[Refractory idiopathic cold agglutinin disease successfully treated with intermittent high-dose cyclophosphamide].

A 56-year-old woman, who had been suffering from idiopathic cold agglutinin disease and treated unsuccessfully with prednisolone and cyclosporine A for 6 months, was referred to our hospital in November 1998. She was given methylprednisolone pulse therapy followed by low-dose cyclophosphamide, but her anemia did not improve. We then began administration of intermittent high-dose cyclophosphamide (1,200 mg/day, every 4 weeks), and this resulted in a dramatic increase of her hemoglobin level and improvement of her symptoms. She is currently receiving 500 mg of cyclophosphamide every 2 months and showing a good response. Intermittent high-dose cyclophosphamide therapy can be an effective treatment for refractory cold agglutinin disease.

[Significance of catalase antibody in Helicobacter pylori infection].

Helicobacter pylori (H. pylori) has been identified as a causative agent of various gastroduodenal diseases. The pathophysiology and various clinical outcomes of this infection can be explained by bacterial factors, host factors and their interactions. To investigate the interaction between H. pylori and host, the author studied H. pylori catalase, which scavenges hydrogen peroxide from neutrophils in the H. pylori-infected stomach, and production of antibody to catalase in the sera of patients as a host response to the organism. Sera from 120 H. pylori-positive patients and H. pylori strains were studied. ELISA to detect anti-H. pylori catalase antibody in serum was established with the use of recombinant catalase protein as a coated antigen. Sixty-nine patients (58%) were positive for anti-catalase antibody in the sera, and histology of the stomach demonstrated infiltration of numerous mononuclear cells and infiltration of less neutrophils in the antrum. In contrast, 51 patients (42%) were negative for anti-catalase antibody in the sera, and the histology exhibited infiltration of numerous neutrophils and infiltration of less mononuclear cells in the antrum. Forty-five patients (37%) were negative for the antibody in the sera even though they were infected with H. pylori-catalase-producing strains. Only 6 patients (5%) were proved to be infected with non-catalase-producing strains and negative for the antibody. However, the structure of catalase genes did not differ between non-catalase-producing strains and catalase-producing strains, which was determined by southern blot and PCR. The presence of anti-H. pylori catalase antibody in the sera might indicate the histological characteristics of the stomach infected with H. pylori.

[Recent endoscopic treatment in gastroenterology].

Endoscopic diagnosis and treatment became to be necessary in gastroenterology for last two decades. Indication of endoscopic treatment is amazingly expanding because of developing new techniques and easy-to-use devices. Nowadays, the indication for endoscopic treatment includes the removal of foreign bodies in alimentary tract, the dilatation of stricture lesions by balloon or expandable metallic stent, the resection of polypoid and superficial tumors by polypectomy and EMR (endoscopic mucosal resection) techniques, the injection sclerotherapy and ligation method for gastroesophageal varices, the hemostasis of gastrointestinal hemorrhages by injection method or heat-burn method. In biliary and pancreatic area, there are some endoscopic treatments that are removal and destruction of stones in common bile duct, biliary and pancreatic drainage by tubing method. Our results of endoscopic resection for esophageal and gastric tumors are shown in this papers. In conclusion, complete resection that means histologically tumor negative of lateral and vertical margin of resected specimen is important to prevent recurrence of tumors after resection.

[Occurrence of angioimmunoblastic T-cell lymphoma six months after onset of Lyme disease].

A 68-year-old man, who had suffered a tick bite one week previously, consulted his home doctor because of fever and an erythematous rash around the bite scar. He underwent a skin biopsy, and Borrelia garinii was detected, from which Lyme disease was diagnosed. He received amoxicillin for two weeks and his symptoms disappeared. After 6 months he noticed swelling of his cervical, axillary and inguinal lymph nodes. A biopsy sample was taken from a left cervical lymph node, and this revealed angioimmunoblastic T-cell lymphoma. The patient achieved a complete remission after chemotherapy. The relationship between Lyme disease and lymphoma is discussed.

Angiotensin II suppresses water absorption through the ventral skin of Japanese tree-frogs in vitro.

We previously described two different water absorption systems in the ventral skin of the Japanese tree-frog, Hyla arborea japonica: i.e., a rapid enhanced flow, which is observed in dehydrated tree-frogs or those stimulated by adrenaline beta-agonists or vasotocin, and a slow basal flow, which is observed in normally hydrated frogs during the non-breeding season. The rapid flow is completely blocked by ouabain, which has no effects on the slow basal flow. In the present experiment, we show that the vaso-constrictive hormone angiotensin II completely inhibits basal water absorption, but has no effect on rapid water absorption. These results confirm our previous finding that the two water absorption systems in the ventral skin of the Japanese tree-frog are independent of each other.

[Physiological and pathophysiological investigations on neuronal mechanisms of locomotion in the cats (author's transl)].

Electromyographic investigation was carried out on the cats in order to analyse the neuronal mechanisms of locomotive movements. 1. When normal unrestrained cats walked gastrocnemius muscle, an extensor, began the activities 77.4 +/- 12.1 msec prior the stance phase. This evidence shows that locomotive movement is preprogrammed in the central nervous system. 2. When hemisection was applied to the spinal cord, reciprocal activities in the antagonistic muscles disappeared for several days. However, the reciprocity resumed again eventually. 3. When two hemisections on both sides were applied at different levels of the spinal cord at intervals of more than 30 days, the cat could not stand for 20-30 days after the second hemisection, but eventually could stand. The reciprocity between the antagonistic muscles were greatly disturbed in many cases. 4. In several cases placing reaction could not be elicited in the two hemisected cats. The possible roles of descending tracts in locomotion were discussed.

Peripheral factors contributing to the volitional control of firing rates of the human motor units.

Human subjects can volitionally control discharge frequencies of isolated motor units at several frequencies. If the tonic firing rates such as 10 Hz are mainly dependent on the gamma-loop and if Xylocaine blocks gamma-fibers before blocking alpha-fibers, application of Xylocaine would preferentially disturb the tonic rates. After application of Xylocaine to the nerve innervating the motor units the tonic discharges at 10 Hz became irregular, while the phasic discharges at 1 Hz could still be performed volitionally. These results suggest that volitional control of tonic discharges of the motor units are dependent upon gamma activity, while the phasic discharges may be controlled by the impulses along the pyramidal tracts.