Recently, the incidence of acute gastric mucosal lesions (AGML) associated with diabetes mellitus (DM) have been increased. However, the pathogenesis of AGML in the DM patients is poorly understood. This experimental study using streptozotocin (STZ)-diabetic rats was performed primarily to investigate whether AGML developed after 24-hour fasting as an emotional stress in STZ-DM rats, and secondary to evaluate the pathogenesis of the development of AGML. The gastric hemorrhagic lesions developed in all rats after 24-hour fasting four weeks after STZ administration, and, histologically, the gastric ulcers beyond muscular is mucosae were observed. Causative factors of gastric mucosal lesions associated with diabetes mellitus were evaluated with reference to aggressive and defensive factors of the gastric mucosa. The impairment of gastric mucosa on DM rats was supposed to be caused by the destruction of defensive factors including decreased gastric mucosal blood flow, ATP and energy charge, mucous hexosamine, microcirculatory alteration of gastric mucosa, and increased phospholipase A_2. Micro vascular structure employing two color microflls revealed lower hight of the true capillaries on gastric mucosa in DM rats and the extravasation of microfil at AGML area.

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To determine whether a hot water extract of leaves of bamboo grass (bamboo extract, BE) would enhance the activity of primary host defense against microbial infection, content of the third component of complement (C3), and that of fibronectin (FN) in plasma and of H_2O_2 produced by glanulocytes in blood from mice 4hr after intraperitoneal (i.p.) injection of BE were calculated. C3 and FN in plasma did not increase but H_2O_2 production by glanulocytes from mice injected with BE increased significantly. The effects of BE on C3 and FN production by murine peritoneal macrophages (PMφ) were examined. Monolayers of PMφ obtained from mice 4hr after i.p. injection of BE and PBS (-) (control) were cultured with ASF-301 medium at 37℃ for 24hr. C3 and FN production by PMφ from mice treated with BE increased significantly to PMφ from control mice. C3 and FN production by PMφ treated in vitro with BE showed no increase. Increased production of H_2O_2 by peritoneal cells was observed in peritoneal cells from mice treated in vivo, but not in vitro, with BE. Increase in opsonic protein and H_2O_2 production by cells in local tissue by treatment with BE would thus appear to contribute to primary host defense against microbial infection.

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Polyclonal antibodies were raised against Na^+,K^+-ATPase (Na pump) holoenzyme and its subunits, α and β, which were isolated from the holoenzyme denatured with sodium dodecyl sulfate. Among the antibodies, the holoenzyme-directed antibodies recognized the intact Na^+,K^+-ATPase and inhibited its activity, whereas α and β-directed antibodies neither recognized the enzyme nor inhibited the activity. To identify antigenic regions to these antibodies, cDNAs coding peptide fragments corresponding to various regions of the α and β subunits were subcloned, and transcribed. The resultant RNAs were translated in the presence of [^<35>S]methionine. The biosynthesized peptides were immunoprecipitated with the antibodies. The immunoprecipitated products were applied to sodium dodecyl sulfate-gel electrophoresis, followed by autoradiography. The holoenzyme-directed antibodies recognized peptide fragments M32-D75, M158-D197 and M470-L534 of the a subunit and a C-terminal half of the β subunit, suggesting that the regions corresponding to these peptides on the α and β subunits locate the surface of the intact Na^+,K^+-ATPase molecule in cell membrane and that some sections of them are essential for ATPase activity. On the other hand, region M615-Q677 of the α subunit and a N-terminal one third of the β subunit, which were recognized with the denatured a and β subunits-directed antibodies, seem to expose on the surface of the enzyme molecule after their denaturation. Region M 267-I442 and a C-terminal one-third of the a subunit, which were not recognized with any antibodies, seem to locate in the interior of the molecule.

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A 55 years-old female was admitted to our hospital because of polyarthralgia, tibial edema, hypertension and renal insufficiency. Laboratory studies disclosed leukocytopenia, thurombocytopenia, hypocomplementemia, protenuria and high titer of IgG class antisingle stranded (ss) DNA antibody without anti-double stranded (ds) DNA antibody. Renal biopsy revealed class V-c lupus nephritis based on WHO classification. After admission rapidly progressive lupus nephritis developed with high titer of IgG class anti-ss DNA antibody without anti-ds DNA antibody. Administration of large dosis prednisolone was started, renal function and other symptoms remarkably improved paralleled with decreased IgG class anti-ss DNA antibody titer. Although it is generally accepted that lupus nephritis is mediated by anti-ds DNA antibody, the data of this case suggested that IgG class anti-ss DNA antibody might also participate in the pathogenesis of lupus nephritis.

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A seventy-two-year-old male patient was admitted because of high fever. Two diverticula were noted in the upper and middle portions of esophagus. He was on a diet for diabetes mallitus and was receiving medication to control hypertension and hyperlipidemia. Five days before admission, he took 4 kinds of prescribed medicine while talking with his wife. Soon after taking medicine, he had a severe burning and regurgitating sensation in his throat and esophagus. He could neither eat or drink, and developed a high fever and severe cough. On admission, chest X-ray revealed an enlargement of the mediastinum and abscess in the right lower lung. Intensive chemotherapy was carried out. Chest CT showed mediastinal emphysema, for which a mediastinal drain was inserted. Esophagography disclosed outflow of the contrast material from two points of the upper and middle thoracic portions of the esophagus into the mediastinum. Diagnosis was established as perforations of esophageal diverticula, abscess in the mediastinum and pyothorax in the right lung. When the perforated diverticula were covered with a fibrinogen-thrombin preparation (Periplast) under esophagoscopy, a press through package (PTP) of the prescribed drug was found in a diverticulum in the middle thoracic part of the esophagus. The PTP was removed. Abscess and fever gradually subsided, and he was discharged 89 days after admission. In this case, the patient, although highly intelligent, carelessly took a prescribed drug without removing the PTP. The PTP caused perforation of a diverticulum in the middle section of esophagus, while severe cough seemed to induce further perforation in another diverticulum of the upper esophagus. Although aspiration pneumonia is very common in the aged, we must also consider this type of pneumonia or abscess due to swallowing a foreign body.

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Report is made on 4 cases clarified to be the natural sudden death caused by the traffic accidents in driving the cars out of 248 autopsy cases examined in cur laboratory in the period from July, 1987 to Dec, 1991. In 4 cases, their average age was 49.5 years, they were 3 males and 1 female. The cause of death was the cardiac diseases in 2 cases, the cerebro-vascular disorder in 1 case, chronic alcoholic liver disease in 1 case. The previous reports indicate a tendency that there were many males of higher age with basic diseases who died suddenly with endogenic causes during the time driving the car. Even in our examined cases, 3 cases were middle and high aged persons. Basic diseases have been clarified for only 1 case, and 3 out of 4 cases have been scarcely treated medically before death. During car-driving, it is difficult to prevent sudden death, but in driving the car by middle and high aged persons, periodical examination shall be obligated for earlier detection of the diseases, and if detected, it seems important to prevent the accident of death with proper and adequate medical treatments.

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