Effect of inhaled beclomethasone dipropionate on bronchial responsiveness in patients with asthma

We investigated the effect of 300 micrograms of inhaled beclomethasone dipropionate (BDP) daily on bronchial responsiveness to methacholine and pulmonary function of 22 subjects with asthma in a single-blind, crossover study. The severity of bronchial hyperresponsiveness lessened significantly during treatment with BDP (P < .01). No significant changes occurred in FEV1 or in the control value of airway conductance. We conclude that a 300-micrograms total daily dose of BDP is an efficacious treatment for patients with asthma. Because suppression of adrenal function and systemic adverse effects can occur in asthmatic patients treated with inhaled corticosteroids, especially children, long-term treatment with inhaled steroids should employ minimal daily doses necessary.

Comparison of the effects of intra-third ventricular administration of interleukin-1 or platelet activating factor on ACTH secretion and the sympathetic-adrenomedullary system in conscious rats

The effects of centrally administered interleukin-1 beta (IL-1) or platelet activating factor (PAF) on adrenocorticotropin (ACTH) and catecholamine secretion, blood pressure and heart rate were examined to determine if these agents stimulate similarly the hypothalamic-pituitary-adrenal (HPA) axis or the sympathetic-adrenomedullary system. Intra-third ventricular administration of IL-1 (50, 200 ng) evoked significant ACTH secretion. Centrally administered IL-1 (50 ng) elevated plasma noradrenaline and adrenaline levels, systolic blood pressure and heart rate. Plasma ACTH, noradrenaline and adrenaline levels were also increased by the higher dose (200 ng) of IL-1 while systolic blood pressure and heart rate were not affected. Intra-third ventricular administration of 9 micrograms of PAF elevated the plasma ACTH level while 3 micrograms of PAF did not stimulate ACTH secretion. Neither dose of centrally administered PAF affected any plasma catecholamine level or systolic blood pressure. These results suggest that central IL-1 stimulates both the HPA axis and the sympathetic-adrenomedullary system, that a higher dose of IL-1 stimulates a mechanism to antagonize the elevation of blood pressure and heart rate and that central PAF is not involved in the control of the sympathetic-adrenomedullary system. Thus, IL-1 and PAF do not interact in the brain, although they interact peripherally.

Pemphigoid vegetans represents a bullous pemphigoid variant. Patient's IgG autoantibodies identify the major bullous pemphigoid antigen

Pemphigoid vegetans is a rare disease; only four cases have been reported. The relationship of pemphigoid vegetans to bullous pemphigoid is not completely defined. We describe a case in a 77-year-old woman who had multiple well-circumscribed, erythematous, erosive, and vegetating plaques in the axillae and inframammary areas and in the neck. Microscopic examination revealed epidermal hyperplasia, dermoepidermal junctional separation, and prominent dermal eosinophilia. In the perilesional skin IgG was deposited linearly at the basement membrane zone. In addition, our patient's IgG autoantibodies, primarily the IgG4 subclass, reacted with the epidermal side of salt-split normal human skin and with the 230 kd major bullous pemphigoid antigen. We conclude that pemphigoid vegetans is best classified as a bullous pemphigoid variant.

Perfusion pressure control by adenosine triphosphate given during cardiopulmonary bypass

Administration of exogenous adenosine triphosphate (ATP) as a vasodilator during cardiopulmonary bypass was assessed in consecutive adult patients (n = 24) who demonstrated a high arterial perfusion pressure (mean, > 90 mm Hg). The action of ATP was characterized by rapid induction and stabilization of the blood pressure level. The dose of ATP ranged from 0.68 to 2.68 mg/min. Within 1 minute after the administration, there was a significant reduction in the perfusion pressure from 102 +/- 18 mm Hg (mean +/- standard deviation) to 72 +/- 19 mm Hg. The ATP was then able to maintain the desired pressure of 69 +/- 12 mm Hg at 5 minutes, 67 +/- 12 mm Hg at 10 minutes, and consistent values thereafter. After the ATP administration was discontinued, there was a prompt recovery of pressure without bradyarrhythmia. The frequency and amount of inotropes used were consistent with the control group (n = 26). Although the administration of ATP reduced the increase in serum catecholamine concentration, there were no significant changes in other vasoactive mediators (eicosanoid, angiotensin II, endothelin) between the two groups during cardiopulmonary bypass. There was neither an accumulation of metabolic products (uric acid, phosphate) nor a decrease in the level of divalent cation (Ca2+), which is observed when the cations combine with phosphates or adenosine nucleotides. This study confirmed the efficacy and safety of ATP infusion during cardiopulmonary bypass.

Biological monitoring of acrylonitrile exposure through a new analytical approach to hemoglobin and plasma protein adducts and urinary metabolites in rats and humans

A new, simple and fast procedure of measuring acrylonitrile (ACN) in ACN derived mercapturic acids such as S-(2-cyanoethyl)-L-cysteine(CyEC), and in hemoglobin (Hb) and plasma protein adducts and urinary metabolites in rats and humans exposed to ACN was developed. ACN in mercapturic acids or proteins was analyzed by capillary gas chromatography (GC) by liberating ACN at a high-temperature in the injector port of GC with or without oxidizing sulfur atoms of the ACN-bound cysteines into sulfoxide form by hydrogen peroxide in vitro. At 350 degrees C, more than 90% of ACN in authentic CyEC was recovered by this method. Increasing a single ip dose of ACN from 5 to 50 mg/kg produced proportional increases in ACN bound to Hb 24 hr after the treatment. The alkylation of plasma protein with ACN was about 1/10 as low as that of Hb. After repeated daily ip doses of 1-10 mg/kg, ACN in Hb decreased with a half-life of about 9 days. ACN was also detected in the blood of workers exposed to ACN for 1 to 10 years at a Siberian synthetic rubber factory.

Hyperpermeability of abdominal capillary vessels to endothelin-1 in patients with diabetes mellitus

To elucidate the pathophysiologic significance of circulating endothelin-1 (ET-1) to the vascular lesions in diabetic patients, ET-1 levels in plasma and peritoneal dialysis fluid were measured in 11 patients receiving continuous ambulatory peritoneal dialysis (CAPD) [five with diabetic nephropathy (group A); six with chronic renal failure without diabetes mellitus (group B)]. ET-1 levels were determined by a highly sensitive and specific enzymeimmunoassay. Plasma ET-1 levels in group A were not significantly different from those in group B (3.3 +/- 0.9 versus 3.5 +/- 0.9 pg/ml). However, the amounts of ET-1 in peritoneal dialysis fluid in group A were significantly greater than those in group B (19.2 +/- 13.2 versus 10.4 +/- 6.3 ng/day). These results suggest that abdominal capillary vessels in diabetic patients are hyperpermeable to ET-1.

[Enkephalinase activity in the guinea pig model of asthma]

Enkephalinase exists in airway epithelial cells, smooth muscle, and submucosa near glands, and cleaves tachykinins to inactive metabolites, thereby reducing there effects. To study the role of enkephalinase in asthmatic response, we measured its activity in guinea pig model of asthma. When compared with the control values, the enkephalinase activity was reduced during in immediate asthmatic response (IAR) and late asthmatic response (LAR). Compared with the control values (100%), each value was 79.7%, 73.4% in the trachea and 74.3%, 55.7% in the lung respectively. Tracheal muscle preparation taken from the control, IAR, and LAR groups were made and mounted in oxygenated modified Krebs-Ringer solution. The response was monitored by isometric transducer. Concentration response curves to NKA with or without phosphoramidon were obtained. The contractile responses of the LAR groups were enhanced in potency and efficiency. Phosphoramidon potentiated the NKA induced contraction of control and the IAR groups but was less potent in enhancing the contractile response in the LAR group, showing less enkephalinase activity in the LAR. These results suggest that the enkephalinase plays an important role in LAR. In LAR, the enkephalinase activity may be inhibited and the responsiveness of the smooth muscle to some bronchoconstrictor, such as tachykinins, may be increased.

Epithelial properties of human intestinal Caco-2 cells cultured in a serum-free medium

Human intestinal Caco-2 cells were cultured under serum-free conditions on an insoluble collagen and FCS matrix (Caco-2-SF), and a comparison was made between several characteristics of Caco-2 and Caco-2-SF cells. Their morphological appearance was identical. Slight differences were found in cell growth and expression of brush border enzymes between Caco-2 and Caco-2-SF cells. Similar levels of activity of Gly-Gly transport were expressed in both types of cell. Caco-2 cells cultured on permeable filters showed high transepithelial electrical resistance (TEER), indicating the high monolayer integrity. The transepithelial transport activity for glucose, alanine and Gly-Gly was detected by measuring the change in short-circuit current (delta Isc) after adding each of these nutrients to the apical chamber. In Caco-2-SF cells, such parameters as TEER and delta Isc were reduced drastically, suggesting that the monolayer integrity and cell polarity that are important for transepithelial transport were not attained. These parameters, however, could be restored by adding FCS or by milk whey. The result suggested that FCS and milk whey contain factors which regulate the formation of the tight junctions and, consequently, the development of cell polarity. Thus the Caco-2-SF cell-culture system will provide a useful model for studying factors which regulate the intestinal transepithelial transport functions.

Ph+ acute myelogenous leukemia with t(7;11)(p15;p15) and clonal evolution in relapse after bone marrow transplantation

A 20-year-old female with Ph+ acute myelogenous leukemia (M2) associated with t(7;11)(p15;p15) is reported. Bone marrow aspirates were hypercellular with leukemic cells including Auer rods. Chromosome analysis showed t(7;11) and the Ph chromosome. After complete remission, normal karyotype was restored. Normal male karyotypic cells replaced the bone marrow following allogeneic bone marrow transplantation from her brother. On day 358, cytogenetic study at relapse revealed 14q+ as an additional change and clearly showed that the abnormal clone was derived from the patient, because metaphases with XX were all of abnormal karyotype and those with XY were normal.

[Changes in bone and lipid metabolisms following oophorectomy and effects of estrogen replacement therapy]

The bone and lipid metabolisms in Japanese oophorectomized (OVX) women and effects of estrogen replacement therapy (ERT) were investigated. Three hundred and two OVX women (mean age of 41.6) and 164 premenopausal women (mean age of 42.1) were examined. BMD of the lumbar spine, serum Ca, P, Al-p, total cholesterol (T-C), HDL-C and LDL-C were measured every three months. BMD within 2 years after OVX was not significantly decreased. The mean BMD between 2 and 5 years or over 10 years after OVX was 0.83 (p < 0.01) and 0.69 (p < 0.001), respectively. Serum Ca and P were increased for 2 years and Al-p was increased for 10 years after OVX. To investigate the effect of ERT on BMD, OVX women were divided into 3 groups: ERT, VD3 and no treatment groups. After 12 months of treatment, the mean % BMD in each group was 102.9, 100.6 and 97.8, respectively. T-C or LDL-C was gradually increased in 10 years after OVX. After 15 months of ERT, the mean percentages HDL-C and LDL-C in hyperlipidemic women (LDL-C > or = 150) were 110.5 (p < 0.05) and 75.2 (p < 0.001). ERT may be requisite for OVX women and effective in preventing increased bone turnover and hyperlipidemism following OVX.

[Late surgical results of operation in partial atrioventricular canal defect]

Twenty-three patients underwent repair of a partial atrioventricular canal defect and have been followed for a mean of 9.4 years. The patients were divided into two groups according to the management of mitral cleft. Mitral cleft was not repaired in seven patients and directly sutured or repaired by valvuloplasty using pericardium in sixteen patients. In seven patients untreated mitral cleft left, two patients have required mitral valve replacement because of progressive severe mitral regurgitation. In sixteen patients mitral cleft repaired, no patients have required re-operation. However, one patient using pericardium in valvuloplasty, mitral regurgitation was in progress recently due to calcification and degeneration of the pericardium. The peak flow velocity, pressure gradient, pressure half time, and valve area in the mitral valve were measured by echo-doppler study. We recognized no statistical difference among two groups about hemodynamic performance in the mitral valve.

IN CONCLUSION

1) As concerns post-operative mitral regurgitation, the mitral cleft should be repaired. 2) After mitral cleft closure, the mitral flow pattern was not disturbed. 3) Autologous pericardium should not be adapted for valvuloplasty, because calcification and degeneration of the pericardium may cause progressive incompetency of the mitral valve.

[The physician executive and laboratory tests]

Sera Central Hospital was founded in 1953 as Sera District Medical Center under the auspices of the neighboring five towns. At that time, the hospital had 3 doctors, 10 nurses, and 20 beds. But now in 1992, we have 12 doctors, 53 nurses and 110 beds. The present medical specialists are physician (4), surgeon (2), orthopedist (3), pediatrician (1), clinical laboratory physician (1), and dentist (1). Although the yearly income and expenditures were well balanced until 1989, thereafter the income began to decrease insidiously and expenditures began to increase year by year. In this symposium titled "Suggestions for Clinical Laboratory Medicine by Experienced Hospital Directors," I must refer to the issue of "Clinical Laboratory Medicine Administrator's Standpoint". Recently, the unaccustomed phrase "Physician Executive" is occasionally heard as the details of medical care become more numerous and more intricate and economic efficiency is strictly persued. From this perspective, the clinical laboratory physician is responsible for managing the laboratory department with well disciplined knowledge and technique. Therefore, training as "Physician Executive" has developed naturally within the field of Clinical Laboratory Medicine. So, I cannot help coming to the conclusion that the management of a hospital, as a matter of course, will be entrusted to a doctor including clinical laboratory physician who can do his best for the citizens, for the patients, and ultimately for ourselves.

Acute interstitial nephritis with symmetric enlargement of the lacrymal and salivary glands and systemic lymphadenopathy

We describe a 40-year-old man who developed symmetric enlargement of the lacrymal and salivary glands and systemic lymphadenopathy. Laboratory findings included eosinophilia, polyclonal hypergammaglobulinemia, elevated circulating immune complexes, hypocomplementemia, and renal insufficiency. The lymph node pathology was atypical of angioimmunoblastic lymphadenopathy with disproteinemia (AILD), in that it lacked a prominence of arborizing small vessel proliferation. Despite extensive examinations, the cause of the atypical AILD process has not been identified. However, a flow-cytometric analysis of immunophenotypes of lymphoid cells from the lymph node revealed a predominance of activated helper/inducer T cells, indicating a hyperimmune state. Acute interstitial nephritis was secondary to the renal propagation of the atypical AILD process. Thus, atypical AILD can be a new cause of acute interstitial nephritis. A course of combined steroids and immunosuppressive treatment resolved those pathologic disorders for 5 years.

Cerebrospinal fluid corticotropin-releasing hormone and ACTH, and peripherally circulating choline-containing phospholipid in senile dementia

Cerebrospinal fluid (CSF) levels of corticotropin-releasing hormone (CRH) and ACTH, plasma levels of ACTH and cortisol, and serum levels of phospholipid and its fractions were determined in samples taken simultaneously from patients with senile dementia of the Alzheimer type (SDAT), multi-infarct dementia (MID) or dementia following a cerebrovascular accident (CVD), and the borderline-to-normal control subjects. CRH levels in CSF were significantly reduced in patients with SDAT and CVD but not with MID compared to the borderline-to-normal controls. ACTH levels in CSF were significantly reduced in SDAT compared to MID. The levels of circulating lecithin (phosphatidyl-choline) were depressed in a similar fashion to the levels of CRH in CSF in the SDAT patients and the group of severe dementia. Dementia and its severity did not affect the morning plasma levels of ACTH and cortisol. CSF CRH was positively correlated with CSF ACTH, while CSF ACTH was negatively correlated with plasma cortisol. No significant correlations were found between serum lecithin and CSF CRH or ACTH. These findings suggest that: 1) abnormalities in the extrahypothalamic CRH system play a role in the pathophysiology of senile dementia, which may not be specific to SDAT; 2) the CRH system and the ACTH system correlate with each other within the brain; 3) CSF ACTH is subject to the feedback inhibition by circulating cortisol; and 4) in the SDAT patients and the severe dementia group CSF CRH and serum lecithin are reduced probably via independent mechanisms.

[A case report of pulmonary embolectomy for acute pulmonary embolism]

In recent years, case reports of the pulmonary thromboembolism which had been comparatively less in our country, have been gradually increasing. However, this disease is more often reported in the chronic stage, and case reports of severe cases in the acute stage are still less. The case reported here was admitted to our hospital by emergency ambulation with severe chest pain. On the second day after the admission, respiratory standstill developed suddenly following recurrent chest pain, which necessitated cardiopulmonary resuscitation. The patient was intubated and the IABP was instituted because of hemodynamic instability. An emergent cardiac catheterization under the mechanical ventilation and the IABP supported displayed massive shadow defect on the pulmonary arteriogram, which was indicating acute pulmonary embolism. The pulmonary pressure was 58/18 mmHg despite of the shock state (the aortic pressure: 60/28 mmHg). Subsequently, a pulmonary thrombectomy was carried out under the emergency cardiopulmonary bypass. The cardiac catheterization performed two weeks after the operation. Revealed that the pulmonary pressure returned to the almost normal volume (38/18 mmHg) in association with the aortic pressure of 113/72 mmHg. The venogram of lower extremities revealed thrombi in the deep veins, suggesting the cause of the thromboembolism in the pulmonary arteries. The Bird's nest filter was inserted for the prevention of recurrence of pulmonary embolism. This patient is doing well 10 months postoperatively.

Transient bullous dermolysis of the newborn. Retention of anchoring fibril- and basal lamina-like structures in keratinocytes and evidence of collagenolysis

In a freshly induced blister from transient bullous dermolysis of the newborn, we found in epidermal basal cells structures similar to anchoring fibrils and lamina densa, often in combination. In the upper dermis, collagenolysis and phagocytosis of degenerated collagen fragments were observed. It is concluded that the stellate inclusions previously reported in this disease are prematurely assembled anchoring fibrils and lamina densa. A disturbance of delivery mechanism of precursor materials for anchoring fibrils and lamina densa may cause the deficiency of these structures which are essential for the integrity of dermo-epidermal adhesion. The presence of many normal anchoring fibrils and lamina densa in perilesional skin and their prompt degeneration after rupture of the inclusions previously led us to conclude that lytic enzymes are involved in the formation of blisters in this disease. The new finding of collagen phagocytosis in the lesional dermis seemed to support this contention.

Activation of phospholipases in platelets by polyclonal antibodies against a surface membrane protein

In a previous paper we demonstrated using immunochemical techniques that propolypeptide of von Willebrand factor was present on the surface of resting platelets. In the present paper we show that polyclonal antibodies against propolypeptide of von Willebrand factor induce activation of phospholipase(s) in platelets and lead to platelet aggregation. The antibody-stimulation of platelets induced the synthesis of thromboxane A2 (TXA2). Furthermore, the aggregation was inhibited by aspirin and an antagonist of TXA2. Aspirin inhibited not only the aggregation but also the activation of arachidonic acid liberation from phospholipids, but the effect of aspirin on arachidonic acid liberation was cancelled by the combined effect of the antibodies and a TXA2 mimetic agonist, which itself did not activate arachidonic acid liberation. The antibody-induced activation of arachidonic acid liberation and the aggregation were blocked by cytochalasin B. All these results obtained with antibodies were quite similar to the results obtained with collagen.

Papular mucinosis (scleromyxoedema) complicating diffuse systemic sclerosis: clinical features and electron microscope observations

Papular mucinosis (scleromyxoedema) is an uncommon disorder characterized by generalized papular eruption and cutaneous induration, which may be associated with a variety of extracutaneous manifestations. Although scleroderma and papular mucinosis share many features, they are clinically and histologically distinct entities. We report here a patient with diffuse scleroderma who developed superimposed papular mucinosis. Degranulating mast cells were a prominent ultrastructural finding in the involved skin. The occurrence of scleroderma and papular mucinosis, two uncommon cutaneous indurative diseases, in the same patient has not been described previously.

[A case of successful surgery for tetralogy of Fallot with single atrium, azygous connection and partial anomalous pulmonary venous drainage in atrio-visceral heterotaxic syndrome]

A 2-year-old girl of heterotaxia associated with complex anomalies was reported. Major cardiac anomaly was tetralogy of Fallot (TOF), which associated with the interruption of the inferior vena cava, persistent left superior vena cava (PLSVC), common atrium and partial anomalous pulmonary venous drainage (PAPVD) to the coronary sinus. The two dimensional echocardiogram displayed the characteristic views of TOF and the additional interesting abnormalities near the mitral ring. The markedly enlarged and protruded coronary sinus by the association of PLSVC and PAPVD overlay along the posterior mitral leaflet and the abnormal muscular septum surrounded immediately above the anterior mitral leaflet. These structures created a sort of supramitral ring structure, although this was not important hemodynamically because of the association of single atrium and TOF preoperatively. At the operation the coronary sinus roof was resected along the posterior mitral leaflet as well as the abnormal muscular flange. The atrial septum was created with a porcine pericardium and the left superior vena cava was ligated. The postoperative course was not eventful.

Polymorphism of coagulation factor XIII B subunit: further occurrence of FXIIIB*15 in Japanese and phenotyping in bloodstains

The polymorphism of FXIIIB was investigated in 555 unrelated Japanese individuals using isoelectric focusing and immunoblotting. Five common phenotypes and a rare variant type FXIIIB 15-3 were observed. The allele frequencies were FXIIIB*1 = 0.3063, FXIIIB*2 = 0.0162, FXIIIB*3 = 0.6766 and FXIIIB*15 = 0.0009. Phenotyping was also possible from bloodstains stored at 37 degrees C for up to 4 months and from bloodstains stored at room temperature and at 4 degrees C for over 6 months. The FXIIIB system can provide a new powerful genetic marker for the medicolegal grouping of bloodstains.

The role of growth factor in wound healing

A pig wound healing model was developed to study the morphological processes involved in incisional and excisional wound healing, the immunohistochemical localization of TGF-alpha in wound healing, and the latter's relevance. In incisional wounds, a few layers of epidermis were regenerated after only 32 hours. In contrast, several layers of epidermis were regenerated on day 7 in excisional wounds. In general, the incisional wound model is useful for evaluating tensile strength, while the excisional wound model is suitable for evaluating epidermal regeneration. Immunohistochemical study showed that keratinocytes migrating from wound edges expressed TGF-alpha very faintly, while TGF-alpha was present prominently in the upper several layers of the epidermis adjacent to the wound, which resembled normal epidermis and showed no changes during the wound healing process.

[Adult T-cell leukemia/lymphoma, histologically presenting Ki-1 positive anaplastic large cell lymphoma]

A 48-year-old woman was admitted with neck tumors and cutaneous nodules. On the histological basis of the skin nodule biopsy, a metastatic anaplastic carcinoma was suspected. Immunohistochemical studies showed the presence of Ki-1 antigen, IL-2 receptor antigen, leukocyte common antigen (LCA), CD3 and CD4 on the tumor cells compatible with Ki-1 positive anaplastic large-cell lymphoma. This case was, however, finally diagnosed as adult T cell lymphoma (ATL) of a helper/inducer phenotype. She was born in Kagoshima. The serum anti-ATL associated antigen (ATLA) was positive. Southern blot analysis on the DNA extracted from the skin tumor cells showed a monoclonal integration of HTLV-1 proviral DNA. The results suggested that Ki-1 positive lymphomas may include a subset of ATL with a large-cell histology.

The growth regulation of keratinocytes

Taken together, all these results suggest that TGF-alpha and amphiregulin are the major growth factors for positive growth control, although we don't know which plays the central role. For negative growth control, TGF-beta is the major factor. However, it remains to be solved which isoform of TGF-beta is naturally involved in keratinocyte growth regulation.