Fluorescence in situ hybridization analysis of chromosomal localization of three human cytochrome P450 2C genes (CYP2C8, 2C9, and 2C10) at 10q24.1

Chromosomal localization of three human cytochrome P450 genes belonging to the CYP2C subfamily (CYP2C8, 2C9, and 2C10) was identified by fluorescence in situ hybridization (FISH). An original MP-8 clone was used as a DNA probe for the assignment of the CYP2C10 gene, while two cDNA probes, a 1.37 kb fragment of CYP2C8 and a 1.19 kb fragment of CYP2C9, were obtained after amplifying the predicted fragments (MP-20 and MP-4 clones, respectively) by polymerase chain reaction using a single human liver cDNA library. The results showed that three human CYP2C8, 2C9, and 2C10 cDNAs were located at the same subchromosomal region, 10q24.1.

Synergy among erythropoietin, interleukin 3, stem cell factor (c-kit ligand) and interferon-gamma on early human hematopoiesis

The stimulatory effect of interferon-gamma (IFN-gamma) on human early hematopoiesis was investigated using CD34+ cells that were purified from peripheral blood as a target. In the presence of human interleukin 3 (IL-3) and stem cell factor (SCF), the growth of colony forming units for granulocyte/macrophage (CFU-GM) in serum-free methylcellulose culture was enhanced up to 5.5-fold over baseline colony formation (n = 10, mean +/- SE, 3.18 +/- 1.00) by coculture with 2.5 x 10(3) U/ml IFN-gamma, whereas burst forming units-erythroid (BFU-E) growth induced by additional erythropoietin (Epo) was reduced dose-dependently. Liquid-suspension culture of the target cells for 24 h with IFN-gamma before secondary plating in serum-free methylcellulose resulted in a marked increase in the colony numbers; 3.62 +/- 1.04-fold for CFU-GM and 5.72 +/- 2.32-fold for BFU-E (n = 5). The effect was most striking in the growth of erythroid lineage supported by Epo alone in serum-free culture. Delayed addition of IFN-gamma between days 4 and 7 of methylcellulose culture suppressed CFU-GM growth, but not that of BFU-E. These results suggest that IFN-gamma is an essential cytokine that affects human hematopoiesis and exerts a bimodal effect on stem cell maturation; potentiating or replacing the effect of early-acting cytokines such as SCF or IL-3, and suppressing the growth of matured progenitor cells.

Remarkable reduction in acetylcholine concentration in the cerebrospinal fluid from patients with Alzheimer type dementia

We determined the concentrations of acetylcholine (ACh) and choline (Ch) in the cerebrospinal fluid (CSF) of patients with Alzheimer type dementia (ATD) in comparison with controls. The ACh concentration was reduced significantly and remarkably (73%, P < 0.0002) in ATD patients and had a significant positive correlation with dementia scale scores (r = 0.82, P < 0.05). The Ch concentration was unaltered in ATD patients. These results suggest that the progressive reduction in ACh in the ATD brain may be reflected in its concentrations in the CSF.

Regeneration of immunity and varicella-zoster virus infection after high-dose chemotherapy and peripheral blood stem cell autografts in children

We assessed recovery of the immune system in 41 children who underwent high-dose chemotherapy (without total body irradiation) and autologous peripheral blood stem cell transplantation (PBSCT) for acute leukemias or non-Hodgkin's lymphoma. The analysis was in two parts. Firstly, we performed serial monitoring of regenerating subsets and blastogenesis of lymphocytes. We then reviewed the incidence of varicella-zoster virus (VZV) infection, based on the belief that this served as a clinical indication of immunological recovery. The CD4/CD8 ratio markedly decreased in all patients, with a nadir at 3 months, due to both abnormally low levels of CD4+ cells and sustained higher levels of CD8+ cells. These abnormalities were sustained for > 12 months post-graft. Within 6 months after PBSCT, all patients showed a decreased in vitro response to mitogens including PHA, Con A and PWM but these responses gradually recovered during the subsequent 6 months. All patients had a previous history of chicken pox. The actuarial incidence of VZV was 45% at 6 months and 67% at 12 months. All patients were treated with intravenous acyclovir with relief of pain and cutaneous healing within 10 days. No patient developed visceral dissemination. These findings suggest that at least in children, no major difference is apparent between immunological reconstitution in bone marrow transplantation and PBSCT. The development of minor and reversible VZV is a common event in this group of patients.

N-ras mutation and karyotypic evolution are closely associated with leukemic transformation in myelodysplastic syndrome

We performed a longitudinal analysis of the karyotypes and N-ras gene configuration of bone marrow cells in 35 patients with myelodysplastic syndrome (MDS). Karyotypic evolution was found in eight patients, and was associated with disease progression, including leukemic transformation, in all the patients. We identified N-ras mutations in six patients, using a polymerase chain reaction (PCR) technique, in which oligonucleotide primers were constructed with induced mismatches, followed by endonuclease digestion. Direct sequencing confirmed single base substitutions at codon 12 in two patients and at codon 13 in four. The incidence of N-ras gene mutations was significantly higher in the karyotypically evolved group (five of eight patients) than in the stable group (one of 27 patients). All of five patients harboring both karyotypic evolution and an N-ras mutation showed concomitant disease progression to overt leukemia or refractory anemia with excess of blasts in transformation (RAEB-T). Two of four patients with either karyotypic evolution or N-ras mutation and six of 26 patients without any of these alterations also progressed to overt leukemia. Our results indicate that the accumulation of these genetic alterations is closely associated with leukemic transformation of MDS, although other genetic alterations may also play a key role in the remaining patients.

Nerve fibers immunoreactive for substance P and calcitonin gene-related peptide in the cervical spinal ventral roots of the mouse

We demonstrate the existence of nerve fibers possessing substance P (SP) and calcitonin gene-related peptide (CGRP) immunoreactivity in the mouse cervical ventral roots. The distribution of the SP and CGRP fibers was similar, but CGRP fibers were generally more numerous. Both types entered the ventral pia mater or formed hairpin loops, but they did not enter the spinal cord directly through these roots. SP and CGRP fibers in the ventral roots were thin and had many varicosities. We suggest that these SP and CGRP fibers are involved not only in a sensory mechanism, but also in other functions, via the release of SP and CGRP from varicosities in the ventral roots.

Elevation of serum group II phospholipase A2 levels in patients with advanced cancer

To investigate the role of group II phospholipase A2 (M-PLA2) in cancer, we examined M-PLA2 serum levels in 170 pre-operative patients with various cancers and found elevated levels in 49% of them. M-PLA2 serum levels were significantly higher in patients with tumor stages T2-4, N1, M1 and stages II to IV than in T1, N0, M0 and stage I tumors, respectively. In all nine post-operative patients tested, M-PLA2 decreased 14 days after tumor resection and reduced to normal levels in 4 patients. Six of 16 carcinoma cell lines (37.5%) spontaneously secreted M-PLA2 into the culture supernatant despite the absence of IL-6 and IL-1 in 5 of the 6 lines. These results demonstrate that M-PLA2 produced by cancer cells may contribute, at least in part, to the elevation of serum M-PLA2 levels observed in cancer patients.

Human carcinoma cell lines produce biologically active leukemia inhibitory factor (LIF)

We investigated the production of leukemia inhibitory factor (LIF) by human carcinoma cell lines. LIF mRNA was detected by Northern blot analysis in all 24 carcinoma cell lines of the lung, breast, stomach, colon, liver, gallbladder, pancreas and melanocytes. Seventeen of them (70.8%) secreted LIF in the culture supernatant (range: 40.4-3990.3 pg/ml, mean +/- SEM: 611.8 +/- 262.9 pg/ml). Biologic activity of LIF was confirmed in the culture supernatant of carcinoma cell lines by the MTT assay using M1 cells. The present results showed that human carcinoma cell lines are constitutively producing biologically active LIF. The possible biological significance of LIF produced by cancer cells is discussed.

Sympathetic ganglion blockade for the management of hyperhidrosis

We present three patients with severe primary hyperhidrosis, refractory to conservative medical treatment, who were successfully managed with sympathetic ganglion blockade with ethanol. We also summarize 10 patients with hyperhidrosis who underwent sympathetic ganglion blockade in the past 2 years. This closed percutaneous method offers the patients considerably less discomfort and less stress with minimal morbidity and has a efficacy similar to that of surgical sympathectomy, which has previously been the only effective and permanent therapy for severe primary hyperhidrosis. It is concluded that chemical sympathectomy is an effective and useful method for treating severe hyperhidrosis which has advantages over surgical sympathectomy.

[Repair of total anomalous pulmonary venous connection in asplenia syndrome without cardiopulmonary bypass]

Two infants with asplenia syndrome underwent repair of total anomalous pulmonary venous connection (TAPVC) without cardiopulmonary bypass (CPB). Both patients had other complex cardiac anomalies; pulmonary atresia, univentricular heart, etc. The first patient previously received a left modified Blalock-Taussig shunt. The common chamber (pulmonary venous confluence) was anastomosed to the right side atrium using a side-biting clamp. Though both patients had good postoperative course immediately after surgery, they subsequently died 43 days and 4 months after surgery, respectively. We conclude that relief of TAPVC can be accomplished without CPB and allowing easier and simpler postoperative care.

[Therapeutic study of intractable vasculitis]

Vasculitis is a clinicopathological entity characterized by primary inflammation and necrosis of blood vessels. Vasculitis virtually involves any size or type of blood vessels in any organ systems. Within a category of vasculitis, there are several of the more serious vasculitides, such as polyarteritis nodosa, Wegener's granulomatosis and the systemic necrotizing vasculitides of the polyarteritis nodosa group are known to be extremely poor prognosis. However, early diagnosis and early treatment with steroid and/or immunosuppressant has been shown to prolong extraordinarily their survival. In this sense, appropriate agents where efficacy has been proven, such as corticosteroid in allergic granulomatous angiitis; cyclophosphamide in Wegener's granulomatosis should be chosen for the proper treatment, which in turn prolong survival of patients with serious vasculitis.

[Steroid and non-steroidal anti-inflammatory drug therapy of vasculitis]

Before corticosteroids were used in the treatment of the systemic necrotizing vasculitides of the polyarteritis nodosa, the disease almost always progressed with variable degree of fulminance leading to death. The use of corticosteroids improves the 5-year survival. The most dramatic break-through in the therapeutic approach to the vasculitides has been clinical experience with cyclophosphamides in treating Wegener's granulomatosis. With this therapeutic regimen, Wegener's granulomatosis can now be considered a curable disease, if treated early and appropriately with therapeutic regimen. These therapeutic strategy can be extended to that of polyarteritis nodosa group of vasculitides. Now, it is clear that cyclophosphamide, either alone or in combination with pre-existing corticosteroid therapy, can effect a dramatic response if instituted early in the course of the disease process. With the advent of deeper insight as to immuno-pathogenesis and pathophysiologic mechanism, the striking therapeutic success can be expected in near future.

[Empiric therapy with fluconazole in granulocytopenic patients with carcinoma or leukemia]

We performed a randomized clinical trial in granulocytopenic patients with carcinoma or leukemia. Patients with persistent fever for more than 2 days despite antibiotic therapy were randomized to antibiotic plus fluconazole therapy group (FLCZ group) or antibiotic therapy only group (antibiotic group) by the envelope method. It was possible to evaluate clinical efficacies in 62 patients (37 patients in FLCZ group and 25 patients in antibiotics group). In patients whose neutrophil counts were less than 100/microliters on the initial day of therapy, clinical efficacy rates were 72.0% (18/25) in FLCZ group and 57.1% (8/14) in antibiotics group. In patients whose neutrophil counts continued to be less than 100/microliters during therapy, clinical efficacy rates were 64.3% (9/14) and 50.0% (3/6), respectively. Further, in patients whose neutrophil counts continued to be less than 500/microliters during therapy, they were 76.9% (20/26) and 53.3% (8/15), respectively. No severe side effects nor severe case of abnormal change in laboratory test values due to fluconazole were observed in this trial. These data suggest that empiric antifungal therapy with fluconazole is effective for fungal infections in granulocytopenic patients with carcinoma and leukemia.

Different cellular mechanisms of vasopressin receptor V1 and V2 subtype in vasopressin-induced adenosine 3', 5'-monophosphate formation in an immortalized renal tubule cell line, TKC2

Vasopressin (VP) stimulates adenosine 3',5'-monophosphate (cAMP) formation in an immortalized renal tubule cell line, TKC2, which is derived from transgenic mouse harboring temperature-sensitive SV40 T-antigen gene. VP (10(-8) M)-induced cAMP formation was significantly attenuated by either non-peptide vasopressin receptor V1 or V2 subtype antagonist, OPC-21268 (10(-8) and 10(-6) M) or OPC-31260 (10(-8) and 10(-6) M), respectively, and it was completely abolished by combination of both agents (10(-6) M). VP (10(-8) M) also induced an increase in cytosolic free Ca2+ and prostaglandin (PG) E2 synthesis, both of which were significantly inhibited by OPC-21268 (10(-8) M), but not by OPC-31260 (10(-6) M). Either OPC-21268 (10(-8) M), depletion of extracellular Ca2+ or inhibition of cyclooxygenase attenuated both VP-induced PGE2 synthesis and cAMP formation. In conclusion, both V1 and V2 receptors can stimulate cAMP formation. V1 receptor, however, stimulates cAMP formation via Ca(2+)-dependent PGE2 synthesis, whereas V2 receptor may stimulate it directly.

Determination of organ blood flows during retrograde inferior vena caval perfusion

Cerebral, renal, and hepatic blood flows and oxygen metabolism were measured in 8 mongrel dogs undergoing hypothermic (20 degrees C) retrograde perfusion via the inferior vena cava (IVC) and compared with cardiopulmonary bypass and retrograde superior vena caval perfusion. Inferior vena caval perfusion was performed with aortic drainage and clamping of the superior vena cava at an IVC pressure of 20 or 30 mm Hg. Cerebral, renal, and hepatic blood flows at 30 mm Hg of IVC pressure were 7.5 +/- 3.8, 8.1 +/- 3.1, and 15.3 +/- 5.5 mL.min-1.100 g-1, respectively, as determined by the hydrogen clearance method. Organ blood flows during retrograde IVC perfusion were 28%, 42%, and 57% of cardiopulmonary bypass values at a flow rate of 1,000 mL/min and 61%, 119%, and 131% of retrograde superior vena caval perfusion values at 30 mm Hg of superior vena caval pressure, respectively. Oxygen consumption was 7.4 +/- 3.7 mL/min. At an IVC pressure of 20 mm Hg, cerebral, renal, and hepatic blood flows and oxygen consumption were 5.1 +/- 2.7, 5.9 +/- 4.1, and 11.6 +/- 4.0 mL.min-1 x 100 g-1 and 3.0 +/- 0.8 mL/min. As IVC pressure increased, cerebral, renal, and hepatic blood flows and oxygen consumption increased. However, high IVC pressure was associated with high portal venous pressure, which may produce ascites. Regional blood flow during retrograde IVC perfusion was measured by the colored microsphere method in another 8 normothermic dogs. Inferior vena caval perfusion at 30 mm Hg supplied adequate blood flow to the liver (15.44 +/- 12.1 mL.min-1 x 100 g-1) and kidneys (6.35 +/- 2.0 mL.min-1 x 100 g-1).(ABSTRACT TRUNCATED AT 250 WORDS)

[Atypical MDR]

Multiple drug resistance(MDR) is a major clinical obstacle in cancer chemotherapy. Acquirement of MDR phenotype in cancer cells is often associated with enhanced expression of human MDR-1 gene: MDR-1 gene codes membranous P-glycoprotein which catalyses energy-dependent outward transport of anticancer agents. By contrast, MDR cancer cell lines without overexpression of P-glycoprotein are called as atypical MDR (at MDR) cells. The acquirement of at MDR has been shown to be partly associated with altered DNA topoisomerase II. Furthermore, a new ATP binding cassette (ABC) family, MRP gene has just recently shown to involve in acquirement of at-MDR in cancer cell lines, which do not express both altered topoisomerase II and P-glycoprotein.

[Reoperation after corrective surgery for tetralogy of Fallot]

Thirty-two of 460 patients (6.9%) who had corrective surgery for tetralogy of Fallot in our institute between January, 1955 and March, 1994 required intracardiac reoperation. The indications for reoperation included residual lesions alone or combination of other lesions. The reoperation consisted of a new patch or direct closure of a residual ventricular septal defect in 28 (73%), reconstruction of a residual pulmonary stenosis in 18 (47%) and pulmonary regurgitation in 6 (16%), repair of tricuspid regurgitation in 11 (29%), recurrent infective endocarditis in 5 (13%), repair of a left ventricle-right atrium communication in 4 (11%). Six patients (19%) had required second reoperation of recurrent infective endocarditis in 3, other three patients required the repair of tricuspid valve disease. There were one operative death (3%) in reoperation and one death (17%) in second reoperation. Three patients (9%) died at follow-up periods of 1-21 years (mean of 9.6 years). Twenty-seven patients (84%) survived operation and 24 (89%) are now in NYHA class I and 3 patients are in class II. Reoperation after correction of tetralogy of Fallot is able to perform with low mortality and with excellent long-term results.

[Adjunctive methods for surgery of descending thoracic aortic aneurysm]

During the last 6 years, we employed partial extracorporeal circulation (PEC) in 7 cases and left heart bypass (LHB) in 9 cases as adjunctive methods for surgery of descending thoracic aortic aneurysm. During the aortic clamping, systemic heparinization was performed to keep an ACT more than 400 seconds in a PEC group, while it was kept from 200 to 250 seconds in LHB group. The bypass flow was controlled to maintain the distal arterial pressure over 50 mmHg in both groups. Hemodynamics during the aortic clamping were stable in both groups and significant differences were not found between them. However, ventricular fibrillation occurred in one case of LHB group, who suffered from coronary artery disease, and required subsequent PEC to maintain systemic circulation. Both PEC and LHB provided adequate intraoperative hemodynamics and postoperative serum biochemistries. But we preferred to adopt PEC to maintain the diatal perfusion in cases with heart disease, who are likely to develop circulatory deterioration under the aortic clamping.

[Bacteriological and clinical studies of biapenem (L-627) in pediatrics]

Bacteriological and clinical studies in the pediatric field have been performed on biapenem (L-627), a newly-developed carbapenem antibiotic, and the following results were obtained. 1. In the pharmacokinetic study, the plasma concentration of L-627 showed dose-dependant change: Cmax was 14.6 micrograms/ml and AUC was 15.4 micrograms.hr/ml with the administration of 6 mg/kg, while Cmax was 49.2 micrograms/ml and AUC was 60.1 micrograms.hr/ml with the administration of 12 mg/kg. After the administration of 6 mg/kg, the urinary concentration reached maximum within 2 hours and the cumulative urinary excretion rate in the first 6 hours was 49.4%. 2. Antibacterial activities of L-627 against 27 strains of clinical isolates were determined. MICs of L-627 against such Gram-positive cocci as Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes were sufficiently low, and those against such Gram-negative rods as Haemophilus influenzae, Escherichia coli and Bordetella pertussis were satisfactory and as low as those of imipenem or ceftazidime. 3. Clinical efficacies of L-627 were evaluated in 36 cases of bacterial infections. The overall efficacy rate was 100%, and excellent responses in 26 cases and good in 10 cases were obtained. As for bacteriological efficacies, all strains except 1 of B. pertussis were eradicated and a high eradication rate of 96.6% was obtained. 4. No side effects were observed in 37 evaluated cases. As abnormal laboratory test results, eosinophilia was noted in 2 cases (5.4%), but they returned to normal values rapidly after the drug was discontinued. From these results, it has been concluded that L-627 is a safe and effective drug to be used in treatment of pediatric infectious diseases.

[Pharmacokinetic, bacteriological and clinical studies on biapenem (L-627) in children]

The results are summarized as follows: 1. A total of 10 patients were treated with biapenem (L-627). We received informed consent from all of their parents. Each dose was 6 mg/kg, and it was administered 3 times daily (40 mg/kg, 4 times daily in meningitis), in a 30-minute intravenous drip infusion for 5-17 days. The clinical efficacies of L-627 in 10 patients with bacterial infections (1 with purulent meningitis, 1 with sepsis, 5 with pneumonia, 2 with urinary tract infection and 1 with purulent tonsillitis) were evaluated as excellent in 8 patients, as good in 2 patients with an efficacy rate of 100%. Seven causative organisms found in 5 patients (Streptococcus pneumoniae in 2, Moraxella (Branhamella) catarrhalis in 2, Haemophilus influenzae in 2 and Pseudomonas aeruginosa in 1) were eradicated. No adverse reaction was observed in any of the 10 patients. 2. Pharmacokinetic studies Peak plasma concentrations of L-627 were 12.5-13.7 micrograms/ml at the dose of 6 mg/kg administered by 30-minute drip infusion. Plasma half-lives of L-627 in the beta-phase averaged 0.72 hour (0.63-0.80 hour). CSF concentration/plasma concentration ratios of L-627 were 1.12/8.16 micrograms/ml (Day 2, 1.17 hours after at dose of 20 mg/kg), 0.88/3.44 micrograms/ml (Day 3, 4.0 hours after at dose of 30 mg/kg) and 0.68/5.12 micrograms/ml (Day 13, 3.0 hours after at dose of 40 mg/kg) administered by 30-minute drip infusion in the child with purulent meningitis (case 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of ageing on regional differences in the contractile responses to acetylcholine and neurokinin A in rabbit airway

1. Experiments were designed to study the effects of ageing on muscarine and NK2 receptor mechanisms in the three different regions of rabbit airway. 2. The pD2 value of acetylcholine changed with age in three different regions while that of carbamylcholine, which is resistant to acetylcholinesterase, did not. 3. The pD2 values of neurokinin A and the activity of protease, a degradative enzyme, changed with age. However, by the pretreatment with phosphoramidon, a protease inhibitor, the regional difference and age related change of the pD2 value of neurokinin A disappeared. 4. In conclusion, the observations about age related changes and regional differences of pD2 value of acetylcholine and neurokinin A were due to the difference of their degradative enzyme activities.

Burkitt type leukaemia associated with multiple myeloma

We describe a 77-year-old man with multiple myeloma (MM) who developed Burkitt type leukaemia (BTL) 16 months after the initial diagnosis of MM. MM was positive for CD10 with immunoglobulin (Ig) kappa, kappa Bence Jones protein (BJP) and a normal karyotype. BTL was positive for CD10, CD19, CD20 and HLA-DR with Ig mu and lambda, lambda BJP and a clonal abnormal karyotype of 46,XY,-13, t(8;14)(q24;q32),11q+,14q+, +mar. The patient died 9 d after diagnosis of BTL despite treatment with multiple agents. This is, to our knowledge, the first such case to be reported.