Longitudinal analysis of antibody profiles against plakins in severe drug eruptions: emphasis on correlation with tissue damage in drug-induced hypersensitivity syndrome and drug reaction with eosinophilia and systemic symptoms.

BACKGROUND: The evidence for severe drug eruption as a trigger for autoimmune disease has recently increased. No information is available on how tissue damage in severe drug eruptions can induce autoimmune responses. OBJECTIVES: To investigate whether the generation of autoantibodies (autoAbs) against plakin family proteins could be the cause or result of tissue damage in patients with severe drug eruptions and whether the generation of autoAbs could be prevented by systemic corticosteroids during the acute stage. METHODS: We retrospectively analysed alterations of serum levels of autoAbs against plakin family proteins in patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) during the acute stage and long after resolution over a period of more than 10 years. RESULTS: AutoAbs against plakin family proteins were detected in patients with either SJS/TEN or DiHS/DRESS regardless of the epidermal damage in the acute stage, and were sustained even long after resolution in DiHS/DRESS, indicating that those autoAbs are neither the cause nor the consequence of epidermal damage, at least in DiHS/DRESS. Severe liver damage and noncorticosteroid therapy during the early and acute stages of DiHS/DRESS were associated with the subsequent generation of these autoAbs. CONCLUSIONS: These autoAbs are neither necessarily the cause nor the result of epidermal damage in DiHS/DRESS, because the presence of these autoAbs was not restricted to patients with SJS/TEN but was also observed in those with DiHS/DRESS, which is characterized by lack of epidermal damage. Severe liver damage and/or immune responses that could be prevented by corticosteroids in the acute stage of DiHS/DRESS are among the causal factors contributing to the generation of autoimmune responses.

Critical role of the neural pathway from the intermediate medial mesopallium to the intermediate hyperpallium apicale in filial imprinting of domestic chicks (Gallus gallus domesticus).

Filial imprinting in precocial birds is a useful model for studying early learning and cognitive development, as it is characterized by a well-defined sensitive or critical period. We recently showed that the thyroid hormone 3,5,3'-triiodothyronine (T3) determines the onset of the sensitive period. Moreover, exogenous injection of T3 into the intermediate medial mesopallium (IMM) region (analogous to the associative cortex in mammals) enables imprinting even on post-hatch day 4 or 6 when the sensitive period has been terminated. However, the neural mechanisms downstream from T3 action in the IMM region remain elusive. Here, we analyzed the functional involvement of the intermediate hyperpallium apicale (IMHA) in T3 action. Bilateral excitotoxic ablation of the IMHA prevented imprinting in newly hatched chicks, and also suppressed the recovery of the sensitive period by systemic intra-venous or localized intra-IMM injection of T3 in day-4 chicks. In contrast to the effect in the IMM, direct injection of T3 into the IMHA did not enable imprinting in day-4 chicks. Moreover, bilateral ablation of IMHA after imprinting training impaired recall. These results suggest that the IMHA is critical for memory acquisition downstream following T3 action in the IMM and further, that it receives and retains information stored in the IMM for recall. Furthermore, both an avian adeno-associated viral construct containing an anterograde tracer (wheat-germ agglutinin) and a retrograde tracer (cholera toxin subunit B) revealed neural connections from the IMM to the IMHA. Taken together, our findings suggest that hierarchical processes from the primary area (IMM) to the secondary area (IMHA) are required for imprinting.

Rikkunshito induces gastric relaxation via the ß-adrenergic pathway in Suncus murinus.

BACKGROUND: Rikkunshito (RKT) is a gastroprotective herbal medicine. In this study, we investigated the role of RKT in the relaxation of the gastric body (fundus and corpus) and antrum. METHODS: We used Suncus murinus, a unique small model animal with similar gastrointestinal motility to humans and dogs. RKT was added at 0.1, 1.0, and 5.0 mg/mL to induce relaxation in vitro; the outcome measure was the intensity of relaxation. The number of spontaneous antral contractions in the absence or the presence of RKT was also counted. KEY RESULTS: Rikkunshito induced the relaxation of the gastric body and antrum and decreased the number of spontaneous antral contractions in a dose-dependent manner. The responses to RKT (1.0 mg/mL) were not affected by pretreatment with atropine, N-nitro-l-arginine methyl ester, ritanserin, or ondansetron. On the other hand, timolol almost completely reversed the relaxation induced by RKT (1.0 mg/mL) on the gastric body and antrum and the occurrence of the spontaneous antral contractions. Both butoxamine, a ß(2) -adrenoreceptor antagonist, and L 748337, a ß(3) -adrenoreceptor antagonist, but not CGP 20712, a ß(1) -adrenoreceptor antagonist, significantly reversed the RKT-induced (1.0 mg/mL) gastric relaxation. CONCLUSIONS & INFERENCES: These results indicate that RKT stimulates and modulates gastric relaxation through ß(2) - and ß(3) -adrenergic, but not ß(1) -adrenergic, pathways in S. murinus.

[Chondromatous hamartoma of the lung with a unique demonstration on diagnostic imaging; report of a case].

A case of pulmonary hamartoma is reported with clinical, roentgenographical and histopathologic findings. The patient was a 53-year-old woman who had undergone right hemithyroidectomy for thyroid cancer 4 years before. An abnormal shadow, which was a non-clearly demarcated tumor, 2 cm in diameter, in the left middle lung field, was noted on her routine X-ray in February 2001. Physical examination and laboratory data revealed no significant findings, but computed tomography(CT) scans of the chest showed a gathering of small-sized high-density lesions in the nodule. She underwent left S8 segmentectomy on March 21, 2001. The pathology report on the frozen section was pulmonary hamartoma. Histopathologically, the lesion was characterized by a composition of bronchial epithelium, fat tissue and cartilage, with being diagnosed as a chondromatous hamartoma of the lung. The patient's postoperative course was uneventful, and she was discharged with no supportive therapy 14 days after the operation. To date, 14 months after the operation, the patient has been in good condition, without evidence of recurrence or distant metastasis on diagnostic imaging. This case is particularly interesting because a gathering of small-sized pulmonary hamartoma was demonstrated by imaging.

Loss of calcitonin binding in rat is not related to calcitonin receptor gene abnormality.

C-cell tumors occur frequently (50%) in old WAG/Rij rats. Interestingly, genetically transmitted loss of CT binding sites in the kidney has also been demonstrated in WAG/Rij rats. To determine if these issues are resulted from mutation of calcitonin receptor (CTR), we analyzed the CTR genomic abnormality in WAG/Rij rat. We demonstrated that both Wistar and WAG/Rij rats expressed type-C1a CTR by RT-PCR analysis and their mRNA expressions were approximately equal by Northern blotting analysis. Direct sequence of RT-PCR products for CTR showed no different nucleotide sequences between the two strains. There were three polymorphisms at the first transmembrane domain and the fourth intracellular membranes, which are different from Sprague-Dawley rat. We concluded that the loss of CT binding in WAG/Rij rat is not related to CTR gene abnormality. Abnormal system of CTR amino acid modification may be occurred in WAG/Rij rat.

[A case of surgical treatment for cardiac tamponade caused by a ruptured coronary aneurysm accompanied by a coronary artery-pulmonary artery fistula].

A 67-year-old woman experienced a sudden severe pain in the area of her left shoulder and back. Three days later the pain recurred, after which she fell into shock and was taken to another hospital by ambulance. A plain chest CT scan showed a cardiac tamponade, while an enhanced chest CT scan demonstrated a coronary aneurysm in the left anterior descending branch draining to the pulmonary artery. Coronary arteriography revealed a saccular type aneurysm, 5 cm in diameter, with a coronary artery-pulmonary artery fistula. After pericardiocentesis, she recovered from her state of shock. The patient was then transferred to our hospital, where she underwent emergency surgery. Under a cardiopulmonary bypass, the stem of the aneurysm and the fistula were ligated and resected. She recovered smoothly and was discharged on the 24th postoperative day.

Gluteal abscess caused by perforating rectal cancer: case report and review of the literature.

An unusual case is described in which an abscess developed remote from a carcinoma of the rectum. A 52-year-old Japanese man developed a gluteal abscess six months after radiation therapy for unresectable carcinoma of the rectum. This case is presented with a review of the literature. Perforating carcinoma of the colon and rectum with abscess formation is best treated by preliminary total diversion colostomy and local drainage of the abscess. However, the mortality rate is still high.

[Anesthetic management for a patient with mental retardation and unexamined complex congenital heart disease].

An 18-year old female with mental retardation and unexamined complex congenital heart disease received dental care under general anesthesia. Anesthesia was induced and maintained successfully without any significant hemodynamic changes with inhalation of nitrous oxide, oxygen (FIO2 0.25-0.3) and sevoflurane after a heavy premedication (morphine 10 mg, scopolamine 0.3 mg and midazolam 5 mg i.m.). After induction of anesthesia, cardiac anomaly was diagnosed by transesophageal echocardiography as TGA, VSD, PS, and operation was completed without any problem. Two points are considered important in this case; first, to appropriately estimate preoperative cardiac function and second, to adequately manage anesthesia to avoid any hemodynamic fluctuation.

Effect of ozone pretreatment on alkali cleaning of alumina fouled with bovine serum albumin.

Pretreatment of alumina particles fouled with bovine serum albumin (BSA) by 0.3% (v/v) gaseous ozone markedly accelerated the removal of BSA during alkali cleaning through partial decomposition of the BSA molecule. The results suggest that ozone pretreatment can reduce the NaOH concentration required for adequate alkali cleaning by at least one order of magnitude.

[Anesthetic management of a patient with congenital cystic adenomatoid malformation].

Congenital cystic adenomatoid malformation (CCAM) is a rare disease that is diagnosed by severe respiratory dysfunction from birth. A 5-day-old-boy with CCAM underwent removal of a large cyst which was present at lower lobe of right lung. Anesthesia was induced slowly and maintained with oxygen and sevoflurane. Severe airway obstruction occurred transiently by the secretion from the lung cyst. Thereafter, the surgery was completed safely and his postoperative course was uneventful. Perioperative anesthetic management of the patient with CCAM is also discussed.

[Clinical studies of isosorbide dinitrate spray in postoperative patients].

We investigated the effect of isosorbide dinitrate (ISDN) single spray, containing 1.25 mg of ISDN, on cardiovascular and respiratory functions in eight postoperative patients. Concentrations of plasma ISDN and its metabolites were also investigated. Hemodynamic as well as blood gas studies were performed at 4 points (before, plus 10, 30 and 60 minutes after administration of ISDN) and the blood levels of ISDN and its metabolites were measured at 5 points (before, plus 5, 10, 30 and 60 minutes after administration of ISDN). Mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), cardiac index (CI), pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) decreased significantly and heart rate (HR) increased significantly at 10 and 30 minutes after the spray. The maximum changes observed of each parameters were MAP 7%, MPAP 22%, CI 9%, PCWP 33%, CVP 36% and HR 6%. Systemic and pulmonary vascular resistance indices did not change significantly throughout the study. PaO2 decreased significantly only at 10 minutes after the spray. Plasma ISDN concentration showed the maximum value of 56.3 ng.ml-1 at 5 minutes after the spray. After this value, the concentrations decreased rapidly. From this study, we conclude that single spray of ISDN is effective in decreasing preload promptly, but it is not effective in decreasing afterload. When using the spray, we should pay attention to pulmonary oxygenation.

[Bronchiectasis treated with negative extra-thoracic pressure ventilation].

A 25-year old man with 5-year history of bronchiectasis was admitted to the ICU complaining of severe shortness of breath. He had a respiratory rate of 40 to 50 breath/min. On 0.5 l/min of oxygen with nasal cannula, arterial blood pH was 7.39, Paco2 52.3 mmHg, Pao2 45.0 mmHg. Then, on 1 l/min of oxygen, Pao2 was unchanged, but Paco2 increased to 58 mmHg. As his consciousness was so clear, we applied to him the negative extra-thoracic pressure ventilator which was designed by the authors. Negative extra-thoracic pressure ventilation (NETPV) was maintained at a IMV rate of 30 breath/min, peak negative extra-thoracic pressure of -20 to -30 cmH2O, and an inspiratory/expiratory ratio of 1:2. During NETPV, his respiratory rate and oxygen consumption were decreased and Pao2 was increased compared with his spontaneous breathing. He made a recovery from dyspnea, especially, he was able to take a deep breath. When NETPV was applied to him, pulmonary artery and arterial catheterizations revealed that central venous pressure was slightly decreased, cardiac index unchanged or slightly decreased, heart rate, systemic blood pressure, and pulmonary arterial pressure unchanged compared with spontaneous breathing. The patient was able to read books and maintained communication in his voice with his family and the medical staff. After 3 days of the treatment with NETPV, a marked improvement was noted and the patient was discharged from the ICU. NETPV has the benefits as follows. First, it is very easy for both a patient and a doctor to assist his breathing because an endotracheal intubation is not necessary.(ABSTRACT TRUNCATED AT 250 WORDS)