[Interstitial pneumonia associated with mixed connective tissue disease--marked improvement with azathioprine]

A 55-year-old man who complained dyspnea on exertion was given a diagnosis of interstitial pneumonia associated with mixed connective tissue disease, based on symptoms and on physical and laboratory findings. Soon afterward, he experienced an acute exacerbation of the interstitial pneumonia. He was given three courses of steroid pulse therapy and cyclophosphamide, but his condition worsened. After administration of azathioprine in addition to corticosteroids, his respiratory status improved. The dose of corticosteroids was tapered and the patient has been free of disease for two years. Pulmonary involvement in mixed connective tissue disease has been considered to be relatively benign and easily treated with corticosteroids. Recently, however, many cases of corticosteroid-resistant disease with poor outcome have been reported. Azathioprine was very effective against the interstitial pneumonia in this case, but general conclusions about the most effective type of immunosuppressive agent and the timing of its administration must await the results of further study.

Influence of fructose on Candida albicans germ tube production

The influence of different fructose concentrations (5, 3, 1 and 0 g/l) was tested on Germ Tube (GT) production by Candida albicans strain AS3P, using a Minimal Synthetic Medium (MSM) without (NH4)2SO4. The results obtained showed good GT production in the presence of all the different fructose concentrations and in the absence of any nitrogen source. The greatest GT production was obtained with 3 g/l of fructose vs 1 g/l of glucose, after 4 hr of incubation. On the other hand fructose consumption was lower than that of glucose at all concentrations over the 4 hour period. The data obtained may suggest that fructose is metabolized in a different way from glucose for GT production by C. albicans.

Phospholipase activity in Cryptococcus neoformans

Phospholipases have only been detected in a few fungi and yeasts, in particular in Candida albicans. Secreted phospholipases are considered by some researchers to be a potential factor of virulence and pathogenicity in C. albicans. Twenty-three Cryptococcus neoformans strains were tested in order to observe phospholipase production. Twenty-two of the 23 strains tested were able to produce phospholipases, and the ratio diameter of the colony to total diameter of the colony plus zone of precipitation (Pz) ranged between 0.271 and 0.949. C. neoformans, just like C. albicans, can be divided on the basis of the Pz into different strains according to their virulence and pathogenicity. There also appeared to be a correlation between the phospholipase production and the size of the capsule in the strains isolated from AIDS patients. For this reason, further studies on C. neoformans phospholipase activity would be useful in evaluating the virulence of different strains.

Fetal ophthalmic artery blood flow velocity waveforms

OBJECTIVE

To evaluate alterations in vascular impedance of the fetal ophthalmic artery (OA) with advancing gestation.

STUDY DESIGN

Color Doppler flow imaging and pulsed Doppler ultrasonographic assessment were performed on 28 normal fetuses, at gestational ages ranging from 21 to 40 weeks. The pulsatility index (PI) was calculated for the OA and the middle cerebral artery (MCA). Optimal models for these PI values were determined by regression analysis. A normal range of PI values for both arteries was generated.

RESULTS

In the OA, the model showed a parabolic pattern during pregnancy, as was the case for MCA. The predicted PI values for the OA were always lower than those for the MCA.

CONCLUSION

Our study is the first to demonstrate alterations in regional vascular impedance of the fetal OA with advancing gestation. These data provide a foundation for the evaluation of fetal ocular circulation in normal and abnormal pregnancies.

Epiduroscopic changes in patients undergoing single and repeated epidural injections

Using a superfine fiberscope with an outer diameter of 0.75 mm, the effect of repeated injections through a single epidural catheter on the epidural space was examined in 18 patients. The subjects were divided into a control group of 10 patients who had not previously received epidural anesthesia (EA) and an EA group of 8 patients who had received repeated EA with 4-6 mL 0.25% bupivacaine through an epidural catheter, two to three times per day for 7-14 days. The epidural space was observed through a fiberscope passed through a 17-gauge Tuohy needle. The epidural space was occupied by large masses of fat, and the blood vessels and connective tissue were confirmed. Adverse reactions in the epidural tissue, such as hemorrhage or congestion with engorgement, were observed in four patients in the EA group. Five patients in the EA group experienced pain when the fiberscope was inserted into the epidural space. These investigations show that continuous EA might be followed by a high incidence of nonspecific epidural changes. Superfine fiberscope may be useful in the detection or diagnosis of local epidural reaction.

Induction therapy with all-trans retinoic acid for acute promyelocytic leukemia: a clinical study of 10 cases, including a fatal [correction of fetal] case with thromboembolism

Ten patients with acute promyelocytic leukemia (APL) were treated with all-trans retinoic acid (ATRA). Eight of 10 patients achieved complete remission (CR), and among the 8 newly diagnosed cases, 7 achieved CR. Five of 8 CR cases remained in CR after 8 to 30 months. Except for hypotension and a large gastric ulcer resulting from hyperhistaminemia, the adverse effects of ATRA were generally mild. Severe thrombotic tendency occurred in a patient treated with ATRA combined with tranexamic acid. Intensive chemotherapy consisting of daunorubicin (DNR) and other agents was scheduled for the patients who achieved CR with ATRA.

[A new system for classifying bronchial asthma]

Classification of bronchial asthma with Rackemann's system or Swineford's system is too simple to be clinically useful. We developed a new system for classifying patients with asthma. Patients were assigned a "0" or a "1" for each of five criteria: the presence or absence of (1) steroid dependence, (2) allergy, and (3) sensitivity to aspirin, and whether or not their asthma was judged to be (4) hereditary and (5) infectious. For example, patients who were sensitive to aspirin and whose asthma was judged to be of the infectious type were classified as 00101. A total of 434 patients with asthma were studied (185 males and 249 females, ranging in age from 10 to 93 years). The patients were classified into 32 subtypes (shown in an accompanying table), and the data were compared to the results of classification by other methods. The present system may be more useful than those of Rackeman or Swineford, because it takes heredity and sensitivity to aspirin into account. A total of 103 patients could not be classified by Swineford's system: those in classes 00000, 00010, 00100, 00110, 10000, 10010, 10100, and 10110. We expect this new system for classifying bronchial asthma to be clinically useful.

[The evaluation of cerebral oxygen balance during moderate hypothermic cardiopulmonary bypass]

The aim of this study was to evaluate cerebral oxygen balance during moderate hypothermic cardiopulmonary bypass (CPB). We measured jugular bulb venous oxygen saturation (SjO2), oxygen extraction ratio (O2 ER), glucose extraction ratio (Glu ER), and lactate production ratio (Lac PR) in 20 adult patients undergoing cardiac surgery. Fentanyl and midazolam anesthesia, alpha-stat blood gas management, non-pulsatile flow of 2.0-2.4 l.min-1.m-2, and moderate hypothermia were used in all cases. During cooling (at 34 degrees C of nasopharyngeal temperature), jugular-arterial blood difference of carbon dioxide partial pressure and O2 ER decreased, and SjO2 increased significantly. On the other hand, O2 ER increased, and SjO2 decreased significantly during rewarming (at 34 degrees C). There were no significant changes in oxygen-glucose index, lactate-glucose index, lactate-oxygen index, lactate production ratio, and lactate-pyruvate ratio. Ten (50 %) of 20 patients who met reduced saturation criteria (defined as SjO2 < 55 %), showed significantly higher O2 ER and lower SjO2 than the non-reduced saturation group from postinduction to rewarming period. We conclude that cerebral venous reduced saturation represents a global imbalance in cerebral oxygen supply-demand-utility that may occur during rewarming period, and that the reduced saturation group represents a significant difference in cerebral oxygen balance during even stable hypothermic CPB. These episodes, however, are not associated with the acceleration of anaerobic glycolysis.

Contribution of parenchymal and non-parenchymal liver cells to the clearance of hepatocyte growth factor from the circulation in rats

PURPOSE

The distribution of 125I-hepatocyte growth factor (HGF) to either liver parenchymal cells (PC) or non-parenchymal cells (NPC) was investigated in rats.

METHODS

After injection of a trace amount of 125I-HGF, the distribution of radioactivity determined by microautoradiography closely resembled that of 125I-epidermal growth factor which distributes mainly to PC.

RESULTS

The uptake clearance of 125I-HGF estimated by determining the radioactivity of isolated liver cells was three times higher for PC than for NPC. This suggests that HGF distributes mainly to PC at relatively low doses. On the other hand, the uptake clearance by PC fell on coadministering an excess (80 micrograms/kg) of unlabeled HGF, while no change was observed for NPC, indicating that a saturable process for the hepatic handling of HGF exists only in PC where the HGF receptor is expressed.

CONCLUSIONS

At such a dose the uptake clearance was comparable for both PC and NPC showing that HGF distributes to both cell types although NPC have few HGF receptors. Since the distribution to NPC was relatively non-specific and heparin-sensitive, it may be that heparin-like substances, which are believed to exist on PC and/or the extracellular matrix, also exist on NPC.

Market basket and duplicate portion estimation of dietary intakes of cadmium, mercury, arsenic, copper, manganese, and zinc by Japanese adults

Daily intakes of selected metals from meals in Shiga Prefecture (Japan) were investigated by the duplicate portion method and market basket method. In 1991 and 1992, daily intakes of metals by women, determined by the duplicate portion method, were, respectively, 37 and 27 micrograms for Cd, 4.3 and 3.5 micrograms for Hg, 260 and 210 micrograms for As, 1200 and 1200 micrograms for Cu, 4700 and 3600 micrograms for Mn, and 8000 and 7200 micrograms for Zn. Those determined by the market basket method were, respectively, 32 and 35 micrograms for Cd, 4.3 and 9.9 micrograms for Hg, 160 and 280 micrograms for As, 1100 and 980 micrograms for Cu, 3600 and 4700 micrograms for Mn, and 8700 and 8500 micrograms for Zn. No wide differences between the 2 methods were found, except for Hg data in 1992. Daily intakes of Cd and Hg in Shiga Prefecture were lower than the provisional tolerable daily intakes of 57-72 micrograms for Cd and 43 micrograms for Hg, proposed by the Food and Agricultural Organization and the World Health Organization.

Circadian expression of the dnaK gene in the cyanobacterium Synechocystis sp. strain PCC 6803

The expression of the dnaK gene in the cyanobacterium Synechocystis sp. strain PCC 6803 was continuously monitored as bioluminescence by an automated monitoring system, using the bacterial luciferase genes (luxAB) of Vibrio harveyi as a reporter of promoter activity. A dnaK-reporting bioluminescent Synechocystis strain was constructed by fusing a promoterless segment of the luxAB gene set downstream of the promoter region of the Synechocystis dnaK gene and introduction of this gene fusion into a BglII site downstream of the ndhB gene in the Synechocystis chromosome. Bioluminescence from this strain was continuously monitored and oscillated with a period of about 22 h for at least 5 days in continuous light. The phase of the rhythm was reset by the timing of the 12-h dark period administered prior to the continuous light. The period of the rhythm was temperature compensated between 25 and 35 degrees C. Thus, the bioluminescence rhythm satisfied the three criteria of circadian rhythms. Furthermore, the abundance of dnaK mRNA also oscillated with a period of about 1 day for at least 2 days in continuous light conditions, indicating circadian control of dnaK gene expression in Synechocystis sp. strain PCC 6803.

Suppression of pannus-like extension of synovial cells by lipid-derivatized chondroitin sulphate: in vitro and in vivo studies using Escherichia coli-induced arthritic rabbits

In rheumatoid arthritis, pannus formation resulting from synovial inflammation is a major factor in cartilage destruction. The ability of arthritic synovial cells to undergo pannus formation depends upon their initial adhesion to the partially deformed cartilage surfaces. Our recent studies using various lipid-derivatized glycosaminoglycans have revealed a preeminent inhibitory activity of phosphatidyl ethanol amine-derivatized chondroitin sulphate (CS-PE) toward cell-matrix adhesion. Here we evaluate whether CS-PE may protect articular cartilage from pannus extension in different in vitro and in vivo model systems using Escherichia coli 0:14-induced arthritis in rabbits and the articular cartilage explants, synovial tissues, and synovial cells obtained from them. These studies showed that CS-PE suppressed the in vivo pannus-like extension on cartilage surfaces, as well as the in vitro extension of the synovial cell layer on both CS-PE treated culture plates and cartilage explants. The results suggest that native chondroitin sulphate proteoglycans in the surface of normal articular cartilage play an important role in protecting the tissues from pannus extension and that the CS-PE immobilized onto partially eroded cartilage can mimic the inhibitory action of native chondroitin sulphate proteoglycans.

Whole body X-ray irradiation to mice decreases ascorbic acid concentration in bone marrow: comparison between ascorbic acid and vitamin E

The change in the ascorbic acid concentration in the bone marrow after whole body X-ray irradiation was compared with that in the vitamin E concentration. The ascorbic acid concentration in the bone marrow significantly decreased by 30% 1 h after exposure to 3 Gy of X-rays, whereas the vitamin E concentration in the bone marrow was significantly decreased 5 h after exposure, when the level of ascorbic acid was less than 10% of that in the control. At 24 h after exposure, the ascorbic acid concentration in the bone marrow was significantly decreased by 80% after exposure to 0.5 Gy, whereas the vitamin E concentration was significantly decreased after exposure to 1 Gy or more. In the bone marrow, the decrease in the ascorbic acid concentration was accompanied by a marked increase in the concentration of dehydroascorbic acid, an oxidized form of ascorbic acid. X-ray irradiation did not decrease either the ascorbic acid or vitamin E concentration in the serum or intestine. These findings suggest that the bone marrow is more highly susceptible to oxidative damage by radiation and that ascorbic acid plays an important defense role against it. On Day 8 after irradiation, the decreases in the vitamin E and ascorbic acid concentrations in the bone marrow showed recovery after exposure to 3 Gy, but not after the exposure to 6 Gy.

Daily intakes of tributyltin and triphenyltin compounds from meals

Daily intakes of tributyltin (TBT) and triphenyltin (TPT) compounds from meals in Shiga Prefecture, Japan, were investigated by 2 methods. Daily intakes of TBT and TPT by the duplicate portion method were, respectively, 4.7 and 0.7 microgram in 1991 and 2.2 and 0.7 microgram in 1992. Those by the market basket method were, respectively, 6.9 and 5.4 micrograms in 1991 and 6.7 and 1.3 micrograms in 1992. Daily intakes of TBT and TPT by the market basket method were higher than those by the duplicate portion method. These values were considerably lower than acceptable daily intakes of 80 micrograms/50 kg body weight specified by the Welfare Ministry of Japan for bis(tri-n-butyltin)oxide and of 25 micrograms/50 kg body weight specified by the Food and Agriculture Organization/World Health Organization for TPT.

[Bence Jones type multiple myeloma showing diffuse infiltration to the dura mater by myeloma cells]

A 62-year-old man with aleukemic Bence Jones type multiple myeloma who developed neurologic abnormalities is reported. After admission, consciousness disturbance appeared and a lumbar puncture obtained M-protein. Though brain CT showed no abnormal findings except a punched out lesion of the temporal bone, MRI disclosed remarkable enhancement of the dura mater. Meningeal involvement by myeloma cells without leukemic blood picture is very rare though it is common in other lymphoproliferative disorders such as acute lymphocyte leukemia and malignant lymphoma. We report a case of BJ type multiple myeloma with meningeal involvement due to diffuse infiltration to the dura mater and discuss a possible mechanism of meningeal involvement in this patient.

[Allogenic bone marrow transplantation for Fanconi's anemia with leukemic transformation from an HLA identical father]

We report a case of a 19-year-old male with congenital aplastic anemia and multiple abnormalities; short stature, hypoplastic thumb, skin pigmentation and mental retardation. He was admitted to our hospital because of severe pancytopenia. Bone marrow aspiration showed markedly hypocellular marrow with 42% myeloblasts. He was diagnosed as AML (M2) transformed from Fanconi's anemia and underwent allo-BMT from an HLA-identical father. The conditioning regimen consisted of high dose Ara-C, high dose etoposide and 12Gy fractionated total body irradiation. Severe toxicity associated with the conditioning regimen was not observed. Cyclosporin A and short-term methotrexate were administered for prophylaxis of acute GVHD. Neither acute nor chronic GVHD were observed. He is well and free of disease for 15 months since BMT. Very few cases of Fanconi's anemia with leukemic transformation treated by BMT have been reported. Long-term observation will be necessary to evaluate our conditioning regimen for Fanconi's anemia with leukemic transformation.

Cerebrospinal fluid levels of S-100b protein and neuron-specific enolase in chronic inflammatory demyelinating polyneuropathy

We measured the cerebrospinal fluid (CSF) concentrations of S-100b protein (S-100b) and neuron-specific enolase (NSE) using enzyme immunoassay methods in 15 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), other three patients with chronic neuropathy with demyelination, eight patients with various axonal neuropathies (AN), and 46 controls, to investigate the clinical usefulness of the determination of these two specific proteins in these neuropathies. S-100b levels were elevated (> the mean +/- 2 SD levels of controls) in the majority of patients with clinically progressing CIDP (9/11), but not in the patients with AN (0/8). In parallel with the clinical improvement, S-100b levels were normalized in patients with CIDP (10/10), though total protein levels in the CSF still remained high in some of these patients (5/10). Elevation of NSE levels were seldom seen in clinically worsening patients with CIDP (1/11) or AN (1/8). Thus our results indicated that the level of S-100b in the CSF may be useful to assess the activity of actual disease process in CIDP.

[Anemia and hemostatic abnormalities associated with multiple myeloma]

Anemia and bleeding are commonly observed in patients with multiple myeloma (MM). Anemia in MM is multifactorial in origin. Three common causes are marrow replacement by the malignant cells, thereby reducing the available number of BFU-E, chronic renal failure and shortening of the half life of erythrocytes. Some patients with anemia but without renal failure show a good response to erythropoietin (Epo) with full correction of anemia. This indicates that human Epo is a promising therapeutic tool or treating myeloma-associated anemia. The incidence of severe bleeding complications is low, despite the diversity of abnormal hemostatic tests in patients with MM. These patients frequently show abnormal coagulation tests, including thrombin time, fibrin degeneration products, platelet aggregation tests and bleeding time. The most effective therapeutic approach to bleeding is to treat the underlying malignancy. Supplemental to this, plasma exchange is useful.

[Bacteriological and clinical studies of SY5555 in pediatric field]

Clinical studies were carried out on SY5555, a new oral penem, in the field of pediatrics. The results obtained are summarized below. The clinical efficacies were examined in a total 31 patients consisting of 4 patients with pharyngitis, 10 with purulent tonsillitis, 4 with scarlet fever, 7 with impetigo, one with balanitis, one with cellulitis and 4 with UTI. The clinical efficacy rate was 96.8% (30/31). Bacteriological efficacies of SY5555 were examined on identified pathogens including 7 strains of Staphylococcus aureus, 6 of Streptococcus pyogenes, 3 of Enterococcus faecalis, 3 of Haemophilus influenzae, one of Escherichia coli and one of Citrobacter freundii. The bacteriological eradication rate was 81.0%. As for side effects, loose stool in one patient was noted. Abnormal laboratory findings test results included eosinophilia in 2 patients, eosinophilia and elevation of serum transaminase in one patient, and thrombocytosis in another.