Angiotensinogen gene polymorphism in Japanese patients with hypertrophic cardiomyopathy

To examine the contribution of the renin-angiotensin system to hypertrophic cardiomyopathy (HCM), we studied 96 patients with HCM (mean age 50 years, 55% male), 105 of their unaffected siblings and offspring, and 160 healthy subjects without known hypertension and left ventricular hypertrophy (LVH) who were frequency matched to cases by age and sex. Patients were divided into familial or sporadic HCM (FHCM or SHCM) groups with or without affected members of their family. The region of interest in the angiotensinogen (AGT) gene, the missense mutation with methione-to-threonine amino acid substitution at codon 235 in angiotensinogen (M235T), was amplified by polymerase chain reaction with the use of allele-specific oligonucleotide primers flanking the polymorphic region of the AGT gene to amplify template deoxyribonucleic acid prepared from peripheral leukocytes. The T allele frequency was higher in the SHCM group than in unaffected siblings and offspring (88% vs 78%, X2 = 4.6, p < 0.05). The M allele frequency was higher in unaffected siblings and offspring than in patients with SHCM (23% vs 12%, X2 = 4.6, p < 0.05). The T allele frequency among unaffected siblings and offspring was similar to that observed in healthy subjects (78% vs 78%). We conclude that HCM, especially in sporadic cases, is partially determined by genetic disposition. The molecular variant of angiotensinogen T235 seems to be a predisposing factor for cardiac hypertrophy in HCM and carries an approximately twofold increased risk.

Stimulation of endosteal bone formation by local intraosseous application of basic fibroblast growth factor in rats

We investigated the effects of local intraosseous application of basic fibroblast growth factor under physiologic conditions. An aqueous solution containing 0 (vehicle), 25, 100, or 400 micrograms of basic fibroblast growth factor was injected via a needle into the ilium of rats. Two weeks later, bone mineral density of the ilium was significantly increased (P < 0.01) with all three doses, and a dose-effect relationship was apparent. Light microscopy revealed proliferation of undifferentiated mesenchymal cells on the endosteal and trabecular surfaces, as well as apposition of newly formed bone on existing trabeculae. Intraosseous injection of basic fibroblast growth factor may be of use for the treatment of osteoporosis.

[Effects of ischemic preconditioning on the recovery of myocardial function after unprotected ischemia and cardioplegia in the isolated and crystalloid perfused rat hearts]

Preconditioning with repetitive brief periods of ischemic (IPC) is known to induce myocardial protection against a subsequent more prolonged period of ischemia. We investigated whether IPC can offer similar beneficial effects on myocardial function after cardioplegic preservation in isolated and crystalloid-perfused rat hearts. IPC was produced by 5 periods of 1 min ischemia followed by 5 min reperfusion before 25 min of unmodified ischemia or 40 min of cardioplegia. IPC had no significant effect on the time to contractile arrest (control: 211 +/- 27 sec, IPC: 240 +/- 32 sec) after unmodified ischemia, while the time to electrical asystole was significantly (p < 0.05) shortened by IPC (676 +/- 107 sec) compared to control (1021 +/- 197 sec). However, rapid contractile arrest concomitant with electrical asystole was induced by infusion of St. Thomas' Hospital solution in control as well as in IPC-treated hearts without a significant intergroup difference (control: 33 +/- 7 sec, IPC 39 +/- 9 sec). Although myocardial ATP was significantly reduced by IPC, IPC-treated hearts showed a significantly higher ATP level after 25 min of unprotected ischemia. Accumulation of myocardial lactate after 25 min of unprotected ischemia was significantly (p < 0.05) inhibited by IPC. However, the levels of myocardial ATP and lactate after 40 min of cardioplegia were comparable between control and IPC-treated hearts. Left ventricular developed pressure (LVDP) at 30 min reperfusion after unprotected ischemia was significantly improved by IPC, while the recovery of LVDP at 30 min reperfusion after cardioplegia was comparable between control and IPC-treated hearts. The onset of ischemic contracture, i.e., a rise of left ventricular end-diastolic pressure (LVEDP), was significantly accelerated and its magnitude was significantly greater in IPC-treated hearts during unprotected ischemia and also during cardioplegia. However, a significant decrease of LVEDP during reperfusion compared to control hearts was observed only after unprotected ischemia. The amounts of creatine kinase (CK) released during 30 min reperfusion after unprotected ischemia was significantly greater in control than in IPC-treated hearts, but there was no significant difference in CK release between control and IPC-treated hearts during reperfusion after cardioplegia. These results suggest that IPC-induced cardioprotection may be induced via inhibition of anaerobic energy metabolism through a negative chronotropic effect during unprotected ischemia, but such a beneficial effect is dissipated with cardioplegia by which rapid electrical asystole is induced. It is, therefore, concluded that IPC may not provide additional myocardial protection over conventional hyperkalemic cardioplegia.

[Diagnostic imaging of renal pedicle injury]

We reviewed the radiological findings of 8 patients with renal pedicle injury admitted to our emergency center from January 1986 through September 1995 and compared them with the previously reported findings. The patients included 3 with renal artery occlusion and 5 with avulsion or disruption of renal pedicle vasculature. Extended retroperitoneal hematoma such as contralateral pararenal or central parahilar hematoma was visualized in all 5 cases with avulsion or disruption of renal pedicle vasculature. Although lack of contrast enhancement of injured renal parenchyma is a hall-mark of renal pedicle injury, three cases did not demonstrate this typical finding. In these three cases, one showed partial and the others showed total enhancement of the injured renal parenchyma on contrast enhanced CT. Partial enhancement in one case was found to represent total occlusion of the main renal artery and an intact accessory polar branch on angiography. The other two cases showed total enhancement of the renal parenchyma, with renal vein perforation done and complete disruption of the main renal artery and vein in the other. The latter findings were thought to be due to the maintenance of vascular flow surrounded by hematoma. In conclusion, when central parahilar hematoma is identified, the possibility of renal pedicle injury should be considered even if the renal parenchyma is well enhanced.

Toxic action of nitric oxide on myocardial cells: direct evidence from gene transfer in vivo

To examine whether nitric oxide (NO) has a protective effect against Ca2+ overdose or a beneficial action on myocardial cells, we employed direct gene-transfer of endothelial (type III) nitric oxide synthase (eNOS), using HVJ (Sendai virus) coated liposomes and beta-galactosidase (lac-z) as a marker for the transfection. The transfection efficiency of the lac-z gene was comparable with adenovirus as a vector, though the subsequent inflammation was much improved. The lac-z gene transfection was restricted to myoplasm between two intercalated discs, indicating that the transfected gene dose not permeate the disc. Co-transfection with human eNOS gene revealed degraded myoplasm of not only transfected cells but adjacent myocytes, fibrotic changes and infiltration of mononuclear cells seven days after the transfection. Electron microscopy of the lesions revealed a huge accumulation of mitochondria and loss of myofilaments, though fragmentation of nucleus or cytoplasm was not obvious. We conclude that an expression of human eNOS gene in cardiomyocytes causes a degenerative process, incompatible with typical apoptosis.

Lack of evidence for an increase in interleukin-6 expression in adult murine bone, bone marrow, and marrow stromal cell cultures after ovariectomy

Interleukin-6 (IL-6) has been implicated as a mediator of postmenopausal bone loss. In vitro studies of bone and bone marrow cells have suggested that estrogen regulates bone turnover by controlling the production of IL-6, a potent stimulator of osteoclastogenesis and bone resorption. To investigate this hypothesis in an in vivo model, we examined the effect of ovariectomy or estrogen replacement on IL-6 mRNA and protein expression in adult mouse bone and bone marrow in vivo and in marrow stromal cell cultures. Eight-week-old CD-1 mice were sham-operated (SHAM), ovariectomized (OVX), or ovariectomized and subcutaneously implanted with 21-day slow-release pellets containing 10 micrograms of 17 beta-estradiol (O + E). Placebo pellets were implanted in the SHAM and OVX mice. Uterine weights at 1, 2, or 3 weeks after surgery were significantly decreased (68-76%) in OVX animals compared with SHAM or O + E. In mice sacrificed at 1 or 3 weeks after surgery, we found by nonquantitative reverse transcribed polymerase chain reaction (RT-PCR), that SHAM, OVX, and O + E calvariae (CALV) constitutively expressed IL-6 mRNA. In contrast, IL-6 mRNA was either barely detectable or absent in the tibia (TIB) and bone marrow (BM). In the mice sacrificed 3 weeks after surgery, we determined by quantitative RT-PCR that IL-6 mRNA in the CALV from the OVX and O + E groups were decreased by 81 and 92%, respectively, compared with SHAM. IL-6 protein levels in the flushed bone marrow (BMSups) were detectable and were not significantly different among the groups. In bone marrow cells that were cultured for 1 week, basal levels of IL-6 protein were low and did not differ significantly among the SHAM, OVX, or O + E groups sacrificed 1, 2, or 3 weeks after surgery. After the addition of hrIL-1 alpha, IL-6 protein levels increased 100- to 1300-fold over control. IL-6 levels in cells from animals sacrificed 2 weeks after surgery were significantly lower in the hrIL-1 alpha-stimulated OVX and O + E groups than in hrIL-1 alpha-stimulated SHAM cell cultures. In conclusion, in this model we could find no increase in IL-6 production with in vivo estrogen withdrawal in calvaria, long bones, bone marrow, or marrow stromal cell cultures. If increases in IL-6 expression are involved in the effects of estrogen withdrawal on bone, the magnitude of these changes are relatively small and below the limits of detection of the assays that we employed.

Multiple-level compression myelopathy: concomitant asymptomatic cervical compression adversely affects surgical outcome for thoracic compression myelopathy

To determine whether asymptomatic spinal cord compression affects surgical outcome for another compression, we retrospectively reviewed the outcome for thoracic myelopathy due to spinal ligament ossification. Improvement assessed by changes in motor function of the lower extremity using the Japanese Orthopedic Association Classification was significantly less in cases associated with asymptomatic cervical ligament ossification (C+T group, N = 5) than in cases without cervical ligament ossification (T group, N = 13) (p < 0.05, Mann- Whitney U test). The "no disability" recovery rate was 61.5% in the T group and none in the C+T group (p < 0.05, Fisher's exact probability test). There was no significant difference in background parameters between the two groups. This study showed that concomitant spinal cord compression, even if asymptomatic itself, can adversely affect surgical outcome at a separate segment.

Altered signal transduction system in hypertrophied myocardium: angiotensin II stimulates collagen synthesis in hypertrophied hearts

Hypertensive cardiac hypertrophy is associated with the accumulation of collagen in the myocardial interstitium. Previous studies have demonstrated that this myocardial fibrosis accounts for impaired myocardial stiffness and ventricular dysfunction. Although cardiac fibroblasts are responsible for the synthesis of fibrillar collagen, the factors that regulate collagen synthesis in cardiac fibroblasts are not fully understood. We investigated the effects of angiotensin II on cardiac collagen synthesis in cardiac fibroblasts of 10-week-old spontaneously hypertensive rats and age-matched WKY rats. Basal collagen synthesis in cardiac fibroblasts from spontaneously hypertensive rats was 1.6-fold greater than that in the cell of WKY rats. Angiotensin II stimulated collagen synthesis in cardiac fibroblasts in a dose-dependent manner. The responsiveness of collagen production to angiotensin II was significantly enhanced in cardiac fibroblasts from spontaneously hypertensive rats (100 nM angiotensin II resulted in 185 +/- 18% increase above basal levels, 185 +/- 18 vs 128 +/- 19% in WKY rats, P < .01). This effect was receptor-specific, because it was blocked by the competitive inhibitors saralasin and MK 954. These results indicate that collagen production is enhanced in cardiac fibroblasts from spontaneously hypertensive rats, that angiotensin II has a stimulatory effect on collagen synthesis in cardiac fibroblasts, and that cardiac fibroblasts from spontaneously hypertensive rats are hyper-responsive to stimulation by angiotensin II. In the hearts of spontaneously hypertensive rats, mRNA of the renin-angiotensin system (renin, angiotensinogen, angiotensin converting enzyme) was expressed. Levels of angiotensinogen and renin mRNA expressed in ventricles, and angiotensinogen mRNA expressed in fibroblasts from SHR were higher than those from WKY. ACE mRNA was also more strongly expressed in the ventricles and fibroblasts from SHR compared with those of WKY. These findings suggest that the cardiac reninangiotensin system may play an important role in collagen accumulation in hypertensive cardiac hypertrophy (fig.4).

A point mutation in exon 7 of the C1-inhibitor gene causing type I hereditary angioedema

The polymerase chain reaction and nucleotide sequence analysis have been used to characterize a point mutation in the seventh exon of one allele of the C1-inhibitor gene in a family with type I hereditary angioedema. A single base change (C-->T) at nucleotide 1482 in C1-inhibitor converted the codon for Gln-339 to a premature translation termination codon, TAG. Family studies suggest that this mutation is responsible for type I hereditary angioedema in a studied pedigree.

Acid lipase inhibitor in chicken plasma identified as apolipoprotein A-I

We have reported a inhibitor of acid lipases in liver lysosomes and erythrocytes from chickens [M. Fujii et al., Int. J. Biochem., 22, 895-898 (1990)]. In this paper, the properties of the inhibitor were described in comparison with those of apo A-I of chicken. The purified inhibitor migrated with the same mobility on SDS-PAGE as apo A-I, and had a molecular weight of 27,000. The peptide map from the lipase inhibitor was similar to that of apo A-I. Antibodies to the acid lipase inhibitor also reacted with apo A-I. Apo A-I inhibited the acid lipase activities of liver lysosomes and erythrocytes from chickens as strongly as the lipase inhibitor. The N-terminal amino acid sequence of lipase inhibitor was identical to that of apo A-I as far as residue 20. The amino acid sequence of peptides obtained from the inhibitor by cleavage with CNBr corresponded to internal sequence of apo A-I, and so the CNBr-peptides were derived by cleavage after the methionine residues in apo A-I. The findings showed that the inhibitor of the acid lipases in liver lysosomes and erythrocytes from chickens was identical to apo A-I.

[A case of AFP (alpha-fetoprotein) producing gastric cancer successfully treated with FEP (5-FU, Epirubicin, cisplatin) therapy by continuous venous daily infusion of 5-FU and low-dose CDDP]

We reported our experience with a case of AFP producing gastric cancer with liver metastasis successfully treated with FEP therapy by continuous daily venous infusion of 5-FU and low-dose CDDP. A 59-year-old male was diagnosed with liver metastasis 2 months after partial gastrectomy of gastric cancer and then admitted. The patient received five courses of 24-hour continuous infusion of CDDP (5 mg/day, on day 1, 2, 3, 4, 5) and 5-FU (250 mg/day, on day 1, 3, 5) and bolus infusion of Epirubicin (10 mg/day, on day 3). No remarkable side effect was encountered. Complete response at the liver metastasis was observed by CT scan. Serum AFP level was down from 614 ng/ml to the normal range of 0.5 ng/ml after the therapy. The patient has been well for 10 months with complete remission.

[Crescent formation in children with Henoch-Schönlein purpura nephritis: a pathological and immunohistochemical study]

There is a strong association between epithelial crescent formation and the outcome of patients with Henoch-Schönlein purpura nephritis (HSPN), but little is known about the mechanisms of crescent formation in this disease. In this study, we examined whether or not glomerular endocapillary proliferation, fibrinoid necrosis and infiltrating inflammatory cells are involved in the process of crescent formation. Renal biopsy specimens were obtained from 19 patients (11 males and 8 females, 7.8 +/- 3.8 years old). The biopsies were performed within the initial 3 months after the onset of urinary abnormalities in all patients. Twelve patients had crescents (% glomeruli with crescents; 27.5 +/- 20.4%), and the other 7 did not. Renal tissues biopsied from 10 patients with asymptomatic hematuria served as controls for quantitative studies of glomerular leukocyte infiltration. Prominent endocapillary proliferation as well as fibrinoid necrosis were encountered in patients with crescents in contrast to patients without crescents. A positive correlation between crescents and endocapillary proliferation or fibrinoid necrosis was also observed. Significant increases in the number of glomerular CD68+ macrophages, CD45RO+ T cells and NP57+ neutrophils were observed in HSPN patients compared with the controls. When patients with or without crescents were compared, patients with crescents had a greater number of inflammatory cells. Although all kinds of inflammatory cells appeared in the endocapillary proliferative lesion, only CD68+ macrophages and NP57+ neutrophils were present in the fibrinoid necrotizing lesion. In conclusion, the present study demonstrated that necrotizing lesions with capillary rupture may be essential in the process of crescent formation seen in HSPN. Although the mechanism by which capillary wall breaks occur is still unknown, this study indicates that infiltrating macrophages as well as neutrophils may be involved in capillary rupture leading to epithelial crescent formation.

rhGH use in children with CRI and undergoing dialysis post-transplant in Japan: a multicentre study. MultiCenter Study Group Japan

We evaluated the effect of rhGH at both 0.5 and 1.0 i.u./kg/week, on the growth of 83 CRI (pre- and dialysis) and 23 transplanted children after one year. Growth velocity (GV) was significantly increased in predialysis children on a dose of 0.5 i.u. (p < 0.001), from 3.8cm/year at baseline to 7.8cm/year at six months and 7.3cm/year at one year. On a dose of 1.0 i.u., GV was increased from 4.5cm/year at baseline to 10.3cm/year at six months and 8.7cm/year at one year (p < 0.01). When the increment in GV was compared a significant difference was noted between 0.5 i.u. and 0.1 i.u. at both six and 12 months (p < 0.01). GV was also significantly increased in dialysed children treated with 0.5 i.u., from 3.5cm/year to 5.6cm/year at six months (p < 0.01) and 5.4cm/year at one year (p < 0.01). On a dose of 1.0 i.u., the increase was from 3.4 to 8.4cm/year at six months (p < 0.001) and 8.3cm/year at one year (p < 0.01). There was a significant difference in GV between the 0.5 and 1.0 i.u. groups at both six and 12 months (p < 0.01). In transplanted children, GV was significantly improved over one year of GH treatment from 5.0 to 7.7cm/year at 0.5 i.u. (p < 0.05) and from 3.7 to 6.3cm/year at 1.0 i.u. (p < 0.05); however, there was no statistical difference between the groups. Seven out of 23 children showed evidence of deterioration of graft function during rhGH treatment. This was due to acute rejection (AR) in every case. AR was noted in two of 10 children (20%) in the 0.5 i.u. group and five of 13 children (38%) in the 1.0 i.u. group. Our results demonstrate that rhGH effectively stimulates GV, not only in CRI, but also in dialysed children. Attention should, however, be paid to deterioration of renal function.

Water-in-oil emulsion containing oxine for the collection of traces of copper(II) in water

An oil type emulsion containing tiny encapsulated droplets of hydrochloric acid has been used for the concentration of traces of copper(II) ions in water. Milligram quantities of oxine and a non-ionic surfactant (Span-80) were dissolved in 5-10 ml of chloroform and mixed vigorously with 3 ml of 1 mol/l hydrochloric acid by ultrasonic irradiation. The resulting water-in-oil type emulsion was gradually added to 50-500 ml of water sample and dispersed by stirring as numerous small globules (0.1 to 0.5 mm in diameter). The copper diffused through the chloroform layer into the small droplets of hydrochloric acid, which occurred quantitatively in the sample of pH 3-10. After separating the emulsion by sedimentation, it was demulsified by heating to segregate the aqueous and organic phases. The copper in the aqueous phase was successfully determined by GFAAS. The emulsion method allows to perform both extraction and back-extraction more easily and rapidly than the conventional liquid-liquid extraction method.

Band neutrophil count and the presence and severity of coronary atherosclerosis

It has been consistently shown that the total blood leukocyte count is an independent risk factor for coronary artery disease. Few studies, however, have addressed the relation between differential leukocyte counts and coronary artery disease. We investigated the relation of total and differential leukocyte counts to angiographically determined coronary atherosclerosis. The study included 486 subjects (335 men, 151 women) who underwent coronary angiography for suspected coronary artery disease. Band neutrophil count was significantly positively related to coronary atherosclerosis (p = 0.004) after adjustments for age, sex, body mass index, cigarettes per day, serum total cholesterol, and hypertension. Although sex and age-adjusted total blood leukocyte count was significantly positively related to coronary atherosclerosis (p = 0.04), this relation did not reach significant levels (p = 0.08) after adjusting for other risk factors. The positive association with band neutrophil counts was at least as strong as that with serum total cholesterol concentrations. This study indicates that band neutrophil counts serve as an independent risk factor for coronary atherosclerosis.

The role of nitric oxide in the cardiovascular system

Nitric oxide (NO) exerts various pathophysiological effects on the cardiovascular system; inhibition of platelet aggregation or leukocyte adhesion on endothelium and vasorelaxation including lethal hypotension in endotoxic shock. In spite of these significant roles of NO, its direct action on individual cardiovascular cells remains unclarified. Therefore, we have investigated the function of NO on cells which constitute vascular wall and heart, and have found this new evidence. 1) ATP increased intracellular ([Ca2+]i) in vascular endothelial cells (ECs) and decreased [Ca2+]i of adjacently cocultured vascular smooth muscle cells (VSMCs), as detected by 2-D fura-2 image analysis. 2) The [Ca2+]i reduction in cocultured VSMCs with ECs by ATP was attenuated by pretreatment of several types of NO inhibitor, whereas the NO inhibitor potentiated the [Ca2+]i elevation in ECs, suggesting that NO affects VSMCs in a paracrine manner while ECs in an autocrine fashion. 3) Physiological concentration of lysophosphatidylcholine, which is an atherogenic constituent of oxidized LDL, but not native phosphatidylcholine, acted on ECs and VSMCs like a NO inhibitor, indicating that this material attenuates NO effect and disturbs vessel relaxation in the short term. 4) Highly efficient transfection of the ecNOS gene in rat heart showed a toxic effect on individual cardiomyocytes in vivo. In conclusion, NO may exert both beneficial and harmful effects on the cardiovascular system.

Regulation of NFIL-6 and IL-6 expression by basic fibroblast growth factor in osteoblasts

We determined whether basic fibroblast growth factor (bFGF) regulated the expression of IL-6 and NFIL-6 in osteoblasts. In mouse osteoblastic MC3T3-E1 cells, bFGF (10(-8) M) increased NFIL-6 mRNA 2-fold at 30 minutes and 3-fold at 2 h. IL-6 mRNA was increased by bFGF 10(-8) M after 1 h. IL-6 protein was detectable in control cultures but was significantly increased by bFGF (10(-8) M) at 4 h. Immunofluorescence analysis of MC3T3-E1 cells showed primarily cytoplasmic and perinuclear NFIL-6 staining in control cultures while bFGF-treated cells showed increased NFIL-6 staining at 2 and 4 h. Western blotting revealed that bFGF increased NFIL-6 protein at 2 h. In calvarial mouse osteoblasts, bFGF 10(-8) M induced IL-6 mRNA as early as 1 h and significantly increased IL-6 protein levels as early as 2 h. In conclusion, bFGF stimulates IL-6 and NFIL-6 mRNA in osteoblasts. The increase in NFIL-6 mRNA was associated with increased NFIL-6 protein. The increase in IL-6 mRNA was also associated with increased IL-6 protein. We propose that activations of NFIL-6 and IL-6 may be important mediators of the effects of bFGF on bone cells.

The Japanese National Registry data on pediatric CAPD patients: a ten-year experience. A report of the Study Group of Pediatric PD Conference

OBJECTIVE

Over the past 10 years, we have collected data on pediatric patients less than 16 years of age from the National Registry of CAPD (continuous ambulatory peritoneal dialysis). We present our experience with this population.

DESIGN

The database details the patient number, age, weight, height, outcome, cause of death, reason for terminating CAPD therapy, peritonitis, and catheter survival.

PATIENTS

Of the 434 patients (239 males, 195 females), 37 patients (8.5%) were under 1 year of age and 164 patients (37.8%) were under 6 years of age. About half of the patients were less than 20 kg in weight, clearly indicating that CAPD was the treatment of choice in young children. The duration on CAPD for these patients was less than 2 years for 233 patients (54%), and was 5 years or more in 48 patients (11%).

RESULTS

The outcome of the total patient population of 434 as of May, 1991, is as follows: 229 patients (52.8%) were being successfully treated with CAPD, 47 patients (10.8%) died, and 78 patients (18.0%) received a kidney transplantation. The patient survival rate was 85.6% at 3 years and 81.7% at 5 years. The technique survival rate was 74.9% at 3 years and 63.5% at 5 years. The rate of peritonitis was one episode over 28.6 patient-months. The mean catheter duration was 1.68 years. Peritonitis rate, catheter survival rate, and the rate of tunnel infection were worse in children less than 6 years of age than in older children.

CONCLUSION

The excellent patient and technique survival rates indicate that CAPD is an effective treatment for children with end-stage renal disease in Japan. The high infection rates in younger children indicate that extra careful management is needed for this young age group.

Helicobacter pylori infection is the major risk factor for atrophic gastritis

OBJECTIVE

To evaluate the association of both Helicobacter pylori (Hp) infection and advancing age with increased prevalence of atrophic gastritis.

METHODS

Two hundred and thirty-eight subjects who had no esophagitis, peptic ulcers, or malignancies in the upper gastrointestinal tract were divided into three groups according to age: group A, < 30 yr; group B, 30-49 yr; group C, > or = 50 yr. Two biopsy specimens were obtained from the lesser curvature of the antrum and two from the anterior and posterior walls of the fundus to assess the degree of gastritis and histological evidence of Hp infection. Hp infection was evaluated by Giemsa staining and serum IgG antibodies. Serum gastrin (SG) and pepsinogen (PG) were determined by radioimmunoassay.

RESULTS

In all age groups, the prevalence of atrophic gastritis was significantly more common in subjects with evidence of Hp infection. In Hp-positive subjects, the prevalence of atrophic gastritis increased with advancing age. Atrophic gastritis was extremely rare, regardless of age, in Hp-uninfected patients. SG increased, and PG I and the PG I:II ratio decreased with age in Hp-positive subjects. This trend was not apparent in Hp-negative subjects.

CONCLUSION

Our results suggest that Hp infection is a stronger predictor than advancing age for atrophic gastritis.

Hereditary angioedema caused by a point mutation of exon 7 in the C1 inhibitor gene

Hereditary angioedema (HAE) is a genetic disease which may be detected serologically. We present a patient with HAE, in whom we examined the gene defect using the polymerase chain reaction. The patient presented with recurrent episodes of abdominal pain, or non-itchy swellings of the hands, feet, and penis. The serum levels of C1 inhibitor (C1-INH) and C4 were below normal. We determined that a single base change (C-->T) at nucleotide 1482 in the seventh exon was present in the C1-INH gene. This mutation converted the codon for the Gln-339 to a premature translation termination codon TAG. A point mutation in the C1-INH gene can cause type I HAE.

[Analysis of maternal and fetal risk in 594 pregnancies with heart disease]

The purpose of this study was to estimate the risk of heart diseases in pregnancy. A total of 594 patients with heart diseases treated at the National Cardiovascular Center between 1982 and 1993 were evaluated. The heart diseases were classified into eight categories: congenital heart disease with or without pulmonary hypertension (8 cases (1%) and 219 cases (37%), respectively), mitral valve prolapse (38 cases (6%)), valvular heart disease with or without valve replacement (9 cases (2%) and 54 cases (9%), respectively), arrhythmia (222 cases (37%)), cardiomyotitis (15 cases (3%)) and miscellaneous (29 cases (5%)). Maternal risk was estimated from the incidence of maternal mortality and artificial preterm delivery. Maternal death within two years after delivery was observed in 7 cases (1.2%): 4 cases with cardiomyotitis (3 DCM and 1 HCH), 2 cases with heart disease with pulmonary hypertension (1 PPH and 1 PDA), and a single case with valvular heart disease with aortic valve replacement. Artificial preterm delivery was carried out in 32 cases (5.4%), most frequently in cases with congenital heart disease with pulmonary hypertension (6/8, 75%) which follows cardiomyotitis (4/15, 27%) and cases with valvular heart disease with valve replacement (2/9, 22%). Fetal risk was measured by the incidence of fetal death, fetal growth retardation and congential heart disease of the fetus. IUFD because of maternal heart disease was observed in 4 cases: two cases with valvular heart disease with valve replacement, a single case with Marfan's syndrome and a single case with DCM. Fetal growth retardation was observed in 59 cases, most frequently in cases with congenital heart disease with pulmonary hypertension and cases with valvular heart disease with valve replacement (3/8 (38%) and 3/9 (33%), respectively). Neonatal congenital heart disease was found in 8 of 228 neonates (3.5%) whose mothers also had congenital heart disease. It is therefore suggested that intensive medical care be recommended in pregnancies complicated with congenital heart disease with pulmonary hypertension or with valvular heart disease with valve replacement, which increase both maternal and fetal risk, and in pregnancies complicated with cardiomyotitis which significantly increases the maternal risk.

Alteration of extracellular matrix in dilated cardiomyopathic hamster heart

The purpose of this study was to characterize the collagen in hereditary dilated cardiomyopathic hamster hearts, and to examine the participation of the collagen in the occurrence and progression of cardiomyopathy. BIO 53.58 hamsters (5, 10, 20 weeks old) were used as the model of dilated cardiomyopathy. Flb hamsters were used as controls. The collagen content was almost constant at any age in the Flb hamsters, but increased with age in BIO 53.58 hamsters. Type III collagen increased significantly in BIO 53.58 hamsters at 10 weeks. The acetic acid solubility of collagen decreased in BIO 53.58 hamsters as the fibrosis progressed, but was unchanged in controls. Reducible crosslinks showed a tendency to decrease progressively in BIO 53.58 hamsters. There were no differences between Flb and BIO 53.58 hamsters at 5 weeks, but its expression in BIO 53.58 hamsters at 10 and 20 weeks of age increased compared to Flb controls. These findings indicate that in the early phase of cardiomyopathy the extracellular matrix of the myocardium is rich in type III collagen. In the later phase, the matrix resembles that of hard tissues, whose collagen is mainly of type I collagen and is insoluble. These data suggest that the increased collagen synthesis may impair the cardiac function in the development of cardiomyopathy.