[A case of pulmonary Nocardia farcinica infection in a patient with non-tuberculous mycobacteriosis]

A 64 years old woman without systemic immunological disorders was admitted to our hospital because of a productive cough, low grade fever and bloody sputum. Chest X-ray revealed multiple nodules with calcification, infiltrates and bronchiectasis. Laboratory findings showed mild hypoproteinemia and elevated sedimentation rate. Both Nocardia farcinica and Mycobacterium intracellulare were isolated from the bronchial lavage fluid. Administration of sulfamethoxazole-trimethoprim improved her symptoms. In a recurrent study of bronchial lavage N. farcinica was not isolated, but M. intracellurale was still isolated. We believe that N. farcinica may cause infectious exacerbation of chronic lung disease: non-tuberculous mycobacteriosis and bronchiectasis.

Essential involvement of 12-lipoxygenase in regiospecific andstereospecific oxidation of low density lipoprotein by macrophages

To establish a role of the 12-lipoxygenase on the generation of oxidized low density lipoprotein (LDL) in macrophages that leads to foam cell formation in atherosclerosis, we overexpressed 12-lipoxygenases in a macrophage-like cell line, J774A.1, that does not show intrinsic enzyme activity. When the 12-lipoxygenase-expressing cells were incubated with 400 microg.mL-1 LDL in Dulbecco's modified Eagle's medium at 37 degrees C for 12 h, LDL oxidation, as determined by thiobarbituric acid reactive substance, was markedly increased compared with the mock-transfected cells. Oxygenated products in the modified LDL were examined by HPLC before and after alkaline hydrolysis. Most of the oxygenated derivatives were of an esterified form, and the major product was identified as 13S-hydroxyoctadeca-9Z,11E-dienoic acid. These results clearly demonstrate that esterified fatty acids in LDL are oxygenated by the 12-lipoxygenases expressed in the J774A.1 cells. Furthermore, the oxidized LDL generated by intracellular 12-lipoxygenases was recognized by a scavenger receptor as assessed by macrophage degradation assay.

Growth stimulation and induction of epidermal growth factor receptor by overexpression of cyclooxygenases 1 and 2 in human colon carcinoma cells

There are two isoforms of cyclooxygenase (COX), COX-1 and COX-2. Recent epidemiological and experimental studies indicated a close relationship between COXs and the pathogenesis of colorectal cancer. The purpose of this study was to investigate the possible roles of both isoforms in the proliferation of colon carcinoma cells. A human colon carcinoma cell line, COLO 320DM, was transfected with an eukaryotic expression vector carrying cDNA of either COX-1 or COX-2, the expression of which was driven by a powerful elongation factor-1alpha promoter in pEF-BOS. Both COX-1- and COX-2-expressing cells possessed a similar enzyme activity, 8-10 nmol/10 min per mg protein. Growth rates of both cell lines were stimulated by about 2-fold during a course of culture for 7 days as compared with mock-transfected cells. Although COX-1 and COX-2 are believed to have fundamentally different biological roles, essentially no differences in growth stimulation were observed between the COX-1 and COX-2 overexpressions in our experiments. The reason may be explained by high levels of COX expression, and subtle differences between the both cell lines would be possibly apparent by lower expression levels. The stimulated growth of the COX-transfected cells was accompanied by increased DNA synthesis as assessed by [3H]thymidine incorporation. Furthermore, expression of epidermal growth factor receptor was markedly increased in these cells as examined by reverse transcription-polymerase chain reaction. A COX inhibitor, indomethacin, suppressed the stimulated growth, increased DNA synthesis and induction of epidermal growth factor receptor in COX-1- and COX-2-transfected cells.

Changes in distortion product otoacoustic emissions from ears with Menière's disease

To investigate changes in distortion product otoacoustic emissions (DPOAEs) associated with hearing improvement in ears with Menière's disease, four parameters were studied. These were: DPOAE amplitudes for a moderate (L1/L2 = 65/55 dBSPL) and a high (L1/L2 = 74/64 dBSPL) primary level (65/55-DP and 74/64-DP amplitudes, respectively); maximum level of DPOAE amplitudes in the growth function (maximum DP level); and DPOAE detection threshold (DP threshold) of the growth function. Significant correlations were found between all four parameters and hearing threshold, except for the 65/55-DP amplitude at 1 kHz, and each parameter appeared to reflect the hearing threshold to some extent. However, the changes in the four parameters associated with hearing improvement were somewhat complicated. Changes could not be evaluated due to lack of detection of responses when the hearing thresholds exceeded 50 dBHL. Findings that parameters became detectable, the DP amplitude or the maximum DP level increased significantly, or the DP threshold lowered significantly were classified as "improved" findings. The number of ears with "improved" findings was larger for the maximum DP level or the DP threshold than for the 65/55-DP and 74/64-DP amplitudes in ears with a 10 dB or greater improvement in hearing threshold at the corresponding F2 frequency. Furthermore, a significant decrease in amplitude was found in some ears, although the hearing threshold was not elevated when the 65/55- or 74/64-DP amplitude was used as a parameter. On the other hand, "improved" findings for the maximum DP level or the DP threshold were observed for a relatively large number of ears without a significant change in hearing threshold, and it was thought that small changes in cochlear function which did not lead to changes in hearing threshold were detected by changes in DPOAEs. These findings suggest that parameters determined from the growth function, such as maximum DP level and DP threshold are better indicators for monitoring cochlear function than is DPOAE amplitude for a single primary level, and demonstrate the usefulness of the growth function measurement for monitoring purposes. Furthermore, evaluation by changes in the overall growth function using combined parameters appeared to increase sensitivity in detection of subtle changes in cochlear function. In conclusion, DPOAE measurement can be a useful examination for clinical monitoring of cochlear function in Menière's disease when the growth function is measured.

Sound lateralization and speech discrimination in patients with sensorineural hearing loss

Sound lateralization and speech discrimination abilities are both closely related to central auditory system function. In this study, we investigated the relationship between sound lateralization and speech discrimination in patients with sensorineural hearing loss (SNHL) of unknown aetiology or presbycusis. Interaural intensity difference (IID) and interaural time difference (ITD) discriminations were measured using a self-recording apparatus for dichotic sound presentation, and the means of bilateral maximum scores in speech discrimination tests were calculated. Subjects with normal sound lateralization had good speech discrimination scores above 70%, while those with abnormal sound lateralization had poor scores below 70%. Some patients, however, had good speech discrimination but abnormal sound lateralization. These findings were obtained in both IID and ITD discrimination tests. Furthermore, some subjects could not discriminate ITD, although all could discriminate IID. These findings suggest that sound lateralization ability may be affected more than speech discrimination in SNHL of unknown aetiology or in presbycusis.

Monitoring of response to radiotherapy with fluorine-18 deoxyglucose PET of head and neck squamous cell carcinomas

We examined the usefulness of positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG) in determining the therapeutic effects of irradiation and chemotherapy on head and neck malignant tumors. Twenty-two patients with head and neck lesions who underwent histological examinations were studied. Squamous cell carcinoma was histologically diagnosed in all cases. Sixteen of them underwent radiotherapy with approximately 40 Gy in combination with carboplatin therapy. The remaining 6 patients underwent radiotherapy alone. After these treatments, 11 underwent surgery. For PET study, each patient was injected with intravenous FDG 185-370 MBq. We evaluated the degree of FDG accumulation using scanned images taken 40-55 min after the injection. We measured the standardized uptake value (SUV), a semiquantative evaluation, ROI activity divided by the dosage per weight of each patient. FDG-PET, CT and MRI were performed twice for each patient, before and after treatment. FDG uptake, but not the tumor size in CT or MRI, was significantly reduced in each patient after the treatment. Therefore, our findings have clearly demonstrated that FDG-PET provides for more valuable therapeutic outcomes than conventional imaging such as CT and MRI. FDG-PET should thus provide a new dimension in the management of head and neck malignant tumors.

Anisakidosis: a cause of intestinal obstruction from eating sushi

We report a case of strangulating small bowel obstruction in a 60-yr-old Japanese woman caused by anisakidosis (previously known as anisakiasis). With the increasing popularity of Japanese cuisine such as sushi in the United States, the incidence of anisakidosis is expected to increase. Intestinal anisakidosis can now be treated temporarily, but this condition may cause a serious obstruction afterwards, as evidenced by this particular case. Over 13,500 cases were reviewed in both the Japanese and English literature, and we discuss the prevention of anisakidosis without negatively altering the taste of the raw fish.

Patterns of change in growth function of distortion product otoacoustic emissions in Menière's disease

The patterns of change in the growth function of distortion product otoacoustic emissions (DPOAEs) associated with hearing improvement in six patients with Menière's disease were investigated. The growth functions of 2F1-F2 DPOAEs at F2 frequencies of 1001, 2002 and 4004 Hz (DP-1, DP-2 and DP-4, respectively) were measured with F2 intensities ranging from 70 to 37 dBSPL in 3-dB steps. The F1 intensity was maintained 10 dB higher than the F2 intensity. The growth function was paired with the hearing threshold at the corresponding F2 frequency, and the relationships between changes in DP-1, DP-2 and DP-4 and those in hearing thresholds at 1, 2 and 4 kHz, respectively, were also investigated. The patterns of change in the growth function associated with hearing improvement could be classified into five types. In the first type, the DPOAE growth function became detectable, while the remaining four types were distinguished by combinations of changes in DPOAE amplitudes for lower and higher primary intensities. Multiple parameters, such as maximum amplitude and detection threshold of the growth function, appeared to be required for simple detection and discrimination of these patterns of change. It was also found that the DPOAE growth functions clearly changed in some cases even though the hearing thresholds did not change significantly at the corresponding F2 frequencies. This finding suggests that DPOAE growth function measurement can detect small changes in cochlear function which do not lead to changes in hearing threshold, and has higher sensitivity than pure tone audiometry in monitoring of cochlear function. In conclusion, our findings suggest that measurement of the DPOAE growth function is useful for monitoring cochlear function, and that information on its patterns of change is clinically important and useful.

Temporal bone pathology of a patient with cochlear implant

A 66-year-old man with profound total deafness received a 22-channel cochlear implant. After surgery, his hearing improved and the postoperative course was uneventful except transient vertigo. The patient died of lung cancer after 2.5 years. Twelve hours after death, the temporal bone was harvested for histological and electron microscopic examination. The mastoid air cells were preserved, although a few mucosal folds were present. The Dacron mesh tie had largely been absorbed, but part remained embedded in fibrous tissue. No inflammation was noted in the tympanic cavity or the round window through which the electrodes were inserted. In the cochlea, the scala tympani was filled with fibrous tissue at the site of electrode insertion. The scala media had collapsed, while the organ of Corti and stria vascularis showed degeneration. Osseous spiral bundles and spiral ganglion cells were noted, though reduced in number.

Familial limb-girdle myasthenia with tubular aggregates

Two sisters developed slowly progressive limb-girdle weakness in their childhood. The weakness responded to acetylcholinesterase inhibitors. Repetitive nerve stimulation showed decremental responses and single-fiber electromyography demonstrated increased jitter and blocking. Needle electromyography revealed myopathic changes. Antiacetylcholine receptor antibodies were negative. Histologic examinations demonstrated myopathy with tubular aggregates in the muscle fibers while the neuromuscular junctions appeared normal. They were diagnosed with familial limb-girdle myasthenia. This is the first report of this syndrome with morphologic studies of neuromuscular junctions.

Postnatal development of the internal auditory canal studied by computer-aided three-dimensional reconstruction and measurement

Postnatal development of the internal auditory canal (IAC) was investigated in 20 normal human temporal bones obtained from individuals 1 month to 72 years old. Computer-aided three-dimensional reconstruction and measurement of bones showed that the superior, inferior, anterior, and posterior walls of the IAC lengthen significantly from birth until about 10 years of age, with development mainly attributable to lengthening of the part of the IAC medial to the foramen singulare. The lengths of the part of the IAC lateral to the foramen singulare and of the transverse crest and Bill's bar did not appear to develop postnatally. The IAC diameter increased slightly at the porus for about the first year after birth, but not at the fundus or the middle portion of the canal. This finding was confirmed by studying the shape of the IAC. Postnatal increases in the volume of the IAC followed patterns similar to that of increases in length of studying the shape of the IAC. Postnatal increases in the volume of the IAC followed patterns similar to that of increases in length of the IAC walls. These results show that postnatally the IAC increases significantly in length until about 10 years of age and slightly in diameter until about 1 year of age, especially medial to the foramen singulare. This concentration of growth of the IAC medially implies that its postnatal development is mainly due to growth of the bone around the otic capsule, which has implications for IAC surgery.

[The bactericidal effects of an amphoteric surfactant with ethanol against Mycobacterium tuberculosis]

Bactericidal activities of an amphoteric surfactant (12 w/v% Alkyl diaminoethylglycine hydrochloride, 3 w/v% Alkyl dietylenetriaminoglycole hydrochloride, Nissan Anon #300, Inui Shouji Co., ADG) against Mycobacterium tuberculosis were examined independently or in cooperation with ethanol. The results obtained in the study are as follows: 1. In the treatment with the surfactant diluted with distilled water in one hundredth, the numbers of tubercle bacilli which survived were 500 cfu/0.1 ml after one minute-treatment, and 25 cfu/0.1 ml after ten minutes-treatment. On the other hand, the surfactant containing 23 v/v% ethanol decreased the bacterial numbers to seven cfu/0.1 ml after one minute and less than one cfu/0.1 ml after ten minutes. The numbers of the survived bacilli treated with the surfactant containing 20 v/v% ethanol were 500 cfu/0.1 ml after one minute-treatment, and less than one cfu/0.1 ml after ten minutes though 20 v/v% ethanol alone was ineffective in ten minutes-treatment. 2. The bactericidal activities of the surfactant against tubercle bacilli in sputum samples in which 1.65 x 10(4) cfu/0.1 ml of the organism were contained were also investigated. The numbers of tubercle bacilli which survived were 25 cfu/0.1 ml after one minute-treatment with the surfactant in one fiftieth, two cfu/0.1 ml after five minutes-treatment and one cfu/0.1 ml after ten minutes-treatment. The numbers of the organism treated with the surfactant containing 23 v/v% ethanol were less than one cfu/0.1 ml after five minutes. 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency analysis of evoked otoacoustic emissions in Meniére's disease

Our study was designed to establish a diagnostic significance in Meniére's disease by means of evoked otoacoustic emissions (EOAEs). EOAEs were recorded from patients with Meniére, and the "main frequency" of the emissions, which shows the maximum peak in the frequency spectrum, was examined as a variable. The main frequencies in ears with Meniére ranged mainly from 0.8 kHz to 1.1 kHz and were to be found at lower frequencies than in ears with normal hearing whose range was mainly from 1.0 kHz to 1.6 kHz. Furthermore, in some ears with Meniére, the main frequencies changed from lower to higher after administration of osmotic diuretics such as glycerol or isosorbide. On the basis of these results it was speculated that in ears with Meniére, lower frequency dominant emissions might be elicited by modification of the basilar membrane in endolymphatic hydrops and that the main frequencies might change from lower to higher with reduction of endolymphatic hydrops induced by osmotic diuretics. It was considered that the EOAE testing might be useful for a diagnosis of endolymphatic hydrops in Meniére.

Evoked otoacoustic emissions from ears with idiopathic sudden deafness

Evoked otoacoustic emissions (EOEs) were examined in ears with idiopathic sudden deafness (ISD) at an early stage after onset and were compared with those in ears with long-standing sensorineural hearing losses of unknown etiology (SHLUE). In ears with SHLUE, EOEs were not recordable from ears with a hearing loss exceeding 35 dB at minimum hearing level of 4 audiometric frequencies: 500, 1,000, 2,000 and 4,000 Hz (4 MHL). On the other hand, although 4 MHLs were greater than 35 dB in most of the ears, EOEs could be detected in about one-half of the ears with ISD, and, moreover, the majority of these EOE detectable ears showed a good hearing prognosis in spite of the degree of hearing loss. There was, however, no correlation between EOE threshold and degree of hearing recovery. From these results it seems that EOE testing might be clinically applicable for predicting whether or not hearing loss due to ISD can be recovered.

Frequency analysis of evoked otoacoustic emissions

Evoked otoacoustic emissions (EOEs) were examined in 8 normal hearing ears without spontaneous otoacoustic emissions (SOEs), and the frequency of the first 10 ms after appearance of the EOE response wave was analyzed, dividing it into the first 5 ms half (First half A) and the last 5 ms half (Last half B). In the First half A, the peak frequency of the power spectrum tended to match the stimulus frequency, but in the Last half B, the peak frequency tended to be constant and moreover, it tended to match the frequency at which EOE can best be recorded. These findings suggest that each ear has its own characteristic EOE frequency.

A case of unexpected gallium-67 uptake by sternum in non-Hodgkin's lymphoma with pleuritis

A case of non-Hodgkin's lymphoma with pleural effusion was presented. Pleural effusion is not a common manifestation of this disease and 67Ga-citrate scintigraphy gave the clue for the diagnosis. The possibility of malignant lymphoma should be considered in cases with pleural effusion, and we showed that 67Ga-citrate scintigraphy can be useful in a case with pleural effusion of undetermined cause.

[Clinical comparison of 99mTc-diethylenetriaminepentaacetic acid-human serum albumin (99mTc-HSA-D) and 99mTc-human serum albumin (99mTc-HSA) for cardiac blood pool imaging]

99mTc-HSA-D has been developed as a new blood pool scanning agent. Clinical comparison of 99mTc-HSA-D and 99mTc-HSA was made in 16 cases. The activity concentration of 99mTc in blood was measured during 2 hours after the injection in five cases. 99mTc-HSA-D showed higher concentration compared to 99mTc-HSA with the passage of time. Quantitative analysis of contrast between left ventricle and septum was performed on end diastolic frames of gated images 10 minutes after the injection. There was no obvious difference between 99mTc-HSA-D and 99mTc-HSA. The subjective comparison of detectability of lesions between the two agents was performed on three directional gated images. 99mTc-HSA-D was superior to 99mTc-HSA, because the images of the latter deteriorated with the passage of time. On anterior view images 1 hour after the injection, left ventricle/lung and abdominal aorta/background count ratios were greater for 99mTc-HSA-D in many cases. There was no obvious difference in liver/background and kidney/background count ratios between the two agents. Urinary excretion of 99mTc was considerably lesser for 99mTc-HSA-D. The results indicated that 99mTc-HSA-D was superior to 99mTc-HSA for cardiac blood pool imaging.

Guinea pig complement fixation by tissues from hypocomplementaemic renal diseases

Recently many studies have been done to identify complement pathway activation in renal tissue from patients with renal disease. We examined whether tissues obtained by renal biopsy from such patients would fix guinea pig complement. Nine out of 15 patients with systemic lupus erythematosus (SLE), 4 out of 7 patients with mesangiocapillary glomerulonephritis (MCGN), and 2 out of 7 cases with acute glomerulonephritis (AGN) fixed guinea pig C3. We found that tissues from 5 out of 9 guinea pig C3-positive SLE cases fixed guinea pig C4, while none of the guinea pig C3-positive tissues from patients with MCGN or AGN fixed guinea pig C4. These guinea pig C3-positive renal tissues were further studied for interaction with C4-deficient guinea pig serum, EDTA guinea pig serum, heated guinea pig serum, and EGTA Mg2+ guinea pig serum. The results indicated that activation of both the alternate and classical complement pathways occurred with tissues from patients with SLE, while activation of the alternate pathway occurred with MCGN and AGN. Results for tissues from AGN and MCGN patients indicated the presence of C3 convertase and protease which interacted with guinea pig C3.