[Evaluation of a combination chemotherapy with nedaplatin and 5-FU for oral cancers]

Nedaplatin (cis-diammine-glycolato platinum: CDGP) is a platinum compound with a molecular weight of 303.18 that was recently developed in Japan. There have been reports of the antineoplastic effects of Nedaplatin on cancers in the cranio-cervical region, lung, esophagus, urinary bladder, testis, ovary, and uterus. In this study, we performed combined therapy of CDGP and fluorouracil (5-FU) for 8 patients with oral cancers, and evaluated the results to elucidate the clinical effect and adverse side effects. The subjects were 8 patients with squamous cell carcinoma (5 males and 3 females aged 33-65 years). The primary carcinoma regions were the tongue in 5 patients, oral floor in 2 patients, and mandibular gingiva in 1 patient. The T-classification was T2 in 6 patients and T4 in 2 patients, and the clinical staging was Stage II in 5 patients, Stage III in 1 patient and Stage IV in 2 patients. We first administered 700 mg/m2 5-FU per day from day 1 to day 5 (total dose 3,500 mg/m2), then 90 mg/m2 CDGP on day 5. The clinical effect was evaluated as a partial response in all cases, showing a 100% success rate. The histopathological findings of resected tumors were evaluated by Ohboshi and Shimozato's classification. One patient was Grade IIA, 5 patients Grade IIB, and 2 patients Grade III. The adverse side effects were slight myelotoxicity, gagging, nausea, alopecia, and stomatitis less than Grade II. Although the oral cancers in this study were extroverted superficial ulcerative cancers, and the number of patients was low at 8, this combined therapy is considered useful and worth evaluating in further accumulated cases.

Suppression of experimental membranous glomerulonephritis in rats by an anti-MHC class II antibody

BACKGROUND

We previously reported that idiopathic membranous nephropathy (IMN) strongly correlated with HLA-DRB1*1501-DRB5*0101-DQAI*0102-DQB1* 0602, a specific haplotype of human major histocompatibility complex (MHC), in Japanese patients. To investigate the role of MHC in the development of rat Heymann nephritis (HN), an animal model of membranous nephropathy, a monoclonal antibody (mAb) specific to rat MHC class II antigen (RT1B) was administered, and its effectiveness in inhibiting HN was assessed.

METHODS

Active HN was induced in HN-sensitive Lewis rats by administering brush border proteins of rat proximal uriniferous tubules (FX1A). Rats were divided into four groups: rats treated with 1,000 micorg anti-rat MHC class II mAb, rats treated with 100 microg anti-rat MHC class II mAb, rats treated with murine myeloma IgG, and rats that did not receive either FX1A or any other mAb. We examined the differences in 24-hour urinary protein excretion and serum alloantibody titers against FX1A between groups at different time intervals, and the histologic features of kidneys at the end of the study.

RESULTS

HN was induced in Lewis rats by inoculation with FX1A antigen. Administration of anti-MHC class II mAb successfully lowered urinary proteins, production of anti-FX1A alloantibodies, and the development of glomerular lesions in a dose-dependent manner.

CONCLUSION

The present results demonstrated that the MHC class II molecule itself is directly involved in the pathogenesis of HN, and suggest that this therapy would be any better (or less toxic) than nonselective immunosuppressants in the treatment of IMN.

Relationship between fluctuation pattern of blood pressure during hemodialysis treatment and cardiovascular morphology: an autopsy study of 53 cases

BACKGROUND

Cardiovascular morphological changes are often conspicuous in autopsy examination of chronic hemodialysis (HD) patients. On the other hand, the fluctuation pattern in blood pressure (BP) during HD treatment varies from one patient to another. Cardiovascular changes may correlate with clinical findings including BP fluctuation patterns during HD, although no autopsy studies have previously examined this issue.

METHODS

In this study, 53 autopsies of patients who had been on chronic HD were reviewed. We determined the relationship between BP fluctuation during HD treatment along with stable and cardiovascular morphology, including heart weight, ventricular wall thickness, circumferences of the valves and the severity of aortic arteriosclerosis and coronary stenosis. Patients were divided into 4 groups according to the pattern of BP fluctuation during HD treatment at about 6 months before death: group 1 (n = 13), symptomatic hypotension and/or decline pattern during HD; group 2 (n = 11), continuously high BP during HD treatment; group 3 (n = 17), continuous normal BP during HD treatment, and group 4 (n = 12), continuously low BP without symptomatic hypotension during HD treatment.

RESULTS

Heart weight and ventricular wall thickness were greatest in group 2. The scores for aortic arteriosclerosis in groups 1 and 2 were higher than in groups 3 and 4. The coronary stenosis index was significantly higher in group 1 than in the other groups, and that in group 2 was higher than in group 4. Multiple regression analysis showed that age, HD duration and pulse pressure were independent variables for the score of arteriosclerosis, and the decline pattern of BP fluctuation during HD and pulse pressure were independent variables for coronary stenosis index.

CONCLUSIONS

Our results suggest that certain clinical parameters including BP during HD may reflect cardiovascular morphological changes in stable HD patients, although further examination, such as 24-hour blood pressure measurement is recommended to elucidate the pathophysiology of cardiovascular diseases in HD patients.

Factors affecting disability in patients attending the internal medicine departments of general hospitals

The aim of this study was to investigate the effect of sociodemographic factors, physical factors and mental factors on the physical and social disability of patients attending outpatient clinics of general hospitals. Physical and psychiatric morbidity in 1580 consecutive patients attending the internal medicine department of general hospitals was assessed using a stratified two-stage sampling design method. Of the total, 336 patients completed the second stage interview composed of Primary Care Version of Composite International Diagnostic Interview and Groningen Social Disability Schedule to assess sociodemographic, physical and mental factors. In this study, restricted activity days, disability days and Brief Disability Questionnaire were used for the assessment of physical disability, and Groningen Social Disability Schedule was used for social disability. Sociodemographic, physical and mental factors were all related to disability. Among sociodemographic factors, unemployment was associated with physical disability and social disability mildly. Among physical factors, the severity of physical disease was not associated with disability and medically explained somatic symptoms were associated with disability. Furthermore, the mental factor was more strongly associated with physical and social disability. It could be said that the mental factor is more strongly associated with physical and social disability than sociodemographic or physical factors. In addition, even mild mental symptoms not leading to ICD-10 mental disorders affected disability. From the viewpoint of the patients' burden, it is important to assess the mental symptoms as well as physical status in outpatient clinics of internal medicine or primary care.

Effects of 16 weeks of treatment with tibolone on bone mass and bone mechanical and histomorphometric indices in mature ovariectomized rats with established osteopenia on a low-calcium diet

Tibolone is a synthetic steroid with tissue-specific estrogenic, progestogenic, and androgenic properties. The therapeutic effects of tibolone on bone mass and strength, bone metabolic markers, and indices of histomorphometry were investigated in ovariectomized (ovx) rats on a low (0.1%)-calcium diet in comparison with 17alpha-ethynylestradiol (EE) or 1alpha-hydroxyvitamin D3 [1alpha(OH)D3]. Tibolone (0.1-3 mg/kg/day), EE (0.1 mg/kg/day), or 1alpha(OH)D3 (0.5 microg/kg/day) was administered orally once a day for 16 weeks, starting 12 weeks after ovariectomy, when the bone mineral density (BMD) of lumbar vertebrae (L4-5) and femur (global, proximal, and distal regions) had already been decreased by the combination of ovariectomy and low dietary calcium. The BMD of the lumbar vertebrae and the femur were higher in the groups treated with tibolone, EE, or 1alpha(OH)D3 than in the ovx control group. The BMD of the mid-diaphysial regions of femur and tibia, which consist mainly of cortical bone, were decreased 28 weeks after ovariectomy in the ovx control group. The BMD of the mid-diaphysial femur was higher in the groups treated with 1alpha-(OH)D3, and the BMD of mid-diaphysial tibia was higher in the groups treated with tibolone or 1alpha(OH)D3 than in the ovx control group. Like BMD, the compressive strength of the vertebral body of L2, corrected for the volume of each individual vertebra tested, was higher in the groups treated with tibolone, EE, or 1alpha(OH)D3 than in the ovx control group. Trabecular bone volume and trabecular number were reduced 12 and 28 weeks after ovariectomy but there was no change in trabecular thickness. These reduced indices were increased in the groups treated with tibolone, EE, or 1alpha(OH)D3 when compared with the ovx control group. Tibolone or EE decreased serum levels of osteocalcin and bone alkaline phosphatase and urinary levels of deoxypyridinoline and pyridinoline compared with the ovx control group. Furthermore, tibolone or EE decreased the mineralizing surface and bone formation rate as well as the osteoclast surface and osteoclast numbers. 1Alpha(OH)D3, however, did not affect these serum and urinary parameters. These data suggest that tibolone suppresses the accelerated bone turnover induced by a combination of ovariectomy and low dietary calcium, and indicate that tibolone may be a potentially useful drug for the treatment of postmenopausal osteoporosis.

Further evidence of westernization of dementia prevalence in Nagasaki, Japan, and family recognition

The present study examined the prevalence of dementia in the Nagasaki Prefecture. The purposes of our investigation were (a) to study the relationship between aging and the prevalence of dementia and the ratio of Alzheimer's disease (AD) to vascular dementia (VD), (b) to understand the features of early-onset dementia as seen in patients from 60 to 65 years, and (c) to examine the recognition of dementia by family members. The subjects of the study, a total of 4,368, were all 60 years old and over and were residing in the three areas of Nagasaki Prefecture at the time of the investigation, August 1995. We adopted a two-stage design. The first-stage questionnaire that we developed was delivered to subjects, and we selected for the second stage those subjects who met the criteria outlined in the Methods section. The second-stage investigation was an interview by community nurses and psychiatrists. The prevalence of dementia in subjects 60 years and over was 6.2% (men: 5.9%; women: 6.8%). The prevalence increased with age. The AD/VD ratio was 1.4, and was similar to the recent trend in Japan in that the ratio has reversed to resemble the western pattern. In regard to the family members' recognition of illness, the higher the severity of dementia, the higher the recognition ratio of family members became. Only half of these subjects were recognized as having dementia by their family members. In conclusion, the westernization of the AD/VD ratio in Japan was proved. There was little study about family recognition of dementia. In this study, it was remarkable that only half of the subjects were recognized as having dementia by their family members.

Methodological issues of an epidemiological study: from the results of a study on psychological problems seen in outpatients visiting the internal medicine departments of general hospitals

The frequency and type of psychological problems of outpatients in general healthcare settings, the recognition and management of those problems by physicians, and the course of the problems were investigated using a two-stage sampling design method. The subjects were outpatients visiting the department of internal medicine of two general hospitals in Nagasaki prefecture. For the first-stage investigation, the General Health Questionnaire 12-item version (GHQ-12) was used. A second-stage investigation was then conducted, which used many instruments containing the Composite International Diagnostic Interview (CIDI) and Groningen Social Disability Scale (GSDS). As a result, 1555 patients participated in the first-stage, 483 were selected and 336 (69.5%) participated in the second-stage investigation. No significant differences were seen in age or sex between the GHQ score groups among the 1555 subjects of the core sample. The background factors of the two hospital samples differed significantly in the distribution of age, sex and physical diseases. There were some differences in the participation between men and women in age and GHQ score. It was then suggested that variances should be considered in such an epidemiological study.

A monoarthritis model in rabbits induced by repeated intra-articular injections of lipopolysaccharide

We attempted to develop a monoarthritis model using repeated intra-articular injections of high-dose Lipopolysaccharide (LPS). Furthermore, the effect of dexamethasone on this arthritis model by intra-articular administration was studied to examine whether the model can be used to screen anti-rheumatic drugs in a short time. Arthritis was induced by one, two or three intra-articular injections of LPS (5-50 micrograms/joint) at 4-day intervals into the knee joint. The rabbits were sacrificed at 7 days following the last injection of LPS. Three intra-articular injections of LPS at 50 micrograms/joint resulted in persistent joint swelling. Hyperplasia of synovium with some discolouration was macroscopically observed. Infiltration of mononuclear cells and lymphoid follicles were histologically observed as the synovial lesions. Concerning the articular bone/cartilage, trabecular destruction of gastrocnemius sesamoid bone and severe loss of safranin-O staining of articular cartilage were observed. Immunohistochemical analysis revealed that inflammatory cells and lymphoid follicles in the synovial lesions consisted predominantly of CD4+ T cells, with few CD8+ T cells. Treatment with dexamethasone markedly reduced the joint swelling and the articular destruction. The results suggest that this arthritis model in rabbits can be utilized to screen anti-rheumatic drugs as a model of rheumatoid arthritis.

Variation of the total amount of fluoride in blood of young women during the menstrual cycle

We have previously reported the distribution and the forms of fluorides in the blood of men. This study is concerned with the distribution of fluorides in the blood of young women and sex-related differences in the fluoride metabolism related to the calcium metabolism keeping the postmenopausal osteoporosis in mind. The present study shows that women, aged 18 to 20 years, retain more fluorides in blood compared with men and that the nonionic fluoride level in blood varies during a menstrual cycle, whereas the ionic fluoride level is constant. Since fluoride has strong affinity for calcium, behavior of fluoride may reflect that of calcium balance during the menstrual cycle. However, fluoride which binds to calcium is believed to be ionic. Therefore, there must be a transformation between ionic fluoride and nonionic fluoride in order to keep the homeostasis.

[CPE chemotherapy for tongue carcinoma--clinical effects and side effects]

Recent advances in chemotherapy have markedly improved the treatment results for oral cancer. Among many chemotherapeutic regimens, the usefulness of multiple combination chemotherapy with cisplatin as the primary drug has been frequently reported. During the past 6-year period, we have performed combination chemotherapy with cisplatin as the primary drug, peplomycin, and etoposide (CPE chemotherapy) as one of the chemotherapeutic regimens for oral cancer. The subjects were 11 patients (7 males and 4 females) with tongue cancer treated by CPE chemotherapy as neoadjuvant chemotherapy at our department between March, 1990 and April, 1995.

RESULTS

PR in 8 (73%), and NC in 3 (27%). No patient showed CR and PD. The side effects observed were reversible findings such as transient myelosuppression, nausea-vomiting, and alopecia. No patient showed severe or persistent suppression of hematopoietic function.

Dexamethasone suppresses mucus production and MUC-2 and MUC-5AC gene expression by NCI-H292 cells

Excessive production of airway mucus is a characteristic feature of many chronic inflammatory lung diseases. Although current pharmacological approaches to excessive mucus production are limited, glucocorticoids appear to be the most effective among a few useful drugs. The exact evidence for the effectiveness of glucocorticoids on mucus production has not been fully elucidated to date. The purpose of this study is to clarify the effect of dexamethasone on mucus production and mucin gene expression in a human pulmonary mucoepidermoid carcinoma cell line (NCI-H292). NCI-H292 cells produced hyaluronidase-resistant high-molecular-weight glycoconjugates (HMWG), which elute in the void volume on Sepharose CL-4B column chromatography. Dexamethasone significantly suppressed the basal production of [3H]glucosamine-or [3H]serine-labeled HMWG in NCI-H292 cells. In Northern blot analysis, dexamethasone attenuated steady-state mRNA levels of MUC-2 and MUC-5AC mucin genes. These data indicate that dexamethasone suppresses the basal production of HMWG and decreases steady-state mRNA levels of mucin genes in airway mucus-producing cancer cells.

Pyridine derivatives stimulate phosphatidylcholine secretion in primary cultures of rat type II pneumocytes

We have examined the effects of pyridine derivatives on phosphatidylcholine secretion in primary cultures of rat type II pneumocytes. Of 12 pyridine derivatives, 4-aminopyridine, 4-dimethylaminopyridine and 4-pyrolidinopyridine had a stimulatory effect on phosphatidylcholine secretion, whereas other derivatives had little effect. The stimulatory effect of 4-aminopyridine was concentration- and time-dependent, and was inhibited by the acetoxymethyl ester of 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (3 microM), an intracellular Ca2+ chelator. In addition, the stimulatory effect of 4-aminopyridine was suppressed by W-7(N-(6-aminohexyl)-5-chloro-1-napthalene-sulphonamide)(10 microM), a calmodulin inhibitor, and sphingosine (10 microM) and staurosporine (0-1 microM), protein kinase C inhibitors. These results indicate that several pyridine derivatives stimulate phosphatidylcholine secretion in type II pneumocytes.

Substance P stimulates the loss of cell-associated high molecular weight glycoconjugates from cultured hamster tracheal epithelial cells through polymorphonuclear leucocytes activation

Abnormal and excessive mucus secretion is a characteristic feature of many chronic inflammatory lung diseases accompanied by the influx of polymorphonuclear leucocytes (PMNs) into the airway and the release of substance P from the peripheral endings of primary sensory neurons. We examined whether PMNs activated by substance P (10 microM) can affect the secretion of high-molecular-weight glycoconjugates (HMWG), which is used as a marker of mucus, from cultured hamster tracheal epithelial cells. We measured both the released and the cell-associated HMWG. Substance P-activated PMNs (10(6) cells/ml) reduced the amount of cell-associated HMWG to 76% of the control level, but did not affect the amount of the released HMWG. The reduction of the amount of cell-associated HMWG was inhibited by ONO-5046, a specific elastase inhibitor. In addition, the HMWG was digested by the activated PMNs. These findings suggested that substance P stimulates the loss of the cell-associated HMWG and degrades the released HMWG from cultured hamster tracheal epithelial cells through PMNs activation.

[Combined acute ascending aneurysm and chronic descending thoracic aneurysms]

A 66-year-old woman with a known chronic descending thoracic dissecting aneurysm was admitted following a chest X-ray which revealed a widening in the mediastinum and an increased cardiothoracic ratio. Echocardiography and chest CT showed a combined ascending thoracic dissecting aneurysm with a tripple lumen, pericardial effision, moderate aortic regurgitation, and the chronic descending thoracic dissection with incompletely thrombosed aneurysm. The chest CT also showed a normal aortic arch. The diagnosis was then made as combined acute ascending aortic dissection (DeBakey II) and chronic descending aortic dissection (DeBakey III). A 2-stage operation was planned, involving first a graft replacement of the ascending aorta, and then one month later a graft replacement of the descending aorta.

[A case of successful operation for chronic aortic dissection (DeBakey 1 type) complicated with cerebral infarction]

We report a successful operation for a patient of chronic aortic dissection complicated with cerebral infarction. A 60-year-old woman has been treated suffering from cerebral infarction for 7 years. She was referred to our hospital for abnormal chest X-ray and complaint of dry cough. The enhanced CT scan and aortogram demonstrated chronic aortic dissection (DeBakey I) extending from ascending aorta to the abdominal aortic bifurcation with occlusion of right common carotid artery and dilated ascending aorta and aortic arch. The onset of aortic dissection seemed to be, from a clinical point of view, coincident with the onset of cerebral infarction seven years ago. The replacement of the ascending aorta and aortic arch with woven Dacron velour graft were performed under hypothermic and selective cerebral perfusion. The postoperative course was uneventful although complicated with transient recurrence nerve palsy and she has been doing well.

Involvement of protein kinase C in mucus secretion by hamster tracheal epithelial cells in culture

Abnormal regulation of airway mucus secretion may underlie many pulmonary diseases. The exact evidence for the involvement of intracellular signaling mechanisms in mucus secretion has not been fully elucidated to date. The purpose of this study is to clarify the involvement of protein kinase C in the secretion of high-molecular-weight glycoconjugates (HMWG) by hamster tracheal epithelial cells in culture, which elute in the void volume on Sepharose CL-4B column chromatography. HMWG were secreted by the cells cultured on the thick collagen gel, but not on the plastic plate. Two known activators of protein kinase C, 4 beta-phorbol 12 alpha-myristate 13-acetate (PMA) and 1-oleoyl-2-acetyl-sn-glycerol (OAG), stimulated HMWG secretion. In contrast, 4 alpha-phorbol 12,13-didecanoate, a biologically inactive phorbol, did not influence HMWG secretion. D-Sphingosine, an inhibitor of protein kinase C, suppressed the maximal PMA- (10(-8) M) and OAG- (200 microM) stimulated HMWG secretion. PMA induced protein kinase C translocation from cytosol to membrane. These data indicate that protein kinase C is involved in HMWG secretion in hamster tracheal epithelial cells in culture.

Increased beta 2-microglobulin in both parotid and submandibular/sublingual saliva from patients with Sjögren's syndrome

Samples of unstimulated saliva from patients with sialoadenopathy were collected by microcapillary tube (1 microliter), and their beta 2-microglobulin (B2-MG) content determined by a sandwich enzyme immunoassay. A higher than normal (control) concentration of the globulin was present in both parotid and submandibular/sublingual saliva from the patients with Sjögren's syndrome but not in the samples from the patients with sialoadenitis or diabetes mellitus. The increase in B2-MG in saliva from patients with Sjögren's syndrome may reflect that immunolopathological events are important in the degeneration of both glands in this disease. Therefore, the determination of B2-MG in saliva may be a simple, non-invasive technique for confirming the diagnosis of Sjögren's syndrome as an autoimmune disease.

[Intra-arterial combination chemotherapy using both regimen selected by chemosensitivity test and caffeine to increase effect for osteosarcoma in extremity]

We treated three patients with osteosarcoma in extremity with intra-arterial combination chemotherapy using a regimen selected by succinate dehydrogenase inhibition chemosensitivity test, and used caffeine to enhance its effect. In two patients with osteosarcoma in distal diametaphysis of the radius and extraskeletal osteosarcoma in sole of the foot, the effect of intra-arterial combination chemotherapy was increased and followed by the functional limb salvage procedure. But in one patient with osteosarcoma in the proximal tibia, the effect of pre-operative intra-arterial combination chemotherapy could not be increased, so amputation was required. He was changed to a post-operative intra-venous combination chemotherapy regimen selected by chemosensitivity test of the surgical material. All patients have been continuously disease-free at five to twelve months after surgery.

Early malignant histiocytosis of the intestine: an autopsy report

A 63-year-old man with malignant histiocytosis of the intestine died 3 days after gastrectomy for early gastric adenocarcinoma. Malignant histiocytosis of the intestine was unexpectedly found at autopsy. The intestine was thickened with mucosal erosions. Histologically, a few atypical large histiocyte-like cells were found in focal aggregates in the mucosa. These large cells expressed the T-cell antigen and monoclonality was demonstrated by the polymerase chain reaction showing variable-joining segment rearrangement in the T-cell receptor delta-chain gene. Malignant histiocytosis of the intestine was thus diagnosed.

[A case of left ventricular hemangioma]

Left ventricle hemangioma in a 54-year-old man is reported. He was admitted to our hospital for chest discomfort. Coronary angiograms showed normal coronary arteries and a contrast blush in the left interventricle septum. Transesophageal echocardiogram also demonstrated the small floating tumor in the ventricular septum below the right coronary cusp. With the aid of cardiopulmonary bypass, the tumor was resected completely through transaortic approach. Histological examination revealed capillary hemangioma. The patient had uneventful recovery. To our knowledge, this is the seventh case of a left ventricular hemangioma treated surgically reported in the world literature.

Two-dimensional electrophoresis of human salivary proteins from patients with sialoadenopathy

Unstimulated saliva was fractionated by micro two-dimensional gel electrophoresis, and the proteins visualized by silver staining and immunostaining. The subjects with Sjögren's syndrome exhibited both quantitative and qualitative alterations in the protein composition of the saliva not only from the parotid gland but also from the submandibular/sublingual glands.

[Post-operative intra-arterial chemotherapy for high grade malignant musculoskeletal sarcoma]

Twenty-nine patients with high grade malignant musculoskeletal sarcoma were treated with chemotherapy. Intra-arterial chemotherapy was performed post-operatively for patients with local recurrence, patients with poor response to pre-operative chemotherapy or patients with intra-lesional or marginal surgical margin. The local recurrence rate in patients with intra-arterial chemotherapy (8.8%) was lower than in those with intravenous chemotherapy (37.5%). Patients with post-operative intra-arterial chemotherapy showed no local recurrence. Of the 29 patients except stage 3 with intra-arterial chemotherapy, the metastatic rate in patients with intra-arterial chemotherapy (41.4%) was lower than in chemotherapy patients with intravenous chemotherapy (83.3%). The rate in the post-operative group (28.6%) was lower than in the pre-operative group (42.9%) or pre- and post-operative group (50.0%). The ten-year survival curve of patients given intra-arterial chemotherapy (51.0%) was higher than in patients on intravenous chemotherapy (17.9%). Among the 34 patients who underwent intra-arterial chemotherapy, the survival rate in the other pre- and post-operative groups and the post-operative group (55.6%) was higher than in the pre-operative group and pre- and post-operative group (49.8%).

[Simultaneous operation of gastrectomy, cholecystectomy and coronary artery bypass grafting using right gastroepiploic artery]

We present a case who received the simultaneous surgical corrections of unstable angina, acute gastric ulcer, and cholelithiasis. A 72-year-old man was admitted to our hospital due to unstable angina. An emergency coronary angiography was performed and we found severe 2 vessels disease (RCA ostium and proximal LAD lesions). After the admission, the angina was poorly controlled and the surgical treatment had been considered. The patient developed sudden hematemesis due to the uncontrolled bleeding from gastric ulcer. Then the emergency operation was performed. Partial gastrectomy with preservation of RGEA and cholecystectomy were done followed by CABG to RCA with RGEA and to LAD with autologous saphenous vein. The postoperative course was uneventful and the patient is in good condition to date.

Ionic and nonionic fluoride levels in blood of dialyzed and undialyzed patients with renal failure and kidney transplanted patients

The present study revealed that the total fluoride level in human whole blood is closely related to the renal function. For the undialyzed patients who had not undergone hemodialysis, the total fluoride level in whole blood linearly increased with the increase of creatinine (Cr) value. The increased fluoride was found to be nonionic in the other blood part than serum, while the nonionic fluoride level in serum was almost constant. That is, the hemodialysis treatment finally reduced the nonionic fluoride level in the other blood part than serum. On the other hand, one hemodialysis treatment could excrete ionic fluoride, but not nonionic fluoride. These results suggest that the ionic fluoride is transformed to nonionic fluoride to be accumulated in other blood part than serum and the nonionic fluoride is transformed to the ionic fluoride to be excreted. Thus the accumulation of nonionic fluoride in other blood part than serum plays a role of the buffer in preventing a too high serum fluoride level.

The effect of a novel thromboxane A2 (TXA2) receptor antagonist (S-1452) on the antigen-induced bronchoconstriction and airway hyperresponsiveness in guinea pigs

The effect of a novel thromboxane A2 (TXA2) receptor antagonist (S-1452) on antigen-induced bronchoconstriction and airway hyperresponsiveness in guinea pigs was studied. Ketotifen was used as a reference drug. S-1452 at doses of 1 and 3 mg/kg (per oral administration, 1 h before the injection of U-46619) clearly inhibited U-46619-induced pulmonary pressure increase. Ketotifen at a dose of 10 mg/kg did not affect U-46619-induced bronchoconstriction. S-1452 at doses of 3 and 10 mg/kg and ketotifen at a dose of 10 mg/kg inhibited the antigen-induced bronchoconstriction in guinea pigs which had been passively sensitized with guinea pig IgE antibody. S-1452 at a dose of 10 mg/kg inhibited repeated antigen provocation-induced airway hyperresponsiveness in guinea pigs. The accumulation of inflammatory cells by antigen provocation in bronchial alveolar lavage fluid (BALF) was inhibited by ketotifen but not by S-1452. These results indicate the efficacy of S-1452 on antigen-induced bronchoconstriction and antigen-induced airway hyperresponsiveness in guinea pigs.

Chromosome abnormalities in liposarcomas

We performed a cytogenetic study of short-term cultures from fresh surgical specimens obtained from four patients with liposarcoma. Myxoid liposarcomas (cases 1-3) were associated with a specific translocation between chromosomes 12 and 16. Trisomy 8, a nonrandom secondary aberration in myxoid liposarcoma, was observed in the third case as the only additional change. Round cell liposarcoma (case 4) showed complex chromosomal aberrations affecting chromosomes 1, 2, 5, 6, 7, 13, 14, 17, 19, and 22. Neither band 12q13 nor 16p11 was visibly rearranged. Three subgroups of liposarcomas are proposed. The first group is characterized by t(12;16)(q13;p11), the second group by ring chromosomes, telomeric associations, and giant markers, and the last by complex numerical and structural aberrations.

Removal of extracellular Mg2+ suppresses sulfation of glycoconjugates secreted from rabbit trachea in culture

The influences of extracellular Ca2+ and Mg2+ concentrations on the basal secretion of glycoconjugates from rabbit trachea in organ culture were examined. Over 80% of the 35S-labeled and [3H]glucosamine-labeled glycoconjugates secreted by the trachea were digested upon incubation with chondroitinase ABC. The basal secretion did not occur in the medium at 4 degrees C, indicating an energy-dependent process. The basal secretion at 37 degrees C of 35S-labeled glycoconjugates was prominently suppressed in Mg(2+)-free Tyrode solution but not in Ca(2+)-free Tyrode solution containing ethyleneglycol bis(2-aminoethylether)tetraacetic acid (EGTA). In contrast, the basal secretion of [3H]glucosamine-labeled glycoconjugates was not affected by the Mg2+ concentration in the medium. The results suggest that extracellular Mg2+ largely contributes to sulfation of glycoconjugates basally secreted from rabbit trachea.

[Malignant fibrous histiocytoma of the heart]

A 59-year-old woman was referred to our hospital by a local cardiologist, with unknown cause of congestive heart failure and respiratory failure. No significant heart murmur was heard and a cardioechogram from the anterior chest was insufficient for diagnosis. On the night of admission, cardio-respiratory shock was found, and Swan-Gantz catheter data showed severe pulmonary hypertension. Transesophageal echo-cardiography (TEE) revealed a left atrial tumor, with wide neck anchored onto the posterior wall of the left atrium, and which was floating into the left ventricle during the diastolic phase. An emergency operation was performed and the tumor, (80 by 50 by 48 mm) was resected. The patient recovered well in the postoperation period. However the residual tumor continued to grow gradually in the pericardial cavity and the patient died 3 months after the operation. Primary MFH of the heart is rare and 29 cases have been reported. The prognosis of MFH is poor despite surgery. Whenever a left atrial tumor with a wide neck is attached to the posterior wall, it must be considered to be possibly malignant and surgical resection is recommended.

Malignant Fibrous Histiocytoma Proliferative Compartment and Heterogeneity of “Histiocytic” Cells

To elucidate the precise origin and characteristics of the proliferating cells in malignant fibrous histiocytoma (MFH), the authors analyzed 33 MFH tumors, using immunohistochemical techniques with a panel of 12 antibodies. All three types of MFH cells (spindle cells, polygonal cells, and bizarre giant cells) stained positively for mesenchymal antigens (FU3 and vimentin) but did not stain for macrophage/histiocyte markers (HAM 56 and CD68). Therefore, the MFH cells may not represent true histiocytes, although they may be mesenchymal-derived cells behaving as "facultative histiocytes" with superficial resemblance to actual histiocytes. Normal histiocytes in the stroma tested positive for macrophage/histiocyte antigens; the most common cells were HAM 56-positive cells constituting 30-80% of nonneoplastic stromal cells, followed by those positive for CD68 (10-50%), Mac 387 (less than 2%), and S-100 protein (less than 1%). Our results indicate the presence of heterogeneity of "histiocytic" cells in MFH. Proliferating-cell nuclear antigen (PCNA) was expressed not only in the spindle and polygonal MFH cells but also in the bizarre giant cells. These findings suggest that all three types of MFH cells participate in the proliferative compartment of MFH. Uneven PCNA staining of the irregular nuclear segments of the bizarre giant cells may result in abnormal DNA synthesis, possibly contributing to the marked diversity of nuclear morphology in MFH. Touton-type and osteoclast-like giant cells did not stain for PCNA but stained positively for histiocytic markers. Therefore, these giant cells may lack proliferative activity and probably result from normal histiocytes fusing together.

Myxoid liposarcoma with t (12; 16)(q 13; p 11). Possible usefulness of chromosome analysis in a poorly differentiated sarcoma

A chromosomal study was used to establish diagnosis of a poorly differentiated soft-tissue sarcoma occurring in the right thigh of a 57-year-old Japanese female. Histopathologically the excised tumor consisted of a poorly differentiated myxoid neoplasm, without specific features to enable the identification of neoplastic cells. Although a tentative diagnosis of poorly differentiated myxoid liposarcoma was made, ultrastructural examination and Oil Red O fat stain failed to demonstrate the evidence of lipoblastic differentiation, except that occasional cells possessed a small number of fine fat droplets. The diagnosis of liposarcoma was suggested by chromosome analysis of the fresh tumor tissue after short time culture and trypsin-Giemsa banding technique. The tumor cells demonstrated a clonal abnormality characterized by a reciprocal translocation, t(12; 16)(q 13; p 11), which is known as a specific aberration in myxoid liposarcoma. Thus, chromosome study seems to be useful for identifying undifferentiated mesenchymal tumors, which lack morphologic evidence of any specific differentiation, as in the present case.

Immunohistochemical localization of proliferating cell nuclear antigen/cyclin in human skin

Expression of proliferating cell nuclear antigen/cyclin (PCNA/cyclin) in skin tissue specimens and cultured keratinocytes was studied using a monospecific antibody, obtained from a patient with systemic lupus erythematosus, and a monoclonal antibody. Indirect immunofluorescent staining revealed that cultured keratinocytes obtained from human foreskins expressed PCNA/cyclin as variable nuclear patterns in 15-30% of the cells. In normal human skin tissue specimens, PCNA/cyclin was demonstrated in only a few basal cells. Interestingly, PCNA/cyclin was expressed strongly in almost all the cells of the lowest layer of the epidermis adjacent to squamous cell carcinomas, whereas the tumor aggregates themselves had no positive staining. In contrast, no such characteristic staining was demonstrated in specimens of basal cell carcinoma. The staining pattern of PCNA/cyclin was different from that of Ki-67 in the skin tissue specimens. Our results suggest that PCNA/cyclin could be a useful marker of cell proliferation.

Proliferating cell nuclear antigen expression in normal, preneoplastic, and neoplastic colonic epithelium of the rat

Expression of the proliferating cell nuclear antigen (PCNA) was examined in normal rat intestinal tissues and in carcinogen-treated nonneoplastic and neoplastic colonic mucosa. In the normal intestine, PCNA expression was confined to the expected region of the proliferative compartment. A strong correlation was observed between PCNA labeling index and both [3H]thymidine labeling index (R = 0.993, P = 0.007) and percent of cells in S phase as determined by flow cytometry (R = 0.982, P = 0.018) and between the location of the maximal staining for PCNA and [3H]thymidine (R = 0.997, P less than 0.05). In animals treated with dimethylhydrazine (DMH), crypt hyperplasia, an increased PCNA labeling index, and shifts in both the region of maximal and the upper extent of PCNA expression were observed during DMH exposure; significant crypt hyperplasia and expansion of the PCNA-positive compartment persisted after completion of DMH injections. The patterns of PCNA expression and bromodeoxyuridine incorporation were similar in DMH-induced tumors. It is concluded that PCNA immunohistochemistry can be used as a reliable marker of the proliferative compartment in both normal and neoplastic colonic mucosa.

The effect of three novel thromboxane A2 receptor antagonists (S-1452, AA-2414 and ONO-3708) on the increase in pulmonary pressure caused by Forssman anaphylaxis in guinea-pigs

The effects were studied of three novel thromboxane A2 (TXA2) receptor antagonists (S-1452, AA-2414 and ONO-3708) on the increase in pulmonary pressure caused by Forssman anaphylaxis in guinea-pigs. Three TXA2 antagonists at doses of between 1 and 10 mg/kg administered orally 1 h before the challenge clearly inhibited the pulmonary pressure increase. At a dose of 10 mg/kg, all three antagonists inhibited the pulmonary pressure increase caused by leukotriene D4 (LTD4) and U-46619, but not that caused by histamine. The decrease in peripheral platelet counts caused by Forssman anaphylaxis was also clearly inhibited by the three TXA2 antagonists. However, the decreased peripheral leukocyte counts were unaffected by the three agents. The decrease in serum complement activity (CH50) was inhibited by S-1452 and AA-2414 at a dose of 10 mg/kg. In bronchoalveolar lavage fluid (BALF), significant increases in eosinophils and neutrophils were observed after Forssman anaphylaxis. Three TXA2 antagonists at a dose of 10 mg/kg (except for AA-2414 on eosinophils) did not affect the changes of leukocyte counts in BALF. Moreover, increases in the TXB2 and 6-keto-PGF1 alpha levels of the BALF brought about by Forssman anaphylaxis were unaffected by the three TXA2 receptor antagonists. Histamine and LTD4 were not changed in the BALF after Forssman anaphylaxis. These results indicate the efficacy of TXA2 receptor antagonists on the increase in pulmonary pressure caused by Forssman anaphylaxis in guinea-pigs by direct antagonism to released TXA2.

Malignant fibrous histiocytoma. A tumor of facultative histiocytes showing mesenchymal differentiation in cultured cell lines

The histogenesis of malignant fibrous histiocytoma (MFH) is controversial. To elucidate the cellular origin and characteristics of this neoplasm, the authors analyzed cell lines grown from 17 patients (15 soft tissue MFH and 2 bone MFH) by using light and electron microscopy, immunocytochemistry, enzyme cytochemistry, and functional tests for receptors for the Fc portion of immunoglobulin (Fc receptors) and immunophagocytosis. Each culture exhibited a storiform/pleomorphic pattern with mixed cellular populations consisting of spindle cells, polygonal cells, and bizarre giant cells; these morphologic features corresponded to the histologic characteristics of the primary tumors. The cells in each MFH line displayed histiocytic functional markers such as lysosomal enzymes, Fc receptors and immunophagocytosis. However, these cells differed from monocyte-derived macrophages (histiocytes) in immunoreactivity; the MFH cells expressed a mesenchymal antigen (FU3) distributed among perivascular cells and fibroblasts but demonstrated no positive reactions with Leu-M1 (CD15) and Leu-M3 (CD14), which recognize the cells of the monocyte-macrophage lineage. In conclusion, these findings suggest that MFH is not a tumor of true histiocytes but of facultative histiocytes showing mesenchymal differentiation in vitro. Chromosomal analysis performed in one MFH line demonstrated abnormal karyotypes; the modal chromosome number was 58, with 5 marker chromosomes.

Malignant fibrous histiocytoma. A tumor of facultative histiocytes showing mesenchymal differentiation in cultured cell lines

The histogenesis of malignant fibrous histiocytoma (MFH) is controversial. To elucidate the cellular origin and characteristics of this neoplasm, the authors analyzed cell lines grown from 17 patients (15 soft tissue MFH and 2 bone MFH) by using light and electron microscopy, immunocytochemistry, enzyme cytochemistry, and functional tests for receptors for the Fc portion of immunoglobulin (Fc receptors) and immunophagocytosis. Each culture exhibited a storiform/pleomorphic pattern with mixed cellular populations consisting of spindle cells, polygonal cells, and bizarre giant cells; these morphologic features corresponded to the histologic characteristics of the primary tumors. The cells in each MFH line displayed histiocytic functional markers such as lysosomal enzymes, Fc receptors and immunophagocytosis. However, these cells differed from monocyte-derived macrophages (histiocytes) in immunoreactivity; the MFH cells expressed a mesenchymal antigen (FU3) distributed among perivascular cells and fibroblasts but demonstrated no positive reactions with Leu-M1 (CD15) and Leu-M3 (CD14), which recognize the cells of the monocyte-macrophage lineage. In conclusion, these findings suggest that MFH is not a tumor of true histiocytes but of facultative histiocytes showing mesenchymal differentiation in vitro. Chromosomal analysis performed in one MFH line demonstrated abnormal karyotypes; the modal chromosome number was 58, with 5 marker chromosomes.

[A case of verrucous carcinoma showing a good partial response by C.P.E. (CDDP, PEP, etoposide) chemotherapy]

A 60-year-old woman was admitted to our hospital with a complaint of rough feeling on the oral mucosa and diagnosed as verrucous carcinoma with histopathological examination. She was treated with CPE chemotherapy, and showed a good response and improvement of clinical symptoms. Toxicities were leukopenia, alopecia and anorexia. However, these were slight side effects. The patient is currently healthy with no recurrence after two years and 3 months. CPE chemotherapy is considered to be effective for a patient with verrucous carcinoma.

[The advantage of active conformity as a communication strategy for compatibility between self assertion and smooth interpersonal relationship]

When a consensus is sought but no compromise seems to be obtainable among opposing opinions, people are often forced to choose one of them. This experiment investigated the effects of giving way and agreeing with the group under topics of either a high or low degree of importance. The results were as follows: 1) Those who have given way to others before perceived that their opinions would be accepted more easily in the next time than those who have insisted their own opinions. This tendency was greater under the condition of topics with higher importance. 2) Consequently, those who wish to assert oneself next time dared to give way and agree to others in the group. 3) Those who have stuck to their own opinions were much more regretful than what those who have given way would guess. From these results, it was suggested that people actively select conformity on a long view.

Symptoms and social adjustment of schizophrenic patients as evaluated by their family members: a cross-cultural psychiatric study between offshore islands and an urban city

We conducted a comparative study of symptoms and social adjustment of schizophrenic patients on offshore islands and one urban region in Japan. In the evaluation of symptoms and social behavior by family members, no differences were observed between the two regions. Looking at social adjustment in the two regions, no differences were observed by family members either in the performance level or in the expectation level of socially expected activities. However, on the offshore islands, the expectation level of socially expected activities by family members was significantly higher than the level of self-accomplishment set by schizophrenic patients themselves. As for leisure activities, both family members and patients on the islands evaluated the level of performance to be significantly higher than in the urban region, and the level of satisfaction of the patients themselves was also higher on the islands. Considering both these findings and Japanese traditional views of work and leisure, it is believed that on the islands patients are required to engage in more productive activities and less leisure activities than in the urban region. Further it seems that patients on the islands compared to patients in the urban region may have greater difficulty in social adjustment.

Participation of collagenase and elastase in LPS-induced airway hyperresponsiveness in guinea pigs

Bacterial lipopolysaccharide (LPS) cause airway hyperreactivity in guinea pigs pretreated with metopirone. LPS inhalation resulted in an increase in airway muscarinic reactivity measured by intravenous acetylcholine injection 1-4 h after the inhalation of LPS. The increase of pulmonary capillary permeability was observed 1-24 h after the inhalation of LPS, whereas the increase of leukocytes in bronchoalveolar lavage fluid (BALF) was observed 2 and 24 h after the inhalation of LPS. Increased cells are mainly neutrophil, eosinophil, and macrophage. From the histopathological study, acute mucosal injury and loss of epithelial cilia were observed 1-24 h after the inhalation of LPS. In order to investigate the phlogistic substance in LPS-induced hyperreactivity, the roles of collagenase and elastase were investigated. The activities of both enzymes were elevated 2 h after the inhalation of LPS. The inhalation of collagenase and elastase caused bronchial hyperreactivity and increased pulmonary permeability. The combined administration of prednisolone (10 mg/kg/day) and cyclophosphamide (10 mg/kg/day) for five days decreased LPS-induced hyperreactivity, pulmonary capillary increase, collagenase and elastase activities, and the number of nucleated cells in BALF 2 h after the inhalation of LPS. These results indicate the participation of collagenase and elastase in the onset of LPS-induced airway hyperreactivity in guinea pigs.

Effects of glibenclamide on cytosolic calcium concentrations and on contraction of the rabbit aorta

1. Using fluorometry of fura-2 and rabbit aortic strips, we studied the effects of glibenclamide (GLB), a sulphonylurea anti-diabetic drug and an inhibitor of opening of K+ channels, on cytosolic calcium concentrations ([Ca2+]i) and on force development. 2. Both high K(+)-depolarization and noradrenaline (NA) increased [Ca2+]i and force, in a concentration-dependent manner, in the presence of extracellular Ca2+ (1.25 mM). However, force development in relation to [Ca2+]i ([Ca2+]i-force relationship) observed with NA was much greater than that observed with K(+)-depolarization. 3. Pretreatment with GLB (10(-6)-10(-4) M) for 10 min partially inhibited, in a concentration-dependent manner, both [Ca2+]i elevation and the force development induced by 118 mM K(+)-depolarization or NA 10(-5) M in the presence of extracellular Ca2+. The [Ca2+]i-force relationship induced by both 118 mM K+ physiological salt solutions and by NA 10(-5) M in the GLB-treated strips overlapped that obtained in the non-treated strips, thereby suggesting that GLB has no effect on the Ca2(+)-sensitivity of the intracellular contractile apparatus. Only high concentrations (10(-4) M) of GLB decreased [Ca2+]i and the force, when applied after the force induced by 118 mM K+ PSS or NA 10(-5) M reached the maximum level. 4. In the absence of extracellular Ca2+, NA induced a transient increase in [Ca2+]i and in the force and these increases were inhibited when the vascular strips were pretreated with GLB for 10 min. The [Ca2+]i-force relationship obtained in the GLB-treated strips overlapped that in the non-treated ones. 5. An ATP-sensitive K+ channel opener, cromakalim (10-5M) reduced the increased [Ca2 + ]i and force induced by 25mm K+-depolarization and NA 10-SM. Subsequent application of GLB concentrationdependently reversed this relaxant effect of cromakalim on the NA-induced contraction (IC50 = 2x 10 7 M). Complete reversal of the effect was observed with 10IsM GLB. 6. We suggest that GLB inhibits both high K+-depolarization- and NA-induced contraction of the rabbit aorta, by decreasing [Ca2+]i and with no effect on the [Ca2+]i-force relationship. However, when NA-induced contractions were inhibited by a K+-channel opener, GLB reversed this inhibitory effect by inhibiting K+-channel opening and increasing [Ca2 +].

Changes in negative symptoms of schizophrenic patients two years later

This study investigated the course of negative symptoms by examining the psychiatric symptoms of 59 new schizophrenic patients at the first consultation and again two years later using a structured interview--the Present State Examination. An examination of the total score of the nine negative symptoms, included in the "Chronic Schizophrenic Syndrome" by Wing, showed that 27 out of the 59 patients (45.8%) had lower symptom scores two years later than they did at the first consultation ("negative symptom improvement" group), while 20 patients (33.9%) had higher scores two years after the first consultation ("negative symptom deterioration" group). There were 12% more patients in the improvement group than in the deterioration group. No significant differences were observed between the "improvement group" and "deterioration group" in relation to the following factors--subclassification of schizophrenia, mode of onset, age at the first consultation, marital status at the time of onset, academic history, employment status prior to the onset, the history of hospitalization after the onset and maintenance therapy of neuroleptics. In relation to psychiatric symptoms at the first consultation, the patients in the "improvement group" had a variety of symptoms compared to the patients in the "deterioration group," and the presence of "incoherence of thought," "delusion of reference" and "special features of depression" was significantly higher in the improvement group than in the deterioration group.