Species difference in susceptibility to phorbol myristate acetate-induced leukopenia and lung injury: rat vs. dog

Phorbol myristate acetate (PMA) was administered intravenously in a single dose to rats (400 micrograms/kg) and in a single and repeated doses to dogs (40 micrograms/kg). Severe leukopenia was observed in both species. The leukopenia in rats was due to a decreased number of both lymphocytes and neutrophils while the leukopenia in dogs was mainly due to a decreased number of neutrophils. The rats recovered from leukopenia much faster than the dogs. The dog which received a single injection developed focal fibrosis in the lungs. Rats showed only slight localized hemorrhage in the lungs, although the rats received a ten-fold larger dose of PMA than the dogs. Lungs of dogs which received multiple injections revealed severe hemorrhagic lesions in most alveoli. Lung lesions induced by PMA are thought to be mediated by activated leukocytes. This suggests that the severity of lung lesion correlates with the degree and duration of neutropenia. In conclusion, intravenous administration of PMA caused lung damage in rats and dogs. However, rats show much less sensitivity to PMA than dogs, resulting from the different response of leukocytes to PMA.

[A case of rheumatoid arthritis with immunotactoid glomerulopathy]

The patient was a 64-year-old female who had been treated by a local doctor for rheumatoid arthritis and hypertension for 10 years. Malaise and edema developed since July, 1990, and as proteinuria and renal dysfunction were noted, the patient was admitted to our hospital on November 2. On admission, BUN was 33mg/dl, creatinine was 2.5mg/dl, and proteinuria was about 3g/day. Renal biopsy was performed after admission. Light microscopy revealed nodular lobulation of glomeruli and occlusion of loops. Dylon staining was negative. Immunofluorescent study showed granular deposition of IgG, IgM, C3, C4, Clq in the glomerular basement membrane and mesangial area. Electron microscopy showed a large amount of electron dense deposits in the subendothelium and mesangial area and dense aggregation of tubular structure in the deposit, part of which exhibited a profile of fingerprint deposit. The tubular structures were classified into three major types, which were 120, 100, and 50nm in diameter. From these findings, a diagnosis of immunotactoid glomerulopathy was made. After renal biopsy, plasmapheresis and prednisolone were administered, and the patient has been managed conservatively to date.

Synthesis of 5-keto-5-oxime derivatives of milbemycins and their activities against microfilariae

Starting from milbemycin D (1), milbemycin A4 (2) and milbemycin A3 (3), a series of 5-keto-5-oxime derivatives were synthesized by selective oximation at the alpha,beta-conjugated carbonyl function of the 5-ketomilbemycins (4-6). The activities of the synthesized compounds were studied in dogs naturally infested with microfilariae of Dirofilaria immitis. The 5-keto-5-oximes of milbemycin D (7), A4 (8) and A3 (9) had quite high efficacy to control the microfilariae and more potency than their parents, while the 5-O-acyl oximes (11-15) also exhibited high activity.

Manganese ion elicits a binding activity of placenta vitronectin receptor to fibronectin cell-binding domain

Some members of the integrin family recognize the RGD sequence which is common to cell adhesive proteins in a divalent cation-dependent manner. In the presence of Ca2+ and Mg2+, the fibronectin receptor of placenta recognizes the RGD sequence of fibronectin, but not that of vitronectin, while the vitronectin receptor of placenta recognizes the RGD sequence of vitronectin, but not that of fibronectin, although both receptors recognize the same RGD sequence. We have found by performing an enzyme-linked immunosorbent assay (ELISA) using receptor-specific monoclonal antibodies and by electrophoretic analysis that in the presence of Mn2+ a vitronectin receptor of placenta binds to an affinity column coupled with the cell-binding domain of fibronectin. By replacing divalent cations from Mn2+ to Ca2+ and Mg2+, the vitronectin receptor was completely eluted from the column. When the synthetic peptides GRGDSP and GRGESP were applied to the column as competitors, the Mn(2+)-dependent binding was inhibited by both peptides. These results suggest that Mn2+ elicits a binding activity of the placenta vitronectin receptor to the RGD site of fibronectin. The modulation of ligand specificity by Mn2+ will provide an important clue in the elucidation of the cause of individual ligand specificity of RGD-recognizing integrins.

[Routine use of the internal mammary artery for aorto-coronary bypass surgery]

Internal mammary artery (IMA) grafts have excellent long-term patency rate and result in improved late survival. Conventional use of IMA was only for selected cases. Elder or acute myocardial infarction case had been excluded from IMA use. During past 30 months we extended the indication of the IMA use for all the ACB case. The present study was undertaken to assess the possibility of routine use of the a IMA for aorto-coronary bypass (ACB). From Nov. 1987 through May 1990, we performed consecutive 110 ACB with the protocol "routine use of the IMA for all the ACB surgery". The 78 men and 32 women (29%) had a mean age of 64 years old (range 38 to 80 years old). Thirty-five patients (32%) were 70 years of age or older. Eighty-four patients had stable angina, nineteen patients had unstable angina, seven patients had acute myocardial infarction. IMA was used in 106 patients (96%). An average of 3.6 coronary arteries per patient were bypassed, and 1.6 distal anastomosis per patient were made with IMA. Combined cardiac surgery was performed in 8 cases (ventricular septal rupture repair: 2 cases, coronary endarterectomy: 4 cases, left ventricular aneurysm resection: 1 case, mitral commissurotomy: 1 case). Post operative complication due to IMA use were infrequent and operative mortality was 6.3%. In summary, routine use of the IMA for ACB surgery was possible method as if in high risked cases (elder or poor left ventricular function). We believe this method result in improved late result. We concluded routine use of the IMA for ACB was possible and usefull method.

[A successful surgical case of ruptured thoracoabdominal aneurysm]

A successful surgical case of ruptured thoracoabdominal aortic aneurysm was reported. The patient was a 77-year-old male. He entered our hospital and was diagnosed ruptured Crawford type 3 thoracoabdominal aortic aneurysm by chest X-ray, CT scan and aortography. Operative procedure was tube graft insertion into thoracoabdominal aorta with celiac artery reconstruction. Postoperative course was excellent and discharged on 55th postoperative day.

[Cineradiographical significance for diagnosis and treatment of thrombosed Björk-Shiley prosthesis in the aortic position]

In the periods between February 1973 and December 1987, 377 Björk-Shiley valve prostheses have been implanted in the aortic position in our institute. The maximum opening angle of the prosthesis have been cineradiographically measured in 30 cases. The maximum opening angle of the convexo-concave valve having an opening angle of 60 degree (CC 60) was measured as 58.8 +/- 1.9 degree and that of the monostrut valve having an opening angle of 70 degree was 69.4 +/- 2.1 degree. During this period we have experienced 6 cases of thrombosed Björk-Shiley prosthesis. They have shown restriction of the opening from 26 to 58.9 degree and restriction of the closing from 9.2 to 41.8 degree. Thrombolytic treatment was successful in case with thrombosed Björk-Shiley prosthesis which showed restriction of the opening angle on cineradiogram. 4 cases with restriction of the closing angle on cineradiogram were treated operative thrombectomy. Three of them have had uneventful reoperative course in the follow up period of 8 years. We believe that cineradiography is very useful for not only diagnosis but also decision of management for thrombosed Björk-Shiley prosthesis in the aortic position.

[Evaluation of the efficacy of ceftriaxone in acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media. A comparative study with cefotiam as the control]

In order to objectively evaluate the efficacy and the safety of ceftriaxone (CTRX) using once daily administration of 1 g to cases of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media, a group comparison study by the envelope method was conducted using cefotiam (CTM) as the control drug (2 g twice daily). The results obtained are summarized as follows. 1. Clinical efficacies evaluated by the committee were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 63% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered both groups evidenced a clinical efficacy of 64%, and no significant difference was observed between the 2 groups. 2. Clinical efficacies evaluated by the physician in charge were 65% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered efficacies were, respectively, 70% and 64%, showing no significant difference between the 2 groups. 3. Bacteriological efficacies were 88% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 74% and 62%, respectively, for chronic suppurative otitis media. With all cases bacterial eradication rates were, respectively, 76% and 67%. Bacterial eradication rates were always higher for the CTRX group than for the CTM group, but the difference was not significant between the 2 groups. 4. Against infections caused by Staphylococcus aureus alone, CTRX showed equal clinical and bacteriological efficacies to CTM. 5. As side effects, dermatitis, vomiting, and malaise were observed in 5 cases (4%) of the CTRX group and 3 cases (3%) of the CTM group. As clinical testing abnormalities, elevations of GOT, GPT, and Al-P, and thrombocytopenia were noted only in 3 cases (5%) of the CTRX group. Furthermore, all of these abnormalities were temporary and of moderate degree or mild, thus the safety of either drug was considered high. 6. Clinical utilities were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 62%, respectively, for chronic suppurative otitis media. When all cases were included, they were 72% and 66%, respectively, and there was no significant difference between the 2 groups. It is concluded from the above results that CTRX is a highly useful drug with once daily administration of 1 g in the treatment of suppurative otitis media.

Accuracy of diagnosis on death certificates for underlying causes of death in a long-term autopsy-based population study in Hisayama, Japan; with special reference to cardiovascular diseases

Major categorical diagnosis by International Classification of Diseases and type-specific diagnosis for cardiovascular diseases in death certificates were compared to the diagnosis made at autopsy in 864 consecutive autopsy cases aged 20 or over, among the Japanese residents in Hisayama town. Cerebral stroke was correctly diagnosed in 84%, malignant neoplasms in 78% and cardiac disease in 66%. Cerebral stroke and cardiac disease tended to be overdiagnosed, while malignant neoplasms were underdiagnosed. The validation of certified diagnosis was less reliable in the aged population, and in type-specific diagnosis of cardiovascular diseases. Cerebral hemorrhage with false negative or false positive diagnoses was usually classified into type unspecified stroke or different categories of cerebral stroke, while those misdiagnosed as cases of cerebral infarction frequently had no significant lesions in the autopsied brain. Finally, the relationship between the validation of diagnosis on the death certificates and the secular trend in cardiovascular disease in the Japanese vital statistics was discussed.

Intracerebral hemorrhage in a Japanese community, Hisayama: incidence, changing pattern during long-term follow-up, and related factors

The incidence of intracerebral hemorrhage over 13 years is compared between two Hisayama cohorts. Among men aged 40 years or older, the annual incidence declined significantly from 3.1/1,000 in the early cohort (1961-1970) to 1.2/1,000 in the recent cohort (1974-1983). Massive ganglionic hemorrhage decreased, while small or medium-sized intracerebral hemorrhage increased in the recent cohort on pathologic or computed tomographic examination. These trends could be due to the reduced prevalence of hypertension in the Hisayama population. The association of serum total cholesterol with intracerebral hemorrhage is discussed based on the results during a 22-year follow-up period.

Transient cerebral ischemic attacks in a Japanese community, Hisayama, Japan

During a 20-year follow-up of 1,621 men and women aged 40 and over in Hisayama, Japan, 18 were found to have suffered transient cerebral ischemic attacks (TIAs) determined by clinical symptoms based on criteria proposed by the US Joint Committee for Stroke Facilities. The average annual incidence rate for the first TIA was 0.56 per 1,000 residents. Age and high blood pressure were strong determinants of TIAs for men. Nine of the 18 cases with TIAs (50%) subsequently developed cerebral infarction, an incidence significantly higher than that in the 1,603 subjects without TIAs (10.9%). Lacunar infarcts were most commonly found on pathologic examination of patients with TIAs who had had a subsequent stroke.

Severe disability related to cerebral stroke: incidence and risk factors observed in a Japanese community, Hisayama

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode. During 20 years of follow-up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting post-ictal functional recovery were discussed.

Hyperbaric oxygen therapy in experimentally induced acute cerebral ischemia

Effects of hyperbaric oxygen (HBO) on acute cerebral ischemia were studied in spontaneously hypertensive rats, which had the carotid artery bilaterally ligated. The animals were exposed to HBO (100% 02 at 2 ATA) for 30 min at 1 or 3 h after carotid ligation (treated group). Survival time and brain tissue metabolites were measured after HBO in these animals and compared with ischemic animals without HBO exposure (nontreated group). The animals treated at 3 h after ligation survived longer (6.5 +/- 0.7 h) than did nontreated ones (4.3 +/- 0.2 h) (P less than 0.05). The cerebral lactate increased much less in these treated animals (24.60 +/- 1.67 mM/kg) than in nontreated ones (31.78 +/- 1.68 mM/kg) (P less than 0.05). Cerebral ATP levels tended to decrease less in the former (0.66 +/- 0.17 mM/kg) than in the latter (0.59 +/- 0.07 mM/kg). When HBO started at 1 h after carotid ligation, however, there were no significant differences of survival time or brain metabolites between treated and nontreated groups of animals. The present results indicate that HBO administered at 3 h after brain ischemia prevents further increase in cerebral lactate and produces a slight but significant increase in survival time.