Enzymatic depletion of serotonin in vivo and its consequences

The serotonin (5-HT) system in the brain is a global modulator thought to tune up a unique subset of brain keynotes such as emotion, motivation, and sleep/conscious states in the deepest seats of cognition and behavior. In pursuit for coherent accounts of such higher-order issues, we have been trying to deduce the system dynamics of 5-HT in full span from the perturbation-response couples elicited by our most quick, specific, extensive, and reversible depletion of the brain 5-HT so far available via plasma precursor annihilation by injection of a tryptophan degrading enzyme (TSO) (ISTRY meetings-1986 in Cardiff, -92 in Nagoya and -98 in Hamburg). Herein discussed are the dynamics of the 5-HT depletion both in the whole brain and regional dimensions, and then the perturbation-induced manifestation of a continuous behavioral quiescence underlain by chaotic patterns of sleep/waking states. This response in sharp contrast to those by earlier serotonin depletors, prompts us to consider a serious revision of the current 5-HT scenario. In the light of our research, future directions will be discussed together with the RTD (rapid tryptophan depletion) claiming the impaired brain 5-HT turnover by a partial decline of plasma tryptophan.

Regeneration of the mandibular condyle after unilateral condylectomy and myotomy of the masseter in lambs

We investigated the degree of regeneration of the mandibular condyle after unilateral condylectomy and myotomy of the masseter in growing lambs. Four 10-week-old lambs had unilateral condylectomy and myotomy of the superficial layer of the masseter on the right side, and were killed 3 months later. The joints were examined radiologically and histologically. All joints showed poor regeneration of the condylar head. In the medial plane there was partial condylar and articular cartilage reformation, but in the lateral plane there was neither condylar nor cartilaginous reformation. The articular cartilage of the temporal bone was thicker in the medial plane and the disc was thicker in the central plane, than in unoperated joints. We conclude that unilateral condylectomy and myotomy of the masseter in the growing period results in poor regeneration of the condyle.

Fate of Legionella pneumophila in macrophages of C57BL/6 chronic granulomatous disease mice

We compared the intracellular survival and growth of Legionella pneumophila Philadelphia-1 in peritoneal macrophages obtained from A/J, C57BL/6, and X-linked chronic granulomatous disease (CGD) mice produced from C57BL/6 strain. The initial killing was observed in A/J and C57BL/6 macrophages at 2, 4 and 6 hr after in vitro phagocytosis, but not in the CGD macrophages. Thereafter, there was a 10-fold increase of CFU in A/J macrophages. The bacteria, however, did not proliferate in C57BL/6 and CGD macrophages at 24 or 48 hr after in vitro phagocytosis. These results suggest that effector molecules for the initial killing are a superoxide anion and its metabolites, and Lgn1 gene product inhibits the intracellular growth of L. pneumophila independently of NADPH oxidase.

Morphological variety of intracellular microcolonies of Legionella species in Vero cells

Intracellular microcolonies of six Legionella species growing in Vero cells showed distinctly varied morphologies. The varieties were observed by light microscopy of Gimenez-stained, Legionella-infected Vero cells and by electron microscopy (EM). Legionella pneumophila Philadelphia-1 formed needle-shaped crystal-like microcolonies. Legionella bozemanii WIGA formed microcolonies like wool balls containing filamentous cells. In EM, these organisms proliferated in endosomes, which were adjacent to swollen rough endoplasmic reticula. Legionella oakridgensis OR-10 showed serpentine chains. Many mitochondria were observed around the microcolonies. Legionella jordanis BL-540 formed spherical moss-like microcolonies which were or were not surrounded by endoplasmic membranes. Legionella feeleii WO-44C spread throughout the cytoplasm without making clusters. Legionella dumoffii Tex-KL made big clusters that spread in the cytoplasm, a portion of which was outside the endosome membranes. These different morphologies imply diversity in modes of intracellular multiplication of Legionella spp.

Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination

The number of airborne methicillin-resistant Staphylococcus aureus (MRSA) before, during and after bedmaking was investigated. Air was sampled with an Andersen air sampler in the rooms of 13 inpatients with MRSA infection or colonization. Sampling of surfaces, including floors and bedsheets, was performed by stamp methods. MRSA-containing particles were isolated on all the sampler stages-stage 1 (>7 microm diameter) to stage 6 (0.65-1.1 microm). The MRSA-containing particles were mostly 2-3 microm diameter before bedmaking and >5 microm during bedmaking. The number was significantly higher 15 min after bedmaking than during the resting period, but the differences in counts after 30 and 60 min were not significant. MRSA was detected on many surfaces. The results suggest that MRSA was recirculated in the air, especially after movement. To prevent airborne transmission, healthcare staff should exercise great care to disinfect inanimate environments. Further studies will be needed to confirm the level of MRSA contamination of air during bedmaking and establish measures for prevention of airborne transmission.

Skeletal aspects of the atlanto-occipital fusion in a Japanese brown calf

Atlanto-occipital fusion in a Japanese Brown calf was examined morphologically, paying special attention to skeletal changes. At the craniovertebral junction, the basal occipital bone fused to the cranial extremity of the ventral arch of the atlas with the rudiment of the atlantal centrum. The dens was not formed at the axis. These changes suggest that a hypocentrum and a centrum of the atlas derived from the first cervical sclerotome had failed to separate the occipital base from the proatlantal sclerotome including the apical element of the dens. Although a developmental disturbance at the cervical and thoracic vertebrae was also associated, critical neurological signs such as ataxia and paralysis were absent.

Characterization of phagosomal subpopulations along endocytic routes in osteoclasts and macrophages

Modifications occurring during the transformation of phagosomes into mature phagolysosomes were investigated in osteoclast-like cells (OCLs) and macrophages using latex beads as markers for the isolation of phagosomal compartments (LBC) at different time points after phagocytosis. In OCLs, newly formed LBC acquired cathepsin K, tartarate-resistant phosphatase (TRAP), lysosome-associated membrane protein-1 (Lamp-1), and cathepsin D, and rapidly lost annexin II in a time-dependent manner. The levels of Rab7 and c-Src in OCLs initially increased and then gradually decreased during the transformation from early to late endosomal LBC or phagolysosomes. Receptor activator of NF-kappaB (RANKL) significantly increased the LBC levels of cathepsin K, TRAP, and c-Src, whereas calcitonin decreased the LBC levels of cathepsin K, TRAP, and Rab7, indicating that the transformation of early to late endosomal elements and lysosomes in OCLs is also regulated by osteoclastogenesis regulatory factors. On the other hand, changes in the LBC levels of Lamp-1, cathepsin D, and annexin II in macrophages were comparable to those in OCLs. However, contrary to osteoclastic LBC, Rab7 levels of macrophage LBC decreased in a time-dependent manner. Macrophage LBC were devoid of cathepsin K, TRAP, and c-Src in all transformation stages. These observations suggest that OCLs and macrophages have different phagosome maturation mechanisms that involve the specific and regulated acquisition of markers from endocytic organelles. The results also demonstrate that the use of LBC is a useful system in which to identify and characterize molecules involved in these different endocytic pathways.

[A case of congenital esophagobronchial fistula discovered incidentally on esophagography]

A 50-year-old man was admitted to our hospital because of an abnormal shadow, detected during an upper gastrointestinal examination. A chest radiograph showed an infiltrating shadow in the right middle lung field. A chest CT showed a fistula communicating between a bronchus (rt. B6) and the middle of the esophagus. Resection of the fistula was performed by video-assisted thoracoscopic surgery (VATS). Isolation of the fistula was straightforward, and there was no evidence of inflammation or adherent lymph nodes around it. Histologic examination of the resected specimen revealed that the fistula lumen was covered with squamous epithelium and muscularis mucosa. These findings suggested that this case could be categorized as Braimbridge type II. In this case, the chest CT showed the esophagobronchial fistula clearly, and was useful for the diagnosis.

Localization of extracellular matrix receptors in ICGN mice, a strain of mice with hereditary nephrotic syndrome

Fibrotic degeneration was examined in the kidneys of ICR-derived glomerulonephritis (ICGN) mice, a novel inbred mouse line with a hereditary nephrotic syndrome of unknown etiology considered to be a good model of human idiopathic nephrotic syndrome. In the present study, we histochemically revealed changes in accumulation of extracellular matrix (ECM) components and in localization of integrins, cellular receptors for ECM, in the kidneys of ICGN mice with the progression of renal failure. Excessive accumulation of basement membrane (laminin and collagen IV) and interstitial (type III collagen) ECM components were demonstrated in the glomeruli and tubulointerstitum of ICGN mice. Marked deposition of type I collagen and tenascin was seen only in the glomeruli of ICGN mice but not in those of ICR mice as normal controls. Increased expression of integrin alpha1-, alpha2-, alpha5- and beta1-subunits in glomeruli with fibrotic degeneration and abnormal distribution of alpha6-subunit were noted in the kidneys of ICGN mice. Excessive laminin, a ligand of alpha6beta1-integrin, was demonstrated on the tubular basement membrane, but alpha6-subunit diffusely disappeared on the basal side of the tubular epithelial cells. We presumed that abnormal integrin expression in renal tubules causes epithelial cell detachment, and consequently tubular nephropathy, and results in disorder of ECM metabolism causing excessive accumulation of ECM components in the kidneys of ICGN mice.

[Studies of the fifth section in the introduction of the Qian jin yao fang - Writings quoted from the Shen nong ben cao jing and the Yao dui]

The fifth section in the introduction of the Qian jin yao fang is composed of three paragraphs. The first paragraph is the same as that of the Shen nong ben cao jing. The second and the third ones begin with the sentences of "Lei gong say ..." and "Yao dui says ..." respectively. We inquired into the origin of these three paragraphs. As a result of our investigation, we inferred that the first and the second paragraphs were part of the writings of the Lei gong ji zhu shen nong ben cao and that the third one was part of the Lei gong yao dui. We also pointed out that the substance of these paragraphs was influenced directly and indirectly by Buddhist medicine.

The effect of gap arthroplasty on temporomandibular joint ankylosis: an experimental study

The aim of this study was to demonstrate the functional and anatomical changes after gap arthroplasty release of unilateral temporomandibular joint (TMJ) ankylosis. Five adult sheep weighing an average of 57 kg were used. All right joints were operated. Ankylosis was induced in the right TMJ by articular damage, disk removal and placement of a bone graft plus immobilization wire. At 3 months the gap arthroplasty were performed. All TMJs were examined functionally, radiologically, macroscopically and histologically. Functionally, the range of jaw movements decreased following induction of ankylosis (P<0.0001), increased immediately on release but was reduced again at 3 months after release (the vertical movement, no statistically significant difference; the right movement, P<0.001; the left movement, P<0.0001). Histologically, all operated joints showed fibrous adhesions across the gap, and further, the articular surface was irregular with osteophytes and with bony islands in the gap. This appearance is more consistent with a fibrous reankylosis than a functioning pseudo joint. This study shows that the gap arthroplasty for TMJ ankylosis did not restore the TMJ functionally and histologically to the preexisting state.

Polymerization of bisphenol A by purified laccase from Trametes villosa

The metabolism of bisphenol A (BPA), an endocrine-disrupting chemical, was studied with a highly purified laccase from the basidiomycete Trametes villosa. The enzyme reaction products ranged widely from water-insoluble to -soluble compounds, one of which was previously identified as 4-isopropenylphenol. (1)H NMR and electron-impact mass spectrum analyses showed that one of the insoluble products was a BPA dimer, 5,5'-bis-[1-(4-hydroxy-phenyl)-1-methyl-ethyl]-biphenyl-2,2'-diol. Field-desorption mass spectrum analysis revealed BPA oligomers, some of which contained phenol, within the insoluble fraction. These results indicate that the laccase reaction may contain successive BPA polymerization, followed by either the addition of phenol to the formed oligomers or their decomposition to release 4-isopropenylphenol.

A comparative study of characteristics of current-type and conventional-type cationic bactericides

We have synthesized new polycationic bactericides, polyloxyethylene(dimethyliminio)trimethylene(dimethyliminio)ethylene dichloridel (OXD) and poly(hexamethyleneguanidine phosphate) (HEP), in order to develop more active but less skin-irritative bactericides. The effects of these bactericides on Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Klebsiella pneumoniae, methicillin resistant Staphylococcus aureus (MRSA) and the degree of their irritations on skin were compared with those of a widely used low molecular-weight cationic bactericide, benzalkonium chloride (BAC), and a polycationic bactericide, poly[2-hydroxyethylene(dimethyliminio)methylene chloride] (2HYC). The minimum bactericidal concentration (MBC) of OXD for 10 min contact incubation was 16 microg/ml against P. aeruginosa, E. coli, S. marcescens and K. pneumoniae, and >1000 microg/ml against MRSA. The MBC of HEP for 10 min contact incubation was 16 microg/ml against P. aeruginosa, 32 microg/ml against E. coli and K. pneumoniae, and 64 microg/ml against S. marcescens and MRSA. Itch, edema, erythema, heat, injury, desquamation and keratinization caused by skin irritation were examined in 21 subjects by patch tests. Only one subject treated with OXD experienced edema, and one subject with HEP experienced keratinization. However, BAC caused itch in 3 subjects, edema in 1, erythema in 10 and desquamation in 2, indicating that the incidence of skin irritation of BAC was higher than that of OXD or HEP. OXD and HEP had sterilization ability similar to BAC, however, they were less skin-irritative than BAC. This indicates that OXD and HEP can be used as safe bactericides.

Sampling and detection of Legionella pneumophila aerosols generated from an industrial cooling tower

Cooling tower water has frequently been cited as a source of infection in outbreaks of Legionnaires' disease. However, there have been few reports on the presence of legionellae in aerosols from cooling towers. This paper describes our use of an impinger or a six-stage microbial impactor for detecting legionellae in air around a cooling tower contaminated with L. pneumophila (1.2+/-0.3x10(5) CFU/100 ml). Phosphate-buffered saline, Page's saline, 2% yeast extract solution and buffered yeast extract (BYE) broth were tested to evaluate their collection efficiency. These solutions were compared in laboratory experiments using an aerosol of L. pneumophila serogroup (SG) 1. Because BYE broth was the most efficient and storable collecting fluid among them, it was used for outdoor air sampling. In the outdoor air sampling, aerosolized L. pneumophila SG 6 was detected in the air around the cooling tower by the impinger (0.09 CFU/l. air). No legionellae were detected by the impactor with Legionella-selective agar plates (WYOalpha) because the plates were overgrown with fungi. Repetitive element PCR (rep-PCR) and arbitrarily primed PCR (AP-PCR) were employed to assess the epidemiological relationship among Legionella isolates from the air sample and the cooling tower water samples. L. pneumophila SG 6 isolated from the aerosols produced rep-PCR and AP-PCR fingerprints identical to those of L. pneumophila SG 6 strains from the cooling tower water, suggesting that the bacterium was aerosolized from the cooling tower.

[A case of mediastinal esophago-bronchogenic cyst associated with high serum level of CA 19-9]

We report a case of mediastinal esophago-bronchogenic cyst in a patient with a high serum level of CA 19-9. A 49-year-old man presented with a complaint of dysphagia. Chest X-ray, CT, and MRI showed posterior mediastinal cystic shadow which was diagnosed preoperatively. The serum level of CA 19-9 was 158 U/ml. We underwent extirpation of the cyst through video-assisted thoracoscopic surgery (VATS) and confirmed to be a bronchogenic cyst histologically. The serum level of CA 19-9 returned to normal after the operation.

Unilateral mandibular condylectomy in lambs

The purpose of this experimental study was to investigate the degree of regeneration of the mandibular condyle after unilateral condylectomy in 10-week-old lambs. The lambs were killed three months after the operation, and the joints examined radiologically and histologically. Scoring systems were used to assess the radiological changes and histological regeneration of the condyle. All joints showed regeneration of the condylar head postoperatively. The maximum degree of regeneration occurred on the medial side rather than the central or lateral areas. There was a significant correlation among the medial, central, and lateral planes (P<0.05). The reformed articular cartilage was irregular and thin (P<0.01), and the disc was thick in the central plane (P<0.01) compared with the control joints. The temporal bone was normal. This study shows that unilateral condylectomy in the growing period results in some condylar regeneration particularly on the medial side and reformation of some irregular and thin articular cartilage.

One-Pot preparation of optically active sec-alcohols, epoxides, and sulfoxides by a combination of synthesis and enantiomeric resolution with optically active hosts in a water suspension medium

Optically active sec-alcohols, epoxides, and sulfoxides were prepared by one-pot process of a combination of synthesis and enantiomeric resolution through inclusion complexation with an optically active host in a water suspension medium.

Localization of proliferative and apoptotic cells in the kidneys of ICR-derived glomerulonephritis (ICGN) mice

The ICR-derived glomerulonephritis (ICGN) mouse is a novel inbred mouse strain with a hereditary nephrotic syndrome, considered to be a good model of human idiopathic nephrotic syndrome and develops proteinuria, hypoproteinemia and anemia. In the present study, we compared the cell kinetics in the kidneys of ICGN mice with age-matched ICR mice as normal controls. The proliferating cells were visualized by 5-bromo-2'-deoxyuridine labeling, and apoptotic cells were determined by terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end-labeling. Many proliferating epithelial cells of renal tubules, glomerular mesangial cells and tublointerstitial fibroblast-like cells were observed in the kidneys of ICGN mice, but no proliferating cells were seen in the kidneys of ICR mice. Apoptotic cells had round nuclei, and were observed only in the tubulointerstitium in the kidneys of ICGN mice but not in that of controls. The proliferation of renal tubular epithelial cells may represent a compensatory response, and that of mesangial and fibroblast-like cells may play a pathogenic role in nephrotic syndrome. Apoptosis in tubulointerstitial cells with round nuclei may have been erythropoietin-producing cells, and probably caused anemia.

Minimal functional structure of Escherichia coli 4.5 S RNA required for binding to elongation factor G

Escherichia coli cells contain abundant amounts of metabolically stable 4.5 S RNA. Consisting of 114 nucleotides, 4.5 S RNA is structurally homologous to mammalian 7 S RNA, and it plays an essential role in targeting proteins containing signal peptide to the secretory apparatus by forming an signal recognition-like particle with Ffh protein. It also binds independently to protein elongation factor G (EF-G) and functions in the translation process. This RNA contains a phylogenetically conserved RNA domain, the predicted secondary structure of which consists of a hairpin motif with two bulges. We examined the binding activity of mutants with systematic deletions to define the minimal functional interaction domain of 4.5 S RNA that interacts with EF-G. This domain consisted of 35-nucleotides extending from 36 to 70 nucleotides of mature 4.5 S RNA and contained two conserved bulges in which mutations of A47, A60, G61, C62, A63, and A67 diminished binding to EF-G, whereas those at A39, C40, C41, A42, G48, and G49 did not affect binding. These data suggested that the 10 nucleotides in 4.5 S RNA, which are conserved between 4.5 S RNA and 23 S rRNA, have a key role for EF-G binding. Based on the NMR-derived structure of mutant A47U, we further verified that substituting U at A47 causes striking structural changes and the loss of the symmetrical bulge. These results indicate the mechanism by which EF-G interacts with 4.5 S RNA and the importance of the bulge structure for EF-G binding.

Significance of airborne transmission of methicillin-resistant Staphylococcus aureus in an otolaryngology-head and neck surgery unit

OBJECTIVES

To quantitatively investigate the existence of airborne methicillin-resistant Staphylococcus aureus (MRSA) in a hospital environment and to perform phenotyping and genotyping of MRSA isolates to study MRSA epidemiology.

DESIGN

Prospective surveillance of patients with MRSA infections or colonizations was performed, as was an observational study of environmental airAirborne samples were taken by an air sampler; samples were obtained from object surfaces by stamping or swabbing. Epidemiological study of MRSA isolates was performed with an antibiotic susceptibility test, coagulase typing, and pulsed-field gel electrophoresis.

SETTING

Three single-patient rooms in a 37-bed otolaryngology-head and neck surgery unit.

PATIENTS

Three patients with squamous cell head and neck cancer were observed to have been colonized or infected with MRSA after surgery.

RESULTS

The MRSA samples were collected from the air in single-patient rooms during both a period of rest and when bedsheets were being changed. Isolates of MRSA were detected in all stages (from stage 1 [>7 microm] to stage 6 [0.65-1.1 microm]). About 20% of the MRSA particles were within a respirable range of less than 4 microm. Methicillin-resistant S aureus was also isolated from inanimate environments, such as sinks, floors, and bedsheets, in the rooms of the patients with MRSA infections as well as from the patients' hands. An epidemiological study demonstrated that clinical isolates of MRSA in our ward were of one origin and that the isolates from the air and from inanimate environments were identical to the MRSA strains that caused infection or colonization in the inpatients.

CONCLUSIONS

Methicillin-resistant S aureus was recirculated among the patients, the air, and the inamimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in hospitals.

Lactate dehydrogenase isozymes in and intralesional steroid injection therapy for pseudocyst of the auricle

BACKGROUND

Various treatments for pseudocyst of the auricle have been reported. Recently, several patients have been treated successfully with steroid injections. The lactate dehydrogenase (LDH) levels of cystic fluid have been reported to be high, and the LDH-4 and LDH-5 isozymes were found to predominate, although the serum LDH levels and LDH isozyme patterns were normal.

OBJECTIVE

To find a way of preventing auricular pseudocyst recurrences after steroid injection therapy and to examine the relationships between recurrences and the LDH level and isozyme pattern of the cystic fluid.

METHODS

Steroid injection therapy was given to nine Japanese patients with pseudocyst of the auricle at our clinic between 1994 and 1999. We determined the LDH level and isozyme pattern of the cystic fluid and sera of seven patients.

RESULTS

All nine patients in this series were treated successfully with steroid injections, although three suffered recurrences. Although the serum LDH levels of seven patients were almost normal, their cystic fluid LDH levels were very high. LDH-4 and LDH-5 predominated in the cystic fluid of all seven, although their serum LDH isozyme patterns were virtually normal.

CONCLUSIONS

Auricular pseudocyst recurrences show no relationship with either the LDH levels or isozyme pattern. An undiluted solution of steroid fluid should be used in order to prevent recurrences.

Costochondral grafts in reconstruction of the temporomandibular joint after condylectomy: an experimental study in sheep

The purpose of this study was to investigate the effect of costochondral grafts in the temporomandibular joint (TMJ) in sheep. Five pure-bred adult Merino sheep were used. The condyle alone was resected and replaced with a costochondral graft from the 13th rib. The sheep were killed 3 months after operation. The range of jaw movements before and after operation and at death were recorded. The joints were examined radiologically, macroscopically, and histologically. A new condylar head with normal configuration and function developed. Histologically, the chondrocytes were arranged in a fashion similar to that of a normal joint. All inferior joint spaces showed fibrous adhesions between the condylar head and disc. This study showed that, when such grafts are used to replace the condyle in an otherwise normal sheep TMJ, they fused to the ramus and reconstituted a nearly normal, fully functional joint.

Effect of partial immobilization on reconstruction of ankylosis of the temporomandibular joint with an autogenous costochondral graft:an experimental study in sheep

The purpose of this study was to show the effect of partial immobilization of a costochondral graft reconstruction of an ankylosed temporomandibular joint (TMJ) in five adult sheep. Ankylosis was induced in all right TMJs. At three months, a graft was inserted and partially immobilized. Three months after the second operation, four sheep were killed by an overdose with pentothal. One sheep was killed at one month because of infection. Functionally, the body weight, which decreases with ankylosis, did not recover after insertion of the graft and the range of jaw movements got worse. Histologically, the grafts were well attached to the mandibular rami in three of four joints. In one joint, the graft showed signs of resorption and a foreign body reaction. We conclude that, if the reconstructed joint is partially immobilized, then there will be a degree of reankylosis. There was also a high failure rate.

Acute myocardial infarction showing total occlusion of right coronary artery and thrombus formation of left anterior descending artery

A 33-year-old Japanese man had an attack of chest pain associated with ST-segment elevation in the inferolateral leads on his electrocardiogram. Emergency coronary angiography showed total obstruction in the mid right coronary artery (RCA) and a movable thrombus in the proximal left anterior descending artery (LAD). We performed emergency percutaneous transluminal coronary angioplasty (PTCA) for the RCA lesion. The operation was successful and we then conducted intracoronary thrombolysis (ICT) with tisokinase 6,400,000 IU for the LAD thrombus. Its size was reduced by ICT. He had an uneventful hospital course. After 1 month, repeat coronary angiography showed no significant stenosis in the RCA nor thrombus in the LAD. A coronary spasm provocation test was performed using acetylcholine. Coronary spasm in the LAD was induced by an intracoronary injection of 100 microg acetylcholine. In this case, we observed a unique condition suggesting simultaneous double coronary artery occlusion.