 g/day) for 2 years. Serum levels of mitotane remained at less than 10 microg/ml. Although such low serum levels of mitotane and delayed initiation of mitotane after surgery have been proposed to weaken the antineoplastic effect of mitotane, the patient had a remission for 2 years. However, there was then local re-recurrence with an increase in serum DHEA-S and death 4 months later. The histological features of neoplastic cells were quite different comparing tumour resected at surgery and tumour at autopsy. The latter had more frequent mitotic nuclei. This tumour was initially sensitive to mitotane, but later became insensitive.

An Ile/Val polymorphism at codon 1464 of the ATP7A gene

An isoleucine/valine polymorphism was observed at codon 1464 of the ATP7A gene, which is thought to encode a copper transporting adenosine triphosphatase (ATPase). The frequency of Val1464 was estimated to be 5.7% in the Japanese population. This polymorphism may be useful in genetic studies of Menkes disease.

Therapeutic advantage of angiotensin converting enzyme inhibitors in chronic glomerulonephritis

Hypertension in chronic progressive renal disease is a major clinical problem leading to renal function loss. We studied the influence of ambulatory blood pressure (ABP) and the effect of hypertension therapy on renal function in 116 patients with chronic glomerulonephritis. Patients were subdivided as hypertensive, normotensive and hypotensive according to the level of ABP and age. Hypotensive subjects showed improvement of renal function and normotensive subjects showed slower rate of progression of renal function loss than hypertensives, suggesting the adequate level of ABP was 100-125/55-75 mm Hg in patients less than 40 years old, 100-135/60-80 mm Hg in patients 40-60 years old, and 105-140/60-85 mm Hg in patients over 60 years, respectively. The renal protection of calcium antagonists was associated with achieving lower blood pressure levels, whereas the blood pressure level did not affect progression of renal function in patient treated with angiotensin converting enzyme (ACE) inhibitor. ACE inhibitor, but not calcium antagonists, showed a reduction of urinary protein excretion. Thus, the mechanisms of renal protection were different between ACE inhibitors and calcium antagonists.

Development of a new catheter-tip pressure transducer

Two major disadvantages of the conventional catheter-tip transducer have been incapability to calibrate baseline pressure and to adjust sensitivity after insertion. A vast majority of conventional catheter-tip transducers are classified as gauge type. Due to their structure they are inherently incapable of recalibrating after insertion. We have overcome this problem by developing a new differential type catheter-tip transducer equipped with a lumen that connects a small chamber at the backside of the transducer to another external port. This lumen is capable of pressure passage. The output of this type depends on the difference between the two imposed pressures. This passage makes a baseline standard possible, when the end of the lumen is exposed to atmospheric pressure. When pneumatic pressure is imposed to the end of the lumen using a syringe, for example, the transducer output shifts up and down in accordance to that pressure, enabling baseline pressure recalibration and verifying the degree of sensitivity after insertion. By obtaining the following data, we confirmed the stability and availability of this transducer: Baseline drift less than 0.04 mmHg/8 hour, frequency characteristics flat up to 60 Hz, and common mode rejection ratio more than 46 dB.

Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction

We have designed a new 4-week hospitalized phase II cardiac rehabilitation program. The purpose of the present study is to clarify whether the physical and psychological status of patients with myocardial infarction (MI) improves after participation in our program. Twenty-nine patients (27 males, two females) with acute MI who enrolled in the 4-week hospitalized phase II rehabilitation program were assessed. All patients enrolled in this study had received coronary interventions. The rehabilitation consisted of exercise training, education and counseling. We evaluated the physical and psychological status of the patients before and just after the program, and at a 6-month follow up. The physical status was assessed by exercise tolerance measured by the peak oxygen consumption and anaerobic threshold, frequency of exercise, and serum concentrations of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol. The psychological status was assessed by the Spielberger state-trait anxiety inventory questionnaire (STAI) and the self-rating questionnaire for depression (SRQ-D). Thirty-four patients (27 men, seven women) with MI who did not participate in our rehabilitation program served as a control group. After participation in our rehabilitation program, exercise tolerance and the serum lipid profiles of the patients were improved compared with those before rehabilitation. These parameters had improved significantly 6 months after rehabilitation. The STAI anxiety score was improved significantly and the SRQ-D depression score tended to be improved just after the rehabilitation program. Regular physical activity was continued even 6 months after the completion of the program. Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the psychological status in patients with MI. This comprehensive program may contribute to the secondary prevention of MI as well as the recovery of physical and psychological activities.

Clinical and immunoregulatory effects of roxithromycin therapy for chronic respiratory tract infection

The clinical and immunoregulatory effects of long-term macrolide antibiotic therapy for patients with chronic lower respiratory tract infections (CLRTI) were investigated. Clinical parameters and neutrophil chemotactic mediators in the epithelial lining fluid (ELF) of CLRTI patients (n = 10) were examined before and after 3 months oral administration of roxithromycin (RXM). The in vitro effects of RXM were also examined on the release of these mediators from alveolar macrophages (AM) and neutrophils. Arterial oxygen tension (p<0.05), vital capacity (VC) (p<0.001), %VC (p<0.05) and forced expiratory volume in one second (p<0.01) were improved after RXM treatment, but airway bacteria were not eradicated. Among the mediators, the levels of interleukin (IL)-8, neutrophil elastase (NE) and leukotriene B4 (LTB4) were higher in ELF than in plasma of CLRTI patients and they decreased after RXM treatment (n = 7, p<0.05 for each). RXM concentrations were significantly increased in the bronchoalveolar lavage cells of the treated patients. In in vitro experiments, RXM showed inhibitory effects on IL-8 release from AM and neutrophils. In conclusion, interleukin-8, neutrophil elastase and leukotriene B4 contribute to the neutrophilic inflammation in the airways of chronic lower respiratory tract infection patients and the clinical effects of roxithromycin may, in part, be attributable to the suppression of excess release of the chemotactic mediators from inflammatory cells.