Bronchial amyloidosis successfully treated with low-dose long-term erythromycin therapy.

A 69-year-old man was admitted for evaluation of an abnormal chest X-ray. A diagnosis of primary bronchial amyloidosis was made on the basis of the chest X-ray, CT scans and bronchial biopsy specimens. The patient was treated with low-dose long-term erythromycin therapy (600 mg/day). After four months of therapy, chest CT scans, bronchoscopic findings and bronchial biopsy specimens revealed significant improvement of inflammatory changes. Low-dose erythromycin therapy may be helpful in terms of its anti-inflammatory effects for patients with bronchial amyloidosis.

[Siblings of familial adenomatosis coli with gastric cancer--case report].

Adenomatosis coli is recently regarded as a systemic disease with a predisposition to multiple tumor formation. We report siblings of familial adenomatosis coli with gastric cancers. Case 1 was a 58 year-old elder brother. His diagnosis was familial adenomatosis coli accompanied with colon cancer and simultaneous early gastric cancer. Total colectomy and partial gastrectomy were carried out on Mar. 13, 1984 at our hospital. Numerous polyps over the whole colon and an ulcerative tumor in the hepatic flexure were found in the resected colon. Histologically tubular adenocarcinoma were demonstrated in the ulcerative tumor, and all other polyps were adenomas. In the resected gastric specimen, there were two shallow, depressed lesions on the each anterior and posterior wall of the antrum. Histologically both of them were adenocarcinoma confined within the mucosa. Postoperative course was satisfactory and he is quite healthy 2 and a half years after surgery. Case 2 was a 56 year-old younger brother. He received a partial gastrectomy for advanced gastric cancer at another hospital on May 20, 1982. In one and a half year from the surgery, a large lung tumor (probably metastasis of the gastric cancer) was found and he received chemotherapy. He also received radiation therapy in June, 1984 and during this admission barium enema study was performed. It revealed numerous polyps over the whole colon. No cancerous lesions were found. He died of lung tumor on Dec. 8, 1985. The similar siblings were first reported by Kokaji et al. in 1984, and our cases seem to be the second ones.

What are the signs of recent hemorrhage, and what do they mean? Criteria for massive bleeding.

Hematemesis, melena, shock, vague symptoms, anemia, blood examinations and endoscopic findings are reviewed as signs of recent hemorrhage. An assessment of the condition of patients with upper GI bleeding is important for planning treatment. Therefore, in order to be able to evaluate a method of treatment of GI bleeding, reports referring to treatment of GI bleeding must contain a clear record of the severity of the patient's state and of the bleeding source. A common criterion for massive bleeding has been proposed. Specifically, a patient suffering from shock who needs more than 1,000 ml of blood or plasma expander by rapid transfusion within one hour, or more than 2,000 ml within the initial 24 hours, to stabilize his circulation, and whose Hb level is 8.0 g/dl or less, should be graded as having massive bleeding. Gastric ulcers with exposed blood vessels need endoscopic YAG laser hemostasis or ethanol injection therapy as quickly as possible, since 43% of the cases rebleed within 72 hours under conventional drug therapy, and such rebleeding can be prevented by the endoscopic hemostatic methods.

Effect of Clostridium perfringens alpha toxin on the cardiovascular system of rats.

Clostridium perfringens alpha toxin decreased heart rate, then elevated blood pressure, and finally caused some changes of electrocardiogram readings. The toxin decreased peripheral blood flow before blood pressure started to increase and the blood flow continued to decrease, without any affect on electrocardiogram readings, until the maximal pressure rise caused by the toxin. The toxin caused a rise in blood pressure in a dose-dependent manner. On the other hand, anti-alpha toxin antiserum inhibited both phospholipase C activity and pressor activity. When the toxin was pretreated with cysteine, calcium disodium ethylenediamine tetraacetate and calcium trisodium ethylenetriamine pentaacetate, pressor activity decreased, as well as phospholipase C activity. The results indicate that alpha toxin possesses pressor activity as well as phospholipase C activity.