[A case of Campylobacter fetus subspecies fetus meningitis]

A 40-year-old male with no history of underlying disease was admitted to Hokusho Central Hospital on May 25, 1991, complaining of high fever and headache. Physical examination on admission revealed a temperature of 38.5 degrees C, a pulse rate of 84 beat/min (relative bradycardia) and no abnormal findings for the chest or abdomen. Slight neck stiffness without Kernig's sign was observed at neurological examination. Laboratory data were: ESR 11 mm/lh, WBC 12000/mm3, C-reactive protein positive. Lumbar puncture showed an initial pressure of 230 mmH2O; CSF revealed a cell count of 2633/3 mm3 with mononuclear pleocytosis, total protein of 76 mg/dl and sugar of 54 mg/dl (CSF:blood glucose ratio 0.47). We initially suspected tuberculous or cryptococcal meningitis, but Campylobacter fetus subsp. fetus (C. fetus) was isolated from the CSF and venous blood on the 27th hospital day. IPM/CS 1 g/day, MINO 200 mg/day and FOM 4 g/day were intravenously administered. This antibiotic therapy was very effective: the patient was soon afebrile, and gradually all signs and symptoms were resolved. C. fetus was sensitive to IMP/CS, MINO, KM, GM, EM, OFLX, CP. The patient was discharged with no complication. He has eaten raw beef frequently before admission, but stool culture for C. fetus was negative.

Radiation-related ophthalmological changes and aging among Hiroshima and Nagasaki A-bomb survivors: a reanalysis

The relationship of ionizing radiation to the age-related ophthalmological findings of the 1978-1980 ophthalmological examination of A-bomb survivors of Hiroshima and Nagasaki has been reanalyzed using DS86 eye organ dose estimates. The main purpose of this reevaluation was to determine whether age and radiation exposure, as measured using the recently revised dosimetry information (DS86), have an additive, synergistic, or antagonistic effect. The data in this study are limited to axial opacities and posterior subcapsular changes, for which a definite radiation-induced effect has been observed in Hiroshima and Nagasaki A-bomb survivors. The best model fitting for axial opacities gives a significant positive effect for both linear dose and linear age-related regression coefficients and a significant negative effect for an interaction between radiation dose and age. Such a negative interaction implies an antagonistic effect in that the relative risks in relation to radiation exposure doses become smaller with an increase in age. On the other hand, the best-fitting relationship for posterior subcapsular changes suggested a linear-quadratic dose and linear age-related effect. The estimate of the quadratic dose coefficient shows a highly negative correlation with age, but the negative quadratic dose term is extremely small and is of little biological significance.

Relationships of plasma viscosity, coagulation and fibrinolysis to coronary risk factors and angina

Plasma viscosity, molecular markers of activated coagulation and fibrinolysis (fibrinopeptides A and B beta 15-42), coagulation factors (fibrinogen and factor VII) and antiplasmins were measured in 529 men aged 35-54 years and related to new angina pectoris (n = 117) and to coronary risk factors in controls without angina (n = 412). Five major risk factors (cigarette-smoking, blood pressure, cholesterol, triglyceride and body mass index) were each associated with increases in plasma viscosity, coagulation factors, and imbalance of coagulation over fibrinolysis (increased ratio of fibrinopeptide A/fibrinopeptide B beta 15-42). Increased viscosity and fibrinogen in smokers were partly reversed in ex-smokers, but the imbalance of coagulation and fibrinolysis persisted. Cholesterol and triglyceride were also associated with increased antiplasmin activity. In men with angina, only fibrinogen was elevated compared to controls. We suggest that increased plasma viscosity and an imbalance of coagulation over fibrinolysis may be mechanisms by which known risk factors promote arterial thrombosis, but are not present in stable angina.

Studies on anti-von Willebrand factor (vWF) monoclonal antibody NMC-4, which inhibits both ristocetin- and botrocetin-induced vWF binding to platelet glycoprotein Ib

Anti-von Willebrand factor (vWF) monoclonal antibody NMC-4 completely inhibited vWF binding to platelet glycoprotein (GP) lb induced by either ristocetin or botrocetin at an IgG concentration of approximately 10 micrograms/mL, and also blocked binding of asialo-vWF to GP lb. NMC-4 coupled beads isolated a 97-Kd fragment (Fr) from a whole tryptic digest of vWF. The N-terminal sequencing of the nonreduced 97-Kd Fr, in combination with amino acid analysis, showed it to be a homodimer of residues 449 through 728 of the constituent subunit. Present data, together with the results obtained from previous studies, confirm the existence of one or three possible inter-subunit disulfide bonds between cysteine residues 459, 462, and 464. NMC-4 bound to reduced vWF Fr(s) more weakly than to nonreduced Fr(s), but it did not react with Fr III-T2 of vWF, a disulfide-linked twin heterodimer of residues 273 through 511 and 674 through 728 (Marti et al, Biochemistry 26:8099, 1987). Fr III-T2 completely inhibited ristocetin-induced vWF binding at a concentration of 100 mumol/L but had no effect on botrocetin-induced binding. In addition, both the N- and C-terminal polypeptides, residues 449 through 549 and 674 through 728, generated by subdigestion of the 52/48-Kd Fr (Fujimura et al, J Biol Chem 261:381, 1986), inhibited preferentially ristocetin-induced vWF binding without affecting to botrocetin-induced vWF binding. These findings suggest that amino acid residues 512 through 673 of the vWF subunit are involved in botrocetin-induced vWF binding.

[Long-term follow-up of pyoderma gangrenosum (PG) associated with aortitis syndrome (AOS)]

It is known that PG is often associated with AOS. However, there have been no reports on long term follow-up of PG associated with AOS. We experienced a case of a 16 year old female who suffered from PG and AOS. The onset of both diseases occurred at the same time. On admission, many pustules and ulcers were found on the extremities. There was no finding of vasculitis in histopathological examinations. Development of skin lesions of PG coincided with the progress of AOS. But, AOS was progressive even when the patient was free of skin eruptions. It was concluded that the activity of PG was not always parallel to that of AOS.

[Isolation of methicillin-resistant Staphylococcus aureus (MRSA) at the Hokusho Central Hospital--observation during the recent 4 years]

Clinical and bacteriological studies were carried out to investigate the isolation of MRSA from clinical materials, during the 4 years from 1985 to 1988 at the Hokusho Central Hospital. The isolation frequency of MRSA from Staphylococcus aureus increased from 5.6% (3 strains) in 1985 to 50.0% (90 strains) in 1988. MRSA from sputum and pressure sore increased significantly. However MRSA from outpatient and inpatient in the ward for common people were constant, about 20%. Inpatients in the ward for aged person were increased significantly from 13.6% (3 strains) to 67.0% (67 strains). Most of the patients with positive MRSA isolation had background diseases (88.3%) and were bedridden (78.4%). Patients with cerebrovascular disease were 55.9% of all of the cases. But most of the MRSA strains were resistant to CZX, FOM, DMPPC, CMX, CEZ, CZON, CZX, most of the MRSA strains were sensitive to RFP, VCM, MINO, IPM/CS.

Sporotrichosis with bilateral lesions. A case report

We report on a case of sporotrichosis in which lesions occurred bilaterally on upper limbs at different periods. The patient was an 84-year-old farmer living in Tsukuba City, Japan. The first lesion appeared on the left upper arm and remained untreated. The second lesion appeared on the back of the right hand 5 years later. Findings suggesting internal metastasis could not be confirmed in various examinations. We judged that the lesion of the left upper arm was primary and the lesion at the back of the right hand was caused by autoinoculation.

[Isolation of Branhamella catarrhalis from sputum and clinical features of bronchopulmonary infection due to Branhamella catarrhalis]

The authors investigated the isolation of Branhamella catarrhalis from sputum and the clinical features of bronchopulmonary infection due to B. catarrhalis from January of 1983 to December of 1987 at the Hokusyo Central Hospital. B. catarrhalis was cultured from 106 (3.8%) of 5,674 sputum specimens. The isolation rate did not vary during the 5 years from 1983 to 1987. Approximately 70% of the patients had some underlying bronchopulmonary disease. The strains of beta-lactamase-positive B. catarrhalis have increased recently in our hospital. Using 4 diagnostic criteria for bronchopulmonary infection by B. catarrhalis, 24 cases were detected. MIC was measured in 97 strains of B. catarrhalis (beta-lactamase positive 63 strains, negative 34 strains). beta-lactamase positive strains had a high MIC value for beta-lactam antibiotics, but antibiotics including beta-lactamase inhibitor markedly improved sensitivity to drugs. Negative strains showed good sensitivity to beta-lactam antibiotics. Cases of bronchopulmonary infection due to Branhamella catarrhalis and beta-lactamase-productive strains are increasing, therefore it is necessary to be careful in the choice of antibiotics.

[Isolation of methicillin-resistant Staphylococcus aureus (MRSA) from sputum and clinical features of bronchopulmonary infection due to MRSA during 4 years (1985-1988)]

Clinical and bacteriological studies were carried out to investigate the isolation of MRSA from sputa and 13 cases with bronchopulmonary infections due to MRSA, during 4 years from 1985 to 1988 at the Hokusyo Central Hospital. The isolation rate of MRSA in Staphylococcus aureus from sputum increased from 0% in 1985 to 51.4% in 1988, and especially from patients in wards for aged people. Most of the MRSA strains were isolated from patients with underlying diseases, or bed sores. The roentgenographic appearances in bronchopulmonary infection patients due to MRSA, showed infiltration and cavitation. Seven out of 13 cases of bronchopulmonary infection due to MRSA died, in spite of therapy with current antibiotics, suggesting poor prognosis of this infection.

[A case of sepsis and meningitis due to capsule-deficient Cryptococcus neoformans with SIADH]

Capsule-deficient Cryptococcus neoformans (CN-CD) infection is very rare. The authors recently experienced the case of CN-CD infection with the complication of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a 83 year old woman. She was admitted to our hospital with the complaints of fever and general fatigue on June 10, 1987. At the time of admission, there were no abnormal findings except a mildly lowered consciousness level on physical examination, there were no abnormal neurological finding nor meningeal signs. Laboratory data revealed a mild leukocytosis and hyponatremia. Chest X-P showed a few small nodular shadows scattered in both lungs. Antibiotics therapy was of no help and hyponatremia became worse. Then with the suspicion of SIADH, Demeclocycline was administered and limitation of water intake was decreased and hyponatremia improvement was used. Yeast-like fungi was detected in the venous blood culture and in the cerebrospinal fluid (cell count: 252/3) CN-CD by India-ink preparation and bacteriological nature were determined. We made a diagnosis of sepsis and meningitis by CN-CD accompanied with SIADH. In spite of Miconazole administration intravenously and intrathecally, she died 2 months after admission. The minimal inhibitory concentration (micrograms/ml) of antibiotics against the isolated CN-CD was as follows: Amphotericin B: 0.78, 5-PC: 1.56, Miconazole less than or equal to 0.05, Nystatin: 25, Ketoconazole: 0.78.

[Adenoidcystic carcinoma of the palate in pregnancy: report of a case]

The Patient was a 28-year-old woman with 8th month of her pregnancy. She had noted a swelling of her palate (6-region) about 3 years before. Incisional biopsy was done in 8th month of her pregnancy and histological diagnosis was confirmed; adenoidcystic carcinoma. After normal health baby was born with cesarean section in 34 weeks, partial maxillectomy was performed. She is now free of the disease. The baby is now 1-year-old and enjoying the good health.

Homozygous protein C deficiency with delayed onset of symptoms at 7 to 10 months

We report an inbred family with two cases of homozygous protein C deficiency and review 11 other such cases. Both patients presented in the second half of their first year of life with recurrent rapidly disappearing ecchymotic skin lesions, disseminated intravascular coagulation, and venous thrombosis. Successful treatment has been achieved by frequent infusions of plasma or prothrombin complex then maintained with Warfarin. Homozygous recessive protein C deficiency usually presents in the neonatal period with purpura fulminans. Two cases have been described elsewhere which presented in the second decade of life with milder symptoms. The present cases appear to be intermediate in time of presentation and severity of symptoms. We also review the distinction that is now evident between recessive and dominant protein C deficiency.

Monoclonal antibodies to human factor VII: production of immunodepleted plasma for VII:C assays

A high affinity monoclonal antibody to factor VII (RFF-VII/1), coupled to sepharose, was used to immunodeplete factor VII from normal plasma. The plasma could be used as a substrate in a one stage coagulation assay and performed as well as, or better than, commercially available factor VII deficient plasma or plasma from congenitally deficient factor VII patients. Plasma from normal donors (n = 20), patients with liver disease (n = 20), and patients receiving warfarin (n = 20), or congenitally factor VII deficient patients (n = 7) was assayed for VII:C concentration in a one stage coagulation assay. The concentration of VII:C detected with the immunodepleted plasma substrate was comparable in all cases with that seen with a commercially available substrate (r = 0.95).

Monoclonal antibodies to human factor VII: a one step immunoradiometric assay for VII:Ag

Three mouse monoclonal antibodies (RFF-VII/1, RFF-VII/2, and RFF-VII/3) which bind specifically to different epitopes on human factor VII antigen were raised. Two of the antibodies, RFF-VII/1 and RFF-VII/2, bound strongly to factor VII antigen (VII:Ag), but only RFF-VII/1 and RFF-VII/3 were potent inhibitors of factor VII coagulation activity (VII:C). RFF-VII/1 and RFF-VII/2 were used in a one step, double monoclonal immunoradiometric assay for VII:Ag. This was highly reproducible and detected as little as 0.05U/dl VII:Ag. Values for VII:Ag obtained for plasma samples from normal subjects (n = 20), patients with liver disease (n = 20), patients treated with warfarin (n = 20), and those congenitally deficient in factor VII (n = 7) correlated very well (r = 0.96) with data obtained in a radioimmunoassay using polyclonal rabbit antiserum to factor VII. This simple and sensitive monoclonal antibody based assay offers a convenient method for the detection of VII:Ag in various disease states.

Manganese inhibits benzoyl peroxide/copper-dependent lipid peroxidation in the microsomal fraction of rabbit dental pulp

1. Of all the cations tested only manganese ion inhibited the benzoyl peroxide/Cu2+-dependent formation of thiobarbituric acid (TBA)-reactive substance. 2. Ki of Mn2+ for the formation of TBA-reactive substance was 5.0 microM. 3. The inhibitory manner of manganese was non competitive against copper.

Free vascularized nail grafts

A considerable amount of literature has been written on microneurovascular surgery for the reconstruction of partial defects in fingers, but little has been published on reconstruction to replace lost fingernails. We report on two clinical cases in which a free vascularized nail graft and a "double onychocutaneous flap" were used successfully. We suggest that the free vascularized nail graft is a superior method in reconstruction to treat fingernail loss or deformity.

Production of factor VIII deficient plasma by immunodepletion using three monoclonal antibodies

Factor VIII deficient plasma was made from pooled, HIV antibody and hepatitis B antigen screened, normal human plasma by cryoprecipitation and immuno-depletion, using three different monoclonal antibodies bound to Sepharose columns, in series. These monoclonal antibodies are specific respectively for von Willebrand factor, factor VIII heavy chain and factor VIII light chain. The immunodepleted plasma contained less than 0.002 u/ml factor VIII coagulation activity (VIII:C) less than 0.0001 u/ml von Willebrand factor antigen and 1-2 g/l fibrinogen, while the levels of other clotting factors were unchanged. This immunodepleted plasma was compared with commercial factor VIII deficient plasma obtained from a severe haemophilia A patient as substrate in the one-stage factor VIII assay. Plasmas obtained from 20 normal subjects and 28 patients with von Willebrand's disease or haemophilia A were assayed for VIII:C using the two substrates. The results were very highly correlated (r = 0.96). The columns have high capacity and can be regenerated at least 10 times. Large-scale production of a substrate for factor VIII assays free of virus contamination is now feasible.

Monocyte activating factor in sarcoidosis. I. Existence of the factor in sarcoidosis sera

Sarcoidosis sera were found to have the ability to induce normal human monocytes to spread. Gel filtration of sarcoidosis sera on Sephadex G-200 showed that the factor mainly responsible for this activity had a molecular weight of about 70,000. The spreading factor also possessed the ability to increase all cell size of normal human monocytes as well as to increase their phagocytosis and glucose consumption. Accordingly, the spreading factor seems to be considered as a monocyte activating factor. Sarcoidosis sera showed a macrophage migration inhibitory activity, as well. On Sephadex G-200 column chromatography of the sera, the most obvious inhibitory activity was eluted in the fraction with a molecular weight of about 45,000. The macrophage migration inhibitory factor had the ability neither to increase cell size of normal human monocytes nor to increase their phagocytosis and glucose consumption.

Monocyte activating factor in sarcoidosis. II. Secretion of the factor from monocytes

The normal human monocytes pretreated with the monocyte activating factor found in sarcoidosis sera were shown to secrete a factor which induced normal human monocytes to spread as well as to increase their cell size. Phagocytosis and glucose consumption of normal human monocytes were also increased by this secondarily obtained factor. Its molecular weight was about 70,000. These results indicate that this secondary factor may be the same substance as the monocyte activating factor found in sarcoidosis sera. The normal human monocytes pretreated with the monocyte activating factor were also shown to liberate a factor which generated macrophage migration inhibitory factor in cooperation with normal human sera.

Studies on precursor proteins PIVKA-II, -IX, and -X in the plasma of patients with 'hemorrhagic disease of the newborn'

Factors II, IX, and X in the plasmas of 10 patients with 'hemorrhagic disease of the newborn' were investigated by means of electroimmunoassay and crossed immunoelectrophoresis (CIE). The biological activity was within 4.2-30 U/dl for factor II, 5.1-20 U/dl for factor IX, and 5.2-24 U/dl for factor X, whereas the immunological antigen was within 33-58, 25-50, and 35-60 U/dl, respectively. Thus, for all factors, 1.7 times more antigen than activity was present. The CIE pattern of factors II and IX in the presence of Ca++ ions clearly showed a biphasic precipitin arc, and in the absence of Ca++ ions, only one precipitin arc was observed. These results implied the presence of precursor proteins PIVKA-II and -IX in the plasma. However, even in the presence of Ca++ ions the CIE pattern of factor X antigen in the patient plasmas only showed a single precipitin arc with a slightly faster than normal electrophoretic mobility. PIVKA-II, -IX, and the abnormal factor X antigen (PIVKA-X) disappeared within 24 h after the patients were treated with vitamin K.

Ophthalmologic changes related to radiation exposure and age in adult health study sample, Hiroshima and Nagasaki

A 2-year ophthalmologic study of age and radiation-related ophthalmologic lesions among the atomic bomb survivors in Hiroshima and Nagasaki was conducted in 1978-80. The study sample in both cities was composed of all persons exposed to 100+ rad, their controls, and all other persons with a previous record of axial opacities or posterior subcapsular changes. Most of the losses were due to persons who refused to participate or for whom it was not possible to arrange for an ophthalmologic examination at the time of the regularly scheduled medical examination. It should be emphasized, however, that the loss of persons in both the control and the 100+ rad groups did not change systematically with increasing age by city. Increased lenticular opacities, other lens changes, and loss of visual acuity and accommodation occurred with increasing age in both exposed and control subjects as manifestations of the normal aging process. A highly significant excess risk for all age categories in the 300+ rad group in comparison to those in the control group was observed for both axial opacities and posterior subcapsular changes in Hiroshima, but not in Nagasaki. A stronger radiosensitive aging effect for persons who were under 15 years old at the time of the bombing (ATB) was observed for both axial opacities and posterior subcapsular changes in Hiroshima.

[Esophageal cancer in chronic lymphocytic leukemia--a case report]

A 58-year-old male was admitted because of severe dysphagia. Radiographic and endoscopic examination revealed squamous cell carcinoma of the esophagus. Physical examination revealed severe splenomegaly and swelling of the cervical and axillary lymph nodes. Laboratory data showed lymphocytosis (more than 90%), severe anemia and monoclonal hyperglobulinemia (IgA type). The patient received irradiation (60 Gy) to the esophageal lesion using Linac X-ray and 40 Gy to the left cervical and axillary region with a tele Co60. Radiotherapy showed a remarkable effect not only on the esophageal cancer but also the chronic lymphocytic leukemia.

Congenital deficiency of alpha 2-plasmin inhibitor in three sisters

3 young Japanese sisters with congenital alpha 2-plasmin inhibitor (alpha 2-PI) deficiency are reported. They have mild umbilical bleeding and/or repeated prolonged bleeding after minor trauma, but rarely spontaneous bleedings. The most characteristic hemostatic findings were shortened whole blood clot lysis time and euglobulin lysis time. Activities of all hemostatic factors except alpha 2-PI were within normal range. Both functional and immunological absence of alpha 2-PI were found in the plasma, and this failure to detect alpha 2-PI was not corrected by the addition of the patient's plasma of the first described case of alpha 2-PI deficiency. Clinical and laboratory data revealed that these patients were probably homozygous for alpha 2-PI deficiency and born of heterozygous parents, but not of consanguineous ones. Bleeding episodes due to deficiency of alpha 2-PI in these patients were well controlled by an antifibrinolytic agent, tranexamic acid.

The repair process in experimentally induced avascular necrosis of the femoral head in dogs

Total necrosis of the femoral head was experimentally produced in dogs by freezing. The healing process was observed in a time sequence. There was a dense fibrous layer at the boundary between the necrotic bone mass and living bone tissue, in each dog which survived for 18 months after the surgery. The layers were similar to that commonly found in avascular necrosis of the femoral head in humans. Histological observation revealed that the establishment of the dense fibrous layer was the final result of three time dependent changes in biological potencies of granulation tissue, i.e., decreasing proliferating and differentiating potencies and increasing osteoclastic potency of mesenchymal cells within the granulation tissue.

Simulation of the initial stage of endochondral ossification: in vitro sequential culture of growth cartilage cells and bone marrow cells

Growth cartilage cells were isolated from the ribs of young rats and cultured at high cell density in Ham's F-12 medium supplemented with 10% fetal calf serum. During 7 days, glycosaminoglycans and proteoglycans were actively synthesized and secreted, forming a metachromatic matrix. When cultured together with growth cartilage cells precultured and biosynthetically prelabeled with 35SO4(2-) in their glycosaminoglycans, bone marrow cells caused release of 35S-labeled material into the culture medium. Glycosaminoglycan was also released by addition of conditioned medium obtained from cultures of bone marrow cells or peritoneal macrophages to the growth cartilage cell cultures. Electron microscopic studies of the extracellular matrix of growth cartilage cells cocultured with bone marrow cells showed that needles of apatite mineral were deposited within and in close apposition to the surfaces of matrix vesicles. These findings suggest that enzymes released from bone marrow cells or macrophages removed glycosaminoglycan or proteoglycans, which may be inhibitors of mineral growth, and consequently mineralization was initiated. From these findings, sequential culture of growth cartilage cells and bone marrow cells is promising as an experimental system for investigating the mechanism of the initial stage of endochondral ossification.

Patterns of factor-VIII related antigen on crossed immunoelectrophoresis and large pore polyacrylamide gel-crossed immunoelectrophoresis in von Willebrand's disease

Plasma samples from patients with various types of von Willebrand's disease were subdivided into six patterns according to the electrophoretic mobility and shape of VIIIR: Ag on crossed immunoelectrophoresis (CIE): pattern 1 no precipitation are, pattern 2 normal mobility with low arc, arc, pattern 3 intermediate mobility with low arc, pattern 4 faster anodal mobility with low arc, pattern 5 normal mobility with normal are height, pattern 6 faster anodal mobility with normal are height. Of 62 patients, 14 had pattern 1, 6 pattern 2, 16 pattern 3, 12 pattern 4, 9 pattern 5, and 5 pattern 6. Large pore polyacrylamide-agarose gel-crossed immunoelectrophoresis (PAAG-CIE) of crude factor VIII fraction from cryoprecipitate revealed no arcs in patients with pattern 1, three arcs of reduced height in the patients with patterns 2 and 3, four arcs very similar to normal control in patients with pattern 5, and two arcs with fast anodal migration in the patients with patterns 4 and 6. Crude factor VIII fractions from normal cryosupernatant showed one low fast anodally migrating arc corresponding to the fourth arc of normal cryoprecipitate. No peak was seen in patients with pattern 1, and one low fast anodal arc similar to normal control was present in the patients with patterns 2, 3, 4, 5 and 6.