The levels of IgG subclasses were determined in patients with active systemic lupus erythematosus (SLE). The levels of all IgG subclasses in these patients were higher than normal controls. However, there were variations in the increase of IgG subclasses, especially IgG 1 or IgG 2. As concerning the relation to the clinical findings, the levels of IgG 1 significantly increased in patients with renal involvements and those of IgG 3 increased in patients with low complements. Thus, it was suggested that some IgG subclass related to some clinical findings.

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We measured serial changes of cytoplasmic bcl-2 oncoprotein in peripheral blood lymphocyte subsets after preparation of cell samples or cultivation with mitogen or interleukin-2 (IL-2) by two-color flow cytometry using monoclonal antibodies to lymphocyte subsets and human bcl-2.
The bcl-2 levels determined by mean fluorescence intensity were diminished in most lymphocyte subsets when the samples were preserved at 4°C for 6 hours or more without 1% paraformaldehyde (PFA) fixation. However, the bcl-2 levels were kept constant for a week or more in the samples preserved at 4°C after immediate staining of cell surface markers and subsequent fixation with PFA.
The percentages of CD 4+ cells, CD 8+ cells, CD 19+ cells and Fas+ cells became high when lymphocytes were cultured with concanavalin-A, and bcl-2 levels were also enhanced in these subsets. In addition, the bcl-2 levels were compared between lymphocytes cultured with and those without recombinant IL-2. IL-2 inhibited spontaneous decrease of bcl-2 in cultured lymphocytes. Apoptosis of the cultured lymphocytes was also determined by a flow cytometric method. IL-2 seemed to diminish apoptosis of cultured lymphocytes.

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It is not uncommon to find cases of fever of unknown origin (FUO) in which no final diagnosis is made ever after various examinations. We investigated such cases of undiagnosed FUO, with fever persisting for a long periods and responding to steroid therapy. Among 4596 patients who were hospitalized over a 3-year period from September 1991, 25 met Petersdorf's definition of FUO. Among these 25 patients, six cases were steroidresponsive undiagnosed FUO (SR-FUO). Patients with SR-FUO had the following characteristics: marked inflammatory findings and severe illness; without a definite underlying disease being found despite various examinations; no findings which indicated any known diseases such as adult-onset Still's disease, polymyalgia rheumatica, or other collagen diseases; elderly onset, at 58 to 77 years of age (mean age: 67 years); no improvement with antibiotics, antituberculous agents, or antimycotic drugs; significant improvement of symptoms and signs with steroid therapy; and a relatively good prognosis. SR-FUO, which is not caused by any known disease and is highly responsive to steroids, is included among the FUO cases which we have difficulty in diagnosing and treating.

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We found 5 cases of prostatic carcinoma with metastasis with α₂ macroglobulin (α₂M) concentration below approximately 40mg/dl in serum. All these patients had bone metastasis, and none of them had DIC. We found no other cases with such a low concentration of α₂M.
Their α₂M level increased to normal level after treatment with transurethral resection of prostate or hormon agents, and the level was correlated with the clinical symptom. During the clinical course, their α₂M level was negatively correlated with prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP). All these results suggest that α₂M concentration in serum reflects the severity of prostatic carcinoma with metastasis and that α₂M deficiency is an indicator of metastasis.
The acute phase proteins of CRP and serum amyloid A did not increase in spite of the presence of metastasis in these patients with extremely low α₂M level (<20mg/dl), suggesting that α₂M is involved in the metabolism of these acute phase proteins.
On immunohistochemical studies, their speciments of prostatic carcinoma gave positive stain for PSA and urokinase-type plasminogen activator (u-PA). Both PSA and u-PA formed a complex with α₂M in vitro. The α₂M deficiency in these patients might be due to the complex formation between α₂M and these prostate-originated proteases and to the rapid disappearance of the complex.

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The correlation between the efficacy of type II collagen (C II) treatment of the rheumatoid arthritis (RA) and the exsitence of HLA-DRB 1*0405 allele was investigated in two groups of patients; the first group had HLA-DRB 1*0405 allele (the 0405 group) and the second had no such allele (the non-0405 group). Thirty-eight RA patients were given a chicken cartilage soup containing heat degenerated C II (the C II group) or a placebo soup (the placebo group) for three months. The 38 cases were composed of 11 cases in the 0405/ C II group, 9 in the 0405/placebo group, 11 in the non-0405/C II group, 9 cases in the non-0405/ placebo group. In the C II group, there was a significant increae in the anti-human C II IgA antibody serum titers (p=0.003) and significant decrease in the anti-human C II IgG titer (p<0.0001).
The differences in the number of swollen and tender joints were statistically significant between the 0405/C II and 0405/placebo groups (p of the swollen joints=0.03, and p of the tender joints=0.03), and between the 0405/C II and non-0405/C II groups (p=0.006 and 0.01, respectively).
We concluded that oral C II could have a therapeutic efficacy in RA patients with HLA-DRB 1*0405 allele.

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A 48-year-old woman was admitted to our hospital with respiratory failure (Hugh-Jones IVV). She was diagnosed as relapsing polychondritis 6 years ago. Her respiratory failure was due to pharyngial stenosis, deformity and inflammation of a trachea and lobar bronchus, and bronchial collapse. Her tracheobronchochondritis was managed by 500700mg/day of hydrocortisone and 50mg/day of cyclophosphamide. Laboratory examination revealed only slight elevation of CRP and no elevation of anti-type II collagen antibody, although these parameters were very high on her first admission when she had severe polyarthritis, polychondritis of nose and auricles. Bronchoscopic findings were compatible with tracheobronchomalacia since pharyngial stenosis due to inflammatory pharyngitis and bronchial collapse due to tracheobronchochondritis were shown without lung parenchymal damage. We refered to the literature on tracheobronchomalacia which was associated by the varieties of respiratory and rheumatic diseases.

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The case of dermatomyositis complicated with cecum perforation and panniculitis occured in a 62-year-old woman was reported. She was admitted to Keio University Hospital with a history of proximal muscular weakness, and dysphagia. Physical examination showed erythema over the face and shoulder. Serum level of muscle enzymes was remarkably increased. The diagnosis of dermatomyositis was made based on proximal muscular weakness, elevated serum level of muscle enzymes and myogenic change of electromyocardiogram. The treatment with 60 mg/day of prednisolone was started, and was a good response. However, 7 months later the disease became active again when the amount of prednisolone was reduced to 13 mg/day. Subsequently she complained of abdominal pain on the right lower quadrant. The surgical findings included peritonitis due to the perforation of the cecum and multiple ulcers of the cecum. After operation, azathioprine was added. Four years and 9 months later, she noticed skin erythema with ulceration and subcutaneous nodule. Skin biopsy indicated the findings of the panniculitis with membrano-cystic lesion.
It was thought that both cecum perforation and panniculitis were caused by angiopathy which was often seen in childhood dermatomyositis.

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We reported a 26-year-old female who had experienced 2 miscarriages associated with a possible cause of antiphospholipid antibody.
She consulted to Kainan Municipal Hospital with major complaints of miscarriages and positive antiphospholipid antibody. No evidence of obstetric disorder was apparent and routine haematological parameters were normal. Serological studies and clinical evidence did not show SLE. While biologically false positive (reaction of serological test for syphilis) and lupus anticoaqulant was negative, IgG anticardiolipin antibody was positive.
She was diagnosed as possible antiphospholipid antibody syndrome based on positive anticardiolipin antibody and the history of miscarriages. In 1993, she was started on prednisolone and aspirin therapy; antiphospholipid antibody returned to negative.
Treatment with prednisolone (7.5 mg/day) and aspirin (40 mg/day) was continued. She was able to be pregnant. She gave birth successfully at our hospital in August 1995. She and her newborn showed no abnormalities.

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A-32-year-old woman was admitted to our hospital because of diarrhea, fever, and liver dysfunction. IgM antibody to hepatitis A, hepatitis C antibody and hepatitis B makers were negative. Antibodies to human dificiency virus was negative. Bacterial cultures of the stool were negative. Sigmoidscopy on the 9^th hospital day showed diffuse edematous and imflated mucosa in the rectum and left-sided colon. Multiple erosions and small ulcers were also present. Polymerase chain reaction examination revealed cytomegalovirus (CMV) DNA in the biopsy specimen of the rectum and the blood on the 10^th hospital day. IgG antibody titer to CMV was low, but IgM titer was high. Her physical state had improved and fever resolved without anti-CMV therapy. Second sigmoidscopy on the 24^th hospital day showed normal mucosa. One month later the patient was free from any symptoms.
Immunocompromised patients such as recipients of solid organ and bone marrow transplants, patients with AIDS, and patients with malignancies frequently complicate CMV colitis, which can be a major cause of death. Thus, CMV colitis is rarely overlooked in immunocompromised patients. Only a few cases of CMV colitis are reported in adult patients with no risk for CMV infection or associated disease. CMV colitis should be concluded in the differential diagnosis of acute or subacute colitis even in immunocompetent patints.

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This report described a 44 years-old female mixed connective tissue disease (MCTD) patient presenting pulmonary hypertension, successfully treated with angiotensin I converting enzyme (ACE) inhibitor. The patient was diagnosed as having MCTD because of Raynaud's phenomenon, swollen hand, and elevated level of anti-U 1 RNP antibodies. She was admitted to our hospital one year after the diagnosis of MCTD, because she experienced dyspnea and pretibial edema. A diagnosis of pulmonary hypertension was made by echocardiography and catheterization study. Pulmonary artery pressure and pulmonary artery resitance declined and returned gradually to normal during a period of three months with prednisolone and enarapril (10mg/day) therapy. Pulmonary hypertension is one of fetal complications with MCTD, and 5 year mortality rate is reported less than 50%. However, a successful therapy for the pulmonary hypertension with MCTD has not been established yet. We considered that ACE inhibitor might be useful to control the pulmonary hypertension with MCTD and could improve the prognosis of MCTD.

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