Effects of smaller physical size on complex arterial grafting in coronary artery operations

BACKGROUND

The trend in coronary artery bypass grafting is for a gradual transition to the more extensive use of arterial grafts. This study was designed to investigate the effects of patient body size on complex arterial grafting in coronary artery bypass procedures.

METHODS

Four hundred forty-five patients who underwent coronary artery bypass grafting with two or more distal anastomoses using arterial grafts were divided into two groups according to body surface area: group A (n = 114), 1.60 m2 or less; and group B (n = 331), greater than 1.60 m2. Preoperative patient characteristics and early and long-term results were compared between the groups.

RESULTS

The prevalence of female sex (27% in group A versus 0.9% in group B; p < 0.0001) and age (62.7 +/- 8.1 years in group A versus 58.9 +/- 7.0 years in group B; p < 0.001) were significantly different. However, the prevalence of previous myocardial infarction and of left ventricular dysfunction and the extent of coronary artery disease were not significantly different. Three patients (2.6%) in group A and 3 patients (0.9%) in group B died within 30 days of operation (p = 0.18). The 1-month patency rate of arterial grafts was not significantly different (98.7% versus 96.7%; p = 0.16), but that of venous grafts was significantly lower in group A than in group B (88.9% versus 97.7%; p = 0.045). No significant difference was noted in the 3-year actuarial survival rate (93.8% versus 91.6%).

CONCLUSIONS

The extensive use of arterial grafts in patients with small body size was associated with excellent long-term results, with no significant increase in operative mortality or morbidity.

Rapid and efficient method to eliminate substances inhibitory to the polymerase chain reaction from animal fecal samples

To detect pathogenic viruses in animal fecal specimens by polymerase chain reaction (PCR) assays, it is important to remove or inactivate PCR-inhibitory substances. Recently, it was reported that such inhibitory substances in human feces could be efficiently eliminated by a cationic surfactant, Catrimox-14 (Iowa Biotechnology, Iowa) during extraction of viral RNA. In the present report, Catrimox-14 was successfully applied to detect pathogenic viruses in fecal specimens from a variety of animals. By extraction of viral DNA in the presence of this cationic surfactant, the PCR assay could detect canine parvovirus (CPV) in all fecal specimens prepared from 13 kinds of animals, i.e., cat, chicken, cow, dog, gerbil, goat, golden hamster, horse, mouse, pig, rat, rabbit, or sheep. Pretreatment by gel-filtration or boiling failed to remove or inactivate the PCR-inhibitory substances in fecal specimens from mouse, goat, rat, and sheep.

Expression of cathepsin E in pancreas: a possible tumor marker for pancreas, a preliminary report

Ductal cancers of the pancreas frequently express markers of gastrointestinal epithelial cells. Cathepsin E (CTSE) is a non-secretory, intracellular, but non-lysosomal proteinase found in the highest concentration in the superficial epithelial cells of the stomach. The aims of our study were to examine the expression of CTSE in the pancreas, to establish an assay system of CTSE and to evaluate the diagnostic usefulness of CTSE in the pancreatic juice. Eleven patients with pancreatic ductal adenocarcinoma, 10 with mucin-producing adenoma, 3 with intraductal papillary hyperplasia and 43 with chronic pancreatitis were examined. Surgically resected pancreatic tissues were subjected to immunohistochemistry for CTSE. Pancreatic juice was collected from the patients and subjected to sandwich ELISA and Western analysis for detecting CTSE. Positive staining for CTSE was observed in pancreatic ductal adenocarcinoma by immunohistochemistry. CTSE was also expressed in mucin-producing adenoma, intraductal papillary hyperplasia and mucinous hyperplasia. CTSE in the pancreatic juice was present in 8 of 11 patients with pancreatic ductal adenocarcinoma, 5 of 10 patients with mucin-producing tumor, 1 of 3 patients with intraductal papillary hyperplasia and 4 of 43 patients with chronic pancreatitis. The detection frequency of CTSE in the pancreatic juice was significantly higher in the patients with pancreatic ductal adenocarcinoma than in the patients with chronic pancreatitis. Our findings suggest that the expression of CTSE is associated with the pathogenesis of pancreatic ductal adenocarcinoma, that CTSE in the pancreatic juice seems to be a useful marker for a definitive diagnosis and that CTSE may be expressed at a relatively early stage of multistep carcinogenesis in pancreatic lesions.

Continuous isolation and characterization of Chlamydia pneumoniae from a patient with diffuse panbronchiolitis

We succeeded in isolating Chlamydia pneumoniae organisms continuously from a 70-year-old man who had received chemotherapeutic treatment with low dosages of erythromycin for five years to improve diffuse panbronchiolitis (DPB). He had two episodes of acute exacerbation of DPB and a total of six strains of C. pneumoniae were isolated at different stages during the past 13 months. The morphological properties and protein profiles of the elementary bodies of all the C. pneumoniae isolates were similar to each other. Interestingly, his serological response against C. pneumoniae in immunoblotting tests was differed between two episodes. The sera collected during the first episode reacted weakly to the major outer membrane protein (MOMP), whereas those collected during the second episode reacted strongly to the 60-kDa protein and weakly to MOMP. These facts suggest that the two different episodes occurred as a result of different mechanisms. Additionally, in spite of the low antibody titer by micro-immunofluorescence test in the second episode as compared with that of the first episode, the immune response against 60-kDa immunodominant protein increased markedly in the second episode, and we suspect that the second episode was due to an allergic reaction caused by this 60-kDa protein. These findings suggest that repeated or prolonged exposure to C. pneumoniae may be associated with acute exacerbations of chronic obstructive pulmonary disease, and that the patient should be noted as a possible source of C. pneumoniae infection.

Pharmaceutical studies for gene therapy: expression of human Cu, Zn-superoxide dismutase gene transfected by lipofection in rat skin fibroblasts

To evaluate whether lipofection using Lipofectin is suitable for delivering foreign genes into skin fibroblasts as target cells, we performed experiments using human superoxide dismutase (hSOD) and neomycin-resistance (Neo) genes as models in rat skin fibroblasts (FR and primary cells) in vitro. The amounts of DNA used in the lipofection procedure significantly affected the transfection efficiencies, and the optimal amounts were determined for all cells used. However, the efficiencies in rat skin fibroblasts were about 20-fold higher than that in rat lung epithelial-like cells (L2 cells). The differences in plasmid vectors (pRc/RSV-SOD and pRc/CMV-SOD) hardly affected the transfection efficiencies. The amounts of Lipofectin significantly affected the transfection efficiencies, and the optimal amounts were determined for both types of skin fibroblasts. However, cytotoxic effects in both skin fibroblasts were observed with high doses of Lipofectin. On the other hand, with optimal amounts of DNA and Lipofectin, the reporter gene (NeoT) introduced into cells was mainly integrated into the host cell chromosome. Western blot analysis showed the continuous expression of hSOD protein for at least 45 d in skin fibroblasts transfected with the expression plasmid for hSOD by Lipofectin under the optimal conditions, and the cellular SOD activity fluctuated in parallel with the expression of hSOD protein. Differences in the type of cells also affected the expression of hSOD. These results indicate that it is necessary to set up optimal conditions for transfection using Lipofectin for each cell type, and that transfection with Lipofectin under optimal conditions may be an efficient method for introduction of foreign genes into skin fibroblasts for use as a clinical delivery system of therapeutic protein.

Relationship between the intracellular reactive oxygen species and the induction of oxidative DNA damage in human neutrophil-like cells

To clarify the mechanisms of intracellular induction of oxidative DNA damage, we have investigated the concentrations of intracellular reactive oxygen species and the amounts of 8-hydroxydeoxyguanosine (8OHdG), a mutagenic oxidative DNA damage, in human neutrophil-like cells, dimethylsulfoxide-differentiated HL60 (DMSO-HL60). We determined intracellular concentrations of hydrogen peroxide and superoxide by flow cytometry with dichlorofluorescein diacetate and hydroethidine, respectively. We determined the 8OHdG amounts with an electrochemical detector connected to HPLC after anaerobic sample processing. DMSO-HL60 releases superoxide upon stimulation with phorbol myristate acetate, and the released superoxide dismutates to hydrogen peroxide. Stimulation of DMSO-HL60 with 100 nM phorbol myristate acetate increased intracellular hydrogen peroxide, superoxide and 8OHdG (control). Addition of 1000 U/ml catalase decreased hydrogen peroxide (31.3% of control) and 8OHdG (20.3%). Addition of 100 U/ml SOD decreased superoxide (18.7%) and 8OHdG (41.6%). Addition of 1 mM deferoxamine decreased 8OHdG (30.4%), but increased hydrogen peroxide (129.6%). Addition of 200 microM 4-acetamido-4'- isothiocyanostilbene-2,2'-disulfonic acid decreased superoxide (59.9%) and 8OHdG (42.0%). Addition of 0.4% ethanol had no effect on superoxide concentration (102.2%), but tended to decrease hydrogen peroxide (83.5%) and 8OHdG (84.3%). Pretreatment of DMSO-HL60 with 0.1 mM FeSO4 increased 8OHdG (117.3%), but decreased hydrogen peroxide (75.8%). These findings indicate that the extracellularly released superoxide and hydrogen peroxide diffuse into the cell, but that such reactive oxygen species are not the direct molecules to induce 8OHdG. Our results suggest that 8OHdG is induced by the hydroxyl radical which is generated from intracellular hydrogen peroxide and superoxide-reduced Fe.

Canine parvovirus binds to multiple cellular membrane proteins from both permissive and nonpermissive cell lines

For identification of canine parvovirus (CPV) binding protein, the SDS-solubilized cell membrane fraction from a permissive cell line. CRPK, was subjected to the virus overlay protein blot assay (VOPBA). Competitive inhibition experiments showed the presence of multiple CPV-binding proteins with molecular masses of 36, 35, 33, 31, 29, 27, 25, and 23 kDa. CPV-binding proteins of same molecular masses were also detected in membrane fractions from nonpermissive, as well as other permissive, cell lines. We confirm that the mechanism of nonpermissiveness to CPV is not operative at the cellular attachment level.

Prognostic significance of circulating matrix metalloproteinase-2 to tissue inhibitor of metalloproteinases-2 ratio in recurrence of urothelial cancer after complete resection

The relationship between the serum matrix metalloproteinase-2 (MMP-2):tissue inhibitor of metalloproteinases-2 (TIMP-2) ratio and disease recurrence was examined in 53 urothelial cancer patients with muscular invasion or with lymph node metastasis who underwent complete resection. The mean MMP-2:TIMP-2 ratio in 31 patients with recurrence was significantly higher than that in 22 patients without recurrence (P < 0.05). Disease-free survival of patients with high MMP-2:TIMP-2 ratios was extremely poor compared with that of patients with lower ratios (P < 0.01). Cox's multivariate analysis suggests that the serum MMP-2:TIMP-2 ratio would be a new independent prognostic indicator of urothelial cancer recurrence.

Hereditary partial deficiency of plasminogen activator inhibitor-1 associated with a lifelong bleeding tendency

We report a family with a partial deficiency of plasminogen activator inhibitor-1 (PAI-1). The affected family members had had lifelong bleeding episodes, such as rebleeding after tooth extraction and trauma. This bleeding tendency in the propositus was autosomally transmitted from grandfather to son. The characteristic abnormalities of fibrinolysis in the patients were shortened eugloblin lysis time, low PAI activity with low antigen levels of plasminogen activator inhibitor-1 in plasma and serum. Furthermore, plasma 'active PAI' which indicates the quantity of plasminogen activator inhibitor-1 bound with plasminogen activator added was very low in these patients. These parameters were markedly low after the venous occlusion test. Moreover, two of the affected members had a much lower level of platelet PAI-1 than the normal controls. Tranexamic acid (Transamine) was useful to control bleeding in these patients.

Potential doubling time and tumour doubling time in meningiomas and neurinomas

Cell kinetic study plays an important role in treatment planning of brain tumour patients. MIB-1 antibody has recently become available, which detects Ki-67 antigen even in the formalin-fixed paraffin-embedded specimens. We performed MIB-1 immunostaining in 50 meningiomas and 50 neurinomas, and estimated the cell cycle time (tc) and potential doubling time (Tpot) from MIB-1 staining index (MIB-1 SI) and mitotic index (MI). MIB-1 SI logarithmically correlated with MI in both meningiomas and neurinomas. The tc and the Tpot were expressed as a function of the mitosis time (tm), while the tm is known to be around one hour and not exceeding two hours. When the tm was assumed to be one hour, the average tcs of meningiomas and neurinomas were 6.53 +/- 3.56 days and 7.67 +/- 3.27 days, respectively. The Tpots were 447 X (MIB-1 SI)-1.29 X tm in meningiomas, and 490 X (MIB-1 SI)-0.98 X tm in neurinomas. The tumour doubling times (Tds) were calculated from serial imaging studies in 22 neurinomas and 15 meningiomas. The Tds were formulated as 794 X (MIB-1 SI)-0.83 in meningiomas and 1380 X (MIB-1 SI)-0.97 in neurinomas. Most of the Tds correlated well with the Tpots in meningiomas and neurinomas, and exceeded values of the Tpot when the tm is assumed to be one hour, although a few tumours showed unexpectedly longer Tds. The Tpot and the to estimated from MIB-1 SI and MI are clinically useful parameters for predicting the growth potential of meningiomas and neurinomas where no other simple methods are available.

Microscale analysis of glycosphingolipids by TLC blotting/secondary ion mass spectrometry: a novel blood group A-active glycosphingolipid and changes in glycosphingolipid expression in rat mammary tumour cells with different metastatic potentials

The glycosphingolipid compositions of rat mammary tumour cell lines with different metastatic potentials for the lung [a parental tumour cell line (MTC) and its subclones MTLn2 (a non metastatic subclone) and MTLn3 (a subclone with high metastatic potential to the lung)] were studied using a newly developed TLC blotting/secondary ion mass spectrometry system and crude glycosphingolipids obtained from 0.5-1 x 10(7) cells of each cell line. GM3 and GM2 were the major components of the MTC cell line, but they were very minor components in the MTLn2 and MTLn3 cell lines, GDla being the major ganglioside HexNAc-fucosyl-GMla was found in the MTLn2 cells by the TLC blotting/SIMS method, and the terminal sugar linkage was shown to be a blood group A-type structure by immunostaining. These findings suggest that the ganglioside is a novel type of blood group A-active ganglioside, GalNAc alpha 1-3(fuc alpha 1 -2)GMla. No blood group A-active lipid was present in MTLn3 cells, whereas Hex-GMla and neutral glycosphingolipids with more than 5 sugar residues were.

Monoepoxide production from linoleic acid by cytochrome c in the presence of cardiolipin

We found that cytochrome c (Cyt c) could oxidize cardiolipin (CL), and detected monoepoxides of linoleic acid (LA) in the fatty acids constituting the oxidized CL. We also found that in the presence of CL and Cyt c, free LA was oxidized and LA monoepoxides were produced. The aim of this study was to elucidate the mechanism of this lipid peroxidation. We concluded that ferric Cyt c produced some radical species from water-soluble oxygen in the presence of CL (CL-Cyt c system) and that radicals oxidized free LA or CL. The CL-Cyt c system may be another LA monoepoxide producing system in the neutrophil and may account for the lipid peroxidation observed in the ischemia-reperfusion-induced cardiac injury.

Characterization of CYP2A6 involved in 3'-hydroxylation of cotinine in human liver microsomes

Nicotine is primarily metabolized to cotinine, and cotinine is further metabolized to trans-3'-hydroxycotinine in human liver, which is a major metabolite of nicotine in humans. We studied the formation of trans-3'-hydroxycotinine from cotinine in human liver microsomes. trans-3'-Hydroxycotinine formation demonstrated single enzyme Michaelis-Menten kinetics (Km, 234.5 +/- 26.8 MicroM; Vmax, 37.2 +/- 2.4 pmol/min/mg protein). Significant correlation (r = .967, P < .001) between cotinine 3'-hydroxylase activities at low (50 microM) and high (1 microM) cotinine concentrations in 20 human liver microsomes suggested the contribution of a single enzyme to cotinine 3'-hydroxylation. The cotinine 3'-hydroxylase activity correlated significantly with immunoreactive cytochrome P450 (CYP)2A6 contents (r = .756, P < .01) and coumarin 7-hydroxylase activity (r = .887, P < .001). The cotinine 3'-hydroxylase activity was inhibited by coumarin, alpha-naphthoflavone, chlorzoxazone and anti-rat CYP2A1 antibodies. Microsomes of B-lymphoblastoid cells expressing human CYP2A6 exhibited cotinine 3'-hydroxylase activity. The Km value of the expressed CYP2A6 (264.7 microM) was almost identical to that of human liver microsomes. In conclusion, cotinine 3'-hydroxylation appears to be catalyzed solely by CYP2A6 in humans. Cotinine is a candidate for a new substrate for CYP2A6 in humans.

[A case of relapsing demyelinating multiple mononeuropathy with multifocal nerve enlargement]

We report a 23-year-old woman, who had a relapsing-remitting multiple mononeuropathy with multifocal nerve enlargement. The patient was characterized by asymmetrical, marked enlargement of multiple nerves in the arms (median and ulnar nerves) and neck (accessory nerve) bilaterally. Sequential nerve conduction studies revealed persistent demyelinative abnormalities, especially across the segment of nerve thickening. The MRI of the proximal arm confirmed the markedly enlarged median and ulnar nerves which showed high signal intensity on T2-weighted images and partial enhancement after administration of gadolinium. We consider that the patient had the clinical features of "multifocal pseudohypertrophic neuropathy" described by Adams et al, and that chronic demyelination and inflammation associated with impairment of the blood-nerve barrier might be underlying mechanisms.

Recurrence of sarcoidosis following interferon alpha therapy for chronic hepatitis C

We report a 67-year-old male patient with a known history of sarcoidosis in remission who had recurrent sarcoidosis following a five-month administration of interferon alpha (IFN-alpha) for chronic hepatitis C. He developed bilateral swelling of the parotid glands and bilateral diffuse reticulonodular pulmonary parenchymal opacities on chest roentgenograms. Serum angiotensin converting enzyme (ACE) levels and soluble IL-2 receptor levels were high and a transbronchial lung biopsy revealed noncaseating granulomas. The abnormalities on both laboratory data and chest roentgenograms were resolved after administration of oral prednisolone.

Subcellular localization of docosahexaenoic acid and arachidonic acid omega-hydroxylation activity in the brain, liver and colonic adenocarcinoma

A homogenate of rat brain, rat liver or human colonic well differentiated adenocarcinoma was prepared in 250 mM sucrose isoosmolaric buffer (pH 7.6) and fractionated by differential centrifugation at 10(3), 10(4) and 10(5) g. Each precipitate or supernatant was incubated with NADPH and docosahexaenoic acid or arachidonic acid as a substrate for 30 min at 37 degrees c under aerobic conditions. omega-Hydroxydocosahexaenoic acid or omega-hydroxyeicosatetraenoic acid from an incubation mixture was detected by reversed-phase high-performance liquid chromatography-thermospray mass spectrometry with selected-ion monitoring. omega-Hydroxy polyunsaturated fatty acids were characterized by high intensity of the molecular ion (MH+) although common hydroxy polyunsaturated fatty acids were characterized by high intensity of the MH+ -H2O ion. For the rat brain, omega-hydroxylation activity (the amount of omega-hydroxy product produced in 30 min) was concentrated to a 10(3) g precipitate although the specific activity (the activity per 1 mg of protein) in the 10(3) g precipitate did not indicate superiority over other fractions. However, the specific activity of the rat brain increased on addition of a 10(4) or 10(5) g precipitate. For the rat liver, although omega-hydroxylation activity was concentrated to a 10(3) g precipitate, the specific activity was concentrated to a 10(5) g precipitate and the subcellular localization differed from that of rat brain. In the human colonic well differentiated adenocarcinoma, although omega-hydroxylation activity was relatively high in the 10(3) g supernatant, the specific activity was relatively high in the 10(3) g precipitates. These results suggest that there is a difference regarding subcellular localization of the omega-hydroxylation activity depending on the species of the organs.

Effects of transfection with the Cu, Zn-superoxide dismutase gene on xanthine/xanthine oxidase-induced cytotoxicity in fibroblasts from rat skin

PURPOSE

The effects of transfection with the human Cu, Zn-superoxide dismutase (hSOD)4 gene on active oxygen-induced cytotoxicity in rat skin fibroblasts (FR) were studied for the purpose of developing the novel delivery system of hSOD using hSOD gene.

METHODS

An expression plasmid for hSOD, pRc/RSV-SOD, was constructed and used to transfect FR cells. Xanthine (X)/xanthine oxidase (XO) system were used to generate active oxygen species. The effects of transfection with the hSOD gene on active oxygen-induced cytotoxicity were assessed by comparing the number of surviving cells and the level of lipid peroxidation in host and transformants after exposure to X/XO system.

RESULTS

The cellular SOD activity in RSV-SOD cells transfected with pRc/RSV-SOD was significantly increased in comparison with host or RSV cells transfected with the pRc/RSV plasmid containing no hSOD gene as a control. Furthermore, Western blot analysis using an anti-hSOD antibody indicated the production of hSOD in RSV-SOD cells. On the other hand, although the numbers of surviving cells in both host and RSV-SOD cultures after exposure to X/XO system decreased in a time-dependent manner, the decrease in number of surviving RSV-SOD cells was less than that in host cells. In the presence of catalase, the decreases in number of surviving cells in both host and RSV-SOD cultures after exposure to the X/XO system were also less than those in the absence of catalase. However, the decreases in cell survival in RSV-SOD cultures were significantly less than those in host cells in the presence of catalase. Furthermore, the levels of lipid peroxidation in RSV-SOD cells exposed to the X/XO system in the presence or absence of catalase were lower than those in host cells. These results indicated that the increase in cellular SOD activity by transfection with the hSOD gene protects cells from oxidative stress.

CONCLUSIONS

Human SOD gene therapy may be useful for treatment of diseases in which oxidative tissue damage is produced.

Determination of 8-hydroxydeoxyguanosine in human cells under oxygen-free conditions

To establish an accurate 8-hydroxydeoxyguanosine (8OHdG) determination system, we examined two potential factors causing experimental error in 8OHdG determination. First, we examined the efficiency of the enzymatic digestion of DNA, that could cause misestimation of 8OHdG. Second, since we considered that the oxygen molecules in atmosphere and in reagents were the main factor contributing to the experimental errors, we carried out the 8OHdG determination under oxygen-free conditions and compared the 8OHdG value with that determined by the methods under ambient atmosphere. The calf thymus DNA was sufficiently digested in the condition we used and the yields of dG were constant, even when the DNA was damaged with H2O2 (80 mM) and UV irradiation. By carrying out the DNA extraction manually, instead of using the DNA extractor, we could reduce the additional 8OHdG formation during sample processing. No trend was found in the difference between the 8OHdG values determined under oxygen-free conditions and under ambient atmosphere. However, when the 8OHdG values were compared in samples with asbestos, the value determined under oxygen-free conditions was significantly lower than that determined under ambient atmosphere. These findings suggest that the removal of oxygen molecules was effective in reducing accidental ROS generation by impurities in the sample, which could cause the additional 8OHdG formation, and that the oxygen-free system made the determination of 8OHdG reproducible and more accurate than before. When the oxygen-free system was applied to human leukocytes, the system showed good reproducibility (r = 0.535, P < 0.001), even though the 8OHdG level was low. With the system, we could detect a significant difference between 8OHdG in polymorphonuclear leukocytes (0.241 +/- 0.129) and mononuclear leukocytes (0.188 +/- 0.126, P < 0.01).

[A case of Legionella micdadei pneumonia]

A 60-year-old male with type C chronic hepatitis was admitted to Kibikogen Rehabilitation Center with high fever, cough and general fatigue. Chest X-ray film on admission showed consolidation in the left middle and lower lung lung field. Initial treatment with intravenous ceftazidime, imipenem/cilastatin and clindamycin were ineffective due to continuous high fever and cough and spread of the pneumonia shadow. Administration of minocycline was started for suspected non-bacterial pneumonia whereupon his symptoms improved and the pneumonia shadow began to decrease in size. However, his symptoms and pneumonia shadow worsened after taking him off of minocycline due to progressive pancytopenia and liver dysfunction. He was transferred to our hospital and intravenous erythromycin treatment was initiated for suspected Legionell pneumonia because of the elevation of Legionella micdadei serum antibody titer. Immediately after starting treatment, his symptoms improved and the pneumonia shadow decreased in size. Erythromycin was stopped after the 14th day of administration. In this case, diagnosis of L. micdadei pneumonia was made because of the positive results of the polymerase chain reaction test and elevation of the L. micdadei serum antibody titer (from 0 to 1,024). This is the second report of a L. micdadei pneumonia case here in Japan.

[Small-cell carcinoma of the lung with paraneoplastic cerebellar degeneration]

A 50-year-old man was admitted to our hospital because of slowly progressing ataxia. After the neurological examination and after observation of the clinical course, paraneoplastic cerebellar degeneration was suspected. Extensive examination revealed a malignant tumor in the right upper lobe of the lung. Immunoblotting with rat cerebellum revealed a 68 KDa protein in the patient's serum, which suggested that paraneoplastic cerebellar degeneration was caused by an auto-antibody. Anti-cancer drugs and radiation therapy were begun 4 months after the onset of symptoms. After 4 months of therapy, the lung cancer had shrunk, but the neurological symptoms had become more severe.

Evaluation of a direct fluorescent antibody assay for detection of Chlamydia pneumoniae

We examined the utility of the direct immunofluorescent antibody test kit, IMAGEN (DAKO Diagnostic Co., Ltd.). The stainability of inclusions and purified elementary bodies (EBs) of all the Chlamydia pneumoniae strains used in this study was highly specific. Immunoelectron microscopy and light microscopy of stained EBs revealed the target antigen of IMAGEN to be located on the surface of the EB outer membrane. In a clinical study, we tested oropharyngeal swab specimens obtained from 41 patients (45 specimens). The results were compared with those obtained by isolation in cell culture, the indirect immunofluorescent antibody (IFA) assay and serum antibody titration. C. pneumoniae was isolated from six specimens (13.3%), and the organisms were detected in 11 specimens (24.4%) with IMAGEN and nine specimens (20%) with IFA. A diagnosis of C. pneumoniae infection was made in six patients (13.3%) by the serological examination. Six specimens positive in isolation were positive in the IMAGEN but there were three cases which seemed to be false-positive by the IMAGEN. We conclude that the use of IMAGEN is an easy, rapid and sensitive method for detecting C. pneumoniae when there is a large amount of chlamydial antigen in the clinical specimen and when identification of the chlamydial species forming inclusions in cell cultures is required.