Sudden death from tourniquet shock

A fatal case of tourniquet shock is reported. The deceased, a 58-year-old tractor driver, died 12 h after his rescue from an overturned tractor. A 'roll-bar' on the tractor had pinned his left arm for approximately 24 h before his rescue. Histological observations revealed the typical findings of tourniquet shock.

Antisweet natural products. VIII. Structures of hodulosides VI--X from Hovenia dulcis Thunb. var. tomentella Makino

From the Fresh leaves of Hovenia dulcis Thunb. var. tomentella Makino, five five new dammarane glycosides named hodulosides VI-X (1-5) were isolated. Their structures were determined on the basis of chemical and spectral evidence. Hodulosides VII-X showed antisweet activities.

Characterization of pigmented granules in minocycline-induced cutaneous pigmentation: observations using fluorescence microscopy and high-performance liquid chromatography

We describe a technique to facilitate histopathological detection and quantitative measurement of trace amounts of tissue minocycline. In a patient with minocycline-induced hyperpigmentation, a series of biopsies were taken from the affected skin over a period of 54 months, and examined for tissue minocycline deposition. Frozen sections treated with 1 M MgCl2-ethanol yielded minocycline-specific yellowish fluorescence, the location of which corresponded to clumps of granular deposits in the dermis. A decrease in the number of fluorescent granules correlated with the clinical resolution of hyperpigmentation and a significant decrease in the tissue minocycline level. Our data also provide further support for the concept that the pigment granules contain insoluble complexes of minocycline chelated with iron. The fluorescence technique is simple, sensitive, and reproducible.

[Posterior sub-Tenon's injections of repository corticosteroids in uveitis patients with cystoid macular edema]

Repository corticosteroid was injected into the posterior sub-Tenon's space in 29 cases (39 eyes) of cystoid macular edema (CME) secondary to uveitis. They included 12 cases of Behçet's disease, 7 cases of Sarcoidosis, one case of tuberculous uveitis and 9 cases of etiology unknown uveitis. In some of the patients injections were repeated twice to seven times at intervals of more than 2 weeks. Twenty two of the 39 treated eyes (56.4%) showed visual improvement in at least two lines of visual acuity. Eleven eyes showed no improvement in vision. Most of them had already had bad visual acuity (0.2 or less) before the injections. Complications of the treatment included cataract in 6 eyes, glaucoma in one, and blepharoptosis in one. Injection of repository corticosteroids into the posterior sub-Tenon's space was effective in the treatment of CME secondary to uveitis. However, we have to beware of the complications of this treatment.

Early stage carcinoma of the gastric remnant in Japan

In recent years, the number of reported cases of early stage cancer of the remnant stomach has been on a gradual increase thanks to the improvement in diagnostic techniques and also to increasing dealings with cancer of the remnant stomach. In this study we reviewed 124 cases of early stage cancer of the remnant stomach which were reported in Japan by the end of 1990, including the 6 cases which we encountered ourselves, during the 11 years starting from 1980. Their average age was 57 years, with a range from 22 to 78 years. The male-to-female ratio was 2:7. There were 63 asymptomatic cases (61%). This fact suggests that periodical examinations are essential after the first operation on the stomach. Out of the 124 cases, 86 cases operated on for benign lesions (benign group) and the remaining 38 cases for malignant lesions (malignant group) for the first time. The average time between the first and the second surgery was 19.7 years in the benign group and 7.8 years in the malignant group. The initial surgery was performed mainly by Billroth II resection. The frequency of tumor development was higher in the nonsutured portion than in the anastomosed portion of the remnant stomach. Protuberant type lesions and differentiated carcinomas were prevalent according to the classification by gross type and histology, respectively. However, the anastomosed portion was most often involved in the subgroup of patients in whom lesions were detected more than 10 years after Billroth II resection for benign lesions.

Efficacy of emulsion containing Gd-DTPA and lipiodol in hepatic transcatheter arterial embolization

We evaluated the clinical efficacy of an embolizing emulsion produced by mixing lipiodol and Gd-DTPA, in transcatheter arterial chemoembolization (TAE). Subjects were 10 patients with hepatocellular carcinoma (HCC). The emulsion used was produced by mixing 3 ml of lipiodol and anticancer agents (mitomycin-C 10 mg and adriamycin 20 mg) dissolved in Gd-DTPA. This emulsion was infused into the proper hepatic artery. Subsequent embolization by Gelfoam was performed in eight patients. MRI and CT examinations were performed soon after TAE (1 or 2 days after) and two weeks afterwards. The position of lipiodol accumulation dipicted on CT at two weeks after TAE did not differ from the site of change in signal intensity induced by Gd-DTPA on MR images soon after TAE in any case. In almost all cases, the washout of Gd-DTPA occurred earlier than that of lipiodol. It might be suggested that Gd-DTPA, which is water-soluble, shows in vivo dynamics similar to anticancer agents rather than to lipiodol, which is oil-soluble. Since the normal tissues showed no definite signal changes, we could easily detect the site of tumors by using the emulsion containing Gd-DTPA even on MR studies immediately after TAE. In addition, the deposits of Gd-DTPA depicted on MR images created fewer artifacts than the lipiodol deposits on CT.

Analysis of the interleukin 6 receptor on normal human keratinocytes by digital imaging fluorescence microscopy

The interleukin 6 receptor (IL 6 receptor) on normal human keratinocytes was analyzed by digital imaging fluorescence microscopy (DIFM). Non-fixed keratinocytes were incubated with monoclonal anti-IL 6 receptor antibody (MT18). The fluorescence intensity was quantitatively determined by an interactive laser cytometer (ACAS 470). IL 6 receptor-positive cells showed high density staining with the specific antibody in the center of the elevated cell surface. Therefore, DIFM appears to be an effective method for study of the distribution of IL 6 receptors at the single living cell level.

Effect of NS-398, a new nonsteroidal anti-inflammatory agent, on gastric ulceration and acid secretion in rats

The ulcerogenic activity of NS-398 was compared with that of indomethacin and the effects of NS-398 on stress-induced ulceration, gastric acid secretion and gastric mucosal prostaglandin (PG) contents were investigated in rats. NS-398 in a single dose of up to 1,000 mg/kg, p.o. did not significantly cause gastric ulceration while other nonsteroidal anti-inflammatory drugs such as, loxoprofen, indomethacin, diclofenac and ibuprofen, produced distinct gastric lesions. In cases of stress-induced ulcerations, NS-398 at 30 mg/kg, p.o. had no significant influence while indomethacin markedly potentiated the ulceration in a dose dependent manner. In basal gastric secretion studies, both NS-398 and indomethacin decreased secretion volume and acidity. However, in the 2-deoxy-D-glucose-stimulated gastric acid secretion study, NS-398 had no significant influence on gastric secretions while indomethacin significantly potentiated the secretion. Both NS-398 and indomethacin to much the same extent significantly decreased prostaglandin E2 (PGE2) contents in inflammatory tissue. However, with respect to gastric mucosal PGE2 contents, NS-398 did not decrease PGE2 contents while indomethacin significantly decreased the contents. It would thus appear that the absence of ulcerogenic properties of NS-398 is due to a relative lack of activity in inhibiting gastric PG synthesis.

[Treatment of severe pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) and Candida krusei with granulocyte colony-stimulating factor (G-CSF): a case report]

A 24-year-old male with chronic renal failure on Continuous Ambulatory Peritoneal Dialysis (CAPD) complained of cough and dyspnea. Chest X-ray film showed a pneumonia shadow and MRSA and Candida krusei were detected in the sputum. Pneumonia improved with vancomycin and fluconazole. Treatment with methylprednisolone was needed for retinodialysis. After this treatment, pneumonia deteriorated. Pneumonia did not improve with vancomycin and anti-fungal agents. This severe pneumonia was improved with a combination therapy of vancomycin, miconazole and G-CSF. A combination therapy of antibiotics and G-CSF is considered to be effective for severe pneumonia.

Isolation of Aspergillus flavus MO-5 producing two types of intracellular alpha-D-xylosidases: purification and characterization of alpha-D-xylosidase I

One strain (MO-5) of fungi producing alpha-D-xylosidase was isolated from sake koji by a method using glucose oxidase. MO-5 was identified as an Aspergillus flavus strain, produced no aflatoxin (B1, B2, G1, and G2). Two different types of alpha-D-xylosidases were detected in the cell-free extract. One of the enzymes (alpha-D-xylosidase I) was purified to an electrophoretically pure state by successive chromatography on Q-Sepharose, Phenyl Superose, PL-SAX, and TSK-gel G3000SWXL. The purified enzyme hydrolyzed p-nitrophenyl alpha-D-xylopyranoside (alpha-p-NPX), methyl alpha-D-xylopyranoside, isoprimeverose [alpha-D-xylopyranosyl-(1-->6)-D- glucopyranose], and xyloglucan oligosaccharide. The activity of this enzyme was highly specific for alpha-D-xylosidic linkages. The apparent Km and Vmax of the enzyme for alpha-p-NPX and isoprimeverose were 1.32 mM and 4.4 mumol/min/mg protein, and 4.00 mM and 58.8 mumol/min/mg protein, respectively. This enzyme had an apparent molecular weight of 100,000 by SDS-polyacrylamide gel electrophoresis and 400,000 by gel filtration chromatography (TSK-gel G3000SWXL). The enzyme showed the highest activity at pH 4.5 and 45 degrees C, and was stable from pH 4.5 to 6.0 and at temperatures up to 45 degrees C. The activity was inhibited by SDS and Hg2+, and slightly by Cu2+ and Fe3+. This enzyme showed transfer action at high concentrations of isoprimeverose and transfer products were detected, and it had transxylosylation activity on maltose from isoprimeverose as a donor, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Transgenic Drosophila carrying mammalian cytochrome P-4501A1: an application to toxicology testing

Transgenic Drosophila which carry a canine cytochrome P-450 were established and evaluated for its value on toxicology testing. Dah1, a cDNA clone for the canine hepatic P-4501A1, was ligated between the promoter of Drosophila heat-shock protein gene and the terminator of actin 5C gene, and then microinjected into Drosophila embryos with a transposon P element. The injected DNA was stably integrated into chromosomal DNA in germ line cells. After heat-shock treatments, transgenic larvae produced mRNA and a detectable amount of protein that cross-reacted with antibodies against rat P-4501A1. The ability of transgenic flies to activate procarcinogens was monitored in the DNA repair test with the endpoint being preadult mortality of repair-defective mei-9a mei-41D5/Y males. Heat-shock treatments of larvae showed that the repair-defective males carrying the P-4501A1 transgene were killed by lower concentrations of 7,12-dimethylbenz[a]anthracene than their non-transgenic or non heat-shocked counterparts. Coadministration of alpha-naphthoflavone, one of the inhibitors of P-4501A subfamily, cancelled the enhanced mortality of transgenic males, supporting that 7,12-dimethylbenz[a]anthracene was metabolized to its genotoxic form by the expressed P-4501A1 enzyme. This study indicates a potential utility of transgenic Drosophila for screening mammalian promutagens and procarcinogens.

Purification and characterization of an intracellular alpha-D-xylosidase II from Aspergillus flavus MO-5

Alpha-D-Xylosidase II activity from Aspergillus flavus MO-5 was increased roughly 5- to 10-fold by use of xylose instead of methyl alpha-D-xylopyranoside (alpha-MX) as a carbon source. The enzyme was purified to an electrophoretically pure state by successive chromatography on Q-Sepharose, Phenyl Superose, PL-SAX, and TSK-gel G3000SWXL. The purified enzyme hydrolyzed isoprimeverose [alpha-D-xylopyranosyl-(1-->6)-D-glucopyranose] and p-nitrophenyl alpha-D-xylopyranoside (alpha-p-NPX), but not alpha-MX or xyloglucan oligosaccharide. The apparent Km and Vmax of the enzyme for alpha-p-NPX and isoprimeverose were 0.97 mM and 28.0 mumol/min/mg protein, and 47.62 mM and 2.0 mumol/min/mg protein, respectively. This enzyme had an apparent molecular weight of 67,000 by SDS-polyacrylamide gel electrophoresis and 180,000 by gel filtration chromatography (TSK-gel G3000SWXL). The enzyme showed the highest activity at pH 6.0 and 40 degrees C, and was stable in the pH range from 6.0 to 7.0 and at the temperatures up to 40 degrees C. The activity was inhibited by Cu2+, Zn2+, Hg2+, p-CMB, SDS, Fe3+, and N-ethylmaleimide. This enzyme had nothing in common with alpha-D-xylosidase I and four alpha-D-xylosidases reported already.

Normal tension glaucoma: the value of predictive tests

Fifty-four normal tension glaucoma cases were studied to determine the value of several clinical tests for predicting the progression of the disease. Outflow facility, intraocular pressure (IOP) increase after water drinking, and diurnal changes in IOP were studied. Progression was determined on the basis of changes in visual sensitivity as measured on the Octopus 201. A minimum of four examinations of the central 30 degrees were conducted over a 3- to 7-year period. Progression of visual field defects was seen in 38.5% of eyes that had demonstrated some degree of abnormality in at least one of three clinical tests, while only 10.7% of those eyes that appeared normal on the basis of these tests showed such progression. The difference was significant (p < 0.04). These results suggest that the three clinical tests may be of value in detecting normal tension glaucoma eyes at risk for progression of visual field defects.

Improved high-performance liquid chromatographic determination of biotinidase activity with biotinyl-6-aminoquinoline as substrate

An improved high-performance liquid chromatographic assay method for biotinidase activity was developed using the fluorimetric substrate biotinyl-6-aminoquinoline, which was found to be more specific than the biotinyl-4-aminobenzoate previously used. The new method measures the intensity of the fluorescent signal at wavelengths (excitation 350 nm; emission 550 nm) longer than those (excitation 276 nm; emission 340 nm) for 4-aminobenzoate. The analysis of fluorescence in the visible spectrum reduced considerably the number of interfering peaks compared with analysis in the ultraviolet region. This method also made it possible to measure the biotinidase activity directly in samples usually difficult to calculate, such as human and bovine milk or porcine serum; the use of biotinyl-6-aminoquinoline allowed the analysis of the enzyme reaction in milk and porcine serum without pretreatment or dialysis. Stoichiometric increase and decrease of the substrate and product, respectively, were demonstrated. Michaelis constants for biotinyl-6-aminoquinoline were measured at various stages of partial purification. Because the solubility of these synthetic substrates in the aqueous phosphate buffer is limited, the determination of both Michaelis constant and maximum velocity by extrapolation may be helpful for the characterization of the kinetics of biotinidase.

Lipase from Pseudomonas aeruginosa. Production in Escherichia coli and activation in vitro with a protein from the downstream gene

The lipase gene from Pseudomonas aeruginosa TE3285 is followed by another gene, lipB. The lipase gene was expressed in Escherichia coli BL21(DE3)pLysS using the T7 RNA polymerase expression system. The mature lipase was accumulated as inclusion bodies at 42% of the total cell proteins. The inclusion bodies were solubilized with 8 M urea, but lipase activity was not detected in the solubilized preparation containing 85% lipase protein even after removing urea by dialysis. The lipB gene, positioned downstream of the lipase gene and thought to be necessary for the expression of the lipase gene, was expressed in Escherichia coli JM109 as a fusion with the glutathione transferase gene from Schistosoma japonicum. The fusion protein was partially purified on glutathione-agarose beads to 36% purity. Incubated with the fusion protein at a molar ratio of 1:1 at 4 degrees C for 24 h, the solubilized lipase showed lipase activity of about a tenth that of the purified lipase prepared from Pseudomonas aeruginosa TE3285. Magnesium ions and ATP were not essential but increased the activation. When the fusion protein was treated with thrombin to release the glutathione transferase part, it retained its activity. The lipase activation with lipB protein probably proceeds to form a 1:1 complex with the inactive, solubilized lipase protein but by a different mode from known chaperones.

[A clinical study of respiratory infection with methicillin-resistant Staphylococcus aureus (MRSA)]

We investigated patients with positive sputum for MRSA at Daido Hospital. The study was conducted from 1990 to 1991. The number of cases with positive sputum for MRSA is moderately increased. We classified 116 MRSA isolated cases into three groups, 67 cases of colonization with MRSA, 26 cases of suspected bronchopulmonary infection, and 23 cases of bronchopulmonary infection with MRSA. The coagulase types of MRSA were type II or type II + III. Examination of the susceptibility to antibiotics of MRSA showed that all MRSA strains were susceptible to sulfamethoxazole trimethoprim, arbekacin, and vancomycin. A few strains were resistant to rifampicin. There were no differences in coagulase types and susceptibility to antibiotics between the three groups. Bronchopulmonary infection with MRSA was frequently associated with underlying bronchopulmonary disease, whether malignant or not. Risk factors for MRSA bronchopulmonary infection could not be identified, but the prognosis of MRSA bronchopulmonary infection was poor in cases with higher grade of performance status. MRSA eradication rate in sputum after therapy was low, and was not improved by adding inhalation of antibiotics including vancomycin to systemic chemotherapy. This investigation demonstrates the importance of environmental prevention of MRSA infection in hospitals.

MR imaging of pleural and peritoneal effusion

The purpose of this study was to assess the efficacy of MR imaging in predicting the quality of ascites and pleural effusion. MR examinations of 20 patients with different benign or malignant diseases accompanied with ascites or pleural effusion were retrospectively studied. Results were compared with histopathological findings. On T1- and T2-weighted images, the MR intensity of the effusion depended mainly on the concentration of protein, whereas on gradient echo images, it depended mainly on the concentration of blood. MR examination was useful in non-invasively differentiating exudative or hemorrhagic effusion from serous effusion. Knowledge or inference of the quality of effusion can direct MR interpretation and may improve diagnostic accuracy.

[Immunohistochemical study of globotriaosyl ceramide (Gb3) in testicular tumors]

Testicular tumor tissues and various normal tissues were examined by immunohistochemical techniques for expression of globotriaosylceramide (Gb3) using anti-Gb3 monoclonal antibody (1A4). In formalin fixed paraffin-embedded specimens (31 cases), Gb3 was positive for every kind of elements of testicular germ cell tumors, especially it's incidence of positive staining were 100% in seminomas (16/16) and embryonal carcinomas (6/6). On the other hand, four cases of testicular malignant lymphoma were all negative for Gb3, and some normal testicle, liver, kidney, pancreas, spleen, ileum and rectum showed very weak reactivity with 1A4. In frozen materials (10 cases), similar incidence of positive staining with that of paraffin-embedded specimens were observed in drying only manner, 4% parafolm-aldehyde fixation following drying and 10 min. of acetone fixation following drying. Incidence of very strong staining in testicular germ cell tumors were as follows, 7/10 in 4% parafolmaldehyde fixation, 6/10 in drying only, 4/10 in 10 min. of acetone fixation and 7/22 in paraffinembedded specimens. Fixation with 30 min. of acetone fixation and 10 min. of 90% ethanol and treatment with 10 min. of chloroform:methanol (2:1, v/v) extremely decreased the reactivity with 1A4, suggesting that Gb3 exists mainly as glycolipid. Gb3 may thus be a useful histological marker for testicular germ cell tumor, and the tissue should be treated with the process of freezing followed by 4% parafolm-aldehyde fixation, drying only or 10 min. of acetone fixation, and formalin fixed paraffin-embedded specimens were also available enough.

Cutaneous oxalate granulomas in a haemodialysed patient: report of a case with unique clinical features

We report a patient undergoing haemodialysis, who developed multiple subcutaneous nodules. Histology showed that the nodules were composed of deposits of crystals in the dermis, with an associated foreign-body reaction. The crystalline deposits were identified as calcium oxalate by histochemical staining, polarizing microscopy, and analytical electron microscopy.

[Shock wave therapy of the rabbit VX2 bladder cancer--THP-ADM concentration in the tissue after combination therapy of THP-ADM and shock wave]

Tissue concentration of THP-ADM was analysed after the administration of THP-ADM with or without exposure of high energy underwater shock waves (SW) to rabbit bladder VX2 cancer. THP-ADM was administered intravenously (2 mg/kg) or into the urinary bladder (10 mg/body). After the administration of THP-ADM, SW was exposed (6,000-10,000 shots) to VX2 bladder cancer or normal bladder tissue. One hour later, THP-ADM tissue concentration was measured by high performance liquid chromatography method. In intra-venous group, THP-ADM concentration of cancer tissue was significantly lower (p < 0.02) in SW group than that of non-SW group. In bladder instillation group, THP-ADM concentration of normal bladder tissue was significantly higher (p < 0.02) in SW group than that of non-SW group and the average concentration of cancer tissue was higher about three times in SW group than that of non-SW group.

Lipid hydroperoxide-resistance gene in Saccharomyces cerevisiae: utilization as a selectable marker gene for yeast transformation

Two kinds of DNA fragments concerned with resistance against lipid hydroperoxide were cloned from the yeast Saccharomyces cerevisiae. When the recombinant plasmid carrying the DNA fragment was introduced into the cells of S. cerevisiae which do not have an appropriate auxotrophic marker, the transformants could be selected by their resistance to t-butyl hydroperoxide. By Southern hybridization analysis, such transformants were found to contain the recombinant plasmid, suggesting that the DNA fragment could be used as a selection marker for the transformation of S. cerevisiae.

[A case report of cardiac failure caused by the new anti-neoplastic agent 'carboplatin']

Carboplatin is one of most commonly used chemotherapeutic agents in clinical oncology practice. We presented a case of subacute cardiotoxicity supposedly due to carboplatin. A patient with ovarian cancer had been treated with carboplatin based chemotherapeutic agent for about a month before surgery. Although she had not shown symptoms of cardiac failure, severe pulmonary edema developed immediately after general anesthesia. It disappeared within a week. For three days following the administration of carboplatin alone for two weeks after surgery, arrhythmias (SVT, SVPB and VPB) and hypotension appeared. Symptoms of congestive heart failure, resembling dilated cardiomyopathy, lasted for one month. It required about two months to restore the normal cardiac functions. Carboplatin seems to have infrequent but possible cardiotoxicity as many other chemotherapeutic agents.