Hemolytic anemia following high-dose intravenous immunoglobulin administration

We describe two cases of hemolytic anemia following high-dose intravenous human immunoglobulin administration in young females with idiopathic thrombocytopenic purpura. Inducement of hemolytic anemia by anti-A and anti-B antibodies in these cases necessitates the performance of a minor crossmatching procedure prior to immunoglobulin use to prevent the occurrence of this adverse reaction.     

Testosterone treatment enhances thromboxane A2 mimetic induced coronary artery vasoconstriction in guinea pigs

Abstract. Thromboxane A₂ (TXA₂) has been implicated as an important mediator of cardiovascular diseases. There have been several clinical reports of acute myocardial infarctions occurring in young male athletes abusing anabolic steroids. The effects of treatment of male Guinea pigs with testosterone on the responses to U46619, a TXA₂ receptor agonist, in the isolated perfused heart were determined. The maximum pressor responses of the isolated perfused Guinea pig heart to U46619 were significantly (P < 0·05) greater in the Guinea pigs treated with testosterone compared to the controls. These results indicate that testosterone can enhance coronary artery vascular reactivity to TXA₂.     

Advanced Ovarian Cancer Treated by Intraperitoneal Immunotherapy With OK-432

Twelve patients with advanced ovarian cancer with ascites weretreated by intraperitoneal immunotherapy with OK-432 in combinationwith surgery and systemic immunochemotherapy. The median timefor total resolution of ascites after the OK-432 injection was7.1 days. In three of the four patients who died, it took morethan the average number of days for the ascites to disappear.The ascites index, the ratio of the ascitic fluid volumes beforeand after intraperitoneal immunotherapy, was significantly higherin the patients who died than in those who survived. The sideeffects of intraperitoneal administration of OK-432 varied,but were not serious and relief was not needed in most cases. Intraperitoneal injection of OK-432 was considered effectivein preventing the reappearance of ascites in these cases ofadvanced ovarian cancer, and the ascites index was believedto be related to the prognosis.     

Stimulation of Interleukin 6-Like B-Cell Differentiation Factor Production in Human Adherent Synovial Cells by Recombinant Interleukin 1

Abnormal production of immunoglobulin in the joint space is frequently observed in patients with rheumatoid arthritis (RA). We have previously demonstrated that adherent synovial cells (ASC) from patients with RA are involved in B-cell differentiation by their spontaneous production of B-cell differentiation factor (BCDF). The regulation of the production of this factor, however, has not yet been described. We investigated the effects of recombinant interleukin 1 alpha and beta (rIL-1 alpha and rIL-1 beta) on the production of BCDF in ASC. Increased production of BCDF was observed with increased rIL-1 concentration. Production of BCDF was detected 3 h after exposure of ASC to rIL-1 and increased throughout a 48-h culture. This BCDF, assayed on SKW6-CL4 cells, was found to share a common active site with interleukin 6. The effect of rIL-1 was almost neutralized by anti-IL-1 antibody and the addition of polymyxin B did not diminish the effect of rIL-1, indicating that rIL-1 itself stimulates ASC in vitro. These results suggest that IL-1 may play a regulatory role in the production of BCDF in synovial tissue.     

Inhibitory Effect of NZ-105, a 1,4-Dihydropyridine Derivative,on Cyclic Nucloeotide Phosphodiesterase Activity

Abstract— The effects of NZ-105, a 1,4-dihydropyridine calcium antagonist, on the intracellular cyclic nucleotide system were investigated in-vitro. In rabbit isolated aorta, both NZ-105 (1 and 10 μm ) and nicardipine significantly and in a concentration-dependent manner increased intracellular cyclic AMP and cyclic GMP content. NZ-105 inhibited bovine cardiac phosphodiesterase activity (K_i 30 μm ) by competitive antagonism. The concentration ranges for inhibition were consistent with the range of increases in cyclic nucleotides.     

In vivo cell kinetics studies of the duodenum during and after healing of cysteamine-induced duodenal ulcer in rats using bromodeoxyuridine incorporation

The present study investigated the defect of duodenal defence responsible for the tendency of recurrence of duodenal ulcer. Male Wistar rats were treated with cysteamine-HCl subcutaneously to induce duodenal ulcer, and bromodeoxyuridine (BrdU) was given intraperitoneally 1 h before laparotomy. Serial tissue sections and immunocytochemical staining of BrdU were done to study the cell kinetics during and after healing. Deep ulcers developed in the proximal part of the duodenum 24 h after cysteamine injection, and the ulcer was replaced by scar tissue 1 week later. BrdU-labelling index of normal duodenal mucosa in control rats was 30-34%. On the peripheral part of the regenerative mucosa, BrdU-labelling index increased from 1.5% to 26-27%, 1-4 weeks after injection and remained at this level thereafter. On the central part, except the most central area, the labelling index remained at 0% until 3 weeks, and was 15% 6 weeks after cysteamine treatment. It never achieved the level seen in control normal mucosa. The labelling rate of fibrous cells in scar tissue decreased from 28% to nearly 0% 1-4 weeks after the injection. It is concluded that both the ulcer scar and the regenerative mucosa do not achieve a mature state in the initial scarred stage; they need more time to reach a relatively mature condition. Moreover, the regenerative mucosa will be the weak, easily damaged part of the duodenum.     

Effect of inspired nitrous oxide concentration on the rate of fall of alveolar concentration: reversed concentration effect

The effect of inspired nitrous oxide concentration on the rate of fall of alveolar nitrous oxide concentration was studied in six patients ranging in age from 25 to 46 years. After equilibrium was reached with nitrous oxide, nitrous oxide administration was stopped and replaced by the same concentration of nitrogen. The decrease in alveolar concentration of nitrous oxide (FE/FE0) was measured continuously, where FE = measured end-tidal concentration of nitrous oxide, and FE0 = the end-tidal concentration immediately preceding the cessation of nitrous oxide administration. The rate of decrease in FE/FE0 was more rapid when 70% nitrous oxide was inspired (Part I) than when 30% nitrous oxide was inspired (Part II). One minute after the cessation of nitrous oxide administration, FE/FE0 was 0.30 +/- 0.03 (mean +/- s.d.) in Part I and 0.36 +/- 0.02 in Part II (P less than 0.05). Mean expired tidal volume increased from 515 +/- 43 ml to 552 +/- 48 ml in Part I and from 510 +/- 48 ml to 526 +/- 39 ml in Part II (P less than 0.05). The authers conclude that the more rapid decrease in alveolar concentration of nitrous oxide (FE/FE0) at higher concentrations of nitrous oxide results from augmentation of expired ventilation. We have called this phenomenon the "reversed concentration effect".     

Experimental His-Bundle Pacing: Histopathological and Electrophysiological Examination

His-bundle pacing gives a more physiological ventricular contraction in comparison to right ventricular apical pacing. However the problems of lead fixation and stability of long-term His-bundle pacing are yet unsolved. We used six adult beagles, in which a screw-in lead was anchored in the His-bundle region for observation of the pacing conditions and histopathologic changes of the conduction system over the course of 2 months. In the results, a satisfactory fixation was obtained using a conventional screw-in lead and no histological influence on the conduction system was observed. The pacing threshold at the time of implantation was 1.15 ± 0.69V (3.23 ± 3.08 mA) in the pulse width of 0.5 ms. R wave amplitude, the impedance and slew rate were 7.28 ± 2.04 mV, 409 ± 102 Ohm, and 0.65 ± 0.41 V/s, respectively. Two months later, these parameters changed to 2.83 ± 1.06 V (10.4 ± 5.71 mA), 5.63 ± 1.62 mV, 310 ± 71.3 Ohm, and 0.49 ± 0.22 V/s, respectively. These results suggest the feasibility of clinical application of permanent His-bundle pacing.     

End-of-life experience of demented elderly patients at home: findings from DEATH project

Background: As the number of demented elderly patients choosing to die at home continues to rise, it is important to ascertain how cognitive impairment is associated with symptom experience and end‐of‐life care received at home. A number of studies have suggested that patients with dementia often receive poor end‐of‐life care, with inadequate pain or other symptom control, so far however, very little research has dealt with community settings. The aim of the present study is to compare symptom experience and end‐of‐life care received by home patients based on cognitive function. Methods: The present data was obtained from the Dying Elderly at Home (DEATH) project, a multicenter observational study conducted in Japan. The following information was collected: decedent characteristics, observed symptoms and end‐of‐life care provided during the last 48 h of life. A total of 98 decedents with dementia and 112 decedents without dementia were included in the analysis. To assess the differences in characteristics and clinical course among decedents, the survey data was divided into two groups: dementia and non‐dementia. Results: Demented decedents were prone to incontinence or cough, but experienced relatively little pain, nausea and vomiting. Demented decedents were given more antibiotics but less opioids than non‐demented decedents. Also, they received a larger volume of intravenous infusion at 24–48 h before death. After controlling for age and other differences in baseline characteristics, dementia was determined to be a significant independent predictor of incontinence or uncontrolled pain. After controlling for age, other differences in baseline characteristics and symptom experience, dementia was determined not to be a significant independent predictor of use of antibiotics or opioids. Conclusions: Our findings suggest that dementia itself was an independent predictor of incontinence or less pain, and that it was not a significant independent predictor of use of end‐of‐life in a home setting.