Automatic head positioning system using PSD-equipped camera-based photostereometry and a 5-degree-of-freedom robotized chair: calibration and accuracy verification

In measurements of jaw movements employing an X-ray television, the orientation of the patient's head must be normalized relative to the measuring device. To avoid interferring with natural jaw movements caused by using a positioning jig, we have developed an automatic head positioning system consisting of a head position sensor and a robotized chair. The position and orientation of the head is monitored by detecting the three-dimensional positions of four non-coplanar LED markers mounted on the head, by means of a set of two photoelectronic cameras. If they are incorrect, the head is moved into the required position, using a 5-degree-of-freedom robotized chair. To accomplish this accurately, the positional relations of system components must be determined precisely. This paper proposes a least-square technique of calibrating the relationship between the position sensor and the chair. Consequently, accurate positioning is achieved. Accuracy verification studies revealed that overall positioning errors lay within 2.42 mm and 1.28 degrees with respect to the position and orientation, respectively, if the markers are secured to the head support of the chair.

[Indication for percutaneous transluminal coronary angioplasty based on quality of life of patients with angina pectoris]

The changes in quality of life (QOL) before and after percutaneous transluminal coronary angioplasty (PTCA) were investigated to establish criteria for determining whether patients with angina pectoris should undergo PTCA. The QOL was surveyed twice by self-completed questionnaire for QOL by Iida and Kohashi (QUIK) before and about 4 months after PTCA in 84 patients (mean age 62.8 +/- 10.1 years) with angina pectoris. High QUIK score reflects a poor QOL, of which the internal consistency was 0.86, demonstrating high reliability. The subjects were classified into three groups according to the changes of total QUIK score before and after PTCA (I: QOL improved 31.0%, II: QOL unchanged 48.8%, III: QOL worsened 20.2%). Age, gender, total QUIK score prior to PTCA, presence of anginal pain, complications extent and degree of coronary artery stenosis, and left ventricular ejection fraction were compared between the three groups. The total QUIK score prior to PTCA in the improved QOL group was higher than that in the worsened QOL group (11.6 vs 5.1, p < 0.01). Most patients showing a poor QOL prior to PTCA demonstrated an improvement in their QOL after PTCA. The number of patients with anginal pain prior to PTCA was high in the improved QOL group (35.8%, p < 0.05). Percutaneous transluminal coronary angioplasty might not aggravate QOL (12.1%, p = 0.1) in patients with single-vessel disease. In patients with multivessel disease, PTCA might not improve (35.3%) but also might aggravate QOL (25.5%). Multivariate analysis showed that PTCA improved QOL in male or sixty-ager patients and in patients with a total QUIK score of 10 or more prior to PTCA (p < 0.01). The total QUIK score, presence of anginal pain and extent of coronary artery stenosis prior to PTCA, gender and age are factors predicting QOL after PTCA. The adaptation of PTCA for those patients should be prudently and inclusively taken into consideration to extend their QOL.

Isolated collagen IV retains the potential to form an 18-nm sided polygonal meshwork of the lamina densa

Polygonal meshworks were revealed in the aggregates reconstituted from isolated collagen IV as well as in the lamina densa of mouse pancreas by the quick-freezing and deep-etching technique. Collagen IV solution with acetic acid from the bovine lens capsules and that isolated from the pepsin-solubilized fraction of human placenta reconstituted polygonal meshworks, which were dimensionally similar to the meshwork seen in the lamina densa of mouse pancreas. The average lengths between branching points in the lamina densa, and the meshworks of collagen IV derived from the bovine lens capsules and from the human placenta were 20.1 +/- 7.7 nm (mode = 18 nm), 21.6 +/- 11.3 nm (mode = 14 nm), and 21.6 +/- 9.0 nm (mode = 18 nm), respectively. These observations suggest that collagen IV can, in the absence of other macromolecules including laminins, comprise a skeletal meshwork similar in dimensions to that of the lamina densa.

Clinical features of familial diffuse Lewy body disease

We present 5 patients from two families with familial autosomal dominant diffuse Lewy body disease. All 5 patients initially showed parkinsonian symptoms that responded well to levodopa therapy; however, dementia followed and later progressed. In 3 patients, the disease was manifested before age 40 years, exhibiting wearing-off phenomenon and choreic limb dyskinesia. One patient was examined neuropathologically, and brain stem lesions compatible with Parkinson's disease were revealed, and Lewy bodies and senile plaques were found in the cerebral cortex. Familial cases of diffuse Lewy body disease may provide some explanation of the pathogenesis of this disease.

Shear stress-induced myosin association with cytoskeleton and phosphorylation in human platelets

Upon platelet activation by a high shear stress (108 dyne/cm2), actin and actin-binding protein increased rapidly into the Triton-insoluble cytoskeleton, whereas the association of myosin increased gradually. The amounts of cytoskeleton-associated myosin depended on the extent of aggregation. Preceding the maximal aggregation and ATP secretion, the 20 kDa light chain of myosin (MLC) is rapidly phosphorylated to approx. 45% of 20 kDa MLC and is then dephosphorylated. Cytoskeletal association of myosin and phosphorylation of 20 kDa MLC was inhibited by OP-41483, a prostaglandin I2 analog, which inhibited the full aggregation response to shear stress. Exposure to high shear stress resulted in an increased association of myosin light chain kinase and protein phosphatase types 1 and 2A with the cytoskeleton, while the cytoskeletal association of protein kinase C was not evident. These results indicate that 20 kDa MLC phosphorylation is involved in shear stress-induced platelet activation, and that cytoskeletal association of protein phosphatases may regulate the phosphorylation level of cytoskeletal elements such as myosin together with myosin light chain kinase.

Interstitial pneumonitis and fibrosis associated with the inhalation of hair spray

We describe a 49-year-old female Japanese hairdresser who presented with a 5-year history of exertional dyspnea, a nonproductive cough, and occasional febrile episodes. Histological analysis revealed interstitial fibrosis with mononuclear cell infiltration, foreign body granuloma, and numerous intra-alveolar macrophages and multinucleated giant cells of foreign body type. Arterial blood gas, pulmonary function studies and computed tomographic findings demonstrated improvement 6 months after cessation of exposure to the salon. Bronchoalveolar lavage fluid findings suggested that the development of lung disease in this case was triggered by an allergic mechanism rather than the storage of hair spray ingredients in the lung.

HELLP syndrome in a pregnant patient with a past history of splenectomy for idiopathic thrombocytopenic purpura. Case report

CASE

We present a case of HELLP syndrome occuring in a patient who at the age of 8 years had undergone a splenectomy for idiopathic thrombocytopenic purpura. She was diagnosed as having HELLP syndrome 37 weeks of gestation and had a cesarean section.

Effects of combined beta-adrenergic and cholinergic blockade on the initial ventilatory response to exercise in humans

To elucidate whether combined adrenergic and parasympathetic blockade would affect the ventilatory response to exercise, especially at the initial stage (phase I), six healthy subjects performed a brief and light voluntary bilateral leg extension exercise and passive movements under the conditions of control (before the blockade) and after intravenous administration of combined beta-adrenergic (propranolol, 0.2 mg.kg-1) and muscarinic (atropine, 0.04 mg.kg-1) receptor antagonists. The movements were continued only within two breaths after the onset of the motion. Ventilation increased immediately and significantly (P < 0.05) within the first breath at the onset of voluntary exercise in all conditions as compared with at rest. However, the magnitude of increase in mean ventilation within two breaths at the start of exercise as against the resting value (delta ventilation) was significantly less (P < 0.05) after the combined blockades (2.5 l.min-1) than in the control condition (3.7 l.min-1). Passive movements showed a similar but smaller change as compared with voluntary exercise. The heart rate response to exercise was attenuated by the combined blockade while cardiac output showed a slight change at the onset of exercise. It is concluded that phase I should occur despite the inhibited activity of the beta-adrenergic and the cholinergic systems; nevertheless, the response was attenuated by the combined blockade. These results suggest a possible role of the beta-adrenergic and/or cholinergic systems in the rapid increase in ventilation that occurs at the start of exercise.

Evolution to dilated cardiomyopathy from acute eosinophilic pancarditis in Churg-Strauss syndrome

We describe the clinical manifestations of a patient with Churg-Strauss syndrome who presented with severe acute cardiac involvement and whose disease evolved to dilated cardiomyopathy (DCM), with special reference to the histopathological findings. Endomyocardial biopsies, conducted sequentially, three times within 10 months, revealed severe eosinophilic endomyocarditis in the acute phase, interstitial fibrosis in the subacute phase, and endocardial thickening with mural thrombi, at 10 months. Although acute inflammation associated with elevation of eosinophil granule proteins subsided with steroid therapy, left ventricular dilatation with reduced contractility progressed. A subgroup of DCM is not considered to be idiopathic but, rather, an aftereffect of hypereosinophilic heart disease.

Effect of estrogen on isoforms of nitric oxide synthase: possible mechanism of anti-atherosclerotic effect of estrogen

While estrogen is known to prevent the development of atherosclerosis, the mechanism is not completely understood. We investigated the effects of superoxide dismutase, acetylcholine, and other compounds on the release of nitric oxide (NO) by measuring the relaxation responses of aortic rings, with and without intact endothelium, taken from rabbits under various experimental conditions. The aorta of female rabbits released a greater amount of NO than did that of oophorectomized females and male rabbits. The greater basal release of NO in female rabbits was decreased in animals with atherosclerosis induced by a high cholesterol diet. We also investigated the effect of estrogen on endothelial, neuronal and inducible NO synthase (NOS), NOS-3, NOS-1 and NOS-2, respectively. Preincubation with a physiologic concentration of 17 beta-estradiol (10(-12) to 10(-8) M) over 8 h significantly enhanced the activity of NOS-3 in the endothelial cells of cultured human umbilical vein and bovine aortas. 17 beta-Estradiol also enhanced the release of NO from endothelial cells as measured by an NO selective meter and NO2-/N/3-, metabolites of NO. Western blot showed a similar effect of 17 beta-estradiol on NO. Estrogen increased NOS-3 via a receptor-mediated system. Low concentrations of 17 beta-estradiol (10(-10) to 10(-8) M) enhanced the activity of crude NOS-1 in the cytosolic fraction of rabbit cerebella. Partially purified NOS-1, obtained from the cytosolic fraction by DEAE column chromatography, had a similar response to estrogen. Estrogen at a low dose enhanced the fluorescence of dansyl calmodulin and augmented it in high doses. We also investigated the effect of estrogen on NOS-2. When J774 cells, a murine macrophage cell line, were incubated with interferon-r and lipopolysaccharide, NOS-2 was induced and a large amount of NO was released. Pre- or co-incubation of 17 beta-estradiol inhibited the induction of NOS-2 protein and NO release. The estrogen receptor antagonists, tamoxifen and ICI 182780, inhibited that effect of 17 beta-estradiol. 17 beta-Estradiol inhibited the induction of NOS-2 by a receptor-mediated system. These results may offer a new mechanism for the anti-atherosclerotic effect of 17 beta-estradiol.

[Successful surgical treatment of aortic regurgitation due to annuloaortic ectasia and mitral regurgitation caused by tendon rupture in a case of osteogenesis imperfecta]

A 54-year-old man presented with osteogenesis imperfecta complicated with both aortic regurgitation due to annuloaortic ectasia and mitral regurgitation secondary to tendon rupture. He had spinal and carpal deformities in his childhood, and heart murmurs were identified at the age of 25. He was admitted complaining of dyspnea on effort. His height was 142 cm and his weight was 46 kg. He had kyphosis, scoliosis and carpal deformity. Blue sclera was not observed. Chest radiography showed cardiomegaly and lung congestion. Echocardiography showed annuloaortic ectasia, mild aortic regurgitation, and serious mitral regurgitation due to postero-apical tendon rupture. Bone deformity and his statues were indicative of osteogenesis imperfecta. He received modified Bentall and mitral valve replacements.

MR imaging of hepatocellular carcinomas: effect of Cu and Fe contents on signal intensity

BACKGROUND

To elucidate the metallic factors contributing to the signal intensities of hepatocellular carcinoma (HCC) on T1-weighted magnetic resonance (MR) images and to determine whether or not changes in signal intensity contribute to the diagnosis of histological grading of HCC.

METHODS

In 35 patients immediately after surgery, the quantities of water, lipid, copper (Cu), iron (Fe), and manganese (Mn) were determined in HCCs and the surrounding hepatic parenchyma. The correlations among these findings, the histopathological findings, and the signal intensities of T1-weighted MR images were evaluated.

RESULTS

Among the 35 HCCs, 12 (34%) were of high intensity, 14 (40%) were isointense, and 9 (26%) were of low intensity on T1-weighted images versus the surrounding hepatic parenchyma. The paramagnetic ions, which contributed to the signal intensity patterns, were assumed to be Cu in HCCs (30.5 +/- 52.9 microg/g ww), and Fe in the livers (106.2 +/- 86.8 microg/g ww) and HCCs (87.7 +/- 49.1 microg/g ww). In 12 HCCs with high intensity, one was grade I, eight were grade II, and three were grade III according to Edmondson-Steiner's histopathological classification.

CONCLUSIONS

Signal intensity and signal intensity patterns alone cannot be signs of low-grade malignancy because of the Fe in livers and in HCCs.

[Saccular aneurysm-like bleb formation after rupture of the internal carotid-posterior communicating artery aneurysm: a case with interesting angiographic findings]

A case of saccular aneurysm-like bleb formation after rupture of an aneurysm in the internal carotid-posterior communicating artery. In connection with this, an interesting angiographic finding was reported. A 65-year-old man suffered from sudden disturbance of consciousness and left hemiparesis. Computed tomography (CT) scan revealed typical subarachnoid hemorrhage localized in the right Sylvian fissure. Next day, a cerebral angiography was performed, but no aneurysm was detected. A second angiography was performed 21 days after the onset, and it revealed a saccular right internal carotid-posterior communicating artery (IC-PC) aneurysm. An operation for the IC-PC aneurysm was performed by conventional pterional approach. However, intraoperative findings were unexpected. The collapsed ruptured true IC-PC aneurysm was found at the orifice of the larger bleb, and the ruptured point was in the neck of the true aneurysm. Clipping of the aneurysm was performed successfully. The patient was discharged on foot. The aneurysm detected by the second angiography was not a true one but a bleb formation. Continuous hemodynamic stress on the rupture point may induce the formation of such an aneurysm-like bleb. It should be kept in mind that an aneurysm found in the chronic period might be an aneurysm-like bleb.

Antihyperglycemic mechanism of M16209, an antidiabetic agent, in 3T3-L1 adipocytes

We investigated the effect of M16209 (1-(3-bromobenzo[b]furan-2-ylsulfonyl)hydantoin) on glucose transport and the insulin signaling system in mouse-derived 3T3-L1 adipocytes. When M16209 (30 and 100 microM) was added to 3T3-L1 adipocytes and preincubated for 24 hours, the uptake of 2-deoxy-D-[3H]-glucose (2-DG) after insulin stimulation was enhanced. This effect was seen when preincubation with M16209 was performed in the presence of 6 and 20 ng/ml insulin, but M16209 did not increase the response to 600 ng/ml insulin. M16209 (100 microM) did not interfere with (125)I-insulin binding or with tyrosine phosphorylation of the insulin receptor beta-subunit and IRS-1. M16209 (100 microM) also had no effect on the level of glucose transporter (GLUT1 and GLUT4) protein, but it promoted the translocation of intracellular GLUT4 to the plasma membrane. In contrast, M16209 had no effect on the translocation of GLUT1. In summary, M16209 enhanced 2-DG uptake by 3T3-L1 adipocytes. Insulin binding to its receptor, autophosphorylation of the insulin receptor beta-subunit, and tyrosine phosphorylation of IRS-1 were unaffected by M16209. However, translocation of GLUT4 from the intracellular pool to the plasma membrane was facilitated.

Preventive effect of oren-gedoku-to (huanglian-jie-du-tang) extract on progression of carbon tetrachloride-induced acute liver injury in rats

The effect of oral administration of Oren-gedoku-to (Huanglian-Jie-Du-Tang) extract (TJ-15) on the progression of acute liver injury was examined in rats intoxicated with carbon tetrachloride (CCl4). When TJ-15 at a dose of 500 mg/kg body weight (b.w.) was administered to male Wistar rats aged seven weeks 6 hours after i.p. injection of CCl4 (1.0 ml/kg b.w.), an apparent liver injury occurred. Significant prevention against the progression of liver injury was found 24 hours after the injection judging from the activities of serum transaminases and other indices of liver cell damage. An increase in lipid peroxide level and decreases in reduced glutathione level and superoxide dismutase (SOD) activity occurred in the liver at 6 and 24 hours after CCl4 injection. Serum SOD activity increased 24 hours after CCl4 injection. Post-oral TJ-15 administration significantly ameliorated all these changes found at 24 hours after CCl4 injection. An increase in liver triglyceride level and a decrease in serum triglyceride level also occurred 6 and 24 hours after CCl4 injection. Post-oral TJ-15 administration prevented the increase in liver triglyceride level at 24 hours after CCl4 injection. Although the activity of liver tryptophan 2,3-dioxygenase (TDO), a marker of the inhibition of liver protein synthesis by CCl4, decreased 6 and 24 hours after injection of the toxicant, post-oral TJ-15 administration had no effect on this decrease in TDO activity at 24 hours after the injection. These results indicate that oral TJ-15 administration can prevent the progression of acute liver injury in CCl4-injected rats, and suggest that this prevention could be due to the action of TJ-15 to scavenge free radicals formed in the liver and to inhibit triglyceride accumulation in the liver.

Basement-membrane stromal relationships: interactions between collagen fibrils and the lamina densa

Collagens, the most abundant molecules in the extracellular space, predominantly form either fibrillar or sheet-like structures-the two major supramolecular conformations that maintain tissue integrity. In connective tissues, other than cartilage, collagen fibrils are mainly composed of collagens I, III, and V at different molecular ratios, exhibiting a D-periodic banding pattern, with diameters ranging from 30 to 150 nm, that can form a coarse network in the extracellular matrix in comparison with a fine meshwork of lamina densa. The lamina densa represents a stable sheet-like meshwork composed of collagen IV, laminin, nidogen, and perlecan compartmentalizing tissue from one another. We hypothesize that the interactions between collagen fibrils and the lamina densa are crucial for maintaining tissue-tissue interactions. A detailed analysis of these interactions forms the basis of this review article. Here, we demonstrate that there is a direct connection between collagen fibrils and the lamina densa and propose that collagen V may play a crucial role in this connection. Collagen V might also be involved in regulation of collagen fibril diameter and anchoring of epithelia to underlying connective tissues.

Serum lipid profile in relation to milk consumption in a Japanese population

OBJECTIVE

To investigate relationships between serum lipid profiles, milk consumption and lifestyle, in a Japanese population.

METHODS

A cross-sectional study in 12,610 Japanese men aged 30 to 69 years. Serum total-cholesterol (TC), HDL-cholesterol (HDLC), LDL-cholesterol (LDLC), TC/HDLC ratio, and triglycerides (TG) were determined. Milk consumption was classified into "Yes" (3553 men) and "No" (9057 men) groups by a self-administered questionnaire "Do you drink a glass of cow's milk (180 to 200 mL) or more everyday?". Five variables (age, body mass index, habitual exercise, and smoking and drinking habits) were considered confounding factors for the serum lipids.

RESULTS

Regardless of age, the "Yes" group had higher levels of serum TC, HDLC and LDLC than the "No" group except for one comparison (HDLC in 50 to 54 year old group). The differences in serum TC (p < 0.001), HDLC (p < 0.001) and LDLC (p < 0.001) between the two groups were significant by ANOVA. However, milk consumption had no significant relations to serum TC/HDLC ratio or TG level. Multivariate models including the five confounding factors confirmed these results, and indicated that the "Yes" group had higher adjusted means of serum TC by 0.079 mmol/L (+1.5%, 5.280 vs. 5.201 mmol/L, p < 0.001), HDLC by 0.018 mmol/L (+1.4%, 1.260 vs. 1.242 mmol/L, p < 0.01), and LDLC by 0.066 mmol/L (+2.0%, 3.382 vs. 3.316 mmol/L, p < 0.001) than the "No" group.

CONCLUSION

Milk consumption is part of a lifestyle related to hypercholesterolemia in the Japanese.

Increased endothelial and epidermal thrombomodulin expression and plasma thrombomodulin level in progressive systemic sclerosis

To clarify the relation between systemic and cutaneous vascular endothelial injury in progressive systemic sclerosis (PSS), we examined thrombomodulin (TM) expression in PSS skin lesions immuno-histopathologically and compared it with plasma soluble TM levels measured by specific enzyme-linked immunosorbent assay. The plasma soluble TM level in PSS patients was significantly higher than that of normal controls and was as high as the levels of SLE patients. In relation to disease activities, the plasma TM levels of sclerotic phase PSS patients were significantly higher than that of atrophic phase PSS patients. The plasma samples with anti-Scl-70 antibody showed a high TM level than samples with anti-centromere antibody or anti-RNP antibody. Barnett's types or systemic corticosteroid treatment did not affect the TM level. Histopathologically, the dermal endothelial TM expression significantly increased in the sclerotic skin and moderately increased in the non-sclerotic skin of PSS compared with that of normal control skin. In addition, immunoreactive TM expression in the epidermis also increased in PSS. Disease activity-dependent elevation of plasma TM levels and immuno-histopathological expression of TM suggested generalized endothelial and epidermal cell involvement in PSS, and compensation in part by overproduction of TM by endothelial cells.

Regional abnormality of iodine-123-MIBG in diabetic hearts

Autonomic neuropathy along with cardiac denervation is one of the prognostic factors of diabetic patients. The aim of this study was to establish qualitative and quantitative assessment of diabetic cardiac denervation using [123I]metaiodobenzylguanidine (MIBG).

METHODS

The study population consisted of 31 diabetic patients and 12 control subjects (C). Diabetic patients were classified into the following three groups according to their presentation of neuropathy: NO, without neuropathy; N1, mild neuropathy; N2, severe neuropathy. All subjects underwent triple-phase MIBG scanning, including dynamic planar imaging as well as early and delayed planar and SPECT imaging. Myocardial uptake ratios of MIBG and heart-to-mediastinum count ratios (H/M) were calculated as global uptake indices. Inferior-to-anterior count ratios and coefficients of variation were calculated as regional distribution indices. The washout rate of the inferior wall and whole myocardium were also studied.

RESULTS

MIBG abnormalities were obvious in the inferior wall, which gradually spread to the adjacent segments. All indices of regional uptake showed a significant difference (p < 0.01) among the groups, while only the H/M of the late image showed significant differences in the two global uptake indices (p = 0.02). the washout rate of the inferior wall was enhanced with neuropathy.

CONCLUSION

Diabetic neuropathy involves an MIBG abnormality in its early stages. Since this abnormality occurs in the inferior segment, an inferior-to-anterior count ratio, an index of regional MIBG uptake could be suitable for the evaluation of this condition because of its superior sensitivity.

Xyloglucan endotransglycosylation in suspension-cultured poplar cells

Xyloglucan endotransglycosylase activity was identified and defined by transfer of a part of xyloglucan to reduced xyloglucan heptasaccharide ([3H]XXXGol) in an enzyme preparations from suspension-cultured poplar cells. Although the activity was distributed in buffer-soluble and buffer-insoluble fractions associated with cells and in the extracellular fraction, it was mostly recovered in the buffer-insoluble fraction, suggesting that the enzyme was bound to the cell wall. The affinity for acceptor XXXGol was increased at a higher concentration of donor xyloglucan with a constant Vmax. The Vmax for donor xyloglucan was increased at a higher concentration of the oligosaccharide without any change in affinity. These kinetic data suggest that the acceptor acts by combining with the enzyme independently of the donor. The velocity of the reaction decreased gradually as the heptasaccharide units was increased from two to four, suggesting that the xyloglucan endotransglycosylase reaction caused donor xyloglucan substantially to decrease in molecular size. The activity in buffer-soluble fraction was increased by ABA in auxin-starved cells, when cultured in MS medium containing various plant hormones. Nevertheless, the activity increased markedly at the exponential growth and decreased immediately at the stationary phase of cells in the presence of 2,4-D. The activity of xyloglucan endotransglycosylase is developmentally regulated during the growth but is not directly induced by plant hormones.

[A case of hemolysis induced by lansoprazole]

Hemolytic anemia and possible aplastic crisis with symptoms including jaundice, general fatigue and dark urine developed in a man being treated only by lansoprazole. Five days later, he was treated with antibiotics. The next day, he was admitted to our hospital because of jaundice. On admission, the hemoglobin was 14.0 g/dl, reticulocyte count 8/1000, platelets 79 x 10(9)/l and total bilirubin 12.4 mg/dl (indirect bilirubin 9.5 mg/dl). The above medications were discontinued. The direct Coombs antiglobulin test was positive. Examination of the complement revealed a C3 fiter at the upper limit of normal and an increased C4 and CH50. Three days after admission, he had a severe anemia. The hemoglobin was 3.3 g/DL. We thought it possible that aplastic crisis had followed the hemolytic anemia induced by lansoprazole. He was treated with blood transfusions and corticosteroids. He recovered from anemia within three weeks. Exhaustive studies to identify the cause of the hemolytic anemia were undertaken with negative results. We detected IgG antibody to lansoprazole. We believe that the hemolytic anemia was induced by lansoprazole.