Platelet-activating factor and arachidonic acid metabolites in psoriatic inflammation

Platelet-activating factor (PAF). as wel as PAF acetylhydrolase (PAF-AH) activity in the peripheral blood plasma of patients with psoriasis and palmoplantar pustolosis, was measured with a radio-immunoassay technique, and compared with leukotriene (LT) B₄. LTC₄. LTD₄, and E₄, (LTD₄/E₄). thromboxane (TX) B₂ and prostaglandin (PG) E₂ levels. In a normal healthy group (n= 1 2) PAF level was 25.9 ± 6.5 pg/0.1 ml plasma (mean ± standard error of the mean: SEM). and this was elevated in patients with psoriasis (68.1 ± 11.8, n= 25. P<0.01), without a change in the PAF-AH level. LTB₄ showed a similar increase (115.0 ± 21.6 pg/ml vs. 68.2 ± 11.8 pg/ml. P < 0.05), while TXB₂, and PGE₂ showed insignificant (P > 0.05) changes. LTC₄ and LTE₄/E₄ were around the level of the limit of detection. Patients with palmoplantar pustulosis (n= 33) demonstrated similar, but milder and statistically insignificant, increases in PAF. LTB₄. TXB₂ and PGF₂ levels. Modulation of the mediator levels before and after treatment was compared in 16 patients with psoriasis and 11 with palmoplantar pustulosis. PAF in psoriasis significantly decreased after treatment (70.9 ± 17.1 to 25.1 ± 5.5, P < 0.05) and this was moderately correlated (r= 0.298) with clinical improvement as indicated by the psoriasis area and severity index (38.5 ± 7.5 to 10.9 ± 4.2. P < 0.01). TXB₂. (180.2 + 100.4 to 34.1 ± 13.5). PGF₂ (3.7 ± 0.7 to 2.9 ± 0.5) and LTB₄ (120.1 + 31.1 to 84.2 + 8.2). in psoriasis, mildly decreased without statistical significance. Patients with palmoplantar pustulosis demonstrated a similar decrease in all mediators without statistical significance. The results obtained suggest a role of PAF in psoriasis. As the priming effects of PAF have been shown, for leucocytes and endothelial cells, to enhance their inflammatory response, we assume that PAF has roles in the acute phase of osoriatic and leucotactic inflammation.     

Secondary amyloidosis complicating arthropathic psoriasis

We report a patient with secondary systemic amyloidosis complicating arthropathic psoriasis, At autopsy amyloidosis was observed in the spleen, kidneys, liver, gastrointestinal tract, lung, heart, pancreas, adrenal glands, thyroid and gall-bladder in addition to the skin by historical, histochemical and ultrastructural studies. The amyloid deposits in these organs were of amyloid A protein type.     

Jejunojejunal Intussusception in a Patient with von Recklinghausen's Disease

Abstract: A 63-year-old female with von Recklinghausen's disease was referred to us because of intermittent periumbilical pain and vomiting. Abdominal ultrasonography showed a segment of the bowel with intussusception in the left ripper quadrant. After intestinal decompression, small-intestinal endoscopy was performed. Endoscopy revealed multiple protruding lesions in the esophagus, stomach, and jejunum, the largest one markedly stenosing the proximal jejunum. We were able to identify a tumor as the lead point preoperatively. Segmental jejunectomy was performed for the resection of the tumor. Pathological studies revealed that the tumor was leiomyosarcoma. Gastrointestinal involvement is well documented in von Recklinghausen 's disease. Thus attention should be paid to gastrointestinal involvement in the management of these patients. The present case had intussusception, a rare complication of von Recklinghausen 's disease. Svnall-intestinal Endoscopy played an essential vole in the diagnosis of gastrointestinal involvement in our patient.     

Increase of sulfated ursodeoxycholic acid in the serum and urine of patients with chronic liver disease after ursodeoxycholic acid therapy

The present study was undertaken in order to investigate the influence of ursodeoxycholic acid (UDCA) on the composition of sulfate-conjugated bile acids in the serum and urine of patients with chronic active hepatitis and compensated liver cirrhosis. After a 12 week UDCA treatment (600 mg/day), total serum bile acid concentration increased two-fold in patients with compensated liver cirrhosis and increased slightly in patients with chronic active hepatitis. The percentage of sulfated bile acids significantly increased in patients with both compensated liver cirrhosis and chronic active hepatitis. UDCA made up 63% of the total serum bile acids in compensated liver cirrhosis and 61% in chronic active hepatitis after UDCA treatment. Of the serum bile acids after UDCA treatment, 35.2 and 53.9% of UDCA was sulfate conjugated in compensated liver cirrhosis and chronic active hepatitis, respectively. Urinary excretion of total bile acid and UDCA after UDCA treatment in compensated liver cirrhosis were higher than in chronic active hepatitis. UDCA made up 68% of the total urinary bile acids in compensated liver cirrhosis and 64% in chronic active hepatitis after UDCA treatment. Of the urinary bile acids after UDCA treatment, 51.8 and 54.8% of UDCA was sulfate conjugated in compensated liver cirrhosis and chronic active hepatitis, respectively. UDCA treatment for compensated liver cirrhosis was less effective than for chronic active hepatitis. We found that sulfate conjugation is one of the major metabolic pathways for UDCA after UDCA treatment in chronic liver diseases.     

Economic evaluation of Helicobacter pylori eradication for the treatment of duodenal ulcer disease in Japan: A decision analysis to assess eradication strategy in comparison with a conventional strategy

To evaluate the socio-economic effects of Helicobacter pylori eradication in the treatment of duodenal ulcer disease in Japan, a clinical decision analysis was performed to assess H. pylori eradication therapy compared with the conventional strategy of maintenance with histamine-2 receptor antagonists. A decision tree-based state transition model (Markov chain approach) implemented to simulate a 5 year period of follow up was constructed. The H. pylori eradication strategy was found to be superior to the conventional maintenance strategy with regard to clinical effectiveness and other dimensions of a patient’s outcome. Furthermore, in a long-term perspective, the eradication strategy was less costly than the maintenance strategy. Helicobacter pylori eradication should be recommended as the ?rst choice treatment of H. pylori-positive duodenal ulcer patients. The clinical implication of H. pylori eradication entails an improvement in clinical effectiveness and other dimensions of a patient’s outcome and a signi?cant reduction in the costs of duodenal ulcer treatment. The long-term total costs do not depend on the initial drug cost of an eradication regimen. Pursuing a high eradication rate of H. pylori is essential in improving the patient’s outcome and the cost-effectiveness of treatment.     

Nonfluoroscopic Guidance for Catheter Placement into the Coronary Sinus under Direct Vision Using a Balloon-Tipped Cardioscope

The right atrial posterior septum, including the coronary sinus (CS) ostium, is an important landmark in radio frequency catheter ablation therapy for supraventricular tachycardia or atrial flutter. The anatomical findings around the CS ostium would be useful to determine a target site or line during catheter ablation. The aim of the study was to test the ability of the imaging catheter to identify structures in the posterior septal area of the right atrium and to evaluate the feasibility of guidance for catheter placement in the CS using a cardiosccpe that we recently developed. In 12 anesthetized dogs, the Cardioscope, consisting of a deflectable 7 Fr fiberoptic endoscope with an inflatable and transparent balloon, was introduced into the right atrium via the femoral vein. The cardioscope was manipulated to observe the right atrial posterior septum. A deflectable electrode catheter was inserted via the jugular vein and positioned in the CS under cardioscopic guidance. In 10 of 12 dogs, the right atrial posterior septum, including the CS ostium, and the tendon of Todaro could be anatomically identified by cardioscopy. It was possible to position an electrode catheter in the CS in all 10 dogs under direct vision without fluoroscopy. But the CS ostium could not be detected in the remaining two dogs, although the cardioscope was placed at as many sites as possible. No complication occurred. The balloon-tipped cardioscope appears to be useful in observing the right atrial posterior septum and in guiding an electrode catheter into the CS.     

IDENTIFICATION OF THE NORMAL MICROGLIAL POPULATION IN HUMAN AND RODENT NERVOUS TISSUE USING LECTIN–HISTOCHEMISTRY

Mistletoe lectin-1 (ML-1) and Ricinus communis agglutinin-120 (RCA-1) both possess D-galactose-specific surface-binding sites. They were used to selectively identify microglial populations in aldehyde-fixed normal brain tissue by lectin immunohistochemistry on paraffin and frozen sections. Mistletoe lectin-1 was superior to RCA-1 in labelling microglia in the rat brain, whereas RCA-1 labelled human microglia better than ML-1. Thus, RCA-1 and ML-1 supplement each other for identifying microglial in human and rodent central nervous system tissues. The high reproducibility of the results and the applicability of the technique to routine histology, using formalin-fixed tissue, should facilitate study of the histogenesis and role of microglia in the CNS.     

Trimethadione tolerance test for the quantitative assessment of liver function in rats

The quantitative estimation of the hepatic functional volume in rats was attempted using the serum dimethadione (DMO)/trimethadione (TMO) ratio in a single blood sampling after oral administration of TMO, which we call the TMO tolerance test, in order to develop a means of pre-operatively assessing hepatic resectability. Serum DMO/TMO ratios correlated well with the total amount of the hepatic microsomal TMO-N-demethylase activity (enzyme activity) and with the remnant liver weight after 37% and 68% partial hepatectomy. These ratios increased after partial hepatectomy in parallel with the changes in the enzyme activity and the remnant liver weight. The results suggest that the quantitative functional changes of the remnant liver after hepatectomy in both CCl4-treated and untreated rats can be estimated pre-operatively by the TMO tolerance test.     

Laparoscopic Observation of Hepatocellular Carcinoma with an Unusual Growth Pattern —Four Case Reports—

Abstract: Usually a laparoscopy is performed for many cases of hepatocellular carcinoma (HCC), but HCC with an unusual growth pattern is not encountered frequently. In this study we report on four cases of HCC which show an unusual growth pattern, who were found out of 96 cases of HCC examined by laparoscopy at our clinic. The first case of HCC considered occurred in a 72–year–old male with intraperitoneal dissemination; the second case, was discovered in a 71–year–old female, and had extrahepatic growth; the third case, in a 56–year–old male, ruptured spontaneously and produced an encapsulated hematoma; the fourth case, present in a 64–year–old male, also ruptured spontaneously. The clinico–pathological and laparoscopic features of HCC with an unusual growth pattern are discussed, placing emphasis on the value of laparoscopy in the diagnosis of HCC with an unusual growth pattern.