Therapeutic potential of zoledronate-activated autologous Gamma-DeltaT cells in atopic dermatitis

No disponible

Non-invasive monitoring of gingival crevicular fluid for estimation of blood glucose level.

Development of a non-invasive method for measuring the blood glucose level is an urgent necessity, and putting such a method into practical use will enable some of the physical and mental stress that patients with diabetes have to endure to be removed. To realise a non-invasive blood glucose monitor, the gingival crevicular fluid (GCF) was measured. A GCF-collecting device was developed that was designed to be disposable, biocompatible and small enough to be inserted in the gingival crevice for collection of a sub-microlitre sample of GCF. Also, a high-sensitivity glucose testing tape incorporated in the device was developed. Red laser light in a portable optical device measured the colour density of the testing tape. Standard glucose solutions were used to investigate the measurement accuracy of the GCF glucose monitor and showed a correlation coefficient of R = 0.99 (n = 20) between the optical density and the glucose levels. The GCF glucose monitor was evaluated on healthy Swedish and Japanese adults (n = 10) and both GCF glucose levels (GCFLs) and blood glucose levels (BGLs) were measured in conjunction with meal loads. The GCFLs were about 1/10-1/560 lower than the BGLs. No difference in the range of GCFLs between the Swedish and the Japanese subjects was observed. Therefore it was concluded that physique, body mass index and life-style, such as dietary habit, did not significantly influence the GCFLs. Further, the correlation coefficients of all the subjects were 0.70 and 0.88 with each group. It was suggested that GCF could be used as a method of non-invasive blood glucose measurement.

Ultrasound measurement using CUBA clinical system can discriminate between women with and without vertebral fractures. Contact Ultrasound Bone Analyzer.

The purpose of this study was to assess the ultrasound (US) parameters measured by Contact Ultrasound Bone Analyser (CUBA) clinical system for discriminating the subjects with vertebral fractures from those without vertebral fractures. The subjects consisted of 114 postmenopausal women over age 50 (mean +/- SD: 72.2 +/- 8.7). Seventy-three had vertebral fractures (fracture group) and 41 had no vertebral fractures (control group). Values of all US parameters and bone mineral density (BMD) in the fracture group were significantly lower than those in the control group, even after adjusting for age. Areas under the receiver operating characteristic (ROC) curve was 0.768 +/- 0.056 (mean +/- SE) for broadband ultrasound attenuation (BUA) 0.828 +/- 0.045 for velocity of sound (VOS), 0.707 +/- 0.058 for lumbar spine, 0.872 +/- 0.050 for femur neck, 0.790 +/- 0.050 for trochanter, and 0.695 +/- 0.060 for Ward's triangle. There were no significant differences among the areas under the ROC curves in BUA, VOS, lumbar spine, femur neck, trochanter, and Ward's triangle. US parameters (BUA and VOS) had the same discriminatory power as spine and hip BMD for evaluating the vertebral fracture risk. As far as disadvantages of the use of BMD measurement against US measurement, US measurement is potentially useful for screening of vertebral fractures. However, the bias concerning the propotion of the number of patients with or without vertebral fractures could not be neglected in this study.

[Determinants of sketch-map orientation: an examination into the adoption of egocentric and conventional systems of reference to sketch-map drawing].

This study examined the determinants of adults' sketch-map orientation in terms of adoption of Egocentric and Conventional Systems of Reference (ESR and CSR) proposed by Sholl and Egeth (1980). If an ESR adoption in sketch-map drawing depends on a tuning activity of 'orienting schemata' (Sholl, 1987), subjects are expected to comprehend their own body direction accurately at the current position. To test this hypothesis, subjects were asked to judge the direction to the library entrance relative to their body direction at the current position. Subjects were asked to judge the direction to the north, to confirm that those who adopted CSR in sketch-map drawing regard the top of the sketch-map as north. In addition, whether the frequency of ESR adoption increases by telling subjects to draw the current position first, or not was examined. Results indicated a significant increase in ESR adoption. Subjects who adopted ESR performed well in judging the direction to the library entrance. On the other hand, subjects who adopted CSR poorly performed in judging the direction to the north.

Direct temperature-controlled trapping system and its use for the gas chromatographic determination of organic vapor released from human skin.

For controlling of trap temperature, the relationship between electric resistance of the trap tube and temperature is used. As the electric resistance of the trap tube (20 cm long stainless steel tubing) was very small, such as ca. 0.040 ohm for -70 degrees C and ca. 0.064 ohm for +90 degrees C, it was estimated by using the value of voltage output at both ends of the trap tube when a direct current (5 A) was applied for 6.5 ms at every 100 ms on the trap. By using this temperature measurement, a cycle of trapping is shortened, especially at the process of desorption, because it is possible to set a large increasing rate of temperature, such as 20 degrees C/s. The present trapping system has faster temperature response compared to that with a thermocouple. This system was applied for the study of the releasing of ethanol and water vapors from the human finger, which was treated as follows: dipping in 10% ethanol aqueous solution for 1 min, followed by washing with water and then drying in the air. In this case, a cycle of trapping took 53 s, and the period of total analysis was only 3 min. The present system is an efficient tool for the study of the exhalation of organic vapors from human skin.

Is endogenous isoprene the only coeluting compound in the measurement of breath pentane?

Pentane is a widely used index of lipid peroxidation. Although isopentane, an isomer of pentane, is a major component of ambient air in urban areas, many studies have disregarded the possibility that this compound is coeluted in the measurement of breath pentane. In the present study, a gas chromatograph equipped with a cold trap apparatus and a large-bore glass capillary column was used for determination of pentane, isopentane and isoprene in breath and ambient air. Isoprene was detected in all subjects at a concentration higher than that in the ambient air. However, the concentrations of breath pentane and isopentane were similar to, or less than, those of the ambient air. We suggest that great care is required in the measurement of breath pentane so that endogenous isoprene and ambient isopentane are not coeluted.

Evaluation of postoperative cardiac function and long-term results in patients after aortic valve replacement for aortic valve disease with increased left ventricular mass.

OBJECTIVE: This clinical study was designed to evaluate the postoperative cardiac function in patients after aortic valve replacement for aortic valve disease with increased left ventricular mass. METHODS: Aortic valve replacement was performed in 117 patients using the St. Jude Medical valve. Their valve lesion was aortic regurgitation in 71, and aortic stenosis in 46. The mean value of the left ventricular mass index was 272 g/m2. The 117 patients were subdivided into 4 groups according to their preoperative left ventricular mass index-Group I (n = 35) with aortic regurgitation and a large left ventricular mass index (> or = 273 g/m2), Group II (n = 36) with aortic regurgitation and a small left ventricular mass index Group III (n = 19) with aortic stenosis and a large left ventricular mass index, and Group IV (n = 27) with aortic stenosis and a small left ventricular mass index. The cardiac function was evaluated by radionuclide ventriculography. RESULTS: In a comparative study of postoperative parameters among the 4 groups, the postoperative systolic and diastolic parameters of Group I patients were more significantly impaired compared with these parameters of the other 3 groups. The postoperative values the left ventricular mass index were significantly higher in Group I than in the other 3 groups. The 10-year survival rate was significantly lower in Group I than in the other 3 groups (30 +/- 22% in Group I). CONCLUSION: Aortic valve replacement is recommended for patients with eccentric hypertrophy in the adequate clinical phase of patients whose left ventricular mass index is less than 272 g/m2.

Argatroban as a potential anticoagulant in cardiopulmonary bypass-studies in a dog model.

Argatroban is a selective thrombin inhibitor synthesized in Japan. Argatroban, which has a high affinity for thrombin, and markedly inhibits thrombin-induced reactions, has been used in patients with artherosclerosis obliterans. The efficiency of argatroban, instead of heparin, as an anticoagulant in dog models of cardiopulmonary bypass was explored. In the first study, argatroban was administered as a bolus plus infusion for 1 h during cardiopulmonary bypass at doses of 1.0 mg + 10 microg/kg per min, 2.0 mg + 10 microg/kg per min and 3.0 mg + 10 microg/kg per min (n = 2 per group). Activated clotting time and arterial gas analyses were performed beforehand and 10 min thereafter. In the second study, there were four groups. In the first group (n = 5), no coated extracorporeal circuit was used and heparin (2 mg/kg) was used as an anticoagulant. In the second group (n = 5), a coated extracorporeal circuit was used and heparin was used (2 mg/kg) as an anticoagulant. In the third group (n = 3), no coated extracorporeal circuit was used and argatroban (2.0 mg + 10 microg/kg per min) was used as an anticoagulant. In the fourth group (n = 5), a coated extracorporeal circuit was used and argatroban was used (2.0 mg + 10 microg/kg per min) as an anticoagulant. All animals were perfused for 120 min at 40 ml/kg per minute. Platelet count, activated clotting time, thrombin-antithrombin III complex, antithrombin III, fibrinogen, fibrinogen degradation products and C3a were measured to evaluate platelet, coagulofibrinolytic and the complement system. Activated clotting time values and the effect of argatroban during cardiopulmonary bypass indicated a dose-dependent response. The next highest dosing group (2.0 mg + 10 microg/kg per minute) had activated clotting time values of 250-300 seconds during cardiopulmonary bypass, and fell after reaching near-normal levels within 60 minutes. No clots were noted in the extracorporeal circuit. The argatroban group showed lower levels in their coagulofibrinolytic system compared with the heparin group. The platelet count remained at a high level in the argatroban group. It is concluded that the combination of heparinized cardiopulmonary bypass circuits, and the use of argatroban as an anticoagulant, is safe and reduces the activation of coagulation and fibrinolytic systems and preserves platelet count.

[Desquamative interstitial pneumonitis accompanied by a variety of autoimmune abnormalities in an individual with a history of asbestos exposure].

A 75-year-old-man who had been occupationally exposed to asbestos over several decades was admitted complaining of dry cough and mild exertional dyspnea. Chest X-ray films revealed the presence of bilateral infiltrates. An open biopsy showed the lung pathology to be desquamative interstitial pneumonitis (DIP), and detected a calcified plaque of the left parietal pleura at cost-phrenic sulcus, which on microscopic inspection demonstrated thin needle-like structures suggestive of asbestos particles. A hormonal examination showed decreased levels of tri-iodothyronine and tetraiodothyronine and an increased level of thyroid stimulating hormone. Additionally, a positive microsome test indicated autoimmune hypothyroidism. A serological study was positive for anti-nuclear antibody and direct Coombs, and showed heightened levels of IgG. The patient was placed on oral prednisolone therapy; one month later, his symptoms had subsided, and his lung function and chest x-ray findings had improved significantly. In addition, the abnormal values for autoimmune and thyroid function eventually returned to normal ranges. These findings suggest that DIP and humoral immune dysfunction were caused by asbestos exposure, and responded well to steroid treatment.

[A case of hypoxemic acute bronchiolitis presenting with diffuse nodular shadows caused by Mycoplasma pneumoniae].

A fifty year-old female who had previously been well presented with a productive cough and a high fever. Her initial chest X-ray film showed no abnormal lung shadows. Despite partial improvement of the fever and the serum level of acute phase reactant (CRP) in response to intravenous administration of piperacillin, she complained of increasing severity of cough and dyspnea. Follow-up chest X-ray films taken five days after therapy with piperacillin showed diffuse nodular shadows in the mid-to-lower lung fields bilaterally. Chest CT scan disclosed diffuse miliary nodules at the lung periphery and thickening of bronchovascular markings. Chest auscultation revealed late inspiratory coarse crackles and expiratory wheezing, and the patient's arterial oxygen tension was 61 mmHg. Suspected of suffering from primary atypical pneumonia, she was started on therapy with intravenous minocyclin (200 mg/day), two days after treatment her symptoms began improving significantly. Anti-mycoplasma antibody was found to be x 1280, and cold hemoagglutinin x 1024, establishing the diagnosis of Mycoplasma pneumoniae infection. The patient's condition completely recovered following a one week treatment with minocyclin. We concluded that her respiratory infection was caused by piperacillin-sensitive mico-organism, and also Mycoplasma pneumoniae which brought about hypoxic acute bronchiolitis to the patient.

Staphylococcal enterotoxin A-induced injury of human lung endothelial cells and IL-8 accumulation are mediated by TNF-alpha.

Staphylococcal enterotoxin A (SEA), a superantigen produced by some strains of Staphylococcus aureus, causes a variety of clinical manifestations ranging from food poisoning to shock. S. aureus can also be associated with the development of acute respiratory distress syndrome, and SEA has been shown to cause an inflammatory reaction in the lung. Therefore, we examined possible interactions between SEA, PBMCs, polymorphonuclear cells (PMNs), and normal human lung microvascular endothelial cells (HMVEC-L), as well as the role of these interactions on the secretion of IL-8. Injury to HMVEC-L, as measured by the release of 51Cr, increased significantly when HMVEC-L were incubated with SEA and PBMCs. IL-8 was secreted by both PBMCs and HMVEC-L. The accumulation of IL-8 in the culture medium of HMVEC-L was increased by SEA in a dose-dependent manner and was directly related to the number of PBMCs present. Although neither anti-human IL-8 nor IL-1 mAb inhibited HMVEC-L cytotoxicity, anti-human TNF-alpha mAb inhibited both the cytotoxicity and IL-8 accumulation completely. When HMVEC-L were incubated with supernatants from SEA-treated PBMCs, HMVEC-L cytotoxicity was comparable with HMVEC-L incubated with SEA and PBMCs at the same time. Although high concentrations of purified PMNs induced HMVEC-L lysis in a dose-dependent manner, the effect of PMNs was not changed in the presence of SEA. These findings suggest that TNF-alpha secreted by SEA-stimulated PBMCs plays a leading role in HMVEC-L injury.

Systemic hypertension as a risk factor for complications with an aortic mechanical valve.

We sought to determine the effect of preoperative systemic hypertension on prosthesis related complications or postoperative aortic dissection after valve replacement in patients with aortic regurgitation. The patients were divided into two groups according to the presence or absence of systemic hypertension: Group I, with hypertension (n = 35), and Group II, without hypertension (n = 37). The survival rate and event free rate were examined for 72 patients who were alive 30 days after valve replacement with a St. Jude Medical valve for aortic regurgitation. The cumulative 10 year survival rate of Group I (65% +/- 12%) was lower than that of Group II (79% +/- 15%). The 10 year event free rate of all prosthesis related complications was 62% +/- 13% in Group I, and 96% +/- 3% in Group II (p < 0.05). The 10 year event free rate for ascending aortic dissection was 73% +/- 12% in Group I and 100% in Group II (p < 0.05). The linearized event rate of all prosthesis related complication was 3.8% per patient-year in Group I and 0.5% per patient-year in Group II. In conclusion, systemic hypertension was a risk factor for prosthesis related complications and for complicated aortic lesions after aortic valve replacement. Careful postoperative management for hypertension is necessary in patients with systemic hypertension after aortic valve replacement. Tissue valves may be recommended in patients with aortic valve disease and severe hypertension.

Aortic complications after aortic valve replacement in patients with dilated ascending aorta and aortic regurgitation.

BACKGROUND AND AIMS OF THE STUDY: Postoperative aortic complications of aortic dissection or enlargement of the ascending aortic develop in patients with aortic valve replacement (AVR) and dilated ascending aorta. This clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with dilated ascending aorta, and to clarify the surgical indication and approach for dilated ascending aorta and aortic regurgitation. METHODS: A total of 82 patients who underwent AVR between 1985 and 1997 were allocated to two groups according to the preoperative diameter of the ascending aorta. A dilated ascending aorta with diameter > or = 40 mm was seen in 38 patients (group I), and a small ascending aorta with diameter < 39 mm in 44 patients (group II). Group I patients were further allocated to two subgroups: 12 patients underwent aortoplasty (group IA) and 26 did not (group IB). Event-free rates of aortic complications and survival rate were compared between groups I and II. RESULTS: Postoperative aortic dissection during the follow up period occurred in four hypertensive patients in group I (one in group IA, three in group IB); no aortic dissection was seen in group II. Freedom from all aortic complications at 10 years after surgery was 75 +/- 10% in group I and 100% in group II (p < 0.05). The cumulative survival rate at 10 years was 59 +/- 11% in group I (group IA: 71 +/- 18%, group IB: 51 +/- 14%) and 95 +/- 4% in group II (p < 0.05). CONCLUSIONS: Patients with a dilated ascending aorta (> or = 40 mm diameter) were more likely to encounter complications of the aortic dissection or enlargement after AVR than those with a small ascending aorta. Surgery to prevent aortic dissection or enlargement must be selected in patients with mildly dilated ascending aorta and hypertension.

[A CR case of amylase-producing tumor treated by hyperthermochemotherapy].

A 64-year-old female who was diagnosed with an amylase-producing tumor of unknown origin was treated by hyperthermochemotherapy. The patient was admitted with a complaint of abdominal fullness due to ascites. Laboratory examination showed high levels of serum amylase and tumor markers, including CA15-3, CA 125 and CA 72-4. Laparotomy showed peritoneal dissemination with histological findings of adenocarcinoma of unknown origin. After laparotomy, she was given hyperthermia combined with chemotherapy using carboplatin (CBDCA), mitomycin C (MMC) and doxifluridine (5'-DFUR). Hyperthermia (13.56 MHz radiofrequency for 40-50 min) was performed a total of six times within one and a half months. The total doses of CBDCA and MMC were 450 mg and 24 mg, respectively, and 600 mg of 5'-DFUR was orally administered every day. By these combined treatments, ascites disappeared and serum levels of amylase and all tumor markers were decreased and normalized. MRI and echo examination also showed complete disappearance of peritoneal metastasis. Two and a half years after the treatment, the patient is alive without any evidence of recurrence, which suggests that this combined therapy is one of the useful modalities for peritoneal dissemination as well as an inoperable tumor itself.

Serum thrombopoietin levels in patients correlate inversely with platelet counts during chemotherapy-induced thrombocytopenia.

We studied serum thrombopoietin (TPO) levels and circulating numbers of platelet during five courses of myelosuppressive post-remission chemotherapy in three patients with acute leukemia in complete remission. Serum TPO levels were measured by a newly developed and sensitive sandwich enzyme-linked immunosorbent assay. In all courses, serum TPO levels changed reciprocally with the platelet counts. When platelets were transfused into patients near the time of platelet nadir, the TPO levels dropped temporarily, while platelet counts temporarily increased. In addition, platelets obtained after transfusion in a thrombocytopenic patient showed lower binding to biotinylated TPO than donor platelets prior to the transfusion. The finding indicated that the TPO receptors were saturated with endogenous TPO of the patient with a high serum TPO level. These results suggest that the platelet mass directly regulates serum TPO levels by receptor-mediated absorption and is one of the major regulators of serum TPO levels in humans.

Hemodynamics after aortic valve replacement with St. Jude Medical valve for patients with small aortic annulus and severe left ventricular hypertrophy.

BACKGROUND AND AIMS OF THE STUDY: Cardiac function after aortic valve replacement (AVR) for patients with small aortic annulus and increased left ventricular (LV) wall thickness has not been clearly defined. The study aim was to examine a potential relationship between postoperative catheterization data (or radionuclide LV cardiac function) and the size of the aortic valve ring of a small St. Jude Medical prosthesis. METHODS: Sixty-one patients with small prosthesis (< or = 23 mm) were allocated to three groups based on the diameter of the native aortic annulus or aortic valve ring of the prosthesis (group I, 19 mm; group II, 21 mm; group III, 23 mm). Pre- and postoperative cardiac function was evaluated from catheterization data and radioisotope (RI) ventriculography. RESULTS: There were no significant inter-group differences in preoperative pulmonary artery pressures (PAPs), total pulmonary resistance (TPR), LV ejection fraction, peak ejection rate (PER) and peak filling rate (PFR). The mean postoperative PAPs and TPR of group I were significantly elevated in ICU compared with those of groups II or III (PAP: group I, 20+/-5; group II, 17+/-4; group III, 14+/-4 mmHg; p <0.01. TPR: group I, 505+/-268; group II, 316+/-134; group III, 276+/-125 dynes.s.cm-5; p <0.05). Postoperative PAPs and TPR of group I at one month after surgery were decreased, and no significant difference was found between the three groups. Cardiac function by RI study showed that postoperative PER and PFR improved in all three groups compared with the preoperative values. CONCLUSIONS: Postoperative reversibility of PAPs and improvement of PER and PFR in patients with a prosthesis of 19 mm or 21 mm showed that a small-sized aortic SJM valve had hemodynamic advantages. However, careful postoperative management in the ICU must be applied to patients with a small aortic annulus of 19 mm and severe concentric hypertrophy.

[Severe Legionella micdadei pneumonia effectively treated with hemofiltration therapy].

A 42-year-old man was admitted because of fever, productive cough, and progressive dyspnea. Chest x-ray films and computed tomographic scans disclosed dense consolidation in the left and right lung fields. No pathogenic agent was found despite extensive bacteriological examinations. Based on serological findings, the patient was given a diagnosis of acute pneumonia caused by Legionella micdadei. It has been reported that Legionnaire's disease is easily complicated by fatal systemic illnesses such as disseminated intravascular coagulation (DIC) and multiple organ failure. In fact, the patient suffered from severe hypotension and DIC on admission. Treatments against systemic complications were started together with intravenous administration of antibiotics including erythromycin. Continuous intravenous cathecolamin, however, failed to alleviate the patient's shock. We therefore applied endotoxin eliminating therapy using a polymyxin-B-column (PMX) and continuous hemofiltration (CHF). The patient recovered from critical shock immediately after the start of PMX, which together with CHF, alleviated his systemic complications. Although the factors responsible for fatal systemic complications in Legionnare's disease are not well-documented, our findings suggested that some substances removable by PMX and CHF play an important role in pathogenesis.

Changes of biochemical markers during fracture healing.

The aim of this study was to evaluate the changes of biochemical markers during fracture healing in patients with osteoporosis. The study included 26 patients; 9 underwent hip hemiarthroplasty (mean age +/- SD: 71.0 +/- 10.2 years, group EN) for femoral neck fractures. 7 underwent osteosynthesis (75.3 +/- 8.2 years, group OS) for trochanteric fractures, and 10 subjects had spinal compression fractures (68.2 +/- 12.0 years, group CO). No operative procedures were performed in group CO. Urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) by high performance liquid chromatography (HPLC), Crosslaps by both enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA) (CTx-ELISA and CTx-RIA) and serum N-terminal mid-fragment osteocalcin (OCN-Mid) by ELISA were analyzed at the time of admission and at weeks 1, 2, 4, 8 and 24 after operation or, in the case of group CO, after admission. As a whole, bone resorption markers started to increase from week 1, with various peak values between weeks 4 and 8 depending upon the particular marker, but returned to the initial vales at week 24. OCN-Mid started to increase from week 8 and remained at elevated levels at week 24. In groups EN and OS, bone resorption markers changed in the same manner as they did as a whole group. OCN-Mid did not change in group EN, although it increased significantly from week 8 in group OS. No biochemical markers changed significantly in group CO. In conclusion, bone resorption was accelerated at an early stage due to acute osteonecrosis or bed rest, followed by bone formation due to callus or mechanical stress later on. As far as bone resorption markers are concerned, 24 weeks are enough to eliminate the effect of fracture.