A 15 year follow-up study of patients with non-insulin dependent diabetes mellitus (NIDDM) in Osaka, Japan. Long-term prognosis and causes of death

A 15 year follow-up study of diabetic patients was performed in Osaka, Japan. The subjects studied were 1939 patients with non-insulin dependent diabetes mellitus (NIDDM), of whom 1000 (51.5%) were alive, 880 (45.4%) had died and 59 (3.0%) were untraceable at the end of 1993. The mortality rate per 1000 person-years of the subjects increased from 28.94 in 1960-1984 to 35.74 in 1985-1993, but the ratio of numbers of observed to expected deaths (O/E ratio) declined from 1.77 to 1.52 for the corresponding periods, suggesting an improvement in the prognosis for diabetic patients, with the exception of patients 65 years or over at the time of entry. Cerebro-cardiovascular and renal diseases were major causes of death, accounting for 48.4% of all deaths. In particular, disease of the heart was the cause of death in 20.5% of all deaths, cerebrovascular disease in 14.5% and renal disease in 12.0%. The O/E ratio was 11.30 for renal disease, which was remarkably high. The O/E ratios were 1.48 for malignant neoplasms, 3.02 for cancer of the liver and 2.15 for cancer of the pancreas. In the subjects less than 65 years of age at entry, a significant decrease in the O/E ratio for overall deaths, malignant neoplasms, disease of the heart, cerebrovascular disease and renal disease was observed, but no notable difference in the O/E ratio for ischemic heart disease was found between the periods 1960-1984 and 1985-1993. By contrast, in the case of subjects 65 years or more at entry, the O/E ratios for overall deaths, malignant neoplasms, disease of the heart, ischemic heart disease and cerebrovascular disease increased markedly in the later period, while there was a considerable decline in renal disease indicated during this period. The analysis suggested a structural change in causes of death of Japanese diabetic patients in recent years, with a relative increase in ischemic heart disease and a relative decrease in renal disease.

MHC class II molecules are not required for survival of newly generated CD4+ T cells, but affect their long-term life span

We grafted fetal thymi from wild-type mice into immunodeficient RAG-2-/- or class II-/-RAG-2-/- (class II MHC-) recipients and followed the fate of naive CD4+ T cells derived from the grafts. In both types of recipients, newly generated CD4+ T cells proliferated to the same extent in the periphery and rapidly filled the empty T cell compartment. However, CD4+ T cells in class II- recipients gradually decreased in number over 6 months. These results show that interactions between the TCR and class II molecules are not required for newly generated CD4+ T cells to survive and proliferate, but are necessary to maintain the size of the peripheral T cell pool for extended periods.

Adult cystic Wilms' tumor (nephroblastoma): radiologic features with pathologic correlation

Wilms' tumor is an uncommon disease in adults. Wilms' tumor typically presents as a large complex mass with cystic component and varying degrees of vascularity. The previously reported radiologic findings have reflected this complex appearance. We present a case of cystic Wilms' tumor in an adult patient. The tumor presented as a large, rapidly growing, hypovascular, multicystic mass with minimal solid component which showed as septation on ultrasound, contrast enhanced CT, and MR studies. The preoperative findings were suggestive of multilocular cystic nephroma. We suggest that Wilms' tumor should be included in the differential diagnosis of a patient who presents with a large, rapidly growing, multicystic renal mass.

Retrospective analysis of long-term surgical results in acromegaly: preoperative and postoperative factors predicting outcome

OBJECTIVE

Sixty-one of 83 patients with acromegaly treated between 1969 and 1993 were analysed retrospectively to clarify which early postoperative factors were significant predictors of a successful long-term outcome and which preoperative factors significantly influenced the early postoperative results.

PATIENTS

Of the 61 patients, 30 were operated on before 1987 and 31 afterwards. A successful long-term surgical outcome was defined as a long-term mean basal GH level < 6 mU/l (comparable to < 3 micrograms/l), a normal IGF-I level, and normal GH dynamics.

RESULTS

Overall, 59% of patients (37% before 1987 and 81% after) had an early postoperative mean basal GH level < 6 mU/l, and 56% (29% before 1987 and 77% after) met all three of the specified criteria for a successful long-term surgical outcome. Statistical analysis confirmed that GH dynamics and postoperative mean basal GH level < 6 mU/l were significant predictors of the long-term surgical outcome, whereas the postoperative IGF-I level alone was not. On the other hand, abnormal preoperative GH dynamics were normalized in all patients with a postoperative mean basal level < 6 mU/l. In addition, there were no patients showing an unsuccessful long-term outcome in those associated with both the early postoperative mean basal GH level < 6 mU/l and normalization of the IGF-I level. Therefore, measurement of the early postoperative mean basal GH level and the IGF-I level may be an economical and simple guide to predict the long-term surgical outcome. Moreover, multivariate analysis indicated that cavernous sinus invasion was an independent significant factor influencing the early postoperative outcome.

CONCLUSIONS

Successful long-term surgical outcome may be predicted if early postoperative mean basal GH level is reduced to < 6 mU/l (< 3 micrograms/l) and IGF-I level becomes normal. This study also confirms that early diagnosis and treatment by an experienced endocrinologist and neurosurgeon can improve the operative results in patients with acromegaly.

Antibody response to Mycoplasma bovis of calves introduced to a farm contaminated with the organism

Antibody against Mycoplasma bovis in sera of 48 calves introduced to a farm, in which calf pneumonia associated with M. bovis had been occurring in the last 3 years, was detected by an indirect hemagglutination test. Significant rises of antibody titers in sera of calves belonging to the groups A (16 calves) and B (14 calves) were recorded by day 60 post-introduction. On the other hand, a significant increase of antibody titers of 18 calves in group C, which had been administered antibiotics as a preventive therapy, was demonstrated at day 248 after arrival. These results indicated that the spread of M. bovis infection occurred easily on the contaminated farm, and a preventive therapy could delay the outbreak of calf pneumonia associated with M. bovis.

Restriction fragment length polymorphism analysis in the HLA class III genes of patients with diffuse panbronchiolitis

Although diffuse panbronchiolitis (DPB) is known to be positively associated with certain major histocompatibility complex (MHC) class I antigens, e.g., HLA-B54 in Japanese patients, it is not clear whether the MHC genes predispose to the disease or are markers for other disease susceptibility gene(s). Because the HLA class III genes such as tumor necrosis factor (TNF) or the fourth component of complement (C4) are localized in the proximity of the HLA-B locus, one or more of these genes might be responsible for susceptibility to DPB. To analyze the role of HLA class III genes in DPB patients, we first evaluated the HLA-B54 association in 32 patients with DPB, and subsequently, studied the restriction fragment length polymorphism (RFLP) of the TNF-alpha and -beta (TNF-alpha/beta) genes as well as the C4A and B (C4A/B) genes in DPB patients and normal individuals. The HLA-B54 antigen was significantly more frequent in DPB patients than in normal individuals (40.3% vs 13.0%, p < 0.001), however, we did not detect a significant association between DPB and gene polymorphisms of either TNF-alpha/beta or C4A/B. Furthermore, there was no evidence of C4A gene deletion in patients with DPB. These results suggest that the HLA-B54 antigen itself might be directly involved in the pathogenesis of DPB.

Automated fetal breathing movement detection from internal small displacement measurement

We have previously proposed a method to measure small displacements of internal tissue which is based on an ultrasonic pulsed Doppler technique. The Doppler frequency shift of the ultrasonic waves due to the tissue movement is detected using a modified quadrature detector, and the displacement of the internal tissue is estimated by using an arctangent method. Based on the algorithm, we have constructed a quantitative monitoring system for fetal breathing movement. The fetal breathing movement is a rhythmic movement of the fetal diaphragm and it is recorded as a nearly sinusoidal displacement with a repetition frequency from 0.5 Hz to 2 Hz. In this paper, an automated fetal breathing movement detection algorithm for the displacement data observed by using the small displacement measurement system is proposed. This method uses a modified autocorrelation technique for detecting the displacement due to the fetal breathing movement. The method is applied to five fetuses of late pregnancy and the result is compared with the manual detection.

Association of life style with high risk of hyperimmunity and of immunosuppression mediated by IgE

To test the hypothesis that the increase in allergic prevalence is related not only to environmental allergens, but also to comprehensive life style, we administered to 733 workers at a hard metal plant a questionnaire that included 17 physical and mental health practices. We have shown that eight practices are associated with increases or decreases of total and specific IgE levels, serving to keep them within the normal range (5-400 IU/ml), after controlling for age, sex, and environmental factors. Further confirmation of the definite effect of life style on allergic reactions comes from higher heritability among younger pairs of identical twins of total IgE levels and allergic disorders than among older pairs of identical twins. A marked synergism was found among Undesirable life-style factors as bipolar high-risk factors for the development of allergic diseases or immunosuppression characterized by low natural killer (NK) cell activity through which soluble low-affinity IgE receptor is kept low. An effort to practice Desirable life styles, therefore, may be of benefit in reducing the risk of immunoallergic disorders.

Loss of heterozygosity on chromosome 17 and mutation of the p53 gene in retinoblastoma

Loss of heterozygosity (LOH) on chromosome 17 and mutations of the p53 gene were examined in 25 retinoblastomas (RB), consisting of three familial tumors, nine hereditary tumors without family history, 11 non-hereditary tumors, one recurrent tumor and one lung-metastatic tumor. LOH on chromosome 17 was detected in only one of the 23 primary RB. No mutations of the p53 gene were detected in the primary tumors. A recurrent tumor showed LOH on the short arm region of chromosome 17. LOH on chromosome 17 and a point mutation of the p53 gene were also detected in a metastatic tumor. These results suggest that LOH on chromosome 17 and mutation of the p53 gene may not be associated with the development of primary RB, but may play a role in the progression of RB.

Telencephalic afferents to the caudolateral neostriatum of the pigeon

The pigeon caudolateral neostriatum (NCL) shares a dopaminergic innervation with mammalian frontal cortical areas and is implicated in the regulation of avian cognitive behavior. Retrograde tracing methods were used to identify forebrain projections to NCL and to suggest a possible role of this area in mediating spatial behavior. NCL receives telencephalic projections from the hyperstriatum accessorium, cells along the border of hyperstriatum dorsale and hyperstriatum ventrale, anterolateral hyperstriatum adjacent to the vallecula, confined cell groups within the anterior neostriatum, and subdivisions of the archistriatum. In addition, labeling of a small number of large cells near the fasciculus prosencephali lateralis was observed at the level of the anterior commissure. In accordance with previous studies, projections of subtelencephalic areas were revealed to originate from the thalamic posterior dorsolateral nucleus and nucleus subrotundus, as well as from the tegmental nucleus pedunculopontinus and locus coeruleus. Forebrain connections of NCL show that somatosensory, visual, and olfactory information can combine in this division of the neostriatum. NCL is therefore suited to participate in a neural circuit that regulates spatial behavior. Moreover, the present study reveals that NCL is reached by a limbic projection from the nucleus taeniae. This projection also suggests similarity between NCL and mammalian frontal cortical areas.

Effects of portal venous inoculation with donor splenocytes on lung allograft survival in dogs

The effects of portal venous inoculation with donor splenocytes on lung allograft survival were evaluated in dogs. Within the dose range examined, portal venous inoculation with donor splenocytes alone did not affect the graft survival time. Although the mean graft survival time was prolonged by FK 506 treatment for 14 days, the transplanted lungs were rejected within 12 days after termination of FK 506 administration. However, when the recipients were given portal venous inoculation with donor splenocytes at the time of transplantation, the graft survival time after termination of FK 506 administration was significantly prolongated. In the recipients that received combined therapy of portal venous inoculation with donor splenocytes and FK 506 treatment, arterial oxygen tension and histologic architecture of the transplanted lungs remained within the normal range for a longer period than these measures did in control animals that received FK 506 treatment alone. Dose-response experiments revealed that 1 x 10(8) cells/recipient was most effective in causing prolonged graft survival after termination of FK 506 treatment. On the basis of these results, perioperative portal venous inoculation with donor splenocytes can enhance the immunosuppressive effect of FK 506 in the canine lung transplantation model.

Histochemical localization of carbonic anhydrase in the trachea of the guinea pig

Tissue specimens from guinea pigs were examined using an enzyme-histochemical reaction to explore the presence of carbonic anhydrase (CA) activity in the trachea. CA activity was detected in a group of morphologically distinct epithelial cells, in goblet cells, and in glands of the tracheal mucosa. The epithelial cells showing CA activity were distributed singly and sparsely throughout the entire trachea. These cells showed a wide morphological variability and were clearly different from those forming the pseudostratified ciliated epithelium. Their number was higher in sections closer to the tracheal bifurcation than in those near the larynx. Although the nature of these cells is unknown, based on their morphological and histochemical characteristics and their distribution, they may represent a specialized chemoreceptor. To our knowledge, this is the first report of CA localized in tracheal epithelial cells.

[Evaluation of the stability of lipiodol-CDDP: suspension (LCS) by the pumping method]

We purified cisplatin (CDDP) powder from CDDP solution and prepared a Lipiodol-CDDP-suspension (LCS) using the oily contrast medium Lipiodol in order to investigate its stability. Non-ionic contrast materials have surface activity. Iopamidol was chosen as a coupling agent. The compounding ratios of Lipiodol/Iopamidol 300/CDDP for stable suspension were 1 ml/1 ml/10 mg and 1 ml/1 ml/20 mg. These were also obtained easily by using the pumping method.

Amyotrophic lateral sclerosis with hypertensive attacks: blood pressure changes in response to drug administration

Blood pressure changes in response to intravenous drug administration were examined in a respirator-dependent 49-year-old patient with sporadic amyotrophic lateral sclerosis (ALS) who developed severe hypertensive attacks. She showed severe hypertension and tachycardia during the daytime and nocturnal hypotension without compensatory tachycardia, which were consistent with the autonomic phenomenon reported in ALS patients. Infusion of phenotolamine (2.5 mg) induced an abrupt 90 mmHg decrease in systolic pressure and slight increase in heart rate. Propranolol (1 mg) infusion induced decreases in both systolic pressure (36 mmHg) and heart rate (17 beats/min), although the pressure decrease was transient while the heart rate remained at the decreased level Infusion of diazepam (10 mg) induced a 47 mmHg decrease in systolic pressure and a 23 beats/min increase in heart rate. These vasomotor responses indicate the distinct participation of abnormally augmented sympathetic tone, and especially of alpha-sympathetic hyperactivity rather than of beta-sympathetic hyperactivity, in the hypertensive attacks occurring in this ALS patient.

[Three-phase dynamic helical CT for hepatocellular carcinoma: optimal scanning protocol]

To assess the optimal scanning protocol for three-phase dynamic helical CT, 20 patients were examined according to the following 4 methods (5 cases each) : (1) 100 ml Iopamidol (300 mgI/ml), at a rate of 2 ml/sec ; (2) 120 ml,3 ml/sec, (3) 150 ml, 3 ml/sec ; (4) biphasic method, initial 100 ml, 3.3 ml/sec ; remaining 50 ml, 1.6 ml/sec. Assessment of the time-density curve of the aorta, and the liver parenchyma, indicated that protocol (4) was superior to the others. Using protocol (4), 32 patients (62 nodules) with hepatocellular carcinoma underwent three-phase scanning, consisting of early, late, and delayed phases. Out of 61 nodules, 43 nodules were detected as high density areas in the early phase, 7 nodules as low density areas only in the late phase, and 3 nodules as low density areas only in the delayed phase. Compared with MRI, three-phase dynamic helical CT demonstrated numerous nodules, especially those less than 10 mm in diameter, and, therefore, was useful for the detection of hepatocellular carcinoma.

Sweet syndrome in a child with aplastic anemia receiving recombinant granulocyte colony-stimulating factor

PURPOSE

To elucidate the pathogenesis of Sweet syndrome, one patient with aplastic anemia was evaluated.

PATIENT AND METHODS

A 15-year-old girl presented with intermittent fever and progressive pallor for 3 months after non-A, non-B, non-C hepatitis. Aplastic anemia was diagnosed and therapy was begun with recombinant granulocyte colony-stimulating factor (G-CSF), methylprednisolone pulse therapy, antilymphocyte globulin and cyclosporin A. There was only an increase in the neutrophil counts. We continued G-CSF therapy of 300 micrograms/m2 on alternate days for 7 months. At this time the white blood cell count was 10,000/microliters and the patient developed high-grade fever and a painful, erythematous, tender plaque (3 X 3 cm) on the left thigh. We diagnosed the lesion as a skin infection and stopped G-CSF therapy and started antibiotics. Cultures were negative. The lesion slowly resolved, G-CSF was restarted after 2 months, and 1 month later disseminated lesions occurred. Antibiotic therapy was not effective.

RESULTS

Biopsy of the lesion demonstrated infiltration of the dermis by sheets of neutrophils. We stopped G-CSF and began corticosteroid therapy. The skin lesions resolved rapidly.

CONCLUSION

We postulated that Sweet syndrome was induced by G-CSF treatment.

DNA fragmentation induced by protease activation in p53-null human leukemia HL60 cells undergoing apoptosis following treatment with the topoisomerase I inhibitor camptothecin: cell-free system studies

We studied the role of proteases in apoptosis using a cell-free system prepared from a human leukemia cell line. HL60 cells are p53 null and extremely sensitive to a variety of apoptotic stimuli including DNA damage induced by the topoisomerase I inhibitor, camptothecin. We measured DNA fragmentation induced in isolated nuclei by cytosolic extracts using a filter elution assay. Cytosol from camptothecin-treated HL60 cells induced internucleosomal DNA fragmentation in nuclei from untreated cells. This fragmentation was suppressed by serine protease inhibitors. Serine proteases (trypsin, endoproteinase Glu-C, chymotrypsin A, and proteinase K) and papain by themselves induced DNA fragmentation in naive nuclei. This effect was enhanced in the presence of cytosol from untreated cells. Cysteine protease inhibitors (E-64, leupeptin, Ac-YVAD-CHO [ICE inhibitor]) did not affect camptothecin-induced DNA fragmentation. The apopain/Yama inhibitor, Ac-DEVD-CHO, and the proteasome inhibitor, MG-132, were also inactive both in the cell-free system and in whole cells. Interleukin-1 beta converting enzyme (ICE) or human immunodeficiency virus protease failed to induce DNA fragmentation in naive nuclei. Together, these results suggest that DNA damage activates serine protease(s) which in turn activate(s) nuclear endonuclease(s) during apoptosis in HL60 cells.

A perfluorochemical prevents ischemia-reperfusion injury of muscle

This investigation evaluated the effect of oxygenated perfluorochemical (PFC) perfusion on the viability of ischemic skeletal muscle compared to hypothermic preservation. Twenty-five hindlimbs of 13 white rabbits were divided into five groups: a PFC group (7 hr of ischemia with 6 hr of PFC perfusion), a PFC/ reperfusion group (8 hr of ischemia with 6 hr of PFC perfusion and 1 hr reperfusion), a hypothermia group (7 hr of ischemia with 6 hr of 4 degrees C cold preservation), a hypothermia/reperfusion group (8 hr of ischemia with 6 hr of 4 degrees C cold preservation and 1 hr of reperfusion), and a control group. The levels of adenine nucleotides, creatine phosphate, hypoxanthine, xanthine, and lipid peroxide were determined in each group. In the PFC and PFC/reperfusion groups, the ATP level remained at 90% of that in the control group. The hypoxanthine level in the hypothermia/reperfusion group was decreased to 70% of that in the hypothermia group and the xanthine level was increased to 130%. In the PFC and PFC/reperfusion groups, hypoxanthine and xanthine levels were much lower and were similar to those in the control group. Lipid peroxide levels were also lower in the PFC and PFC/reperfusion groups than in the hypothermia/reperfusion group. Electron microscopy showed that endothelial cells from the PFC/reperfusion groups were not swollen. These results suggest that PFC perfusion is superior to hypothermia in inhibiting the generation of free radicals and in preventing ischemia-reperfusion injury of skeletal muscle.

Purification and characterization of a prolidase from Aureobacterium esteraromaticum

An EDTA-insensitive prolidase (proline dipeptidase, EC 3.4.13.9) was isolated from a cell-free extract of Aureobacterium esteraromaticum IFO 3752. The enzyme was purified almost to homogeneity using acetone precipitation, hydrophobic chromatography, ion-exchange chromatography, and gel-permeation chromatography. The enzyme has a molecular weight of about 440,000 by gel permeation chromatography, and about 40,000 by SDS polyacrylamide gel electrophoresis. The isoelectric point was 4.6. The enzyme hydrolyzed aminoacylprolines such as Ser-Pro. Thr-Pro, Gly-Pro, Ala-Pro, Ile-Pro, Leu-Pro, and Pro-Pro. It also hydrolyzed Gly-Hyp and Pro-Hyp. The rate of hydrolysis for Pro-Hyp was the highest among the substrates tested. Optimum pH for hydrolyzing Pro-Hyp was 9.0 and the enzyme was stable in the pH range from 5 to 10. The optimum temperature was estimated to be 45 degrees C using 10 min of reaction. At least 90% of the initial activity remained after 30 min of incubation at 60 degrees C. p-Chloromercuribenzoic acid and o-phenanthrolin inhibited the enzyme's activity while EDTA did not. Addition of Mn2+ ion did not stimulate activity. These results suggest either that the metal ion in the enzyme may be tightly bound to the polypeptide chain, or that the enzyme is not a metallo-enzyme but a thiol-enzyme.

Characteristic upregulation of dopamine D1-receptor in rat striatum after 6-hydroxydopamine treatment

We measured the number of D1-receptors (Bmax) in the striatum whose dopaminergic terminals were destroyed to various degrees by 6-hydroxydopamine (6-OHDA) to clarify the relationship between the degree of denervation and the change in Bmax for D1-receptor. Rats were sacrificed 28 days after 6-OHDA treatment, and [3H]SCH23390 (R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4, 5-tetrahydro-1H-3-benzazepine) binding capacity and monoamine content were measured in striatal homogenate. Bmax was significantly upregulated when dopamine content was reduced to less than 5% of that in the vehicle-treated striatum. In contrast, it was significantly decreased when dopamine content was 5-25% of that in the vehicle-treated striatum. The D1-receptors showed either upregulation or downregulation depending on the degree of denervation.

[Clinical significance of additional ST segment elevation immediately after successful reperfusion in patients with anterior wall acute myocardial infarction]

The clinical significance of additional ST segment elevation immediately after reperfusion in acute myocardial infarction (AMI) is still unclear. The influence of additional ST elevation on myocardial damage was examined in 62 patients with first anterior AMI. All patients had coronary reflow (thrombolysis in myocardial infarction: TIMI grade III) within 6 hours after the onset of infarction and no subsequent reocclusion for at least 14 days. The patients were classified into two groups: group ST (+), 26 patients with additional ST elevation (> or = 5 mm increase in sigma ST in lead V1-V6) immediately after reperfusion, and group ST(-), 36 patients without additional ST elevation. Myocardial damage was estimated by the number of abnormal Q wave before and 1 hour after reperfusion (nQpre and nQpost. There were no significant differences in the elapsed time, ECG indexes before reperfusion and regional wall motion (RWM: SD/chord; SD = standard deviation) in the acute phase and 14 days after the onset between the two groups. Moreover, within each group the patients were classified into two groups on the basis of RWM 14 days after the onset: group A = RWM < -2.5 in group ST (+) (n = 17); group B = RWM > or = -2.5 in group ST(+) (n = 9); group C = RWM < -2.5 in group ST (-) (n = 14); group D = RWM > or = -2.5 in group ST(-) (n = 22). There were no significant differences in the elapsed time between the four groups. nQpre was highest in group C and was lowest in group D (group A: 2.1, group B: 1.9, group C: 4.1, group D: 1.4), and nQpost was highest in group C and group A, and was lowest in group D (group A: 4.1, group B: 2.7, group C: 4.4, group D: 2.0). There was a significant increase in nQ after reperfusion (nQpost-nQpre) in group A and group B, which was greater in group A than in group B. The increase in sigma ST after reperfusion was greater in group A than in group B. There was no significant increase in nQ after reperfusion in group C and in group D, and both nQpre and nQpost were highest in group C, and lowest in group D. Infarct size was larger in group A and in group C than group B and group D, and there was no significant improvement in RWM in group A and in group C. In conclusion, additional ST elevation immediately after reperfusion seems to occur in patients with not so severe myocardial damage before reperfusion, and may reflect reperfusion injury. Additional ST elevation is not observed in patients with preceding extensive myocardial damage which may be irreversible or not still advanced at the time of reperfusion.

Effect of age, height, and prechallenge respiratory resistance on bronchial hyperresponsiveness in childhood asthma using the forced oscillation technique

To evaluate the effects of age, height and prechallenge respiratory system resistance (Rrs) on bronchial responsiveness to methacholine inhalation (BRm) as measured by the oscillation technique in children with mild asthma, we studied BRm in 92 atopic children aged from 8 to 13 years (mean +/- SD, 10.5 +/- 1.7 years). Inhalation challenge was performed by administering progressively doubling doses of methacholine, until a twofold increase in Rrs from baseline had been reached. The minimum cumulative dose of methacholine (Dmin) at which Rrs deviated from baseline was identified by the point of deflection of the continuously recorded Rrs tracing. The Dmin represented the amount of methacholine which elicited BRm. By using single-regression analysis, height was negatively correlated with Rrs (p < 0.001). Height was positively and Rrs was negatively correlated with age (p < 0.001 and p < 0.001, respectively). Furthermore, height and age were correlated with Dmin (p < 0.001 and p < 0.001, respectively), but prechallenge Rrs was not correlated with Dmin (p > 0.1). To minimize the effect of height and prechallenge Rrs on BRm, the relationships between Dmin and age was studied in a subgroup with a narrow range of heights (135-155 cm, n = 32), and a narrow range of prechallenge Rrs (5.0-6.9 cmH2 O/L/s, n = 42); there remained a statistically significant correlation between Dmin and age in the groups with comparable heights (p = 0.026) and Rrs (p = 0.003). These data suggest that the BHR in childhood asthma may be affected by height and age when measured by the oscillation technique. Considering the many advantages of the oscillation method, this technique may be very suitable for measuring BHR in childhood asthma.

[Dystrophin abnormality in a patient with polymyositis associated with primary biliary cirrhosis and myocardial injury]

We have reported a 58-year-old Japanese female with polymyositis, primary biliary cirrhosis (PBC) and arrhythmia. In contrast to the previously reported 13 cases of polymyositis associated with PBC, symptoms and laboratory data abnormalities responded to oral administration of predonisolone. Interestingly, immunohistochemical and immunoblot analyses of biopsied skeletal muscle revealed diminished expression of dystrophin carboxyl-terminal domain in the sarcolemma, suggesting that, in analogy to Duchenne muscular dystrophy, secondary abnormality of the link between the basal lamina and cytoskeleton via the dystrophinglycoprotein complex may have played a role in the molecular pathogenesis of muscle fiber degeneration in this patient.