<症例>マムシ (Agkistrodon halys Blomhoffii) 咬傷における少量抗毒素血清投与の経験 : 43症例の検討

Forty-three consecutive patients of venomous snakebite by the Japanese viper (Agkistrodon halys Blomhoffii, "Mamushi" in Japanese) were treated with an uniformly scheduled therapy from 1990 and 1994. The therapy was mainly composed of minimal dose of antivenin, methylprednisolon and cepharanthin. There were two clinical courses, i.e., the minimal envenomation course (Group A, n=14) and the severe one (Group B, n=29). Our treatment was so satisfactory that all patients of both groups fully recovered activities of daily living with neither organic disorders nor sequelae of the bitten extremities. The high appearance ratio of atypical lymphocytes (P < 0. 05) and the increased ratio of lymphocyte count to White blood cell count (P<0. 02) could be indicators that predict hich clinical courses the patients take.1990年から1994年までの5年間に当院で治療したマムシ咬傷43例について検討した. 当院では原則として抗毒素血清, ステロイド, セファランチンの投与を行っているが, 死亡例はなく, 咬傷部の機能障害を示した症例もなかった. 4例（9. 3%）に即効型過敏反応が認められた. 1例は anaphylaxy shock を呈したが治療により即時改善をみた. 遅延型血清病は入院期間中観察されなかった. McCollough らの分類により軽症例（n=14）と重症例（n=29）に分け予後因子を検討した. 治療開始前の WBC, CPK, LDH, BUN, Cr はいずれも重症化指標とはなりえなかったが, 白血球中のリンパ球比率（P<0. 02）, 異型リンパ球出現率（P<0. 05）が高い程, 重症化することが示唆された. 死亡報告が散見されるマムシ咬傷に対し受傷早期の抗毒素血清投与は有用であり, 即効型過敏反応に即座に対応すれば比較的安全に投与できるものと考えられた. しかし, 軽症例に対しての抗毒素血清投与には疑問が残り, 今後は重症化が危倶される症例を的確に選択する必要があると思われた

Partial liquid ventilation does not affect BALF TNF-, MIP-2, CINC-1 concentrations, or CD11b cell surface expression, but does increase macrophage proportion among BALF cells in the acute phase of rat LPS-induced lung injury.

To elucidate the mechanism of anti-inflammatory effect of partial liquid ventilation (PLV), cytokine concentration, surface CD11b, and macrophage expression were investigated in BALF. The 30-minutes group was treated with gas ventilation (GV) for 30 minutes after intratracheal LPS administration. The GV group was prepared in the same manner as the 30-minutes group, then the GV was continued for the following 2 hours. The PLV group was treated in the same manner as the 30-minutes group, and then received PLV with perflubron for the following 2 hours. Animals were euthanized to receive BAL. The PLV group showed a tendency to have a higher concentration than the GV group of TNF-alpha, MIP-2, and CINC-1 as measured by ELISA, although there were no significant differences. The ratio of expressions of CD11b and macrophages to total leukocytes were determined by flow-cytometry. There were no significant differences in the ratio of CD11b-positive expression to acquired cells (GV: 63.6 +/- 8.4%, PLV: 60.5+/-5.4%, P=0.73). However, the proportion of macrophages was significantly increased (GV: 5.6 +/-1.5, PLV: 14.0+/-1.3, P=0.006). These results suggest that the anti-inflammatory effect of PLV is not caused by the change in CD11b expression, and that PLV affects the proportion of macrophage among BALF cells.</p

Class VI myosin moves processively along actin filaments backward with large steps

Among a superfamily of myosin, class VI myosin moves actin filaments backwards. Here we show that myosin VI moves processively on actin filaments backwards with large ( approximately 36 nm) steps, nevertheless it has an extremely short neck domain. Myosin V also moves processively with large ( approximately 36 nm) steps and it is believed that myosin V strides along the actin helical repeat with its elongated neck domain that is critical for its processive movement with large steps. Myosin VI having a short neck cannot take this scenario. We found by electron microscopy that myosin VI cooperatively binds to an actin filament at approximately 36 nm intervals in the presence of ATP, raising a hypothesis that the binding of myosin VI evokes hot spots on actin filaments that attract myosin heads. Myosin VI may step on these hot spots on actin filaments in every helical pitch, thus producing processive movement with 36 nm steps