Interaction between nitric oxide and angiotensin II on antidiuresis and norepinephrine overflow induced by stimulation of renal nerves in anesthetized dogs

We examined the effects of NG-nitro-L-arginine (NOARG) on antidiuresis and norepinephrine (NE) overflow in anesthetized dogs, induced by renal nerve stimulation (RNS), with or without blockade of an action of endogenous angiotensin II (AII) on the AT1 receptors by losartan. RNS (2.5-5.0 Hz) caused significant reductions in renal blood flow (RBF), glomerular filtration rate (GFR), filtration fraction (FF), urine flow (UF), and urinary excretion of sodium (UNaV) and increases in the differences in renal arteriovenous NE concentrations (NEC). Intrarenal arterial (i.r.a.) infusion of NOARG (40 micrograms/kg/min) significantly decreased RBF and UF, and increased FF, but did not alter GFR. When losartan 100 micrograms/kg/min was infused simultaneously, NOARG reduced RBF, UF, and GFR but had no effect on FF. With high-frequency RNS, NOARG enhanced the RNS-induced decreases in RBF, GFR, UF, and UNaV and the increases in NEC. During losartan infusion, NOARG-induced enhancements on renal actions in response to RNS were observed in a manner qualitatively similar to that without losartan. Most likely endogenous nitric oxide (NO) plays the role of inhibitory modulator of renal noradrenergic neurotransmission. Enhancement of renal noradrenergic neurotransmission induced by NO blockade is likely to be independent of an action of endogenous AII on the AT1 receptors.

[The etiology of peptic ulceration in patients with chronic pulmonary emphysema]

The purpose of this study was to determine the etiology of peptic ulceration in patients with pulmonary emphysema. We performed endoscopy in 50 patients with chronic pulmonary emphysema, these were patients with and without peptic ulcer. There was no significant differences between the patients with and without ulcer, with respect to past history of pneumonia, degree of dyspnea, current drugs, nutritional status, the extent of gastric mucosal atrophy, gastric mucosal blood flow, gastric mucosal hexosamine content and serum pepsinogen levels. But patients with peptic ulcer were significantly younger than patients without peptic ulcer. Cigarettes per day in patients with peptic ulcer 29.3 +/- 11.6 cigarettes/day were significantly higher than those without peptic ulcer 22.5 +/- 10.0 cigarettes/day. We concluded that increased incidence of peptic ulceration in patients with chronic pulmonary emphysema is related to the quantity of cigarette smoking.

Climbing fiber responses of Purkinje cells to retinal image movement in cat cerebellar flocculus

1. The complex spike (CS) of the floccular Purkinje cell has been reported to be driven by retinal image movement in the rabbit, the rat, and the monkey, but not yet in the cat, in which the floccular neuronal network is well known. We recorded the CS activity together with concomitant simple spike (SS) activity of the floccular Purkinje cells that responded to large-field visual pattern movement in the anesthetized cat. 2. On the basis of the direction selectivity we divided the cells into two major types: the horizontal type that preferred horizontal stimuli and the vertical type that preferred vertical stimuli. The CS activity of the horizontal-type cell increased during stimuli directed contralaterally to the recording site and decreased during ipsilaterally directed stimuli, whereas that of the vertical-type cell increased during upward stimuli and decreased during downward stimuli. 3. In both types the CS response was larger at lower-velocity stimuli and the response was well maintained at higher-velocity stimuli < or = 180 degrees/s tested. The mean response decline was only 50% at stimulus velocities 90-150 degrees/s compared with the response amplitude at 2 degrees/s stimulus velocity. 4. The majority of the horizontal-type cells were modulated by the stimuli presented to either eye and the dominant eye was ipsilateral to the recording site. The majority of the vertical-type cells were also modulated by the stimuli presented to either eye without obvious differences between two eyes. 5. In both types the receptive field of the ipsilateral eye always included the area centralis and extended widely on both visual hemifields. The receptive field of the contralateral eye also included the area centralis and was usually restricted within the ipsilateral visual hemifield. The stimuli of small visual field (15 degrees x 15 degrees) projecting to the area centralis evoked especially large responses (70% of the full-screen response). 6. The CS and SS responses were reciprocal to each other, that is, when the CS firing increased the SS firing decreased and vice versa. 7. These CS responses are well suited for the direction detection of large-field retinal image motion at a wide velocity range. In light of the present unitary spike data together with the anatomic and eye movement data reported previously, we conclude that the cat flocculus is responsible for reduction of the large-field retinal image motion by producing eye movement in the same direction with the visual motion.

Hereditary elliptocytosis associated with spectrin Le Puy in a Japanese family: ultrastructural aspect of the red cell skeleton

A dominantly-inherited hereditary elliptocytosis of intermediate severity was recorded in a Japanese family from Yamagata. The condition was associated with a spectrin truncated beta-chain (MW: 214 kD; 31% of total beta-spectrin), and a defect of mutant spectrin as regards tetramerization and phosphorylation. cDNA analysis revealed skipping of exon X, the third-to-last exon of the spectrin beta-gene. At the gene level, a one-base substitution (A-->G) changed position +4 of the 5' donor splice site consensus sequence of intron X. This mutation has been described before in a French kindred, defining spectrin Le Puy. Electron micrographs following quick-freeze deep-etching showed that the skeletal network was disorganized.

Enhancement of noradrenaline release from rat frontal cortex by thyrotropin releasing hormone and its analog, (3R,6R)-6-methyl-5-oxo-3-thiomorpholinylcarbonyl-L-histidyl-L-prolinami de, as studied by intracerebral microdialysis

The effects of thyrotropin-releasing hormone (TRH) and NS-3 [CG-3703: (3R,6R)-6-methyl-5-oxo-3-thiomorpholinylcarbonyl-L-histidyl-L- prolinamide], a metabolically stable analog of TRH, on the extracellular concentration of noradrenaline (NA) in the frontal cortex of urethane anesthetized rats were examined by using intracerebral microdialysis coupled with high-performance liquid chromatography with electrochemical detection. NS-3 (0.1 and 0.3 mg/kg i.v.) produced a significant increase in NA release. This effect reached to its peak 20 to 40 min (174% of basal level) after NS-3 (0.3 mg/kg) injection and exhibited a duration of 80 min. TRH (10 mg/kg i.v.) also significantly increased NA concentrations to the same extent as that produced by 0.3 mg/kg of NS-3, although the effect of TRH was transient. Blockade of NA reuptake by perfusion with desipramine (10(-7) M) caused a gradual increase in extracellular NA concentration. NS-3 at 0.3 mg/kg (i.v.) produced a significant elevation of NA concentrations after desipramine perfusion. When NS-3 (10(-6) and 10(-5) M) was perfused to the frontal cortex through the dialysis probe for 1 hr, no significant change in cortical NA concentration was observed. In contrast, perfusion of NS-3 (10(-5) M) through the dialysis probe implanted into the locus ceruleus induced a significant increase in the cortical NA release. These results suggest that NS-3 is far more active than TRH in facilitating cortical NA release and that the locus ceruleus is one of sites of action of this drug.

[Relationship of Helicobacter pylori to chronological transition of endoscopic atrophic pattern]

The prevalence of Helicobacter pylori (HP) were studied in 117 subjects with no gross findings whose stomach age was equal to its chronological age. HP was detected by culture. The prevalence of HP significantly was higher in thirties and forties than other ages, and in C3 and O1 groups than other groups. Most of forties and fifties belonged to C3 or O1 groups. Histologically, HP infection was significantly frequent in the gastric mucosa with advancing inflammation. These findings suggest that HP infects in early middle age, causes the destruction and atrophy of gastric mucosa and disappears with ageing and chronological expansion of mucosal atrophy. We consider that HP infection may play a causative role of the aging process of the stomach.

Ten-year complete remission in an 84 year-old patient with acute myeloid leukemia

We report an unusual case in which complete remission of acute myeloid leukemia (AML) had lasted for almost 10 years in a patient who was 94 years and 7 months old as of September 1989. An 84 year-old man was admitted to our hospital with gingival bleeding on October 15, 1979. Hematological data were: RBC 327 x 10(4) microliters, hemoglobin concentration 10 g/dl, platelets 3.8 x 10(4) microliters and WBC 9000 microliters, including 34% blastic cells. Bone marrow aspiration showed nucleated cells 48.0 x 10(4)/microliters with 69.2% blastic cells. He was diagnosed as having AML (M2). Induction chemotherapy consisted of daunorubicin, cyclocytidine, an anhydride analogue of cytosine arabinoside, and prednisolone (DCP). Complete remission was achieved after 1 month of this therapy. After two cycles of consolidation therapy (DCP), intensification therapy (DCP) was performed twice. Thereafter, complete remission lasted without any further therapy, up to September 1989, when he died of pancreatic cancer. The prolonged disease-free survival in this extremely aged patient was attributed to the high sensitivity of leukemic cells to DCP therapy and his good performance status at the time of initial induction chemotherapy. This is the oldest patient with long-term remission, lasting for over 5 years, to be reported in Japan. If an elderly patient with typical acute leukemia has a good performance status, intensive chemotherapy should be tried at least once, while carefully controlling complications specific to the elderly.

Barbiturate depresses simple spike activity of cerebellar Purkinje cells after climbing fiber input

1. Some scientists reported that the simple spike (SS) activity was transiently depressed after climbing fiber input, but others reported that predominant population of Purkinje cells increased their SS activity after the complex spike (CS). In the present study, SS activity after spontaneous CS was compared before and after the administration of pentobarbital sodium and of ketamine in high decerebrate cats. 2. Frequencies of spontaneous CS and SS firing were reduced (P < 0.001, t test) after pentobarbital administration of a total dose of 20-30 mg/kg. 3. In the peri-CS time histogram, the SS activity during a post-CS period of 10-110 ms with respect to that during a pre-CS period of -100-0 ms was reduced (P < 0.001) after the pentobarbital administration from, on average, 132.4 to 81.9%. In contrast, the SS activity during a post-CS period of 110-210 ms remained unchanged (P > 0.2). 4. In the pre-CS time histogram constructed after the pentobarbital administration, there were no significant differences (P > 0.01) between the SS activity during a pre-CS period of -600 to -500 ms and that during each of other pre-CS periods, suggesting that the barbiturate had little effect on the SS activity preceding the CS. 5. Analysis of raster diagrams revealed the variability of individual SS activity after the CS.(ABSTRACT TRUNCATED AT 250 WORDS)

Direction selective climbing fiber responses to horizontal and vertical optokinetic stimuli in the cat cerebellar flocculus

In ketamine anesthetized cats, complex spike (CS) responses to movement of a large-field visual surround (optokinetic stimulus) were recorded in the cerebellar flocculus. Two types of Purkinje cells were found. One type showed increased CS activity to optokinetic stimuli directed contralaterally to the recording site and decreased activity to stimuli directed ipsilaterally. The modulation occurred in both monocular (responses to the stimuli for only the ipsilateral eye) and binocular forms (dominant eye, ipsilateral). The other type of cell showed increased CS activity during upward optokinetic stimuli and decreased activity during downward stimuli. The responses occurred only in the binocular form. The dominant eye was either ipsilateral or contralateral with respect to the recording site. Thus, there are two types of Purkinje cells in the cat flocculus: horizontal type cell showing CS modulation during horizontal optokinetic stimuli, and vertical type cell showing CS modulation during vertical optokinetic stimuli.

Complex spike responses of cerebellar Purkinje cells to constant velocity optokinetic stimuli in the cat flocculus

In the cat cerebellar flocculus without cerebrum but with intact accessory optic tract, complex spike (CS) responses to horizontal optokinetic stimuli (velocity-step at 2 degrees/s) were investigated. The directionally selective CS responses were present only during the short-duration stimuli but not during the continuous unidirectional stimuli. Following the end of the stimuli during the stationary surround phase, the CS activity was modulated in a manner opposite to the preceding CS response during the stimulation. These CS responses cannot simply be interpreted as sensory responses to the retinal slip input; they may in fact be deeply associated with the motor control command of the eye movement which would be elicited by the retinal slip.

Short-term modulation of cerebellar Purkinje cell activity after spontaneous climbing fiber input

1. There are two opposite points of view concerning the way climbing fiber input in a Purkinje cell modifies simple spike (SS) activity transiently: depression versus enhancement of SS activity. The different groups of investigators favored one effect predominating over the other. In the decerebrate unanesthetized cat, we recorded spontaneous activity of single Purkinje cells and investigated time course of SS activity after the complex spike (CS). 2. In the peri-CS time histogram, there was a SS pause lasting, on average, 10.8 ms after onset of the CS in all of the 316 cells recorded. The pause was followed by a rapid increase in SS activity to a maximum, which was on average 175.6% of a pre-CS control level, and a gradual return to around the control level in the majority of the cells recorded (pause-facilitation type, 71.2%). The increase in SS activity was significant (P < 0.01, t test) during 20-100 ms. The SS activity during the 20-100 ms was, on average, 163.7% of the control level. In some cells (pure-pause type, 25.3%), no significant changes were found (P > 0.01) in the post-pause SS firing. In contrast, only 3.5% of the cells (pause-reduction type) showed a significant (P < 0.01) firing decrease (average 54.0% of the control level) lasting 20-60 ms after the pause period. 3. Analysis of the pre-CS time histogram revealed no significant differences (P > 0.01) in the SS activity between pre-CS periods in all of the cells recorded, suggesting that the SS activity enhancement is not due to a coactivated mossy fiber input just preceding the activation of the climbing fiber input. 4. Analysis of the raster diagram revealed variability of individual SS responses after the CS. The probability of occurrence of the increase in SS number during a post-CS period of 0-100 ms with respect to that during a pre-CS period of -100-0 ms in individual raster traces was high (on average 78.2%), medium (57.3%), and low (36.3%) in the pause-facilitation, pure-pause, and pause-reduction types of the cell, respectively. 5. Nonsequential time histograms showing frequency distribution of the pause duration after the CS in individual raster traces and that showing interspike intervals of the SS were constructed.(ABSTRACT TRUNCATED AT 400 WORDS)

[Renal and electrolyte disturbances in chronic myelogenous leukemia]

Renal and electrolyte disturbances in 91 patients with chronic myelogenous leukemia (CML) were analyzed over a period of these twenty years. At diagnosis, renal and electrolytes were studied in 72 patients including 65 in chronic cases, 5 in accelerated phase and 2 in blastic crisis. There were 8 cases of hypocalcemia among 62 patients and 5 cases of hyperphosphatemia among 48 patients. The cases of hyperphosphatemia and renal dysfunction had short median survival. There were no significant differences of renal and electrolyte disturbances between before and after chemotherapy. Various electrolyte disturbances, that is, hyponatremia, hypo-, hyperkalemia, hypocalcemia, hypo-, hyperphosphatemia, were found in the blastic crisis of CML. In the last admission, renal dysfunction and various electrolyte disturbances were present in almost half of the cases. Pathological studies were performed in 18 autopsy cases. Acute tubular insufficiency or necrosis, hypercalcemic nephropathy, and renal infiltration of leukemic cells were recognized in patients who had renal dysfunction.

Total occlusion of the left main coronary artery associated with acute myocardial infarction. A case report

A 64-year-old man with total occlusion of the left main coronary artery associated with acute anterior infarction was treated successfully with combined emergency intracoronary thrombolysis and coronary bypass surgery. Postoperative angiography demonstrated patent bypass grafts with good preservation of left ventricular function.

[Clinical evaluation of effects of KRN8601 (rhG-CSF) on neutropenia]

Clinical effects of KRN8601 (recombinant human granulocyte colony-stimulating factor:rhG-CSF) were studied in 26 patients with chronic neutropenia including 4 Kostmann's disease, 1 Shwachman's syndrome, 1 Lonsdale's syndrome, 1 glycogen storage disease Ib-associated, 6 chronic benign, 5 chronic hypoplastic, 2 cyclic, 4 autoimmune and 2 miscellaneous neutropenia. The patients were given rhG-CSF intravenously at doses of 20-540 micrograms/m2 or subcutaneously at doses 20-400 micrograms/m2, over the periods of 2-32 weeks. Increases in neutrophil counts occurred after rhG-CSF administration in 23 of the 26 patients. Patients with Kostmann's disease, Shwachman's syndrome and chronic hypoplastic neutropenia responded poorly compared to patients with other types of neutropenia. There were no serious side effects which caused interruption of the study. These results indicated a beneficial effect of KRN8601 in various types of chronic neutropenia.

[B-cell chronic lymphocytic leukemia complicated by autoimmune thrombocytopenic purpura]

A 74-year-old Japanese male was admitted because of anemia. Hepatosplenomegaly, lymphoadenopathy, and purpura were not found. The laboratory data on admission revealed that the white-cell count was 9,400/microliters, the hemoglobin 11.1 g/dl, and the platelet count 17,000/microliters. Platelet-associated IgG was 794.2 ng/10(7) cells. The patient was diagnosed as having autoimmune thrombocytopenic purpura (ATP) at this time. He was treated with prednisolone, but his thrombocytopenia not improve. In addition to prednisolone, azathioprine was given to him. During the course of treatment, leukocytosis gradually appeared and the white-cell count reached more than 30,000/microliters with over 70% lymphocytes. A bone marrow aspiration revealed 70% of small lymphocytes, and surface marker analysis showed that CD19 and HLA-DR were positive on these lymphocytes. Southern blotting analysis demonstrated rearrangements of JH and JK. He was finally diagnosed as B-CLL complicated by ATP. One month after the azathioprine administration, the platelet count increased more than 30,000/microliters and the white-cell count decreased less than 10,000/microliters. About 2% of patients with CLL are known to be complicated by ATP. To our knowledge, the present case is the first case of B-CLL complicated by ATP in Japan.

T cell-mediated inhibition of erythropoiesis in aplastic anaemia: the possible role of IFN-gamma and TNF-alpha

The inhibitory activity of T cells on autologous erythroid colony-forming units (CFU-E) (T cell inhibitory activity) in patients with aplastic anaemia (AA) was investigated. In 11 (32.4%) out of 34 AA cases, T cell inhibition on autologous CFU-E growth was greater than that in normal individuals. In order to evaluate the mechanism of this inhibitory activity, T cell surface markers, interferon (IFN) production in peripheral blood mononuclear cell (PBMNC) liquid culture, and cytokine levels such as IFN and tumour necrosis factor-alpha (TNF-alpha) in CFU-E clot cocultured with T cells, were measured in a portion of the patients. In five patients investigated for IFN production in PBMNC liquid culture, all produced statistically more IFN activity than normal individuals under phytohaemagglutinin (PHA-P) stimulation (P less than 0.01) with no relation to T cell inhibitory activity. In only one patient whose T cells displayed increased CD8 and HLA-DR antigen (CD8+HLA-DR+) and inhibitory activity, a significant amount of IFN-gamma was observed in CFU-E clot cocultured with T cells, and the addition of anti-IFN-gamma antibody to the coculture resulted in recovered CFU-E colony growth. These results suggest that IFN-gamma production by T cells may explain, at least in part, the pathogenesis of haematopoietic defects in AA. In other patients however, T cell inhibitory activity neither correlated to the T cell subpopulations (CD4+/CD8+, CD8+HLA-DR+), IFN production in PBMNC liquid culture, nor to IFN and TNF-alpha levels in CFU-E clot culture. The roles played by cytokines other than IFN and TNF-alpha on haematopoietic precursor cells require further evaluation in a larger sample of patients with AA.

Autoimmune hemolytic anemia and myasthenia gravis

A case of autoimmune hemolytic anemia associated with myasthenia gravis in a 33-year-old female is presented. The association of autoimmune hemolytic anemia and myasthenia gravis is a very rare event, with only eight cases reported. The known association of these two diseases is reviewed. To our knowledge, this is the first reported case in which autoimmune hemolytic anemia preceded systemic myasthenia gravis.