[Similarities in calcium and magnesium metabolism between amyotrophic lateral sclerosis and calcification of the spinal cord in the Kii Peninsula ALS focus]

Current epidemiological surveys in the Western Pacific area and Kii Peninsula have suggested that low calcium (Ca), magnesium (Mg) and high aluminum (Al) and manganese (Mn) in river, soil and drinking water may be implicated in the pathogenetic process of amyotrophic lateral sclerosis (ALS) and parkinsonism-dementia (PD). The condition of unbalanced minerals was experimentally mimicked in this study using rats. Male Wistar rats, weighing 200 g, were maintained for 90 days on the following diets: (A) standard diet, (B) low Ca diet, (C) low Ca-Mg diet, (D) low Ca-Mg diet with high Al. In the groups maintained on unbalanced mineral diets, calcium and magnesium contents of the bones were lower than those fed with standard diet. On the other hand, Ca content of CNS showed higher values in the unbalanced diet groups (especially in spinal cord of the low Ca-Mg plus high Al diet group) than those in the standard diet group. This was determined by neutron activation analysis (NAA) at Research Reactor Institute, Kyoto University. Also, Ca content in soft tissues of rats given unbalanced mineral diets was higher than those on standard diet. Mg content of soft tissues and spinal cord of rats was markedly lower in the low Ca-Mg plus high Al diet group than the other three groups as determined by inductively coupled plasma emission spectrometry (ICP). Six Kii cases with amyotrophic lateral sclerosis (ALS) also showed higher Ca and lower Mg contents in the CNS tissues than those of neurologically normal controls. As of today, calcification of the spinal ligaments (CSL) has been reported in only 120 cases in the world and 28 cases of CSL in the Kii Peninsula have been found in the same foci as ALS. We analyzed Mg content of 7 spinal bones and 10 ligaments of the CSL and Ca content of 5 spinal bones compared with controls. The CSL showed lower values of Mg contents in bones and ligaments compared to controls. The Ca content in bones of CSL was significantly lower than that of controls. These results suggest that the environmental factor may contribute to the pathogenesis of CSL due to low Ca and Mg intake as well as for ALS.

Inhibition of brain cyclooxygenase-2 activity and the antipyretic action of nimesulide

The antipyretic action and the mechanism of action of 4-nitro-2-phenoxymethanesulfonanilide (nimesulide), a new nonsteroidal antiinflammatory drug, were investigated in yeast-induced febrile rats. Yeast-injected rats developed marked fever and exhibited an approximately 7-fold increase in brain levels of prostaglandin E2 and an approximately 2-fold increase in the expression of cyclooxygenase-2 mRNA despite an almost unchanged expression of cyclooxygenase-1 mRNA. Nimesulide produced a dose dependent antipyretic action, which was stronger than that of indomethacin and ibuprofen, and decreased dose dependently the increased brain prostaglandin E2 levels, whereas it did not influence the expression of cyclooxygenase-2 mRNA. It inhibited markedly the enhanced brain cyclooxygenase activity, primarily cyclooxygenase-2, in vivo and dose dependently increased brain cyclooxygenase activity in vitro. These results suggest that the marked antipyretic action of nimesulide is primarily mediated through the selective inhibition of the activity of brain cyclooxygenase-2 induced under febrile conditions.

[A case of successful endoscopic treatment for traumatic bronchial rupture]

Successful endoscopic treatment with fibrin glue for traumatic bronchial rupture was reported. 21-year-old male, who was injured in a traffic accident was brought to ICU in our hospital. Six days after injury, bronchoscopic findings showed a rupture from right truncus intermedius to lower bronchus (B8). We preferred an endoscopic treatment with fibrin glue because of poor respiratory function caused by lung contusion as a complication and those resulted in successfully healing. In general, basic strategy for traumatic bronchial rupture is the earlier diagnosis and surgical treatment. But in a case of high risk for operation, we recommend endoscopic treatment with fibrin glue might be useful.

Severe cutaneous and venous damage after DIC therapy

A 79-year-old woman with skin ulcers caused by disseminated intravascular coagulation (DIC) therapy is reported. The patient had been treated by injection of drugs, including gabexate mesilate, into the right great saphenous vein. The maximum concentration of gabexate mesilate was calculated as 0.893%. Although the drugs did not extravasate, purpura initially appeared around the affected vein, followed by brown pigmentation with infiltration and ulcers with widely necrotic tissue from the middle portion of her thigh to the malleolus along her right great saphenous vein. As the ulcer showed no tendency to heal for more than 3 months, surgical debridement and skin grafts were performed.

Epitope specificity of IgE antibodies to a major allergen (Cry j 1) of Japanese cedar pollen in sera of humans and monkeys with pollinosis

Japanese cedar (Cryptomeria japonica) pollinosis has been reported to occur naturally in Japanese monkeys (Macaca fuscata) as well as humans. Using monoclonal antibodies (mAb) specific to Cry j 1, a major allergen in Japanese cedar pollen, we identified five independent epitopes (EP-1 to EP-5) on the molecule. The epitopes recognized by IgE antibodies in the sera of humans and monkeys with the pollinosis were analysed by an IgE enzyme-linked immunosorbent assay inhibition method with these mAb. In human patients, the mAb to EP-1 strongly blocked the binding of IgE antibodies in all patients' sera to Cry j 1. The reaction patterns of IgE antibodies in monkeys, however, varied among the troops of monkeys. In some troops, the mAb to EP-1 showed a blocking pattern similar to that for human patients. In other troops, mAb to EP-4 and EP-5 blocked binding of IgE. These results indicate that some, but not all, monkeys have antibody responses to the major allergen similar to those of humans.

The efficacy and safety of one-week triple therapy with lansoprazole, clarithromycin, and metronidazole for the treatment of Helicobacter pylori infection in Japanese patients

BACKGROUND

The aim of this study was to evaluate the efficacy and tolerability of 1-week, low-dose triple therapy with lansoprazole, clarithromycin, and metronidazole (LCM) for the cure of H. pylori infection and to establish the adequate dosage of a new triple therapy for Japanese patients.

MATERIALS AND METHODS

One hundred four H. pylori-positive Japanese patients were assigned alternatively to one of two groups: one to receive either 30 mg lansoprazole once in the morning, 200 mg clarithromycin twice daily, and 250 mg metronidazole twice daily for 1 week (LCM1; n = 52); the other to receive 30 mg lansoprazole once in the morning, 200 mg clarithromycin twice daily, and 500 mg metronidazole twice daily for 1 week (LCM2; n = 52). H. pylori infection was assessed by smear, culture, and histological assessment (Giemsa stain) performed before and 4 weeks after cessation of the therapy.

RESULTS

The overall cure rates of H. pylori infection were 92.3% (48 of 52; 95% confidence interval (CI), 85% to 100%) in LCM1 and 92.3% (48 of 52; 95% CI, 85% to 100%) in LCM2. The cure rates in the patients without prior treatment were 95.7% (44 of 46; 95% CI, 89%-100%) in LCM1 and 95.7% (45 of 47; 95% CI, 89%-100%) in LCM2. Minor side effects were observed in 7.7% of LCM1 and 9.6% of LCM2, respectively.

CONCLUSION

The LCM1 regimen consisting of 30 mg lansoprazole once daily, 200 mg clarithromycin twice daily, and 250 mg metronidazole twice daily (the regular doses in ordinary use in Japan) is a highly effective and safe regimen for Japanese patients. LCM1 as a new triple therapy is a promising regimen for the first-line treatment of H. pylori infection in Japanese patients.

Subcutaneous extensor tendon rupture associated with calcium pyrophosphate dihydrate crystal deposition disease of the wrist

We report a patient with rupture of the ring extensor tendon associated with calcium pyrophosphate dihydrate crystal deposition disease of the wrist. Crystal deposits were noted in synovium and the triangular fibrocartilage complex. Histological examination revealed chronic synovitis with foreign body giant cell reaction to crystals. The cause of the tendon rupture was synovitis due to crystal deposition.

Role of intercellular adhesion molecule-1, lymphocyte function-associated antigen-1, and macrophages in ddY mouse nephropathy

ddY mouse nephropathy is an animal model of human IgA nephropathy that is characterized by spontaneous IgA deposition in the glomerular mesangium, mesangial cell proliferation, and matrix expansion. We investigated the involvement of intercellular adhesion molecule-1, lymphocyte function-associated antigen-1, and macrophages in the pathogenesis of ddY mouse nephropathy. Five mice each underwent urinalysis, light microscopic examination of the kidneys, immunofluorescent detection of immunoglobulins and complement, and immunohistochemical examination for intercellular adhesion molecule-1, lymphocyte function-associated antigen-1, and infiltrating macrophages at 5, 10, 20, 30, 40, 50, 60, and 70 weeks of age. Albuminuria was observed from the age of 20 weeks and all mice showed albuminuria by 70 weeks. Histological glomerular damage was significantly related to the appearance of albuminuria (p < 0.01). In the glomeruli, positivity for intercellular adhesion molecule-1 and lymphocyte function-associated antigen-1, as well as the number of infiltrating macrophages, were significantly increased in mice with nephropathy compared to pre-nephropathy mice (p < 0.01). These results suggest that intercellular adhesion molecule-1, lymphocyte function-associated antigen-1, and infiltrating macrophages are involved in the progression of histological damage in ddy mouse nephropathy.

Comparison of ranitidine and lansoprazole in short-term low-dose triple therapy for Helicobacter pylori infection

AIM

To evaluate the efficacy and safety of two 1-week low-dose triple-therapy drug regimens involving antisecretory drugs for Helicobacter pylori infection. 99 patients with H. pylori infection were treated with either lansoprazole or ranitidine used together with clarithromycin and metronidazole.

METHODS

The drug combination and administration periods in the proton pump inhibitor group were lansoprazole 30 mg o.m., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d., all given for 7 days (LCM group). The ranitidine group received ranitidine 150 mg b.d., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d. also for 7 days (RCM group). The presence or absence of H. pylori was determined from gastric biopsy specimens taken from both the antrum and the body, by smear, culture and tissue section (Giemsa stain). Cure was defined as failure to find evidence of H. pylori infection 4 weeks after antimicrobial therapy had ended.

RESULTS

The cure of H. pylori infection was 88% in the LCM group (44 of 50; 95% confidence interval (CI) = 79-97%) and 92% in the RCM group (45 of 49; 95% CI = 84-99%). The incidence of adverse events was 16% and 18% for the two groups, respectively.

CONCLUSIONS

No significant differences in cure rate and safety profiles were noted between the two regimens, suggesting that moderate acid inhibition using an H2-blocker is sufficient to achieve optimal H. pylori eradication.

RBP-L, a transcription factor related to RBP-Jkappa

RBP-Jkappa is a sequence-specific DNA binding protein which plays a central role in signalling downstream of the Notch receptor by physically interacting with its intracellular region. Although at least four Notch genes exist in mammals, it is unknown whether each Notch requires a specific downstream signalling molecule. Here we report isolation and characterization of a mouse RBP-Jkappa-related gene named RBP-L that is expressed almost exclusively in lung, in contrast to the ubiquitous expression of RBP-Jkappa. For simplicity, we propose to call RBP-Jkappa RBP-J. The RBP-L protein bound to a DNA sequence almost identical to that of RBP-J. Surprisingly, RBP-L did not interact with any of the known four mouse Notch proteins. Although we found that RBP-L and EBNA-2 cooperated in transcriptional activation, they did not show significantly strong protein-protein interaction that can be detected by several in vivo and in vitro assays. This is again in contrast to physical association of RBP-J with EBNA-2. Several models to explain functional interaction between RBP-L and EBNA-2 are discussed.

Role of transforming growth factor-beta 1 and -beta 2 in ddY mouse nephropathy

We investigated the glomerular distribution of transforming growth factor-beta (TGF-beta 1 and TGF-beta 2) protein and the expression of its mRNA, and related factors, in ddY mice, aged 5-60 weeks, before and after the onset of nephropathy, TGF-beta 1 protein expression was observed from the age of 20 weeks onwards, peaking at 50 weeks, and then declining. Expression of TGF-beta 2 protein gradually increased from 5 to 60 weeks. TGF-beta 1 and TGF-beta 2 mRNA were both detected from 5 to 60 weeks. The mesangial matrix expansion index (MMEI) was significantly higher in mice with nephropathy than in those without nephropathy, as was the expression of TGF-beta 1 and TGF-beta 2 proteins (P < 0.05). TGF-beta 2 was significantly positively correlated with the MMEI (P < 0.05). Infiltration of CD68-positive monocytes/macrophages gradually increased until 60 weeks, and was significantly correlated with the expression of TGF-beta 1 (P < 0.05) and TGF-beta 2 (P < 0.01). These findings indicate that TGF-beta 1 and TGF-beta 2 were overexpressed in ddY mice with overt nephropathy compared with pre-nephropathic mice. TGF-beta 2 may be an important mediator of mesangial matrix expansion in ddY mouse nephropathy.

Validity of the 13-C-urea breath test for the diagnosis of Helicobacter pylori infection

Infection with Helicobacter pylori (H. pylori) plays an important role in the pathogenesis of gastritis, peptic ulcer and gastric cancer, and the 13C-urea breath test (13C-UBT) is a convenient and non-invasive method for the detection of H. pylori in the stomach. We have examined the sensitivity, specificity and accuracy of 13C-UBT. The 13CO2/12CO2 ratio was measured using infrared spectroscopy (IR) and gas chromatography/mass spectrometry (GC-MS).

Septal perfusion and wall thickening in patients with left bundle branch block assessed by technetium-99m-sestamibi gated tomography

Septal hypoperfusion is often observed in patients with complete left bundle branch block (LBBB) in myocardial perfusion imaging. Abnormal wall motion in the septal region may potentially cause artifactual perfusion abnormalities. To assess the effect of abnormal wall thickening on myocardial perfusion images, ECG-gated sestamibi SPECT was performed on 12 patients with LBBB and 10 normal subjects used as controls.

METHODS

After administration of 740 MBq 99mTc-sestamibi injection at rest, ECG-gated SPECT was obtained 60 min later with division of the cardiac cycle into eight frames.

RESULTS

Septal hypoperfusion was noted in 10 patients on nongated images and 11 patients on end-systolic (ES) images, whereas only two patients showed abnormalities on end-diastolic (ED) images. The septal to lateral wall count ratio in the LBBB group was lower (0.72 +/- 0.09) than in the control group (0.84 +/- 0.09) (p < 0.01) at nongated images, while it was similar at ED images (0.84 +/- 0.11 versus 0.86 +/- 0.12; ns). In addition, the count increase from ED to ES during a cardiac cycle in the septal region was smaller compared with the lateral region in the LBBB patients (25% +/- 19% in the septal region, versus 48% +/- 14% in the lateral region; p < 0.01), indicating less wall thickening in the septal region.

CONCLUSION

Smaller count increase due to reduced wall thickening in the septal region may mimic hypoperfusion in patients with LBBB. This artifact can be eliminated with ECG-gated 99mTc-sestamibi SPECT, particularly with ED images.

[Oral single-dose and 13-week repeat-dose toxicity studies of RCC-36, the active metabolite of (+/-)-4-diethylamino-1,1-dimethylbut-2-yn-1-yl 2-cyclohexyl-2-hydroxy-2-phenylacetate monohydrochloride monohydrate(NS-21), a novel drug for urinary frequency and incontinence, in rats]

Oral single-dose and 13-week repeat-dose toxicity studies of (+/-)-4-ethylamino-1, 1-dimethylbut-2-yn-1-yl 2-cyclohexyl-2-hydroxy-2-phenylacetate monohydrochloride (RCC-36), an active metabolite of (+/-)-4-diethylamino-1,1-dimethylbut-2-yn-1-yl 2-cyclohexyl-2-hydroxy-2-phenylacetate monohydrochloride monohydrate (NS-21), a new drug for the treatment of urinary frequency and incontinence, were conducted in male and female Sprague-Dawley rats. In the single-dose toxicity study, rats were given the drug at doses of 0 (control), 400, 600, 900, 1350 and 2030 mg/kg. In the 13-week repeat-dose toxicity study, rats were given the drug for 13 weeks at doses of 0 (control), 3, 30 and 300 mg/kg. After discontinuation of the treatment, a 5-week recovery test was also conducted. In the single-dose toxicity study, death occurred in the 600 mg/kg group and over, and LD50 values were 735 mg/kg in both sexes. The major clinical signs observed following the administration of this drug were mydriasis, salivation, decreased spontaneous locomotor activity, ataxic gait, lacrimation and urorrhea in the 400 mg/kg group and over, hypopnea and soft feces in the 600 mg/kg group and over. In addition, prone or lateral position and tonic or clonic convulsion were observed in the dead animals. Rats showed a decrease in body weight or a suppression of its weight gain in the 400 mg/kg group and over. Macroscopic findings in the dead animals were congestion in lung and retention of foamy mucinous fluid in trachea. The animals alive showed no abnormalities attributable to the treatment. In the 13-week repeat-dose toxicity study, 13 cases of death occurred in the 300 mg/kg group. Main pathological findings in these cases were congestion and edema in lung. Mydriasis was seen in the 30 mg/kg group and over. Lacrimation, salivation, wheezing, emaciation [corrected] wasting and unkempt fur were seen in the 300 mg/kg. A suppression of body weight gain and a decrease in food consumption were observed in the 300 mg/kg group. An increase in water consumption was seen in the 30 and 300 mg/kg groups. Ophthalmologic examination confirmed the mydriasis in the 30 mg/kg group and over. Urinalysis showed an increase in urine volume and a decrease in Na+ excretion in the 30 and 300 mg/kg groups and decreases in K+ and Cl- excretions in the 300 mg/kg group. Hematological examination showed decreases in hemoglobin, hematocrit, MCV and MCH, and an increase in MCHC in the 300 mg/kg group. Blood chemical examination showed decreases in triglyceride and glucose, and an increase in total protein in the 300 mg/kg group. Pathological examination disclosed hepatocellular hypertrophy associated with hyperplasia of smooth-ER, a decrease in number of glycogen granules and an increase in number of lipofuscin in the 300 mg/kg group. Stimulated thyroid follicles were seen in the 300 mg/kg/group. In kidney, an increase in number of hyaline droplets in the proximal tubular epithelium, in which lysosomes and dense bodies were increased, was observed in the 300 mg/kg group. Dense bodies were increased also in the glomerular epithelium. In this dose group, adrenocortical hypertrophy was also observed. The recovery test showed that the above-mentioned changes were satisfactorily reversible or the degree and frequency of these changes were lowered. No treatment-related effects were seen in the 3 mg/kg group. These results show that the NOAEL (no observed adverse effect level) of RCC-36 is 3 mg/kg for 13-week oral toxicity in rats.

Role of transforming growth factor-beta 1 in glomerulonephritis

The role of transforming growth factor-beta 1 (TGF-beta 1) in human glomerulonephritis is still poorly understood. The relationship between expression of TGF-beta 1 protein or TGF-beta 1 mRNA and tissue damage was investigated using the enzyme-antibody and in situ hybridization method in frozen slices of renal tissue from 30 patients: 25 with glomerulonephritis (18 with immunoglobulin A nephropathy; two with focal glomerulosclerosis, one with membranous nephropathy, one with crescentic glomerulonephritis and three with lupus nephritis) and five control patients with minimal change disease. The expression of TGF-beta 1 mRNA was high in sclerotic and proliferative glomeruli, as well as in the tubular epithelial cells within tubulointerstitial lesions. There was significant correlation between the severity of tissue damage in immunoglobulin A nephropathy and the presence of TGF-beta 1 protein and TGF-beta 1 mRNA. These findings suggest that TGF-beta 1 is involved in glomerulosclerosis and the development of tubulointerstitial lesions, indicating its potential importance in the progression and aggravation of immunoglobulin A nephropathy.

[Four cases of subpleural intrapulmonary lymph node]

We presented four cases of subpleural intrapulmonary lymph node showing the indeterminate pulmonary nodule. Case 1 was a 54-year-old male who had a subpleural nodule, 7 mm in diameter in the right S8 segment on chest CT. This nodule showed difficulty to differentiate from small peripheral lung carcinoma. Case 2 was a 72-year-old male who was diagnosed adenocarcinoma of lung. Chest CT showed multiple pulmonary nodules, about 5 mm in diameter except main tumor in the right middle and lower lobes. These nodules showed difficulty to differentiate from intrapulmonary metastasis. Case 3 was a 70-year-old female who was diagnosed lung metastasis of sigmoid colon cancer. Chest CT showed a subpleural nodule, 3 mm in diameter except main tumor in the right S9 segment. This nodule also showed difficulty to differentiate from lung metastasis. Case 4 was a 40-year-old female who had a subpleural nodule, 10 mm in diameter in the right S9 segment. This nodule also showed difficulty to differentiate from small peripheral lung carcinoma. We diagnosed subpleural intrapulmonary lymph nodes, in case 1, 2 and 3, by open thoracotomy and in case 4, thoracoscopic surgery. It should be always kept in mind that subpleural pulmonary nodules in especially middle and lower lobes of lung might be intrapulmonary lymph nodes. Thoracoscopic surgery would be a very useful procedure for diagnosis and therapy of subpleural intrapulmonary lymph nodes.

[Surgical treatment and result for metastatic pulmonary tumor: comparison between sarcoma and carcinoma]

Purpose of this study is to estimate the effectiveness of surgical treatment for metastatic pulmonary tumor by comparing sarcoma with carcinoma. There ware 43 cases and 64 operations of metastatic pulmonary tumor from 1981 to 1995 in Tottori university hospital. When we compared the background factors between sarcoma and carcinoma, there were significant differences in age, numbers of metastatic tumor and times of operation. Patients of sarcoma were much younger and had more number of metastatic tumor and more times of operation than those of carcinoma. Long term results after operation were 50.8% at 5 years and 44.4% at 10 years survival rate in all cases. The 5 year survival rate of sarcoma (38.1%) had a tendency of worse result than that of carcinoma (57.3%). Important factors that influence the post operative long term result were more numbers of pulmonary metastasis and more times of operation in sarcoma. On the other hand, because cases of carcinoma included many low grade malignancies in the group of multiple metastasis, the postoperative result of multiple metastasis became relatively better in our study.

Responses of monkeys with pollinosis to two major allergens of Japanese cedar pollen

We examined the responses of two Japanese monkeys with pollinosis to two major allergens (Cry j 1 and Cry j 2) of Japanese cedar pollen. The two monkeys (A and B) had specific IgE antibodies to the allergens and showed a strong positive reaction to both of them in the intradermal test. In the histamine release test with peripheral blood mononuclear cells (PBMC), monkey A showed a typical pattern similar to that seen in human patients, while monkey B released a low level of histamine. The proliferative response of PBMC to both allergens in monkey A was weak, but was typical in monkey B. From clinical as well as immunological points of view, these monkeys may be a suitable animal model for Japanese cedar pollinosis in humans.

Decrease in myocardial polyamine concentration in rats with myocardial infarction

Cardiac polyamines are thought to protect the myocardium against harmful stimuli and to be regulated by sympathetic nerve activation. In the present study, polyamines concentrations in non-infarcted myocardium were investigated. Myocardial polyamines contents decreased significantly in the non-infarcted regions by day 3 in rats with myocardial infarction compared with sham-operated rats and with the untreated control rats. The cardiac catecholamine concentration decreased by day 1 after myocardial infarction. Myocardial ornithine decarboxylase activity also decreased in the non-infarcted regions; suggesting that the decrease in cardiac polyamines contents relate to an insufficiency of the ornithine decarboxylase activity in rats with myocardial infarction. These results suggest that the decrease in polyamines concentrations after myocardial infarction is associated with functional sympathetic nerve denervation and that the vulnerability of the heart after myocardial infarction may be due to a decrease in polyamine concentrations in the non-infarcted region.