Synthesis and structure--antibacterial activity relationships of 7-(3-amino-1-propynyl and 3-amino-1-propenyl)quinolones

7-(3-Amino-1-propynyl)-1-cyclopropyl-6,8-difluoro-1,4-dihydro-4- oxoquinoline-3-carboxylic acid (7a) and some related compounds (7b-f, 8a, b, 9) were prepared via palladium(0)-catalyzed cross-coupling reaction of 7-iodoquinolone 12 with acetylenic compounds and their antibacterial activity was tested. The methylene homologue (7d) and the N-methyl derivative (7e) of 7a showed essentially the same activity as that of 7a. Addition of methyl group(s) to C'-3 of 7a (giving 7b, c) reduced the activity. The hydrogenation of 7a to (Z)-3-amino-1-propenyl (8a), (E)-3-amino-1-propenyl (8b) and 3-amino-1-propyl (9) compounds retained or enhanced the activity of 7a. Among the compounds prepared, 8a was the most active, but was less active than ciprofloxacin (1). In order to get insight into structure-activity relationships, the spatial distribution of the amino groups of 7a, 8a, b, and 9 was examined by means of computer-aided molecular modeling.

Dissecting aortic aneurysm presenting as pyrexia of unknown origin: report of a case

We describe herein the case of a 51-year-old woman with a dissecting aneurysm of the aorta who presented with pain in the chest followed by prolonged pyrexia of unknown origin (PUO) lasting 6 weeks. Because of the fever associated with a murmur of aortic regurgitation, she was initially misdiagnosed as having infective endocarditis. This unusual case serves to remind us that clinicians should bear in mind the possibility of aortic dissection in patients presenting with PUO.

Synovial fluid cytokines and proteinases as markers of temporomandibular joint disease

PURPOSE

In this article, biochemical markers in the synovial fluid (SF) for detecting intraarticular inflammation and early cartilage degradation of the temporomandibular joint (TMJ) disease were examined.

PATIENTS AND METHODS

SF was obtained from 25 TMJs in 22 patients with internal derangement (ID) or osteoarthritis (TMJ-OA), 15 asymptomatic TMJs in 11 normal volunteers, and 10 osteoarthritic knee joints (KNEE-OA). Cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA), and the proteinase activities were detected by enzymography.

RESULTS

SF from TMJs with ID and OA showed higher (P < .05) levels (330.1 +/- 347.7 pg/100 microg SF protein) of IL-1beta than the asymptomatic control TMJs (76.7 +/- 95.3 pg/100 microg of SF protein). SF from TMJs with OA contained significantly (P < .05) higher levels of IL-1beta (531.8 +/- 379.6 pg/100 microg of SF protein) and IL-6 (979 +/- 552 pg/100 microg SF protein) than those with ID (IL-1beta: 216.7 +/- 280.1 pg, IL-6: 293 +/- 434 pg). Two matrix metalloproteinases (MMPs) with gelatinolytic activities at 92 kDa and 72 kDa were consistently detected in both the TMJ-SF (either normal or disease) and SF from KNEE-OA. Also detected were weak bands with molecular weight of 83 and 66 kDa. These bands were clearly shown, particularly in knee joints with advanced stages of OA. Western blot analysis delineated that these were active forms of MMP-9 (83 kDa) and MMP-2 (66 kDa). The same bands were also detected in TMJs with OA that showed high levels of IL-1beta and IL-6.

CONCLUSION

These findings suggest that concomitant increases in the levels of cytokines (IL-1 and IL-6) and active forms of MMPs could be potential catabolic markers for cartilage degradation in the TMJ.

[A case of asynchronous quadruple cancer arising from the prostate, stomach, rectum and urinary bladder]

Herein, we report a case of quadruple cancer arising from the prostate, stomach, rectum and urinary bladder. A 92-year-old man was admitted to our hospital on March, 1996, with complaints of macroscopic hematuria and micturition pain. He had a history of prostate cancer (no details) at the age of 67, and subtotal gastrectomy for gastric cancer (tubular adenocarcinoma, conclusive stage Ia) at the age of 89. He underwent a polypectomy for rectal cancer (well-differentiated adenocarcinoma)2 at the age of 90. There was no evidence of local recurrence or metastasis of these three carcinomas. Cystoscopy revealed multiple papillary tumors which were resected transurethrally. At the same time transrectal needle biopsy of prostate was performed. Pathology revealed transitional cell carcinoma G2 of urinary bladder and well differentiated adenocarcinoma of prostate. The postoperative course was uneventful and the patient has been doing well without recurrence of bladder cancer during the follow-up period of six months.

[Reoperation for relief of valvular and supravalvular stenosis late after aortic valve replacement with Manouguian's anulus enlargement: report of a case]

Thirteen year-old boy who received aortic valve replacement with Manouguian's anulus enlargement for congenital aortic stenosis 7 years ago developed valvular and supravalvular stenosis. Pressure gradient between left ventricle and aorta was 55 mmHg. The etiology of supravalvular stenosis was extensive patch plasty of ascending aorta and severe degeneration of expanded polytetrafluoroethylene patch. Moreover, white hard mass existed just outside the patch and was one of the components of the stenosis. This mass was acellular calcification without foreign body reaction. Degenerated prosthetic patch was thoroughly resected, and redo Manouguian's procedure with autogeneous pericardium was performed. We tried to use two sizes larger 21 mm valve, but, after all, 19 mm valve was sewn into place. His postoperative course was uneventful.

Fatality due to severe Salmonella enteritis associated with acute renal failure and septicemia

A 66-year-old man was hospitalized for abdominal pain and diarrhea of more than 10 times a day. He had been under regular medication with prednisolone for rheumatoid arthritis. On admission, laboratory data and clinical examination indicated inflammation, dehydration, acute renal failure with a high level of serum musculogenic enzyme (creatine kinase), and ileus. Salmonella enteritidis was isolated from his fecal and blood samples. The patient died within 24 hours after admission, and autopsy showed hemorrhagic necrotic enteritis localized to the ileum. Enterocolitis due to Salmonella enteritidis, which is usually an acute self-limited gastrointestinal illness, may occasionally be a serious and lethal disease.

Children's smoking habits in an agricultural community in Japan and the importance of a no smoking program integrating family, school and community health

The object of this study is to establish a model of integration of the health promotion projects which have been planned separately by schools and communities so far in an agricultural area in Japan, to solve the problem of children's smoking. The subjects of the study were 10-15 y old schoolchildren and their parents. The questionnaires were completed by the children themselves at school and also by their parents at home, in July 1995. One fourth of the junior high school boys had ever tried smoking, while most of their parents did not notice that their children were smoking. More than half of the children who had ever tried smoking mainly acquired tobacco from their homes. One tenth of them were prompted to smoke by their fathers or other relatives. To develop a health promotion project for children which includes prevention of smoking, the provision of a health education program and an environment which encourages health are important for children. The project should also be community-based because participation of local inhabitants in the project gives it additional impetus. In order to promote the comprehensive health of children, we emphasize the importance of setting up a healthy district plan based on the health policy of the general community.

[The significance of arterial chemotherapy for multiple hepatic metastases from colorectal carcinoma]

We studied 54 patients with multiple (more than 5 nodules) hepatic metastases from colorectal carcinoma retrospectively. Twelve cases in the non-chemotherapy group had a 0% one-year survival rate and 3.0 months of 50% survival period; 15 patients in the general chemotherapy group had 23.4% and 5.1 months respectively. In contrast, 27 subjects in the arterial chemotherapy group showed 48.3% and 11.5 months respectively (p < 0.05). Five cases that received hepatectomy were all alive but the prognosis remains unclear. It is suggested that long survivors with multiple metastases from colorectal cancer need radical resection of primary lesion and intrahepatic arterial chemotherapy.

Successful treatment by direct hemoperfusion of coma possibly resulting from mitochondrial dysfunction in acute valproate intoxication

PURPOSE

We evaluated the efficacy of direct hemoperfusion (DHP) for treatment of acute valproate (VPA) intoxication and speculate on the biochemical perturbations that suggest a mechanism of coma induced by VPA overdose.

PATIENT AND METHODS

The comatose patient was hospitalized approximately 6 h after ingesting 18 g VPA. DHP, with 200 g activated charcoal, was performed for 6 h. The plasma concentrations of VPA and Glasgow coma scale scores after admission were estimated. Before and after DHP, urine samples were tested in serial fashion for VPA metabolites, organic acids, and acyl carnitine esters of fatty acids.

RESULTS

Plasma VPA was efficiently adsorbed on activated charcoal. The patient's plasma concentration of VPA decreased from 471 microg/ml (2,830 microM) to 45 microg/ml (270 microM), at which point the patient became alert. The half-life (t1/2) of VPA was calculated as 4.4 h before DHP and as 1.8 h during DHP. Before DHP, lactate and VPA-glucuronide markedly increased in urine samples, but beta-keto-VPA, a major mitochondrial metabolite, was not detected. Urinary excretion of carnitine esters of medium chain (C8-C10) dicarboxylic acids was increased. After DHP, lactate and VPA-glucuronide decreased, but a significant amount of beta-keto-VPA was demonstrated. Carnitine esters of medium chain dicarboxylic acids were decreased.

CONCLUSIONS

DHP with activated charcoal was effective treatment for the patient with acute VPA intoxication and coma. The onset of coma may have been related to inhibition of beta-oxidation in the mitochondria, which was reversible by elimination of plasma VPA by DHP.

Synthesis, structure and quantitative structure-activity relationships of sigma receptor ligands, 1-[2-(3,4-dimethoxyphenyl)ethyl]-4-(3-phenylpropyl) piperazines

A set of the title compounds having different substituents (R1, R2) on their phenyl groups was synthesized to find sigma receptor binding affinity. Among the compounds, 2b (R1 = R2 = Cl) has the most potent sigma 1-binding activity, while 2a (R1 = R2 = H, SA4503) was most selective to sigma 1 over sigma 2 receptor. The crystal structures of 2a and 2b were shown, by X-ray crystallography, to be similar except for the one torsional angle of their propylene parts. Quantitative structure-activity relationship study suggested the affinity of the compounds to the sigma 1 receptor was dependent on the electronic feature, Swain-Lupton's R or Sz that was derived by molecular orbital method, of R1 and R2.

[Pharmacokinetics of isosorbide dinitrate examined by physiologically-based pharmacokinetic model]

To make a physiologically-based pharmacokinetic model of isosorbide dinitrate (ISDN), the author infused ISDN at 1, 10, 30 micrograms.kg-1.min-1 into anesthetized rabbits and measured concentrations of ISDN and its metabolites (2-ISMN and 5-ISMN) in plasma and in the brain, liver as well as fat tissue. There was the accumulation of ISDN in the brain and fat tissue. There was no significant difference in concentrations of ISDN between the plasma and liver, or in concentrations of its metabolites among plasma, and the tissues of the brain, liver and fat. Using these informations, the author constructed a physiologically-based pharmacokinetic model to human and estimated values were compared with observed values to determine the validity of the model. There was no remarkable differences between the estimated values and observed values. This suggests the validity of the model. The plasma concentrations of ISDN estimated by this model, showed a linear increase (Y = 25 X) with the infusion rate less than 6.0 micrograms.kg-1.min-1. The accumulation of ISDN, especially in the brain was suggested by this model.

Transgenic medaka fish bearing the mouse tyrosinase gene: expression and transmission of the transgene following electroporation of the orange-colored variant

Transgenic fish bearing the mouse tyrosinase gene (mg-Tyrs-J) were produced by transfection into fertilized eggs of the homozygous normal orange-colored variant of medaka fish, Oryzias latipes, by means of electroporation. Of 589 eggs transfected, 38 fish (6%) exhibited brownish wild-type skin pigmentation, which was discernible from control siblings. Light microscopy of the skin from the founders thus generated disclosed that 1) melanization occurred and was restricted to melanophores formed presumably from pre-existing amelanotic melanophores, 2) there was a wide variation in the degree of melanization observed among melanophores, and 3) no melanin deposition was recognized in xanthophores or leucophores. Immunofluorescence using an antibody raised against mouse tyrosinase disclosed that melanophores at varying stages of maturation were reactive. Thus, it was shown that the transgene in medaka fish expressed its action in a cell type-specific manner. Crossing of transgenic founders with homozygous orange-colored variant fish yielded two groups of offspring expressing either the wild-type or the orange-colored skin pigmentation at an approximate ratio of 1:1. Crossing between founders exhibiting wild-type pigmentation yielded only offspring with melanized skin. Skin melanophores in these offspring formed vertical stripes, which are rare in this species. The hereditary basis of melanized skin was demonstrated in matings of F1 progenies, which resulted in similar degrees of melanization over whole skin melanophores. The sum of these findings implied that the transgene is expressed as a dominant character gene and is transmitted through germ cell lines according to the Mendelian law. PCR analysis combined with nested PCR technique strongly suggested that the transgene was integrated into the medaka genome, even though the copy number deduced from gel banding was largely diminished, possibly as a result of fragmentation or instability within the medaka genome.

Abnormal head MRI in a neurologically normal boy with hypomelanosis of Ito

We report on an 8.5-year-old boy with hypomelanosis of Ito (HI) who has an abnormal MRI of the brain but is neurologically normal. There have been many reports of abnormal brain imaging studies in patients with HI, but all reported patients have had abnormal neurologic findings or symptoms. Our patient has had serial, stable head MRI white matter changes and has remained neurologically normal without any neurologic sequelae.

[An autopsy case of renal failure as its cause of death in a patient with primary hyperparathyroidism associated with chronic pancreatitis]

This paper presents a 59-year-old man who was admitted to our hospital because of abdominal pains in 1973. He had pancreatic calcification and showed high levels of serum amylase, Ca, and PTH. He was diagnosed as primary hyperparathyroidism with chronic pancreatitis. After excision of an ectopic parathyroid adenoma, serum Ca levels were decreased and normalized by dihydrotachysterol p.o. At the same time his symptoms disappeared. The exocrine and endocrine pancreatic functions, however, decreased gradually. Diabetes mellitus appeared in 1975 and he required insulin injection since 1983. In spite of the treatment, his diabetic control was poor. Seventeen years later in 1992, he showed hypertension and edema (nephrotic syndrome). Because of renal failure, he underwent hemodialysis and passed away due to myocardial infarction in 1993. Autopsy findings showed existence of diabetic nephropathy as the cause of renal failure. Clinical course of this patient suggests that severe complications occur even in pancreatic diabetes and that we have to control diabetes strictly in pancreatic diabetes as well as in primary diabetes.

[A case resectable hepatic metastases of breast cancer following intrahepatic arterial chemotherapy]

A 38-year-old woman who had undergone Patey's operation for left breast cancer in July 1990 was admitted in December 1992 for hepatic metastases. Due to bone metastasis (Th10), oophorectomy and hepatic arterial cannulation were performed. Hepatic arterial chemotherapy and oral chemoendocrine therapy yielded a partial response for liver and unclear metastasis of the bone. She had arterial and oral administration after a hepatectomy in October 1994. The patient has had no recurrent signs now (July 1996). We experienced 522 patients with breast carcinoma and 14 cases (2.7%) of all having hepatic metastases. Hepatic arterial chemotherapy was done in three patients. Although one of them had a complete response, she died after 35 months because of bone, brain and liver metastases. Another case was underwent hepatectomy after arterial chemotherapy, but recurrent liver and bone tumors soon appeared. The mean survival period of 15 hepatic metastases, including the case under study here was 9 months, and the one-year survival rate was 23.4%.

[Use of the inferior epigastric artery for coronary artery bypass grafting: preoperative digital subtraction angiography]

Between September 1994 and January 1995, the inferior epigastric artery (IEA) was used as a free graft for direct coronary artery bypass grafting in 4 patients. The IEA is excised from its origin from the external iliac artery as a pedicle with an "oval cuff" of 3 mm in diameter to facilitate the direct anastomosis with the aorta. The 4-week postoperative angiographic study showed that the IEA grafts were patent in all patients. We found that the IEA varies in length, diameter, and the pattern of branching between patients and between the right and left sides in the same patient. The preoperative digital subtraction angiography was useful for evaluating the suitability of IEA.

Cadmium-induced dental lesions in ovariectomized rats

The effects of cadmium chloride on both incisor and molar teeth of ovariectomized female rats were studied histopathologically. The rats were injected intravenously with the compound at doses of 1.0 and 2.0 mg/kg, 5 days/wk. Six rats per group were sacrificed at 4, 8, and 13 wk. Discoloration of the incisors was observed in the rats of the 2.0-mg/kg group from 8 wk. Histopathologic examination of the incisor demonstrated decreased iron-containing pigment in ameloblasts and destruction of the enamel organ. These changes were accompanied with accumulation of cadmium and loss of iron in the teeth. Necrosis of the dental pulp occurred from the coronal end of both the incisor and molar teeth extended to the apical, deep portion of the teeth. The dental pulp of the molar teeth, which is shorter than that of the incisor, was mildly affected by cadmium intoxication. These findings suggested that intradental ischemia due to cadmium toxicity may have contributed to the development of the pulpal necrosis.

Prenatally diagnosed ureterocele presenting as fetal bladder outlet obstruction

The prenatal detection of fetal genitourinary abnormalities is becoming more frequent. The exact nature of these anomalies is frequently difficult to delineate before delivery. We report a case of fetal bladder outlet obstruction caused by an ectopic ureterocele associated with a duplicated renal collecting system, which was visible on prenatal ultrasonographic examination. Postnatal follow-up is presented.

5-Alkoxyimidazoquinolones as potential antibacterial agents. Synthesis and structure-activity relationships

4-Substituted 6-cyclopropyl-6, 9-dihydro-5-methoxy-9-oxo-1H-imidazo[4,5-f] quinoline-8-carboxylic acids (6) and 8-substituted 1,5,6,11-tetrahydro-5-methyl-1-oxo-imidazo[4,5-g]pyrido[1,2,3-de][1,4] benzoxazine-2-carboxylic acids (7) were prepared as potential antibacterial quinolone derivatives. The appendages at C-4 of -6 and at C-8 of -7 were selected from 1-piperazinyl, 4-methylpiperazinyl, 3-aminomethylpyrrolidinyl, and 3-aminomethylpyrrolidinyl groups. The 5-methoxyimidazoquinolones 6 were superior to the corresponding ofloxacin type analogues 7 in in vitro antibacterial activity. The activity of 6 was equipotent against S. aureus, but 2 to 16 times less potent against E. coli and P. aeruginosa compared to that of the 5-fluoro analogue 3.

Intraoperative assessment of functioning mitral valve

A technique is presented that allows intraoperative assessment of mitral valve function with the heart filling and actively beating. This technique secures steady coronary perfusion and avoids possible air embolism of the coronary arteries. Repeated assessment and repair during reparative mitral operations are greatly facilitated when this technique is accompanied by warm blood cardioplegia.

Molecular cloning and sequence analysis of the gene encoding the H2O-forming NADH oxidase from Streptococcus mutans

To discover the molecular properties of two distinct NADH oxidases, corresponding to H2O2-forming oxidase (NOX-1) and H2O-forming oxidase (NOX-2) induced in Streptococcus mutans, for the first step we had cloned and sequenced the nox-1 gene encoding NOX-1. In this paper, a nox-2 gene encoding NOX-2 from S. mutans was cloned, and the nucleotides sequenced. The nox-2 gene comprises 1371 base-pairs, encoding a polypeptide of 457 amino acid residues. The deduced relative molecular mass (M(r) = 49919) agreed with the previous value obtained from the purified NOX-2 protein. The nox-2 gene was expressed in Escherichia coli using its own promoter. Alignment of the NOX-2 protein sequence with that of the NOX-1 showed that the proteins do not significantly resemble each other. Comparisons with the NADH oxidase from Streptococcus faecalis 10C1 yield identities of 41%. The redox-active cysteine in the enzyme from S. faecalis was found to correspond to Cys 44 in the NOX-2.