Effect of recombinant human erythropoietin administration on peripheral blood neutrophil counts of premature infants

To clarify whether administration of recombinant human erythropoietin (rHuEpo) may have toxic effects on neutrophil production in premature infants, 10 low birth weight infants who received rHuEpo, 200 U/kg per week, were studied retrospectively. Treated infants were compared with 10 untreated infants. None of the infants studied had infection antenatally or postnatally. In both groups the neutrophil count remained greater than 5000/mm3 for the first 3 weeks and decreased markedly at approximately 4 weeks. Although reticulocyte counts were significantly elevated in the rHuEpo-treated group, the difference in neutrophil counts between the groups was not significant. In addition, administration of rHuEpo did not exert any significant effect on granulocyte-macrophage colony formation of circulating hematopoietic progenitors in neonates. Thus no evidence was found that administration of rHuEpo has toxic effects on granulopoiesis in premature infants.

Monoamine oxidase activity in rat organs during pregnancy

To elucidate the involvement of MAO activity in rat pregnancy, female rats exhibiting at least 3 consecutive 4-day estrous cycles were used. The day of sperm-positive smears was designated as day 0 of pregnancy. The rats were sacrificed on day 2 of diestrus (diestrus-2) and days 7, 14 and 21 of gestation. The organs were collected and weighted, and mitochondrial fractions were prepared for MAO analysis with kynuramine dihydrobromide as substrate. Specific activity (pmol/mg of protein/min) in the ovary is significantly lower in rats on diestrus-2 (792 +/- 127) (mean +/- S.D.) than on day 14 (1,038 +/- 140) and day 21 (1,580 +/- 61) of pregnancy. However, the levels of MAO activity in the uterus of rats on diestrus-2 (899 +/- 266) is higher than on day 21 (570 +/- 80) of pregnancy. The MAO activity in the placenta on day 21 (644 +/- 82) was higher than day 14 (356 +/- 88) of pregnancy. Total MAO activity per organ (nmol/min) of ovary on day 21 (27.2 +/- 5.2) is higher than on diestrus-2 (8.7 +/- 3.0) and on day 14 (14.2 +/- 3.6). Our results suggest that MAO activity in rat reproductive organs such as uterus, ovary, and placenta might fluctuate significantly near term, in correlation with steroid levels, tissue catecholamine contents and so on, in order to maintain pregnancy.

[A case report of BWG syndrome in an elderly patient performed with mitral valve replacement 11 years after single CABG]

A 46-year-old female who had undergone single CABG for BWG syndrome 11 years ago was referred to our hospital for paroxysmal atrial fibrillation. The roentgenogram showed slightly cardiomegaly and the enlargement of LA. Ischemic changes of ECG appeared at I, aVL, V5, V6, as inverted T wave, and low voltage R wave at V1-V4, but non Q wave. The thallium-201 emission computed tomogram at exercise revealed poor perfusion at apical region without redistribution pattern. Catheterization showed mitral regurgitation (grade III), big right coronary artery (RCA) arising from aorta, rich collateral to poor left coronary artery (LCA), and bypass graft was obstructed. The proximal end of LCA was closed, and didn't arise from both pulmonary artery and ascending aorta. In this cases, MVR only without re-CABG to LCA was selected and performed. Postoperative course was uneventful. The result of this case suggested that MVR was an effective surgical procedure for MR of BWG syndrome in the adult case and it was better to add CABG to LCA as much as possible if the ischemic region was large.

[Clinical assessment of complement activation and leukocyte kinetics during cardiopulmonary bypass: the effect of cepharanthine]

Complement activation and leukosequestration to the lung was studied during cardiopulmonary bypass in eleven patients undergoing cardiac operation without blood transfusion. Six patients (group I) received methylprednisolone before and after the bypass, and the other five (group II) received cepharanthine (biscoclaurin alkaloid) before the bypass associated with methylprednisolone therapy. Leukosequestration to the lung was observed at the time of reperfusion of the lung only in group I, although complement activation estimated by the increase of C 4 a and C 3 a was quite similar in both group. Cepharanthine prevented the sequestration of the leukocyte to the lung may be by its membrane stabilizing effect.

[A case of gastric cancer with multiple liver metastases responding significantly to intra-arterial infusion of epirubicin/mitomycin C-lipiodol suspension]

We encountered a case of partial response in a patient with multiple liver metastases from gastric cancer as a result of treatment by hepatic artery infusions of epirubicin/mitomycin C-Lipiodol suspension. A 56-year-old man was diagnosed as having advanced gastric cancer with multiple liver metastases. Subtotal gastrectomy with regional lymph node dissection and cholecystectomy were performed, and an injection port was implanted in the proper hepatic artery. Ten days after the operation, the intermittent chemotherapies were performed, and 3 months after the effect was judged to be a partial response by CT scan. Severe side effects were not seen during treatment, and the man is now healthy and working for more than one year after the operation. Thus, this regimen may be found useful for patients with liver metastases.

Deep breathing test (DBT) in predicting white coat hypertension

We have evaluated the diagnostic value of deep breathing test (DBT) in detecting the patients with white coat hypertension on the outpatient basis. Thirty patients with untreated mild to moderate hypertension underwent 24-hour ambulatory blood pressure monitoring. Those who had a mean 24-hour blood pressure less than 135/80 mmHg were categorized as having white coat hypertension and the remainder were categorized as sustained hypertension. These two groups were compared with regard to the differences of office blood pressures before and after DBT (i.e., deep breathing 5 times for a minute in sitting position). Although the office systolic pressure significantly fell after DBT in both groups (p < 0.001 vs p < 0.05), there was no significant difference (p = 0.27) between the two groups. On the other hand, the office diastolic blood pressure significantly fell in the white coat hypertensives in contrast with no meaningful fall of it in the sustained hypertensives (p < 0.01 vs p = 0.66). At the cutoff level of -3%, -5% and -10% of the differences in office diastolic blood pressure before and after DBT, the sensitivity for the presence of white coat hypertension were 64.7%, 58.8% and 29.4%, respectively, and the specificity were 61.5%, 84.6% and 100%, respectively. These findings demonstrate that the deep breathing test is useful for identifying white coat hypertension in the outpatient clinic.

Young female alcoholics with and without eating disorders: a comparative study in Japan

OBJECTIVE

The authors sought to delineate the characteristics of female alcoholics with eating disorders.

METHOD

The study subjects were 29 female Japanese outpatients and inpatients, 30 years of age or younger, with DSM-III-R diagnoses of either alcohol dependence or alcohol abuse and eating disorders. Twenty-one female alcoholics within the same age range who did not have eating disorders served as the comparison group. The social and familial backgrounds, clinical course, and clinical symptoms of the two groups were compared with the use of a structured interview form developed for the study.

RESULTS

Ninety-three percent of the subjects with eating disorders had bulimia nervosa; 52% had anorexia nervosa. In all cases, both disorders continued after the onset of problem drinking. The age distributions of the two groups of alcoholic subjects clearly differed: no one in the comparison group was under the age of 24, and the number of comparison subjects increased with age after age 24, whereas the subjects with eating disorders ranged in age from 19 to 30 years, with the greatest number at age 26. More of the alcoholic subjects with eating disorders had never been married, they had had an earlier onset of alcoholism, and they had lower body weights than those without eating disorders. Also, more of them had depression and borderline personality disorder.

CONCLUSIONS

The findings suggest that young female alcoholics with eating disorders constitute a clinical subgroup of alcoholics with distinct sociodemographic characteristics and a clinical course and symptoms that differ from those of both younger and older female alcoholics without eating disorders.

[Alcohol and sudden death: a survey on alcohol-related deaths at tokyo Metropolitan Medical Examiner's Office (1989)]

Seven thousand three hundred seventy-six sudden or violent manner of deaths were inspected or autopsied at Tokyo Metropolitan Medical Examiner's Office in 1989. Out of these victims, 693 (9.4%) victims were regarded as heavy drinkers on the basis of the drinking habits and the autopsy reports and 196 (2.7%) victims without past problem drinking were thought to be drunk at death from the family statements or the blood alcohol analysis. The total 889 (12.1%) alcohol-related cases (autopsy was performed on the 489 cases) were studied from epidemiological and etiological viewpoints. The average age of the alcohol-related victims (male: 811, female: 78) was 52 +/- 11 years. In middle-aged (45-54 years) men, 34% of the all sudden or violent deaths were alcohol-related. About half of the alcohol-related victims were living alone and jobless and they often died at home, particularly in the bed. In the alcohol-related victims, the blood alcohol concentration (BAC) analysis revealed that the average BAC of female was significantly higher than that of male. (2.12 +/- 1.73 mg/ml vs. 1.33 +/- 1.75, P < 0.01). This difference may be associated with sex difference in ethanol metabolism, body composition and drinking habits. Among the major causes of the alcohol-related deaths, alcoholic liver diseases accounted for 226 (25%), gastro-intestinal bleedings for 115 (13%), cardiovascular diseases for 105 (12%) and violent deaths (e.g., acute alcohol intoxication, falls, traffic accidents, suicide) for 329 (37%). By histopathological examination of the liver, about 30% of the alcoholic liver disease cases showed mainly fatty metamorphosis and 48% showed liver cirrhosis. Only 12% of the cirrhotics had either jaundice or ascites, suggesting hepatic failure. Alcoholic cardiomyopathy was suspected in only 11 cases. In conclusion, many people, particularly middle-aged men, lose their lives due to heavy drinking and there are many pathologically unexplainable sudden deaths of alcoholics.

Alcoholics with eating disorders: prevalence and clinical course. A study from Japan

Investigation of the prevalence of eating disorders among a large sample of Japanese alcoholics admitted for hospital treatment revealed a strong association between eating disorders and alcohol abuse and alcohol dependence among young women. That association was not apparent in young men. The results of this study of the clinical courses of eating disorders and alcohol abuse and alcohol dependence suggest that women with eating disorders, especially bulimia nervosa, are at high risk of becoming alcoholic.

Effect of ethanol and progesterone on monoamine oxidase activity in cultured cells of human term placenta

OBJECTIVE

The aim of this study was to evaluate the effect of ethanol and progesterone on the monoamine oxidase activity in cultured human term placental cells.

STUDY DESIGN

Human placental cells were prepared from normal human term placentas by enzymatic dispersion in Dulbecco's modified Eagle medium. The viability of placental cells prepared by our method was 90%, and the yield of placental cells was 0.6 x 10(6) cells per gram of wet placental tissue. Five milliliters of Dulbecco's modified Eagle medium containing 3 x 10(5) placental cells was plated in a 25 cm2 flask and cultured for 8 days in an incubator at 37 degrees C under an atmosphere of 5% carbon dioxide and 95% oxygen with a saturated humidity. During the culture period the culture medium was replenished every 2 days. A confluent monolayer condition was achieved after 8 days in culture. The cultured placental cells were treated with different concentrations of ethanol (0, 34.6, and 69.2 mmol/L) and progesterone (0, 16, and 32 mumol/L) on day 8 of culture for 48 hours. At the end of treatment placental cells from control and treated flasks were harvested for the analysis of monoamine oxidase activity by spectrophotometry. The effects of ethanol and progesterone on cultured placental cells were statistically analyzed by one-way analysis of variance followed by Duncan's multiple comparisons procedure.

RESULTS

A human placental cell culture system has been established from normal human term placentas. The monoamine oxidase activity in 8-day-cultured human term placental cells was significantly higher than that of freshly prepared placental cells. Ethanol concentrations at 34.6 and 69.2 mmol/L significantly increased and progesterone concentration at 32 mumol/L significantly decreased the monoamine oxidase activity.

CONCLUSION

These results suggest that the cultured human term placental cells can be used to examine the in vitro effects of ethanol and progesterone on monoamine oxidase activity. However, the physiologic significance of progesterone's inhibitory effect and the stimulatory effect of ethanol monoamine oxidase activity in the in vivo system have yet to be further investigated.

[ALDH phenotype in eating disorders with and without alcoholism]

Individuals who have inactive low Km aldehyde dehydrogenase (ALDH2) are much less likely to develop alcoholism than those who have active ALDH2. On the other hand, frequent alcoholism has been reported in eating disorder patients. Whether inactive ALDH2 works as an inhibitory factor for alcoholism in these patients is not known. We compared the ALDH2 phenotype in eating disorder patients with and without alcoholism. Among the 25 subjects (4 with anorexia nervosa, 6 with anorexia nervosa and bulimia nervosa, 13 with bulimia nervosa and 2 with eating disorder not otherwise specified according to the DSM-III-R), 13 were alcoholics and 12 were non-alcoholics. Isoelectric focusing of hair roots samples demonstrated that 8% of the alcoholic subjects had the inactive ALDH2, while 58% of the non-alcoholic subjects had this variant form of the isozyme (p < 0.01). The results suggest inactive ALDH2 has a similar inhibitory effect for alcoholism as in eating disorder patients as has been reported in normal populations.

Alcohol-related problems encountered by Japanese, Caucasians, and Japanese-Americans

Using population-based survey data, personal-problematic and socioproblematic factors were examined among Japanese in Japan, Japanese-Americans in Hawaii, and Japanese-Americans; Caucasians in California were analyzed as a control group. Caucasian males were more likely to exhibit drinking-related social problems, whereas Japanese males showed more personal-problematic symptoms. Japanese-American men, both in Hawaii and California, were least likely among the three ethnic groups to have personal-problematic symptoms and were more likely to have socioproblematic symptoms than Japanese men. These differences might be explained by differences in the perception of social problems.

[Eosinophilic leukemia with cyclic eosinophilic leukocytosis]

A 36-year-old male was admitted to the Ehime University Hospital with anemia, eosinophilia and hepatosplenomegaly. Peripheral blood examination demonstrated severe anemia (Hb 7.1g/dl), thrombocytopenia (Plt 6.8 x 10(4)/microliters) and increase of peripheral leukocyte counts (53,000/microliters) with 32.0% of eosinophils which had lobulated nuclei, abnormal distribution of eosinophilic granules and a few vacuoles. The level of serum IgE was low (< 5IU/ml), while that of serum vitamin B12 was elevated. A diagnosis of eosinophilic leukemia was made. He was noted to have spontaneous fluctuations in his eosinophil and total leukocyte counts. To analyze the mechanism of cyclic eosinophilic leukocytosis, we examined eosinophil colony stimulating activity of the serum and plasma of the patient. These examination showed that eosinophil colony-stimulating activity was not found in his serum and plasma, and cyclic eosinophilic leukocytosis was due to the hemopoietic stem cell disorder.

The effect of acculturation on drinking attitudes among Japanese in Japan and Japanese Americans in Hawaii and California

Data from a joint Japan-U.S. collaborative study were examined to determine the relationship of acculturation to drinking attitudes among Japanese in Japan and Japanese Americans in Hawaii and California. Drinking attitudes (i.e., self-reported acceptable or appropriate levels of drinking) among ethnic groups differed significantly for the nine situations studied: (1) at a bar with friends, (2) at a party at someone else's house, (3) as a parent, spending time with small children, (4) during working hours, (5) visiting in-laws, (6) with friends at home, (7) with friends after work, (8) with people at sports events and (9) before driving a car. Factor analysis was used to determine the differences in drinking attitudes among these ethnic groups. Japanese and Japanese Americans differentiated drinking situations into different categories. The major difference between the two groups was that the Japanese associated spending time with small children with a situation appropriate for drinking, such as being with friends at home, whereas Japanese Americans associated spending time with small children with a situation inappropriate for drinking, such as before driving.

The relationship between low Km aldehyde dehydrogenase phenotype and drinking behavior in Japanese

The relationship between the low Km aldehyde dehydrogenase (ALDH2) phenotype determined by the isoelectric focusing of hair root lysates, facial flushing and alcohol drinking patterns in Japanese (N = 282) was examined. Men who had inactive ALDH2 drank significantly less alcohol than those with active ALDH2. Although the effect was less noticeable, a similar relationship was detected in women. Two types of flushing responses were determined: one due to the inactive ALDH2, the other unrelated to this variant form of the isozyme. A striking difference between these flushing types, in terms of the inhibitory influence over drinking patterns, was noted. Nearly 86% of the subjects who reported always flushing in the face were shown to have inactive ALDH2, whereas infrequent flushing and absence of flushing were associated with active ALDH2. Thus, facial flushing may be used as an indicator of ALDH2 phenotype.

Special treatment facilities for alcoholics in Japan

No comprehensive study on special treatment facilities for alcoholics in Japan has been reported. We conducted a questionnaire survey of alcoholism treatment wards, alcoholism treatment rooms, special outpatient clinics for alcoholics and halfway houses for alcoholics. The survey covered nearly all of such facilities in Japan. The results of the survey revealed the following characteristics: (1) The number of such facilities has increased rapidly in recent years; (2) the facilities are concentrated in cities; (3) the great majority of the facilities are privately operated; (4) many of the facilities are associated with psychiatric departments; and (5) there are very few facilities exclusively for female alcoholics. The most fundamental and important point is that the number of special treatment facilities for alcoholics is insufficient to meet current needs. These facilities have not diversified sufficiently to address adequately the changing needs of Japanese alcoholics.

Impaired autonomic nervous system in alcoholics assessed by heart rate variation

The suppression of heart rate variation reflects cardiac autonomic nervous dysfunction and is known to be associated with a poor prognosis or sudden death in diabetic patients. We investigated consecutive changes in the heart rate variation in 51 alcoholics using the coefficient of variation of R-R interval (CVRR). To correct for age effects, a ratio of CVRR to the standard predicted value (CVP) was calculated. On the whole, CVRR/CVP was suppressed on admission and on the 7th day of abstinence and increased on the 30th day. However, alcoholics could be divided into two groups by their CVRR/CVP on the 30th day: one group with transient autonomic dysfunction whose CVRR/CVP was more than 0.8 (n = 32), and the other group with persistent autonomic dysfunction whose CVRR/CVP was less than 0.8 (n = 19). Withdrawal hypertension occurred more frequently (63% vs. 19%) and mean systolic pressure (159 +/- 24 mmHg vs. 138 +/- 17 mmHg) was higher in the latter group than in the former, suggesting that persistent autonomic damage might, at least in part, contribute to withdrawal hypertension. To investigate further the relationship between the persistent autonomic damage and other complications, the CVRR/CVP on the 30th day of abstinence was analyzed in an additional 85 alcoholics (total n = 136). Persistent suppression of the CVRR/CVP was more frequently found in alcoholics with leg paresthesia (64%, n = 22), the Wernicke-Korsakoff syndrome (73%, n = 11), or diabetes mellitus (69%, n = 68), than in alcoholics without these complications (31%, n = 35).(ABSTRACT TRUNCATED AT 250 WORDS)

[Problem drinkers among high school students in Japan]

In Japan, an increase in the consumption of alcohol by young people has been noted. This survey on drinking problems was performed on 1062 students of second year high school in 1990 using the Adolescent Alcohol Involvement Scale (AAIS). The results revealed that among all of the survey subjects of both sexes, 21.4% were abstainers, 4.2% normal adolescents, 60.9% non-problem drinkers, 12.6% alcohol misusers and 0.9% alcoholic-like drinkers. A high alcohol consumption rate and high percentages of those with drinking problems were observed among high school students. Students who used other addictive substances (i.e., smoking or thinner inhalation) reported significantly higher AAIS scores than those who didn't. Similarly high mean AAIS scores were found among students with family problems such as drinking parents or broken homes than those without this problem. Alcohol misusers and alcoholic-like drinkers accounted for 14.2% of males and 12.7% of females. In a survey performed 10 years previously on high school students, no alcoholic-like drinkers were found and only 1% were alcohol misusers. These results indicated that problem drinkers have dramatically increased among Japanese high school students in the last 10 years.

Gossypol effects on monoamine oxidase (MAO) activity in several organs of term rats

In order to study the effect of gossypol on the monoamine oxidase (MAO) activity in pregnant rat organs, 20 day pregnant rats were sacrificed, and MAO activity/0.02 g tissue of several organs and total MAO activity/organ, were determined. The control group (n = 5) were injected with vehicle intramuscularly on the 17th, 18th and 19th day of pregnancy, and the gossypol treated group (n = 4) were injected with gossypol acetic acid (GAA) (25 mg/kg of body weight) intramuscularly on the 17th, 18th and 19th day and were decapitated on the 20th day of pregnancy. Maternal liver, uterus, placenta, and fetal liver were collected and examined. In placenta, total MAO activity/organ was significantly (p less than 0.05) lower in the GAA treated group than that in the control group. However, in maternal liver, uterus and fetal liver, there was no significant difference in total MAO activity/organ between the two groups. There was no significant difference in MAO activity/0.02 g tissue (specific activity), weight of organ, protein weight/organ and protein/g tissue between the two groups in maternal liver, uterus, placenta and fetal liver. These results suggest that, after intramuscular injection of GAA, total MAO activity/organ in the placenta of pregnant rats might decrease significantly.

Effects of progesterone and gossypol on monoamine oxidase activity in human term placental explant

Human placental explant was cultured, using fresh full term placenta delivered by elective cesarean section (n = 10), and monoamine oxidase (MAO) activity was measured in the tissue by the spectrophotometric method. Placentae were obtained from patients without complications in pregnancy. Chorionic villi 2 g was incubated for 3 hr under the 95% air-5% CO2 humidified condition at 37 degrees C. When progesterone was added in the media (100-500 micrograms/ml), MAO activities significantly decreased, compared with the control. The gossypol (100 micrograms/ml) treated group showed no inhibitory or stimulatory effects on MAO activities, compared with the control. However, progesterone (100-500 micrograms/ml) and gossypol (100 micrograms/ml) treated group showed the same value of MAO activities, compared with the control. Those results indicate that gossypol might block progesterone action which is inhibitory against MAO activity. The mechanism of pharmacological function of gossypol was discussed.

The protein synthesis of human full term placenta cell in monolayer culture system

Protein synthesis of human placenta from cesarean section was analyzed by SDS gel electrophoresis using full term cell culture system. The qualitative pattern of cytoskeletal proteins before and after culture was also examined. After trypsinization, cytotrophoblasts were cultured for 20 days in the humidified incubator of 5% CO2 in 95% air. The confluency was obtained in 10 days after inoculation. The pattern of SDS-PAGE showed several protein bands including actin (43,000 Da) and desmin (55,000 Da) as major constituents of 12 and 20 day cultures. The significant differences between band appearances in samples before and after culturing were noted. The present results indicated that myosin may not be synthesized in high content, differing from previous observations. Cytoskeletal protein production seemed to be markedly enhanced in the cultured system.