[Effects of 4-(o-benzylphenoxy)-N-methylbutylamine hydrochloride (bifemelane) on deposition of calcium and magnesium in the central nervous system tissues of rats maintained on low-calcium diets]

Since the reduction of calcium (Ca) intake leads Ca and magnesium (Mg) to mobilize from their bone pool and to deposit Ca in the soft tissues, especially in the central nervous system (CNS) tissues, the effects of 4-(o-benzylphenoxy)-N-methylbutylamine hydrochloride (bifemelane) on the deposition of Ca and Mg in the CNS tissues, heart, liver, kidney, muscle, abdominal aorta and bones were studied in rats maintained on low-Ca diets. Thirty-two male, 7-week-old Wistar rats, randomly divided into four groups, each consisting of 8 rats, were maintained for 90 days on the following diets: (A) standard, (B) standard with bifemelane (10 mg/100 g diet), (C) low-Ca, and (D) low-Ca with bifemelane (10 mg/100 g diet). Neither the A-B groups' nor the C-D groups' blood chemistry changed. However, Mg concentration in the cerebellum showed higher values in the B group than in the A group (p less than 0.05). And Mg concentration in pons, cerebellum, spinal cord, heart, liver and femur of the D group increased more than that of the C group (p less than 0.05-0.01), as determined by inductively coupled plasma emission spectrometry (ICP). On the other hand, Ca concentration in the liver was less in the D group than that of the C group (p less than 0.05). In general bifemelane had a tendency to decrease Ca deposition in the CNS and soft tissues of B and D groups. Bifemelane may possibly participate in activating the cerebral metabolism and in keeping an adequate Mg level in the CNS and soft tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum decreases the zinc concentration of soft tissues and bones of rats fed a low calcium-magnesium diet

The relationship between magnesium (Mg) and zinc (Zn) in soft tissues and bone of rats was studied after administration of unbalanced mineral diets. Minerals and metals in soft tissues and bone were determined using inductively coupled plasma emission spectrometry (ICP). There were significant positive correlations between serum Zn and Mg levels, between serum Zn and Zn content of soft tissues and bone, and between serum Mg levels and Zn content of bone and soft tissues in rats fed unbalanced mineral diets. A significant positive correlation was also found between Zn and Mg content in the lumbar spine and femoral bone of rats. It appears that altered bone mineralization induced by unbalanced mineral diets leads to mobilization of Mg and Zn from rat bones in similar ways.

Clinical application of modified polyurethane graft to blood access

Based on a study of 34 clinical implantations, a porous poly(ether-urethane) graft developed for blood access was evaluated. Although it became clear that the graft has several advantages over expanded polytetrafluoroethylene (E-PTFE), it was also revealed that the occlusion at the anastomotic site was more frequently observed than that with E-PTFE. To improve the patency rate, a small modification of the luminal surface was attempted to give a better anchoring of the neointima. The results so far are better than those with the unmodified graft. However, the number of cases is small and the period of observation is short. More work will be necessary to confirm these preliminary results.

[Burkitt's lymphoma with monoclonal pattern (IgG, kappa type) of cytoplasmic immunoglobulin--clinical report and review of Japanese literature]

A 52-year-old male was admitted to the hospital because of abdominal mass. Bone marrow examination revealed 26% blasts, which morphology was L3 in FAB criteria. Abdominal tumor was resected and histologic feature of the tumor was malignant lymphoma, small non-cleaved cell, Burkitt's. Lymphoma cells from the resected tumor were cultured and a cell line was established. Cytological studies of the original tumor cells and the cell line revealed that the lymphoma was negative both for EBNA and EBV DNA, and possessed t(8;14) (q24;q32) in chromosome analysis. Surface antigens were positive for HLA-DR, CD19 and CD20, but negative for CD10. The lymphoma also expressed a monoclonal pattern (IgG, kappa type) both of surface immunoglobulin and cytoplasmic immunoglobulin. Thus, the lymphoma was originated from mature B-lymphocyte. We analysed clinicopathological findings of 216 patients who were reported as Burkitt's lymphoma in Japan. Of 35 cases examined for cell EBNA, 7 (20%) were positive for EBNA. Of 86 cases tested for surface immunoglobulin of tumor cells, 67 expressed IgM alone and 10 IgG alone on tumor cells. Cytoplasmic immunoglobulin of tumor cells was positive in 61% of patients. Of 11 cases positive for cytoplasmic immunoglobulin, IgM was detected in 8 patients and IgG only in our patient.

[Expression of CD56 antigen on acute nonlymphocytic leukemia]

CD56 antigen (detected by NKH-1) is distributed on NK cells, monocytes, and ectodermal neural cells. In this study, the blasts of 29.2% of 27 patients with acute nonlymphocytic leukemia (ANLL) expressed CD56 antigen, but not CD16, CD2, or CD3 antigen. Leukemic cells isolated from 3 patients with CD56-positive ANLL did not have NK activity. There were no significant differences between CD56-positive and CD56-negative ANLL in CD13-positive cases, CD33-positive cases, and HLA-DR-positive cases. These results suggest that CD56-positive ANLL could be so-called mixed-lineage leukemia (lymphoid-associated antigen in ANLL).

[Autologous blood transfusion aided with erythropoietin in transurethral resection of the prostate]

Erythropoietin (EPO) with an established clinical efficacy in renal anemia has in recent years become applied as an aid to autologous blood transfusion in surgical patients. This report describes our experience with autotransfusion along with the use of EPO in transurethral resection of the prostate (TUR-P), indicating its usefulness. Ten patients with benign prostatic hypertrophy aged 60 to 74 years received 3000 units of EPO, with an iron preparation, nine times beginning 3 weeks prior to operation. Autologous blood of 300 ml was collected from the patient each at 2 and 1 week before operation and was used at TUR-P. Five other patients who underwent TUR-P with the same volume of autotransfusion accompanied by preparative medication with the iron alone served as controls. In the EPO treated group (mean age, 68.3 years) the mean value for hemoglobin concentration (Hb) was 14.0 +/- 1.6 g/dl on the day of operation, which showed a recovery rate of 94.9 +/- 5.4% (Hb recovery rate) as against the pre-EPO treatment value (mean: 14.8 +/- 1.3 g/dl). This Hb recovery rate was significantly greater (p less than 0.001) when compared to 82.2 +/- 2.5% in the control group (mean age, 68.2 years). Of the EPO treated patients, those in their sixties (n = 6; mean age, 66.3 years) exhibited a significantly higher Hb recovery rate (98.3 +/- 3.5%) than the rate (89.9 +/- 3.0%) for patients in their seventies (N = 4; mean age, 71.3 years) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of bifemelane on calcium and magnesium deposition in the central nervous system tissues of rats maintained on low-calcium diets

The effects of bifemelane [4-(o-benzylphenoxy)-N-methylbutylamine hydrochloride] on the deposition of calcium and magnesium in central nervous system (CNS) tissues, heart, liver, kidney, muscle, abdominal aorta and bones were studied in rats maintained on standard and low-calcium diets. Rats were maintained for 90 days on the following diets: standard calcium (12.5 g/kg diet); standard with 100 mg/kg bifemelane; low-calcium (30 mg/kg diet); and low-calcium with bifemelane. The presence of bifemelane did not affect blood chemistry, but the magnesium concentration in the cerebellum was significantly (P less than 0.05) higher in rats receiving standard diet after bifemelane treatment. Magnesium concentrations in the pons, cerebellum, spinal cord, heart, liver and femur of bifemelane-treated rats fed low-calcium diets were significantly (P less than 0.05) higher compared with the corresponding controls, whereas the calcium concentration in the liver was significantly (P less than 0.05) lower. In general, bifemelane tended to decrease calcium deposition in the CNS and soft tissues of rats fed standard or low-calcium diets. Bifemelane may activate cerebral metabolism and maintain magnesium concentrations in the CNS and soft tissues, and be implicated in metal metabolism in rats fed low-calcium diets.

[Zinc concentration in the central nervous system in a case of multiple sclerosis--comparison with other neurological diseases]

The possible role of trace elements in a pathogenesis of central nervous system (CNS) on degenerative and demyelinating diseases has been suggested. Simultaneous measurements of Zinc (Zn) and iron (Fe) concentration in CNS were undertaken by neutron activation analysis in CNS tissues: a patient with multiple sclerosis (MS), five patients with amyotrophic lateral sclerosis (ALS), five with spinocerebellar degeneration (SCD), and five with cerebral infarction (CVD) in non-invasive area of CNS as control. Although Zn and Fe concentration were present in white matter and gray matter of CNS in each disease, 1) Zn concentration showed no special pattern in gray matter among four diseases, but decreased more in white matter of MS and ALS than that of CVD (p less than 0.05); 2) Fe concentration in gray matter of SCD increased more than that in CVD (p less than 0.05), but Fe concentration in white matter of CVD was increased more than that of ALS (p less than 0.05); 3) Fe concentration of CNS in a patient with MS was not notable except for high Fe concentration in caudate nucleus and globus pallidus. The demyelinated pathological area in CNS of MS showed a decrease in Zn level but no change in Fe level. These results indicate that low Zn concentration in CNS tissues of MS seemed to be responsible for CNS demyelination, but not for undernutrition due to poor conditions of a patient with MS. It seems that Zn might be one pathogenetic factor of MS, but the action of Fe in MS can not be ruled out.

[Aluminum deposition in the central nervous system tissues of patients with Parkinson's disease]

Aluminum (Al) concentration in the 26 anatomic central nervous system (CNS) regions, liver, kidney, spleen and heart of our patients with Parkinson's disease, and five neurologically normal controls was measured by a non-destructive neutron activation analysis (NAA), in order to clarify the implication of Al on pathogenesis of Parkinson's disease. Al concentration in substantia nigra, caudate nucleus and globus pallidus increased in patients with Parkinson's disease more than that in controls (p less than 0.05). There was a significant difference in Al concentration of gray matter and basal ganglia in Parkinson's disease, compared with those of controls (p less than 0.01). It is likely that high Al deposition in pathological foci responsible for Parkinson's disease might be implicated in the pathogenesis of Parkinson's disease.

Distribution of calcium in central nervous system tissues and bones of rats maintained on calcium-deficient diets

Current changing epidemiological pattern in the Western Pacific area suggests a contribution of the environmental factors to the pathogenetic process of amyotrophic lateral sclerosis (ALS). The condition of unbalanced mineral levels found in the soil and drinking water samples from the ALS foci showing low content of calcium (Ca) and magnesium (Mg) plus high content of aluminum (Al) was experimentally mimicked in this study using rats. In the groups fed low Ca, low Ca-Mg, and low Ca-Mg plus high Al diets, serum Ca levels were lower than that in the group fed the standard diet. Ca content of CNS tissues showed higher values in the unbalanced diet groups, especially in the spinal cord of low Ca-Mg plus high Al diet group, than those in the standard diet group, determined by inductively-coupled plasma emission spectrometry (ICP). Ca content in heart, liver, kidney, and abdominal aorta in groups fed low Ca-Mg, and low Ca-Mg plus high Al diets was higher than that in low Ca, and standard group. Ca content in muscle in the three unbalanced diet groups was significantly higher than in the standard diet group. Ca and Mg contents in lumbar spine and cortical bone showed lower values in the unbalanced diet groups than those values in the standard diet group. These findings suggest that under the condition of derangement of bone mineralization induced by unbalanced mineral diets fed to the experimental rats, Ca and Mg may be mobilized from bone, keeping their content in soft tissues, including CNS tissue, for utilization of vital activities, thereby resulting in a deposition of Ca while maintaining an almost normal value of magnesium in the CNS tissues.

Effect of vasopressin on cardiovascular and renal functions and ANP release under plasma volume expansion

To assess the mechanisms whereby arginine vasopressin (AVP) increases atrial natriuretic peptide (ANP) release and to examine whether AVP-mediated ANP release affects the effect of AVP on the cardiovascular and renal function, AVP was infused continuously at a rate of 20 ng.kg-1.min-1 for 75 min following 200 ng/kg bolus injection under stepwise increases in plasma volume in anesthetized dogs. Moreover, the effect of an AVP antagonist, a V1 blocker, 1-(beta-mercapto-beta, beta-cyclopentamethylenepropionic acid)-2-(o-methyl)tyrosine AVP (TMeAVP), on these parameters was also investigated. In the control study, saline alone was infused. AVP infusion increased total peripheral resistance (TPR), pulmonary capillary wedge pressure (PCWP), and plasma ANP, but decreased cardiac index (CI) and heart rate (HR) without increases in mean arterial blood pressure (MABP). Stepwise rises in plasma volume further increased plasma ANP, CVP, CI and PCWP, but gradually decreased TPR. TMeAVP curtailed AVP-induced increases in TPR and plasma ANP as well as decreases in CI and HR. The replacement of ANP to prevent a fall in plasma ANP following TMeAVP never affected cardiovascular function. AVP infusion increased plasma volume accompanied by a fall in urinary Na excretion (UNaV) and urine flow (UF) under the stepwise plasma volume expansion compared to the control group, but did not affect mean circulatory filling pressure (MCFP). ANP administration enhanced UNaV and UF and decreased MCFP. These results indicate that AVP may preferentially increases ANP release via the increased cardiac afterload, not preload, but increased plasma ANP per se may not be involved directly in the AVP-induced cardiac suppression.

[Mutual supplementation in treatment of renal failure by blood purification and kidney transplantation]

More than 100,000 uremic patients have been maintained by various blood purification modalities in Japan. However, their quality of life is far from satisfaction not only in terms of physical problems related to the complications specific to long-term dialysis treatment, but also the restriction in social activities by spending much time for hospital dialysis. A graft functioning rate in kidney transplantation has been remarkably improving after introduction of Cyclosporine A as an immunosuppressant and is presently approximately 90% one year after transplantation. As long as the transplanted kidneys function, further extensive social activities and highly-graded quality of life is warranted compared to artificial kidney treatment. On the other hand, patients in end-stage renal diseases and with rejected transplants are expected to undergo safe kidney transplantations as being maintained by dialysis therapy. Furthermore, recent development in blood purification technology has made the specific kidney transplantations successful in recipients with the preformed antibody (-ies) and the incompatible ABO blood type antibody (-ies). Nowadays, relation between blood purification and kidney transplantation is not competitive, but mutually supplementary as a matter of realism.

Presentation of autoantigen by human T cells

Activated human T cells express MHC class II and have been shown to present foreign Ag to autologous T cells. We now demonstrate that MHC class II+ T cell clones can present myelin basic protein (MBP) peptide autoantigen in the absence of traditional APC to autologous MBP reactive T cell clones. MBP peptide-pulsed T cell clones specifically stimulated autologous MBP-reactive T cell clones to flux calcium and proliferate. Activation responses were peptide epitope specific and blocked by mAb to MHC class II, indicating a TCR-mediated response. In addition, mAb to the adhesion molecules LFA-3, CD2, LFA-1, CD29, and to the tyrosine phosphatase CD45 also inhibited proliferation, indicating the involvement of T to T cell interactions. In contrast to peptide Ag, T cell clones did not respond to autologous T cells pulsed with HPLC-purified MBP, suggesting that T cells are unable to process whole MBP. However, batch-purified MBP Ag preparations containing lower m.w. breakdown products were presented by T cells, indicating that naturally occurring breakdown products of autoantigens could be presented by activated T cells in vivo. These results raise the possibility that T cell presentation of autoantigen at inflammatory sites may be important in regulation of immune responses to self Ag.

Presentation of autoantigen by human T cells

Activated human T cells express MHC class II and have been shown to present foreign Ag to autologous T cells. We now demonstrate that MHC class II+ T cell clones can present myelin basic protein (MBP) peptide autoantigen in the absence of traditional APC to autologous MBP reactive T cell clones. MBP peptide-pulsed T cell clones specifically stimulated autologous MBP-reactive T cell clones to flux calcium and proliferate. Activation responses were peptide epitope specific and blocked by mAb to MHC class II, indicating a TCR-mediated response. In addition, mAb to the adhesion molecules LFA-3, CD2, LFA-1, CD29, and to the tyrosine phosphatase CD45 also inhibited proliferation, indicating the involvement of T to T cell interactions. In contrast to peptide Ag, T cell clones did not respond to autologous T cells pulsed with HPLC-purified MBP, suggesting that T cells are unable to process whole MBP. However, batch-purified MBP Ag preparations containing lower m.w. breakdown products were presented by T cells, indicating that naturally occurring breakdown products of autoantigens could be presented by activated T cells in vivo. These results raise the possibility that T cell presentation of autoantigen at inflammatory sites may be important in regulation of immune responses to self Ag.

Prolongation of cardiac xenograft function after reduction of natural antibodies using double filtration plasmapheresis

A double filtration plasmapheresis (DFPP) technique was applied to selectively remove the natural antibodies in discordant xenotransplantation. A swine heart was heterotopically transplanted in a canine neck after two DFPP procedures during which 200 to 500 ml of plasma were replaced with the same amount of Hartman's solution containing 7% human albumin. Mean removal rate of IgC and IgM by DFPP ranged from 74.2 +/- 0.5 to 95.9 +/- 2.8%. The anti-swine lymphocytotoxic reaction of canine serum was decreased after DFPP but still remained in low titers. Mean graft survival time in the group treated by DFPP in which 1000 ml of plasma was totally replaced was prolonged to 107 +/- 47 min, while it was 9 +/- 5 min in the group without any treatment (p less than 0.01). Deposits of canine IgM and C3 on the vascular endothelium of the graft were observed on immunofluorescence, while there were no deposits of IgG. In conclusion, DFPP effectively removed the natural antibodies, resulting in prolongation of xenograft survival time. Immunofluorescence study suggested that natural IgM antibodies played an important role in this xeno-hyperacute rejection.

A case of syndrome of inappropriate secretion of antidiuretic hormone associated with diabetes mellitus

A 46-year-old man, presenting with headache, nausea, and lassitude, was diagnosed as having diabetes mellitus and hyponatremia, and admitted to Tohoku University Hospital. Insulin treatment improved the hyperglycemia but aggravated hyponatremia, which was proved to be elicited by the inappropriate secretion of antidiuretic hormone (SIADH). An acute water load failed to suppress ADH release in the supine posture but slightly increased plasma atrial natriuretic peptide (ANP). On the other hand, plasma ADH markedly increased in response to an upright posture, accompanied by a fall in blood pressure and a rise in heart rate. After treatment with droxidopa "a sympathomimetic drug", ambulatory blood pressure gradually increased and hyponatremia disappeared. However, blood pressure and ADH responses to upright posture were not improved by treatment with the drug. Moreover, plasma ADH was still not sufficiently suppressed by acute water loading in the supine position, but plasma ANP markedly increased, thereby resulting in urinary dilution and natriuresis. These results suggest that exaggerated ADH release (SIADH) was brought about by the baroreceptor reflex stimulated by the postural hypotension, and also by the impaired osmoregulation associated with diabetic neuropathy, and that droxidopa improved cardiovascular function and increased ANP release with resultant urinary dilution and natriuresis in spite of slightly increased ADH release.

[Sex hormones and calcium regulating hormones in rheumatoid arthritis]

Rheumatoid arthritis (RA) occurred frequently in women. Exogenous estrogen has been reported to alleviate the symptoms of patients with RA. But the implications of sex hormones and immunological abnormalities in RA remain to be elucidated. Therefore, we measured sex hormones (LH, FSH, estradiol, testosterone and prolactin), bone metabolic markers (midregion and carboxy terminal mainly recognized PTH1-84, intact PTH1-84, bone GLA protein and alkaline phosphatase), bone mineral, in lumbal bone with quantitative tomography (QCT) and with of cortex with microdensitometry in 52 females with RA and 46 females with osteoarthritis (OA) as a control group. Sex hormones and bone metabolic markers were analyzed as independent variables of serum LH, FSH and estradiol levels, using one way analysis, in patients with RA and OA. The more increased serum FSH and LH levels were, the more decreased serum estradiol levels were in both RA and OA groups, when they were considered as independent variables. These results indicate that the secretory function of pituitary and ovary axis hormones are normally enacted in RA. On the other hand, when the sex hormones of the patients under 53 years of age were studied in both groups, serum FSH adn LH showed significantly higher levels, while serum estradiol levels revealed decreased tendency in RA, compared with these in RA. Thus the pituitary ovary secretory function in patients with RA was suggested to be disturbed in early stage of age, indicating that the sex hormones would be partly implicated in calcium and bone metabolism in patients with RA.

Involvement of ovarian steroids and endogenous opioids in the fasting-induced suppression of pulsatile LH release in ovariectomized rats

The participation of the ovarian steroids and opioid peptides in the suppression of pulsatile LH release during acute fasting was examined in rats. Ovariectomized rats bearing silicone elastomer implants of oestradiol and/or progesterone were fasted for 48 h and subsequently blood samples were taken every 6 min for 3 h. Pulsatile LH release was suppressed after 48 h of fasting in the ovariectomized rats implanted with oestradiol but not in the oil-implanted controls. This suppression was enhanced after the administration of progesterone together with oestradiol. In a second experiment, ovariectomized rats bearing implants of oestradiol or oil were fasted for 48 h and injected s.c. (2.5 mg/kg body weight) with an opioid antagonist, naloxone hydrochloride, immediately before blood sampling. In the fasted oestradiol-treated ovariectomized rats, naloxone was able to prevent the suppression of pulsatile LH release. In the absence of oestradiol, however, naloxone was without effect on LH release in either the fasted or unfasted animals. These experiments indicate that the suppression of pulsatile LH release after 48 h of fasting is dependent upon oestradiol and that endogenous opioids are involved in the suppression.

[Evaluation of magnesium, calcium and aluminum deposition in bone in situ]

Current changing epidemiological pattern in the Western Pacific strongly suggests a contribution of the environmental factors to the pathogenetic process of amyotrophic lateral sclerosis (ALS). As a reflection of excess metals and a deficiency of minerals in soil and water samples in these foci, this study was designed experimentally to evaluate the concentration of calcium (Ca), magnesium (Mg) and aluminum (Al) in the bones of rats fed unbalanced mineral diets. Twenty-eight male Wistar rats, weighing 200 g, were fed either a standard diet, a low Ca diet, a low Ca-Mg diet, or a low Ca-Mg diet with high Al for 90 days. The composition of the diet/100 g consists of Ca 1250 mg, Mg 300 mg, Al 10 mg, Zn 4 mg in the standard diet; Ca 3 mg and Mg 2 mg in the low Ca-Mg diet; and Al 194 mg in the high Al diet, Al supplied as Al lactate. Ca, Mg and Al concentrations were determined by using inductively coupled plasma emission spectrometry (ICP) for bone and atomic absorption spectrometry for serum. Serum Ca levels in the groups fed unbalanced mineral diets were lower than those in the group fed standard diet. Serum Mg levels were markedly decreased in the groups fed low Ca-Mg diet and low Ca-Mg plus high Al diet, compared with those in the groups fed standard diet and low Ca diet.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronic lymphocytic leukemia with peripheral T lymphocytes expressing CD 2+, CD 3+, CD 4-, CD 8-, CD 16+, and CD 56+ and lymph-node lymphocytes expressing CD 2+, CD 3-, CD 4-, CD 8-, CD 16+, CD 38+, and CD 56+]

A 33-year-old man was hospitalized because of thrombocytopenia and severe splenomegaly. On admission 78% of peripheral lymphoid cells were abnormally large, with pale cytoplasm. Flow cytometry of the abnormal lymphocytes showed that they expressed CD 2, CD 3, CD 11, CD 16, and CD 56, but not CD 4 nor CD 8, so they were T-cell large granular lymphocytes (T-LGL). Abnormal lymphocytes obtained from a lymph node expressed CD 2, CD 16, CD 38, and CD 56, but not CD 3, CD 4, and CD 8, so they were natural killer(NK) cells. Splenectomy was performed and the operative specimen showed diffuse infiltration of pleomorphic lymphocytes, probably chronic lymphocytic leukemia cells. After splenectomy, the platelet count returned to normal but the lymphocytosis continued. Two years after discharge, chemotherapy was done because of thrombocytopenia and hepatomegaly. The patient died of disseminated intravascular coagulation arising from sepsis. The differences and similarities between peripheral and lymph-node lymphocytes suggest that LGL and NK cells may be differentiated from the same kind of cell, somewhat differentiated from stem cells.

Cyclical edema in a patient with hypothalamic disorders and chronic glomerulonephritis: arginine vasopressin-dependent atrial natriuretic hormone release

A 28-year-old woman had hypothalamic disorders (amenorrhea, obesity, psychiatric abnormalities, polydipsia and fever) and chronic glomerulonephritis. She also suffered from general edema associated with cyclical oliguria and polyuria. Her body weight and plasma osmolality increased during the oliguria phase lasting 2 to 8 days and decreased after paroxysmal polyuria accompanied by the natriuresis. These episodes occurred repeatedly, regardless of the treatment with or without diuretics. The release of arginine vasopressin in response to increased plasma osmolality was exaggerated, but changes in plasma volume did not affect arginine vasopressin release. Plasma atrial natriuretic hormone increased in response to a rise in plasma arginine vasopressin and plasma volume during the oliguria phase, thereby resulting in the diuresis and natriuresis. The renin-angiotensin-aldosterone system was secondarily activated by body fluid depletion and diuretics, and this might play an additive role in general swelling. Plasma gonadal hormones did not change to explain the edema. The mechanism of this cyclical edema remains unknown, but it is likely that hypothalamic dysfunction related to psychiatric abnormalities may exaggerate arginine vasopressin release, and enhanced renal sympathetic activity may cause retention of Na and water, and the increase in atrial natriuretic hormone release responding to the plasma volume expansion may bring about the diuresis and natriuresis.