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We purified a novel serine proteinase inhibitor (serpin)-like protein from the bovine brain and named it B-43 from its molecular mass, 43 kDa. A cleaved peptide from B-43 was copurified with the native B-43. Partial amino acid sequencing of the purified B-43 showed that this protein was homologous to glia-derived nexin/protease nexin-1 (GDN/PN-1), plasminogen activator inhibitor 2, leukocyte elastase inhibitor (LEI) and placental thrombin inhibitor (PTI) among the serpins. Although B-43 had a similar amino acid composition to these serpins, the biochemical features of B-43 were different from them. B-43 did not form sodium dodecyl sulfate (SDS)-resistant serpin-proteinase complexes with thrombin, urokinase, pancreatic elastase and plasmin, suggesting that these proteinases were not the targets of B-43. In contrast to GDN/PN-1, B-43 did not have an affinity for heparin. B-43, having different biochemical properties from GDN/PN-1, appears to be an additional serpin expressed in the brain.

Fournier's gangrene (FG) is rapidly progressing acute gangrenous infection of the anorectal and urogenital area. FG needs precocious diagnosis and aggressive treatment with the use of wide spectrum antibioticus and surgical debridement. In our case, a 91-year-old Japanese female who had rehabilitation after treatment of pneumonia and her past history was rheumatoid arthritis treated with steroid and chronic heart failure. Her activities of daily living was bedridden with dementia. Necrotic skin was observed in urogenital and anorectal area and skin redness enlarged to the hip with high fever. Surgical debridement was performed. Both Peptostreptococcus Sp. and Fusobacterium Sp. was cultured from resected necrotic tissue. We used antibioticus, PAPM and PIPC, which had sensitivity for them. But unfortunately, disseminated intravascular coagulation occurred after 4th day of operation, and finally she died after 10th day of operation. We discussed the treatment for FG in patient with complication.

Acute appendicitis often presents as right lower quadrant (RLQ) pain, severe tenderness at the point of McBurny or Lanz, and Blumberg's sign. Scrotal events with appendicitis are very rare. In our case, a 63-year-old Japanese man presented with severe RLQ pain and high fever. Physical examination revealed severe tenderness (including both points of McBurny and Lanz) and Blumberg's sign. The scrotum was slightly swollen and showed local heat with severe testicular pain. Abdominal computed tomography revealed ascites in a pelvic space and the right side of the spermatic cord was swollen. Emergency operation was performed and the final diagnosis was catarrhal appendicitis and acute epididymitis. This is the first report of acute appendicitis concomitant with acute epididymitis.

"Takotsubo" cardiomyopathy is characterized by transient left ventricular dysfunction. We have reported a case of "Takotsubo" cardiomyopathy unrecognized during anesthesia because of no ischemic changes in monitored electrocardiogram (ECG). The patient was an 80-year-old woman undergoing open reduction surgery for fractures of the left tibia and ulna. Anesthesia was maintained with O2, N2O, sevoflurane and fentanyl. Sinus tachycardia was noted throughout anesthesia which was unresponsive to fluid loading and blood transfusion. ECG of limb leads showed no ST-T changes or abnormal Q waves and the blood pressure was stable during anesthesia. Postoperative echocardiography showed extensively decreased left ventricular wall motion with akinesis of the anterior wall and anterior septum from the mid-papillary level to apex. ECG showed negative T waves in V2-V6 without abnormal Q waves or ST changes. The increase in CPK-MB was very little. The abnormal left ventricular wall motion was completely recovered on the third postoperative day. Her perioperative cardiac event was diagnosed as "Takotsubo" cardiomyopathy by reversible ampulla-shaped ventricular dysfunction. She had no symptoms throughout the perioperative period and recovered without any sequela.

We gave propofol anesthesia to a patient with limb-girdle type of progressive muscular dystrophy. A 42 year-old male was to have skin graft for third degree burn. His respiratory function test showed %VC of 73.6% and %FEV1.0 of 107.6%. Arterial blood gas data were within normal ranges. He was anesthetized with propofol, fentanyl, vecuronium and nitrous oxide. During position change, Wenckebach type of second degree AV block occurred. AV block returned to sinus rhythm easily by injection of ephedrine hydrochloride and atropine sulfate, and reduction of propofol infusion rate. There were no perioperative respiratory complications and no clinical manifestations of malignant hyperthermia. Propofol anesthesia is suitable for limb-girdle type of progressive muscular dystrophy, because of very little possibility of triggering malignant hyperthermia, rapid awaking, minimal residual effects of the respiratory system, and easiness in controlling anesthetic depth.

[ d -Ala 2 ,MePhe 4 ,Gly(ol) 5 ]enkephalin (DAGO) (10 ng/0.5 μ1 saline solution) injected into the tuberomammillary nucleus (TM) of rats in minute amounts decreased the amount of histamine released to approximately 50% of the basal value on measurements taken 20–40 min after administration. This effect of DAGO was inhibited by the simultaneous microinjection of naloxone (320 ng). These results may be explained in two ways. The first is that the stimulation of μ-receptors results in the inhibition of histaminergic cell bodies. The second is that the somatodendritic release of histamine was increased by the stimulation of μ-receptors and as a result of increased histamine concentration in TM, many histaminergic neurons may be inhibited through the stimulation of H 3 -receptors. Further studies are necessary regarding the influence of μ-agonists on various cellular sites of histaminergic neurons.