Antibacterial iodine-supported titanium implants

Deep infection remains a serious complication in orthopedic implant surgery. In order to reduce the incidence of implant-associated infections, several biomaterial surface treatments have been proposed. This study focused on evaluating the antibacterial activity of iodine-supported titanium (Ti-I(2)) and its impact on post-implant infection, as well as determining the potential suitability of Ti-I(2) as a biomaterial. External fixation pins were used in this experiment as trial implants because of the ease of making the septic models. The antibacterial activity of the metal was measured using a modification of the Japanese Industrial Standards method. Activity was evaluated by exposing the implants to Staphylococcus aureus or Escherichia coli and comparing reaction of pathogens to Ti-I(2) vs. stainless steel and titanium controls. Ti-I(2) clearly inhibited bacterial colonization more than the control metals. In addition, cytocompatibility was assessed by counting the number of colonies that formed on the metals. The three metals showed the same amount of fibroblast colony formation. Japanese white rabbits were used as an in vivo model. Three pins were inserted into both femora of six rabbits for histological analysis. Pin sites were inspected and graded for infection and inflammation. Fewer signs of infection and inflammatory changes were observed in conjunction with the Ti-I(2) pins. Furthermore, osteoconductivity of the implant was evaluated with osteoid formation surface of the pin. Consecutive bone formation was observed around the Ti-I(2) and titanium pins, while little osteoid formation was found around the stainless steel pins. These findings suggest that Ti-I(2) has antimicrobial activity and exhibits cytocompatibility. Therefore, Ti-I(2) substantially reduces the incidence of implant infection and shows particular promise as a biomaterial.

Estimation of fibrous aerosol deposition in upper bronchi based on experimental data with model bifurcation

Lung deposition of fibrous aerosol was studied by using a model of the lung bifurcation with dimensions based on the symmetric model A of Weibel. The fibrous aerosols were introduced to the model under steady inspiratory flow conditions. Glass fibers depositing in the daughter tubes and these escaping from them were observed under a scanning electron microscope (SEM). The deposited fractions were calculated for each length and diameter using a bivariate lognormal distribution. In this study the authors propose empirical equations to estimate total deposited fractions of fibrous aerosol at upper bronchi. The dimensionless relationship among deposited fractions Fd, Stokes number St for randomly-oriented fibers and interception parameter I were used to estimate the deposited fraction at arbitrary position in the upper bronchi. The calculation procedure for Fd(St,I) consists of two steps: the determination of the four deposited fractions, Fdn for each In (n=1-4) followed by interpolation or extrapolation from Fdn to find the deposited fraction Fd at a given I. With this procedure, it is possible to determine the deposited fraction Fd in the range of 2 x 10(-3)<St<5 x 10(-2) and 5 x 10(-4)<I<5 x 10(-2). Penetration from the trachea to the 10th generation of lung bifurcation was calculated for several cases of fiber diameter, length and flow rate. In the case corresponding to an inspiration of 500 cm3 air at a constant rate for 2 s, more than half of the fibers with a length of 100 microm and diameter of 3 microm are deposited at upper bronchi but more than 90% of fibers of the same length and 1 microm in diameter pass through the region.

Lung lesions induced by intratracheal instillation of vanadium pentoxide powder in rats

To clarify acute toxicity and histopathological changes in the lung after exposure to V2O5 powder, rats (SD, male, n=66) were observed for 4 weeks after an intratracheal administration of V2O5 powder (geometric mean diameter 0.31 microm, geomertic standard deviation sigmag=2.19) at three doses (0.88, 3.0, 13.0 mg/kg body weight). The histopathological lung lesions were developed dose-dependently, and characterized by exudative inflammation, injury of alveolar macrophages, and swelling and mucous degeneration in the broncho-bronchiolar epithelia. Growth rate of the V2O5 powder-instilled rat was also retarded dose-dependently. The V2O5 powder used was composed of not coagulated but well dispersed particles consisting of vanadium pentoxide of more than 99.8% (w/w) with vanadium tetraoxide of less than 0.2%. The V2O5 powder was found to be 8 times more soluble in an artificial biological fluid "Gamble's solution" than in a pure water. From the present findings as well as those from the related literature, it was inferred that the histopathological lesions induced by the intratracheally instilled V2O5 powder are caused not only by the V2O5 particles per se but also by vanadium ions dissolved from the particles into the lung fluid.

Selective determination method for vanadium (V) and vanadium (IV) controlling the pH of media for a solid-liquid extraction column

Solid-liquid extraction separation based on a speciation method was studied for selective determination of vanadium (IV) and vanadium (V). Both V (IV) and V (V) cations transform to oxo-acid anion along with pH changes in the solution. The pH values for the transition points are different from each other and the difference was utilized in the separation. In the first step, particulate samples are dissolved by strong acids such as 1 M H2SO4 or 85% H3PO4. The pH of the strong acidic sample solutions of V (IV) and V (IV) are adjusted to the range between 3 and 4. In this condition, V (IV) is in the form of cation but V (V) is anion. The pH adjusted solution is applied to an anion exchange column. The solution is expected to contain V (IV) only. The trapped V (V) anion is eluted as VO2+ cation by a pH 1 acid. The author and coworker have already developed an HPLC separation method utilizing this separation concept. However, the HPLC method has some limitations, mainly originated in physical and chemical weaknesses of the HPLC column. In the present study, a firm solid-liquid column is adopted to replace the feeble HPLC column as a separation device. And a simple and convenient pH adjustment technique for making the sample solution is investigated at the same time. With these improvements, the speciation method developed with strong acidic solutions could determine the amount of V (IV) and V (V) in various environmental and biological samples.

Laboratory measurement of hazardous fumes and gases at a point corresponding to breathing zone of welder during a CO2 arc welding

Concentrations of fumes, ozone (O3), carbon monoxide (CO), nitric oxide (NO), manganese (Mn) and total and hexavalent chromium (Cr) as well as size distribution of fumes were measured at a point corresponding to the welder's breathing zone during CO2-arc welding, using a welding robot and three kinds of wires. Concentrations of fumes, O3, CO, Mn and total-Cr were found to exceed their corresponding occupational exposure limit (OEL) values, while the concentrations of NO and Cr(VI) were below those OEL levels. Airborne concentration of Mn exceeded its OEL value, and the Mn content was 8 times higher in welding fumes than in the wire. Using an additive equation of OEL and exposure concentration of each hazardous component, health risk in welders with combined exposure to welding fumes and gases was assessed as 18.6 to 46.0 times of OEL, which exceeded the unity. This finding suggests that effective protection of welders from the exposure can be attained by use of the supplied-air respirator or combined use of a dust respirator and a local exhaust system.

Development of an analytical method for beryllium in airborne dust by micellar electrokinetic chromatography

The separation of diacetylacetonato-beryllium [Be(acac)2] from acetylacetone was achieved with micellar electrokinetic chromatography (MEKC) followed by subsequent beryllium analysis carried out using capillary electrophoresis. Analysis using a separation and absorption detector, with a 50 microns capillary cell, could detect approximately 1000 ppb of beryllium in the final sample. Be(acac)2 is a promising reagent for absorption spectrophotometry, because its molar absorption coefficient, (32,000 l mol-1 cm-1) is very large. As the complex and acetylacetone have a similar absorption wavelength, the excess free ligand must removed from the sample to be measured. Acetylacetone is a weak acid with keto-enol tautomerism in aqueous solution. Acetylacetone and neutral Be(acac)2 should be separated with capillary zone electrophoresis (CZE) using a neutral or basic buffer solution as the mobile phase. Although the pH and temperature of the mobile phase were optimized, separation with CZE was interfered with by a portion of acetylacetone. This interfering portion seems to be a neutral keto-form with the same migration time as Be(acac)2. As a neutral species separation method, MEKC with sodium dodecyl sulfate was tried and the separation was completed. The optimum pH value and buffer temperature are pH 7.8 and 15 degrees C, respectively.

A probable case of chronic occupational thallium poisoning in a glass factory

A male worker who handled thallium-containing raw material for glass manufacturing over a period of four years complained of alopecia, abdominal pain, diarrhea and tingling in the four extremities. Neurological examination of this patient revealed signs of mild glove-stocking-type polyneuropathy. Lower sensory nerve conduction velocity of the median nerve in the right hand than in the left hand suggested that conduction function in the dominant hand was reduced. The thallium content of the hair, as determined by an ICP-MS method, was 20 ng/g for the patient and 576 ng/g for his successor in the time of 32 months and 13 months, respectively, after they had ceased their glass production work. Those levels of thallium exposure were considered high, compared with the control levels so far reported. The clinical course of signs and symptoms, neurophysiological findings and thallium content of hair suggested that the patient suffered from chronic poisoning due to occupational exposure to thallium-containing dust.

[Treatment with pilocarpine hydrochloride for sicca symptoms in Sjögren's syndrome]

We studied the efficacy of oral pilocarpine hydrochloride (9 mg/day, three times daily) on sicca symptoms in 21 patients with Sjögren's syndrome (SS) of the patients, 19 continued the treatment for at least one month, and subjective improvement of dry mouth and dry eye was observed in 10 patients (53%) and 5 patients (26%), respectively. As adverse effects, diaphoresis was most frequently recognized, but it was generally mild and tolerable. In the four patients who have been taking pilocarpine for 12 months, any severe side effects have not been observed. Since the incidences of clinical improvement of sicca symptoms and adverse effects were comparable with the other studies reported from US or Europe, our treatment protocol using pilocarpine hydrochloride (9 mg/day) was considered as appropriate for Japanese SS patients.

Correlation between transcranial Doppler ultrasonography and regional cerebral blood flow in experimental intracranial hypertension

BACKGROUND AND PURPOSE

Transcranial Doppler ultrasonography (TCD) provides useful information on cerebral circulation even under raised intracranial pressure. This study was designed to evaluate the correlation between cerebral blood flow (CBF) and TCD parameters under conditions of boundary intracranial hypertension that can cause brain death.

METHODS

Intracranial pressure was raised by inflation of a supratentorial epidural balloon in cats. Blood flow velocity of the middle cerebral artery was measured transorbitally with microvascular Doppler sonography, and intracranial pressure and CBF were evaluated.

RESULTS

In this study, four characteristic flow patterns were observed, appearing in the following order with progressive increases in intracranial pressure: sharp wave, systolic flow, systolic spike, and no flow. These flow patterns showed a significant correlation with flow velocity, CBF, the pulsatility index, and cerebral perfusion pressure. The systolic-spike and no-flow patterns and pulsatility index over 4.0 indicated decreased CBF, under 10% of control values.

CONCLUSIONS

The critical level of brain circulation can be detected by Doppler sonography, indicating that TCD is available as a tool for the assessment of cerebral circulatory arrest in brain death.

Vagus nerve stimulation induces a sustained anticonvulsant effect

PURPOSE

Stimulation of the vagus nerve can effectively abort several types of experimentally induced seizures in animals when administered near the time of seizure onset. Indirect evidence from human trials and animal studies suggests that the anticonvulsant effects of vagus nerve stimulation (VNS) extend beyond the duration of stimulation. We used the pentylenetetrazol model to determine whether VNS exerts a persistent anticonvulsant effect.

METHODS

VNS (1 mA, 30 Hz, 500 microseconds pulse width) was administered continuously for 0.1, or 60 min, or intermittently (30 s on, 5 min off) for 60 min, to awake and freely moving animals. After the end of stimulation, pentylenetetrazol (50 mg/kg i.p.) was administered to induce seizures. Time-course studies were also performed, consisting of 60 min of VNS followed by pentylenetetrazol injection after 0, 3-, 5-, and 10-min intervals.

RESULTS

The greatest anticonvulsant effect occurred after 60 min of continuous VNS, which prevented convulsions in four of 12 rats and reduced significantly seizure duration, the total number of seizures, and number of tonic seizures. Intermittent VNS was less effective than continuous stimulation for 60 min, but more effective than that for 1 min. The anticonvulsant effect declined in a time-dependent fashion after discontinuation of VNS, with return to nonstimulated control values by 10 min.

CONCLUSIONS

The results of this study verify a persistent VNS-induced anticonvulsant effect and indicate that its efficacy is dependent on the cumulative stimulus duration.

Decay-accelerating factor (DAF, CD55)-negative T lymphocytes in the peripheral blood of Sjögren's syndrome patients

OBJECTIVE

To clarify possible associations of decay-accelerating factor (DAF, CD55), expressed on circulating lymphocyte subsets and other hematologic cells, with corresponding cytopenias observed in primary Sjögren's syndrome (SS).

METHODS

DAF expression on peripheral blood (PB) cells was determined in 21 patients with SS and 11 healthy controls by single or 2 color flow cytometry.

RESULTS

In the PB from SS patients, anemia, monocytopenia, neutropenia, and lymphocytopenia were observed. Compared to the controls, the percentages of DAF-negative cells were higher in CD4+ and CD8+ T cell subsets from SS patients, but the expression of DAF was similar in the other PB cells, including CD19+ B cells, CD56+ NK cells, monocytes, granulocytes, and erythrocytes. The percentages of DAF-negative cells among the CD4+ and CD8+ cells were positively correlated in SS patients, but the numbers of cells in both subsets were decreased in those patients being treated with prednisolone. However, these proportional changes are thought to reflect a decrease in the numbers of DAF-positive CD4+ and CD8+ cells, because the absolute numbers of circulating DAF-positive CD4+ and CD8+ cells, but not DAF-negative cells, were significantly decreased in SS patients. In addition, DAF-negative cells were detectable in both CD45RA+ (naive) and CD45RO+ (memory) T cells from healthy individuals, and the expression of DAF was remarkably increased in both subsets after in-vitro activation with concanavalin-A.

CONCLUSION

DAF-negative cells are proportionally increased among circulating CD4+ and CD8+ T cells in SS patients, although such changes are due to decreased numbers of DAF-positive cells within each subset. When considering previous observations, the DAF-negative CD4+ and CD8+ cells probably belong to activated T cell subsets in both SS patients and controls. However, the patterns of DAF expression seemed to be different between activated T cells recognized in the PB, and those induced by in vitro-stimulation.

The coexistence of systemic sclerosis and rheumatoid arthritis in five patients. Clinical and immunogenetic features suggest a distinct entity

To elucidate the clinical characteristics and pathogenesis of scleroderma-rheumatoid arthritis (SSc-RA) overlap syndrome, we analyzed the clinical features of 5 patients with SSc-RA overlap. Their HLA phenotypes and genotypes were also determined. Generalized skin sclerosis, severe seropositive polyarthritis, pulmonary fibrosis, anti-topoisomerase I antibodies, and HLA-DR4,53;DQA1*0301;DBQ1*04 haplotype were observed in all of the patients. Similar clinical features were recognized in most of the 10 cases reported previously. Our case studies indicate that SSc-RA overlap may be a distinct entity.

[Systemic sclerosis with various gastrointestinal problems including pneumoperitoneum, pneumatosis cystoides intestinalis and malabsorption syndrome]

We describe here an experience of successful treatment of systemic sclerosis (SSc) complicated with various gastrointestinal (GI) problems including pneumoperitoneum, pneumatosis cystoides intestinalis and malabsorption syndrome. A 35-year-old female had developed selerodactyly since February, 1990. She had been treated under the diagnosis of SSc at other hospital. She had required several hospitalizations because of nausea, vomitting and abdominal distension, but her GI symptoms had gradually deteriorated. In April 1993, she was referred to our hospital and admitted for the treatment of her GI problems. On admission, she had systemic cutaneous sclerosis and marked abdominal distension without peritoneal signs was recognized. Chest and abdominal roentgenograms demonstrated massive free air under the diaphragm, marked dilation of small and large bowels, and multiple intestinal cysts (pneumatosis cystoides intestinalis ; PCI). We treated her GI problems with various modalities combined with medications, oxygen breathing, intravenous hyperalimentation and hyperbaric oxygen therapy. Pneumoperitoneum and PCI had disappeared after 8 courses of hyperbaric oxygen therapy and her GI symptoms had been well controled by intravenous hyper alimentation. Thereafter, she has been on intermittent parenteral nutrition through subcutaneous port inplantation. During the courses of this treatment, she developed an episode of Wernicke-Kolsakoff (W-K) syndrome which was considered to associate with malabsorption syndrome. The W-K syndrome had recovered by intravenous administration of vitamin B1.

[Isotypes and subtypes of anti-SS-A and/or SS-B antibodies in different subgroups of Sjögren's syndrome]

Profiles of anti-SS-A/SS-B antibodies, including their isotypes and subtypes, in patients with primary Sjögren's syndrome (SS) were similar to those in SS patients with systemic lupus erythematosus (SLE), except for anti-SS-A52-Kd/60-Kd antibody profiles. The incidence and titers of these antibodies in SS patients with rheumatoid arthritis, however, were lower than those in primary SS or SS patients with SLE. It is suggested that IgA anti-SS-A/SS-B antibodies are produced in the salivary gland. In addition, IgG1 anti-SS-A antibodies were dominant in all groups of SS patients examined. The results indicate a preferential activation of Th2 helper T cells in SS.

Study of aneurysmal subarachnoid hemorrhage in Izumo City, Japan

BACKGROUND AND PURPOSE

Estimation of the actual incidence rate of subarachnoid hemorrhage and evaluation of the treatment require the inclusion of all patients in a defined geographic area.

METHODS

During 1987 through 1992 in Izumo City, Japan, we estimated the incidence rate of subarachnoid hemorrhage by including dead-on-arrival patients and by further adding the results obtained after reviewing all death certificates registered in this city in the corresponding period. In addition, we compared the management and surgical outcomes in hospitalized patients from 1987 through 1992 with outcomes from 1980 through 1986.

RESULTS

During 1987 through 1992, we diagnosed 123 patients as having subarachnoid hemorrhage. The crude and the age- and sex-adjusted incidence rates using the 1990 population statistics for Japan were 25 (95% confidence interval, 21 to 30) per 100,000/y and 23 (95% confidence interval, 19 to 28) per 100,000/y for all ages, respectively; these occurrences are the highest among those reported to date. Of these patients, 8% died before receiving medical attention, 27% in the first week, and 39% at 1 month. The survival curve for 2 years improved significantly from 1980-1986 to 1987-1992 in patients with admission grades 4 and 5 (P = .035) and in operated patients with preoperative grades 1 through 3 (P = .036). However, there was little improvement in the overall management results (P = .168), possibly because patients with high risk and/or old age were admitted and/or diagnosed more often in the latter period.

CONCLUSIONS

The incidence rate of subarachnoid hemorrhage is much higher than that reported so far in the literature, and despite improvement of management and surgical therapy, the actual case-fatality rate is still high, mainly because of the high mortality rate directly associated with the primary bleeding.

Abnormal expression of apoptosis-related antigens, Fas and bcl-2, on circulating T-lymphocyte subsets in primary Sjögren's syndrome

OBJECTIVE

To clarify the pathological role of the apoptosis-related molecules expressed on peripheral blood (PB) lymphocyte subsets in primary Sjögren's syndrome (SS).

METHODS

The levels of apoptosis-regulating proteins, Fas and bcl-2, were determined in the PB lymphocyte subsets from 21 patients with SS and 14 healthy controls by 2-color flow cytometry.

RESULTS

In the PB from SS patients, lymphocytopenia, especially CD4+ cell-lymphocytopenia, was prominent. As observed in previous studies, the percentages of CD4+ CD45RA+ cells were lower in the SS patients than in the controls, while activated (DR+) cells were increased in CD4+ cells from the patients. Fas+ cells were also increased in the patients' CD4+ cells and CD8+ cells, but not in their B cells or natural killer cells. Furthermore, we observed several positive correlations among the percentages of activated cells (DR+ cells or CD45RA-cells) and Fas+ cells recognized in the CD4+ and/or CD8+ cells from the patients. On the other hand, intra-cellular bcl-2 proteins measured as mean fluorescence intensity were significantly diminished in the CD4+ cells, CD8+ cells, CD19+ cells, CD45RO+ cells and Fas+ cells from 14 SS patients compared with 12 healthy controls. In addition, the numbers and/or percentages of CD4+ cells and Fas+ cells positively correlated with their expression of bcl-2 in SS patients.

CONCLUSION

The abnormal balance between Fas and bcl-2 expression detected in the PB lymphocyte subsets from SS patients relates, at least partially, to the lymphocytopenia observed in the patients.

Circadian variations and prednisolone-induced alterations of circulating lymphocyte subsets in man

We determined the circadian variations and prednisolone (PSL)-induced alterations of circulating lymphocyte subsets in 10 healthy adults by two-color flow cytometry using monoclonal antibodies to various lymphocyte subsets in order to collect fundamental data for monitoring of the subsets in clinical practice. This study first examined the changes of CD5+ B cells, gamma delta+ or gamma delta-T cells, activated (HLA-DR+) CD4+ or CD8+ cells, CD11b+ or CD11b-CD8+ cells, and natural killer (NK) cell subsets (CD16+CD57-, CD16+CD57+, CD16-CD57+), in addition to other subsets described before. Compared with the base line values obtained at 9:00 (AM) on day 1, lymphocytes, total B cells, CD5+ B cells, total T cells, gamma delta-T cells, CD4+ cells, activated CD4+ cells, CD45RA-CD4+ cells, and activated CD8+ cells were significantly increased at 20:00 (PM). However, the numbers of CD45RA+CD4+ cells, CD11b+ or CD11b-CD8+ cells and three NK cells subsets did not show significant circadian variations. After oral PSL (30 mg), which was given at 7:00 (AM) on day 2, lymphocytes and almost all lymphocyte subsets, except for CD16+CD57- cells, were significantly decreased; these changes recovered between 13 and 26 hours after PSL administration. The circadian variations and PSL-induced alterations of lymphocyte subsets were relatively comparable, but PSL administration cause a decrease in a wider range of lymphocyte subsets including relatively corticosteroid-resistant subsets such as CD45RA+CD4+ cells, CD8+ cell and NK cell subsets.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative use of Doppler ultrasound and endoscopic monitoring in the stereotactic biopsy of malignant brain tumors. Technical note

An intraoperative monitoring tool is described that prevents mechanical injury to intracerebral vessels during stereotactic surgery. The method, which combines pulse Doppler ultrasonography and fiberendoscopy, allowed stereotactic biopsy to be performed without serious intracerebral bleeding in 25 patients with hypervascular malignant brain tumors, 13 with glioblastoma multiforme, five with anaplastic astrocytoma, five with metastatic tumor, and two with malignant lymphoma. The ultrasound apparatus has a built-in fast-Fourier transformation system analyzer and an improved filtering system that provide real-time measurement of blood flow velocity. The source of flow (arterial or venous) could be identified by both real-time sonography and acoustic signal frequencies. It was possible to measure the size and distance of a vessel by adjusting the Doppler signal gain dial from initially waxing to waning sounds, because the acoustic signal was adjusted to the axial flow of each vessel in 0.1-mm steps. Each of three Doppler probes (1 mm, 2 mm, and 3 mm in diameter) fit through the outer cannula of the biopsy needle. Vessels located within 7 mm from the tip of these probes could be detected easily and rapidly, so the biopsy needle could be advanced safely to the desired target in 7-mm steps. If sonograms revealed blood flow, indicating the presence of larger vessels in the intended stereotactic trajectory, the angle of the needle was changed slightly to avoid vascular injury. Because the fiberendoscope was connected to a video processor, the vessel could be visualized at a higher magnification on the video display, unless there was active bleeding. This technically simple and reliable system enhances operative safety while maintaining accuracy.

[Pulmonary functions in patients with progressive systemic sclerosis]

We studied the correlations of pulmonary function with clinical symptoms or autoantibody profiles in patients with progressive systemic sclerosis (PSS). Percent vital capacity (% VC) was low in 40% of PSS patients and percent diffusing capacity of carbon oxide (% DLCO) was decreased in 76% of the patients. Eighty-five percent of the patients had abnormal pulmonary functions. The % DLCO was significantly low in male patients compared with female patients. The arterial partial pressure of oxygen (PO2) in patients with esophageal hypomotility was significantly lower than those without esophageal hypomotility. PSS with Sjögren's syndrome (SS) showed a significant decrease of the % VC (p < 0.05) and PO2 (p < 0.05), and of lung fibrosis was frequent in the patients compared with those without SS. Pulmonary fibrosis was recognized in 63% of PSS patients and was more frequent in the patients with anti-Scl-70 antibody than those without the antibody. The annual decrease of VC was 62 ml in PSS patients, and that of DLco was 0.12 ml/min/mmHg. The annual decrease of VC was more prominent in the PSS patients with severe pulmonary fibrosis or anti-Scl-70 antibody. The decrease of VC, however, was mild in the patients with anti-RNP antibody compared with those without the antibody.

[Studies on pyridazinone derivatives. XVI. Analgesic-antiinflammatory activities of 3(2H)-pyridazinone derivatives]

In order to examine analgesic and antiinflammatory activities of the position isomers of 4-ethoxy-2-methyl-5-morpholino-3(2H)-pyridazinone (1, emorfazone), an analgesic-antiinflammatory drug, 5-ethoxy-2-methyl-4-morpholino-3(2H)-pyridazinone (2), 6-ethoxy-2-methyl-4-morpholino-3(2H)-pyridazinone (3) and 6-ethoxy-2-methyl-5-morpholino-3(2H)-pyridazinone (4) were prepared. Since 4 showed the most strong activity among the compounds tested, various 6-alkoxy- or 6-allyloxy-2-alkyl- or 2-cyclohexyl- or 2-phenyl-5-substituted amino-3(2H)-pyridazinones (15, 16) were prepared and examined for their activities. As a result, 4 and 2-methyl-5-morpholino-6-n-propoxy- or 6-n-butoxy-3(2H)-pyridazinone (15b, c) and 6-ethoxy-2-ethyl-5-morpholino-3(2H)-pyridazinone (15 l) were revealed to be more potent in analgesic and antipyretic activities than commercial drugs (1, aminopyrine, mepirizole, tiaramide HCl, phenylbutazone, mefenamic acid). On the basis of the available data, the structure-activity relationship in a series of 6-alkoxy-2-alkyl-5-substituted amino-3(2H)-pyridazinones (15, 16) was also discussed.

Speciation of vanadium(IV) and vanadium(V) using ion-exchange chromatography and ICP-AES

A speciation method for vanadium(IV) and vanadium(V) is presented that uses a combination of HPLC and ICP-AES. In this method, 1 mM HNO3 solution and 100 mM HNO3 solution were applied in sequence as eluent. A vanadium(IV) and vanadium(V) mixture was injected into a HPLC anion-exchange column; and vanadium(IV) cation was then eluted by 1 mM HNO3, while vanadium(V) oxoacid anion was trapped on the column. After this separation, vanadium(V) was eluted as a cation from the column by 100 mM HNO3. Vanadium was detected by ICP-AES. In this separation, about 15% of vanadium(V) interfered with vanadium(IV), and trace vanadium(IV) interfered with vanadium(V). This interference could be estimated by simple calculation based on standard observations, and the speciation of vanadium(IV) and vanadium(V) was performed. The lower determination limit was 1 microgram/mL, which is insufficient to speciate vanadium sampled by conventional sampling methods in a working environment. However, impurity of the other valent vanadium species in a vanadium(V) reagent can be determined by the present method, which should be valuable in precisely assessing the toxicities of vanadium species.

Thrombomodulin levels in the plasma and joint fluid from patients with rheumatoid arthritis

The hemostatic mechanism is thought to contribute to the inflammatory process of rheumatoid arthritis (RA). Thrombomodulin (TM), an inhibitor of blood coagulation, is synthesized by various cells which are recognized in the inflammatory lesions of RA. To elucidate a possible relation of TM with the process of RA, therefore, we measured soluble forms of TM in the plasma and joint fluid (JF) from RA patients by a recently developed sandwich enzyme immunoassay using monoclonal antibodies. TM levels in the plasma and JF were not significantly elevated in RA patients, although TM levels in plasma were positively correlated with those in JF. The plasma TM levels were related to renal functions (serum creatinine levels), but the levels showed no connection with systemic inflammatory indices of RA such as erythrocyte sedimentation rates, serum C-reactive protein levels and Lansbury's activity index. In the JF, TM levels were not correlated with the numbers of neutrophils or monocytes/macrophages associated with articular inflammations. Our results indicate that TM levels in the plasma and JF do not reflect systemic and articular inflammations of RA, and suggest that TM molecules in JF are mainly recruited from circulating TM.

Comparison of antinuclear antibody and other immunohematological profiles among primary Sjögren's syndrome, secondary Sjögren's syndrome associated with rheumatoid arthritis or systemic lupus erythematosus, and corresponding systemic disease

Sjögren's syndrome (SS) is currently classified into two groups (primary and secondary), because of differences in the disease in the two groups. We determined antinuclear antibody and other immunohematological parameters by using newer, more sensitive serologic methods on patients with primary SS, or secondary SS associated with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), and patients with just the systemic disease free of SS. This study defined both distinctive and common features between primary SS and each systemic disease: High titers of fluorescent antinuclear antibodies (FANAs), anti-SS-A/SS-B antibodies, and rheumatoid factors (RFs), as well as leukocytopenia were considered the main features of primary SS. Elevated levels of RFs and C-reactive protein were prominent in RA patients. In contrast, high titers of FANAs and anti-single stranded or anti-double stranded DNA antibodies, positive anti-ribonucleoprotein or Sm antibodies, leukocytopenia, and hypocomplementemia were characteristic for SLE. Furthermore, patients with secondary SS plus RA or SLE were found to have mixed features of SS and the associated systemic disease. The results strongly suggest that patients with secondary SS have two separate diseases, SS and the associated systemic disease.

[Studies on pyridazinone derivatives. XV. Oxidative reactions and antibacterial antifungal activity of sulfur derivatives of pyridazinone]

Oxidative reactions of o-nitrophenylthio substituted 2-phenyl-3(2H)-pyridazinones (3, 4, 13) with hydrogen peroxide were examined and o-nitrophenylsulfinyl compounds (5, 7, 14) and o-nitrophenylsulfonyl compound (6) were obtained. As the results of antibacterial antifungal screening tests in vitro, 3, 5 and 6 revealed strong antitrichophyton activities.

MRI demonstration of cervical meningocele

The MRI appearances of a cervical meningocele are reported. The operation demonstrated the accuracy of the preoperative MRI diagnosis.

[Soluble IL-2 receptor levels in rheumatic diseases]

We measured soluble interleukin-2 receptors (sIL-2R) in plasma and/or joint fluid (JF) from patients with rheumatoid arthritis (RA: 16 patients), Sjögren's syndrome (SS: 24 patients) and Behçet's disease (BD: 23 patients). Plasma sIL-2R levels were significantly higher in RA patients (956 +/- 994 U/ml, p < 0.01) and SS patients (1025 +/- 1112 U/ml, p < 0.01) than 20 healthy subjects (338 +/- 159 U/ml), but not significantly increased in BD patients (408 +/- 329 U/ml). sIL-2R levels higher than the mean of healthy subjects +2 standard deviations were observed in 3 BD patients (13.0%), 7 RA patients (43.8%) and 10 SS patients (41.7%). sIL-2R levels positively correlated with erythrocyte sedimentation rates and C-reactive protein levels in RA patients, or IgM levels in SS. There was no significant correlation between plasma sIL-2R levels and disease activity, clinical symptoms, or other laboratory parameters in BD patients. However, sIL-2R concentrations in the JF from 4 BD patients (1644 +/- 198 U/ml: p < 0.05) or 16 RA patients (3946 +/- 5424 U/ml: p < 0.01) were significantly higher than corresponding plasma sIL-2R concentrations. Above results indicate that lymphocytes are being activated in patients with RA or SS and in the inflammatory lesions of BD patients, while the whole immunologic activation are relatively lower in BD than RA and SS.

Crystallization and preliminary X-ray diffraction studies of peroxidase from a fungus Arthromyces ramosus

Peroxidase (donor: H2O2 oxidoreductase [EC 1.11.1.7]) was purified from the culture broth of the hyphomycete Arthromyces ramosus in the early log phase to show a single band on SDS-PAGE. The crystals of A. ramosus peroxidase (ARP) were formed by salting out with ammonium sulfate at room temperature and pH 7.5. The repeated seeding technique was employed to grow the crystals to the size large enough for X-ray diffraction study. The crystals were characterized as tetragonal, space group P4(2)2(1)2, with unit cell dimensions of a = b = 74.5 A, c = 117.6 A. The asymmetric unit contains one molecule of peroxidase. They diffract X-rays to at least 2.0 A resolution and are stable to X-rays.

Accessory molecules expressed on the peripheral blood or synovial fluid T lymphocytes from patients with Sjögren's syndrome or rheumatoid arthritis

We previously demonstrated that the cells expressed by activation antigens were increased in several T cell subsets from the peripheral blood (PB) and joint fluid (JF) of patients with Sjögren's syndrome (SS) or rheumatoid arthritis (RA). In the present report, we further determined by three-color flow cytometry the homing receptors (Leu8) for peripheral lymph nodes expressed on naive (CD45RA+) or memory (CD45RA-) CD4+ cells and on the two subsets of CD8+ cells (CD11b+ and CD11b-) in the PB and JF from SS and RA patients. In addition, the activation antigens (HLA-DR) and two adhesion molecules, including the alpha-chain of the leukocyte function associated antigen-1 (LFA 1 alpha: CD11a) and its ligand (intercellular adhesion molecule-1: ICAM-1: CD54) expressed on T cells, were compared. We found that CD45RA-CD4+ cells were markedly increased in JF, while CD45RA+CD4+ cells were almost absent. Leu8+ cells were decreased in both CD45RA-CD4+ and CD8+CD11b-cells (cytotoxic T cells) in the JF, and were also decreased in the CD8+CD11b-subset in the patients' PB. Furthermore, activated (DR+) T cells were markedly increased in JF, and the cells expressed more adhesion molecules in both the PB and JF from patients, compared with the DR-T cells. The DR+ T cells therefore are considered to be memory T cells, which are more efficient for cell-to-cell interactions. These observations also suggest that the Leu8- and DR+ T cells with increased adhesion molecules might preferentially migrate into inflammatory tissues, and that naive T cells are being further converted to to memory T cells by in vivo stimulation within the tissues.

Antibodies against myofibrillar proteins in myasthenia gravis patients

Antibodies against various myofibrillar proteins were measured by enzyme-linked immunosorbent assay (ELISA) in sera of thirty-one myasthenic patients. The antibody activity expressed as optical absorbance values was higher in 15 (48%) patients for myosin, 10 (32%) patients for tropomyosin, 9 (29%) patients for troponin, 7 (23%) patients for alpha-actinin, and 1 (3%) patient for actin as compared with 95% tolerance limits of eleven normal individuals. Twenty-five (81%) of the patients had one of these antibodies or more. Anti-myosin antibody titer was higher in male patients (0.447 +/- 0.196; mean +/- SD, p less than 0.05) than in female patients (0.316 +/- 0.107), and positively correlated with the age of onset of myasthenia gravis (r = 0.41, p less than 0.05). Anti-tropomyosin antibody titers had an inverse correlation with the age of onset (r = -0.46, p less than 0.01). No significant correlation was found between the antibody activities and other clinical conditions, including the severity and duration of disease, and treatments (systemic treatment with corticosteroids or previous thymectomy). Positive correlations were observed between anti-myosin antibody and anti-troponin antibody titers (r = 0.44, p less than 0.02), and between anti-actin antibody and anti-alpha-actin in antibody titers (r = 0.39, p less than 0.05), but no significant correlation between other pairs of antibodies against myofibrillar proteins was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of deletion of complement C4 and steroid 21-hydroxylase genes in Japanese patients with primary Sjögren's syndrome

A null allele at C4A (C4AQO) is associated with primary Sjögren's syndrome (SS) in Japanese. Since a deletion of the C4A and CyP21A genes is reported to account for C4AQO in patients with systemic lupus erythematosus (SLE) in Caucasians, we studied the restriction fragment length polymorphism (RFLP) of genomic DNA to determine whether similar deletions of the C4A and CyP21A genes occur in Japanese patients with SS. Patients with C4AQO did not show the extensive deletion of C4A and CyP21A, which would be recognized by the appearance of 8.5 kb/HindIII and 6.4 kb/TaqI fragments hybridizing with a C4 probe. It is yet to be shown whether the lack of expression of C4A genes in Japanese patients with primary SS is due to point mutations, or to small deletions or insertions that were not detected by the RFLP approach.

Serum apolipoprotein H levels in systemic lupus erythematosus are not influenced by antiphospholipid antibodies

Anticardiolipin antibodies (aCL) were recently discovered to recognize a complex consisting of phospholipids and apolipoprotein H (apo H). In this study, we determined the serum apo H levels in 36 systemic lupus erythematosus (SLE) patients with or without antiphospholipid antibodies (aPL), including aCL and lupus anticoagulants, to clarify the possible effects of aPL on apo H levels in vivo. The apo H levels were low in SLE patients as compared with 22 healthy controls. However, no associations were found between apo H levels and circulating aPL or clinical features of the antiphospholipid antibody syndrome. A secondary hyperlipidemic state, which probably related to lupus nephritis (proteinuria) and/or prednisolone treatment, increased apo H levels in SLE patients.

T cells bearing gamma/delta T cell receptor and their expression of activation antigen in peripheral blood from patients with Sjögren's syndrome

T cells bearing gamma/delta T cell receptor (gamma/delta + T cells) and their expression of activation antigen (HLA-DR) or the marker of natural killer (NK) cells (CD56), were examined in the peripheral blood lymphocytes (PBL) from twenty-two patients with Sjögren's syndrome (SS) by three-color flowcytometry to elucidate possible pathological roles of the T cell subset in SS. The frequency of gamma/delta + T cells in PBL was not elevated in SS patients, while that of gamma/delta - T cells, which are T cells bearing the alpha/beta T cell receptor (alpha/beta + T cells), was significantly low in the patients, as compared with 22 healthy controls. We found that the proportions of activated cells (HLA-DR+) in both the gamma/delta + and alpha/beta+T cell subsets were significantly higher in the patients than in the controls. The proportions of HLA-DR+ cells in cells in both patients and controls. Furthermore, the frequency of activated cells in both T cell subsets correlated with the duration of disease in SS patients. However, no difference was found in the percentages of total CD56+ cells, CD56+CD3- cells (true NK cells), CD56+CD3+T cells, CD56+gamma/delta+T cells, or CD56-gamma/delta+T cells between the patients and controls. The above results indicate that immunologic activation in SS patients is progressive and involves both alpha/beta+ and gamma/delta+ T cell subsets.

Serum thrombomodulin and anticardiolipin antibodies in patients with systemic lupus erythematosus

Since thrombomodulin (TM) is a specific cell surface glycoprotein for vascular endothelial cells, serum TM (s-TM) might be a useful marker of endothelial cell damage. Antiphospholipid antibodies (aPL) frequently detected in systemic lupus erythematosus (SLE) have been associated with vascular occlusive diseases. Therefore we measured the s-TM in 60 patients with SLE, in 23 patients with other diseases including aPL (disease control group) and in 26 healthy subjects, by means of an enzyme immunoassay using monoclonal antibodies to human TM. A significant positive correlation was found between s-TM and serum creatinine levels in SLE patients (r = 0.813, p less than 0.001). When the s-TM level was divided by the serum creatinine level (TM/Cr) to exclude the effect of renal clearance, the TM/Cr ratios were significantly increased in SLE patients with active lupus nephritis (LN) compared to those without LN (p less than 0.05). The ratios did not correlate with the presence of aPL or antiphospholipid antibody syndrome (APLS) in SLE patients or in the disease control group, although a weak correlation between the TM/Cr ratios and IgG-anticardiolipin antibody titers was found in the SLE patients without LN (r = 0.449, p less than 0.01). The present results suggest that elevated TM/Cr ratios reflect renal and possibly extra-renal endothelial cell damage in SLE patients with active LN, but that s-TM levels do not associate with the presence of aPL or a history of APLS.

Sjögren's syndrome and pregnancy

We analyzed 117 histories of pregnancy obtained from 40 female patients with Sjögren's syndrome (SS) including 13 patients with primary SS and 27 patients with secondary SS. The frequency of spontaneous abortions did not differ in the 40 patients and those with primary SS compared with 129 healthy women. However, both spontaneous abortions and premature deliveries were significantly more frequent in the SS patients with systemic lupus erythematosus (SLE). Anti-SS-A and anti-SS-B antibodies were not associated with the outcomes of pregnancy although spontaneous abortions were more frequent in secondary SS patients with false positive serological tests for syphilis, anti-erythrocyte antibodies, thrombocytopenia or prolonged activated partial thromboplastin time. Neither congenital anomalies nor connective tissue disease was found in the 77 neonates of the patients. We concluded that SS does not influence the outcome of pregnancy except in patients with SLE or those with serological and hematological abnormalities related to lupus anticoagulants or antiphospholipid antibodies.

[Pathophysiological study of corona radiata infarcts by clinically available diagnostic methods]

The authors evaluated 18 patients who presented with corona radiata infarction, one of the 'water-shed infarctions', on CT and/or MRI to determine its etiology and pathophysiology using cerebral angiography, single-photon emission computed tomography (SPECT), and tests of hemostatic function including hematocrit, platelet aggregation and adhesiveness. On angiography, 8 of these 18 patients had ulcerative lesions in the common carotid artery bifurcation with or without minimal stenosis and exhibited no or a minimal area of hypoperfusion localized to the corona radiata on SPECT. In these, microembolism from the lesions at the common carotid bifurcation seemed play an important role in the genesis of corona radiata infarction. In 7 of the remaining 10 patients, cerebral angiography showed occlusive lesions of the internal carotid artery around its origin in 3, more than 90% stenosis of the internal carotid artery in 1, severe stenosis of the M1 segment of the middle cerebral artery in 2, and M1 occlusion in 1. In 5 of these 7, SPECT demonstrated a larger area of hypoperfusion than the corona radiata in the involved hemisphere. In the remaining 2, SPECT demonstrated a hypoperfusion area localized to the corona radiata. In all 7, the hematocrit was elevated. A collateral blood supply was visualized in 5 of 7 on cerebral angiography. In these 7 patients, hemodynamic disturbance was considered to contribute to the pathogenesis of infarction in the corona radiata. In the final three patients, cerebral angiography showed significant occlusive lesions in the main trunk of the cerebral arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of the complement allele C4AQ0 with primary Sjögren's syndrome in Japanese patients

We studied allotypes of the fourth component of complement (C4) and factor B in 76 patients with Sjögren's syndrome (SS) and in 63 normal subjects. C4A-null (C4AQ0) was found in 10 of 28 patients who had primary SS, compared with 1 of 63 control subjects (P less than 0.005). In contrast, no significant difference in the frequency of any C4 allotype was observed between patients with secondary SS and control subjects. An association of HLA-DRw53 with primary SS in Japanese patients has been reported. Since there is no linkage disequilibrium between DRw53 and C4AQ0, it is possible that at least 2 genes in the major histocompatibility complex may determine susceptibility to the development of primary SS in the Japanese population.

[Successful pregnancy outcome in a patient with HbE/beta (0)-thalassemia]

Successful pregnancy outcome is described in a patient with hemoglobin E/beta(0)-thalassemia which is expressed as thalassemia major. A 21 year-old Laotian female complicated by severe anemia became pregnant. The diagnosis of hemoglobin E/beta (0)-thalassemia was made by hemoglobin analysis. The fetal weight estimated by abdominal echogram decreased during pregnancy. She received blood transfusions, in order to improve intrauterine growth retardation. Hemoglobin concentration was maintained at the level greater than 9 g/dl. Fetal growth was improved by the treatment. A normal full-term male infant was born by a caesarean section, and splenectomy was performed at the same time.

Expression of MHC class II antigens and other T cell activation antigens on T cells and salivary duct epithelial cells in the salivary gland of cases of Sjögren's syndrome

We studied infiltrating T cells and salivary duct epithelial cells in the sublingual glands of 10 patients with primary Sjögren's syndrome (SS) using monoclonal antibodies (MoAb) to T cell subsets (OKT-series), natural killer cells (Leu7) and activation antigens of T cells such as OKT10, OKT9, interleukin 2 receptor (anti-Tac antibody) and major histocompatibility complex (MHC) class II antigens (anti-DR and anti-DQ antigens). DR antigens were identified on salivary duct epithelial cells, suggesting that the cells might function as antigen-presenting cells (APC). Among the salivary duct epithelial cells, OKT8+ cells, which are known to be suppressor/cytotoxic cells, were found in 9 out of 10 patients. Three types of mononuclear cell infiltrations were also evaluated separately: (1) periductal foci, (2) periacinal foci and (3) lymph follicles. We found that the majority of the infiltrating cells in the central portion of the periductal foci were activated T cells (OKT3+, OKT4+, OKIa-1+, DR+ and DQ+), but OKT9, OKT10 and Tac antigens were rarely found in this portion. However, most of the infiltrating cells in the peripheral portion of the periductal foci were OKT10+, and some of them were also positive for OKT9 antigen (transferrin receptor). The results indicated that the T cells in the peripheral portion of the periductal foci are at an early or intermediate phase of activation, whereas the T cells around the salivary ducts are at a later phase. Infiltrating cells in the periacinal foci resembled the cells on the peripheral portion of the periductal foci. Cells within lymph follicles were mainly B cells although scattered OKT4+ or OKT8+ cells were also present.

Lupus cystitis and performation of the small bowel in a patient with systemic lupus erythematosus and overlapping syndrome

We describe a patient with systemic lupus erythematosus (SLE) and overlapping syndrome who had repeated gastrointestinal (GI) symptoms such as nausea, vomiting and malabsorption. With a subacute process, she developed paralytic ileus and contracted bladder, and died of perforation of the ileum. When 13 reported cases with lupus cystitis were reviewed, an extremely strong correlation between GI and urinary tract symptoms was observed, indicating the presence of a unique subgroup of SLE.

[A case of lupus nephritis resistant to steroid pulse therapy markedly improved by bolus intravenous cyclophosphamide therapy]

Bolus intravenous cyclophosphamide therapy (IVCY) has recently been the subject of considerable attention because it is occasionally very effective in the treatment of severe lupus nephritis. However only a few reports on this form of therapy have been noted in Japan. Described here is a patient with lupus nephritis accompanied by multi-organ disorders resistant to various therapies including methylprednisolone pulse therapy which responded dramatically to IVCY. The patient, a 37-year-old woman with a history of systemic lupus erythematosus (SLE) starting in 1984, was admitted to our hospital with increasing generalized edema and malaise in January 1987. Evaluation revealed hypoalbuminemia, hypoxemia, ascites, hypocomplementemia and leukopenia. The patient was treated with high-dose oral prednisolone, however the lupus nephritis deteriorated and a high urinary protein level, massive ascites, and pericardial and pleural effusions were noted. Involvement of the central nervous system (CNS) was also observed. Subsequently, she was treated with intravenous methylprednisolone pulse therapy and low-dose oral cyclophosphamide. As her disease was refractory to these treatments IVCY was initiated in May 1987, at a dose 0.5-0.8 g/m2. A total of 3 doses were given, and treatment was discontinued in October 1987 because of marked clinical improvement. After the final IVCY treatment she was discharged, and her subsequent clinical course over a year with a maintenance dose of prednisolone has been uneventful. Thus, IVCY seemed to be useful in the treatment of severe lupus nephritis. More rigorous comparisons of IVCY with other therapies are necessary.

Anticardiolipin antibodies by an enzyme-linked immunosorbent assay: fundamental studies on the conditions for antigen-application and specificity of the assay

We have established an enzyme-linked immunosorbent assay (ELISA) for anticardiolipin antibodies (aCL) using standard sera obtained from the Rayne Institute, St. Thomas' Hospital (London, U.K.). In this study, we compared several fundamental requirements for the assay with the standard assay as a reference, such as conditions for antigen application and test samples using our patients' samples. In addition, the specificity of our assay and cross-reactivities of aCL were also evaluated. In the standard assay, the concentration of antigen was optimal in the range of 30-100 micrograms/ml. The antigen-coating temperature was optimal at 4 degrees C for 16 hours. The method based on rapid evaporation of CL-ethanol solution can be used instead of the standard method. On the other hand, there was no significant difference in the results between physical conditions of the antigen (CL-ethanol solution vs. CL-micelles), between washing solutions (saline vs. PBS containing 0.05% Tween-20) and between test samples (sera vs. plasma). The aCL activity in our patients' samples was almost completely inhibited by pre-incubation of sera with either CL or phospholipid reagent for activated partial thromboplastin time (APTT). Interestingly, the aCL activity of the lupus anticoagulant was negative, but aCL-positive samples were also absorbed by the reagent for APTT. No inhibition of the aCL activity, however, was observed when patients' sera were preincubated with ss-DNA.

Lymphocyte subsets of the peripheral blood in Sjögren's syndrome and rheumatoid arthritis

Lymphocyte subsets were determined in the peripheral blood from twenty-three patients with primary Sjögren's syndrome (SS) and sixteen patients with clinically active rheumatoid arthritis (RA) by two-color flowcytometry using various monoclonal antibodies. In both diseases, T-cells (CD3+), suppressor/cytotoxic cells (CD8+) and their cytotoxic subset (CD8+CD11-) were decreased, as compared with thirty-one healthy controls. B-cells (CD 21+ and CD 3-DR+) and activated T-cells (CD 3+DR+) were increased in SS patients. Helper T-cells (CD 4+Leu8-), suppressor-inducer T-cells (CD4+Leu8+), suppressor T-cells (CD8+Leu 15+) and three natural killer (NK) cell subsets determined by both CD16 and Leu7 antibodies did not differ between controls and SS or RA, although Leu7+NK cells were significantly increased in SS patients. In addition, we found that the treatment with low-dose prednisolone decreased B-cells and suppressor-inducer T cells, and increased suppressor T-cells, cytotoxic T-cells and Leu7+NK cells. The results indicate similar changes in the proportion of lymphocyte subsets and suggest immunologically activated and deficient conditions in both diseases. Immunomodulating effects of the treatment with low-dose prednisolone on some of the lymphocyte subsets in patients with these diseases were also supported by the study.

[Experimental study of the usefulness of evoked potentials in predicting the reversibility of the brainstem function following infratentorial epidural balloon compression]

With few warnings signs, posterior fossa mass lesions can affect life-supporting brainstem systems directly and cause a precipitous failure of vital functions. Consequently, a technique, by which brainstem dysfunction could be detected at its reversible stage, would have clinical value. Recently manly reports have suggested that the evoked potentials might be advantageous in assessing a developing brainstem dysfunction and might be a more sensitive or reliable detector of deteriorating neurological function than the physical or neurological signs. To explore this possibility, we recorded somatosensory evoked potentials (SEP) and brainstem auditory evoked potentials (BAEP) serially during inflation and deflation of balloons placed in the suboccipital epidural space of cats, as a model of an acutely expanding posterior fossa lesion. The results were correlated simultaneously recorded cardiovascular and pupillary function and with supratentorial and infratentorial epidural pressure. In this study, N1 of cortical SEP (CSEP), wave IV of BAEP, and wave III of short latency SEP (SSEP) were found to be useful parameters in predicting the electrophysiological reversibility. Experimental results were as follows: 1) As the infratentorial epidural balloon was expanded, CSEP, wave IV of BAEP and wave III of SSEP showed remarkable changes both in latency and in amplitude. Decrease in blood pressure and pulse rate preceded or developed at the same time as the apparent change in CSEP. Futher expansion of the balloon resulted in Cushing phenomenon and lability of blood pressure.2) As long as wave IV of BAEP remained, and decompression was started within 15 minutes after N1 of CSEP were completely suppressed, changes in SEP. BAEP and cardiovascular function were all reversible.2+ decompression. (ABSTRACT TRUNCATED AT 250 WORDS)

Clinical trial of ambroxol (Mucosolvan) in Sjögren's syndrome

A clinical trial is described in which twelve patients with Sjögren's Syndrome (SS) were given a dose of 135 mg ambroxol (Mucosolvan) daily for eight weeks. Nine of the patients completed the trial. Three patients dropped out because they developed side effects (generalized rashes in two patients and stomatitis in one). The side effects, however, were mild and cleared off after cessation of treatment. Ambroxol improved sicca symptoms, especially ocular symptoms, in the SS patients, although lacrimal and salivary gland functions measured by Schirmer test or gum test were not changed. Furthermore, the treatment did not alter any chemical findings determined in the stimulated tear and saliva. Our results suggest that ambroxol is useful for the management of sicca symptoms in some patients with SS.