[Clinical study of Pseudomonas aeruginosa isolated from the urine of patients with urinary tract infections]

We studied the characteristics of Pseudomonas aeruginosa isolated from the urine specimens of the patients with urinary tract infections (UTI), in the urological unit at Kitasato University Hospital, between April, 1989 and March, 1990. Pseudomonas aeruginosa was detected in 8.0% of the total urine specimens (1.1% from outpatients, 6.9% from inpatients). Serotype of Pseudomonas aeruginosa was F (33%), G (17%), M (14%) and others (36%). In sensitivity tests, imipenem (IPM) had the lowest MIC among 8 antimicrobial agents tested, which were imipenem, piperacillin, cefsulodin, ceftazidime, aztreonam, gentamicin, amikacin, and ofloxacin with 5.0%, 82.0%, 74.0%, 69.0%, 92.0%, 67.0%, 79.0% and 82.0% resistant strains, respectively. Bladder cancer was the most common underlying disease in the urological patients with Pseudomonas infection. Pseudomonas aeruginosa infection is still an annoying problem in UTI among compromised patients suffering from advanced urinary tract malignancies.

Endothelin-1- and endothelin-3-induced vasorelaxation via common generation of endothelium-derived nitric oxide

The vasorelaxant effects by endothelin-1 (ET-1) and endothelin-3 (ET-3), and their mechanisms of action were studied in isolated porcine pulmonary arterial strips. ET-1 and ET-3 dose-dependently (10(-9) - 10(-8) M) relaxed vascular strips precontracted with norepinephrine only in the presence of endothelium. The maximal vasorelaxant effect by ET-1 was about 70% of that by ET-3. The ET-1- and ET-3- induced vasorelaxation was blocked by NG-nitro-L-arginine, an inhibitor of nitric oxide synthesis, and methylene blue, an inhibitor of soluble guanylate cyclase. The present data suggest that vascular smooth muscle relaxation induced by ET-1 and ET-3 is mainly ascribed to synthesis and release of nitric oxide from L-arginine in endothelium.

Duplication mitosis in carcinoma

As proposed in 'Duplication mitosis in epithelio-glandular tissue' (1), histological continuity is dependent on duplication mitosis. Organoid continuity of carcinomas is also likely to be dependent on duplication mitosis. Cancerous duplication may be due to deterioration of the maturation capacity of carcinoma cells and caused by a cellular abnormality that rejects the effect of the maturation factor. The fundamental therapeutic approach to carcinoma should be altered from one of cell destruction to one of inducing cell-phase maturation.

Changes of circulating atrial natriuretic peptide and antidiuretic hormone in obstructive sleep apnea syndrome

Patients with obstructive sleep apnea (OSA) syndrome are known to exhibit nocturnal natriuresis/diuresis. We studied plasma and urinary levels of atrial natriuretic peptide (ANP), a potent natriuretic hormone released from the heart, and plasma antidiuretic hormone (ADH) levels in patients with OSA during awake and sleeping periods, to compare with those of normal subjects. Seven patients with OSA and 6 normal subjects were studied. Arterial blood samples were drawn during the awake and the sleeping period, while in patients with OSA, blood samples were obtained during the apneic period. Urine samples were collected over two 12-hour periods (9 a.m.-9 p.m. and 9 p.m.-9 a.m.) In patients with OSA, plasma ANP as well as urinary ANP excretion increased during the apneic period compared with the awake period. There was a significant negative correlation between plasma levels of ANP and ADH in patients with OSA. On the other hand, normal subjects had no apparent differences in plasma and urinary ANP levels between the two periods. It is suggested that nocturnal increase in ANP and decrease in ADH are responsible for the nocturnal diuresis and natriuresis associated with OSA.

Brain catecholamine concentrations in hyperosmolar diabetic and diabetic rats

The concentration of brain catecholamines were measured and compared in the experimentally made hyperosmolar diabetic, diabetic and normal control rats in order to clarify the metabolic changes of the brain in these states. Diabetes was induced with streptozotocin and hyperosmolarity was achieved through deprivation of water for 50 hours prior to experimentation. Dopamine, norepinephrine and epinephrine concentrations were measured in the left cerebral cortex, hypothalamic-thalamic area, cerebellum and medulla oblongata. Dopamine and norepinephrine concentrations were significantly elevated in the cerebral cortex, hypothalamic-thalamic area and cerebellum of the dehydrated hyperosmolar-diabetic rats relative to those of normal controls (p < 0.01-0.05). In diabetes with high blood sugar level, the norepinephrine concentration was significantly elevated in the cerebral cortex, cerebellum and medulla oblongata, and these changes generally paralleled the increase in fasting blood glucose. It was concluded that hyperosmolarity due to dehydration contributed these changes. The findings of this study further suggest that changes in brain catecholamines may be involved in the nervous system disturbances that occur in the dehydrated hyperosmolar-diabetes and severe diabetes.

An investigation of Japanese subjects maps susceptibility to type 1 (insulin-dependent) diabetes mellitus close to the DQA1 gene

Insulin-dependent diabetic and control subjects of Japanese origin were HLA-DRB1, -DQB1, and -DQA1 typed using restriction fragment length polymorphism analysis and sequence-specific oligonucleotide gene probing. The DQA1 allele DQA1*0301 was positively associated with the disease [48/52 (92%) diabetic patients versus 44/64 (69%) control subjects, Pc less than 0.03, RR = 4.97]. Alleles of the DRB1 and DQB1 genes showed no significant association with the disease. The frequency of DQB1 genotypes encoding the amino acid aspartic acid at position 57 of the DQ beta chain did not differ significantly between subjects with insulin-dependent diabetes mellitus (IDDM) and controls. These findings suggest that a susceptibility allele for IDDM in the Japanese is more closely associated with the DQA1 gene than the DQB1 gene.

Duplication mitosis in epithelio-glandular tissue

As duplication mitosis occurs in epithelio-glandular tissue, a different concept of histological continuity and organization of this tissue is needed. In epithelio-glandular tissue, duplication mitosis play a role in histological continuity, while maturation mitosis leads to histological organization. Duplication mitosis reproduces stem cells for the cell turnover process. The life-span of the cell copies is limited to a certain period by maturation mitosis. Conservation of duplication mitosis and its alteration to maturation mitosis are regulated by a histological mechanism in the gland crypt, involving duplication and maturation factors. The result is that epithelio-glandular tissue is maintained within a prescribed physiological volume without excessive multiplication.

Incidence of attic retraction after staged intact canal wall tympanoplasty for middle ear cholesteatoma

Incidence of retraction pocket and recurrent cholesteatoma in the attic after surgery for middle ear cholesteatoma using the staged intact canal wall technique were investigated in 95 ears of 91 patients, all of which had various degrees of bone defect in the tympanic scutum. Surgical procedures employed in the second stage for prevention of attic retraction were classified into three types: Type I, no scutumplasty; Type II, scutumplasty; Type III, scutumplasty plus mastoid obliteration. In 83 ears followed up for more than 1 year after the second stage, such retraction troubles occurred in 2 of 13 ears (15%) in Type I, 8 of 20 ears (40%) in Type II, and 24 of 50 ears (48%) in Type III. Incidence of retraction troubles was higher in Types II and III, probably because these procedures were indicated in ears with large scutum defects. Dislocation and atrophy of the graft materials, together with bone resorption around the bone defect were the main reasons for failure in scutumplasty. Dysfunction of the eustachian tube and traction of the eardrum by the scar tissue behind it may have also contributed to attic retraction. Mastoid obliteration with small blocks of hydroxyapatite was more effective in prevention of retraction troubles than that with pedicled temporalis muscle flap.

[Improvement of ischemic symptoms and cerebral blood flow after percutaneous transluminal angioplasty for renovascular hypertension. Report of a case with multiple cerebrovascular occlusive disease]

A 53-year-old male complained of frequent left motor-sensory transient ischemic attack for 4 months. On admission, he demonstrated mild right hemiparesis, dysarthria, and right hemisensory disturbance of all modalities. Cerebral angiography demonstrated complete occlusion of the left internal carotid artery just above the origin of the ophthalmic artery and a stenotic lesion at the horizontal segment of the right middle cerebral artery. Renal angiography showed severe stenosis of the right renal artery. Systolic blood pressure was over 200 mmHg and marked circadian variation of blood pressure was noted. Serum renin was 4.0 ng/ml/hr. Four months after superficial temporal artery-middle cerebral artery anastomosis, left carotid angiography showed good patency of the bypass and the ischemic symptoms completely disappeared. Single photon emission computed tomography (SPECT) showed increased cerebral blood flow (CBF), especially in the left hemisphere after surgery. Six months after the bypass surgery, he complained of mild right hemiparesis again. Shortly after percutaneous transluminal angioplasty (PTA) for renal arterial stenosis, his hemiparesis was improved and the systolic blood pressure stabilized to 150-170 mmHg. SPECT showed the CBF had also recovered in both hemispheres. The improvement in ischemic symptoms and increased CBF after PTA were probably related to stabilization of the systemic blood pressure or inhibition of serum renin-angiotensin.

Comparison of diagnostic criteria of IGT, borderline, and GDM. Blood glucose curve and IRI response

A 75-g oral glucose tolerance test (OGTT) was performed in 615 nonobese pregnant women (mean +/- SD age 29.7 +/- 4.3 yr) who were referred to the Division of Internal Medicine at our diabetes center because of glycosuria. Seventy-seven cases were found to have urinary glucose at the first trimester, 185 at the second trimester, and 353 at the third trimester. With their 75-g OGTT results, the diagnostic criteria of borderline (formulated by the Japan Diabetes Society), impaired glucose tolerance (IGT; defined by the World Health Organization [WHO]), and gestational diabetes mellitus (GDM; determined by the Japan Society of Obstetrics & Gynecology standards) were compared through blood glucose (BG) curves and immunoreactive insulin (IRI) responses. Borderline (fasting BG greater than or equal to 6.1 and less than 7.8 mM and 2-h BG greater than or equal to 6.7 and less than 11.1 mM) is neither diabetes nor normal. IGT is as referred to by the WHO. GDM exceeds two points of fasting BG greater than or equal to 5.6 mM, 1-h BG greater than or equal to 10.0 mM, or 2-h BG greater than or equal to 8.3 mM. Diabetes mellitus (DM) is as referred to by the Japan Diabetes Society (same as the WHO). The prevalence of abnormal glucose tolerance among all 615 pregnant women was 54.6% in borderline, 24.5% in IGT, 7.3% in GDM, and 3.4% in DM. The 2-h BG levels in IGT during the first trimester were higher than in borderline (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of a novel transcription unit in the human insulin-like growth factor-II gene

The human insulin-like growth factor-II (hIGF-II) gene has until now been thought to be composed of eight exons, including three independent leader exons. In the present study two additional exons, one leader exon and one alternatively used ordinate exon, have been newly identified. They were abundantly expressed in human histiocytoma tissue, generating mRNA species of about 5.0 kb in length. The new leader exon shows significant sequence similarity with the rE1 exon, previously reported to be transcribed only in the rat, and is mapped at nearly the same genomic location as in the rat. On the other hand, sequence similarity with another exon in the corresponding region of the rat genome was also found. It was, however, obvious that the rat sequence would not work as an active exon, since both splice acceptor and donor sites were deviated considerably from the consensus sequences. It has thus become apparent that the complex transcription unit of a single-copy hIGF-II gene comprises at least 10 exons, including four leader exons, one alternative exon and three common protein-coding exons.

Determination of rates and yields of interchromophore (folate----flavin) energy transfer and intermolecular (flavin----DNA) electron transfer in Escherichia coli photolyase by time-resolved fluorescence and absorption spectroscopy

Escherichia coli DNA photolyase, which photorepairs cyclobutane pyrimidine dimers, contains two chromophore cofactors, 1,5-dihydroflavin adenine dinucleotide (FADH2) and 5,10-methenyltetrahydrofolate (MTHF). Previous work has shown that MTHF is the primary photoreceptor which transfers energy to the FADH2 cofactor; the FADH2 singlet excited state then repairs the photodimer by electron transfer. In this study, we have determined the rate constants for these photophysical processes by time-resolved fluorescence and absorption spectroscopy. From time-resolved fluorescence, we find that energy transfer from MTHF to FADH2 and FADH degrees occurs at rates of 4.6 x 10(9) and 3.0 x 10(10) s-1, respectively, and electron transfer from FADH2 to a pyrimidine dimer occurs at a rate of 5.5 x 10(9) s-1. Using Förster theory for long-range energy transfer and assuming K2 = 2/3, the interchromophore distances were estimated to be 22 A in the case of the MTHF-FADH2 pair and 21 A for the MTHF-FADH degrees pair. Picosecond absorption spectroscopy identified an MTHF single state which decays to yield the first excited singlet state of FADH2. The lifetimes of MTHF and FADH2 singlets and the rates of interchromophore energy transfer, as well as the rate of electron transfer from FADH2 to DNA measured by time-resolved fluorescence, were in excellent agreement with the values obtained by picosecond laser flash photolysis. Similarly, fluorescence or absorption lifetime studies of the folate-depleted enzyme with and without photodimer suggest that FADH2, in its singlet excited state, transfers an electron to the dimer with 89% efficiency. The distance between FADH2 and the photodimer was calculated to be ca. 14 A.

[Postoperative changes in immunoreactive plasma endothelin concentrations]

We investigated postoperative changes in immunoreactive plasma endothelin (ET-1) concentrations using a highly specific and sensitive radioimmunoassay developed for this purpose. The patients were divided into two groups: 10 patients underwent subtotal-esophagectomy by combined right thoracotomy and celiotomy (EC-group), and an other 10 underwent total gastrectomy via celiotomy only (GC-group). Before operation, plasma ET concentrations in both groups were within the normal range. After operation, the mean plasma ET-1 concentration in the EC group was significantly higher than the preoperative concentration (p less than 0.01). But in the GC-group, there were no significant change. A significant correlation existed between the change in plasma ET-1 concentration and the amount of intraoperative hemorrhage (p less than 0.05). Additionally in the EC group, a significant correlation existed between plasma ET-1 concentrations after operation and the change in the atrial-natriuretic-peptide (ANP) concentration during operation (p less than 0.05). There was no correlation between ET-1 concentrations and blood pressure. We believe that the increase in the ET-1 concentration was attributable to endothelial cell injury and may increase ANP secretion. We speculate that the plasma ET-1 concentration may be a reliable index of surgical stress.

cDNA clones of Japanese hepatitis C virus genomes derived from a single patient show sequence heterogeneity

Twelve cDNA clones of Japanese hepatitis C virus (HCV) have been isolated from liver tissue of a single non-A, non-B hepatitis patient. These clones represented the non-structural domains of HCV. The degree of substitution in the nucleotide sequences and deduced amino acid sequences between these clones was 9.5 and 7.7%, respectively. This high level of substitution suggested that repeated infections of different HCVs may have occurred in the patient.

Hemangioma of the temporalis muscle: case report and review of the literature

A 51 year-old man presented with a 10-year history of a painless, slowly growing mass (35 x 25 x 15 min) in the right temporal fossa. The T1-weighted image on magnetic resonance imaging demonstrated a partial, low-signal intensity lesion with high intensity in the lower part and significant enhancement with contrast medium. The tumor, which lay within the temporal muscle, was totally excised, and histological examination confirmed the lesion to be an intramuscular, cavernous type of hemangioma. The therapeutic options are described.

Effects of atrial natriuretic peptide on endothelin-induced vasoconstriction and intracellular calcium mobilization

Mechanisms for the antagonistic action of atrial natriuretic peptide (ANP) toward endothelin were studied. We examined the effects of ANP on endothelin-induced vasoconstriction in isolated perfused kidney and the elevation of intracellular free calcium concentration using Fura-2 in cultured rat vascular smooth muscle cells (VSMC). Endothelin produced an increase in renal vascular resistance in isolated perfused kidney (2 x 10(-10) mol/l, +109%; P less than 0.01). ANP completely abolished renal vasoconstriction induced by endothelin. Endothelin produced a biphasic elevation in intracellular calcium concentration in the VSMC. Ethyleneglycol-bis-(beta-amino-ethylether)-N,N,N',N'-tetr aac etic acid (EGTA; 3 mmol/l) or nicardipine (10(-8) mol/l) decreased the sustained elevation of intracellular calcium concentration by 10(-8) mol/l endothelin to the basal level (endothelin, +15% versus EGTA + endothelin, -1%; P less than 0.05; endothelin, +18% versus nicardipine + endothelin, +5%; P less than 0.01). Pretreatment with 10(-6) mol/l ANP suppressed neither the peak phase of intracellular calcium concentration elevation (endothelin, 10(-8) mol/l, +35% versus endothelin + ANP, +31%; not significant) nor the sustained phase of intracellular calcium concentration elevation (endothelin, 10(-8) mol/l, +21% versus endothelin + ANP, +16%; not significant). ANP markedly increased the production of cyclic 3',5'-guanosine monophosphate (cGMP) in the VSMC (ANP, 10(-6) mol/l, +1100%; P less than 0.01). However, endothelin did not influence cGMP production in the presence or absence of ANP. ANP may antagonize the vasoconstrictive action of endothelin through an effect on the steps subsequent to the mobilization of intracellular calcium in the pathway of vascular smooth muscle contraction.

[Successful treatment of a pretreated elderly case of small-cell lung carcinoma with continuous five-day intravenous infusion of cisplatin plus etoposide]

A 78-year-old man was admitted to our hospital with dyspnea in June 1988, and diagnosed as having small-cell lung carcinoma by cytological findings of pleural effusion. He was treated three times with CAV (cyclophosphamide, doxorubicin, vincristine) therapy and a partial response was achieved. In March 1989, he was again admitted complaining of right dull hypochondralgia accompanied by enlargement of primary tumor in the right lower lobe of the lung and metastases to mediastinal and intraabdominal lymph nodes. Because it was an aged and recurrent case, he was treated with continuous five-day infusion of etoposide, 30 mg/m2/day and CDDP, 18.5 mg/m2/day. After the second course, subjective symptoms clearly disappeared and swelling of mediastinal and intraabdominal lymph nodes was markedly reduced on computed tomography. No severe side effects except for moderate myelosuppression, alopecia and nausea were observed. This regimen appears useful in the treatment of small-cell lung carcinoma in elderly patients.

Plasma immunoreactive endothelin-1 concentration in human fetal blood: its relation to asphyxia

To elucidate the effects of birth stress on immunoreactive endothelin-1 (irET-1) concentrations in fetal blood, we determined irET-1 levels in cord plasma in different modes of delivery associated with or without complications such as asphyxia. The irET-1 concentrations in both the umbilical artery and vein were significantly higher than those found in maternal venous blood at delivery, although there was no significant difference between preterm and full-term infants. When plasma irET-1 concentrations of healthy infants born by vaginal delivery and by cesarean section without labor were compared, the former had significantly (p less than 0.05) higher levels than the latter (15.4 +/- 4.9 pg/mL versus 11.1 +/- 3.1 pg/mL). Furthermore, umbilical venous plasma obtained from vaginally delivered infants complicated by asphyxia showed significantly (p less than 0.001) higher irET-1 levels (28.2 +/- 9.4 pg/mL) than those of nonasphyxiated infants (14.2 +/- 4.5 pg/m). These data suggest that birth stress, especially asphyxia, may contribute to the increase in fetal circulating irET-1 levels.

Atrial natriuretic peptide inhibits the aldosterone response to metoclopramide in patients with glomerular disease and essential hypertension

1. We examined the effects of metoclopramide (MCP: 10 mg i.v.) on plasma atrial natriuretic peptide (ANP) and aldosterone concentrations (PAC) and the effect of ANP on MCP-induced PAC in four patients with primary glomerular diseases and seven patients with essential hypertension. 2. MCP injection caused no significant changes in plasma ANP. MCP produced a marked increase in PAC without a significant change in plasma renin activity. 3. The increase in PAC induced by MCP injection was markedly attenuated when preceded by the infusion of ANP (25 ng/kg per min). 4. These results suggest that the dopaminergic D2 mechanism is not involved in the regulation of ANP secretion and that ANP modulates the dopaminergic regulation of aldosterone secretion.

Familial aggregation of cancer from proband cases with childhood adrenal cortical carcinoma

Family pedigree of Li-Fraumeni syndrome was investigated from probands with childhood adrenocortical carcinoma in Japan. From 47 probands, 7 families had 3 or more cancer cases at ages less than 45 years within the first generation; one satisfied Li's original criteria, two were acceptable because of multiple primary cancer in the probands, and others showed an aggregation of cancers with onsets at early ages, though no sarcoma of mesenchymal origin was found. A significantly higher occurrence of cancer in the mothers of the probands, especially of the breast, was consistent with reports from the USA, and liver cancer, osteosarcoma and lung cancer among family members under the age of 45 also showed a higher frequency than in the general population. Similarities and differences between Japanese and Caucasian cases are discussed.