Role of endogenous endothelin in gastric mucosal injury induced by hemorrhagic shock in rats

We examined the role of endogenous endothelin in the pathogenesis of hemorrhagic shock-induced gastric mucosal injury in rats. Animals were bled to induce hypotension (20-30 mm Hg) for 20 min and the shed blood was retransfused. Rats were sacrificed at the end of hypotension, 20 min, and 60 min after retransfusion, respectively. Gastric erosions were induced with this experimental protocol. The total area of erosions was minimal only at the end of hypotension, and increased time-dependently after blood retransfusion. Plasma endothelin concentration significantly increased at the end of hypotension and persistently increased after retransfusion, whereas in gastric endothelin concentration a significant increase was observed at 60 min after retransfusion. The gastric mucosal hemodynamics as assessed by continuous measurement with reflectance spectrophotometry showed ischemia associated with congestion after retransfusion. Treatment with a monoclonal antibody against endothelin (0.2 mg/100 g BW/h) prevented these hemodynamic disturbances, rendering a significant decrease in the total area of erosions at 20 and 60 min after retransfusion. These results strongly suggest an important role of circulating endothelin in the pathogenesis of hemorrhagic shock-induced gastric mucosal injury through mucosal microcirculatory perturbation.

[A case of carpal tunnel syndrome caused by a ganglion cyst--diagnosis and follow-up study with magnetic resonance imaging]

We report a case of carpal tunnel syndrome (CTS) caused by a ganglion cyst which was diagnosed by magnetic resonance (MR) imaging of the left wrist. MR images depicted a 10-mm ganglion cyst which pressed the median nerve toward the ulnar side. The ganglion cyst was punctured under direct endoscopic visualization in the carpal canal, subsequently the clinical and the electrophysiologic findings of CTS improved. The median nerve was delineated in its proper position. MR imaging of the wrist, a noninvasive means to observe median nerve, is useful for the diagnosis and the follow-up study of CTS.

[Clinical studies on treatment by ESWL using EDAP LT-02 for upper urinary tract calculi]

From July 1993 through March 1994, 512 ESWL therapy was performed on upper urinary tract calculi in 277 renoureteral units using an EDAP LT-02 Lithotripter. Of these cases, 244 renoureteral units which were followed up for more than 3 months after ESWL were examined. These included 124 renal stones and 100 ureteral stones. Complete removal or sufficient stone disintegration was obtained in 66.7, 98.0 and 94.1% in the R1, R2 and R3 groups of renal stones, respectively, and in 92.4, 87.5 and 100% in the U1, U2 and U3 groups of ureteral stones, respectively. The over-all stone-free and success rates were 78.2 and 95.2%, respectively for renal stones and 93.0% and 94.0% respectively for ureteral stones. These results were better than those obtained by LT-01 in our experiences. The newly built-in coaxial X-ray system greatly contributed to these high success rates. As side effects, there were no serious complications. It is concluded that ESWL using an EDAP LT-02 is safer and more effective for the treatment of upper urinary tract calculi.

[Change in lobar uptake of 99mTc-galactosyl serum albumin after transarterial embolization therapy]

Liver function was studied by hepatic scintigraphy with 99mTc-galactosyl serum albumin (GSA) before and after transarterial embolization (TAE) therapy in 16 patients with hepatocellular carcinoma. The percent uptake of GSA in liver was measured separately in the treated and non-treated areas. GSA uptake increased in both areas. The change was more marked in the non-embolized lobe than the embolized lobe. We conclude that the increase in GSA uptake reflects the regeneration of liver cells after TAE.

Activation of prothrombin by a novel membrane-associated protease. An alternative pathway for thrombin generation independent of the coagulation cascade

We herein report that a novel membrane-associated protease capable of activating prothrombin is present in several mammalian cells. This protease can directly convert prothrombin to active thrombin and induces blood clotting both in vivo and in vitro but is apparently different from coagulation factor Xa, which has been thought to be the only physiological activator of prothrombin. This protease activity was initially found and was very high in 8C feline kidney fibroblast cells, and we characterized its enzymological features using this cell line. Activity was detected in neither the cytosolic fraction nor the culture medium but found in the membranes and identified on the surface of intact cells. The activation of prothrombin required Ca2+ ions, and the apparent Km value for prothrombin was 0.2 microM. The activity was irreversibly inhibited by exposure to EDTA, but various inhibitors for serine proteases including antithrombin III were without effect. Based on these results, we propose that this novel enzyme, membrane-associated prothrombin activator, catalyzes an alternative pathway for generation of thrombin, which is independent of the blood coagulation cascade, and that the thrombin generated is involved in certain pathological states and/or in activation of cells that are spatially separated from the bloodstream.

Rapid potentiation of DNA binding activities of particular transcription factors with leucine-zipper motifs in discrete brain structures of the gerbil with transient forebrain ischemia

Binding of radiolabeled double stranded oligonucleotide probes for nuclear transcription factors with leucine-zipper motifs, such as activator protein-1 (AP1), cyclic AMP response element binding protein (CREB) and Myc, was unevenly distributed in gerbil brain in a manner peculiar to each factor. Among 3 different hippocampal subfields examined, the dentate gyrus had the highest basal DNA binding activities of AP1 with progressively less potent binding in the CA3 and CA1 subfields. Similarly, the dentate gyrus was highest in the basal binding of probes for both CREB and Myc among the 3 distinct hippocampal subregions. However, transient forebrain ischemia for 5 min induced more potent enhancement of the AP1 binding in the CA1 subfield 4 h after the insult than in the CA3 subfield and dentate gyrus. In contrast, the ischemic injury similarly tripled DNA binding activities of CREB without markedly affecting those of Myc in hippocampal CA1 and CA3 subfields. Binding of the probe for AP1 was also markedly potentiated following ischemia in the thalamus, caudate putamen, frontal cortex and cerebellar cortex in a rank order of decreasing magnitude, while the ischemic insult induced slight but statistically significant potentiation of both CREB and Myc binding in the thalamus without affecting that in other discrete brain regions. These results suggest that expression of AP1 may be a determinant of unique vulnerability and/or resistance to an ischemic insult in the gerbil hippocampus.

Molecular construction of Clostridium botulinum type C progenitor toxin and its gene organization

The 16S progenitor toxin of Clostridium botulinum type C is made up by conjugation of a neurotoxin with nontoxic components designated as nontoxic-nonHA and hemagglutinin (HA). The HA was found to be composed of subcomponents having 53, 33, 22-23, and 17 kDa molecular masses. Since we previously determined the whole nucleotide sequences of the genes for neurotoxin, nontoxic-nonHA, and HA-33, the cloning and nucleotide sequencing of the genes for the remaining HA subcomponents were performed. Two open reading frames coding for 16.7 kDa (HA-17) and 70.6 kDa proteins were identified. The N-terminal amino acid sequences of HA-53 and HA-22-23 indicated that the 70.6 kDa protein is split into 53 and the 22-23 kDa proteins after translation and that the 22-23 kDa protein consists of at least four proteins showing slightly different molecular weights.

Effect of etodolac on prostaglandin E2 biosynthesis, active oxygen generation and bradykinin formation

The inhibitory actions of etodolac on prostaglandin (PG) E2 biosynthesis, active oxygen generation and bradykinin formation were compared with those of indomethacin, diclofenac Na, piroxicam, naproxen, ketoprofen and aspirin. The inhibitory action (IC50 5.35 x 10(-8) M) of etodolac on PGE2 biosynthesis in rabbit articular chondrocytes stimulated by interleukin-1 (IL-1) beta was about 1/5 that of indomethacin. The inhibitory action of etodolac on spontaneous PGE2 biosynthesis in rabbit gastric epithelial cells (RGEs) (IC50 2.27 x 10(-5) M) and Madin-Darby canine kidney cells (MDCKs) (IC50 4.54 x 10(-7) M) was much less than that in rabbit articular chondrocytes stimulated by IL-1 beta and about 1/19 and 1/9 that of indomethacin in rabbit gastric epithelial cells (RGEs) and Madin-Darby canine kidney cells (MDCKs), respectively. The inhibitory action of etodolac on active oxygen generation was similar to that of indomethacin and piroxicam, and more potent than that of naproxen, ketoprofen and aspirin. The inhibitory action of etodolac on bradykinin formation was the most potent among the seven anti-inflammatory drugs tested. Both etodolac and bromelain inhibited the inflammatory pain in concanavalin A-treated paws of rats in a dose-dependent manner, but indomethacin did not. These results indicate that etodolac is an anti-inflammatory drug which suppress IL-1 beta-stimulated PGE2 biosynthesis in rabbit articular chondrocytes, active oxygen generation and bradykinin formation. It has less suppressive action against spontaneous PGE2 biosynthesis in RGEs and MDCKs. Thus, etodolac is considered to be a safe anti-inflammatory drug for clinical use.

Anti-inflammatory effects of etodolac: comparison with other non-steroidal anti-inflammatory drugs

The anti-inflammatory effects of etodolac (Eto) were compared with those of 6 other anti-inflammatory drugs: indomethacin (Ind), diclofenac Na (Dic), piroxicam (Pir), naproxen (Nap), ketoprofen (Ket) and aspirin (Asp). Eto inhibited carrageenin-induced edema in rats, adjuvant-induced arthritis in rats, acetic acid-induced writhing in mice and brewer's yeast-induced hyperalgesia and fever in rats. In the adjuvant arthritis test, the ED30 value (1.88 mg/kg) on day 3 and ED50 values (adjuvant-injected paw: 1.18 mg/kg and non-injected paw: 0.96 mg/kg) on day 18 for Eto were comparable to those for Dic (2.16, 1.72 and 1.28) when given prophylactically and the ED50 values for Eto (adjuvant-injected paw: 1.61 and non-injected paw: 1.20 mg/kg) were comparable to those for Ket (1.24 and 1.22) when used therapeutically. The analgesic activity of Eto (ED50 value: 3.67 mg/kg) in the acetic acid-induced writhing test was greater than that of Nap (9.83) or Asp (31.6) and less than that of Ind (0.71), Dic (1.54), Pir (0.92) or Ket (1.34). In the antipyretic test, the minimum effective dose (MED: 1 mg/kg) for Eto was comparable to that for Ind (1.0), Nap (1.0) or Ket (1.0). Eto was less potent in inhibiting carrageenin-induced edema (ED30 value: 6.99 mg/kg) and inflammatory pain (ED50 value: 9.24 mg/kg) than the other drugs (Ind: 2.32 and 3.47, Dic: 0.69 and 3.80, Pir: 1.31 and 1.94, Nap: 1.83 and 2.78, Ket: 1.12 and 0.63), except for Asp (167 and 51.8).(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Ro/SS-A antibody-positive interstitial pneumonitis in a non-lupus patient

We describe a 42-year-old anti-Ro/SS-A antibody positive non-lupus patient who developed interstitial pneumonitis in combination with several common clinical features with previously reported lupus pneumonitis patients whose anti-Ro/SS-A antibodies were positive, while whose antinuclear antibodies were negative. We consider that these patients may belong to a same new clinical entity. A variety of characteristic manifestations related to anti-Ro/SS-A antibodies has been reported in patients with systemic lupus erythematosus (SLE) and other connective tissue diseases [1] [2], and an association between these antibodies with pulmonary parenchymal involvement has been reported by Hedgpeth and Boulware in patients with SLE [3] [4]. We report here a 42-year-old non-lupus male patient with pulmonary fibrosis who presented with anti-Ro/SS-A antibodies.

Effect of anti-inflammatory agent etodolac on antigen-induced contractions of the trachea and lung parenchyma of guinea pigs

Etodolac, which inhibits the activity of cyclooxygenase, did not affect antigen-induced contractions of the trachea and lung parenchyma of guinea pigs. Indomethacin tended to enhance antigen-induced contractions of the trachea and significantly enhanced contractions of the lung parenchyma. The inhibitory activity of AA-861, a 5-lipoxygenase inhibitor, in antigen-induced contractions of the trachea and lung parenchyma was more potent than that of ozagrel, a thromboxane A2 (TXA2) inhibitor. Thus, lipoxygenase products played a more important role than TXA2 in antigen-induced contractions of the trachea and lung parenchyma. These results suggest that the enhancement of antigen-induced contractions by indomethacin might be due to an increase in anaphylactic release of lipoxygenase products through the inhibition of cyclooxygenase. Since etodolac did not enhance antigen-induced contractions, we attempted to determine whether or not etodolac inhibits 5-lipoxygenase. Etodolac was found to have no effect on 5-lipoxygenase activity. Therefore, the low adverse effect of etodolac on antigen-induced contractions of the airway may be due to its weak inhibition of cyclooxygenase in the airway. These results suggest that etodolac would have only a very slight, if any, adverse effect on the airway in patients with asthma.

Intercostal muscle pedicle flap for prophylaxis against bronchopleural fistula after pulmonary resection

Between April 1982 and March 1994, we did 384 pulmonary resections for lung cancer. Until March 1991, we did 249 pulmonary resections in which none of the bronchial stumps were reinforced; nine patients developed bronchopleural fistula (incidence, 4%). After April 1991, bronchial stumps of 135 patients were reinforced by an intercostal muscle pedicle flap for prophylaxis against bronchopleural fistula. Only one patient developed it (incidence, 1%). In these two periods, the proportion of patients in stage IIIa or more advanced stages increased from 24% to 41%, resulting in more extensive operations and more patients being given chemo-radiation therapy in the perioperative period. These are risk factors for bronchopleural fistula, but the incidence of the fistula decreased. These results suggest that reinforcement of the bronchial stump with an intercostal pedicle flap is useful for prophylaxis against developing bronchopleural fistula.

Block by apomorphine of acetylcholine receptor channels expressed in Xenopus oocytes

Effects of apomorphine and other compounds related to dopamine receptors on nicotinic acetylcholine receptor channels were investigated by expressing functional channels in Xenopus oocytes. When channels were expressed with a combination of alpha 3 and beta 4 subunits, acetylcholine activated an inward current, and apomorphine suppressed the current in a concentration-dependent manner with an IC50 value of about 3 microM. SKF38393 (R(+)-1-phenyl-2,3,4,5-tetrahydro-(1H)-3-benzazepine-7,8-diol; dopamine D1 receptor agonist; 3 and 30 microM), quinpirole (dopamine D2 receptor agonist; 30 microM), SCH23390 (R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benza zepine; dopamine D1 receptor antagonist; 10 microM) or sulpiride (dopamine D2 receptor antagonist; 10 microM) also inhibited the acetylcholine-activated current whereas dopamine (100 microM) was ineffective. The inhibition by apomorphine of the acetylcholine-activated current was also apparent when alpha 3 subunit was combined with beta 2 subunit instead of beta 4 subunit, or beta 4 subunit was combined with alpha 2 or alpha 4 subunit instead of alpha 3 subunit to express channels. The results suggest that apomorphine blocks acetylcholine receptor channels through a binding site that is similar to, but cannot be included in dopamine receptors. The binding site may not be present in a single specific subunit.

Effects of erucic acid therapy on Japanese patients with X-linked adrenoleukodystrophy

Ten Japanese boys with childhood adrenoleukodystrophy (ALD), one adult patient with adrenomyeloneuropathy (AMN), and two presymptomatic ALD boys were treated with dietary erucic acid (C22:1) for more than 12 months; except in a case of childhood ALD patient who died 7 months after beginning erucic acid therapy. During erucic acid therapy, the serum levels of very long-chain fatty acid (VLCFA) (C24:0/C22:0) decreased within 1-2 months in all patients, and these levels in four of the patients decreased to the normal range. Neurological examination and MRI findings in all 10 of the childhood ALD patients showed progression of the disease while they were receiving the dietary therapy. However, the mean interval between the onset of awkward gait and a vegetative state in diet-treated patients was significantly longer than that in the untreated patients. One AMN patient showed slight improvement of spastic gait and lessened pain in the lower limbs due to spasticity. The two presymptomatic ALD boys remained intact on clinical examination and on MRI findings for 38 and 23 months, respectively, after starting the diet.

Etretinate-induced heterotopic bone formation about the hip joint. A case report including ultrastructural study

Despite considerable documentation for retinoid-induced hyperostosis, sufficient knowledge regarding its management and histologic features is not available. In a 26-year-old man with etretinate-induced heterotopic bone formation about the hip joint, the use of etidronate disodium was unsuccessful. Surgical excision of the heterotopic bone dramatically improved restricted motion of the hip joint without initiating significant postoperative heterotopic ossification. Ultrastructural study showed abundant myofibroblasts in the fibrous tissue close to the heterotopic bone. Their role in local biologic events should be determined.

[Dissecting aortic aneurysms that occurred in aged brothers without Marfan syndrome]

The occurrence of familial dissecting aortic aneurysms without Marfan syndrome is rare. This report describes two aged siblings who underwent successful surgery for this disease. Neither patient had the clinical features of Marfan syndrome, and both had histories of systemic hypertension. Case 1: A 76-year-old man had dissecting aortic aneurysm, DeBakey type IIIa, which was localized and had multiple lumina with thrombi. Case 2: A 71-year-old man (younger brother of case 1) had retrograde dissecting aortic aneurysm, DeBakey type IIIa. Histological examinations of the aortae showed cystic medial necrosis in both cases, and also showed atherosclerotic changes in case 1. These two siblings had no familial history of cardiovascular incidents and were much older than previously reported cases. Therefore it may be possible that the dissecting aortic aneurysms of these two cases occurred coincidently rather than due to hereditary factors.

ATP reduces voltage-activated K+ current in cultured rat hippocampal neurons

Effects of extracellular ATP were investigated in cultured rat hippocampal neurons using whole-cell voltage-clamp techniques. When a depolarizing step to +10 mV was applied from a holding potential of -60 mV, an outward K+ current was activated. ATP (3 to 300 microM) reduced the K+ current. Among adenosine derivatives, ADP (100 microM) slightly inhibited the K+ current, and AMP or adenosine (100 microM) was ineffective. UTP was as potent as ATP and alpha,beta-methylene ATP was less effective than ATP. The inhibition by ATP of the K+ current was abolished by inclusion of 2 mM GDP beta S in the intracellular solution. The results indicate that ATP inhibits K+ channels in rat hippocampal neurons through UTP-responsive P2-purinoceptors coupled with GTP-binding proteins.

Intrapulmonary lymph nodes

We report two cases of intrapulmonary lymph nodes detected by a chest roentgenogram or CT scan. The first patient was a 61-year-old fisherman referred complaining of cough and hemosputum. Chest roentgenogram showed a subpleural small nodular shadow at the superior segment of the right lower lobe. Thoracotomy showed a small anthracotic lymph node. The other case was a 68-year-old female patient admitted for further examination of a subpleural small nodular shadow at the latero-basal segment of the left lower lobe detected on a chest CT scan. Thoracoscopic surgery revealed that the black nodule was an anthracotic lymph node. The appearance of an intrapulmonary lymph node on radiological examination is rare, however, it should be considered in the differential diagnosis of a solitary or multiple peripheral pulmonary nodules in adults. A small nodular shadow should be resected if malignancy is suspected though not proven. Subpleural intrapulmonary lymph node warrants thoracoscopic surgery.