Quantitative detection of hepatitis C virus genome in liver tissue and circulation by competitive reverse transcription-polymerase chain reaction

We quantified hepatitis C virus RNA in 25 Japanese patients with chronic type C liver disease by competitive reverse transcription-polymerase chain reaction. The amount of the viral RNA in the serum (2 x 10(5)-2 x 10(8) copies/ml) correlated with that in the liver tissue (10(8)-10(11) copies/g) (N = 23, r = 0.727, P < 0.0001). One gram of the infected liver tissue contained 10(2)-10(4) (geometric mean, 10(3), N = 23) times as many copies of the viral RNA as did 1 ml of the serum. Liver tissues of chronic aggressive hepatitis contained significantly higher amounts of the viral RNA than those of chronic persistent hepatitis (P < 0.05). These observations suggested that this method is useful to evaluate viral amount, and the amount of the circulating hepatitis C virus RNA could be used as a marker of the intrahepatic viral amounts, which might contribute to disease activity.

Prognostic factors of renal dysfunction induced by environmental cadmium pollution

To assess the influence of environmental cadmium (Cd) exposure on long-term outcome, a follow-up study was conducted from 1981-1982 to March 1991 on 3178 inhabitants living in the Cd-polluted Kakehashi River basin. The standardized mortality ratios of the urinary beta 2-microglobulin (beta 2-MG)-, protein-, and amino acid-positive subjects of both sexes and the urinary glucose-positive female subjects were higher than those of the subjects with urinary-negative findings or the general Japanese population during the observation period. After adjusting for age using Cox's proportional hazards model, significant associations were found between mortality and urinary indices. In multiple comparisons using all of the indices, urinary protein and beta 2-MG in the women and urinary protein in the men were the factors most contributing to the mortality rates. In the urinary protein-negative female group as well, a significant association was found between urinary beta 2-MG and mortality. These results suggest that the prognosis of subjects with Cd-induced renal dysfunction is unfavorable, with the mortality rate increasing even in the early stage of proximal tubular dysfunction. Urinary protein and urinary beta 2-MG are important prognostic factors, with the latter, in particular, considered to be useful as an early index predictive of premature mortality.

[Myelin basic protein in the cerebrospinal fluid of patients with neurological disease: especially with malignant brain tumors]

Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) of patients with brain tumors and other neurological diseases was measured before, during and after various treatments such as surgery, chemotherapy and irradiation. We assessed the significance of changes in the MBP levels during the course of treatment, and speculate on what the elevated level of MBP in brain tumor patients indicates. In meningeal dissemination of malignant tumors, meningeal carcinomatosis from cancer of the systemic organ showed the highest level of MBP followed by meningeal gliomatosis and meningeal lymphoma. Meningeal carcinomatosis and meningeal lymphoma, which have responded to chemotherapy, showed normal levels of MBP after chemotherapy. Six of eight patients with newly diagnosed malignant glioma showed moderate to high levels of MBP (range 4.6-35.5ng/ml) just before intraarterial chemotherapy with VP-16 and CDDP. The level increased in five patients during the course of chemotherapy and then decreased in relation to the degree of tumor reduction by chemotherapy. In the solid type of metastatic brain tumor, five of seven patients with multiple tumors showed high levels of MBP and these levels also returned to normal after treatment in four patients. As for the influence of irradiation, levels of MBP did not increase after irradiation except in three patients who developed radiation necrosis, local extensive edema or atrophic change. In other brain tumors, levels of MBP were high in a patient with a large meningioma with very extensive edema and during an unstable postoperative condition after total removal of a large craniopharyngioma.(ABSTRACT TRUNCATED AT 250 WORDS)

Nephrotoxicity induced by a single dose of adenine: effects of 4-aminopyrazolo[3,4-d]pyrimidine and allopurinol

The effects of allopurinol and 4-aminopyrazolo[3,4-d]pyrimidine (4APP) on adenine-induced renal injury in mice were examined. Plasma urea nitrogen (UN) and creatinine levels increased after the oral administration of adenine to mice. However, plasma UN and creatinine levels decreased inversely with the dose of 4APP when a different dosage of 4APP was administered together with adenine. Yet 4APP did not have any effect on the UN or creatinine levels when 4APP was administered after adenine administration. Plasma UN and creatinine levels increased in the allopurinol-administered group as in the adenine-administered group. Moreover, from light microscopic observation by hematoxylin-eosin staining, microvacuolic changes in the proximal tubuli were detected in the mouse kidney in the adenine-administered group, and epithelial cell loss, degeneration and microvacuolic changes in the proximal tubuli were observed in the mouse kidney in the adenine-and-allopurinol-administered group. However, there were no changes in the proximal tubuli in the mouse kidney in the adenine-and-4APP-administered group. These findings suggested that 4APP inhibits the action of adenine in the mouse kidney.

A subpopulation of olivocerebellar projection neurons express neuropeptide Y

By neuropeptide Y (NPY) immunohistochemistry and in situ hybridization histochemistry with digoxigenin-labeled oligonucleotide probes for this peptide, a subpopulation of neurons in the caudal portions of the rat dorsal and medial accessory olives were found to express NPY immunoreactivity and mRNA. In the cerebellum, NPY-immunolabeled climbing fibers were distributed to the flocculus and parts of vermal cortex. The results suggest particular association of NPY with the climbing fiber system presumably mediating spinal, visual and vestibular inputs.

Non-receptor tyrosine kinases in mammalian neurogenesis

Several members of the Src family of non-receptor tyrosine kinases are expressed at high levels in embryonic neural tissues as well as in adult brain. Relatively little has been known, however, about their roles in neural development. Attempts to clarify this by production of mutant mice have been unsuccessful because of gene redundancy. We earlier isolated a new cytoplasmic protein tyrosine kinase, Csk, and showed that it inactivates uniquely all members of non-receptor tyrosine kinases in vitro. Here, we have generated Csk-deficient mouse embryos and shown that Csk is indeed an indispensable negative regulator for all non-receptor tyrosine kinases in vivo, and that regulated activity of these kinases is essential for normal development of mice at the neural stage. The signaling pathway through Src-family kinases during neurulation is also discussed.

Selective intra-arterial chemotherapy with a combination of etoposide and cisplatin for malignant gliomas: preliminary report

We administered selective intra-arterial chemotherapy consisting of a combination of etoposide and cisplatin to 20 patients with malignant glioma (seven with recurrent and six with enlarged tumors after initial treatment, and seven newly diagnosed patients). Evaluation of efficacy was based on computed tomographic and magnetic resonance imaging findings. In the process of establishing a safe technique for superselective intra-arterial chemotherapy, we encountered cerebrovascular accidents in two patients (after etoposide in one and after etoposide plus cisplatin in the other). In these two cases, 100 mg/m2 of etoposide and 100 mg/m2 of cisplatin were delivered via the horizontal segment of the middle cerebral artery (M1) or the tip of the basilar artery, with the infusion time reduced to 20 minutes. Thereafter, the etoposide was diluted, and the doses of both drugs were reduced to 80 or 50 mg/m2, and finally to 60 mg/m2, and both were infused over 60 minutes. In addition, for prevention of local spasm, papaverine hydrochloride and nicardipine were given via the same catheter at 5-minute intervals during administration of etoposide and cisplatin. No complications developed in the later cases. Thereafter, selective intra-arterial infusion of etoposide and cisplatin into the anterior cerebral artery, middle cerebral artery, posterior cerebral artery, or the basilar artery for malignant gliomas in the basal ganglia, internal capsule, and brainstem--a procedure generally considered risky in terms of potential complications--was performed safely, with tolerable side effects. Computed tomography and magnetic resonance imaging indicated improvement in 13 patients, including four whose tumors completely disappeared. This method of intra-arterial chemotherapy may be useful as an adjuvant treatment for malignant glioma.

[Pharmacokinetics of plasma and cerebrospinal fluid cisplatin in patients with malignant glioma and metastatic brain tumor after selective intraarterial or intravenous and intracarotid administration of etoposide and cisplatin]

CSF and plasma platinum levels were examined in patients with malignant glioma after administration of etoposide and cisplatin each at doses of 60 mg/m2 by 60-minute selective intraarterial infusion. These same factors were also examined in patients with metastatic brain tumors after administration of cisplatin at a dose of 60 or 100mg/m2 by 60-minute intracarotid or intravenous infusion. Plasma and CSF samples taken through an Ommaya reservoir placed in the lateral ventricle or postoperative cavity were analyzed for platinum content by atomic absorption spectroscopy. Plasma and CSF platinum levels were dose dependent. The overall plasma platinum curves were biphasic, with mean half-lives of 35 minutes and 56 hrs. The mean peak total CSF concentration was 10.0% of the peak total plasma platinum and 20.2% of the peak free plasma platinum in patients with malignant glioma. In patients with a solid metastatic brain tumor, the mean peak total CSF concentration was 1.9% of the peak total plasma platinum and 4.0% of the peak free plasma platinum after i.v. infusion. After intracarotid infusion, the mean peak total CSF concentration was 3.4% of the peak total plasma platinum and 7.0% for the peak free plasma platinum. In patients with meningeal carcinomatosis, the mean peak CSF concentrations were 7.7% of the peak total plasma platinum and 13.7% of the peak free plasma platinum. The free to total platinum ratio in plasma decreased quickly and that in CSF increased and was maintained at the high levels of 80% for two hours or more.(ABSTRACT TRUNCATED AT 250 WORDS)

[Penetration of potassium clavulanate/ticarcillin sodium into cerebrospinal fluid in neurosurgical patients]

Concentrations of potassium clavulanate (CVA) and ticarcillin sodium (TIPC) in the plasma and cerebrospinal fluid (CSF) of patients after neurosurgical intervention were determined at various times after a 1-hour drip infusion (3.2-g dose). Patients whose blood-brain barriers were supposed to be maintained in almost a normal condition were selected. CSF was obtained through a catheter placed in the anterior horn of the lateral ventricle in all the patients. Maximum plasma levels (micrograms/ml) of 57.6 to 384.0 with an average of 169.7 (TIPC) and 0.41 to 26.2 with an average of 6.1 (CVA) were achieved at the termination of infusion. The maximum CSF levels (micrograms/ml) were 0.61 to 18.8 (TIPC) and 0.1 to 6.81 (CVA) with mean values of 4.5 and 1.2, respectively. Plasma half lives (T1/2) (minute) were 24 to 93 (TIPC) and 32 to 227 with mean values of 58 and 127, respectively. The mean values of the CSF half lives (minute) were 237 (TIPC) and 113 (CVA). The ratios (%) of CSF levels to plasma levels in maximum concentration (Cmax), AUC (area under concentration curve) and half life (T1/2) were calculated. Cmax ratios were 0.2 to 29.2 (TIPC) and 1.4 to 69.8 (CVA) with mean values of 4.4 and 22.8, respectively. AUC ratios were 0.3 to 23.5 (TIPC) and 1.1 to 70.2 (CVA) with mean values of 4.3 and 22.4, respectively. T1/2 ratios were 1.3 to 18 (TIPC) and 1.1 to 4.3 (CVA) with mean values of 5.5 and 2.3, respectively. These values indicate that CVA/TIPC may be classified into a group of antibiotics with good penetration into the CSF.

Plain radiological findings in Ménière's disease

In order to investigate the characteristics of plain radiography of Ménière's disease, the degree of the pneumatization and the distance between the sigmoid plate and the bony wall of the vestibule in Schüller's view were examined in patients with unilateral and bilateral Ménière's disease, non-Ménière vertiginous disease and healthy subjects. There was no difference of the degree of pneumatization and the distance among the patients with Ménière's disease, the non-Ménière inner ear disease group and in healthy subjects. The distance of the unaffected ear was significantly shorter in patients showing a shorter distance of the affected ear. There was no relationship between the distance and age of onset of the disease, and duration of the disease. Therefore, it is concluded that the dysfunction of endolymphatic sac does not always reflect poor mastoid pneumatization and/or shorter distance in the plain radiography and that other etiological mechanisms such as autoimmune disease should be considered in some patients having evidence of endolymphatic hydrops.

Regulation of interleukin-5 production by peripheral blood mononuclear cells from atopic patients with FK506, cyclosporin A and glucocorticoid

Upon stimulation with phorbol ester and ionomycin, peripheral blood mononuclear cells (PBMC) of atopic patients with moderate eosinophilia produced significantly higher amounts of IL-5 compared to that of normal subjects. This finding renders further support to the notion that T cell-eosinophilic inflammation plays a central role in allergic disorders. IL-5 induction in vitro was completely inhibited by immunosuppressant FK506, cyclosporin A and dexamethasone. FK506 applied in vivo effectively suppressed clinical symptoms of atopic dermatitis and IL-5 production of PBMC. FK506 and cyclosporin A may become a better therapeutic modality against allergic diseases.

[A case of Hangman's fracture associated with vertebral arteriovenous fistula treated with trapping]

A case of a traumatic vertebral arteriovenous fistula associated with a hangman's fracture is reported. A 45-year-old male fell down about 2 meters and struck his parietooccipital region against the ground. Profuse nasal bleeding developed. He was transferred to a local hospital, where his respiration was ataxic and blood pressure was low. After intubation, he was transferred to our emergency department. Cervical x-p revealed fracture of C1, C2 and subluxation of C2 body. Because of uncontrollable nasal bleeding, the bilateral maxillary arteries were embolized with spongel. At this time, right vertebral angiograms demonstrated a vertebral arteriovenous fistula with an pseudoaneurysm located at C2 level. On the 13th hospital day, direct balloon occlusion of the fistula was attempted; this could not be achieved because the subclavian and vertebral arteries were tortuous and the balloon catheter could not be introduced to the level of the fistula in the vertebral artery. The patient was only observed until follow-up angiogram on the 24th hospital day revealed enlargement of the pseudoaneurysm. We performed trapping of both the proximal and distal ends of the involved vertebral artery; from C5 to C1. Postoperative course was uneventful, hangman's fracture was fixed with a Halo vest. Four months after operation, fistula and pseudoaneurysm were not opacified on angiogram. We believe that transvascular techniques are the treatment of choice for vertebral arteriovenous fistulas. However, as the next best thing, we can use trapping for the patient whose vessels are too tortuous to introduce the balloon catheter to the involved vessel.

Genetic polymorphisms in HLA-A, -B, -C and -DR antigens in Japanese patients with palmoplantar pustulosis

Genetic polymorphisms in HLA-A, -B, -C and -DR antigens were investigated in 78 unrelated Japanese patients with palmoplantar pustulosis (PPP) and compared with a total of 472 normal persons. Only HLA-DR9 showed a significantly increased frequency among all HLA antigens investigated (chi 2 = 11.57, p < 0.001). It is suggested that major histocompatibility complex class II antigens including HLA-DR antigen may determine the susceptibility to PPP and PPP may be a distinct disease entity from psoriasis.

[Successful collection of peripheral blood stem cells mobilized by a combination of G-CSF with high-dose Ara-C or high-dose etoposide]

The author evaluated the effectiveness of a combination of G-CSF with high-dose Ara-C (HD Ara-C) or high-dose etoposide based on the collection of peripheral blood stem cells (PBSC) during the recovery phase from myelosuppression in 17 patients with various types of hematopoietic malignancies. Following therapy with HD Ara-C or HD etoposide, G-CSF (250 micrograms/body) was administered from the nadir state and blood mononuclear cells were collected using a CS-3000 by processing 15 litres of blood at each apheresis. Stem cell-enriched fractions obtained from discontinuous Percoll gradients were collected and stored in liquid nitrogen. The mean numbers of granulocyte-macrophage colony-forming units (CFU-GM) obtained by the first apheresis were 10.9 x 10(5)/kg after chemotherapy with HD Ara-C and 13.4 x 10(5)/kg after HD etoposide therapy, respectively. In 14 out of the 17 first apheresis, more than 2 x 10(5) CFU-GM/kg were collected. Serial apheresis was performed in seven patients, at intervals ranging from 21-79 days, and the progenitor yield in the second apheresis decreased in five patients. These results suggest that the use of either HD Ara-C or HD etoposide induces an effective mobilization of PBSC and enables large scale collection of PBSC for autotransplantation.

Radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential

BACKGROUND

Verapamil-sensitive, idiopathic left ventricular tachycardia (ILVT) with right bundle branch block configuration and left-axis deviation has been suggested to originate from the left posterior fascicle. The purpose of this study was to determine how frequently potentials generated by the Purkinje fiber network (P potential) can be recorded preceding ventricular activation, and the role of the P potential in guiding radiofrequency catheter ablation.

METHODS AND RESULTS

Eight patients (mean age, 26 +/- 10 years) with ILVT (cycle length, 346 +/- 59 milliseconds) were studied. Right and left ventricular endocardial mapping during tachycardia identified earliest ventricular activation at the posteroapical left ventricular septum. In all patients, earliest ventricular activation during tachycardia was preceded by a distinct potential. This potential also preceded ventricular activation during sinus rhythm, consistent with activation of a segment of the left posterior fascicle (P potential). The earliest recorded P potential preceded the QRS during tachycardia by 15 to 42 milliseconds (mean, 27 +/- 9 milliseconds). The application of radiofrequency current at 1 to 4 sites (median, 1) eliminated ILVT in all eight patients. In the seven patients with P potentials recorded at multiple sites within the posteroapical septum, ablation was successful at the site of the earliest P potential and unrelated to the timing of ventricular activation. In the remaining patient, ablation was successful at a site recording a late P potential fusing with earliest ventricular activation. During follow-up (1 to 67 months; median, 10.5) ILVT recurred only in the latter patient. Pace mapping during tachycardia at the successful ablation site in four patients produced a similar QRS with stimulus-QRS interval equal to P-QRS interval during tachycardia. However, a similar QRS was obtained by pacing at nearby sites that recorded a later P potential.

CONCLUSIONS

These findings support the hypothesis that ILVT originates from the Purkinje network of the left posterior fascicle. A P potential can be recorded at the posteroapical left ventricular septum during ILVT, and ablation is successful at the site recording the earliest P potential. Pace mapping with similar QRS is not specific due to capture of the Purkinje fiber network at a site remote from the origin of the tachycardia.

Terguride as a new anti-hyperprolactinemic agent: characterization in rats and dogs in comparison with bromocriptine

Terguride, a derivative of the ergot alkaloid, was characterized as a new anti-hyperprolactinemic agent in rats and dogs in comparison with bromocriptine. Terguride was found to bind selectively to the pituitary dopamine D2-receptors with a high affinity (Kd = 0.39 nM). In reserpinized rats, terguride at 0.03 mg/kg, p.o. significantly reduced the serum prolactin (PRL) level. The PRL lowering effect and the effective dose were longer lasting and about 30 times lower than those of bromocriptine, respectively. In rats bearing estrogen-induced pituitary prolactinoma, chronic terguride induced shrinkage of the prolactinoma as well as reduction of the high serum PRL level. In lactating rats, terguride (1.0 mg/kg, s.c.) reduced milk production in the mammary gland, whereas bromocriptine showed no significant effect up to 10 mg/kg, s.c. Terguride (10 mg/kg, p.o.) did not induce any stereotypy and hypermotility in reserpinized rats, while bromocriptine induced both stereotypy and hypermotility significantly at 10 mg/kg, p.o. In dogs, terguride, like bromocriptine, reduced the serum PRL level, but did not affect the serum levels of growth hormone and luteinizing hormone. In dogs, bromocriptine induced both emesis and PRL-lowering at almost the same dose, whereas emesis-inducing doses of terguride were about 100 times higher than the PRL-lowering dose. These results suggest that terguride as a dopamine D2-agonist is a potent inhibitor of PRL secretion with less neurotropic side effects compared to bromocriptine, and thus a useful drug for the treatment of galactorrhea and hyperprolactinemia including prolactinoma.

[A case of splenial astrocytoma with various neuropsychological symptoms]

A case with splenial astrocytoma that showed various neuropsychological symptoms after disappearance of tumor due to chemo- and radiation therapies. A 40-year-old right-handed truck driver visited the Neurosurgical Clinic with complaints of memory disturbance and loosing his way during truck driving. Under diagnosis of protoplasmic astrocytoma chemotherapy and radiation treatments were carried out. These treatments were satisfactorily effective, but the patient showed marked memory deficits and personality change. He was hospitalized, therefore, into the Neuropsychiatric Clinic 20 months after the above mentioned treatments. Aside personality changes such as lack of inhibition and shameless acts, the patient showed interhemispheric disconnection symptoms (dyslexia in the left visual hemifield), memory deficits, and visual perceptual disturbances. His memory deficits consisted of anterograde and retrograde amnesia and disorientation of time and place, indicating that he had typical amnesic syndrome. In other words he had so-called retrosplenial amnesia. His visual perceptual deficits were impaired performance on many tasks already described as tests of visual perception.

Bilateral vertebral artery occlusion secondary to atlantoaxial dislocation with os odontoideum: implication for prophylactic cervical stabilization by fusion--case report

A 27-year-old male presented with an unusual atlantoaxial dislocation associated with os odontoideum, after suffering sudden onset of significant neurological deterioration. Angiography demonstrated simultaneous occlusion of the bilateral vertebral arteries assumed responsible for the devastating neurological deficits. He initially underwent cervical immobilization with a Crutchfield tong for 2 months and subsequent posterior fusion using an iliac bone graft and wires. The neurological symptoms gradually subsided, and 5 years later good healing of the bone graft without instability and ample subarachnoid space around the spinal cord were radiologically confirmed. Early prophylactic stabilization of atlantoaxial dislocation due to os odontoideum is recommended to prevent a poor outcome. Careful angiographic evaluation of the vertebrobasilar circulation is important for management of patients with os odontoideum.

Evaluation of antibody against AR142, a synthetic peptide derived from the core sequence of hepatitis C virus, in the diagnosis of non-A, non-B chronic liver disease

We evaluated serum anti-hepatitis C virus (HCV) using a synthetic peptide (AR142) which includes an epitope in the core region of HCV. The incidence of anti-AR142 in 98 patients with type non-A, non-B chronic liver diseases (NANB-CLD) was 89.8%, while all the 28 patients with non-type C chronic liver diseases were negative for anti-AR142. Among 98 NANB-CLD patients, 74 were positive for both anti-AR142 and anti-C100-3, 23 showed discordant results, and one was positive for neither. Eighty-one NANB-CLD patients underwent reverse transcription-polymerase chain reaction assay to detect viremia and 76 (93.8%) had a detectable level of HCV-RNA. Titers of anti-AR142 were not different among groups of different disease activities, genotypes of HCV, nor amount of serum HCV-RNA. These observations suggest that anti-AR142 could be a useful marker for chronic HCV infection.

33-kDa peptides prepared from chicken gizzard smooth muscle bundle both actin and desmin filaments in vitro

A group of 33-kDa peptides was prepared from chicken gizzard. Gizzard smooth muscle was extracted with Hasselbach-Schneider's high ionic strength solution. The extract was fractionated by ammonium sulfate precipitation. The soluble fraction obtained at 60% ammonium sulfate saturation was dialyzed against 0.1 M KCl. The precipitate formed during the dialysis mainly contained 33-kDa peptides. On SDS-PAGE, two major bands and one minor band were stained reddish purple by Coomassie Brilliant Blue R-250. These peptides, which were insoluble in physiological salt solutions, bundled not only actin filaments but also desmin filaments. Actin was markedly coprecipitated with the 33-kDa peptides on the usual centrifugation at 22,000 x g.

[The utility of endoscopic ultrasonography (EUS) in endoscopic mucosal resection of early gastric cancer]

The utility of EUS was evaluated in 27 patients with early gastric cancer undergoing endoscopic mucosal resection over the past 2 years. Accuracy of the assessment of depth of cancerous invasion was studied in 16 patients undergoing EUS before endoscopic mucosal resection. Patients showing no changes in the submucosal (sm) layer or below on EUS included 15 with mucosal (m) cancer and one with sm cancer showing very slight infiltration. Seven patients with m cancer, a negative stump, and no ulcer in the cancer focus at endoscopic mucosal resection, were followed up for more than 1 year after endoscopic mucosal resection. On EUS, four patients showed Ul-IIs changes resembling benign ulcers, two showed Ul-IIIs changes and two showed no changes in the sm layer or below. All patients were negative for cancer in follow up biopsies. No lymphadenopathy was observed. EUS was effective in diagnosing the depth of cancerous invasion in patients undergoing endoscopic mucosal resection and also in clarifying changes in the sm and deeper layers during follow up.

Urinary beta 2-microglobulin concentration and mortality in a cadmium-polluted area

A 9-y follow-up study of 3,178 persons who lived in a cadmium-polluted area was conducted to assess the influence of environmental cadmium exposure on long-term outcome. The standardized mortality ratios of the urinary beta 2-microglobulin-positive subjects (> 1,000 micrograms/g creatinine) of both sexes were higher than those of the general Japanese population, whereas the cumulative survival curves were lower than those of the urinary beta 2-microglobulin-negative group. A significant association was also found between urinary beta 2-microglobulin and mortality, using a Cox's proportional hazards model. Moreover, mortality rates increased in proportion to increases in the amount of urinary beta 2-microglobulin excreted. These results suggest that the prognosis for cadmium-exposed subjects with proximal tubular dysfunction is unfavorable. The mortality rate tended to become higher as the severity of renal dysfunction progressed.

Accumulation of new quinolones in the blood of elderly patients

The correlation between serum levels of five new quinolones (norfloxacin, ofloxacin, enoxacin, ciprofloxacin and lomefloxacin), age and 24 h creatinine clearance was studied in 180 patients. One of five new quinolones was orally administered, before transurethral resection of the prostate, at the dosage of 200 mg three times daily for 3 consecutive days. Serum levels were checked 5.5 h or about 17 h after the final administration. Creatinine clearance was found to be negatively correlated with aging (P < 0.001). After oral administration, the level of certain accumulated new quinolones in serum increased with the age of patients (P < 0.001-0.1). This tendency was more marked for ofloxacin, lomefloxacin and enoxacin than for ciprofloxacin and norfloxacin. The investigators concluded that the level of accumulated new quinolones in serum with aging is correlated to the 24 h urinary excretion rate of each new quinolone. These results indicate that ofloxacin, lomefloxacin and enoxacin, which have higher 24 h urinary excretion rates, should be administered at lower doses according to the age of the patient, in order to prevent adverse reactions.

Enhanced production of rat interleukin-8 by in vitro and in vivo infections with influenza A NWS virus

We investigated the interleukin-8 (IL-8)-producing activity of influenza A NWS virus in cultured rat kidney NRK-52E cells and a rat influenza model. The production of rat IL-8 increased significantly in the virus-infected cells but not in UV-inactivated virus- or split-product-treated cells. The increase in IL-8 production could be detected in the bronchoalveolar lavage of infected rats. These data suggest that infectious virus has the potential to accelerate the production of IL-8 in cultured cells and in vivo in airway-lining cells.