[Pure red cell aplasia induced by erythromycin and furosemide effects on in vitro erythroid colony forming unit (CFU-E)]

A 84-year-old man was treated with antibiotics including erythromycin and a diuretic (furosemide) because of acute heart failure and pneumonia. During the treatment, he developed moderate anemia (Hb 8.7g/dl). His anemia improved after the treatment. He again developed marked anemia (Hb 6.3g/dl) during the second treatment with erythromycin and furosemide and received blood transfusions. Bone marrow aspiration study revealed severe erythroid hypoplasia (0.2%). He was referred to our hospital, but he was not treated because his hemoglobin levels and reticulocyte count increased (80%) and his bone marrow showed increased erythroblasts (41.5%). His anemia gradually improved without any treatment. We diagnosed the case as drug-induced pure red cell aplasia (PRCA). We cultured bone marrow cells obtained from the present case and four normal healthy volunteers by a plasma clot method to determine the effects of two drugs on the number of erythroid colony forming unit (CFU-E). Furosemide strongly inhibited the CFU-E colony formation in the patient, but the inhibition effect of erythromycin was moderate. Furthermore, CFU-E was markedly suppressed by a combination of erythromycin and furosemide in both patient and control materials. These results indicate that both furosemide and erythromycin were related to the occurrence of PRCA in this patient.

Hepatitis C virus particle detected by immunoelectron microscopic study

To clarify the morphology of hepatitis C virus (HCV), an indirect immunogold electron microscopic study was carried out on two plasma samples with high HCV RNA titres using polyclonal and monoclonal antibodies specific to the putative HCV envelope protein. Spherical virus-like particles, 55 to 65 nm in diameter with spike-like projections, were found in 1.14 to 1.16 g/ml fractions after sucrose density gradient centrifugation. These particles were found only in HCV-infected blood donors and had morphological features similar to those of flaviviruses. Moreover, these particles specifically reacted with the polyclonal and monoclonal antibodies to the putative HCV envelope protein. This is the first known report in which the morphology of the HCV particle is clearly shown.

Role of actin and calmodulin in migration and proliferation of rabbit gastric mucosal cells in culture

The aim of this study was to develop a new cellular restoration model using primary cultured rabbit gastric mucosal cells, and to evaluate the role of cytoskeleton and calmodulin in this process. Confluent monolayer mucosal cell sheets consisting mainly of mucous cells were wounded, and a rotating silicon tip was used to make cell-free areas of constant size. The process of restoration was monitored, and the cell-free area was measured and analysed quantitatively. Artificial wounds recovered in 36 h in controls; however, mucosal cell repair was inhibited by treatment with the actin inhibitor, cytochalasin B, and the calmodulin inhibitor, W-7. In the process of restoration, bromodeoxyuridine (BrdU)-positive cells appeared around the wound 24 h after injury and then disappeared after the complete repair. Because BrdU-positive cells were never detected within 24 h after wounding, initial recovery of the wound occurred only by cell migration. Both the migration and the proliferation stage are seen with this model. This culture model is suitable for the analysis of gastric mucosal restoration. Present data are consistent with the hypothesis that the integrity of the cytoskeletal system is important for restoration after damage of the gastric mucosa.

Intraoperative combined administration of indomethacin and buprenorphine suppositories as prophylactic therapy for post-open-cholecystectomy pain

Buprenorphine and indomethacin are quite different pharmacologically. The objective of this study was to determine the analgesic effect from their combined administration in suppository form. Eighty patients undergoing open cholecystectomy under nitrous oxide-oxygen-sevoflurane anesthesia, in addition to epidural anesthesia using lidocaine, were divided into four groups: Group A received buprenorphine 0.4 mg and indomethacin 50 mg; Group B, buprenorphine 0.4 mg; Group C, indomethacin 50 mg; and Group D, no drug. The drugs were administered after induction of general anesthesia. One patient was withdrawn because of the administration of the wrong drug. Patients in Group A required fewer analgesics, had a longer period of analgesic effect from the end of surgery, and enjoyed a better pain score. This group also included more patients who required no analgesics. We conclude that the combined administration of opioid and nonopioid suppositories may provide far better prophylactic analgesia than a single drug.

[Our experience with breast conservation]

In the Cancer Institute Hospital, two kinds of breast conservation have been adopted. Q + Ax is applied for cancers at the upper--outer quadrant and LUART is applied for those at other quadrants. The method, clinical matters, pathological findings and results are discussed together with the LUART of the national BCT group study funded by the Japanese Ministry of Welfare.

A "bubble-tip" (Airguide) tracheal tube system: its effects on incidence of epistaxis and ease of tube advancement in the subglottic region during nasotracheal intubation

Epistaxis and tubal obstruction in the subglottic region are difficulties encountered during nasotracheal intubation. Trauma to the nasal airway must be avoided, especially in patients receiving anticoagulant therapy. In addition, smooth passage of the tracheal tube through the larynx is desired. The tip of an Airguide tracheal tube system has a soft, round, glossy balloon head which should be less traumatic to the nasal mucosa than other more commonly used tubes. We, therefore, determined whether the Airguide reduces the incidence of epistaxis and increases smooth passage of the tracheal tube in the subglottic region during nasotracheal intubation. Sixty-six patients were divided into two groups, Airguide (n = 39) and Standard (n = 27). Each group was divided into two subgroups, topical epinephrine application as a mucosal decongestant and non-epinephrine. The incidences of epistaxis and smooth passage were compared between the two groups. The Airguide group had a significantly lower incidence of epistaxis (9/39 vs 13/26; P < 0.05; bleeding was not checked in one patient in the Standard group) and provided a significantly smoother passage in the subglottic region than the Standard group (tube impingement in the subglottic region, 0/39 vs 11/27; P < 0.01). There was no significant difference in the incidence of epistaxis between the subgroups with and without topical application of epinephrine. The Airguide helps to minimize epistaxis and increases navigability in the subglottic region during nasotracheal intubation.

[Pulmonary sequestration diagnosed by combined computed tomography without contrast enhancement and magnetic resonance imaging: a case report]

A 71-year-old woman with pulmonary sequestration had iodine hypersensitivity. Diagnosis was made using computed tomography without contrast enhancement and magnetic resonance imaging. An anomalous artery arising from the descending thoracic aorta was clearly defined. Thus the diagnosis of pulmonary sequestration was confirmed before successful operation without angiography. This diagnostic procedure is safe, noninvasive and useful to detect the anomalous artery, especially in the patient with iodine hypersensitivity.

[Effects of cytarabine ocfosfate on colony-stimulating factor in myelodysplastic syndrome with monosomy 7]

A 42-year-old man was admitted to our hospital because of pancytopenia in April 1992. A diagnosis of refractory anemia was made. The karyotype was normal male type on the initial study. Subcutaneous administration of granulocyte colony-stimulating factor (G-CSF) initially increased the peripheral neutrophil count, bat in January 1993, although blast cells did not increase, neutrophils had decreased in spite of the continuation of G-CSF administration. Chromosome analysis showed 46XY, +Y, -7 at this point. By adding 50 mg of cytarabine ocfosfate (SPAC) daily, the peripheral neutrophil count again rose dramatically. However, anemia, thrombocytopenia and the chromosomal abnormality were unchanged. These results indicate that SPAC may upregulate the effect of G-CSF on granulopoiesis in patients with myelodysplastic syndrome.

[A case of solitary plasmacytoma of the chest wall]

A 58-year-old man with a solitary plasmacytoma of the chest wall is reported. He was admitted because of a painless tumor on the right lateral chest wall. The chest CT scan showed a chest wall tumor surrounding the 7th and 8th ribs without rib destruction. A transcutaneous needle biopsy of the tumor with a Sure-Cut-Needle revealed a plasmacytoma. The bone marrow biopsy findings were normal. Under a diagnosis of solitary plasmacytoma, the chest wall tumor was resected. The tumor was an extramedullary plasmacytoma. Southern blot analysis of the immunoglobulin light chain gene of the tumor cells detected a rearrangement of genes in the lambda chain, while no rearrangements of immunoglobulin genes were detected in the bone marrow specimen. Seven months later another solitary plasmacytoma was found at the left radius, and was resected. Southern blot analysis of the immunoglobulin light chain gene was useful in the differential diagnosis from systemic myeloma and in determining the monoclonality of the tumor.

Elevation of ceruloplasmin activity involved in changes of hepatic metal concentration in primary biliary cirrhosis

Primary biliary cirrhosis (PBC) patients showed increased ceruloplasmin activity and Cu content in the serum as compared to the control group. Moreover, Cu, Fe, and Zn contents were measured in the livers of autopsied cases. The PBC patients showed increased Cu content and reduced Fe and Zn levels. In PBC cases, Cu transportation via bile is disturbed due to collapse of the interlobular bile ducts and consequently Cu accumulates in the liver. Thus, it is likely that serum ceruloplasmin activity increases to metabolize the accumulated hepatic Cu and that Cu content increases in the serum as a ceruloplasmin-bound form. Furthermore, reduction of Fe and Zn contents in the liver of the PBC patients indicated the possible relationship of ceruloplasmin to Fe and Zn metabolism as well as Cu metabolism.

[Clinical studies of a newly developed miconazole preparation for intravenous drip infusion (MJR-1761) in hematologic disease patients with deep-seated fungal infections]

The efficacy and safety of a newly developed miconazole preparation (MJR-1761) for intravenous drip infusion were evaluated in 22 patients with hematological diseases complicated by documented or suspected deep-seated fungal infections. They consisted of 15 patients with fungemia, 2 patients with pulmonary mycosis, and 5 patients with mycosis of the digestive tract. Of the 5 patients, 3 had a complication of fungemia and 1 a complication of urinary tract mycosis. Of the 22 patients, 21 were clinically evaluable. All the patients were included in safety evaluation. The effective rate was 86% (18/21) when moderately improved or better evaluations were included, and the usefulness rate was 81% (17/21) when moderately or more useful evaluations were taken into consideration. Side effects occurred in 4 patients, and abnormal laboratory values were obtained in 4 patients. All these changes, which were previously reported, improved after the discontinuation of the treatment. The results presented indicate that the miconazole intravenous drip infusion solution used in this study is as effective as conventional similar preparations. Since the infusion solution need not be diluted immediately before use, it is simple to use, and its safety may be highly rated. The purpose can be met with less volume of solution per use than before because the preparation contains as much as 200 mg of miconazole in 75 ml of solution. This preparation seems to lend itself better to clinical application than conventional similar infusion solutions.

Anti-hypertensive effect of low Na connection (120 mEq/l) solution for CAPD patients

In patients undergoing continuous ambulatory peritoneal dialysis (CAPD), transperitoneal sodium (Na) flux plays a crucial role in the control of blood pressure (BP), as it determines the net Na balance of the patient. However, with the conventional solution, Na removal into the effluent greatly depends on the drained ultrafiltration (UF) volume, and this can hinder the success of adequate Na removal in some patients. Therefore, we developed a low Na concentration solution to increase Na removal through diffusion force, and studied the clinical effect of this solution in patients with Na overload. The composition of the low Na solution is as follows: Na: 120 mEq/l, Ca: 3.5 mEq/l, Mg: 0.5 mEq/l, Cl: 84 mEq/l, lactate: 40 mEq/l, glucose (G) and osmolality: 1.36% (322 mOsm/l) and 2.27% (372 mOsm/l), vol: 2 l. Nine patients (age: 43 +/- 2 yr, oral Na intake: 3.4 +/- 0.3 g/day, mean arterial pressure: 123 +/- 6 mmHg, drained UF volume: 918 +/- 187 ml/day; mean +/- SEM) were studied. Compared to the conventional solution (Na: 132 mEq/l), Na removal using the low Na solution (4 h dwell) was increased from -7.8 +/- 8.7 to -2.3 +/- 5.7 mEq in 1.36% G solution, and from 25.3 +/- 3.1 to 35.4 +/- 4.7 mEq (p < 0.05) in 2.26% G solution. Patients were switched from the conventional solution to the low Na solution, exchanging four times daily for up to 4 weeks. Two patients discontinued low Na solution before the study ended, due to overhydration and hyponatremia, the remaining seven cases showed no adverse symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging impairs methamphetamine-induced free-running and anticipatory locomotor activity rhythms in rats

In the present experiment, under drinking of 0.01% methamphetamine (MA), young rats exhibited free-running locomotor rhythm ranging from 24.6 to 30.9 h period under light-dark cycle. In contrast, 24-month-old rats showed a low activity and did not exhibit MA-induced free-running rhythm. When MA was injected at a fixed time of day (14:00), young rats exhibited intense locomotor activity from 1-2 h before drug-injection time. This preinjection activity was still detected on the withdrawal day. In addition, intense locomotor activity was observed for 12:00-17:00, even on the withdrawal day (MA-associated anticipatory activity). Thus, MA-associated activity of the withdrawal day became an another good index for MA anticipatory activity rhythms whereas old rats did not exhibit this anticipatory activity. The present study suggests that aging strongly impairs the manifestation of MA-induced free-running and anticipatory activity rhythms in rats.

Effects of nitric oxide synthase inhibitors on N-methyl-D-aspartate-induced phase delay of circadian rhythm of neuronal activity in the rat suprachiasmatic nucleus in vitro

Excitatory amino acid (EAA) receptors such as N-methyl-D-aspartate (NMDA) and non-NMDA receptors have been suggested to play an important role in the regulation of photic information from the retina to the suprachiasmatic nucleus (SCN). Therefore, we investigated the role of glutamate as a retinohypothalamic transmitter by analyzing the phase-resetting effects of NMDA and a non-NMDA agonist, (R,S)-alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA), on the circadian rhythm of SCN firing activity. Nitric oxide (NO) production is believed to be an essential intermediate in NMDA-induced cGMP production in the CNS. Thus, we examined the effects of blockers of NO production on NMDA- or AMPA-induced phase delay of SCN activity rhythm. N-nitro-L-arginine methylester (L-NAME) blocked NMDA- but not AMPA-induced phase shift, indicating the involvement of NO synthesis in NMDA-induced phase changes. L-arginine but not D-arginine caused a phase delay, and L-NAME blocked L-arginine-induced phase delay. In addition, cotreatment with NMDA and L-arginine did not have an additive effect. These results suggest that NO production itself is involved in the phase change of SCN neuron activity, and NMDA-induced phase changes are also mediated via activation of NO synthesis in this nucleus.

Facilitatory effect of vasopressin on the ischemic decrease of the CA1 presynaptic fiber spikes in rat hippocampal slices

We investigated the effects of vasopressin-related neuropeptides on the hypoxia/hypoglycemia (ischemia)-induced decrease of the CA1 presynaptic potential elicited by stimulation of Schaffer collaterals in rat hippocampal slices. Treatment with arginine-vasopressin (AVP) potentiated the ischemic decrease of the CA1 presynaptic potential. In contrast, a V1 receptor antagonist produced a dose-dependent neuroprotective effect, whereas a V2 receptor antagonist had no effect. The AVP-induced decrease of the CA1 presynaptic potential was completely blocked by simultaneous application of the V1 receptor antagonist. Because AVP4-9 is regarded as the major proteolytic product of AVP in the rat brain, we examined its effect on the ischemic decrease of the CA1 presynaptic potential. Treatment with AVP4-9 produced a more marked reduction of the potential than treatment with AVP itself. The present study demonstrates that stimulation of the V1 receptor has a detrimental effect on the development of ischemic damage whereas V1 receptor blockade has a neuroprotective effect, suggesting that AVP may potentiate ischemic neuronal deficits via V1 receptor stimulation.

Two cases of acute myocardial infarction associated with aplastic anemia during treatment with anabolic steroids

Thrombosis is a rare complication in patients with aplastic anemia because of the presence of coincidental thrombocytopenia. We have recently treated two cases, a 61-year-old male and a 59-year-old female, with acute myocardial infarction associated with aplastic anemia. Although their platelet counts were lower than normal in spite of treatment with anabolic steroids for aplastic anemia, the coronary angiographic findings strongly suggested coronary thrombosis in both cases. Anabolic steroids, which have been commonly used for the treatment of aplastic anemia, are a possible risk factor for coronary thrombosis because they have an accelerating effect on thrombus formation. We report two very rare but clinically important cases.

Age-related impairment of food anticipatory locomotor activity in rats

In rats of various ages (11 weeks to 24 months), restricted feeding was carried for 6 successive days and food was withheld completely on the 7th day to assess the effect of aging on food anticipatory activity. When feeding was restricted to a single meal at a fixed time of day (1330-1730), rats exhibited intense locomotor activity from 1-3 h before feeding time (prefeeding activity). This prefeeding activity was still detected on the fasting day. In addition, intense locomotor activity was observed for 1330-1730 even on the fasting day (mealtime-associated activity). Thus, mealtime-associated activity of the fasting day became an another good index for food anticipatory activity. These results indicate that the rats had come to anticipate the mealtime. Both prefeeding and mealtime-associated activities were similar at 11 weeks and 9 months of age, but they were impaired at 12 and 24 months of age. In 11-week-old rats, there was a negative correlation between the level of mealtime-associated activity and the daily duration of access to food, but this relationship was absent in 12-month-old rats. The present study suggests that aging strongly impairs the manifestation of food anticipatory activity in rats.

Parabolic flight experiments on physiological data acquisition and processing technologies using small jet aircraft (MU300)

The parabolic aircraft flight provides a short low gravity environment for approximately 20 seconds, which may not be sufficient for a research on the physiological phenomenon induced by actual weightlessness in space. However, the method is still useful to reveal essential and characteristic feature of physiological signs, and is available for testing hardware and also training of crew member during altered gravity. This paper reports the summary of parabolic flight experiments recently conducted as a NASDA program (1990-1992). The program is providing opportunities in low gravity research with small jet aircraft for researchers and agencies. The flight experiments in the life science area have been conducted mostly focused on a physiological changes and basic methodology which may be effective under the altered gravity condition. In this study, the following research team, NASDA, Research Institute of Environmental Medicine, Nagoya University, Toyohashi University of Technology, Tokyo Metropolitan Hospital, Torey Research Center and JSUP were involved and coordinated for the research.

Regional contraction improves, then declines after reperfusion of ischemic myocardium in the dog

Myocardial ischemia occurs during cardiac surgery and coronary artery angioplasty. If ischemia is short-term or the heart is protected, cellular necrosis can be avoided. Nevertheless, myocardial stunning occurs and can reduce cardiac performance in the hours after ischemia. Such stunning is preceded by a short period of normal or above normal contraction immediately after reperfusion. The time course of this phenomenon was investigated in six anesthetized dogs subjected to a 10-minute total coronary occlusion. Regional contraction was measured in the ischemic zone and in a remote zone of the heart with a sonomicrometer. Remote zone contraction increased during ischemia, returned toward baseline values after reperfusion, and was stable for the next hour, indicating little effect of time on the experimental preparation. In contrast, ischemic zone contraction was abolished by 10 minutes of coronary occlusion, returned to baseline or greater levels within 1 to 3 minutes following release of the occlusion, then gradually declined over 10 to 20 minutes to a level about 40% below baseline values, indicating myocardial stunning. These findings support the notion that a honeymoon period of normal or above normal function exists during early reperfusion, and that stunning manifests later. This reperfusion "honeymoon" may create a false sense of security.

Salty food intake and risk of Helicobacter pylori infection

To clarify the risk factors for Helicobacter pylori infection, which is considered to play an etiologic role in atrophic gastritis, duodenal ulcer and gastric cancer, various parameters including diet and socioeconomic characteristics were compared between H. pylori-infected and non-infected men. In a cross-sectional study of 634 men aged 40 to 49 years selected randomly from five areas with different rates of gastric cancer mortality, 474 of 628 men evaluated were positive for IgG antibody against H. pylori. After logistic regression analysis adjusted for area, the results showed a significant association between frequent intake of pickled vegetables and prevalence of H. pylori antibody (odds ratios against men who consume < 1 day/week 1.19 for 1-2 days/week, 1.92 for 3-4 days/week, 1.90 for 5-7 days/week; P for trend = 0.02). Daily consumption of miso soup was also associated with an increased risk (odds ratio against non-daily consumer = 1.60, 95% confidence interval = 1.03-2.49). Occupation, number of siblings, education, smoking and alcohol drinking, and other dietary habits were not significantly associated with the prevalence of infection in this population. Although there are limitations in a cross-sectional study such as this, consumption of salty foods appears to increase the risk of H. pylori infection, which could be a marker of salty food intake or an intermediate risk factor in the etiologic sequence between salty food intake and gastric cancer.