Helicobacter pylori infection in early gastric adenocarcinoma: relationship between histologic subtypes and ulcer-formation

Early stage of gastric cancers were divided into two subtypes; differentiated and undifferentiated adenocarcinomas, histologically. We examined the involvement of Helicobacter pylori (Hp) infection in the development and progression of cancer, and presence or absence of peptic ulcer (UL+/UL-). From the results, these findings obtained as follows; 1) Hp positive rate of UL+ group was significantly higher than that of UL-group. 2) Neither of gross features nor depth of the tumor did not correlate with Hp positive rates. 3) Hp positive rate of undifferentiated type carcinoma was significantly higher than that of differentiated type, contrarily to our expectation. These findings suggested that Hp infection might relate with ulcer formation in the cancerous lesion. The hypothesis which is "gastritis-intestinal metaplasia-differentiated type carcinoma sequence" was not supported by present study. Hence, Hp infection was suggested as an important factor of the gastric cancer development and progression, not only in differentiated type but also in undifferentiated type.

Cloning and characterization of a mariner-like element in the silkworm, Bombyx mori

We have identified a mariner-like element (MLE) in the genome of the silkworm, Bombyx mori. The cloned MLE, desiqnated as BmMLE, contained an ORF that was interrupted by insertions, stop codons, and frameshifts. The complete ORF sequence was estimated by sequencing the PCR products. The hypothetical protein coded by this ORF showed 34% homology to the Mos1 element of Drosophila mauritiana, and is phylogenetically very close to MLE of Hyalophora cecropia. BmMLE is present in 80 to 100 copies in the B. mori genome. Many BmMLEs with different lengths were identified by Southern blot analysis and LA PCR of the genomic DNA. The distribution of these BmMLEs differed in geographic races.

Near-infrared monitoring of myocardial oxygenation during intermittent warm blood cardioplegia

OBJECTIVE

This study was performed to examine the ability of near-infrared spectroscopy to monitor tissue oxygenation in the cardioplegically arrested heart and to assess myocardial oxygen metabolism during intermittent warm blood cardioplegia.

METHODS

Using a three-wavelength near-infrared spectroscopy, we continuously measured myocardial tissue oxygen saturation and the tissue hemoglobin concentration during intermittent warm blood cardioplegia. Under normothermic cardiopulmonary bypass, 20 dogs received three 5-min periods of antegrade warm blood cardioplegia, interrupted by three 10-min episodes of ischemia in group 1 (n = 7), three 15-min episodes of ischemia in group 2 (n = 6), or three 20-min episodes of ischemia in group 3 (n = 7).

RESULTS

Myocardial oxygen saturation during beating and ventricular fibrillation was 80 +/- 1 and 59 +/- 1%, respectively. Myocardial oxygen saturation rapidly increased to 82 +/- 1% at blood cardioplegic infusion and decreased to 58 +/- 1% 3 min after cardioplegic interruption. The time required to reach the peak oxygen saturation level decreased significantly at the second and third infusions compared to the first infusion in group 1, whereas the time increased significantly at the third infusion in groups 2 and 3. The slower rate of increase in oxygen saturation suggested reduced coronary vasodilator reserve due to microvascular abnormalities. Reperfusion ventricular fibrillation occurred in none of group 1, one of group 2 and three of group 3.

CONCLUSIONS

Near-infrared spectroscopy is a useful method of continuously monitoring myocardial oxygenation and ischemia during warm heart surgery. Episodes of ischemia longer than 10 min during warm blood cardioplegia resulted in less-than-optimal myocardial preservation and should be avoided.

Esophageal cancer in patients with head and neck cancers

Nine male patients with separate primary cancers of the esophagus and head and neck (pharynx, larynx) presented with a mean age of 56 years (41-69). They included 7 pharyngeal cancer patients and 2 laryngeal ones. Esophageal cancer was discovered synchronously in 6 patients and metachronously in 3 (1, 4, and 11 years later, respectively). The head and neck cancer was stage-I in one patient, stage-II in 4 and stage-IV in 4. The esophageal cancer was cervical in 2, thoracic in 6 and abdominal in 1. It was early cancer (stage-0) in 6 patients and advanced (stage-IV) in 3. The esophageal cancer was more advanced in the metachronous group, while it was early in the synchronous group. Since the head and neck cancer was advanced, all patients underwent a total laryngectomy for their head and neck cancers. As for esophageal surgery, a transhiatal esophagectomy was, in principle, performed for early cancers while a total thoracic esophagectomy was done for advanced cancers. For the reconstruction of the esophagus, a gastric tube was used. Four patients are still alive with a mean survival time of 25 months, whereas five died of cancer recurrence of either type a mean of 19 months after surgery. As compared with the survival rates of the patients with esophageal cancer alone, the 5-year survival rate was 18.2% for patients with double cancers in this series and 27.9% for those with esophageal cancer alone.

[Preservation of olfaction in frontal transbasal approach]

Lesions in the frontal base and clival area have conventionally been approached using the transbasal approach described by Derome and Guiot. However, this approach necessitates removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia and cerebrospinal fluid leak and, in addition, complex reconstruction of the frontal base is required. We describe a new approach to deeply situated tumors in the frontal base, parasellar and clival area which is a modification of Spetzler's craniofacial approach with preservation of olfaction. In this approach, circumferential osteotomy cuts are made around the cribriform plate to permit en block removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the frontal base. Three patients underwent surgery using this approach for treatment of recurrent pituitary adenoma in two cases and for clivus chordoma in one. In one patient, olfactory function was not preserved because resection of nasal mucosa was small. In the other two patients, however, olfaction was preserved by creating a cribriform plate complex with a sufficient area of resection of nasal mucosa and tumors were completely removed. Olfaction can be preserved, CSF leakage can be prevented, and facial skin incision and complex frontal base reconstruction can be avoided when this technique for maintaining normal olfactory-cribriform anatomy is used in frontal transbasal approaches.

[Physical activity assessed by pedometer in patients under home oxygen therapy]

Most of the patients under home oxygen therapy (HOT-patient) tend to stay inside because of their poor cardiopulmonary function, change of the physical and the cosmetic appearances brought about by oxygen supply apparatuses and weakening of the muscle power. Daily decrease in the physical activities possibly causes sleeplessness, further reduction of the cardiopulmonary function and depressive feeling. In order to solve these interrelating problems, it is necessary to help HOT-patients go out of home and gain some social roles. In this regard, elevation of the physical activities of patients themselves and family supports to encourage them are important. The present study was performed to elucidate the relation between daily physical activities as measured by a pedometer and family function and psychosocial factors including depressive state and emotional supports. The depressive state was assessed using Center for Epidemiologic Studies Depression Scale (CES-D) and the family function was measured by Family APGAR score. Pedometer score was recorded everyday for a month and the values were averaged. The averaged score was assumed to represent the patient's physical activity. Six-minutes walking test was done on the plain isle in hospitals. CES-D score was well correlated with pedometer score, i.e., more depressive patients had less pedometer scores. Patients with longer six-minute walking distance had more pedometer scores. Physical activity had nothing to do with Family APGAR score in this study. It was demonstrated that the physical activity was related with depressive state as well as with cardiopulmonary function assessed from six-minute walking distance. The result suggests that supports to expand the HOT-patients' territory of action may improve their depressive state and inhibit cardiopulmonary function from deteriorating.

Interaction between soluble type I receptor for bone morphogenetic protein and bone morphogenetic protein-4

Bone morphogenetic proteins (BMPs) are multifunctional proteins that comprise the largest subfamily of the transforming growth factor-beta. These proteins bind to types I and II serine/threonine kinase receptors. Ligand-induced heteromeric dimerization of these receptors is the key event in initiation of biological responses. We report here large-scale expression and purification of extracellular domain of the type I receptor for BMP-2/4, using a silkworm expression system. This soluble form of BMP receptor (sBMPR) was in monomer form in solution and bound to BMP-4 but not to activin or transforming growth factor-beta1. Surface plasmon resonance studies showed that kinetic parameters of sBMPR for BMP-4 consisted of a relatively rapid association rate constant (ka = 3.81 +/- 0.19 x 10(4) s-1 M-1) and an extremely slow dissociation rate constant (kd = 3.69 +/- 0.26 x 10(-4) s-1). From these two kinetic parameters, affinity was determined to be similar to that of the intact membrane-associated receptor expressed on COS cells. sBMPR inhibited the alkaline phosphatase activity in BMP responsive cell lines such as mouse osteoblastic cell MC3T3-E1 and bone marrow stromal cell ST2. These data indicate that the extracellular domain of type I receptor for BMP-2 and BMP-4 is sufficient for high-affinity binding to its ligands and should prove useful in understanding the role of BMP-2/4 in vivo, because a suitable high-affinity anti-BMP antibody has yet to be developed.

Hot-knife dissection of the latissimus dorsi muscle for dynamic cardiomyoplasty

The overall purpose of circulatory assistance utilizing skeletal muscle is the most efficient application of muscle power. From the histological viewpoint, hot-knife dissection of the latissimus dorsi muscle (LDM) is presented to preserve muscle tissue. The shaw hemostatic scalpel could be used similarly to standard surgical blades, and its hemostatic performance was efficient in sealing collateral vessels from the thoracic wall. Muscular and nervous twitching was never observed throughout dissecting the LDM. Histological findings revealed that muscle fibers could be preserved by hot-knife dissection rather than by electrocautery. This technique may reduce the inconvenience of the operators, and, therefore, shorten the operation time in dynamic cardiomyoplasty and other experiments.

A case of malignant Triton tumor of the lung

The present paper reports a 28-year-old male with an asymptomaticmalignant Triton tumor of the lung. Chest radiographs revealed a mass in the left hilum. The left lower lobe including the tumor and the mediastinal lymph node was resected. There was no metastasis or tumor recurrence during the one-year period following the surgical procedure. To our knowledge, this is the first case report of a primary pulmonary malignant Triton tumor.

[The relationship between hemorrhagic gastric ulcers often appearing among in the great Hanshin-Awaji earthquake sufferers and Helicobacter pylori infections]

Hemorrhagic gastric ulcer were often found in the population who suffered from the Great Hanshin-Awaji earthquake. Gastric biopsy samples taken from 136 patients in the population were examined for Helicobacter pylori by culture and PCR methods. Furthermore, production of CagA protein from isolates was investigated. Number of positive cases with culture and PCR method were 20 (50.0%) and 26 (65.0%) in hemorrhagic ulcer, 62 (86.1%) and 65 (90.3%) in other ulcers, respectively. Number of CagA positive strains from the patients of the hemorrhagic ulcer and other ulcers were 20 (76.9%) and 21 (32.3%), respectively. The significance in both ulcers was observed (p < 0.001). From the present results, it was considered that the stress of the earthquake, the infection of H. pylori and the production of CagA protein of the organism were combined and this caused hemorrhagic gastric ulcers.

Characteristic properties of a retinoic acid synthetic cytochrome P-450 purified from liver microsomes of 3-methylcholanthrene-induced rats

An inducible cytochrome P-450 (P-450) catalyzing retinoic acid synthesis was purified from liver microsomes of 3-methylcholanthrene (3-MC)-treated rats, based on the activity of all-trans-retinoic acid formation from all-trans-retinal. We previously reported that the retinoic acid synthesis by microsomes was catalyzed by a cytochrome P-450-linked monooxygenase system (Tomita et al. (1993) Int. J. Biochem. 25, 1775-1784). This microsomal retinoic acid synthesis in rat liver was induced more than 8-fold by 3-MC. The purified P-450 electophoretically gave a single protein band and its minimum molecular weight was estimated to be 57.2 kDa on SDS-PAGE. The optical spectrum of the oxidized P-450 without retinal revealed it was the low-spin form, and the CO-complex exhibited a maximum peak at 447 nm. The specific activity of the reconstituted P-450-linked monooxygenase system was 29.5 nmol/min per nmol P-450 at pH 7.6 and 37 degrees C. The K(m) and Vmax values for all-trans-retinal were 11.6 microM and 38.5 nmol/min per nmol P-450, respectively. The amino-acid sequence of the N-terminal region of the P-450 was identical to that of rat P-450 1A1 (CYP 1A1). Xenobiotic activities, such as 7-ethoxycoumarin O-deethylase (7-ECOD) and 7-ethoxyresorufin O-deethylase (7-EROD) activities, of the P-450-linked monooxygenase system were specific to the P-450 1A1. The retinoic acid formation in the reconstituted monooxygenase system was specifically inhibited by alpha-naphthoflavone (alpha-NF), which is a P-450 1A1-specific inhibitor, citral, which is a retinoid analogue structurally, and an anti-rat P-450 1A1 antibody. These results further support that the purified P-450 is P-450 1A1. This paper describes that P-450 1A1 was purified and characterized as a retinoic acid synthetic P-450.

Sustained transgene expression by transfection of renin gene into liver of neonates

Although transfection of renin gene into adult liver resulted in increased blood pressure (BP) for 1 week, sustained transgene expression must be considered to produce a continuous hypertensive animal. We hypothesized that gene transfer into neonatal rats would result in long-term transgene expression, given with highly replicating hepatocytes in neonates. Initially, chloramphenicol acetyltransferase (CAT) vector was transfected into the liver of 1-day-old rats. Immunohistochemical staining showed positive staining of CAT throughout the liver. Therefore, we transfected renin vector to study biological effects. At 2, but not 4 and 8, weeks, a significant increase in plasma angiotensin II concentration was observed in rats transfected with renin vector. Expression of renin mRNA in the liver transfected with renin vector could be detected at least up to 6 weeks, while no significant changes in BP were observed. These results demonstrated that in vivo gene transfer into the neonatal liver resulted in sustained transgene expression, suggesting the potential use of in vivo gene transfer as a tool to produce a novel model.

[Surgery for acute type A aortic dissection associated with Marfan syndrome]

Recently, extended operation has been recommended for aortic dissection associated with Marfan syndrome. However, the operation for acute type A aortic dissection associated with Marfan syndrome is controversial. Between May 1985 and July 1994, 5 patients associated with acute type A aortic dissection and Marfan syndrome underwent surgical repair. CT examination on all patients, the survivors of the initial operation, revealed a gradually enlarged residual pseudolumen. 2 patients who underwent aortic root reconstruction and ascending aortic replacement for the initial operation eventually had to undergo aortic arch repair. From the results of this study and the improvements of intraoperative cerebral protection, we recommend aortic arch repair with aortic root reconstruction and ascending aortic replacement on initial emergency operation for acute type A aortic dissection associated with Marfan syndrome.

Bone loss of the radius in rheumatoid arthritis. Comparison between 34 patients and 40 controls

We measured bone mineral density (BMD) in the radius by dual energy X-ray absorptiometry in 34 patients with rheumatoid arthritis (RA) and in 40 healthy controls. The BMD in RA patients in their fifties and sixties, but not in their forties and seventies, was significantly lower than that in the control subjects. The decrease in total radial BMD correlated with grip strength, RA activity and RA stage. The decrease in distal radial BMD correlated with RA activity, but not with grip strength. The levels of serum parathyroid hormone, alkaline phosphatase, and urinary hydroxyproline/creatinine were significantly higher in the patients. From these findings, we suggest that the bone loss in RA patients is affected by severity of inflammation, disuse, postmenopausal osteoporosis and secondary hyperparathyroidism.

[Surgical results of elderly patients with valvular heart disease in acute surgical stage and late follow-up]

Surgical and late follow-up results were compared between 40 elderly patients over 70-years-old (group I) and 43 patients aged from 65 to 69-years-old (group II) with acquired valvular heart disease. There was one hospital death in group I, and two hospital deaths in group II. There was no difference between group I and group II in the rate of hospital mortality of the occurrence of the surgical complications. Postoperative respiratory failure did not occur even in the elderly patients with preoperatively impaired vital capacity (%VC below 60%). Postoperative cardiac function after aortic valve replacement for aortic stenosis in elderly patients more significantly improved in comparison with preoperative function. Survival rate was 62% in group I and 78% in group II from actual survival curve at 9 year after surgery by Kaplan-Meier method. Late survival rate and cardiac event free rate were not significantly different between group I and II. Surgical results in elderly patients with valvular heart disease were satisfactory.

Pituitary apoplexy after subtotal thyroidectomy in an acromegalic patient with a large goiter

A case of pituitary apoplexy occurring after subtotal thyroidectomy in an acromegalic woman with a large adenomatous goiter is described. The patient had severe apnea because the large goiter was causing airway compression. Prior to the planned hypophysectomy, a subtotal thyroidectomy was performed to relieve tracheal stenosis. Shortly after the operation, the patient developed a headache that lasted for several days. The serum levels of growth hormone and somatomedin-C spontaneously normalized seventeen days after this episode and have remained normal for two years. Pituitary apoplexy was thought to have caused the observed results without deterioration of the pituitary function.

In vivo gene transfer of insulin gene into neonatal rats by the HVJ-liposome method resulted in sustained transgene expression

In Many areas of disease such as homozygous familial hypercholesterolemia, no known effective therapy exists. The time is ripe for the introduction of gene therapy for the management of incurable disorders. However, for clinical gene therapy it is necessary to establish an efficient and non toxic gene delivery system. Recently, we have developed a gene delivery system mediated by Sendai virus as a potential means of gene therapy. However, this HVJ-liposome method has some disadvantages: (1) transient transgene expression; and (2) no integration. In gene therapy, it is desirable for transgenes to be expressed for as long as possible. To deal with this issue, we hypothesized that gene transfer into newborn animals would result in sustained expression of transgene. Our results demonstrated that transgene expression in liver was subsequently sustained for at least up to 8 weeks, as detected by reverse transcriptase PCR and radioimmunoassay, while our previous studies documented that transgene expression in adult animals disappeared within 2 weeks. Interestingly, we detected the presence of transgene in the host genomic DNA extracted from the nuclei of hepatic cells assessed by PCR. These findings provide new important information for gene therapy, although the mechanisms of sustained transgene expression are not clear.

[Usefulness of neoadjuvant brachytherapy in the treatment of pineoblastoma: a case report]

The treatment strategy and prognosis of pineal cell tumors are still subjects of debate because of their rarity and the mixture of pineoblastoma and pineocytoma as components. Pineoblastoma is believed to be the more malignant tumor and total gross resection of this tumor is very difficult because of its invasive tendency and location. Although the effectiveness of external irradiation and chemotherapy has been reported, the outlook for patients with this tumor is extremely poor. We treated a case of pineoblastoma with a single total resection nine months after interstitial irradiation and chemotherapy. In this case, brachytherapy was successful as neoadjuvant therapy for decreasing the tumor's volume and clarifying its boundary. The patient was a 36-year-old woman who had complained of occipital headache for about a month. On admission, neurological examination revealed bilateral papilloedema but, otherwise, there were no deficits. A magnetic resonance image (MRI) showed a homogeneously enhanced tumor in the pineal region and obstructive hydrocephalus. Two weeks after ventriculo-peritoneal shunting, a stereotactic needle biopsy was performed using a BRW MRI-guided stereotactic apparatus, and three catheters for interstitial brachytherapy were implanted into the tumor through the biopsy tract. Iridium-192 seeds were inserted through the catheters and kept there for 8 days to irradiate 40 Gy at the tumor periphery. Four courses of chemotherapy with carboplatin (400 mg/m2) and VP-16 (400 mg/m2) were administered after brachytherapy. Repeat MRI scans every month showed a gradual regression of tumor volume. However, the tumor did not disappear and no further decrease in tumor volume was observed 8 months after brachytherapy. A suboccipital craniotomy was performed 9 months after brachytherapy and en bloc tumor resection was achieved readily via an infratentorial supracerebellar approach. After receiving another course of chemotherapy and external irradiation at 40 Gy, the patient was discharged without any symptoms and no residual tumor or recurrence was observed for 24 months after brachytherapy and 15 months after surgery. The clinical course of this case suggests that a combination of stereotactic biopsy and brachytherapy with chemotherapy followed by surgery may be a good strategy for the treatment of pineal cell tumors regardless of their histopathological features.

Increased mast cell infiltration in varicose veins of the lower limbs: a possible role in the development of varices

BACKGROUND

This study shows increased infiltration of mast cells in the walls of varicose veins in the lower limbs as an explanation of the pathogenesis of varix formation.

METHODS

Great saphenous veins exhibiting varicosity were histologically examined after vein stripping surgery, and the numbers of mast cells in the varicose lesions were estimated in 20 high-power fields (x400). Normal-looking regions of the veins were referred to as controls, and normal saphenous veins were prepared during coronary artery bypass grafting and designated baseline controls.

RESULTS

The varicose lesions showed a greater extent of mast cell infiltration (15.0 +/- 8.4 cells; mean +/- standard deviation), whereas control veins (5.9 +/- 4.0) and baseline control veins (4.4 +/-2.9) had a smaller number of mast cells.

CONCLUSIONS

The study suggests that increased mast cell infiltration contributes to the development of varicose veins.

[Mitral valve repair by the sliding leaflet technique employed for a broad prolapse in the posterior leaflet: a case report]

We report a case of a broad prolapse in the posterior leaflet successfully treated by a mitral valve repair by the sliding leaflet technique. The mitral valve regurgitation was caused by a rupture and elongation in the chordae supporting the middle scallop. First 3 cm of the leaflet was quadrangularly resected, then the posterior leaflet was detached from the annulus. Suture annuloplasty of that portion was performed and then the posterior leaflet was reattached to the annulus. Finally a Carpentier-Edwards annuloplasty ring was sutured in position. A postoperative study revealed no regurgitation. The sliding leaflet technique seemed to be effective to reduce tension in the isovolumic stress area caused by covering the broad gap left by the resected leaflet. When mitral valve repair by the sliding leaflet technique is performed, we recommend the use of an annuloplasty ring to decrease the stress on the suture line, to remodel the annular configuration and to prevent annular dilatation.

A novel mutation in the cytochrome P450(27) (CYP27) gene caused cerebrotendinous xanthomatosis in a Japanese family

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid storage disease caused by mutations in the cytochrome P450(27) (CYP27) gene. This disease is characterized by the accumulation of a bile alcohol, cholestanol, in diverse tissues. Accumulation in the central nervous system leads to neurological dysfunction including dementia, spinal cord paresis, and cerebellar ataxia. Accumulation in other tissues causes tendon xanthomas, premature atherosclerosis, and cataracts. In a Japanese family with CTX, we identified two points mutations in the CYP27 gene at different sites. One is a novel transversion, which substitutes G for C at Pro 368 (CCC) to Arg (CGC). The other is a transition, which substitutes A for G at Arg441 (CGG) to Gln (CAG), this being the same mutation that Kim et al. reported (1994. J. Lipid Res. 35: 1031 - 1039). Allele-specific polymerase chain reaction analysis indicated that the father and mother of this family, who themselves had no clinical manifestations of CTX, had the former and latter mutations heterozygously, respectively. On the other hand, the patients each had both mutations heterozygously. These results are highly suggestive, but not conclusive, that the newly identified transversion in the CYP27 gene accounts for the sterol 27-hydroxylase (EC 1.14.13.15) deficiency in these patients.

[Familial cancer and oncogenic factors]

The recent remarkable progress in molecular biology has revealed that various kinds of genetic alteration occur in cancers. Recently, many genes that cause hereditary cancer have been identified. For example, hMSH2 and hMLH1, which are known as DNA mismatch repair genes have been found to cause HNPCC (hereditary non-poliposis colorectal cancer). Mutation of RET oncogene has been recognized in the families of MEN (multiple endocrine neoplasia) type II. Mutations of the tumor suppressor genes are the most common changes in the genes of familial cancer. BRCA1 and BRCA2 are tumor suppressor genes that have recently been identified as familial breast and ovarian cancer, familial breast cancer genes. This paper reviewed the hereditary cancer families in which genetic alterations have been revealed and the recent progress in mapping and cloning of familial breast cancer candidate genes which have not been identified.

Influence of head model in biomagnetic source localization

We evaluated the influence of the head model on biomagnetic source localization by utilizing a computer simulation. We localized the source of a magnetic field that was calculated using a realistic head model, and then evaluated the localization errors. It was seen that the sphere model adequately localized the dipole in cases near the sensor, but not in cases where the dipole was deeply situated.

[A case report of mitral valve plasty for traumatic mitral regurgitation]

A 64-year-old man was admitted to our hospital with a chief complaint of general fatigue on June 24, 1993. He had no history of rheumatic fever but bruised in the chest in September 1990. After that, his systolic murmur was noticed at the apex and echocardiogram showed the posterior chordal rupture of mitral valve. Mitral valve plasty was performed successfully.

Importance of preserving the mitral subvalvular apparatus in mitral valve replacement

BACKGROUND

This clinical study sought to determine whether mitral valve replacement (MVR) with the preservation of both anterior and posterior chordae tendineae (MVR group II) would be more effective on the improvement of left ventricular regional wall motion than MVR with the preservation of posterior chordae tendineae alone (MVR group I).

METHODS

Postoperative left ventricular wall motion was analyzed by a centerline method in three groups of MVR--group I (n = 13), group II (n = 15), and repair group (n = 15)--for mitral regurgitation. Shortening fraction of chordal length was determined in 100 chords, and these chords were divided into five regions.

RESULTS

The comparison of postoperative versus preoperative shortening fraction among the three groups revealed that postoperative wall motion improved more strikingly at apical and diaphragmatic regions in the MVR group II and repair group in comparison to the MVR group I. The postoperative shortening fraction at the apical region in the MVR group II was significantly increased in comparison to preoperative shortening fraction (preoperative, 3.68% +/- 1.87%; postoperative, 5.38% +/- 2.33%; p < 0.05). However, postoperative shortening fraction in cardiac base was decreased in the MVR group II as well as other two groups.

CONCLUSIONS

The MVR with the preservation of both anterior and posterior chordae tendineae contributed to the improvement of left ventricular regional wall motion in the apical and diaphragmatic regions.

[Reversal of portal-systemic encephalopathy by shunt-preserving disconnection of portal and systemic circulation]

Obliteration of portal-systemic shunts surgically or by interventional radiological techniques is fairly effective in reversing intractable portal-systemic encephalopathy (PSE), but is often associated with ascites accumulation and/or formation of esophageal varices. This study reports four patients with incapacitating PSE who were treated by interventional radiological techniques via percutaneous transhepatic route. One case had the shunt embolized directly. In the other three the blockage was placed on the proximal part of the splenic vein, whereby disconnecting the mesenteric-portal blood flow from the systemic circulation while preserving the shunt. The patient of shunt closure showed transient correction of encephalopathy, but developed massive ascites and esophageal varices, encephalopathy recurred, resulting in death from hepatic failure two months after the procedure. In the cases of shunt-preserving disconnection of portal and systemic circulation (SPDPS) immediate and permanent clearing of encephalopathy was achieved without manifestation of ascites or esophageal varices during the follow-up period of 10 to 31 months. The difference of portal pressure between before and after the procedure was 18 mmHg in the shunt-closed patient and 3 mmHg in SPDPS group. We conclude from this limited experience that SPDPS can be an effective and safe method in treating PSE in adequately selected patients.

Molecular cloning of an ecdysone receptor (B1 isoform) homologue from the silkworm, Bombyx mori, and its mRNA expression during wing disc development

We reported the isolation and sequence of a clone encoding a putative ecdysone receptor B1 isoform of the silkworm, Bombyx mori. The predicted open reading frame encoded 543 amino acids, with 51%, 95% and 71% identities with the Drosophila melanogaster ecdysone receptor B1 isoform in the N terminal A/B region, DNA binding domain (C region) and ligand binding domain (E region), respectively. A single 6.2 kb message for the EcR gene was abundant in wing discs and fat bodies at the onset of metamorphosis. At the same stage, however, no or a tiny amount of mRNA was shown in posterior or middle silk glands, respectively. During the final instar, the mRNA expression in wing discs was maximal on the day of wandering. These data suggest the transcription of the Bombyx EcR gene is regulated in tissue-specific and stage-specific manner during metamorphosis.

A case of Trichuris trichiura infection diagnosed by colonoscopy

A 65-year-old Japanese female was admitted to our hospital because of right lower abdominal pain. Laboratory and roentgenological tests revealed no abnormalities. Repeated stool examinations revealed no ovum or parasite. However, colonoscopic examination demonstrated the presence of a parasite on the edematous mucosa of cecum. The adult male whipworm (Trichuris trichiura) was then removed endoscopically. Her symptoms disappeared quickly, and no additional parasite was found in the feces during or after the mebendazole treatment. Repeated stool examinations failed to show any ova, because this patient was infected by a single male parasite. Colonoscopic study should be considered a useful tool for the diagnosis of T. trichiura infection, even if no ovum is found in stool examination.

[The study of the relationship between serum eosinophil cationic protein and bronchial responsiveness in the patients with bronchial asthma]

Eosinophil cationic protein (ECP) has been expected as an index of eosinophilic inflammation in bronchial asthma. However, there are many questions about the clinical meaning of the serum ECP, yet. To examine that problem, we measured serum ECP levels in healthy subjects and the asthmatics patients, with and without attack. We also studied the relationship between bronchial responsiveness and serum ECP levels in the asthmatics patients without attack. Patients taking any steroids (including inhaled steroid), anti-allergic agents or cigarettes were excluded. The highest levels of ECP were found in serum sampled from the patients with asthma attack. The levels of the patients without attack were lower, and the levels of the healthy subjects were the lowest of all. To study the relationship between serum ECP and bronchial responsiveness in the asthmatics patients, who had not an asthma attack for at least one week, serum was sampled and simultaneously bronchial responsiveness (Dmin) was measured by Astograph. The serum ECP levels correlated negatively with Dmin, a threshold-type index of bronchial responsiveness (r = -0.569, p < 0.01). These data indicate that between attacks of bronchial asthma, bronchial responsiveness is related to the levels of serum ECP, and that during attacks the level of serum ECP increases further. They also suggest that abnormally high levels of serum ECP are associated with a preattack state in patients with bronchial asthma.

Effect of angiotensinogen on blood pressure regulation in normotensive rats: application of a loss of function approach

OBJECTIVE

To investigate the effect of plasma angiotensinogen on blood pressure regulation in normotensive rats, by a loss of function approach using antisense oligonucleotides.

DESIGN AND METHODS

Eight-week-old male Wistar rats were transfected with antisense, sense or scrambled oligonucleotides using liposomes containing viral agglutinins, which are reported to be highly efficient in promoting fusion with target cells. The abdomen was opened with a median incision, and the liver and portal vein were exposed. Then 2.5 ml of hemagglutinating virus-liposome complex containing oligonucleotides was introduced into the liver by multiple direct injections or infusion via the portal vein. Blood pressure, plasma angiotensinogen and angiotensin II levels were measured after transfection. The hepatic angiotensinogen level was examined by Northern blotting and radioimmunoassay.

RESULTS

The in vivo injection of antisense oligonucleotides against rat angiotensinogen by the hemagglutinating virus-liposome gene transfer method into normotensive rats resulted in a transient fall in blood pressure from day 1 to day 4 after injection. This was accompanied by a decrease in plasma angiotensinogen and hepatic angiotensinogen messenger RNA levels on day 2. No significant changes were noted in untreated rats or those treated with sense or scrambled oligonucleotides. Plasma angiotensin II concentration was also reduced by antisense treatment, but not sense or scrambled treatment.

CONCLUSIONS

In vivo administration of antisense angiotensinogen oligonucleotides resulted in a transient decrease in blood pressure accompanied by a decrease in plasma angiotensinogen and angiotensin II levels, which suggests that angiotensinogen plays a pivotal role in the regulation of blood pressure in normotensive rats.

[Surgical treatment for Stanford type A acute aortic dissection]

From March 1983 to September 1994, 53 consecutive patients underwent an emergency operation for type A acute aortic dissection. Eighteen patients before 1988 (Group I) underwent simple ascending aortic replacement (n = 13) and composite graft replacement (n = 5) by conventional method. Thirty-five patients after 1989 (Group II) underwent extended ascending aortic replacement (n = 17), hemiarch replacement (n = 6), total arch replacement (n = 8) and composite graft replacement (n = 4) using a brief period of circulatory arrest. The overall hospital mortality rate was 36.8% in Group I and 25.7% in Group II. The survivals after initial operation was 47% at 10 years (Kaplan-Meier) and the event free rate was 78% at ten years, respectively. Computed tomographic scanning and aortogram demonstrated the patent false lumen in 20 patients (64.5%) at the descending thoracic aorta. In conclusion, extended ascending aortic replacement is the useful operative technique to perform accurate resection of intimal disruption and clamp-site aorta because the replacement of the entry site could reduce the risk of operative mortality and reoperation. Total arch replacement is not necessarily required, if the entry is properly resected by extended ascending aortic replacement or hemiarch replacement. Close follow-up must be considered at the patients with patent false lumen, especially in patient with Marfan's syndrome.

[The use of twist drill craniostomy in stereotactic surgery for brain tumors]

A twist drill craniostomy is a rapid and relatively simple technique for perforating the skull in order to gain access to the epidural and subdural spaces and the brain. Fifty-eight patients underwent 173 twist drill craniostomies in the stereotactic procedures for the diagnosis and the treatment of brain tumors (brain tumor biopsy, implanting radioactive sources and placement of the catheters for navigation surgery) from September, 1992, through to May, 1995, at our institute. The technique was compared with standard burr hole craniostomy used in 42 patients with brain tumor. In the twist drill craniostomy, the scalp was penetrated directly by hand twist drill (2.7 mm in diameter) and scalp bleeding was able to be be controlled by injecting local anesthetic with epinephrine subcutaneously. The safety stop on the drill was set in advance based on the expected thickness of the skull at its penetration point to provide control of penetration depth as it passed through the skull hole and dura. A hole in the skull was made as the drill was advanced until a change in resistance indicated that the inner table of the skull had been penetrated and the dura lacerated. The cannula with stylet was then inserted through the guide tube to assure the penetration of the skull and dura. As the cannula penetrated the dura, a loss of resistance was noted as it proceeded through the dura toward the pial surface, The time needed in this procedure was less than 3 minutes. Associated with this procedure, there were no complications such as bleeding, or infection in 173 twist drill craniostomies in the 58 patients. Our experience with this procedure proved it to be simple, efficient, safe and superior to conventional burr hole craniostomy.

Electron paramagnetic resonance investigation of cytochrome P-450c21 from bovine adrenocortical microsomes: a new enzymatic activity

Cytochrome P-450c21 (CYP21A1) purified from bovine adrenocortical microsomes was investigated by electron paramagnetic resonance (EPR) spectroscopy to clarify the interactions among heme active center, protein surroundings, water molecules and bound substrates or analogues. The low-spin EPR signals of the oxidized enzyme (as purified) consisted of two species; one at gz = 2.39, gy = 2.23, and gx = 1.925 (component A) and the other at gz = 2.42, gy = 2.23, and gx = 1.916 (component B). The component A is probably representing a product-bound form, whereas the component B indicates either occupation of the substrate-binding site with a substrate analogue or absence of steroid at the site. Upon addition of progesterone, the component A signal completely disappeared and the intensity of high-spin signal (g = 8.06, 3.54) increased. Addition of 17 alpha-hydroxyprogesterone caused a development of a new low-spin signal at gz = 2.42, gy = 2.21, and gx = 1.966 (component C) and a further increase in intensity of the high-spin signal (g = 8.06, 3.54). Addition of 20 beta-hydroxyprogesterone caused an increase in intensity of the component C signal (and the g = 8 high-spin signal) even stronger than did 17 alpha-hydroxyprogesterone. These observations suggest that 20 beta-hydroxyprogesterone binds to the cytochrome P-450c21 active center in a very similar manner as 17 alpha-hydroxyprogesterone does and, therefore, may be a metabolizable substrate. A new enzymatic pathway catalyzed by cytochrome P-450c21 was confirmed with a reconstituted enzymatic system consisting of cytochrome P-450c21, NADPH-cytochrome P-450 reductase and an NADPH-generating system. 20 beta-Hydroxyprogesterone was converted to progesterone via a putative 20 beta-oxidase reaction in a comparable turnover number to that of the 21-hydroxylation of 17 alpha-hydroxyprogesterone.

[Image guided stereotactic biopsy for brain tumors: experience of 71 cases]

Despite advances in the neuroimaging of the brain, an accurate diagnosis of intrinsic lesion of the brain requires tissue sampling and histological verification. Seventy-one patients with intraparenchymal lesion of the brain underwent CT or MRI-directed stereotactic biopsy at Okayama University Hospital between June, 1987 and March, 1995. There were 32 men and 39 women whose ages ranged between 7 and 78 years (mean 46.1 years). All patients underwent preoperative cerebral angiography, high resolution contrast enhanced CT and MRI. The lesions were located in the hemisphere in 40 cases, the thalamus or basal ganglia in 14, the midline (corpus callosum or ventricle) in 11, the pineal region in 4, the suprasellar in one and multiple sites in one. A Brown-Roberts-Wells (BRW) CT-directed stereotactic system was used for biopsy under CT guidance. For MRI-directed biopsies a prototype modification of the BRW frame was employed. Target localization was performed using either CT or MRI. Usually one or two targets within the lesion were chosen and target coordinates were calculated using the CT or MRI scan soft ware. Positive diagnosis was obtained in 67 cases and the accuracy of the histological diagnosis was 94.4%. There were 53 gliomas, 4 metastasis, 5 germinomas, 3 malignant lymphomas, one pineoblastoma, one infarction and 4 negative biopsies. Bleeding as a complication due to stereotactic intervention occurred in one patient (1.4%). To patients with potentially inoperable lesions or lesions which might be best treated by chemotherapy or irradiation, modern techniques of neurosurgery now offer the option of precise stereotactic biopsy through small twist-drill burr holes as opposed to open biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetazolamide-induced inhibition of carbonic anhydrase influences energy metabolism and respiratory work in healthy subjects

To assess the usefulness of acetazolamide in weaning a patient from a respirator, we monitored the changes in the respiratory quotient ratio (RQ ratio), the ventilation volume (VE; l/min.), carbon dioxide elimination (VCO2; ml/min.), the oxygen consumption (VO2; ml/min.) and the metabolic energy expenditure (EE; Cal/day) for 6 hours before (baseline) and after the intravenous administration of acetazolamide, 6 mg/kg, in 12 healthy adult volunteers. The RQ ratio decreased significantly from 0.88 to 0.82 after the injection of acetazolamide, 6 mg/kg, and remained below baseline throughout the 6 hours of observation. VCO2 decreased significantly and VE increased significantly after acetazolamide administration. There were no significant changes in VO2 or EE. The RQ ratio increased only slightly, from 0.85 to 0.87, in the control group (no acetazolamide). No significant changes in VCO2 or VE were observed in the control group. Findings suggest that acetazolamide may alter the main pathway of energy metabolism from being carbohydrate-dominant to being fat-dominant, with a resulting fall in CO2 production to maintain the adequate work of ventilation. The inhibition of carbonic anhydrase by acetazolamide may be useful in reducing respiratory work in a patient who is weaned from a respirator.

Effect of an antihypertensive drug on brain angiotensin II levels in renal and spontaneously hypertensive rats

1. Although numerous studies suggest that brain angiotensin (AII) may play an important role in the regulation of blood pressure, it is still unclear what factors may influence brain AII. In this study, we hypothesized that brain AII is influenced by circulating factors. To investigate the role of blood pressure and plasma AII in brain AII level, we studied the effect of an antihypertensive drug on brain AII in two-kidney, one-clip (2K1C) and spontaneously hypertensive (SHR) rats. 2. Hydralazine (20 mg/kg per day) and vehicle (water) were given to 2K1C rats between 2 and 6 weeks after operation and SHR for 4 weeks. In addition, vehicle was applied to sham operated rats and Wistar-Kyoto (WKY) rats. Brain and plasma AII was measured by a highly sensitive radioimmunoassay coupled with high performance liquid chromatography. 3. Hydralazine treatment effectively lowered blood pressure to the same level of sham-operated and WKY rats. 2K1C rats showed significantly higher plasma AII than sham rats, but hydralazine treatment did not show any change in plasma AII. Brain AII in the hypothalamus region of 2K1C rats showed a significantly higher level than sham rats. Interestingly, hydralazine treatment diminished this increase in brain AII. In contrast, SHR showed higher brain AII levels in the hypothalamus, brainstem and cerebellum than in WKY rats, whereas there was no significant change in plasma AII concentration between SHR and WKY rats. In contrast to the results found in 2K1C rat experiments, hydralazine treatment failed to decrease brain AII levels despite lowered blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical study on the ideal temperature of blood cardioplegic solution in coronary artery bypass graft surgery]

The effect of myocardial protection in coronary artery bypass graft surgery was evaluated from enzymatic examination and cardiac function to clarify the ideal temperature of blood cardioplegic perfusate (BCP). The surgical cases were divided into two groups from the temperature of BCP; 8 degrees C BCP in 64 cases (Group I) and 20 degrees C BCP in 64 cases (Group II). Peak total creatine-Kinase (CK) and CK-MB fraction were significantly elevated in Group I than in Group II. The value of CK-MB was 79 +/- 79 IU/L in Group I and 37 +/- 26 IU/L in Group II (p < 0.01). The parameters of cardiac function were measured from radio-isotope (RI) ventriculography in the 35 cases with depressed ejection fraction and elevated left ventricular end-diastolic pressure (17 cases in Group I and 18 cases in Group II). Postoperative parameters such as ejection fraction, first third ejection fraction, peak ejection rate and early diastolic peak filling rate improved more significantly than preoperative values in Group II, although these parameters did not improve in Group I. From these results, 20 degrees C BCP provided excellent myocardial protection to arrested heart during coronary artery bypass surgery probably because of decreased viscosity of BCP and adequate oxygen carrying capacity to myocardium.

Meningiomas arising from the falcotentorial junction. Clinical features, neuroimaging studies, and surgical treatment

Meningiomas arising from the falcotentorial junction are extremely rare. The authors describe the clinical features, neuroimaging studies, and results of surgical treatment of meningiomas of the falcotentorial junction and clarify the characteristics of this lesion based on a review of the literature and seven patients treated at their institution. The most common symptoms resulted from intracranial hypertension. Upward-gaze palsy appeared in only one patient. Computerized tomography (CT) showed no specific findings, but there was no evidence of edema around the tumor. Magnetic resonance (MR) imaging revealed a round, smooth-bordered mass with a peritumoral rim, without edema, and showing marked contrast enhancement. The multiplanar capability of MR imaging delineated the relationship between the tumor and adjacent structures better than did CT. Detailed knowledge of the vascular structures, especially evidence of occlusion of the galenic venous system and the development of collateral venous channels, is critical for successful surgery; stereoscopic cerebral angiography is necessary to achieve this aim. The seven patients described developed five types of collateral venous channels: through the basal vein of Rosenthal to the petrosal vein, through the veins on the medial surface of the parietal and occipital lobes to the superior sagittal sinus, through superficial anastomotic veins, through veins of the posterior fossa to the transverse or straight sinus, and through the falcian veins to the superior sagittal sinus. The first three types mainly developed after occlusion of the galenic system. The tumors were removed through the occipital transtentorial approach with a large window at the posterior part of the falx. A favorable prognosis for patients undergoing surgical treatment of falcotentorial junction meningiomas can be expected if detailed neuroimaging studies and microsurgical techniques are used.

Pineal region tumours treated with interstitial brachytherapy with low activity sources (192-iridium)

Three patients with tumours of the pineal region underwent interstitial Ir-192 brachytherapy. Histological diagnoses were obtained in all patients, by stereotactic biopsy and included one germinoma, one mixed pineoblastoma/pineocytoma, and one astrocytoma grade III. Our approach to pineal region neoplasms is first to decide whether stereotactic biopsy or surgery should be performed. When a pineal lesion is thought to be benign on the basis of imaging, such as benign teratoma, surgery is performed to resect the entire lesion. When a definitive diagnosis is not possible, stereotactic biopsy is performed to obtain a histological diagnosis for treatment planning, using a Brown-Roberts-Wells (BRW) stereotactic apparatus with computed tomography (CT) or magnetic resonance imaging (MRI). When a lesion is malignant and localized, stereotactic implantation of catheters for interstitial brachytherapy is performed simultaneously. Radioactive Ir-192 seeds are inserted into the catheters and maintained for 5-10 days to give 36 Gy of irradiation at the tumour periphery. Sequential CT scans and MRI after treatment revealed tumour disappearance in two patients with germinoma and high grade astrocytoma and tumour reduction in the patient with mixed pineoblastoma/pineocytoma. No significant morbidity or mortality occurred in any of these patients after stereotactic biopsy and brachytherapy. The technique and the advantages of this therapeutic approach to selected pineal region tumours are described and discussed.

Resection of deep-seated gliomas using neuroimaging for stereotactic placement of guidance catheters

A simple computed tomography- (CT) or magnetic resonance (MR) imaging-guided stereotactic method for guided microsurgical resection of either deep-seated gliomas or tumors adjacent to an eloquent area is described. The technique employs the Brown-Roberts-Wells stereotactic system and twist drills, 2.7 mm in diameter, for the stereotactic placement of 2.4 mm diameter scaled guidance catheters through the calvaria. In a patient with a deep-seated small glioma, less than 2 cm diameter, one catheter was implanted into the center of the enhanced mass through the cerebral cortex. In the other 14 patients, three to six catheters were used which made the tumor border clearer. After implantation of the guidance catheters, the stereotactic frame was removed and a standard open craniotomy performed. Target localization is not affected by brain movement, which is inevitable during open surgery. The tumor involved the frontal lobe in eight patients, the parietal lobe in two, and the thalamus in five. In all cases the lesion was quickly localized and radical removal was achieved. Neurological complications occurred in only one patient who suffered transient hemiparesis after the resection of a lesion in the pyramidal tract. The results demonstrate that microsurgery combined with CT- or MR imaging-guided stereotactic placement of guidance catheters is a new option for surgery of deep-seated gliomas or tumors adjacent to an eloquent area.

Anti-neutrophil cytoplasmic antibody for proteinase 3 in a child with polyarteritis nodosa

We report a case of a 15 year old boy with polyarteritis nodosa associated with antineutrophil cytoplasmic antibody (ANCA) against proteinase 3 (PR3). After months of steroid and immunosuppressant therapy, the symptoms subsided and the polyaneurysms almost disappeared. The levels of anti-PR3 antibody and of cytokines also decreased. The results indicate that ANCA is a good indicator of this disease activity, and may play some pathogenic role in the disease.

Isolation of p10 gene from Bombyx mori nuclear polyhedrosis virus and study of its promoter activity in recombinant baculovirus vector system

A homologue of Autographa californica NPV (AcNPV) p10 gene was identified and cloned from Bombyx mori NPV (BmNPV). BmNPV p10 gene encodes truncated protein of 70 amino acid residues that lacks carboxyl terminus comparing with the p10 protein encoded by AcNPV. The putative TATA box sequence and the ATAAG motif which is the consensus sequence of baculovirus very late promoter were conserved. A transfer vector, pBNT1, which includes the p10 promoter region of BmNPV for foreign gene expression was constructed. By using pBNT1, a recombinant BmNPV, Bmp10-Luc, in which the p10 gene was replaced by the firefly luciferase gene, was obtained. We also obtained another recombinant virus, BmPH-Luc, in which the polyhedrin gene was replaced by the luciferase gene. The luciferase activity detected in BoMo-15AIIc insect cells infected with Bmp10-Luc was approximately 50% of that infected with BmPH-Luc, suggesting that although both the p10 and polyhedrin promoters of BrnNPV are effective in high-level expression of foreign genes, the p10 promoter is not so strong as the polyhedrin promoter.

Flow Cytometric Analysis to Assess the Malignant Potential of Phyllodes Tumor

To evaluate DNA content as a prognostic indicator in phyllodes tumor of the breast, flow cytometric DNA analyses were performed retrospectively in 13 patients who were selected, based on the availability of paraffin-embedded tumor specimens. ALL were women with an average age of 41.9 years and a mean follow-up of 51.2 months. Pathologically, 3 patients (23.0%) had malignant tumor and 10(77.7%) had benign lesions. The patients with malignant tumors tended to be older and had larger tumors. Aneuploidy was seen in one patient with malignant tumor (7.7%), with the S-phase fraction ranging from 0.8 to 12.6. This patient died of lung metastases 6 months after mastectomy. One benign tumor showing diploid, developed local recurrence 100 months after lumpectomy. DNA stem cell lines were not detected in the only patient with aneuploid tumor. There was no significant correlation between DNA content and local recurrence. In this series, the number of patients was too small to draw the certain conclusions from date. However, it appears that, compared to diploid tumors, aneuploid tumor are more often malignant and have poorer prognosis. Our study indicates that DNA content has little prognostic value, DNA aneuploidy appears to be associated with a poor prognosis.

Immunochemical detection of human lactoferrin in feces as a new marker for inflammatory gastrointestinal disorders and colon cancer

We have developed a new immunochemical test for fecal lactoferrin (LF) utilizing an enzyme-linked immunosorbent assay (ELISA). The ELISA had a sensitivity of about 10 micrograms/L of lactoferrin and the measurable range was 10.0-1000.0 micrograms/L (1.0-100.0 micrograms LF/g feces). The stability of lactoferrin in feces was greater than that of myeloperoxidase and leucocyte elastase. The fecal concentration of lactoferrin (mean +/- SD) in 35 normal subjects was 0.75 +/- 0.83 microgram/g feces, whereas that in 24 patients with colon cancer was 74.4 +/- 88.3 micrograms/g feces. The fecal lactoferrin concentration of 38 patient with active ulcerative colitis was 307.4 +/- 233.9 micrograms/g feces, and that in 36 patients with active Crohn's disease was 191.7 +/- 231.1 micrograms/g feces. The ELISA for human fecal lactoferrin might be useful in the diagnosis of colon disease.