Biochemical characterization of various catalytic complexes of the brain platelet-activating factor acetylhydrolase

Brain intracellular platelet-activating factor acetylhydrolase (PAF-AH) isoform I is a member of a family of complex enzymes composed of mutually homologous alpha(1) and alpha(2) subunits, both of which account for catalytic activity, and the beta subunit. We previously demonstrated that the expression of one catalytic subunit, alpha(1), is developmentally regulated, resulting in a switching of the catalytic complex from alpha(1)/alpha(2) to alpha(2)/alpha(2) during brain development (Manya, H., Aoki, J., Watanabe, M., Adachi, T., Asou, H., Inoue, Y., Arai, H., and Inoue, K. (1998) J. Biol. Chem. 273, 18567-18572). In this study, we explored the biochemical differences in three possible catalytic dimers, alpha(1)/alpha(1), alpha(1)/alpha(2), and alpha(2)/alpha(2). The alpha(2)/alpha(2) homodimer exhibited different substrate specificity from the alpha(1)/alpha(1) homodimer and the alpha(1)/alpha(2) heterodimer, both of which showed similar substrate specificity. The alpha(2)/alpha(2) homodimer hydrolyzed PAF and 1-O-alkyl-2-acetyl-sn-glycero-3-phosphorylethanolamine (AAGPE) most efficiently among 1-O-alkyl-2-acetyl-phospholipids. In contrast, both alpha(1)/alpha(1) and alpha(1)/alpha(2) hydrolyzed 1-O-alkyl-2-acetyl-sn-glycero-3-phosphoric acid more efficiently than PAF. AAGPE was the poorest substrate for these enzymes. The beta subunit bound to all three catalytic dimers but modulated the enzyme activity in a catalytic dimer composition-dependent manner. The beta subunit strongly accelerated the enzyme activity of the alpha(2)/alpha(2) homodimer but rather suppressed the activity of the alpha(1)/alpha(1) homodimer and had little effect on that of the alpha(1)/alpha(2) heterodimer. The (His(149) to Arg) mutant beta, which has been recently identified in isolated lissencephaly sequence patients, lost the ability to either associate with the catalytic complexes or modulate their enzyme activity. The enzyme activity of PAF-AH isoform I may be regulated in multiple ways by switching the composition of the catalytic subunit and by manipulating the beta subunit.

Possible involvement of IL-12 expression by Epstein-Barr virus in Sjögren syndrome

AIM

To determine the correlation between interleukin 12 (IL-12) expression and Epstein-Barr virus (EBV) in Sjögren syndrome.

METHODS

Indirect immunohistochemical technique, enzyme linked immunosorbent assay (ELISA), and immunoblot analysis were used to investigate IL-12 expression by EBV activation, using 13 surgical specimens and four B cell lines.

RESULTS

Marked expression of IL-12 was found in the epithelial cells and the infiltrating B cells of salivary gland tissues from patients with Sjögren syndrome (six of 10 cases), but not in those from normal individuals (none of three cases). A striking topographic correlation between IL-12 and EBV was found. In addition, levels of IL-12 production by B cell lines were clearly enhanced by EBV activation in vitro.

CONCLUSIONS

IL-12 expression closely reflects the intracellular event of EBV activation in Sjögren syndrome, and may contribute to the T helper cell type 1 (Th1) cytokine overexpression seen in this disease.

[A case of pelvic aggressive angiomyxoma involving urinary bladder]

A 23-year-old man visited hospital with the complaints of hematuria and miction pain. Computed tomography and magnetic resonance imaging of the pelvis showed a large pelvic tumor contiguous to the urinary bladder. Resection of the tumor with partial cystectomy was performed on February, 1998. Histopathological examination showed that the tumor composed of angiomyxoma infiltrating into the urinary bladder. The patient is alive without recurrence of aggressive angiomyxoma 12 months after surgery. To our knowledge, this is the first report in the Japanese literature of aggressive angiomyxoma involving the urinary bladder. Awareness of this uncommon neoplasma is important in the diagnosis of pelvic tumor to prevent an extensive surgery.

Increased glomerular cytosolic phospholipase A2 activity of OLETF rats with early diabetes

In view of the potential role of prostaglandins (PGs) in development of glomerular hyperfiltration leading to diabetic nephropathy, we studied the temporal relationship of the activity of cytosolic phospholipase A2 (cPLA2), a rate-limiting enzyme for eicosanoid biosynthesis, with hyperfiltration and the histological changes in glomeruli using OLETF rats, a model for non-insulin-dependent diabetes mellitus (NIDDM). Diabetes mellitus and associated histopathological changes, which developed spontaneously by 30-46 weeks after birth of OLETF rats, were accompanied by approximately 65% increase in glomerular cPLA2 activity that showed significant correlations with elevated plasma glucose levels and creatinine clearance. Moreover, mesangial cells cultured for 5 days with high glucose exhibited approximately 2-fold higher cPLA2 activity than those cultured with physiologic level of glucose. These data suggest that increased glomerular cPLA2 activity leads to production of PGs, which may promote the progression of early diabetic glomerular hyperfiltration and subsequent diabetic nephropathy.

Vectorcardiographic evaluation of myocardial infarct size: comparisons with thallium myocardial scintigraphy

OBJECTIVE

To determine the usefulness of vectorcardiography (VCG) in assessing myocardial infarct size.

METHODS

The correlation of spatial and scalar parameters of VCG with the percent defect volume (%DV) of thallium myocardial single photon emission computed tomography (SPECT) was investigated in 63 patients with first-onset myocardial infarction (MI). VCG parameters included: (1) spatial parameters: magnitude, azimuth and elevation of the maximal vector, vectors at 20 ms and 30 ms, and (2) scalar parameters: amplitudes of 20 ms and 30 ms vectors at X, Y, and Z scalar leads abbreviated as X20, Y20, Z20, X30, Y30 and Z30, respectively.

RESULTS

For anteroseptal MI, the azimuth of 30 ms vector and Z20 showed a significant correlation with %DV (r = 0.572, P < 0.05 and r = 0.832, P < 0.001) while in anteroseptal MI with involvement of lateral wall, the azimuth of 30 ms vector and X30 were correlated with %DV significantly (r = 0.775, and r = 0.780, P < 0.01). For inferior and inferoposterior MI, the elevation of 30 ms vector and Y30 were correlated well with %DV (r = 0.871, P < 0.01, r = 0.928, P < 0.001 for inferior MI and r = 0.678, P < 0.01, r = 0.760, P < 0.001 for inferoposterior MI).

CONCLUSION

VCG parameters, especially scalar parameters, can be used to evaluate myocardial infarct size easily and non-invasively with remarkable accuracy.

Androgenetic complete mole coexistent with a twin live fetus

OBJECTIVE

The aim of this study was to evaluate the clinical course and the management policy of complete mole coexistent with a twin live fetus confirmed with DNA polymorphism in a single hospital.

METHODS

From 1981 to 1995, six patients with androgenetic complete hydatidiform mole coexistent with a twin live fetus were diagnosed by DNA polymorphism analysis. The clinical course of these six patients was analyzed.

RESULTS

Two patients chose to terminate pregnancies and four patients desired to continue the pregnancy. However, the pregnancy had to be interrupted in two patients because of severe preeclampsia and sudden intrauterine fetal death. In two patients, fetuses were growing unremarkably and normal babies were delivered at term. The development of persistent trophoblastic tumor (PTT) in these rare pregnancies was higher (50.0%: 3/6) than that of single complete mole. In three patients, serum hCG titers during pregnancy were monitored. Although serum hCG levels progressively decreased during pregnancy in one patient without PTT, hCG levels initially decreased, but subsequently increased or showed a plateau with advancing gestational age in two patients with PTT.

CONCLUSIONS

In patients with complete mole coexistent with a live fetus, the pregnancy may be allowed to continue when the fetal karyotype and development are normal and serum hCG titers are constantly falling with advancing gestational age.

67Ga whole-body scintigraphy in the evaluation of head and neck squamous cell carcinoma

The diagnostic accuracy of 67Ga-citrate whole-body scintigraphy for the evaluation of primary tumours, local recurrences, cervical node metastases and distant metastases was investigated in patients with head and neck squamous cell carcinoma (SCC). Altogether, 102 67Ga-citrate whole-body scans were performed on 83 patients with head and neck SCC using a dual-headed gamma camera. The results were compared with those of computed tomography (CT) and final diagnosis. 67Ga scintigraphy correctly diagnosed 28 of 29 primary lesions, a sensitivity of 97% (CT = 97%). For tumour recurrence, 67Ga scintigraphy correctly diagnosed 13 of 15 recurrences and 53 of 58 instances of no recurrence, giving a sensitivity of 87% and a specificity of 91% (CT = 80 and 62%, respectively). Scintigraphy correctly diagnosed 23 of 31 metastatic sides of the neck and all 173 negative sides of the neck, giving a sensitivity of 74% and a specificity of 100% (CT = 90 and 84%, respectively). Finally, scintigraphy correctly diagnosed all 12 distant metastases as well as 86 of 90 cases of no metastasis, resulting in a sensitivity of 100% and a specificity of 96%. Furthermore, in five patients, distant metastases were initially detected on 67Ga scintigraphy. In conclusion, 67Ga whole-body scintigraphy with a dual-headed camera resulted in a high sensitivity and specificity for the detection of primary lesions, recurrences and distant metastases of head and neck SCC. Although the sensitivity for detecting neck node metastases was relatively low, the specificity was high. Thus, 67Ga scintigraphy is an effective technique for the evaluation of head and neck SCC, especially tumour recurrence and distant metastases.

Small GTPase RhoD suppresses cell migration and cytokinesis

Rho family small GTPases regulate organization of the actin cytoskeleton. Among them, RhoA plays essential roles in the formation of the actin stress fibers, the associated focal adhesions, and the contractile rings necessary for cytokinesis. Recently, RhoD, a novel member of Rho family has been identified. The amino acid sequences of its effector domain is distinct from those of the other Rho family proteins, suggesting its unique cellular functions. Introduction of the constitutively active form of RhoD(G26V) into fibroblasts by microinjection or transfection resulted in disassembly of the actin stress fibers and the focal adhesions, whereas the dominant negative form of RhoD(T31K) did not affect these structures. The degree of cell migration assessed by the phagokinetic tracks on a substrate covered with gold particles was diminished by the expression of RhoD(G26V) but not by RhoD(T31K). Thus, cytoskeletal alterations including the loss of stress fibers and focal adhesions by RhoD seems to lead to the retardation of cell migration. Transfection of RhoD(G26V) cDNA into cultured cells also induced multinucleation. Moreover, RhoD(G26V) microinjected into fertilized eggs and embryos of Xenopus laevis caused cleavage arrest only in the injected cells, and the uncleaved cells contained multiple nuclei. These results imply that RhoD does not affect nuclear division but can interfere with cytokinesis presumably by preventing the formation of the actin-based contractile ring. Enhancement of the stress fibers by RhoA or RhoA-activating lysophosphatidic acid was reversed by the transfection of RhoD cDNA. Accordingly, the cellular functions of RhoD are likely to be antagonistic to those of RhoA.

[The role of angioscopy and intravascular ultrasound imaging in acute coronary syndrome]

Evaluation of the severity of coronary atherosclerosis by intracoronary imaging may be closely relevant with the prevention and treatment of acute coronary syndromes. Coronary angioscopy as one of the innovative methods of imaging and intravascular ultrasound makes the insight visualization of coronary vessel wall and histological recognition possible recently. Yellow plaques rich in lipid materials and covered by thin membrane are more often ruptured than white ones to cause acute coronary syndromes. In patients with unstable angina and acute myocardial infarction, the yellow plaques with intimal flaps and irregularities are frequently observed by angioscopy. Angioscopy is also the most powerful tool to detect intracoronary thrombus. In patients with acute myocardial infarction, thrombosis occludes vessel lumen totally, but it does not in the unstable angina cases. After thrombolytic therapy, the white thrombus is more often observed than the red one. Although angioscopy is superior to any other examination in diagnosing thrombosis, some complicated plaques are difficult to distinguish from thrombus. In addition to measurements of vascular dimension and plaque volume, histological diagnosis of plaque is being made by intravascular ultrasound. More precise evaluation of plaque histology may be a clue to predict the occurrence of acute coronary syndrome. Intravascular ultrasound is not so useful enough to diagnose thrombosis. In conclusion, the applications of intravascular imaging technologies, such as angioscopy and intravascular ultrasound, may play a critical role in the diagnosis and treatment of acute coronary syndromes.

Ultrasonography in the diagnosis of palatal tumors

OBJECTIVE

The purpose of this study was to evaluate the usefulness of ultrasonography for the preoperative evaluation of palatal salivary gland tumors.

STUDY DESIGN

Eleven surgically treated patients with salivary gland tumors of the palate were examined retrospectively. Intraoral ultrasonic scanning examinations were performed with a 10-MHz transducer.

RESULTS

The ultrasonographically well-delimited tumors had a complete capsule histologically, whereas the poorly delimited tumors had no capsule or only an incomplete capsule. The tumors that had a reinforced posterior wall echo were associated with pressure bone absorption, and the tumors that had a reinforced posterior echo were associated with bone destruction. Echograms of the tumors were classified into 4 types on the basis of the internal echoes.

CONCLUSIONS

Intraoral ultrasonography of palatal tumors can be used to determine the localization and condition of the tumors by close analysis of the echogram. The internal echo pattern on the ultrasonogram of a palatal tumor was found to reflect the pathologic structure of the tumor. Ultrasonography can therefore be a quite useful technique for the preoperative evaluation of palatal salivary gland tumors.

[Implementing HPN in an SEP case following long-term CAPD]

BACKGROUND

Sclerosing encapsulating peritonitis (SEP) is one of the most serious complications in continuous ambulatory peritoneal dialysis (CAPD). SEP causes severe bowel obstruction leading to malnutrition and eventually to a high mortality rate. The basic strategy for the care of SEP is to sustain the rest of the bowel, i.e., long-term TPN. We report a case successfully restored to a useful life through HPN.

CASE PRESENTATION

The patient is a 26-year-old man, diagnosed as primary nephrotic syndrome in 1980. He had to begin hemodialysis (HD), which was immediately switched to CAPD, due to uremia in 1983. He had been on CAPD for 12 years since that time. He developed SEP as a serious complication of CAPD in July, 1995. CAPD was discontinued, and maintenance HD was started three times a week. Although only liquid diet (such as Renalen and Ensure-Liquid) was allowed as a meal, he often developed intermittent bowel obstruction and repeated hospitalizations were needed to relieve the symptoms. Home parenteral nutrition (HPN) was implemented in May, 1997, in the hope of improving his quality of life. No hospitalization has been needed since then. At present, he is working as an active pharmacist utilizing the HPN system developed by Terumo Co., Ltd. So far a few HPN pump failures have been encountered, but they were promptly handled by the Home Health Care Business Project staff at Terumo Co., Ltd.

CONCLUSION

Although further improvements of the present HPN system are necessary, HPN can be a useful tool to effectively manage SEP patients who are suffering from persistent or intermittent bowel obstruction.

Genetic differentiation of complete hydatidiform moles coexisting with normal fetuses by short tandem repeat-derived deoxyribonucleic acid polymorphism analysis

OBJECTIVE

We applied deoxyribonucleic acid polymorphism analysis on the basis of differences in the number of short tandem repeat sequences to genetically differentiate dizygotic twins with complete hydatidiform moles and normal fetuses from partial moles presenting a similar appearance.

STUDY DESIGN

Six pregnant women exhibiting apparent moles and coexisting fetuses were the subjects of this study. Eight polymorphic loci including short tandem repeat sequences were amplified by polymerase chain reaction from deoxyribonucleic acid of peripheral leukocytes of parents, umbilical cord, grossly normal placenta-villi, and molar tissue. The segregation of alleles among samples were determined by comparing band patterns on polyacrylamide gels.

RESULTS

In all 6 cases amplifications of polymorphic loci provided sufficient information to determine the parental origin. At informative loci the alleles of cord and placenta-villi were transmitted from both patients and husbands whereas molar tissue had only paternal alleles. These allele segregations indicated 2 different genetic origins, namely, normal parental for a fetus and androgenetic for molar tissue, and thus the diagnosis of dizygotic twins with a complete hydatidiform mole and a normal fetus was made. Additionally, the molar component was defined as a heterozygous mole in 2 cases.

CONCLUSION

Short tandem repeat-derived deoxyribonucleic acid polymorphism analysis was demonstrated to be a useful and precise procedure for the differential diagnosis of a complete hydatidiform coexisting with a normal fetus and the determination of its zygosity as well.

Familial hypercholesterolemia with cholesteryl ester transfer protein deficiency

A 21-year-old male was clinically diagnosed with familial hypercholesterolemia (FH) by the manifestations of hypercholesterolemia, tendon xanthoma and family history of premature coronary heart disease. Low density lipoprotein receptor gene was analyzed in attempt to determine a possible point mutation. The normal sequence was partially preserved, and the patient was genetically diagnosed as a heterozygote of FH. In addition, screening for two cholesteryl ester transfer protein (CETP) gene mutations common to Japanese revealed the patient to be a heterozygote of CETP deficiency. A complication of two influential mutations for atherosclerotic ailments was genetically ascertained.

Tumor necrosis factor-alpha regulates the gene expression of macrophage migration inhibitory factor through tyrosine kinase-dependent pathway in 3T3-L1 adipocytes

Macrophage migration inhibitory factor (MIF) has been rediscovered as a proinflammatory cytokine, pituitary hormone, and glucocorticoid-induced immunoregulator. We have recently identified the expression of MIF in adipocytes and found that tumor necrosis factor (TNF)-alpha stimulates its secretion from 3T3-L1 adipocytes. Since adipocytes are regarded as a potential source of various biologically active substances, we examined in more detail the effect of TNF-alpha on MIF expression in 3T3-L1 adipocytes in the present study. We found that TNF-alpha induced MIF mRNA in dose- and time-dependent manners. After stimulation with TNF-alpha, the amount of intracellular MIF protein was unchanged or slightly decreased, concomitant with increased release of this protein into the extracellular space. This observation indicates that TNF-alpha stimulates MIF secretion from the constitutively expressed intracellular pool of 3T3-L1 adipocytes and promotes de novo synthesis of MIF. From evaluation of the mechanism of MIF gene expression, we found that tyrosine kinase inhibitors, either genistein or herbimycin A, suppressed the MIF mRNA induction by TNF-alpha. The results suggest the possibility that upregulation of MIF mRNA expression by TNF-alpha is mediated by a tyrosine kinase-dependent pathway. Taken together, the present observations shed light on the role of MIF in the metabolism of obesity and diabetes.

TSH receptor antibody-associated thyroid dysfunction following subacute thyroiditis

OBJECTIVE

Autoimmunity plays an important role in the development of thyrotrophin (TSH) receptor antibodies and the pathogenesis of Graves' disease and Hashimoto's thyroiditis. On the other hand, subacute thyroiditis is a self-limited inflammatory disease of presumed viral aetiology. The aim of this study was to examine whether subacute thyroiditis triggers TSH receptor antibody-associated thyroid disorders.

PATIENTS

We reviewed 1,697 patients with subacute thyroiditis seen between 1985 and 1995.

DESIGN AND MEASUREMENTS

We measured antibodies which inhibit the TSH binding to the TSH receptor (TBIAb), thyroid stimulating antibodies (TSAb) and antibodies that block TSH action (TBAb). Other thyroid autoantibodies were also determined.

RESULTS

TBIAb became positive in 38 patients following subacute thyroiditis. Thyroid function after the development of TBIAb appeared to be influenced by the bioactivity of the antibody. Hyperthyroidism developed in the presence of TSAb, and so did hypothyroidism in the presence of TBAb, although 21 patients did not have thyroid dysfunction despite high titres of TBIAb. Fifteen out of 17 patients recovered from hyperthyroidism or hypothyroidism after the disappearance of TBIAb sometimes even without medication. TBIAb-positive patients had a high incidence of a family history of thyroid disease and positive anti-thyroid microsomal antibodies. An ophthalmopathy similar to Graves' disease was also observed in 3 patients.

CONCLUSIONS

Subacute thyroiditis may trigger autoreactive B cells to produce TSH receptor antibodies, resulting in TSH receptor antibody-associated thyroid dysfunction in some patients.

Elevated serum granulocyte colony-stimulating factor levels in patients with Graves' disease

OBJECTIVE

Agranulocytosis is a serious side effect of anti-thyroid drugs (ATD). Granulocyte colony-stimulating factor (G-CSF) is one of the cytokines that increase granulocyte number. The aim of this study was to examine the sequential variation of serum G-CSF levels in patients with Graves' disease before and after ATD therapy.

PATIENTS

Sixty-three patients with Graves' disease were studied before, during and after treatment with methimazole (MMI). Serum samples from 71 healthy subjects were used as controls.

DESIGN AND MEASUREMENTS

Serum levels of G-CSF were measured by a novel chemiluminescent enzyme immunoassay, which was sensitive enough to determine G-CSF levels in healthy subjects. Blood granulocyte counts, serum, thyroid hormone and TSH levels, and titres of thyroid autoantibodies were also measured.

RESULTS

Serum G-CSF levels in Graves' patients before and 2 weeks after MMI were significantly higher than in healthy subjects. There was a significant correlation between serum G-CSF levels and granulocyte counts in untreated patients with Graves' disease. Untreated patients with granulocyte counts less than 2 x 10(9)/I had significantly lower serum G-CSF levels as compared with other untreated patients. Serum G-CSF levels gradually decreased thereafter. No correlation was observed between serum G-CSF levels and serum thyroid hormone levels or titres of thyroid autoantibodies. After ATD treatment, no correlation was found between serum G-CSF levels and granulocytes counts. There was no significant correlation between the change of serum G-CSF levels and that of granulocyte counts before and after MMI treatment. Graves' patients with mild agranulocytosis had normal or elevated serum G-CSF levels.

CONCLUSIONS

Significantly elevated serum G-CSF levels were observed in patients with Graves' hyperthyroidism. During ATD therapy, deficiency of G-CSF was not identified as a cause of agranulocytosis in this study.

Chromatographic screening of growth inhibitors for Cladosporium herbarum in the extracts of calcareous red algae

The thin-layer chromatographic screening of growth inhibitors for an imperfect fungus was carried out in two types of calcareous red algae, Corallina pilulifera (Corallinaceae) and Lithothamnium pacificum (Corallinaceae) and Crathromorchum circumscriptum (Corallinaceae). Several substances having positive activities on Cladosporium herbarum were detected in the alcoholic extracts of the marine plants. The observed differences among the substances can be attributed to the morphological characteristics of the sea weeds.

[Comparison of effects of thrombolytic therapy followed by elective coronary intervention and direct coronary intervention in acute myocardial infarction: usefulness of dobutamine stress echocardiography]

The effects of intravenous administration of tissue plasminogen activator (t-PA) followed by elective percutaneous transluminal coronary angioplasty (PTCA) were compared to those of direct PTCA (d-PTCA) in patients with acute myocardial infarction using dobutamine stress echocardiography 1 week and 1 month after the acute episode. There were 12 patients in the t-PA group and nine patients in the d-PTCA group. Dobutamine was infused at incremental doses (5 micrograms/kg/min for each 5 min step). Wall motion changes were classified during infusion into four patterns, improvement, biphasic, worsening and no change. One week after the acute episode, seven of 12 patients in the t-PA group showed biphasic the pattern and five showed the improvement pattern. The biphasic pattern was observed in three patients in the d-PTCA group, worsening in one and improvement in five. One month later, the biphasic pattern in five patients in the t-PA group changed to the improvement pattern. No patients in the d-PTCA group showed changes in the wall motion pattern. There was no difference between the two groups in the frequency of the change of wall motion patterns 1 week and 1 month after infarction, but the improvement pattern was significantly increased from five to 10 patients in the t-PA group after 1 month (p < 0.05). The sensitivity, specificity and accuracy of the biphasic pattern in the t-PA group for indicating remnant coronary stenosis were 78%, 100% and 83%, respectively. Evaluation of wall motion pattern by dobutamine stress echocardiography is useful for assessment of reperfusion therapy for acute myocardial infarction. The administration of t-PA followed by elective PTCA has similar efficacy to d-PTCA.

[Local eosinophilia of the nose, the larynx and the trachea in rats sensitized with Japanese cedar pollen]

Eight Brown Norway rats were immunized twice at days 0 and 13 by intraperitneal injections of 10 micrograms Cry j I, one of major allergen to Japanese cedar pollinosis, mixed with 4.5 mg aluminium hydroxide gel. Serum level of Anti-Cry j I IgE antibody was detected by the method of ELISA. Mean value of serum levels of specific IgE to Cry j I in the sensitized rats was significantly higher than that in the non-sensitized five rats (p < 0.01). The grades of eosinophil and lymphocyte accumulation in the nasal mucosa of the sensitized rats were higher than those in the non-sensitized rats respectively (p < 0.05, p < 0.01). In the laryngeal mucosa, the grade of eosinophilia in the sensitized rats was higher than that in the control (p < 0.01), but no significant differences of lymphocyte accumulation in the larynx between the two groups were found. Only a small number of eosinophil and lymphocyte accumulations in the trachea of the both groups were observed and no significant differences of the grade of inflammatory cells accumulation between the two groups were found. According to the results of this fundamental study, allergic laryngitis in Japanese cedar pollinosis might be originated from Japanese cedar pollen.

[Efficacy and safety of sulbactam/cefoperazone for hepato-biliary infections]

We studied efficacy and safety of sulbactam/cefoperazone (SBT/CPT) in the treatment of biliary tract infections in hospitalized patients at 26 hospitals from February 1993 to March 1995. Secondary to dropout, 273 out of 338 patients entered in the study were evaluated, 127 patients with cholecystitis, 132 patients with cholangitis, and 14 patients with liver abscesses. Of these, 93 patients (34.1% had malignancy as an underlying disease. SBT/CPZ had an efficacy of 79.9% (218 patients; excellent: 52, good: 166), with the efficacy in patients with cholecystitis, cholangitis and liver abscess at 89.0% (113 patients), 77.3% (102 patients and 21.4% (3 patients), respectively. A significant difference (p < 0.05) was observed in the efficacy rates of patients with (59 patients [63.4%]) and without malignancy (159 patients [88.3%]). A total of 84 strains were isolated from bile specimens of 53 patients, and the major isolates were Escherichia coli, Pseudomonas aeruginosa and Enterococcus spp. Two or more bacterial strains were isolated simultaneously in 20 patients. Mild or moderate side effect (allergic reaction including rash etc.) were noted in 4 patients (1.18%), and laboratory abnormalities (increased GOT, etc.) were in 16 patients (4.71%) out of the total 338 patients. This study clearly demonstrated that SBT/CPZ retains its excellent clinical efficacy and safety profile, throughout its use over the past decade.

[A case of cardiovascular Behçet's disease detected as multiple nodular shadows on chest X-ray]

A case of cardiovascular Behçet's disease is reported. A 30-year-old man was admitted to our hospital with a high fever. Multiple nodular shadows were revealed on chest X-ray. Echocardiography revealed a mural thrombus in the right ventricle. A diagnosis of multiple pulmonary septic embolisms was made, and antibiotics were administered. The mural thrombus soon resolved, but later recurred in the same location. On the 90th day after admission. The mural thrombus was surgically removed. Histologically, the thrombus consisted of numerous neutrophils and fibrin. Examination of the endocardium attached to the thrombus revealed nonspecific inflammation, with fibrotic change and necrosing granulation present. A diagnosis of cardiovascular Behçet's disease was made based on the following findings: oral ulcerations, acneiform nodules, thrombophlebitis, bilateral uveitis, and positive HLA-B51. After treatment with steroid hormones and cyclosporine, the thrombus resolved completely, and inflammatory signs diminished. Though various clinical and pathological characteristics of cardiovascular Behçet's disease have been reported, it is rare for a mural thrombus to produce multiple pulmonary septic embolisms.

Serum concentrations of myoglobin vs human heart-type cytoplasmic fatty acid-binding protein in early detection of acute myocardial infarction

We compared the diagnostic utility of serum concentrations of human heart-type cytoplasmic fatty acid-binding protein (H-FABPc), myoglobin, and their ratio for the early diagnosis of acute myocardial infarction (AMI) in 104 healthy volunteers and 165 patients at admission within 6 h of the onset of chest pain. The ROC curves of the H-FABPc [0.946, 95% confidence interval (CI) = 0.913-0.979] and myoglobin (0.895, 95% CI = 0.846-0.944) between patients with AMI and healthy volunteers were significantly greater than the area under the ratio of myoglobin to H-FABPc (0.823, 95% CI = 0.765-0.881). In 165 patients, the sensitivity (81.8%, 95% CI = 74.2-89.4%), specificity (86.4%, 95% CI = 78.1-94.6%), and predictive accuracy (83.6%, 95% CI = 78.0-89.3%) of H-FABPc > 12 micrograms/L in diagnosing AMI were significantly higher than those of myoglobin, and were similar to those of the combination of H-FABPc > 12 micrograms/L and the ratio < or = 14. We conclude that H-FABPc is a more sensitive and specific marker than myoglobin for the early diagnosis of AMI, and that their ratio cannot give a clear advantage over the measurement of H-FABPc alone.