[Pulmonary dirofilariasis resected by video-assisted thoracoscopy; report of a case]

A 35-year-old female was admitted for biopsy of abnormal shadow on chest X-ray. She was operated on for partial wedge resection of the right lower lobe by video-assisted thoracoscopy without complication. Pathological findings in operation showed inflammatory benign tissues and suggested pulmonary dirofilariasis. Serologic examination was negative after operation, however histological diagnosis supported pulmonary dirofilariasis because a pulmonary artery embolism of calcified tissues consisted of non-human cells. There may be many cases due to old infections like this one, so it is important to consider it for diagnosis and perform more positive surgical procedures. We review a case of pulmonary dirofilariasis safely resected by video-assisted thoracoscopy for diagnosis by exclusion.

Chronopharmacological studies of ketamine in normal and NMDA epsilon1 receptor knockout mice

BACKGROUND

The effectiveness and toxicity of many drugs depends on the dosing-time schedule, relative to the circadian rhythms of biochemical, physiological, and behavioural processes. Previous studies have found chronopharmacology of ketamine, which is a N-methyl-d-aspartate (NMDA) receptor antagonist. The in vivo contribution of the NMDA receptor epsilon1 subunit (NR2A) in this effect is unclear.

METHODS

In the present study, daily variations in the hypnotic effect of ketamine were determined in wild-type mice and NMDA epsilon1 knockout (KO) mice.

RESULTS

The effect of ketamine had a definite daily variation in wild-type mice. No significant difference in blood concentration was observed at different dosing times (10:00 and 22:00). In NMDA receptor epsilon1 KO mice, the hypnotic effect of ketamine was weaker than in wild-type mice and there was no dependence on the time of administration. Significant pharmacokinetic differences were not observed between wild-type and KO mice.

CONCLUSIONS

The enhanced hypnotic effect in the active phase of the circadian cycle is likely a result of changes with the time of day in the susceptibility of the central nervous system to ketamine. Knockout of the NMDA receptor epsilon1 subunit gene markedly reduced the effect of ketamine, and eliminated the time-dependent sensitivity to ketamine.

Protective role of vanilloid receptor type 1 in HCl-induced gastric mucosal lesions in rats

BACKGROUND

Effects of vanilloid-receptor agonists and antagonists on HCl-induced gastric lesions in rats were investigated to elucidate the role of vanilloid receptor type 1 (VR1) in gastric mucosal defense mechanisms.

METHODS

Gastric lesions in rats were evaluated after intragastric administration of 0.6 N HCl. The localization of VR1 in the stomach was investigated immunohistochemically.

RESULTS

Intragastric administration of capsaicin inhibited the formation of gastric lesions in a dose-dependent manner (0.1-2.5 mg/kg). The functional VR1 antagonists ruthenium red and capsazepine markedly aggravated HCl-induced gastric lesions in rats. The gastroprotective effect of capsaicin was attenuated by ruthenium red or capsazepine. It is reported that resiniferatoxin, [6]-gingerol and lafutidine are compounds that activate VR1 and/or capsaicin-sensitive afferent neurons. These compounds significantly inhibited the formation of HCl-induced gastric lesions, and their gastroprotective effects were inhibited by treatment with ruthenium red. The immunohistochemical studies revealed that nerve fibers expressing VR1 exist along gastric glands in the mucosa, around blood vessels in the submucosa, in the myenteric plexus, and in the smooth muscle layers, especially the circular muscle layer.

CONCLUSION

The results of this study suggest that VR1 plays a protective role in the gastric defensive mechanism in rats.

Fascicularones A and B from a mycelial culture of Naematoloma fasciculare

Two sesquiterpenoids, fascicularones A and B, have been isolated from the culture broth of a poisonous mushroom, Naematoloma fasciculare. Their structures were determined using spectroscopic methods.

Fascicularones C and D, Tricyclo[5.4.0.02.5]undecane Sesquiterpenoids from the Liquid Culture of Naematoloma fasciculare

Two novel sesquiterpenoids of tricyclo[5.4.0.02.5]undecane skeleton, fascicularones C (5) and D (6) have been isolated from liquid culture of a poisonous mushroom, Naematoloma fasciculare. Their structures were elucidated on the basis of spectroscopic methods. Compounds 5 and 6 promoted radicle elongation of lettuce seedling.

(+)-Menthol and its hydroxy derivatives, novel fungal monoterpenols from the fusicoccin-producing fungi, Phomopsis amygdali F6a and Niigata 2

In our search for new fusicoccins of unique diterpene glucosides from Phomopsis amygdali, we found that a fragrant substance was formed in the early stage of fusicoccin fermentation. This fragrant constituent was isolated and identified as (+)-menthol, which is a novel fungal metabolite as the enantiomer of well-known peppermint (-)-menthol. (+)-7-Hydroxymenthol and new (+)-(6S)-hydroxymenthol were also isolated and identified as fungal metabolites. In addition, p-menthanetriol, which has been reported as the first fungal monoterpene from the fungus, was also isolated. The possible biosynthetic relationship of these metabolites is discussed.

Inhibitory effect of propofol on ketamine-induced c-Fos expression in the rat posterior cingulate and retrosplenial cortices is mediated by GABAA receptor activation

BACKGROUND

Non-competitive N-methyl-D-aspartate (NMDA) receptor antagonists, including ketamine, have psychotomimetic activities and cause neuronal damage in the posterior cingulate and retrosplenial cortices (PC/RS), which are suggested to be the brain regions responsible for their psychotomimetic activities. We previously demonstrated that ketamine induced marked c-Fos (c-fos protein) expression in the rat PC/RS, which was inhibited by propofol, and the expression was closely related to ketamine-induced abnormal behavior. In the present study, we investigated whether the inhibition by propofol was mediated by GABAA receptor receptor activation.

METHODS

Using Wistar rats, propofol alone, propofol with bicuculline or propofol with flumazenil was injected intravenously and then continuously infused. Fifteen minutes later, 100 mg kg-1 of ketamine or normal saline was injected intraperitoneally. Two hours after the ketamine or saline injection, the brain was extracted and brain sections were prepared, and c-Fos expression was detected using immunohistochemical methods.

RESULTS

Ketamine induced marked c-Fos expression in the PC/RS (171 +/- 9/0.4 mm2), which was significantly inhibited by propofol (5 +/- 5/0.4 mm2). The inhibition by propofol was disinhibited dose-dependently by both bicuculline (0.5 and 1.0 mg kg-1 bicuculline groups: 46 +/- 15 and 143 +/- 16, respectively) and flumazenil (0.1 and 1.0 mg kg-1 flumazenil groups: 79 +/- 6 and 130 +/- 15, respectively).

CONCLUSION

These results demonstrate that the inhibitory effect of propofol on ketamine-induced c-Fos expression in the PC/RS is mediated by GABAA receptor activation, and suggests that ketamine-induced psychoneuronal adverse effects may be suppressed by propofol via the activation of GABAA receptors.

Activation of the alternative complement pathway by Agaricus blazei Murill

Components of Agaricus blazei Murill have been demonstrated to have a wide range of immunopotentiating activities. The present study was designed to evaluate the effect of A. blazei Murill upon activation of the complement system in human serum in vitro. Additional studies were performed to determine the cytotoxic effect of complement-opsonized particles of A. blazei Murill against human tumor cells in culture. A fine particle of A. blazei Murill (ABP), prepared by mechanical disruption, was used throughout the experiments. ABP activated the human complement system via the alternative pathway in human serum. Activation of the alternative pathway was both time- and dose-dependent. When the particles from fruiting bodies of A. blazei Murill (ABP-F) were reacted with human serum, the formation of complement-opsonized ABP, iC3b-ABP-F complexes, and binding of the complexes to human peripheral blood monocytes, were demonstrated in vitro by immunofluorescence. Further, the resident human peripheral nucleated cells incubated in the presence of iC3b-ABP-F complexes inhibited the proliferation of human tumor cell line TPC-1 in vitro.

Mode of inheritance of HLA-DRB1 shared epitope in Japanese familial rheumatoid arthritis

OBJECTIVE

To clarify the mode of genetic contribution of the HLA-DR shared epitope (SE) to the pathogenesis of familial cases of Japanese rheumatoid arthritis (RA).

METHODS

Fifty-three unrelated Japanese RA families that had more than 2 affected sibs were selected. The HLA-DR shared epitope typing was carried out by the PCR method and PCR-SSCP (single stranded DNA conformation polymorphism) method. Affected sib pair analysis was carried out using the MAPMAKER/SIB 2.0 program. The mode of inheritance was also calculated based on the sharing of genes identical by descent (IBD) between siblings in each of the 53 affected sib-pairs (propositus and the 2nd affected sib).

RESULTS

The maximum LOD score of HLA-DR was 0.437, and the sharing of 2 IBDs, 1 IBD, and no IBDs between affected sibs were 0.330, 0.500, and 0.170, respectively. The sharing distribution of IBD was confirmed to be compatible with the dominant or additive mode since the observed gene frequency of SE was 0.255.

CONCLUSION

The HLA-DR shared epitope participated in the pathogenesis of familial cases of Japanese RA. The SE contributes to this pathogenesis in either the dominant or additive mode of inheritance.

Effects of vanilloid receptor agonists and antagonists on gastric antral ulcers in rats

Defunctionalization of capsaicin-sensitive afferent nerves by pretreatment with a neurotoxic dose of capsaicin aggravates gastric ulcers in rats. In the present study, we investigated the roles of vanilloid receptors in gastric antral ulcers, using vanilloid receptor agonists and antagonists. Gastric antral ulcers were induced by a combination of diethyldithiocarbamate and 1 N HCl in refed rats. The administration of ruthenium red (1.5 mg/kg, s.c., twice daily) aggravated gastric antral ulcers (ulcer index: control, 33.7+/-13.7 mm(2); ruthenium red, 99.9+/-11.0 mm(2)). A similar result was observed in rats pretreated with a neurotoxic dose of capsaicin. On the other hand, capsaicin (1-10 mg/kg, p.o., twice daily) inhibited antral ulcer formation (ulcer index: control, 99.2+/-20.6 mm(2); capsaicin 10 mg/kg, 37.0+/-11.7 mm(2)). A similar effect was obtained in rats treated with the novel antiulcer drug, lafutidine (3-10 mg/kg, p.o., twice daily), which has gastroprotective activity mediated by capsaicin-sensitive afferent nerves. The antiulcer effects of capsaicin and lafutidine were abolished by ruthenium red and by pretreatment with a neurotoxic dose of capsaicin. These results suggest that vanilloid receptors play a gastroprotective role in gastric antral ulcers. In addition, treatment with ruthenium red may be an alternative tool for defunctionalization of capsaicin-sensitive afferent nerves.

[Cytopenia associated with low dose pulse methotrexate in the treatment of rheumatoid arthritis]

OBJECTIVES

To assess the associated risk factors of methotrexate (MTX)-induced cytopenia in rheumatoid arthritis (RA).

METHODS

We followed 420 patients started on MTX for RA. We evaluated the frequency and clinical significance of patients with cytopenia related to MTX therapy.

RESULTS

The prevalence of patients remaining in the follow-up in the MTX treatment was 21% at 60 months. eighty-seven patients (21%) continued treatment. The treatment termination in MTX was 28% for toxicity, 78 (19%) for no effect, 70 (17%) for relapse and 116 (28%) for toxicity and 69 (16%) for other reasons. A total of 10 patients with cytopenia related to MTX therapy were identified among them. The prevalence of cytopenia, including leukopenia (n = 6), thrombocytopenia (n = 3) and pancytopenia (n = 1), estimated to be 2.4% in MTX treated RA patients. Patients with cytopenia received 2.5-8 mg/w over a mean duration of 60.0 months (10-119 months). nine of 10 patients received NSAIDs with MTX therapy. The presence of renal abnormality (Cr > 1.2 mg/d) was in 3 cases, age over 70 years old in 4 patients, body weight under 50 kg in 8 patients, mean corpuscular volume (MCV) over 100 fl in 2 patients. High MCV value (over 94 fl) was in 7 patients, 6 of whom had some symptoms including fever (n = 3) and oral mucosa/lip abnormalities (n = 3). Low MCV value (under 84 fl) was in 3 patients, who had no symptom but arthralgia and no renal abnormality. And they were younger and received MTX in shorter period than high MCV group.

CONCLUSIONS

In patients with high MCV (over 94 fl), most hematological toxicities seen during the course of MTX therapy can be predictable. But, some patients may develop unpredictable hematological reaction. We need to monitor hematological examination frequently and observe patients closely for the appearance of hematological toxicity throughout the presctiption period of MTX irrespective of the duration of treatment.

Prognosis of conservative therapy of advanced interstitial cystitis: experience of five cases

BACKGROUND

It is generally believed that surgical procedures, particularly the more invasive ones, should be reserved for patients who fail to respond to conservative therapy by several established modalities. We studied whether conservative therapy was applicable to patients with interstitial cystitis (IC) in which an individual's awake bladder capacity decreases to 100 mL or less with vesicoureteral reflux (VUR).

METHODS

Five cases that satisfied the criteria proposed by the National Institutes of Health were examined. The maximum awake bladder capacity was 50-100 mL (average, 74 mL). The bladder capacity under anesthesia was 70-300 mL (average, 199 mL). Only conservative treatments were carried out.

RESULTS

The observation period ranged from 3 to 16 years with an average of 9 years. The awake bladder capacity ranged from 200 to 300 mL (average, 250 mL). The symptom index total score, which was previously 18.5, decreased to 5.5 and the problem index total score, which was previously 14.3, decreased to 3.5. Symptoms of bladder irritation improved. In four cases, VUR disappeared as the bladder capacity increased. Vesicoureteral reflux persisted in one case although its severity decreased and there was no fever.

CONCLUSION

The patients treated with conservative therapy were able to maintain an awake bladder capacity that was sufficient for acceptable quality of life and their symptoms of bladder irritation improved. This suggests that we should regenerate the original remaining bladder using conservative therapy, even if IC is in a late stage.

Role of oxidized LDL in atherosclerosis

A critical event in the early stages of atherosclerosis is the focal accumulation of lipid-laden foam cells derived from macrophages. In various cholesterol-fed animal models of atherosclerosis, localized attachment of circulating monocytes to arterial endothelial cells appeared to precede the formation of foam cells. It is suggested that monocyte recruitment into early lesions depends on the endothelial adhesiveness for monocytes and lymphocytes. In vivo and in vitro experiments have identified molecules, such as ICAM-1, VCAM-1, and P-selectin, that can support the adhesion of monocytes and lymphocytes. Moreover, oxidized LDL, lysophosphatidyl-choline, and oxidized fatty acids induce the expression not only of these adhesion molecules but also of scavenger receptors, such as CD-36, SR-A, and LOX-1. Recently, we isolated and characterized the novel receptors for oxidized LDL, namely, LOX-1 and SR-PSOX. Expression of LOX-1 is found on endothelial cells, smooth muscle cells, and macrophages, whereas SR-PSOX is expressed on macrophages. In this paper the significance of oxidized LDL and its receptors, LOX-1 and SR-PSOX, in terms of atherogenesis is discussed.

T-cell receptor gammadelta T-cell leukemia with the morphology of T-cell prolymphocytic leukemia and a postthymic immunophenotype

T-cell prolymphocytic leukemia (T-PLL) is a postthymic T-cell neoplasm with a characteristic morphology and heterogeneous immunophenotype. Most cases of T-PLL express membrane T-cell receptors (TCRs) of the alphabeta phenotype. We experienced a 30-year-old man suffering from TCRgammadelta T-cell leukemia with morphology compatible to T-PLL with a postthymic phenotype. He was admitted with skin eruption and pancytopenia. Peripheral blood and bone marrow were occupied with medium-sized lymphocytes, which had moderately condensed chromatin with a single nucleolus and sparse, nongranular basophilic cytoplasm. The immunophenotype was CD1a-, CD2-, CD3+, CD4-, CD5+, CD7+, CD8-, and terminal deoxynucleotidyl transferase negative. Hepatosplenomegaly was absent. He was diagnosed as having T-PLL and was treated with combination chemotherapy. Six months later the leukemic cell became chemoresistant. Although the patient showed transient improvement in response to pentostatin, he died 13 months after the diagnosis. To our knowledge, this is the first case of T-PLL with a TCRgammadelta phenotype.

Comparison of transthoracic Doppler echocardiography and natriuretic peptides in predicting mean pulmonary capillary wedge pressure in patients with chronic atrial fibrillation

The purpose of this study was to assess whether transthoracic Doppler echocardiography and serum natriuretic peptide levels could predict mean pulmonary capillary wedge pressure (PCWP) in patients with chronic atrial fibrillation. We examined mitral flow velocity and pulmonary venous flow (PVF) velocity patterns in 32 patients with chronic atrial fibrillation. Plasma A-type and B-type natriuretic peptide (ANP, BNP, respectively) levels in the peripheral vein were measured. Significant correlations were observed between mean PCWP and the following: peak velocity (r = 0.51) and deceleration time (r = -0.65) of the mitral flow; peak velocity (r = 0.64) and deceleration time (r = -0.80) of the PVF; BNP (r = 0.60); and ANP (r = 0.36). Stepwise multiple linear regression analysis selected PVF deceleration time and mitral flow deceleration time as independent predictors of PCWP. A cutoff value of PVF deceleration time of < or =150 ms and a mitral flow deceleration time of < or =100 ms predicted a mean PCWP of > or =18 mm Hg, with a sensitivity of 100% and 80% and a specificity of 96% and 85%, respectively. In conclusion, PVF deceleration time and mitral flow deceleration time obtained from transthoracic Doppler echocardiography are more accurate predictors of mean PCWP than values obtained with natriuretic peptides in patients with chronic atrial fibrillation.

Stimulatory effect of centrally injected capsaicin, an agonist of vanilloid receptors, on gastric acid secretion in rats

Capsaicin, the main pungent ingredient in chilli peppers, acts through specific vanilloid receptors on sensory neurons. The vanilloid receptors have been localized in the brain. We describe here a stimulatory effect of centrally injected capsaicin on gastric acid secretion in urethane-anesthetized rats. Injection of capsaicin (10-30 nmol per rat) into the lateral cerebroventricle markedly stimulated the secretion. Injection of capsazepine (30 nmol) or ruthenium red (30 nmol), antagonists for vanilloid receptors, into the lateral cerebroventricle inhibited the secretion induced by capsaicin, although these antagonists alone significantly stimulated the secretion. Injection of capsaicin into the fourth cerebroventricle also stimulated gastric acid secretion. The effects of centrally injected capsaicin into the lateral and fourth cerebroventricle were mediated via the vagus cholinergic nerve, because the effects were abolished by bilateral vagotomy at the cervical level. The present findings showed that central injection of capsaicin stimulated gastric acid secretion, via vanilloid receptors in the central nervous system (CNS), and through vagus nerve mechanisms in the perfused stomach of urethane-anesthetized rats.

Role of the diurnal variation of urinary pH and urinary calcium in urolithiasis: a study in outpatients

BACKGROUND

We previously reported that the urinary excretion of calcium and the diurnal variation of urinary pH were important for stone formation in hospitalized inpatients with hospital standard diet. Because almost all urinary stones are formed in outpatients with ambulatory free diet, it is essential to investigate these factors in outpatients.

METHODS

We examined the urinary excretion of calcium, oxalate, uric acid, phosphate and magnesium in 96 male outpatients and 142 male inpatients. We also studied the relationship between the stone composition and the diurnal variation of urinary pH in 32 male outpatients (five uric acid stones (UA), 13 pure calcium oxalate stones (CaOX) and 14 mixed calcium oxalate and calcium phosphate stones (CaOX-CaP)) and 53 male inpatients (nine UA, 15 CaOX and 29 CaOX-CaP).

RESULTS

There was a significant difference in the urinary excretion of calcium among outpatients with UA, CaOX and CaOX-CaP (133 +/- 96 vs 219 +/- 97 vs 268 +/- 102 mg per day, P < 0.05). In outpatients with UA, urinary pH was constantly low throughout the entire day. In contrast, outpatients with CaOX and those with CaOX-CaP had diurnal variation of urinary pH that was low in the early morning, followed by elevation in the daytime and was lowered in the night. The pHs in the early morning, afternoon and night were significantly higher in outpatients with CaOX-CaP than in those with CaOX.

CONCLUSION

The diurnal variation of urinary pH and the urinary calcium are important for stone formation.

Possible involvement of amino acid transporters on S-nitroso-cysteine-induced inhibition of arachidonic acid release in PC12 cells

Previously, we proposed that S-nitroso-cysteine (SNC) was incorporated via the L-type-like amino acid transporters in rat brain slices. In PC12 cells (rat neuronal cell line), SNC inhibited [(3)H]arachidonic acid (AA) release induced by mastoparan (wasp venom peptide). We investigated the involvement of amino acid transporters on SNC-induced inhibition of [(3)H]AA release in PC12 cells. SNC inhibited mastoparan-stimulated [(3)H]AA release in a concentration-dependent manner in normal Na(+)- and low Na(+)-containing buffer. The inhibitory effect of 0.6 mM SNC in low Na(+) buffer decreased by 10 mM L-leucine, L-phenylalanine, L-methionine and L-cysteine. In contrast, L-alanine, L-threonine, L-valine or L-isoleucine showed very limited effects. Addition of L-leucine and L-phenylalanine, but not L-alanine or L-valine, also decreased the inhibitory effect of SNC on ionomycin/Na(3)VO(4)-stimulated [(3)H]AA release in normal Na(+) buffer. These findings suggest that SNC is incorporated via the amino acid transporters and inhibits AA release in PC12 cells.

Gastric acid secretion by central injection of dynorphin A-(1-17), an endogenous ligand of kappa-opioid receptor, in urethane-anesthetized rats

Gastric acid secretion has been proposed to be regulated by opioid receptors in the central nervous system (CNS). Previously, we reported that central injection of synthetic agonists of kappa-opioid receptors stimulated gastric acid secretion in rats, and the secretion by the agonists was inhibited by norbinaltorphimine (an antagonist of kappa-opioid receptor). In the present study, we investigated the effect of dynorphin A-(1-17), an endogenous ligand of kappa-opioid receptor on the gastric acid secretion in the perfused stomach of urethane-anesthetized rats. Injection of dynorphin A-(1-17) (0.1-1 microg per rat) into the lateral cerebroventricle (LV) stimulated the secretion in a dose-dependent manner. The effect of dynorphin A-(1-17) was almost completely inhibited by the LV injection of norbinaltorphimine (10 microg) and in vagotomized rats. Although some studies of dynorphin A-(1-17) after central injection showed non-opioid effects such as the involvement of N-methyl-D-aspartate (NMDA) receptor, the effect of dynorphin A-(1-17) was not inhibited by a selective antagonist of the NMDA receptor ((+/-)-3-(2-carboxypiperazin-4-yl)-1-propylphosphonic acid, 10 microg). The LV injection of naloxone benzoylhydrazone (a kappa3-opioid receptor agonist, 100 microg) also stimulated the secretion in norbinaltorphimine-sensitive manner. These findings showed that both an endogenous ligand dynorphin A-(1-17) and a synthetic kappa3-opioid receptor agonist stimulated gastric acid secretion via kappa-opioid receptors in the CNS of rats in vivo.