[Adrenal hepatoid carcinoma producing alpha-fetoprotein: a case report]

A case of left adrenal hepatoid carcinoma is reported. The patient was a 57-year-old male and his chief complaint was general fatigue. Preoperative laboratory data showed markedly increased levels of alpha-fetoprotein (AFP) (30,500 ng/ml) and PIVKA-II (3.01 AU/ml). Both computed tomography (CT) and magnetic resonance computed tomography (MRCT) showed left adrenal tumor (8 x 5 cm). Angiography showed hypervascular tumor over the upper pole of the left kidney. Thoracoabdominal nephro-adrenalectomy was performed. Histological examination demonstrated hepatoid carcinoma of the left adrenal gland. AFP was positive in the tumor cells. The levels of both AFP and PIVKA-II dropped to the normal range postoperatively. Hepatoid carcinoma in the urological field is very rare. As hepatoid carcinoma in the Japanese literature in the urological field, there were only 4 cases of renal tumor, 2 cases of renal pelvic tumor, 2 cases of retroperitoneal space and 1 case of urachal tumor. This is the first report of adrenal hepatoid carcinoma in Japan.

Beraprost sodium protects occlusion/reperfusion injury in the dog by inhibition of neutrophil migration

1. The effects of beraprost sodium (beraprost) on myocardial infarct size in an anesthetized open-chest canine model of regional myocardial ischemia and reperfusion were investigated. 2. Administration of beraprost (300 ng/kg/min, intravenously) to dogs 45 min after left circumflex coronary artery occlusion until 105 min after reperfusion resulted in a significant reduction in infarct size. 3. The values of control and beraprost treated infarct size expressed as a percentage of the total left ventricle were 15 +/- 3% and 4 +/- 2%, respectively. 4. Reperfusion arrhythmia, plasma creatine phosphokinase (CK) and lactate dehydrogenase (LDH) level were significantly suppressed by treatment with beraprost. 5. By histological examination, beraprost proved to reduce neutrophil migration in the ischemic myocardium after 5 h reperfusion. 6. Therefore, it is suggested that the cytoprotective effect of beraprost during myocardial ischemia and reperfusion may be the consequence of the inhibition of neutrophil migration.

Contribution of a hydrogen bond to the thermal stability of the mutant human lysozyme C77/95S

The structural stability due to a disulfide bridge between Cys77 and Cys95 of the wild-type human lysozyme is partly recovered by a putative hydrogen bond introduced in to the mutant human lysozyme C77/95S, where Cys77 and Cys95 have been replaced by serines (Yamada et al. (1994) Biol. Pharm. Bull., 17, 192 (1994). In order to understand quantitatively the role of the hydrogen bond in the thermal stability of the mutant human lysozyme, we constructed further mutant proteins, C77SC95A in which Cys77 and Cys95 were replaced by serine and alanine, respectively, and C77AC95S, in which Cys77 and Cys95 were replaced by alanine and serine, respectively. From the thermal unfolding studies of these mutant proteins, both C77SC95A and C77AC95S were shown to be destabilized up to -0.81 and -1.32 kcal/mol, respectively, as far as the free energy changes of unfolding were concerned by compared with C77/95A, where both Cys77 and Cys95 were replaced by two alanines. Considering that these decreases in conformational stability are attributable to hydrophobic effects, the hydrogen bond between Ser77 and Ser95, buried in the hydrophobic cavity in C77/95S, was estimated as 3.0 kcal/mol.

Rubella arthritis. An outbreak in Kyoto

OBJECTIVE

To investigate the incidence of arthritis in patients with rubella in an Asian compared to a Western setting.

METHODS

During a widespread outbreak of rubella in Kyoto, Japan, 29 patients with rubella who visited a general medical clinic in that city were investigated for arthritic symptoms.

RESULTS

Among 9 women with rubella infection, 3 (33%) had acute polyarthritis. Among 20 men with the infection, 2 (10%) had arthritis. Of the 5 patients who developed rubella arthritis, 4 were over 18 years old. Recurrence of arthritis was not seen in any individuals.

CONCLUSION

The high incidence of arthritis observed among adult women was consistent with that of earlier reports from Western countries.

Polyarthritis associated with hepatitis C virus infection

Two cases of polyarthritis associated with hepatitis C infection are reported. In Patient 1, stiffness and polyarthritis occurred during the acute stage of hepatitis. The arthritic symptoms lasted for 4 months. A transient polyarthritis recurred 4 yr later. The persistent presence of anti-hepatitis C viral antibodies was noted. Hepatitis C viral RNA (HCV RNA) was identified in the serum using the polymerase chain reaction proving that the patient was a carrier. In Patient 2, polyarthritis occurred associated with chronic hepatitis C liver disease. Synovial biopsy showed infiltration of mononuclear cells. HCV RNA was demonstrated in both serum and SF. These cases suggest an aetiologic association between arthritis and hepatitis C antigenaemia.

Effect of temocapril on haemodynamic and humoral responses to exercise in patients with mild essential hypertension

1. This study was carried out to evaluate the effect of temocapril on haemodynamic and humoral responses to exercise in nine patients with mild essential hypertension (WHO stages I and II). 2. After a 4-week placebo period, temocapril was administered at a dose of 1.0 mg once daily for 2-4 weeks. Graded submaximal bicycle ergometer exercise was performed before and after temocapril treatment, and the changes in arterial blood pressure, heart rate, cardiac output (CO), and systemic vascular resistance (SVR) were evaluated. In addition, the plasma norepinephrine (NE) level was determined both at rest and peak exercise before and after temocapril treatment. 3. Both the systolic and diastolic blood pressure were reduced at rest and during exercise by temocapril treatment. No significant change in the resting heart rate and CO was observed, and the exercise-induced increase of these parameters was also not affected by temocapril. In contrast, the resting SVR was significantly decreased by temocapril, although the exercise SVR was similar during both temocapril and placebo treatment. 4. Although there was no significant change in the plasma NE level with temocapril treatment, the exercise-induced increase of plasma NE was significantly suppressed by temocapril. 5. These results indicate that temocapril reduces the blood pressure without causing any significant changes in the heart rate and CO at rest, and that it does not produce any changes in the haemodynamic response to exercise.

In vitro activity of azithromycin: A long-acting azalide

The in vitro activity of azithromycin, an orally active azalide, was compared with that of erythromycin and oral beta-lactams against 893 clinical isolates of staphylococci, streptococci, enterococci, Haemophilus influenzae and Salmonella typhi. MIC90 of azithromycin for streptococci was 0.12 mg/L, 0.5 mg/L for H. influenzae, 8.0 mg/L for Salmonella typhi and methicillin-susceptible Staphylococcus aureus. Like erythromycin and the beta-lactams tested, it had little or no activity against enterococci, methicillin-resistant S. aureus and coagulase negative staphylococci.

Clinicopathological study of proliferating cell nuclear antigen (PCNA) of hepatocytes in primary biliary cirrhosis

The DNA synthesis activities of hepatocytes in primary biliary cirrhosis (PBC) and other chronic liver diseases and control subjects were examined by staining proliferating cell nuclear antigen (PCNA) with anti-PCNA monoclonal antibody. The number of PCNA-positive cells (PCNA value) was significantly higher in PBC (375 +/- 281 parts per thousand; ppt) than in other chronic liver diseases, i.e., chronic hepatitis (95 +/- 83 ppt), liver cirrhosis (72 +/- 71 ppt), and alcoholic liver disease (73 +/- 56 ppt), and in control subjects (11 +/- 14 ppt). The PCNA value of PBC in stages I-III of Scheuer's classification was remarkably high, while in stage IV it was low. Even in identical, Scheuer's stages, the PCNA value of PBC was higher in patients who were not given ursodeoxycholic acid (UDCA) than in those who received UDCA. In identical patients, the PCNA value was lowered significantly after UDCA treatment. It was concluded that the DNA synthesis activity of PBC in stages I-III was accelerated and that UDCA can alleviate the abnormality in DNA synthesis activity.

Stabilization and enhanced enzymatic activities of a mutant human lysozyme C77/95A with a cavity space by amino acid substitution

Amino acid substitutions were examined to increase the stability of the mutant human lysozyme C77/95A by filling the cavity created by this mutation. To modulate the cavity with hydrophobic amino acids or by the formation of a hydrogen bond, five amino acid-substituted mutants, C77AC95L, C77AC95I, C77LC95A, C77IC95A and C77/95S, were designed and constructed based on computer graphics investigations for stabilizing the mutant protein. The values of the melting temperatures, Tm, at pH 3.0 of the two mutant proteins C77LC95A and C77/95S were increased by 2.9 degrees C and 2.3 degrees C, respectively, as compared to that of C77/95A. The C77IC95A and C77AC95L proteins showed almost the same stability as C77/95A. The increase in the stability of the proteins might be explained by the filling of the cavity space around positions 77 and 95 with the side residue of Leu77 in C77LC95A, and by the formation of a hydrogen bond between Ser77 and Ser95 in C77/95S. On the other hand, the substitution with isoleucine at 95 (C77AC95I) decreased the stability. The activities of the five mutant proteins against the synthetic substrate, p-nitrophenyl tetra-N-acetyl-beta-chitopentaoside, were higher than that of the wild-type human lysozyme, while the lytic activities against M. lysodeikticus were decreased in C77LC95A and C77IC95A, and increased in C77AC95L.

Variant type of congenital stomatocytosis

A 52-year-old female with congenital stomatocytosis showed hemolytic anemia, an increased mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC), reticulocytosis and an increased osmotic fragility. Lipid and protein content of membranes, the activities of membrane-associated enzymes in erythrocytes and the elution pattern of hemoglobin were normal. Erythrocyte Na+ influx was moderately increased and Na+ efflux, particularly ouabain-insensitive Na+ "leak-out" was also increased. K+ concentration of erythrocytes was abnormally low with a slightly increased Na+ content. These phenotypes are very rare, and should be classified as a variant type.

Comparison of in vitro antifungal activity of itraconazole and hydroxy-itraconazole by colorimetric MTT assay

The in vitro antifungal activities of itraconazole and its active hydroxyl metabolite, hydroxy-itraconazole (R 63372), against Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans were compared by visual assessment of growth as well as by colorimetric MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide] assay using microtitre plates containing four different media. Minimum inhibitory concentration (MIC) end points determined by the colorimetric MTT assay correlated well with those obtained by visual assay. The two drugs showed different MIC values depending on the medium used. The activity of itraconazole was equal to or greater than the activity of hydroxy-itraconazole against most of the fungi tested. Both drugs showed lower MIC values against A. fumigatus and Cr. neoformans in brain heart infusion broth (BHI) medium than in yeast nitrogen base (YNBG) medium, Sabouraud glucose broth (SAB) or "synthetic amino acid medium, fungal" (SAAMF). However, the MIC end point of these drugs against C. albicans in BHI and SAB media was difficult to determine visually as well as by MTT assay. In C. albicans, the MTT assay method using SAAMF and YNBG media is recommended for the determination of MICs.

Occurrence of nivalenol, deoxynivalenol, and zearalenone in imported cereals in Papua, New Guinea

A preliminary survey for the natural occurrence of Fusarium mycotoxins--nivalenol (NIV), deoxynivalenol (DON) and zearalenone (ZEN)--in cereals imported mostly from Australia to Papua, New Guinea (PNG) in 1991 was carried out by TLC, GLC, and HPLC analysis. The data have revealed various kinds of cereals and cereal flours, such as wholemeal flour, millet meal, corn flour, brown trukai rice, and others, were significantly contaminated with these mycotoxins in various concentrations. Among these Fusarium mycotoxins, the level of ZEN was surprisingly high. This is the first report on the natural occurrence of Fusarium mycotoxins in PNG cereals.

Susceptibility of methicillin-resistant Staphylococcus aureus to minocycline and other antimicrobials

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) is on the rise, especially in nosocomial and intravenous-drug-abuse-related infections, with a concomitant increase in morbidity, mortality and health care costs. At present the drug of choice, vancomycin, which must be administered intravenously, is expensive and can cause serious side effects in vancomycin-intolerant patients. Recently, minocycline has received much attention as an antibiotic to combat the increasing frequency of MRSA-related infections. We tested 102 recent clinical isolates of MRSA from tertiary-care patients and found none to be resistant to minocycline, with minimum inhibitory concentrations of < 1-2 micrograms/ml. The only other drug that inhibited all the strains was vancomycin, followed by ciprofloxacin (87%), clindamycin (55%) and chloramphenicol (52%). Gentamicin, beta-lactams, tetracycline and trimethoprim-sulfamethoxazole had little or no activity against our isolates of MRSA.

Primary hepatic carcinoid tumor

A case of primary carcinoid tumor arising in the liver of a 69 year old woman with no endocrine symptoms is reported. Histopathologically, the tumor was diagnosed initially as a hepatocellular carcinoma in the biopsy specimen, and was shown subsequently to be a carcinoid tumor, demonstrating diffuse positive staining with Grimelius method. Mucin stained with periodic acid-Schiff (PAS), alcian-blue, and mucicarmine, and was shown partially in the glandular structures. Immunohistochemically, most of the tumor cells stained positively for chromogranin-A, epithelial membrane antigen (EMA) and neuron specific enolase (NSE). Ultrastructural examination revealed electron-dense core granules, measuring 40-120 nm in diameter in some of the tumor cells. Intensive and careful searches pre- and post-operatively revealed no other primary source of tumor other than the liver. The patient was reported well with no symptoms 3 1/2 years after the operation. This case is considered to be a primary hepatic carcinoid tumor. The recent literature is reviewed, and the possible histogenesis of hepatic carcinoid tumor is discussed.

Recurrent forearm thrombophlebitis after transvenous permanent pacemaker insertion

This report describes a 69-year-old Japanese woman with bilateral forearm thrombophlebitis that developed soon after transvenous permanent pacemaker insertion. Intravenous administration of urokinase and heparin rapidly resolved fever, painful forearm swelling and inflammatory findings. Digital subtraction venograms revealed a brachiocephalic vein thrombosis. A ten-month treatment with warfarin and ticlopidine resulted in the complete restoration of venous flow. Although thrombophlebitis associated with transvenous permanent pacemaker insertion has a relatively low incidence (0.3%), prompt diagnosis and treatment with anticoagulant and/or thrombolytic agents are important for the late clinical outcome in cases with deep venous thrombosis.

Anti-Brucella activity of Ro 23-9424, a dual-action antibacterial

The in vitro activity of dual-acting antibacterial Ro 23-9424 was determined by the agar dilution method against 126 clinical isolates of Brucella melitensis. It was compared with fleroxacin, ciprofloxacin and five conventional drugs. MIC50 and MIC90 for Ro 23-9424 were 1.0 and 4.0 mg/l, respectively, as compared with 0.25 and 0.5 mg/l for fleroxacin and ciprofloxacin. One strain which was resistant to other fluoroquinolones, with an MIC of > 8.0 mg/l, did not show cross-resistance to Ro 23-9424 and had an MIC of 4.0 mg/l. All the strains were susceptible to conventional drugs like gentamicin, streptomycin rifampicin, tetracycline and trimethoprim-sulfamethoxazole, with MICs ranging between 0.12 and 2.0 mg/l. Ro 23-9424 did not exhibit in vitro synergy with any of the conventional drugs.

Lymphomatous polyarthritis in patients with peripheral T-cell lymphoma

Direct involvement of the joints is a rare complication of malignant lymphoma and lymphoma cells in synovium or synovial fluid have been characterized in only a very few cases. We report two cases of CD4-positive, HTLV-I-negative peripheral T-cell lymphomas that manifested polyarthritis infiltrated with lymphoma cells which we further characterized. Patient 1, with a prior 7-year history of cutaneous T-cell lymphoma (mycosis fungoides) and polyarthralgia, developed pain and swelling in the right knee joint and right femoral region. Patient 2 was initially diagnosed with immunoblastic lymphadenopathy, later rediagnosed as the prodromal stage of T zone lymphoma. Seven years later she developed skin eruptions, cervical lymph node swelling, polyarthritis, and pleural effusion. Synovial fluid analysis in both cases showed predominant CD3+ or cytoplasmic CD3+, CD4+, and CD8- atypical lymphoid cell infiltration. In both cases the T-cell receptor beta and gamma chains were rearranged in the synovial fluid mononuclear cells. Analysis of these two cases and a review of the literature suggest that lymphoma cell infiltration of synovium occurs preferentially in patients with CD4+ peripheral T-cell lymphoma.

A modified method of mixed lymphocyte reaction: establishment of the assay system and its application to extracts of fungal cultures

A modified mixed lymphocyte reaction (MLR) assay was developed to screen immunosuppressive agents. In the MLR, irradiation of splenocytes with UV light was employed for the preparation of stimulator cells, and the highest response was observed with the combination of splenocytes of C3H/He mice as a stimulator and those of C57BL/6 as a responder. The blastogenesis of the responder cells was quantified by a colorimetric method using MTT in 96-well microculture plates. For screening immunosuppressive substances, the MLR in combination with a cytotoxicity test can distinguish immunosuppressors from cytotoxic agents. The applications of this assay system to extracts of fungal culture was also described.

[Recent advances in the study on the mechanism of brain injury]

A cerebral contusion and DAI (diffuse axonal injury) are practically very important in a medico-legal case of the closed head injury. In this paper, we will report the epitome of the recent advances in the study on the mechanism of them. Coup contusion can be mainly attributed to the skull inbending and/or the skull fracture which develop in the impact region. As to the mechanism of the contrecoup contusion, several theories are reported. During rotational movement of the head, intracerebral shear strains would be produced because of brain lag (Holbourn's rotation theory). Anatomical features of the skull plays an important role (Gurdjian). Relative movement between a brain and a skull induces intracranial cavitation due to pressure gradient (Gross's cavitation theory). Brain is injured by deformation pressure induced by skull deformation and acceleration one done by a movement of the head (Lindenberg). The last one is Courville's transmitted waves of force theory. As to DAI, there is Gennarelli's theory. During a rotational movement of a brain caused by high rate of angular acceleration operating for a long period, intracerebral shear strains occur and injure a brain. As to the brain injuries which include a cerebral contusion and DAI, two theories are reported. Centripetal progression of strains to the core of a brain injuries the brain (Ommaya). Natural frequency of impact determines the nature of resulting injury to the brain (Willinger).

Histo-pathological findings of abraded skins in the cases of automobile dragging

We histologically examined skin which had been abraded by automobile dragging. In the first case, the victim was a 57-year-old drunken male. He was hit by a passenger car while walking on a road and dragged for a distance of 30 m. He soon died from the pelvic bone fractures. Extensive and deep abrasions were observed on both shoulders and the back. In the second case, a 20-year-old drunken male was lying on a road. He was run over by a passenger car and dragged for a distance of 800 m. During the dragging the car's underbody strongly compressed his thoraco-abdominal region and killed him by causing insufficiency in breathing. Deep abrasions were found in the right temporal region and right back at the waist. In the third case, when a 50-year-old woman was riding a moped it collided with a passenger car at an intersection and she fell to the ground. Soon after, she was run over by another passenger car and dragged for a distance of 718 m. The cause of death was profuse bleeding from the crushed right axillary artery and vein. Autopsy revealed very extensive and severe abrasions in the right upper arm, right axilla, lateral surface of the right chest and abdomen, right back, back pelvic region, and lateral surface of the right lower leg and foot. Especially in the arm, axilla and chest, the skin and soft tissues were worn away, muscles and bones were exposed, and the right axillary artery and vein were crushed.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro activity of Ro 23-9424, a dual-acting cephalosporin-quinolone antimicrobial agent

In vitro activity of new dual-acting antibacterial Ro 23-9429 was tested against 1294 bacterial isolates from patients in a major tertiary care referral hospital in Saudi Arabia. Its activity was compared with that of ciprofloxacin, fleroxacin, ampicillin, cephalothin, cefoxitin, cefotaxime, ceftazidime, piperacillin, oxacillin, gentamicin, amikacin, imipenem, and vancomycin. Of the 621 members of Enterobacteriaceae tested, every single isolate was inhibited by Ro 23-9429 at minimum inhibitory concentration ranging between < .03 and 8 micrograms/mL. No other antimicrobial tested was as active as this dual-acting cephalosporin-fluoroquinolone. Similarly, all of the 255 isolates of Acinetobacter, Aeromonas hydrophila, Pseudomonas aeruginosa, and Xanthomonas maltophilia were susceptible to Ro 23-9429. It inhibited all the 120 isolates of methicillin-resistant Staphylococcus aureus. Its in vitro activity against coagulase-negative staphylococci and enterococci was superior or comparable to that of other drugs that are commonly used in clinical practice.

Luteoskyrin, an anthraquinoid hepatotoxin, and ascorbic acid generate hydroxyl radical in vitro in the presence of a trace amount of ferrous iron

Luteoskyrin is a bis-dihydroanthraquinone mycotoxin produced by Penicillium islandicum Sopp. By using EPR spin-trap techniques we investigated whether .OH is formed in a model system containing ascorbic acid and the toxin. In the presence of DMSO and DMPO, we found signals of DMPO-CH3, a more specific and reliable signature of .OH than DMPO-OH, together with the signals of ascorbyl radical. DMPO-CH3 signals increased with time of incubation up to 5.5 min. The DMPO-CH3 formation depended completely on both luteoskyrin and ascorbic acid, and deferoxamine, an iron-chelator, inhibited its formation. The signals disappeared in the presence of excess amount of catalase whereas SOD showed no effect. These results suggest that .OH is formed from ferrous ion present in the mixture of H2O2 generated from ascorbic acid and luteoskyrin.

[The relation between the attitude toward humor, aggression and altruism]

This study investigated the attitude towards humor and the relationship among the attitude, aggression and altruism. Four hundred and seven subjects answered the questionnaires consisting of (1) items about attitude toward humor, (2) items about aggression and altruism, and (3) items about humorous statements, frequently heared in negative situations. Factor analysis revealed that the attitude toward humor consists of two factors; (a) preference for aggressive humor and (b) preference for playful humor. The former is related to aggression and altruism, while the latter is related to altruism only. The items about humorous statements frequently heard in negative situations suggested that preference for aggressive humor is related to aggressive behavior, while preference for playful humor is related to moderation of the atmosphere.