[Analysis of cases showing adverse reactions toward many kinds of DMARDs]

There are only six DMARDs (disease modifying anti-rheumatic drugs) available in the clinical practice, such as gold sodium thiomalate, D-penicillamine, bucillamine, auranofin, salazosulphapyridine, and lobenzarit disodium. It is important to select an appropriate DMARD for the patient. However, 57 of the 171 patients showed an adverse reaction toward one DMARD and 26 (46%) of these 57 patients showed undesirable reactions to other DMARDs. In this paper we emphasized (1) that this rate 46% of adverse reaction against multiple DMARDs was elevated and (2) that the rate of frequency of adverse reactions against two drugs was elevated. The ranking orders of the frequency of the adverse reactions of the switching of one DMARD to another are as follows; 1. gold sodium thiomalate to D-penicillamine, 2. gold sodium thiomalate to bucillamine, 3. D-penicillamine to bucillamine. Therefore, a special attention for switching DMARDs should be paid to the patient who has already shown an adverse reaction to one DMARD, and we should lower the dose of DMARDs administered to the patient. In addition, steroid was found not to decrease the rates of the adverse reaction against DMARDs.

[A case of mediastinal fibrosarcoma]

Mediastinal fibrosarcoma is rare and comprises only 0.18% of mediastinal tumors. A case of mediastinal fibrosarcoma is reported. A 57-year-old woman was admitted to our hospital with a chief complaint of chest oppression. Computed tomogram and magnetic resonance imaging revealed an anterior mediastinal tumor expanding beneath the diaphragm. The tumor invaded the pericardium, the left lung and the diaphragm, so extensively resected. The resection was non-curative because of the presence of bloody pericardial effusion and maligant stump of the pericardium. Pathological examination showed fibrosarcoma. Although she recovered well postoperatively, she died with recurrence of the tumor, especially direct oppression of the heart, 8 months after the operation. In this case adjuvant chemotherapy did not effective and noncurative operation did not improve the prorhylaxis.

[A rare complication of catheter balloon valvuloplasty of pulmonary stenosis--a case report]

We describe a rare complication which occurred during catheter balloon valvuloplasty to the stenosis of the pulmonary artery. A 4-year-old girl with cyanosis who was diagnosed as having tetralogy of Fallot, patent foramen ovale and Down's syndrome underwent the cardiac catheralisation and angiography. Angiography showed the stenosis from outlet of right ventricle to bifurcation of the pulmonary artery. We attempted catheter balloon valvuloplasty to the stenosis of the pulmonary artery subsequently. We used the PTA catheter (NuMED INC, canada), 10 mm in diameter. The balloon was inflated twice (6 atm, 5 sec, 8 atm, 7 sec) at the bifurcation of the pulmonary artery safely. However, during third trial to inflate to 8 atm, it proved impossible to increase pressure to the desired level of 8 atm. Blood backed up in the catheter and it became impossible to deflate the balloon. We failed to remove the catheter through the left femoral vein, so we led the catheter to the right internal jugular vein with a guidewire. The catheter was successfully extracted in this way. The proximal connection between the balloon and the outer tube was broken and the balloon was compressed. To our knowledge, such as complication as this has not reported previously.

[A case in which bronchorrhea was alleviated by oral erythromycin and inhalation of beclomethasone and furosemide]

A 55-year-old woman with bronchorrhea and bronchial asthma was admitted to our hospital in June, 1992. On admission, she was producing a large volume of sputum (200 ml) each day. The volume decreased with oral administration of erythromycin and inhalation of beclomethasone. Next, inhalation of furosemide was added to the regimen, which lead to symptomatic improvement in mucus clearance, although the sputum increased in volume. The concentrations of albumin, fucose, sialic acid, and phosphatidylcholine in the sputum changed with these treatments, as did the lecithin/sphingomyelin ratio. These observations suggest that these drugs affect not only the quantity but also the quality of sputum.

Effects of semotiadil fumarate (SD-3211) and its enantiomer, SD-3212, on the changes in cytosolic Ca2+ and tension caused by KCl and norepinephrine in isolated rat aortas

Semotiadil fumarate (SD-3211), a Ca2+ channel blocker of benzothiazine derivative and its (S)-(-)-enantiomer (SD-3212), inhibited K(+)- and norepinephrine (NE)-induced contractions in isolated rat aortas. Inhibition of NE contraction induced by both drugs was greater than that induced by diltiazem or bepridil, whereas inhibition of K(+)-contraction was similar to that induced by diltiazem or bepridil. Semotiadil and SD-3212 (10 microM) inhibited the increase in cytosolic Ca2+ ([Ca2+]i) induced by 65.4 mM K+ in fura-2-loaded preparations as well as diltiazem and bepridil (10 microM). On the other hand, semotiadil and SD-3212 (10 microM) inhibited only the early phase of increase in [Ca2+]i induced by 1 microM NE. After 5 min, no significant effect on [Ca2+]i was observed with these compounds despite the significant decrease in the contraction. In contrast to these compounds, diltiazem and bepridil 10 microM affected neither the increase in [Ca2+]i nor the contraction induced by NE. Semotiadil and SD-3212 inhibited the transient contraction induced by 1 microM NE in the absence of external Ca2+. Both compounds partially but significantly inhibited the NE-induced contraction in nifedipine-treated muscles. These results suggest that semotiadil and SD-3212 inhibit contractions of vascular smooth muscle (VSM) not only through blockade of voltage-dependent Ca2+ channels but also through other mechanisms, such as inhibition of Ca2+ release from Ca2+ stores or decrease in sensitivity of the contractile elements to Ca2+.

Cutaneous ciliated cyst: a case report and histochemical, immunohistochemical, and ultrastructural study

A 19-year-old woman with a cutaneous ciliated cyst on her buttock is reported. Histological, histochemical, and electron microscopic studies revealed ciliated cells, mucinous cells showing merocrine secretion, and areas of squamous metaplasia in the cyst wall. This is the first case of cutaneous ciliated cyst that contained non-ciliated mucinous cells as a component.

Moyamoya disease in three siblings--follow-up study with magnetic resonance angiography (MRA)

Three siblings with moyamoya disease including identical twins are reported. Although the younger of identical twins had no neurological problems, CT and MRI detected cerebral infarctions and cerebral angiography showed the typical features of moyamoya disease. All three cases underwent encephalo-duro-arterio-synangiosis (EDAS), and serial magnetic resonance angiography (MRA) showed that the distal portions of the middle cerebral artery (MCA) were well perfused through surgically created anastomoses. There were no findings of disease progression. MRA might play an important role in follow-up studies of moyamoya disease.

Expression of tissue-type plasminogen activator and its inhibitor couples with development of capillary network by human microvascular endothelial cells on Matrigel

Human omental microvascular endothelial (HOME) cells seeded on Matrigel begin to migrate within 1 h, forming honeycomb-like structures and capillary-like networks within 18 h. Cross-sections of the capillary networks show them to be tube-like structures. Northern blot analysis showed that tissue-type plasminogen activator (t-PA) mRNA synthesis increased from the initial state at 0 h after seeding on Matrigel, reaching a steady state after 4 h. This elevated cellular t-PA mRNA level decreased markedly at 24 h. In contrast, the cellular plasminogen activator inhibitor-1 (PAI-1) mRNA level demonstrated biphasic curves during the 24 h after seeding on Matrigel: the PAI-1 mRNA level was increased eightfold initially at 4 h over that at 0 h, then declined, and again secondarily increased to greater than tenfold at 18 h. Cellular levels of both 72 kD type IV collagenase and tissue inhibitor of metalloproteinase (TIMP-2) mRNA were increased only a slightly within 2-4 h. These elevated mRNA levels were maintained for 18 h, while the TIMP-1 mRNA level increased up to 18 h, reaching around three times the level at 0 h. However, on collagen-coated dishes, cellular levels of t-PA, PAI-1, 72 kD type IV collagenase, TIMP-1, and TIMP-2 mRNA were not greatly changed during incubation for 24 h. On Matrigel, the cellular t-PA mRNA level at 18 h after seeding was greatly increased when treated with specific anti-transforming growth factor-beta (TGF-beta) antibody. In contrast, both PAI-1 and TIMP-1 mRNA levels at 18 h were reduced in the presence of anti-TGF-beta antibody. Development of the capillary network on Matrigel was inhibited in the presence of anti-t-PA antibody. Epidermal growth factor (EGF) enhanced t-PA gene expression and TGF-beta inhibited its expression in HOME cells cultured on collagen-coated dishes. On the other hand, TGF-beta enhanced cellular expression of the PAI-1 gene. The formation of a capillary network by HOME cells on Matrigel appears to be balanced by angiogenic EGF and anti-angiogenic TGF-beta through modulation of PA activity.

The homeobox gene repo is required for the differentiation and maintenance of glia function in the embryonic nervous system of Drosophila melanogaster

We describe the cloning, expression and phenotypic characterisation of repo, a gene from Drosophila melanogaster that is essential for the differentiation and maintenance of glia function. It is not, however, required for the initial determination of glial cells. In the embryo, the gene, which encodes a homeodomain protein, is expressed exclusively in all developing glia and closely related cells in both the central and peripheral nervous systems. The only observed exceptions in the CNS are the midline glia derived from the mesectoderm and two of three segmental nerve root glial cells. Using a polyclonal antibody we traced the spatial and temporal pattern of the protein expression in detail. Embryos homozygous for null alleles of the protein exhibit late developmental defects in the nervous system, including a reduction in the number of glial cells, disrupted fasciculation of axons, and the inhibition of ventral nerve cord condensation. The expression of an early glial-specific marker is unaffected in such homozygotes. By contrast, the expression of late glial-specific markers is either substantially reduced or absent. The specificity of expression is also observed in the locust Schistocerca gregaria and is thus evolutionarily conserved.

Inhibition by suramin and reactive blue 2 of GABA and glutamate receptor channels in rat hippocampal neurons

Effects of suramin and reactive blue 2 (RB2), compounds known as antagonists at P2-purinoceptors, on ionic currents mediated through GABA and glutamate receptor channels were investigated in rat hippocampal neurons. Under whole-cell voltage-clamp, suramin (30 to 300 microM) and RB2 (10 to 100 microM) inhibited a current activated by 10 microM GABA in a concentration-dependent manner. Suramin (100 and 300 microM) and RB2 (10 and 30 microM) also inhibited an inward current activated by kainic acid (100 microM), an agonist at non-NMDA type glutamate receptor channels, and an inward current activated by N-methyl-D-aspartate (NMDA; 100 microM), an agonist at NMDA type glutamate receptor channels. The inhibition by suramin or RB2 did not exhibit voltage-dependence between -30 and -90 mV in the case of the GABA- or the kainate-evoked current. In contrast, the inhibition by these compounds of the NMDA-evoked current exhibited voltage-dependence and was enhanced by hyperpolarization. When the concentration of agonists was increased by 5- or 10-fold, the magnitude of the inhibition by suramin of the kainate-evoked current and the magnitude of the inhibition by RB2 of the NMDA-evoked current were attenuated. alpha,beta-Methylene ATP (100 microM) did not affect the GABA-, kainate- or NMDA-activated current. The results suggest that suramin and RB2 inhibit GABA receptor channels and glutamate receptor channels. The blockade of these channels must be taken into account when these compounds are used as pharmacological tools to examine an involvement of P2-purinoceptors, especially in preparations where GABAergic or glutamatergic neurotransmission is expected.

Multiple forms of mouse PG-M, a large chondroitin sulfate proteoglycan generated by alternative splicing

We have isolated and sequenced cDNA clones that encode the core protein of PG-M-like proteoglycan produced by cultured mouse aortic endothelial cells (Morita, H., Takeuchi, T., Suzuki, S., Maeda, K., Yamada, K., Eguchi, G., and Kimata, K. (1990) Biochem. J. 265, 61-68). A homology search of the cDNA sequence has suggested that the core protein is a mouse equivalent of chick PG-M(V1), one of the alternatively spliced forms of the PG-M core protein, which may correspond to human versican. Northern blot analysis revealed three mRNA species of 10, 9, and 8 kilobases (kb) in size. The analysis of PG-M mRNA species in embryonic limb buds and adult brain revealed the presence of other mRNA species with different sizes; the one with the largest size (12 kb) was found in embryonic limb buds, and the ones with smaller sizes of 7.5 and 6.5 kb were in adult brain. Sequencing of cDNA clones for the smaller forms in the adult brain showed that they were different from PG-M(V1) in encoding the second chondroitin sulfate attachment domain (CS alpha) alone. Occurrence of the PCR products striding over the junction of the first and second chondroitin sulfate attachment domains suggested that a mRNA of 12 kb in size corresponded to a transcript without the alternative splicing (PG-M(V0)). It is likely, therefore, that multiforms of the PG-M core protein may be generated by alternative usage of either or both of the two different chondroitin sulfate attachment domains (alpha and beta) and that molecular forms of PG-M may vary from tissue to tissue by such an alternative splicing.

How MHC class II molecules reach the endocytic pathway

We have examined trafficking of major histocompatibility complex (MHC) class II molecules in human B cells exposed to concanamycin B, a highly specific inhibitor of the vacuolar H(+)-ATPases required for acidification of the vacuolar system and for early to late endosomal transport. Neutralization of vacuolar compartments prevents breakdown of the invariant chain (Ii) and blocks conversion of MHC class II molecules to peptide-loaded, SDS-stable alpha beta dimers. Ii remains associated with alpha beta and this complex accumulates internally, as ascertained biochemically and by morphological methods. In concanamycin B-treated cells, a slow increase (> 20-fold) in surface expression of Ii, mostly complexed with alpha beta, is detected. This surface-disposed fraction of alpha beta Ii is nevertheless a minor population that reaches the cell surface directly, or is routed via early endosomes as intermediary stations. In inhibitor-treated cells, the bulk of newly synthesized alpha beta Ii is no longer accessible to fluid phase endocytic markers. It is concluded that the majority of alpha beta Ii is targeted directly from the trans-Golgi network to the compartment for peptide loading, bypassing the cell surface and early endosomes en route to the endocytic pathway.

Voltage-gated Ca2+ channel blockers, omega-AgaIVA and Ni2+, suppress the induction of theta-burst induced long-term potentiation in guinea-pig hippocampal CA1 neurons

It is widely believed that a rise in post-synaptic calcium concentration ([Ca2+]i) is a necessary step in the induction of long-term potentiation (LTP) (Bliss and Collingridge, Nature, 361 (1993) 31-39). In this experiment, we examine the involvement of voltage-gated Ca2+ channels (VGCC) in the induction of AP5-sensitive LTP induced by theta-burst stimulation in guinea-pig hippocampal CA1 neurons. The VGCC blockers, Ni2+ (25 microM, T-channel blocker) or omega-AgaIVA (60 nM, P-channel blocker), which have no effect on synaptic transmission, suppress 60% or 78% of the theta-burst induced LTP, respectively. This implies that Ca2+ entry through VGCC is an important step in this form of LTP.

[Psychological profiles of patients with bronchial asthma. First report: analysis according to the difference in severity of asthma]

Although it is well known that asthma is influenced by psycho-social factors, the present medical system does not take any measures to deal with these underlying factors. Many physicians are unable to assist patients with psycho-social problems due to the lack of time they are allowed for each patient. We have employed a variety of psychological test scales to assist in screening patients. As a result, we found that many severe asthmatics lack enthusiasm for therapy, possess pessimistic feelings toward their prognosis. They also have personality traits of extroversion in combination with psychological instability, which may given them problems of compliance, while some manifest a tendency to flight to illness. These factors may lead to further difficulty in treatment, including steroid dependency and death from asthma. Early intervention must be contemplated to prevent such outcomes.

Regulation of heat production of brown adipocytes via typical and atypical beta-adrenoceptors in the rat

Previous studies in our laboratory demonstrated that microcalorimetry is an appropriate method for estimating the physiological function of isolated rat brown adipocytes. In the present study, to elucidate the mode of action of typical and atypical beta-adrenoceptors on heat production of this cell, the effect of novel adrenergic beta 3-agonists was compared with that of other typical adrenergic reagents by direct microcalorimetry. Isoproterenol and beta 3-agonists, BRL37344, ICI215001, and CGP12177, increased heat production in a dose-dependent manner, however, phenylephrine had no effect. Propranolol and pindolol did not increase the heat production but attenuated the effect of isoproterenol and BRL37344 in a dose-dependent manner. Molar IC50 values of propranolol and pindolol for BRL37344 were about 10(-5) and 3 x 10(-6) M, respectively, whereas those of the two antagonists for isoproterenol were about 3 x 10(-7)M. The pA2 values by Schild analysis of propranolol vs. isoproterenol and BRL37344 were 7.91 and 6.13, respectively. These results suggest that heat production may be regulated via both beta 3- and typical beta-adrenoceptors in brown adipocytes.

Mitosis and the presence of binucleate cells among glomerular podocytes in diseased human kidneys

Podocytes are highly differentiated cells that appear to be postmitotic. However, it is unclear whether cell division or the proliferation of podocytes takes place in the setting of glomerular injury. In this study, we analyzed the presence of mitotic figures and of binucleate or multinucleate podocytes in diseased human kidneys by light and electron microscopy. Among the 164 cases analyzed, mitotic figures in podocytes were found in only one cell, in a case of focal and segmental glomerulosclerosis, and 6 cases provided evidence of two or more nuclei in a single podocyte. Serial sections by light microscopy confirmed that the nuclei in multinucleate cells were separate and of approximately the same size. Electron-microscopic analysis of the binucleate podocytes revealed hypertrophy and effacement of foot processes. These findings indicate that, in human podocytes, mitosis without cytokinesis (cell division) results in binucleate cells in cases of glomerular injury.

Plasma plasminogen activator inhibitor-1, tissue plasminogen activator and serum lipoprotein(a) after reperfusion therapy in acute myocardial infarction: comparison between sequential and direct percutaneous transluminal coronary angioplasty

To determine which reperfusion therapy for acute myocardial infarction (AMI) is advantageous to avoid subsequent thrombotic coronary occlusion, 8 patients with AMI were studied. Four of them (group S) underwent sequential PTCA following unsuccessful intracoronary thrombolysis and the others (group D) direct PTCA. Serial changes in plasma plasminogen activator inhibitor-1 (PAI-1), plasma tissue plasminogen activator (t-PA) antigen and serum lipoprotein(a) levels were compared between the two groups. In group S, plasma PAI-1 levels showed no significant serial change after PTCA. However, in group D, plasma PAI-1 levels increased significantly 4-24 h after PTCA. We suggest that more attention should be focused on the prevention of thrombotic coronary closure as well as mechanical abrupt occlusion after direct PTCA.

Defective insulin and glucagon secretion in isolated perfused pancreata of diabetic WBN/Kob rats

To elucidate the pathophysiology of diabetes mellitus in male WBN/Kob rats, we performed pancreatic perfusion experiments and histopathological studies. Intraperitoneal glucose tolerance tests showed a diabetic pattern in 12-month-old WBN/Kob rats. In perfused pancreata of WBN/Kob rats, both the first and the second phases of insulin secretion in response to a 16.7 mM glucose challenge were markedly reduced compared with those in age-matched Wistar rats (p < 0.01, respectively). Furthermore, the insulin secretion rate in response to glucopenia (1.4 mM) was significantly higher (p < 0.05) and the decrement in insulin secretion was significantly lower (p < 0.05) in WBN/Kob rats. The decrement in glucagon secretion with 16.7 mM glucose was significantly blunted (p < 0.001), and the glucagon secretion rate in response to glucopenia was also significantly lower in WBN/Kob rats than in controls (p < 0.01). Although insulin secretion in response to 10 mM arginine was also moderately reduced in WBN/Kob rats (p < 0.05), the glucagon secretion rates in response to 10 mM arginine were similar in the two groups. Histopathological examination revealed widespread disappearance of acinar cells and islets, inflammatory changes, and marked fibrosis in the pancreata of WBN/Kob rats. Immunohistochemical studies showed decreased numbers of B cells in the islets of WBN/Kob rats. These findings suggest that this WBN/Kob rat strain is a useful model for studying not only pathogenesis, but also pathophysiology, i.e., defective hormonal secretion, in some types of human diabetes mellitus.