Novel lactone compounds from Mortierella verticillata that induce the human low density lipoprotein receptor gene: fermentation, isolation, structural elucidation and biological activities

Among methods of controlling hypercholesterolemia and hyperlipidemia is the direct stimulation of hepatic low density lipoprotein (LDL) receptors. Two novel lactone compounds, CJ-12,950 and CJ-13,357, containing and unusual oxime moiety, were isolated from a zygomycete Mortierella verticillata. These lactones are potent inducers of the LDL receptor gene in vitro, that enhanced LDL receptor expression in human hepatocytes 2-fold at 100 nM.

[Change in intraocular pressure after intraocular lens implant during a follow-up period of over 10 years]

Changes in intraocular pressure were studied in 141 eyes following intraocular lens implant. The average observational time was twelve years. We tried to fix both loops of the implant in the ciliary sulcus. The intraocular pressure increased over the ten year interval at 0.19 mmHg per year. Twenty-seven of the 141 eyes developed glaucoma. We studied the intraocular pressure of the cases with or without complications. Thirty-eight eyes had complications, fifteen eyes (39%) developed secondary glaucoma, and three eyes (8%) developed glaucomatous visual field defect. In twenty-three cases without secondary glaucoma, the intraocular pressure increased over a three-year interval after surgery and remained constant thereafter. 103 eyes had no complications to influence the intraocular pressure, twelve eyes (12%) developed secondary glaucoma, and four eyes (4%) developed glaucomatous visual field defect. In 91 cases without secondary glaucoma, the intraocular pressure increased over a five-year interval after surgery at 0.28 mmHg per year and remained constant thereafter. We recommend regular examination, especially during the initial five-year period when the intraocular pressure is apt to increase even if complications are not evident.

Laparoscopic intervention to relieve small bowel obstruction following laparoscopic herniorrhaphy

In this report, we present two cases of small bowel obstruction after laparoscopic herniorrhaphy (LH). One case involved incarceration of the small intestine into the port site, resulting in obstruction in an 80-year-old man on the third day after LH. The other case involved a 78-year-old man with bilateral inguinal hernia and a recurrent type on one side. In this case, a small bowel obstruction occurred due to intestinal herniation through the repaired peritoneum in the pelvic floor. In both cases, the location of the obstruction was diagnosed by means of a computed tomography scan. Subsequently, the trocar incision was extended to relieve obstruction with laparotomy in the first case, and the herniated intestinal loop was extracted followed by reclosure of the defective peritoneum under laparoscopic intervention in the second case. After the second operation, the clinical course of each patient was uneventful, and they were discharged from hospital at 10 days after the second surgery. In conclusion, (a) although patients can greatly benefit from LH, it must be kept in mind that problems can occur and (b) laparoscopic surgery to relieve small bowel obstruction following LH is the preferred procedure.

CJ-12,954 and its congeners, new anti-Helicobacter pylori compounds produced by Phanerochaete velutina: fermentation, isolation, structural elucidation and biological activities

Seven new phthalide compounds with anti-Helicobacter pylori activities were isolated from the basidiomycete Phanerochaete velutina CL6387. The two most potent phthalide compounds, CJ-12,954 and CJ-13,014, have MICs of 5 ng/ml. The structure-activity relationship shows that the presence of a spiroketal part in addition to the phthalide part, greatly enhances the activity. The phthalide compounds appear to be specific for H. pylori, since they did not show antibacterial activities when tested against a panel of other microorganisms.

Mutations in the SGR4, SGR5 and SGR6 loci of Arabidopsis thaliana alter the shoot gravitropism

Shoots of higher plants grow upward in response to gravity. To elucidate the molecular mechanism of this response, we have isolated shoot gravitropism (sgr) mutants in Arabidopsis thaliana. In this report, we describe three novel mutants, sgr4-1, sgr5-1 and sgr6-1 whose inflorescence stems showed abnormal gravitropic responses as previously reported for sgr1, sgr2 and sgr3. These new sgr mutations were recessive and occurred at three independent genetic loci. The sgr4-1 mutant showed severe defect in gravitropism of both inflorescence stem and hypocotyl but were normal in root gravitropism as were sgr1 and sgr2. The sgr5-1 and sgr6-1 mutants showed reduced gravitropism only in inflorescence stems but normal in both hypocotyls and roots as sgr3. These results support the hypothesis that some mechanisms of gravitropism are genetically different in these three organs in A. thaliana. In addition, these mutants showed normal phototropic responses, suggesting that SGR4, SGR5 and SGR6 genes are specifically involved in gravity perception and/or gravity signal transduction for the shoot gravitropic response.

Abdominal wall lifting with spinal anesthesia vs pneumoperitoneum with general anesthesia for laparoscopic herniorrhaphy

BACKGROUND

Laparoscopic herniorrhaphy has generally been very successful since any postoperative inguinal pain or tension is considerably less troublesome than after other open methods. The conventional laparoscopic approach in the treatment of inguinal hernia involves the use of pneumoperitoneum and general anesthesia. Nevertheless, some complications can be encountered and the procedure is costly. We, therefore, examined the possibility of using a more practical and cost efficient method.

MATERIALS AND METHODS

Based on our findings, we propose the use of a Kirschner lifting wire as a means of separating the abdominal wall during laparoscopic herniorrhaphy. Two Kirschner wires are introduced through the subcutaneous tissue, between the umbilicus and inguinal ligament, and parallel to the inguinal ligament. Furthermore, we recommend the use of spinal anesthesia as a means by which the problems associated with general anesthesia and the potential cardiopulmonary complications of carbon dioxide insufflation, are circumvented. Fifteen cases of inguinal hernia have been treated with this new method and compared to the more conventional procedure of pneumoperitoneum under general anesthesia.

RESULTS

Visibility of the operative field when used in the inguinal region was not limited at all, and Kirschner wire is considerably less expensive. The postoperative course for the patients who were operated by the new method was uneventful.

CONCLUSIONS

Our results indicate that this new method can be useful for the treatment of inguinal hernia.

Hypoglycemia in healthy, full-term, breast-fed neonates during the early days of life: preliminary observation

To examine the incidence of symptomatic and asymptomatic hypoglycemia during the early days of life, the blood glucose levels were analyzed in 38 healthy, full-term, breast-fed neonates cared for by rooming-in immediately after birth. Blood glucose levels were measured randomly using a blood glucose analyzer from birth to discharge. Preliminary results have shown that hypoglycemia (< 40 mg/dL) seldom occurred in healthy, full-term, breast-fed neonates when cared for in rooming-in with frequent suckling immediately after birth.

[A study of 44 patients with Kirisawa type uveitis]

We studied 50 eyes of 44 patients with acute retinal necrosis, Kirisawa type uveitis (KU), in order to examine clinical symptoms, pathogenic viruses, clinical grading, therapy and prognosis for this disease. Varicella-zoster virus (VZV) was the pathogenic organism in 37 eyes of 31 patients, while herpes simplex virus (HSV) was responsible in 13 eyes of 13 patients. There were more elderly patients in the VZV-KU group than in the HSV-KU group. In addition, mutton fat keratic precipitates and retinal exudates were more common in VZV-KU than in HSV-KU. We divided KU eyes into 3 clinical grades: severe, serious, and mild. Using statistical analysis, we found that the VZV-KU group had a significantly greater number of severe and serious cases than the HSV-KU group. Furthermore, some HLA antigens were found to be statistically more common in the VZV-KU group, although no associations were found in the HSV-KU group. 32% of VZV-KU and 67% of HSV-KU eyes had a final visual acuity (fVA) of greater than 0.5. When eyes with an fVA of greater than 0.1 were compared to eyes with an fVA of less than 0.1, we found that combined therapy using acyclovir, interferon beta, and prednisolone was especially effective for VZV-KU, although no significant difference was found for HSV-KU. Thus, it is essential to determine the pathogenic virus causing KU, in order to understand the disease pathogenesis as well as to select appropriate treatment.

Role of submandibular and sublingual saliva in maintenance of taste sensitivity recorded in the chorda tympani of rats

1. To evaluate the role of saliva in the maintenance of taste sensitivity, the activities in the rat chorda tympani innervating taste buds in the anterior part of the tongue were analysed. The effects of chronic extirpation of the submandibular and sublingual salivary glands were tested and compared with results after chronic oral administration of artificial saliva. 2. Removal of the salivary glands sharply decreased chorda tympani responses to four different taste stimuli by 7 days post-desalivation, while a stable response to cold water was observed by at least 28 days. 3. This selective decrease in taste responses was considerably recovered by 7-day-oral injection of artificial saliva (containing NaHCO3, KCl and/or mucin) or distilled water. However, the injection of the salt-containing artificial saliva induced significantly larger sucrose and smaller NaCl, HCl and quinine responses than did the injection of distilled water. 4. In our salivary manipulations, an alteration in the number of the functional sweet receptors was suggested by the cross-adaptation technique using NaHCO3, whereas sensitivity to the epithelial sodium transport blocker, amiloride, was stable in the NaCl response. 5. Salivary water and electrolytes which may participate in forming the external environment of the taste receptor cells modulated taste sensitivity in the chorda tympani.

In vivo implantation of human osteosarcoma cells in nude mice induces bones with human-derived osteoblasts and mouse-derived osteocytes

Two human osteosarcoma cell lines, Hu09 and OST, were suspended in Matrigel (Becton Dickinson Labware, Bedford, Massachusetts) and implanted subcutaneously in the backs of nude mice. To study phenotypic changes of tumor cells and host cells, expression of mRNA for osteopontin (OPN), osteocalcin (OC), and osteonectin (ON) was analyzed by in situ hybridization. Bone tissue was formed in the tumors derived from Hu09 cells. OPN mRNA was transcribed predominantly in osteocyte-like cells within the bone, whereas OC mRNA was transcribed in osteoblast-like cells that surrounded the bone. ON mRNA was detected in both types of cells. The similarity of the expression pattern of OPN, OC, and ON during osteogenesis of Hu09 cells to that of normal skeletal development suggests that the bone formed in Hu09-implanted mice is the same as normal bone tissue. By DNA-DNA in situ hybridization using a human-specific Alu probe and a mouse-specific m-L1 probe, osteoblast-like cells in Hu09 tumorous bone were, however, of human origin, whereas osteocyte-like cells were of mouse origin. In the tumors derived from OST cells, no osteogenesis was observed during the experimental period, and the expression of OPN, OC, and ON was not detected in tumor cells. An endochondral bone formation was not evident when these cells were simply implanted into muscle tissue. An endochondral bone was, however, reactively induced in the host mUscle tissue either when 1 alpha-hydroxyvitamin D3 and all-transretinoic acid were administered to OST-implanted mice or when Hu09 cells were pretreated with dexamethasone before implantation. Hu09 implantation seems to be a useful tool not only for the study of the differentiation of osteosarcoma cells but also for the investigation of the mechanism of bone formation. This system, using Hu09 and OST, may provide us with a new tool for the isolation of the unidentified factors that induce or inhibit osteogenesis in vivo.

[A simultaneous determination of various main components in oriental pharmaceutical decoction "heii-san" by ion-pair high-performance liquid chromatography]

A simple and precise method was established for the simultaneous determination of five selected marker components in oriental pharmaceutical decoction "Heii-San" by means of high-performance liquid chromatography using tetra-n-amylammonium bromide (TAA) as an ion-pair reagent. For the separation of these five components, such as hesperidin (1), 6-gingerol (2), honokiol (3), glycyrrhizin (4) and magnolol (5), an ODS column was used with multi-step gradient elution with 10 mM TAA (H3PO4, pH 4.0)-acetonitrile. The acetonitrile content linearly increased from 25 to 90%. This method was compared with other three methods, i.e. a water-acetonitrile method, a phosphate buffer method and an ion-suppression method. Five main components were eluted within 50 min without interference from co-existing components.

[Massive swelling of the tongue in two patients following the repair of cleft palate]

Massive swelling of the tongue occurred following the repair of cleft palate in a one-year-old girl and a one-year-old boy. The duration of operation was 285 min and 225 min respectively. Massive swelling of the tongue became prominent within 30 min after the operation in both infants. The trachea was intubated immediately. Swelling of the tongue recovered slowly, and the trachea was extubated 6 and 7 days after the operation, respectively. The compression of the tongue by the retractor for a long time during the operation probably caused the reperfusion edema of the tongue. Early recognition of the swelling and prompt maintenance of the airway are essential to prevent the serious outcomes resulting from the swelling of the tongue.

Direct enzymatic assay of urinary sulfated bile acids to replace serum bilirubin testing for selective screening of neonatal cholestasis

Direct enzymatic assay of urinary sulfated bile acids is a sensitive, rapid, minimally invasive, and convenient method of detecting cholestasis in young infants. It may replace measurement of serum direct bilirubin for selective screening for biliary atresia and neonatal hepatitis syndrome at 1 month of age.

Microbial cyanide sensor for monitoring river water

A microbial cyanide sensor using Saccharomyces cerevisiae for monitoring a river water is described. This sensor is based on the inhibition of S. cerevisiae's respiration by cyanide. This sensor is a reactor type flow system and composed of two oxygen electrodes and a reactor which contains S. cerevisiae immobilized beads. The S. cerevisiae's respiration activity is measured using the oxygen electrodes. The sensor showed a linear response in the range from 0 to 15 microM and maintained stable response for 9 days at ambient temperature. The sensor was optimized for the monitoring of river water and was applied to river water analysis.

Lymph node swelling due to bacille Calmette-Guérin vaccination with multipuncture method

SETTING

In the mass bacille Calmette-Guérin (BCG) vaccination programme using the multipuncture method practised in Japan for young children, lymph node swelling is a not uncommon complication and its management is sometimes unnecessarily radical.

OBJECTIVES

To determine the frequency of lymphadenitis after BCG vaccination with the multipuncture method, and to describe its clinical features.

DESIGN

A total of 34,516 children aged 0-3 years, who received primary vaccination with BCG between 1985 and 1989, were observed for the occurrence of lymphadenopathy. Oral explanation was given to the parents about lymph node swelling, and a postcard with a reporting form was given, to be returned if any lymph node swelling was observed in the baby. The parents were then contacted, and invited to our clinic for further observation. Cases with one or more swollen nodes greater than 7 mm were included in this analysis as cases of lymphadenopathy.

RESULTS

The frequency of lymphadenopathy was 0.73% (95% CI 0.65-0.83). Babies under 1 year of age had higher incidence. Lymph nodes greater than 10 mm were seen among 0.40% of babies, with a higher rate among boys than in girls (0.95% and 0.50%, respectively). Sixty-five percent of the cases were first noticed 4-6 weeks after vaccination; others were detected before or after that period. Nineteen percent of the cases had multiple swollen nodes, and 2% had adenitis only outside the axilla. Eight cases progressed to suppurative adenitis with rupture, comprising 0.02% (95% CI 0.012%-0.046%) of those vaccinated. In the remaining cases the swelling subsided quickly (92% within 2 months and the others later), with no medical or surgical treatment.

p53 mutations in the non-neoplastic mucosa of the human stomach showing intestinal metaplasia

In order to ascertain whether genetic alterations occur during the early stages of gastric carcinogenesis, abnormal accumulation of p53 protein and mutation of its gene in stomach tissue showing intestinal metaplasia were investigated using immunohistochemistry and polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. Immunohistochemistry detected 19 foci showing nuclear accumulation of p53 protein in non-neoplastic gastric mucosa in a total of 756 sections (477 of which contained intestinal metaplasia) from 16 resected stomachs containing gastric adenocarcinomas. Of these 19 p53-positive foci, 17 were diagnosed histologically as incomplete-type intestinal metaplasia and 2 as pseudopyloric glands in the regenerative mucosa. Furthermore, 14 such foci were detected in 6 patients with multiple gastric cancers. No correlation between high-iron diamine (HID)-positive sulfomucin production and p53-positive glands was observed. The DNAs were extracted selectively from these p53-positive metaplastic glands and examined for p53 mutations by PCR-SSCP analysis followed by direct sequencing. In only 10 lesions could exons; 5 to 8 be investigated completely, and of these, 4 were shown to possess p53 mutations, which were on exon 5 in 3 cases and on exon 7 in 1 case. These results indicate that irreversible genetic changes had already occurred in morphologically non-neoplastic gastric mucosa with intestinal metaplasia, and are consistent with the hypothesis that intestinal metaplasia, especially the incomplete type, may contain precursor lesions of gastric cancer.

Emergence of proteases in germinating cucumber cotyledons and their roles in the two-step degradation of storage protein

The degradation of storage protein in germinating cucumber seeds was shown to proceed via two distinct steps. First, several proteases with acidic isoelectric points (pIs) were involved in solubilization and partial degradation of 11S globulin. Treatment of seedlings with cycloheximide inhibited this step and the expression of these proteases. Thus, the first step appeared to be governed by these proteases, which were synthesized de novo after imbibition. The first step was observed in dark-grown cotyledons, but the complete degradation of 11S globulin did not occur in the absence of illumination. An additional protease, with a pI of 4.5, was induced by illumination, and it was involved in the further cleavage of the partially degraded products of 11S globulin. Thus, the complete degradation of the storage protein proceeded via a two-step process in illuminated germinating seedlings. Light is needed to induce the second step in the degradation of 11S globulin that supplies the nitrogen required for development of the photosynthetic apparatus in the greening cotyledon.

Suppressive effects of a herbal formula, TBL-1, on type II collagen-induced arthritis in DBA/1J mice

1. The effects of a formula of traditional Chinese medicine, TBL-1, on collagen-induced arthritis (CIA) were investigated in DBA/1J mice. 2. From 4 weeks after the first immunization with bovine type II collagen (CII), TBL-1 or indomethacin was administered orally for 13 weeks. 3. Clinical scores of CIA were decreased by both TBL-1 and indomethacin intervention compared with the control CII-immunized group. 4. Radiographic scores of phalangeal destruction were markedly improved by TBL-1 intervention (P < 0.001), but indomethacin failed. 5. The suppressive effects of TBL-1, but not indomethacin, were manifested in reduced serum anti-CII antibody titres (P < 0.001). 6. These findings suggest that TBL-1 may play a role in regulating some immune responses in the present arthritis model.

Time- versus frequency-domain analysis in predicting cycle length of inducible ventricular tachycardia after myocardial infarction

To determine whether time- and frequency-domain analyses differ in their ability to predict sustained ventricular tachycardia (VT) induced by programmed ventricular stimulation, 60 consecutive patients with myocardial infarction and 30 healthy control subjects were evaluated. Programmed ventricular stimulation using three extrastimuli and signal-averaged ECG recordings were performed in patients with myocardial infarction. Of the 60 patients, sustained monomorphic VT (SMVT) with cycle length (CL) > or = 250 ms (slow SMVT) was inducible in 9, and SMVT with CL < 250 ms (fast SMVT) was inducible in 9. The durations of the filtered QRS (f-QRS) at each high-pass filter (25, 40, and 80 Hz) and the low amplitude signal (LAS) at 25-Hz high-pass filtering were significantly longer in the slow SMVT group than in the fast SMVT, no VT, or normal control group. The root-mean-square voltages at 25-Hz and 80-Hz high-pass filters in the slow SMVT group were significantly lower than in the fast SMVT, no VT, or normal control group. There was no significant difference in time-domain variables among fast SMVT, no VT, and normal control groups. The CL of the induced sustained VT was significantly correlated with the durations of f-QRS and LAS. Concerning frequency-domain variables (area ratio and factor of normality), there was no significant difference between slow and fast SMVT groups. Both the slow and fast SMVT groups had a significantly higher area ratio and a significantly lower factor of normality than the group with no VT or the normal control subjects. In conclusion, there were significant correlations between time-domain variables and CL of SMVT, while there was no correlation when using frequency-domain parameters.

p53 mutations in the non-neoplastic mucosa of the human stomach showing intestinal metaplasia

In order to ascertain whether genetic alterations occur during the early stages of gastric carcinogenesis, abnormal accumulation of p53 protein and mutation of its gene in stomach tissue showing intestinal metaplasia were investigated using immunohistochemistry and polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. Immunohistochemistry detected 19 foci showing nuclear accumulation of p53 protein in non-neoplastic gastric mucosa in a total of 756 sections (477 of which contained intestinal metaplasia) from 16 resected stomachs containing gastric adenocarcinomas. Of these 19 p53-positive foci, 17 were diagnosed histologically as incomplete-type intestinal metaplasia and 2 as pseudopyloric glands in the regenerative mucosa. Furthermore, 14 such foci were detected in 6 patients with multiple gastric cancers. No correlation between high-iron diamine (HID)-positive sulfomucin production and p53-positive glands was observed. The DNAs were extracted selectively from these p53-positive metaplastic glands and examined for p53 mutations by PCR-SSCP analysis followed by direct sequencing. In only 10 lesions could exons; 5 to 8 be investigated completely, and of these, 4 were shown to possess p53 mutations, which were on exon 5 in 3 cases and on exon 7 in 1 case. These results indicate that irreversible genetic changes had already occurred in morphologically non-neoplastic gastric mucosa with intestinal metaplasia, and are consistent with the hypothesis that intestinal metaplasia, especially the incomplete type, may contain precursor lesions of gastric cancer.

VLA-5-mediated interaction with fibronectin induces cytokine production by human chondrocytes

Adhesion molecules of the integrin family, including very late activation antigens (VLA), have been implicated in various cellular functions. In this study, we investigated the contribution of integrin-mediated interaction with ECM proteins to the cytokine gene expression in human chondrocytes. Human articular chondrocytes expressed VLA-1, -2, -3 and -5 on the cell surface, and could adhere to various ECM proteins, especially to fibronectin (FN). Furthermore, the production of GM-CSF and IL-6 was potently induced by culturing chondrocytes on immobilized FN. This stimulative effect of FN was completely inhibited by an anti-integrin alpha 5 chain mAb, as well as by anti-integrin beta 1 chain mAbs. These results indicate an important role of the VLA-5-mediated interaction with FN in regulating inflammatory cytokine production by human articular chondrocytes.

Genetic evidence for the Lewis enzyme, which synthesizes type-1 Lewis antigens in colon tissue, and intracellular localization of the enzyme

To determine whether the Lewis enzyme responsible for the Lewis blood type antigens on erythrocytes synthesizes the Lewis antigens on normal cells and cancer cells in colon tissue, we performed genotyping of the Lewis gene by the PCR-RFLP method and by immunohistochemical staining of Lewis antigens and the Lewis enzyme with specific monoclonal antibodies (mAbs) in colon tissues obtained from 100 colon cancer patients. Five of the 100 patients were identified as homozygotes for the mutant Lewis gene, i.e., the le/le genotype that cannot encode functional Lewis enzyme. The cells in both the normal and cancerous regions of colon tissue from these five le/le patients were completely devoid of staining with mAbs against Lewis antigens with the type 1 chain, i.e., Lewis a, Lewis b, and sialyl Lewis a. In contrast, the cells in cancerous regions of the colon tissue of the 95 patients with the Le/Le or Le/le genotype positively stained with all three mAbs, anti-Lewis a, anti-Lewis b, and anti-sialyl Lewis a. The cells in the cancerous regions of the colon tissue of the five le/le patients stained with DU-PAN-2 mAb, whose recognizing epitope is known to be sialyl Lewis c, a precursor structure of sialyl Lewis a. By immunohistochemical staining with FTA 1-16 mAb, which is directed at the human Lewis enzyme, we were able to demonstrate for the first time that the enzyme is localized in the Golgi area of the colon epithelial cells of patients with the Le/Le or Le/le genotype. No staining was observed in the Golgi area of the cells of the patients with the le/le genotype. From these results, we conclude that individuals with the Le/Le or Le/le genotype possess a functional Lewis enzyme synthesizing fucosylated type-1 Lewis antigens in the Golgi apparatus of the colon epithelial cells, but that individuals with the le/le genotype are devoid of the Lewis enzyme in the Golgi apparatus, resulting in an inability to synthesize Lewis antigens with the type-1 chain, and that it is inappropriate to use CA19-9, whose antigenic epitope is defined as sialyl Lewis a, as a tumor marker in patients with the le/le genotype.

[Cytomegalovirus retinitis and Pneumocystis carinii choroidopathy in a patient with AIDS]

A case of Pneumocystis carinii (P. carinii) choroidopathy is reported. The patient was a 17-year-old man with acquired immunodeficiency syndrome (AIDS) who developed bilateral, multifocal, yellow-white, round, flat choroidal lesions ranging in size from 1/8 to 1/6 of the disc diameter while undergoing treatment for cytomegalovirus retinitis. He had had P. carinii pneumonia 43 months previously, and received inhaled pentamidine as suppressive therapy. Over a 4-week period of observation, the choroidal lesions appeared to enlarge slowly and increased in number in the posterior pole, with no clinical evidence of intraocular inflammation and retinal involvement. He was diagnosed as having P. carinii choroidopathy and treated with intravenous pentamidine. Three months after systemic pentamidine therapy was begun the choroidal lesions disappeared. Despite the fact that P. carinii choroidopathy is a rare opportunistic ocular infection, ophthalmic manifestations may be an important initial marker of extrapulmonary disseminated infection in some patients. Therefore we recommend ophthalmologic examinations in patients with AIDS who receive long-term aerosolized pentamidine prophylaxis for pneumonia.