[Role of endothelin-B receptors in the pulmonary circulation]

Endothelin-1 (ET-1) is a potent vasoactive peptide and is thought to play an important role in the regulation of vascular tone. ET-1 can both constrict blood vessels, via endothelin-A (ET-A) receptors in vascular smooth muscle cells, and dilate then via endothelin-B (ET-B) receptors in endothelial cells in the systemic circulation. To determine the role of ET-B receptors in the pulmonary circulation, we examined the hemodynamic effects of a selective ET-B receptor agonist (IRL 1620) in rats. In rat lungs perfused with a salt solution, IRL 1620 caused pulmonary vasoconstriction in a dose-dependent manner. In lungs perfused with a hypoxic half-blood solution (10% O2), doses of IRL 1620 less than 10 nM caused pulmonary vasodilation, but higher doses caused pulmonary vasoconstriction. IRL 1620 caused transient vasodilation of the systemic circulation at every dose used (0.1, 1, and 5 nmol/kg) in anesthetized rats. In contrast, the effects of IRL 1620 on the pulmonary circulation varied with the dose. Small doses (0.1 or 1 nmol/kg) caused pulmonary vasodilation, but a higher dose (5 nmol/kg) caused pulmonary vasoconstriction. These results show tachyphylaxis in the pulmonary vasodilator response to IRL 1620, but not in the systemic vasodilator response. The present data show the dual action (vasoconstriction and vasodilation) of ET-B receptors.

[A case of severe odontogenic infection with allergic skin reaction for beta-lactam antibiotics]

A 54-aged woman consulted with right buccal phlegmon caused by lower apical periodontitis. The primary chemotherapy using flomoxef induced allergic skin eruption. A decision was made for using clindamycin, levofloxacin and fosfomycin as chemotherapeutic agents. Cultured organisms from the abscess revealed the mixed infection with Streptococcus sanguis, Veillonella sp., Prevotella loescheii, Wolinella spp. On 12th hospital day, her serum CRP turned to negative. This case carried numerous implications for the use of antibiotics as chemotherapy agents.

[Survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who received home oxygen therapy]

We studied the relationship between survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis. We also studied the effect of home oxygen therapy (HOT) on pulmonary hemodynamics in those patients. The subjects were 59 patients who were treated with HOT after right-heart catheterization. Blood gases and pulmonary hemodynamics were measured twice: while the patients breathed air and after they had inhaled pure oxygen. In 11 patients, right-heart catheterization done before and after HOT was begun. Before HOT was begun, 49 patients were given the diagnosis of pulmonary hypertension, but the difference in survival between those who had and those who did not have pulmonary hypertension was not statistically significant. Mean pulmonary artery pressure fell by more than 5 mmHg after inhalation of pure oxygen in 5 patients (responders), but survival did not differ between responders and non-responders. Blood-gas volumes and pulmonary hemodynamics did not differ between those who died within 2 years after right-heart catheterization and those who lived for more than 5 years. Pulmonary arterial resistance and mean pulmonary artery pressure decreased significantly after HOT was begun. HOT can reduce mean pulmonary artery pressure in patients with sequelae of pulmonary tuberculosis, but survival on HOT is not related to the presence of pulmonary hypertension or to the effect of pure oxygen on mean pulmonary artery pressure.

Third complementarity-determining-region sequence analysis of lymphocytic interstitial pneumonia: most cases demonstrate a minor monoclonal population hidden among normal lymphocyte clones

We analyzed the third complementarity-determining region (CDR3) of the immunoglobulin heavy chain (IgH) gene in five patients with lymphoid interstitial pneumonia (LIP) through a two-step polymerase chain reaction (PCR) and sequencing analysis. By sequencing analysis of the PCR products, morphologic LIP could be divided into two groups: a polyclonal type and a minor monoclonal type. Because of their high frequencies, minor monoclonal clones seemed to be neoplastic clones hidden in normally reactive lymphocyte clones. Consequently, only the polyclonal type might have represented true LIP. Sequencing of the PCR products from open-chest biopsy and transbronchial lung biopsy (TBLB) specimens obtained 8 yr later in one patient with minor monoclonal type LIP confirmed this possibility. In true LIP, six of 20 lymphocyte clones showed 67 to 86% homology with lymphocyte clones derived from fetal tissue. In three of these six clones, the D-region (N-D-N) lengths were very short, whereas four clones showed a high homology with autoreactive lymphocytes (rheumatoid factor, anti-DNA antibody, and G6-positive lymphocytes). Since rheumatoid factors, anti-DNA antibodies, and G6 are autoreactive antibodies, immature B cells stimulated by autoantigens might play some role in the pathogenesis of true LIP.

The effect of endovascular therapy for cerebral arterial spasm, its limitation and pitfalls

PURPOSE

The effect of endovascular treatment for vasospasm was investigated by analysing the results of patients treated in Wakayama City in 1994.

MATERIALS AND METHODS

Ninety nine patients with ruptured cerebral aneurysms, who survived more than one week and were treated in Wakayama City in 1994, were studied. Twenty five patients caused symptomatic vasospasm and 25 were treated by endovascular therapy, percutaneous transluminal angioplasty (PTA) and/or intra-arterial papaverine infusion (IAP). PTA was performed for proximal vasospasm which located in the main arterial trunk, such as ICA, M1, BA (n = 3). IAP was chosen for distal vasospasm which located mainly in the M2, A1, A2 (n = 12). PTA and/or IAP was performed for diffuse vasospasm which located in proximal and distal arteries (n = 10).

RESULTS

In the proximal vasospasm group, all patients were good to moderately disabled on the Glasgow outcome scale (GOS). In the distal vasospasm group, 8 patients were good to moderately disabled, and 4 patients were severely disabled. The overall results were as follows: 17 (68%), good to moderately disabled, 4 (16%), severely disabled, 4 (16%), dead. The morbidity and mortality rate was 8/25 (32%) in symptomatic spasm group.

CONCLUSION

PTA was very effective especially for proximal vasospasm, but IAP was not always effective for distal or diffuse vasospasm. Diffuse vasospasm revealed a high mortality rate in spite of the endovascular therapy.

Identification of macrophage migration inhibitory factor in murine neonatal calvariae and osteoblasts

Bone resorption and formation are dynamic processes that occur in both normal and injured bone tissues. Regulation of these processes is mediated at the local level by cytokines and growth factors. Macrophage migration inhibitory factor (MIF) is one of the proinflammatory cytokines that activates macrophages and regulates production of other cytokines, such as tumour necrosis factor-alpha and interleukin-1. We here demonstrate, by reverse transcription-polymerase chain reaction, high expression of MIF mRNA in murine osteoblasts obtained from mouse neonatal calvariae and murine osteoblastic MC3T3-E1 cells. The presence of MIF protein in the osteoblasts was confirmed by Western blot analysis using anti-rat MIF antibody. Moreover, the immunohistochemical study revealed that MIF was localized largely in the cytoplasm. The pathophysiological function of MIF remains undefined; however, the present results suggest that MIF takes part in the osseous metabolism as well as in immunological events.

Effect of prior O2 breathing on ventilatory response to sustained isocapnic hypoxia in adult humans

Sixteen healthy volunteers breathed 100% O2 or room air for 10 min in random order, then their ventilatory response to sustained normocapnic hypoxia (80% arterial O2 saturation, as measured with a pulse oximeter) was studied for 20 min. In addition, to detect agents possibly responsible for the respiratory changes, blood plasma of 10 of the 16 subjects was chemically analyzed. 1) Preliminary O2 breathing uniformly and substantially augmented hypoxic ventilatory responses. 2) However, the profile of ventilatory response in terms of relative magnitude, i.e., biphasic hypoxic ventilatory depression, remained nearly unchanged. 3) Augmented ventilatory increment by prior O2 breathing was significantly correlated with increment in the plasma glutamine level. We conclude that preliminary O2 administration enhances hypoxic ventilatory response without affecting the biphasic response pattern and speculate that the excitatory amino acid neurotransmitter glutamate, possibly derived from augmented glutamine, may, at least in part, play a role in this ventilatory enhancement.

[Outcome of long-term nasal intermittent positive pressure ventilation in 41 patients with hypercapnic respiratory failure]

Nasal intermittent positive pressure ventilation (NIPPV) is widely used in domiciliary treatment of chronic ventilatory disorders. The outcomes of long-term NIPPV were analyzed in 41 patients with hypercapnic respiratory failure due to pulmonary tuberculosis sequelae (PTS; n = 17), neuromuscular disease (NMD; n = 8), kyphoscoliosis (KS; n = 7), chronic obstructive pulmonary disease (COPD; n = 6), and miscellaneous diseases (n = 3). Twenty-seven patients with chronic conditions but without acute exacerbations began receiving NIPPV, and fourteen patients began receiving NIPPV after an acute exacerbation. Outcome measures included the probability of continuing NIPPV, survival after starting NIPPV, survival after starting home oxygen therapy (HOT), arterial blood gases, nocturnal oxygen saturation, pulmonary function, and the number of hospital days. Two patients with PTS died, 7 and 40 months after starting NIPPV. Two patients (one with PTS and one with COPD) switched from NIPPV to intermittent positive pressure ventilation via a tracheostomy. The condition of one patient with NMD improved and NIPPV was discontinued. The three-year and five-year probabilities of continuing NIPPV in all patients were 82%, and 71%, respectively. The survival rates three and five years after starting NIPPV were 97% and 85%, respectively. The survival rates one to nine years, and ten to eleven years after starting HOT were 98% and 65%, respectively. The arterial PO2 and PCO2, nocturnal oxygen saturation, vital capacity, and forced expiratory volume, in one second all improved after NIPPV was begun. NIPPV also reduced the number of hospital days, particularly in patients with KS. In conclusion, the long-term outcome of NIPPV in patients with hypercapnic respiratory failure is encouraging.

[Prognostic value of acute pulmonary vascular response to oxygen inhalation in patients with chronic obstructive pulmonary disease]

Seventy-two patients with chronic obstructive pulmonary disease (COPD) underwent right heart catheterization when they were clinically stable and the relationship between length of survival and acute pulmonary vascular response to 100% oxygen inhalation was studied. Oxygen inhalation significantly reduced mean pulmonary arterial pressure (PPA), cardiac index (CI), and pulmonary arteriolar resistance (PAR). The percent change in PAR (% delta PAR) was used as an index of the acute pulmonary vascular response to 100% oxygen inhalation. Each patient was classified as a responder (% delta PAR > or = 15%) or a nonresponder (% delta PAR < 15%). The cumulative survival rates of these two groups were compared. Responders survived significantly longer than did nonresponders (mean survival times were 2571 days and 1432 days, respectively). The two groups did not differ significantly in anthropometic data, pulmonary hemodynamics, or blood gas data measured at base line during air inhalation. However, FEV1 and VC were significantly lower in nonresponders than in responders. The % delta PAR was not significantly related to age, PPA, PAR on air inhalation, FEV1, FEV1%, VC or VC%. We conclude that the pulmonary vascular response to oxygen inhalation (% delta PAR) may be an independent prognostic factor in patients with COPD.

Quality of life and anxiety before and after lung cancer chemotherapy: relationship to patient's personality

The purpose of the study was to assess the quality of life (QOL) and anxiety in 50 inpatients with primary lung cancer and examine the influence of their personalities on the QOL assessment. We used a psychological personality test to evaluate the patient's personality, then followed the course of QOL and anxiety before and after chemotherapy. To measure QOL, we used Holmes's QOL checklist, and the State-Trait Anxiety Inventory was adopted to estimate the patient's anxiety. Eighty courses of chemotherapy were administered, and QOL evaluations were performed 235 times. By using factor analysis, the somatic, social and psychological factors were extracted which confirmed the reliability and validity of the QOL checklist. The psychological QOL score showed a correlation with A (Adult) and AC (Adapted Child) of the five ego states in the Egogram. Therefore, it is important to survey the patients' personalities in order to grasp their QOL accurately.

Genomic structure and chromosomal assignment of the mouse Ku70 gene

DNA-dependent protein kinase (DNA-PK) consists of three polypeptide subunits: Ku70, Ku80, and the DNA-PK catalytic subunit (DNA-PKcs). Mammalian mutants deficient in either Ku80 or DNA-PKcs function have been shown to be lacking in DNA double-strand break repair and V(D)J recombination, respectively. The precise role of the Ku70 gene in this process has not yet been determined, in part because no cell lines, animals, or human diseases involved with deficiencies in this gene have yet been identified. Both the human and the mouse Ku70 cDNAs have been cloned, and the human gene has been mapped to chromosome 22q13. The original mouse cDNA clones, however, lacked a complete 5'-region, and none of the mammalian Ku70 genomic sequences have been characterized. This report contains an analysis of the 5'-region of the mouse cDNA sequence, a characterization of the mouse Ku70 genomic structure, and fluorescence in situ hybridization data that map the mouse gene to chromosome 15. The deduced amino acid sequence of the mouse gene consists of 608 amino acids compared to 609 for the human gene. The genomic sequence is 24 kb and consists of 13 exons, including an untranslated first exon. Sequences from the upstream region of exon 1 revealed four consensus GC box sequences and a strong transcription initiation site at a reasonable location. The assignment of the mouse Ku70 gene to chromosome 15 is consistent with the syntenic relationship of this gene in human (chromosome 22q13) and mouse and adds to the comparative mapping data for the genes involved in the SCID phenotype.

Sleep oxygen desaturation in late sequelae of pulmonary tuberculosis

Thirty-eight patients with late sequelae of pulmonary tuberculosis (TB seq.) were studied to clarify the characteristics of sleep desaturation in comparison with 40 patients with chronic obstructive pulmonary disease (COPD). While awake, the TB seq. group had a lower % VC and a higher PaCO2. In both groups, the sleep lowest SaO2 was positively correlated with the awake SaO2. The regression line between the sleep lowest SaO2 and the awake baseline SaO2 in the TB seq. group was located below that in the COPD group. Awake PaCO2 was negatively related to the sleep lowest SaO2 only in the TB seq. group. These results indicate that the sleep lowest SaO2 values were lower in TB seq. than in COPD patients with the same levels of SaO2 while awake. Sleep studies are necessary to reveal the indication for nocturnal oxygen therapy in TB seq. patients, especially when they are hypercapnic in spite of their good awake oxygenation.

[Serial computed thermography for Raynaud's phenomenon of patient with progressive systemic sclerosis (PSS)]

We reported a case with progressive systemic sclerosis, a relatively rare disease in childhood. Raynaud's phenomenon (RP) of the patient was serially monitored by computed thermography for 1 year. Although clinically apparent RP manifested only in winter season, thermographical changes were documented through all season, suggesting that RP is a constitutional sign which may emerge in winter by provocation of atmosphere. Thus, we recommend to use the words, "Raynaud's phenomenon" and " Raynaud's symptom", in an appropriate meaning. RP of the patient, however, varied depending on the time determined, which indicated that the cause of RP is not due to the irreversible tissue degenerations, but due to the reversible functional factors. Computed thermography was proved useful for detecting RP objectively, and will be valuable for estimating the effects of medications for RP.

[Relation of pulmonary hemodynamics and ventilation to tissue hypoxia during exercise in patients with tuberculosis sequelae]

We examined a relationship between tissue hypoxia and pulmonary hemodynamics or ventilatory capacity during rest and exercise in patients with tuberculosis sequelae. Nine patients performed exercise test until their symptom limit. Mean pulmonary arterial pressure (PPA) during exercise was plotted against cardiac index (C.I.) from rest to maximum exercise in each patient. In most of the patients, the changes of PPA showed linear relation with the C.I., and a slope (P-F slope) was obtained from the regression equation in each patient, and it was used as an index of circulatory disability during exercise. At the same time a coefficient of oxygen delivery (COD) was calculated and mixed venous oxygen tension (PvO2) was measured to evaluate a tissue hypoxia at rest and during exercise. The changes of COD were similar to those of PvO2 during exercise. COD positively correlated with PvO2 (R = 0.873, P < 0.01) from rest to maximal exercise, indicating that the values of PvO2 depended on those of COD. P-F slope negatively correlated with S.I. (R = -0.887, P < 0.01), oxygen transport (R = -0.780, P < 0.01), COD (R = -0.827, P < 0.01) and PvO2 (R = -0.760, P < 0.01) at maximal exercise. Whereas no significant relationship between ventilatory variables and COD or PvO2 was noted at maximal exercise. In conclusion, the patients with pulmonary tuberculosis sequelae who had a step P-F slope showed low mixed venous oxygen tension during exercise as a result of limited oxygen transport in consequence of low stroke volume.

[Patient's delay and doctor's delay in the pulmonary tuberculosis--the experience of the National Chiba Higashi Hospital]

Out of 1628 tuberculosis patient discharged from the to National Chiba Higashi Hospital, 537 previously untreated pulmonary tuberculosis patients were selected for the study to examine the delay in case-defection. Patient's delay were longer but doctor's delay were shorter in male than in female. The main reasons for doctor's delay were the delay in taking chest X-ray, and the error in the interpretation of initial chest X-ray findings. In 88 patients who were detected in the advanced stage, the total delay were longer than the others common cases and the doctor's delay was found in 13 cases. To avoid such an unnecessary delay, the importance of sputum examinations must be re-emphasized in all patients who show respiratory symptoms and/or abnormal chest X-ray findings.

Monoclonality of B-cell lineage in primary pulmonary lymphoma demonstrated by immunoglobulin heavy chain gene sequence analysis of histologically non-definitive transbronchial biopsy specimens

Immunoglobulin heavy chain (IgH) gene rearrangements were amplified in transbronchial lung biopsy (TBLB) specimens taken from five patients with primary lymphoma of the lung in whom the diagnosis was established by surgical specimens. By histopathological analysis of TBLB specimens, only two of the five cases were diagnosed as lymphoma, the other three cases being classified as equivocal due mainly to low levels of cellular atypia and to artefactual distortion. All five TBLB specimens, as well as the subsequent surgical specimens, showed a sharp monoclonal band of IgH gene rearrangement on electrophoresis of polymerase chain reaction (PCR) products. By contrast, three surgical biopsy specimens from cases of lymphoid interstitial pneumonia (LIP) showed smear polyclonal bands. No clonal rearrangements were detected in six non-neoplastic controls, including five cases of chronic bronchitis and one of sarcoidosis. The PCR products of three of the lymphoma cases were sequenced from both TBLB and surgical specimens. In all three cases, there was dominant expression of a particular rearrangement, assumed to be tumour-derived. In each case, the major clones derived from the TBLB and the surgical specimen were identical. In both lymphoma and LIP cases, more frequent usages of JH4 and JH6 were evident. The diagnosis of lymphoma can be confirmed on TBLB specimens by use of this technique.

Third complementarity determining region sequence analysis of low-grade bronchus-associated lymphoid tissue lymphoma: genotypic analysis reveals heterogeneity in maturation

It has recently been suggested that autoimmunity may play a role in the pathogenesis of low-grade mucosa-associated lymphoid tissue lymphomas, but precise genotypic analysis of antigen binding sites of low-grade bronchus-associated lymphoid tissue (BALT) lymphomas has not been reported. We analyzed the third complementarity determining region (CDR3) in eight cases of low-grade BALT lymphoma by 2-step PCR and sequencing analysis. All cases showed a distinct monoclonal band (about 100 base pairs) on electrophoresis. In seven cases, a single major CDR3 sequence was identified with five to nine clones among 10 vector clones being identical; and in the remaining case, two major sequences were obtained, with four clones among nine vector clones being identical. Findings suggestive of the autoimmunity of low-grade BALT lymphoma were obtained: (1) VHDJH rearrangements in seven of the eight lymphoma cell clones were potentially functional; (2) genotypically, two lymphoma cell clones showed 60 to 74% homology with G6 positive lymphocyte clones; and (3) five lymphoma cell clones showed 61 to 71 % homology with lymphocyte clones derived from fetal liver or cord blood. In one case, the N-D-N length of the neoplastic clone was very short and lacked N nucleotides at the D-JH junction. Therefore, our study demonstrates genotypic heterogeneity in maturation in low-grade BALT lymphoma.

[Relation among lifestyle, social network, blood pressure and serum lipids in the elderly]

The relationships among seven lifestyle factors including stress, which is focused on as a risk factor for cardiovascular disease recently, social network, blood pressure and serum lipids in the elderly were examined in a cross sectional study of 85 males and 65 females aged 60 years or over in the city of Sayama, Saitama Prefecture. The seven lifestyle factors were as follows: (1) amount of alcohol consumption, (2) cigarette smoking, (3) Physical exercise, (4) sleeping time per night, (5) nutritional balance, (6) body weight, and (7) stress. As social network factors, marital status and coping factor for stress and/or anxiety were introduced. Stressful life events strongly associated with stress status were also discussed. In this study, it was clear that age, alcohol consumption, stress status and stressful life events caused higher blood pressure. On the other hand, the social network was associated with lifestyle status and a controlled blood pressure level. Obesity and physical exercise were significantly associated with serum lipids. There results suggest that it is very important for the maintenance and promotion of health and risk reduction of disease among the elderly to control socio-psychological factors such as stress and stressful life event, and that a social network helps maintain a healthy lifestyle.

Preoperative embolization of meningiomas fed by ophthalmic branch arteries

BACKGROUND

The efficacy of preoperative embolization for hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries was examined.

CASES AND METHODS

Five hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries, four posterior ethmoidal arteries, one anterior falx artery, and one recurrent middle meningeal artery were embolized with Gel-foam powder, polyvinyl alcohol (PVA) particles, and/or microcoils as a preoperative treatment using a microcatheter.

RESULTS

Catheterization of the ophthalmic and tumor feeding artery was possible and feeding arteries and lesion embolization were effective to reduce the bleeding during surgery in all cases. In three cases, visual acuity and visual field were preserved. However, in one case, visual acuity and visual field defect appeared due to the migration of Gelfoam powder (Upjohn, Kalamazoo, MI) into the retinal artery. In another case, the retinal artery was embolized with the feeding arteries since the patient was already blind.

CONCLUSION

Embolization of hypervascular meningioma feeding vessels arising from the ophthalmic artery is possible and effective with preservation of vision, if embolic agents are injected gently enough not to reflux into the central retinal artery.

[Effects of thromboxane A2 on chronic hypoxic pulmonary hypertension in the rat]

Chronic hypoxia (10% O2 for 2-3 weeks) causes pulmonary hypertension and vascular remodeling in the rat. To study the role of thromboxase A2 in chronic hypoxic pulmonary hypertension, the hemodynamic effects of intravenous administration of a thromboxane analogue (STA2) were measured in chronic hypoxic (H) and normoxic (N) Sprague-Dawley rats. During anesthesia baseline pulmonary arterial pressure (PAP) was higher in H rats (34.6 +/- 1.0 mmHg) than in N rats (18.4 +/- 1.2 mmHg). Intravenous STA2 (0.3 microgram) acutely increased pulmonary artery pressure by 74% +/- 11% (25 +/- 4 mmHg) in H rats and by 47% +/- 2% (9 +/- 1 mmHg) in N rats, which indicates that both the absolute and relative acute pulmonary vasoconstriction caused by STA2 were greater in H rats. The changes in systemic arterial pressure caused by STA2 were smaller than the changes in pulmonary arterial pressure both in H rats (11% +/- 3%) and in N rats (17% +/- 3%). Lungs were isolated and perfused with saline, and the vasoconstrictive response to 0.05 microgram of STA2 in lungs (14.5 +/- 2.4 mmHg) from H rats was greater than the response to 0.1 microgram of STA2 (5.6 +/- 1.3 mmHg) in lungs from N rats. To examine whether blockade of calcium channels could suppress the vasoconstrictor response to STA2, the effects of the calcium channel blocker nicardipine hydrochloride on vasoconstriction caused by STA2 were measured in H and N rats. In vivo, the blockade of calcium channels suppressed the increase in pulmonary artery pressure caused by STA2. This suppression was greater in H rats (56% +/- 11%) than in N rats (25% +/- 4%). Similar results were obtained with isolated perfused lungs. Blockade of calcium channels suppressed the vasoconstriction caused by STA2 and this suppression was greater in H rats than in N rats. The finding that thromboxane A2 induced greater vasoconstriction in H rats than in N rats indicates that thromboxane A2 may play an important role in pulmonary hypertension, and suggests that blockade thromboxane A2 may benefit some patients with primary and secondary pulmonary hypertension. Furthermore, the finding that suppression of thromboxane-induced vasoconstriction by blockade of calcium channels was greater in H rats than in N rats indicates that such treatment may also benefit some patients.

Importance of correlations between phagocytic activity and superoxide production of neutrophils under conditions of voluntary exercise and stress

The importance of the neutrophil function to host defense and tissue damage has been widely recognized. However, the usefulness of the correlation analysis between phagocytic activity and superoxide production of neutrophils is unknown. We investigated the relationship by histochemical NBT assay using rats and mice exposed to voluntary exercises and stresses. The following conclusions were shown from the results in this report and from our previously published findings. The results of voluntary exercise showed significant positive correlations between phagocytic activity and superoxide production of neutrophils after the continuation of the exercise for 8 months, but no relationship after only 3 or 4 months. However, when Salmonella was injected into the same group after 4 months, significant positive correlations were observed immediately following and on the 6th and 14th days after injection. In contrast, negative correlations emerged after psychological stress and severe-crowding stress, suggesting that appropriate expression of neutrophil function was disturbed by the reverse effects, such as by suppression of oxygen-dependent killing capacity or over-production of toxic free radicals subsequent to these stress. These results suggest that the correlations of phagocytic activity and superoxide production of neutrophils reflect whether a neutrophil functional state is appropriate or not.

[Compliance with long-term home oxygen therapy]

Long-term home oxygen therapy has been shown to benefit patients with hypoxemic chronic obstructive pulmonary disease. However, to obtain the expected maximal benefit it is important for the oxygen to be used correctly and for a sufficient length of time. We examined compliance with home oxygen therapy in patients with chronic obstructive pulmonary disease, pulmonary fibrosis, late sequelae of pulmonary tuberculosis, and pulmonary hypertension who used oxygen concentrations. Compliance was defined as the ratio of the amount of oxygen used to the amount prescribed. The average daily length of time the concentrator actually ran was measured from the concentrator meters. These were read every 6 months by an engineer from the company that installed the concentrator. Factors thought to affect compliance were studied. These factors included age, the degree of dyspnea, arterial blood gases, and pulmonary function. Weak positive correlations were found between compliance and age and between compliance and PaCO2. A weak negative correlation was observed between compliance and PaO2. Compliance in patients with chronic obstructive pulmonary disease was higher than in patients with pulmonary fibrosis or pulmonary hypertension. Among those given prescriptions for 24-hr oxygen therapy, compliant patients had more severe dyspnea on excertion than did noncompliant patients. These data suggest that the compliant patients had more severe gas exchange problems.

[Wilson-Jones type angiosarcoma with marked response to intrapleural administration of interleukin-2]

A 64-year-old woman was admitted to our hospital with a hemothorax after one year of therapy for angiosarcoma that had arisen from the skin of the head. The hemothorax was believed to have resulted from metastasis of the angiosarcoma. Interleukin-2 (IL-2) at a dose of 20 x 10(4) U once daily was administered intrapleurally. Clinical improvement was first observed on the second day after the first dose of IL-2. Increases in natural and in lymphokine-activated killer activity of lymphocytes in pleural effusion were found on the eighth day. Starting on the 16th day of IL-2 therapy, no more fluid was drained, so administration of IL-2 was stopped. The clinical course indicated that the pleural effusion disappeared not because of pleurodesis but because of the anti-cancer effects of IL-2. There were no marked side effects, and intrapleural administration of IL-2 may be useful in patients with hemothorax due to metastasis of angiosarcoma.