[Significance of residual renal functions of patients with end-stage renal failure undergoing continuous ambulatory peritoneal dialysis]

It is generally accepted that residual renal function remains well-preserved longer with CAPD than with hemodialysis. However, consideration and impact of the contributory effects of residual renal function on the adequacy of renal replacement therapy has not been well defined. In this report, creatinine clearance (Ccr), Kt/V, normalized protein catabolic rate (nPCR) and urinary excretion of uremic solutes were studied in 26 stable CAPD patients with a four-bag exchange. Weekly Ccr, weekly Kt/V and nPCR were 62.3 +/- 20.2 l/week/1.73 m2, 1.77 +/- 0.35, and 0.90 +/- 0.13 g/kg/day, respectively. These parameters correlated significantly with the daily urine volume. The weekly Ccr and Kt/V of anuric patients seemed to be inadequate. Urinary excretion of urea nitrogen, Cr, Na, Cl, Pi and beta 2-microglobulin (beta 2-MG) were dependent upon the daily urine volume. Significant phosphorus and beta 2-MG excretion seemed to have an effect on the prevention of bone and joint complications, because serum iPTH and beta 2-MG levels increased after the patients fell into an anuric state. It was suggested from this study that CAPD should be started before the patient loses residual renal function because four bag exchange as the standard CAPD prescription might not be adequate once the patient loses urine excretion.

Plasma concentrations of antipsychotic drugs in psychiatric inpatients

In current psychiatric therapy, two or more kinds of antipsychotic drugs are usually prescribed in Japan. However, there are few data on the therapeutic plasma concentrations of antipsychotic drugs or on the correlation between the daily dose and the plasma concentration, in cases where several antipsychotic drugs had been prescribed for each patient. We measured the therapeutic plasma concentrations of 9 antipsychotic drugs in 24 psychiatric inpatients during a 6-month period. They were treated with fixed dosages of antipsychotic drugs. Plasma samples were collected early in the morning once a month, and the concentrations of antipsychotic drugs were determined by gas chromatography with nitrogen phosphorus detection, high-performance liquid chromatography (HPLC) with fluorescence detection and HPLC with UV detection. The plasma levels of chlorpromazine, levomepromazine, thioridazine, haloperidol, bromperidol, zotepine, oxypertine, sulpiride and sultopride were 21.8-92.4, 31.7-156, 101-203, 16.4-56.2, 2.72-11.7, 13.6-84.0, 29.9-80.4, 70.1-1,120 and 35.7-2,990 ng/ml, respectively. A linear correlation between the daily dose and the plasma concentration was noted for sultopride, levomepromazine, sulpiride, haloperidol, chlorpromazine and zotepine.

Reducing cell membrane n-6 fatty acids attenuate mucosal damage in food-sensitive enteropathy in mice

Mucosal damage is commonly observed in food-sensitive enteropathy in infants, and the generation of leukotrienes is involved in the pathogenesis of this enteropathy. Because supplementing n-3 fatty acids is known to modify the production of leukotrienes, we investigated whether a change of dietary fatty acid composition affects leukotriene synthesis and food hypersensitivity reactions in the intestine by using a mouse model of food-sensitive enteropathy. The model was prepared by feeding ovalbumin to BALB/c mice after intraperitoneal injection of cyclophosphamide. Diets were prepared from soybean oil (control), perilla oil, lard, corn oil, and 0.125 volume of corn oil (low fat diet) and given to mice for 4 wk. Villous heights, crypt depths, leukotriene B4 and C4 production in the intestine were measured. Crypt hyperplasia and villous atrophy were severer in the corn oil-fed group than those of control group, whereas mucosal damage in the perilla oil and low fat diet groups was minimal. In the corn oil-fed group, red blood cell membrane levels of n-3 fatty acids were lower than the control, and the synthesis of leukotrienes was highest among all groups. In the perilla oil and low fat diet groups, n-6 fatty acids were lower than those of control group and leukotriene production was significantly suppressed. These results indicate that reducing cell membrane levels of n-6 fatty acids by feeding less n-6 fatty acids or supplementing n-3 fatty acids, is important to suppress leukotriene biosynthesis for prevention from mucosal damage in food-sensitive enteropathy.

Detection of tumor thrombus in children using color Doppler ultrasonography

Color Doppler ultrasonography (CDUS), which provides information regarding both the tissue and the blood flow simultaneously in real time, is a relatively new and noninvasive technique for the evaluation of organ perfusion. The authors investigated the usefulness of CDUS in the detection of tumor thrombus in 34 children who had malignant tumor (21 neuroblastomas, 2 Wilms' tumors, 5 hepatoblastomas, 2 rhabdomyosarcomas, and 4 others) who underwent CDUS between April 1992 and March 1995 in our department. The CDUS showed tumor thrombus in four patients (11.8%). Three thrombi (in one patient each with neuroblastoma, Wilms' tumor, and hepatoblastoma) were situated in the inferior vena cava, and one (in a patient who had hepatoblastoma) in the portal vein. Each tumor thrombus was monitored and followed up using CDUS every month during the entire clinical course; two of the four thrombi remained despite intensive treatments. The authors have found CDUS to afford rapid and noninvasive detection of tumor thrombus, and it proved useful not only in the detection of tumor thrombus but also in its follow-up in these children who had malignant tumor.

[Small cell carcinoma of the urinary bladder: a case report and review of the Japanese literature]

A 50-year-old man presented with asymptomatic gross hematuria which he had first noticed 3 months earlier. Clinical examinations revealed a non-papillary, broad-based tumor on the left lateral wall of the urinary bladder with a clinical stage of T3N0M0. The pathological diagnosis of a transurethral biopsy tissue specimen was small cell carcinoma. Neoadjuvant intraarterial infusion chemotherapy using cisplatin and adriamycin was initially administered but proved to be ineffective. Thus, we performed a radical cystectomy. The tumor tissue was apparently homogenous and composed of small cells arranged in sheets and solid patterns, and was staged to be pT3bR1L2V0N0. An electron microscopic study confirmed small cell carcinoma with neurosecretory granules. Postoperatively, 4 courses of adjuvant chemotherapy consisting of cisplatin, etoposide and ifosfamide were administered. The patient is alive without any evidence of tumor recurrence 26 months after the operation.

Proinflammatory cytokines and Helicobacter pylori stimulate CC-chemokine expression in gastric epithelial cells

Helicobacter pylori (H. pylori) has been shown to stimulate secretion of IL-8, a CXC-chemokine, from gastric epithelial cells, and this process is important in the induction of gastric mucosal inflammation associated with H. pylori infection. However, considering the biological effects and target cells, CC-chemokines may also be playing an important role in H. pylori-associated gastritis. In the present study, we investigated the expression of IL-8 (CXC-chemokine), MCP-1 (CC-chemokine), and RANTES (CC-chemokine) in human gastric mucosa by RT-PCR analysis. The positive rates of IL-8, MCP-1, and RANTES in 35 patients were 68.5%, 80%, and 80% respectively, suggesting the possible importance of CC-chemokines. We next examined the production of MCP-1 by MKN28 gastric epithelial cells. MKN28 cells were found to secrete MCP-1 in response to IL-1 beta or TNFalpha in a dose- and time-dependent manner. Quantitative RT-PCR analysis showed the induction of MCP-1 mRNA by these proinflammatory cytokines. Co-culture with H. pylori also induced the expression of MCP-1 mRNA. These results suggest that gastric epithelial cells secrete CC chemokine MCP-1 in response to proinflammatory cytokines and H. pylori, and this process may also be important in the chronic gastric inflammation associated with H. pylori infection.

Epileptic encephalopathies in early infancy

Of the epileptic syndromes beginning in early infancy, we described the clinical and electrical characteristics of early myoclonic encephalopathy (EME) and Ohtahara syndrome (OS), and the differential diagnosis between the two syndromes, reviewing previous articles and our own study of 6 cases with EME and 15 cases with OS. With regard to the clinical seizure types, the main seizure type was tonic spasms in OS while myoclonias, especially erratic myoclonias, and frequent partial seizures were predominant in EME. The suppression-burst (S-B) pattern was a common feature of both syndromes, although their form, time of appearance, and duration of appearance differed considerably. The S-B pattern in OS was characterized by periodic and consistent appearances during both waking and sleeping states, whereas in EME, the S-B pattern was enhanced by sleep and often not manifested in the awake states. OS showed a specific pattern of evolution as age-dependent epileptic encephalopathy with concomitant EEG change while EME had no specific evolution with age. In OS, obvious brain lesions such as brain malformations were often seen. In contrast, frequent occurrence of familial cases suggested some kind of congenital metabolic disorder as the etiological factor in EME.

Functional reconstruction of total lower lip defects with a radial forearm free flap combined with a depressor anguli oris muscle transfer

Two total lower lip reconstructions were accomplished by combining a radial forearm free flap and a depressor anguli oris muscle transfer. The radial forearm flap was used to reconstruct the inner surface of the lower lip. The bipedicled musculofascial flap, which includes both depressor anguli oris muscles, the depressor labii inferioris muscles, and the mentalis muscles, was elevated onto the chin and sutured superiorly to the modioli to obtain innervated sphincter function. Good results were obtained both aesthetically and functionally. Electromyography revealed almost normal mobility of the depressor anguli oris muscles 6 months after the operation. No drooling was seen during mastication, and no air leakage was observed during puffing of the cheeks. This is an effective procedure for the reconstruction of the sphincter function of the lower lip.

Solubility control of thin calcium-phosphate coating with rapid heating

The thin calcium-phosphate (Ca-P) coatings produced by the ion-beam-mixing method instead of the plasma-spraying method have been found to be amorphous, resulting in films that easily dissolved in simulated body fluid. These coatings crystalized with conventional heat treatment in an electric furnace but tended to crack easily. Therefore, the purpose of this study was to find a suitable heat treatment that controls the solubility of Ca-P coatings without weakening their adhesion to titanium (Ti) substrate. Thin coatings (approximately 1 microm) were coated onto Ti substrates, followed by heat treatment in a conventional furnace and rapid heating by infrared radiation and laser radiation. X-ray diffraction analysis revealed untreated films to be amorphous but to become crystalline after being heated in a furnace at 500 degrees C, heated rapidly with infrared radiation higher than 600 degrees C and with laser radiation at output power of 10W. We evaluated solubility by estimating the film thickness after immersion in simulated body fluid for 5 weeks: Untreated films dissolved within 1 day. Coatings treated with infrared radiation at 600 degrees C dissolved minimally. Cracks were observed in coatings subjected to infrared radiation at 800 degrees C and furnace-heated at 500 degrees C. Coatings treated with laser radiation tended to dissolve easily, with non-uniform surface degradation. X-ray photoelectron spectroscopy analysis at the interface between the coating and the Ti substrate showed that cracks were the result of decreased Ca-implanted layers and too much growth of Ti-P compounds. No difference was recognized in the Ti-oxidation state among specimens. These data indicate that rapid, homogeneous, and comparatively low-temperature heating, such as defocused infrared radiation, controls Ca-P solubility and ensures the adherence of the coatings to the substrate.

Measurements of the complex degree of spectral coherence by use of a wave-front-folded interferometer

A wave-front-folded interferometer composed of a Kösters prism and an image-forming lens provides a good way of measuring the complex degree of spectral coherence. Demonstrative experiments are implemented by incorporation of uncorrelated two-point spectral sources in the primary-source plane; these sources establish a spatially partially coherent wave field over the secondary source plane just in front of the interferometer. The complex degree of spectral coherence of the secondary source is successfully measured after an a priori calibration is made for the interferometer that was constructed.

Arterialized venous flaps from the thenar and hypothenar regions for repairing finger pulp tissue losses

Pulp tissue loss of the fingers was repaired with arterialized venous flaps from the thenar or hypothenar regions in 13 patients. Thirteen of the 15 flaps transferred survived completely. The thenar and hypothenar skin is durable and of appropriate texture for replacement of finger pulp defects. An average flap size of 2 x 3 cm was adequate for repairing the tissue loss of the fingers. These are not sensory flaps. However, they exhibited useful sensory recovery within 6 months of the operation. This method is simple and results in minimal donor-site morbidity. The arterialized venous flap is thus a useful alternative for the repair of finger pulp tissue losses.

The estimated incidence of cystic fibrosis in Japan

BACKGROUND

It is believed that the incidence of cystic fibrosis (CF) among Asiatic races, including the Japanese, is very rare. This epidemiological study was carried out to investigate the incidence of CF in Japan.

METHODS

We collected literature describing CF cases among pure Japanese and found 124 cases reported as CF during the 43 years from 1951, when the first case was reported, to 1993. Only 104 cases (57 male and 47 female patients) of 124 cases met our diagnostic criteria.

RESULTS

A simple calculation based on the number of reported CF cases and of live births after 1980 suggested that the incidence of CF is about 1 in 350,000 in the Japanese population. Twenty-nine (27.9% of the total) of 30 patients diagnosed in the neonatal period presented symptoms of meconium ileus, an incidence higher than that reported for the white population.

CONCLUSIONS

Our study results suggest that the incidence of CF in the Japanese population is even rarer than had been estimated before and that there is a genetic difference between northern European and Japanese populations.

Transient DNA relaxation in Escherichia coli induced by nalidixic acid

We report here the transient relaxation of plasmid DNA by inhibitors of DNA gyrase in Escherichia coli. Relaxation of plasmid DNA in the presence of nalidixic acid, an inhibitor of the A subunit of DNA gyrase, lasted less than 60 min. The effect of nalidixic acid was not observed in a nalA26 mutant, a strain resistant to nalidixic acid due to a mutation in the gyrA gene. Novobiocin, whose target is the B subunit of DNA gyrase, also caused transient DNA relaxation. Resupercoiling of relaxed DNA in the presence of nalidixic acid was inhibited by pretreatment of the cells with chloramphenicol. As mutations of both the rpoH and recA genes did not affect the resupercoiling reaction, this step seems to require protein synthesis that is independent of both heat shock and SOS responses.

Physical effects of negative air ions in a wet sauna

The physical effects of negative air ions on humans were determined in an experimental sauna room equipped with an ionizer. Thirteen healthy persons took a wet sauna bath (dry bulb temperature 42 degrees C, relative humidity 100%, 10 min exposure) with or without negative air ions. The subjects were not told when they were being exposed to negative air ions. There were no differences in the moods of these persons or changes in their blood pressures between the two saunas. The surface temperatures of the foreheads, hands, and legs in the sauna with negative ions were significantly higher than those in the sauna without ions. The pulse rates and sweat produced in the sauna with ions were significantly higher than those in the sauna without ions. The results suggest that negative ions may amplify the effects on humans of the sauna.

Sensitive determination of sulpiride in human plasma by high-performance liquid chromatography

We developed a simple, sensitive and reliable method for the determination of sulpiride, a specific antipsychotic drug, in human plasma using high-performance liquid chromatography. A structurally related benzamide, tiapride, was used as the internal standard. A Sep-Pak C18 cartridge was used to extract a sample from 1 ml of plasma. The extract was dissolved in methylene chloride, and then back-extracted with 0.01 M hydrochloric acid. The aqueous layer was put on a octadecylsilica column with a mobile phase of 50% acetonitrile in 0.01 M phosphate buffer (pH 3.0). A fluorescence detector with excitation at 300 nm and emission at 365 nm was used for detection. The calibration curve was linear in the concentration range of 10-1500 ng/ml, and the lower limit of detection was 1 ng/ml. We used this method to examine plasma levels of sulpiride in 14 inpatients being treated with sulpiride for 6 months. The determined plasma levels were 70.1-1121.2 ng/ml, and the correlation between daily dose and plasma concentration was positive. This simple, reliable method is expected to be put to good use in forensic and hospital laboratories.

Temporal and spatial expression of distinct troponin T genes in embryonic/larval tail striated muscle and adult body wall smooth muscle of ascidian

During development of the ascidian Halocynthia roretzi, the tadpole larva hatched from the tailbud embryo metamorphoses to the adult with a body wall muscle. Although the adult body wall muscle is morphologically nonsarcomeric smooth muscle, it contains a troponin complex consisting of three subunits (T, I, and C) as do vertebrate striated muscles. Different from vertebrate troponins, however, the smooth muscle troponin promotes actin-myosin interaction in the presence of high concentration of Ca2+, and this promoting property is attributable to troponin T. To address whether the embryonic/larval tail striated muscle and the adult smooth muscle utilize identical or different regulatory machinery, we cloned troponin T cDNAs from each cDNA library. The embryonic and the adult troponin Ts were encoded by distinct genes and shared only < 60% identity with each other. These isoforms were specifically expressed in the embryonic/larval tail striated muscle and the adult smooth muscle, respectively. These results may imply that these isoforms regulate actin-myosin interaction in different manners. The adult troponin T under forced expression in mouse fibroblasts was unexpectedly located in the nuclei. However, a truncated protein with a deletion including a cluster of basic amino acids colocalized with tropomyosin on actin filaments. Thus, complex formation with troponin I and C immediately after the synthesis is likely to be essential for the protein to properly localize on the thin filaments.

Electroclinical study of localization-related epilepsies in early infancy

To clarify the characteristics of localization-related epilepsies in early infancy, we performed an electroclinical study of 28 epileptic patients whose first seizures occurred before 6 months of age. The patients were retrospectively divided into two groups: the seizure-controlled group (8 patients) and the refractory group (20 patients). The seizure-controlled group included the patients whose seizures were suppressed within 1 year after onset; the refractory group included all other patients. The characteristics of the refractory group were as follows: (1) most patients had serious underlying pathologies; (2) the seizure type in most cases was simple partial seizure or complex partial seizure without secondary generalization; (3) the interictal EEG showed focal abnormalities and severe dysrhythmia on the basic pattern associated with multifocal spikes in most cases; and (4) in some patients, West syndrome developed after localization-related epilepsies and generalized seizures appeared later in some cases.

[Effects of corticosteroid pulse treatment on outcomes in acute exacerbations of idiopathic interstitial pneumonia]

We studied the relationship between the effectiveness of corticosteroid pulse treatment, clinical characteristics and outcomes in 17 patients with acute exacerbatin of idiopathic interstitial pneumonia. Acute exacerbation was defined as a decrease in PaO2 by more than 10 Torr, worsening of chest-radiographic findings, and deterioration of symptoms within 1 month. Effects of corticosteroid pulse treatment were judged 2 weeks and 3 months after the end of treatment. The change in AaD2 was computed and was used to determine whether the treatment had been effective, temporarily effective, or ineffective. The effects at three months were difficult to predict on the basis of those at two weeks. The treatment was often effective in patients who had not previously received steroids and in those with mild disease. Those in whom the treatment was effective at three months lived longer after the exacerbation than did those in whom it was ineffective, but the average lengths of survival through the whole clinical course were not significantly different among the three groups. We suggest that corticosteroid pulse treatment is effective in acute exacerbatins of idiopathic interstitial pneumonia and that effectiveness should be evaluated three months after treatment.

Increase in synthesis and stability of sigma 32 on treatment with inhibitors of DNA gyrase in Escherichia coli

We report here that in Escherichia coli, the anti-bacterial agent nalidixic acid induces transient stabilization and increased synthesis of sigma 32, accompanied by the induction of heat shock proteins (Dnak and GroEL proteins). The induction of heat shock proteins, increased synthesis of sigma 32, and stabilization of sigma 32 observed on treatment of wild-type cells with nalidixic acid were not observed in a nalA26 mutant, a strain that is resistant to nalidixic acid as the result of a mutation in the gyrA gene. Not only oxolinic acid, but also novobiocin, whose targets are the A and B subunits of DNA gyrase, respectively, also induced stabilization and increased synthesis of sigma 32. Thus, inhibition of the activity of DNA gyrase may cause stabilization and increased synthesis of sigma 32, resulting in turn in induction of heat shock proteins.

Efficient lipase-catalyzed preparation of long-chain fatty acid esters of bile acids: biological activity and synthetic application of the products

A highly regioselective (3-position) and efficient (quantitative yield) acylation of bile acids catalyzed by immobilized Candida antarctica lipase was established. Methyl cholate derivatives acylated with long-chain fatty acids (C12-C16) showed an inhibitory effect on the growth of some strains of Gram-positive and -negative bacteria (27-400 micrograms/ml). The anti-bacterial activity was slightly weaker than has been observed for methyl cholate, while the increased lipophilicity and lower melting points of the present derivatives are well suited for a potential germicide which would be safe and be topically applied. This enzyme-catalyzed transesterification is also demonstrated as an expeditious route to ursodeoxycholic acid, in respect of the regioselective introduction of acyl protecting groups on the hydroxyl groups of the intermediates. 7-Ketolithocholic acid, a known direct precursor of ursodeoxycholic acid, was obtained from cholic acid via chenodeoxycholic acid in a 46% yield and 9 steps.

[Characteristics of auditory brainstem response in presbyacusis--compared with the results of pure tone, speech or binaural audiometry]

The relationships between the auditory brainstem response (ABR) latencies and the results of three phychophysical measurements-pure tone audiometry, speech discrimination test and directional hearing test-were investigated in 58 subjects with presbyacusis. ABR latencies in presbyacusis patients were also compared with those in young adults with normal hearing or cochlear hearing loss. The results were as follows: There was a significant correlation between the average thresholds of pure tone audiometry and latencies of ABR waves I, III, V and/or interpeak latencies of waves I-III and I-V. There was a significant correlation between the scores of the speech discrimination test and latencies of waves I, III and V. There was also a significant correlation between the value of the directional hearing test and only interpeak latency of waves I-III. It was found that the I-III peak interval was prolonged in the ABR of presbyacusis, and that the results of pure tone audiometry and directional hearing tests were rather well correlated with the prolonged I-III peak interval.

Partial seizures in West syndrome

PURPOSE

To study the occurrence of partial seizures (PS) and elucidate the characteristics of patients with West syndrome (WS) with PS.

METHODS

We investigated the electroclinical and radiologic features in 92 children with WS who were older than 3 years at follow-up.

RESULTS

Thirty-six (39.1%) children had PS at some time during the course of the disease. They had a significantly high incidence of asymmetric spasms, hemiparesis, and asymmetric hypsarrhythmia. Their seizure prognosis was significantly less favorable. PS appeared only before spasms (group A, six children), concomitant with spasms (group B, 18 children), and only after spasms ceased (group C, 12 children). Five children in group B had PS after spasms stopped. PS in group A and during the period of active spasms in group B showed high seizure frequency and variability of both seizures and EEG manifestations. The PS and EEG epileptiform discharges were mainly in parietal-posterior temporal-occipital, and central regions. Late PSs in group B and PSs in group C were characterized by stereotyped manifestations and relatively low seizure frequency. These PSs originated mostly from frontal regions.

CONCLUSIONS

In some children with WS, cortical lesions can induce both PS and spasms in series, whereas in others, both types of seizures occur with abnormally increased excitability throughout the cortex rather than as the result of a single cortical lesion. These findings suggest caution in interpreting focal discharges, which may fluctuate and are not necessarily indicative of a surgically accessible lesion. When the discharges are stable and correlate with an equally stable clinical pattern, the likelihood of an underlying cortical lesion is greater.

[Pharmacokinetic and clinical studies on azithromycin in children]

Azithromycin (AZM) is a new oral macrolide antibiotic drug. AZM either in 10% fine granules form or in 100 mg capsule form was studied for its pharmacokinetics and treatment efficacy in pediatric patients with various infections. 1. Pharmacokinetics. Plasma and urine samples were collected from four patients with pharyngitis and post-dosing drug levels were determined. The drug was given once daily at 10 mg/kg body weight for 3 days. The drug concentrations found in plasma at 96 hours after the first dosing (48 hours after the final dosing) lay in a range of 0.02 and 0.04 microgram/ml and in urine at 120 hours after the first dosing (72 hours after the final dosing) in a range between 3.2 and 7.7 micrograms/ml. AZM was found in two patients but no effect was observed on blood levels of theophylline determined between 48 and 96 hours after the first dosing in the treatment of underlying bronchial asthma. 2. Clinical study results. Clinical studies of AZM was carried out in 25 pediatric patients with bacterial infections that mainly affected the respiratory tract. The patients received either 10% fine granules at 10 or 20 mg/ kg body weight or 100 mg capsules at 10 mg/kg body weight once daily over 3 to 6 days. The drug was found markedly effective in six patients, moderately effective in thirteen patients, while the investigators could not assess the drug efficacy in six patients. Although no side effect was reported in the study, two patients experienced slight decrease in WBC.