[Three cases of hypersensitivity pneumonitis caused by inhalation of spores of Pholiota nameko and the background of the disease]

Here we report a new type of hypersensitivity pneumonitis caused by inhalation of spores of Pholiota nameko. P. nameko is a kind of mushroom which is of Japanese delicacy. Among people who are working in nameko cultivation, we found three patients suffering from hypersensitivity pneumonitis, and identified that it was caused by inhalation of spores of P. nameko. Every patient was engaged in indoor nameko cultivation inside a building equipped with a air and moisture conditioning system for two to ten years. In the indoor environment, it was thought that they were exposed to and inhaled a high density of nameko spores. Among 15 healthy indoor nameko growers, we found 6 who had precipitating antibody against extracts from nameko spores; however, there were no antibody positive people in 17 outdoor nameko growers. As seen in dairy farmers, it was clarified that there is a percentage of precipitin positive nameko growers who are asymptomatic. This is concrete evidence that changes of mushroom cultivation style can induce a new type of hypersensitivity pneumonitis. These findings were considered to be an important experience from the view points of environmental pulmonary diseases and industrial medicine.

Eosinophilic leukaemia with a t(2;5) (p23;q35) translocation

Although the diagnosis of rare eosinophilic leukaemia is possible based on cytogenetic abnormalities, the chromosomal aberrations reported are diverse. We found a t(2;5) (p23;q35) translocation on bone marrow cells of a patient with chronic eosinophilia who suffered from multiple pustular folliculitis but lacked the clinical symptoms commonly observed in hypereosinophilic syndrome. No morphological abnormalities in an eosinophilic series were apparent and other haemopoietic cells were well preserved. A therapeutic trial with interferon-alpha failed after a 2-month period, and the patient is currently undergoing a combination therapy with interferon and intermittent administrations of hydroxyurea.

[Multiple cooperative study of UFT-adjuvant chemotherapy for malignant tumor in the jaw and oral cavities. The Oral Surgery Malignant Tumor Research Association in Kanto Kohshinetsu District]

We studied the usefulness and safety of long-term administration of uracil and tegafur (UFT) after primary therapy of the malignant tumor in jaw and oral cavity regions randomized controlled trial. 112 cases were totallized 6 institutes belonging to the Oral Surgery Malignant Tumor Research Association in Kanto Kohshinetsu District during 2 years and 10 months, beginning in September 1986. After completing the primary therapy, treatment was not performed in group A and 400 mg/day of UFT was orally administered in group B for 1 year. A variation was observed in the stages of background factors such as sex and age (more than 30 years old and less than 80 years old), while no such discrepancy was observed in other stages. No significant difference of 1-year-survival ratio and non-recurrence ratio was noted in either group, while the non-recurrence ratio was more favorable in group B than group A, and the usefulness of UFT for adjuvant chemotherapy was suggested. The incidence of side effects in group B was 42.6%, and no serious side effect was observed.

Congenital diaphragmatic hernia treated by perinatal stabilization

The delay of surgery in conjunction with high-frequency oscillation ventilation combined with preoperative stabilization is a standard treatment for congenital diaphragmatic hernia neonates in the high-risk group. A new protocol of perinatal stabilization with this preoperative stabilization has been developed at the University of Tokyo Hospital. The most important components of this method of perinatal stabilization are cesarean section and the injection of morphine and pancuronium through the umbilical vein prior to ligation of the umbilical cord. In order to benefit from this treatment, congenital diaphragmatic hernia patients should be diagnosed antenatally by ultrasonography and be delivered by cesarean section. This protocol of perinatal stabilization appears effective in congenital diaphragmatic hernia patients.

Subtype cross-reactive, infection-enhancing antibody responses to influenza A viruses

Antibody-dependent enhancement of the uptake of influenza A virus by Fc receptor-bearing cells was analyzed by using virus strains of the three human influenza A virus subtypes, A/PR/8/34 (H1N1), A/Japan/305/57 (H2N2), and A/Port Chalmers/1/73 (H3N2). Immune sera obtained from mice following primary infection with an H1N1, H2N2, or H3N2 subtype virus neutralized only virus of the same subtype; however, immune sera augmented the uptake of virus across subtypes. Immune sera from H1N1-infected mice augmented uptake of the homologous (H1N1) and H2N2 viruses. Antisera to the H2N2 virus augmented the uptake of virus of all subtypes (H1N1, H2N2, or H3N2). Antisera to the H3N2 virus augmented the uptake of the homologous (H3N2) and H2N2 viruses. These results show that subtype cross-reactive, nonneutralizing antibodies augment the uptake of influenza A virus strains of different subtypes. Antibodies to neuraminidase may contribute to the enhanced uptake of viruses of a different subtype, because N2-specific monoclonal antibodies augmented the uptake of both A/Japan/305/57 (H2N2) and A/Port Chalmers/1/73 (H3N2) viruses.

Non-synchronous behavior of neuronal activity, oxidative metabolism and blood supply during mental tasks in man

In near-infrared spectroscopic studies during mental tasks such as problem solving and mental arithmetic, we found that 9 of 33 healthy volunteers showed decreases in both the regional cerebral blood flow (r-CBF) and oxygen consumption rate (CMRO2) in the frontal region of the dominant hemisphere. To confirm these unexpected observations, we performed simultaneous measurements by positron emission tomography (PET) and near-infrared spectroscopy (NIRS) in two such subjects. PET images also showed that CBF decreased within the presumptive area illuminated by near-infrared light during mental task. However, CBF decreased in almost all regions while the subject gave a correct answer. Thus, the questions arose: Are mental tasks always associated with increases in r-CBF and/or CMRO2?

Extra-axial ependymoma--case report

A 13-year-old boy presented with a very unusual ependymoma extending extra-axially. Computed tomography demonstrated a tumor with a cyst and calcification adjacent to the dura and extending over the right occipital and parietal lobes. The cyst wall and solid tumor were enhanced postcontrast. Magnetic resonance imaging revealed that the solid tumor was isointense on T1-weighted images and a mixed iso- and high-intensity on T2-weighted images. The solid tumor and tissue surrounding the cyst were enhanced markedly by gadolinium-diethylenetriaminepentaacetic acid. Sagittal and coronal images demonstrated a multilocular tumor shadow. Cerebral angiography demonstrated a tumor fed by a posterior branch of the right middle meningeal artery but no feeders from the internal carotid and vertebral arteries. The tumor was removed en bloc. The histological diagnosis was clear cell-type ependymoma.

Probucol-induced QT prolongation and syncope

We report a patient who experienced a reversible prolongation of the QT interval and episodes of syncope while receiving probucol. A 64-year-old woman experienced syncopal attacks 8 and 11 weeks after beginning probucol treatment (500 mg twice daily). The pre-treatment ECG showed a slight prolongation of the corrected QT interval (QTc) (0.46 sec). Her QTc increased to 0.62 sec 12 weeks after beginning probucol treatment and decreased to about the baseline value (0.48 sec) 6 weeks after treatment was discontinued. Probucol is known to prolong the QT interval. A long QT interval has been linked to an increased risk of ventricular arrhythmias, syncope or sudden death. However, clinical reports which causally relate probucol treatment to syncope are very rare. Although an ECG during the episodes of syncope was not available, this patient's syncope might be due to ventricular tachyarrhythmia associated with probucol-induced QT prolongation. This case emphasizes the need for careful evaluation of the QT interval before and during probucol treatment.

Modulation by polymyxin B of the effects of interferon on human myelogenous leukemia cells

Natural and recombinant human interferon-alpha (IFN-alpha) and -gamma (IFN-gamma) exert differentiation-inducing and cytocidal effects in vitro on cells of the human myeloblastic leukemia cell line ML-2. These activities of IFNs are modulated by polymyxin B (PMB), a cyclic polycationic peptide antibiotic effective on Gram-negative bacilli. The modulating effect of PMB varies according to the species of IFN, namely, PMB enhances the activities of either natural IFN-gamma or recombinant IFN-gamma, while it inhibits the effects of either natural IFN-alpha or recombinant IFN-alpha. The cause of this variety in PMB effect on IFNs remains to be clarified.

Identification of two cardiac glycosides as Na(+)-pump inhibitors in rat urine and diet

Endogenous Na(+)-pump specific inhibitors are present in the plasma, urine, and tissues of humans and animals. To date, the source of these inhibitors has not been rigorously defined. In the present study, large amounts of several Na(+)-pump specific inhibitors have been demonstrated to exist in the urine of rats raised on a regular chow diet and tap water. All of the inhibitor levels have been found to increase 1.5-8-fold by the surgical preparation of reduced renal mass (RRM) and one-kidney, one-clip (IK, IC) hypertension. These urinary inhibitors, however, except for the ouabain-like inhibitor which eluted from a high performance liquid chromatography C18 column at the same retention time as [3H]ouabain, disappeared within a week after switching the diet from regular diet (number 5001, PMI Feeds, Inc.) to pure synthetic diet (number 5755). The urinary level of the ouabain-like inhibitor decreased to only one-half of the level in the control rat raised on a regular diet. Two of these inhibitors were purified from both urine and diet by a combination of Amberlite XAD-2 adsorption chromatography, reverse phase low pressure liquid chromatography, and several high performance liquid chromatographies. Reverse phase high performance liquid chromatography, liquid secondary ion and gas-liquid mass spectrometries, and proton nuclear magnetic resonance spectroscopy identified these inhibitors as a stereoisomer of convalloside, probably neoconvalloside, and a mono-rhamnoside of periplogenin or its stereoisomer. These cardiac glycosides exhibited inhibitory potencies comparable to ouabain against ouabain-displacement from Na+,K(+)-ATPase and against 86Rb uptake into human erythrocytes, and they also exhibited cross-reactivity to anti-ouabain antibodies and anti-digoxin antibodies. These results clearly demonstrate that the principal source of most of the inhibitors in rat urine is the diet. The results suggest that the ouabain-like inhibitor may be derived from an endogenous origin.

Doppler echocardiographic evaluation of left ventricular output and left ventricular diastolic filling changes in the first day of life

The aim of this study was to evaluate the changes in Doppler transmitral flow patterns during the 1st d of life. Doppler echocardiography of the ascending aorta and mitral valve was performed serially in 20 normal neonates at 2, 12, and 24 h of age. A computer-interfaced digitizer pad was used to measure the following: ascending aorta flow velocity-time integral, total diastolic filling flow velocity-time integral, flow velocity-time integral of early diastolic filling, and flow velocity-time integral of atrial contraction. The inner diameter of the ductus arteriosus was 4.2 +/- 0.6 mm at 2 h of age, 2.3 +/- 0.5 mm at 12 h of age, and had closed in 17 of 20 neonates (85%) by 24 h of age. The ascending aorta flow velocity-time integral and total diastolic filling flow velocity-time integral, which were high at 2 h of age, decreased significantly at 12 h of age [12.2 +/- 2.1 cm versus 9.6 +/- 1.7 cm (p < 0.001) and 8.0 +/- 1.1 versus 7.1 +/- 1.4 (p < 0.01), respectively] but remained constant thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

[A juvenile case of radiation-induced meningioma two years after radiation for craniopharyngioma]

The patient was a 7-year-old boy who received radiation therapy of 50 Gy after total gross removal of a craniopharyngioma. After two years a follow up CT scan showed a new enhanced lesion in the right temporal tip within the previous irradiation field. Total removal of the tumor was performed and its histological examination showed it to be an atypical meningioma. This atypical meningioma satisfied Cahan's criteria. So we diagnosed this atypical meningioma as radiation-induced meningioma. Immunohistochemically this meningioma stained for Vimentin. An electron-microscopical examination showed neither desmosome nor interdigitation. The score of Ki-67 and BrdU-L. I. was very small. Compared with previously reported juvenile radiation-induced meningioma, the latency was very short. The patient received growth hormone (GH) replacement therapy. We suspected relation between GH replacement therapy and short latency. He was discharged without any new neurological deficits and we haven't detected tumor recurrence for two years.

Right ventricular diastolic filling in the first day of life

To evaluate the effects of altered preload on the Doppler flow pattern of right ventricular inflow in the first day of life, serial Doppler echocardiography of the pulmonary artery (PA) and tricuspid valve was performed in 16 normal neonates at 2, 12, and 24 hr. A computer-interfaced digitizer pad was utilized to measure the followings: PA flow velocity-time integral, total transtricuspid flow velocity-time integral, flow velocity-time integral of early diastolic filling (E area), and flow velocity-time integral of atrial contraction (A area). The PA flow velocity-time integral, total transtricuspid flow velocity-time integral, E area, A area, peak E, and peak A were increased significantly by 24 hr compared with the values at 2 hr of age. However, the peak E/A, E/A area and peak E/total transtricuspid flow velocity-time integral did not show significant changes from 2 to 24 hr. The ductus arteriosus size was inversely correlated with the peak E (r = -0.46, p < 0.05), E area (r = -0.37, P < 0.05), and A area (r = -0.34, p < 0.05). Therefore, the increase in right ventricular preload at 24 hr is considered to be due to the cessation of the left-to-right shunt through the ductus arteriosus. These results suggest that the pattern of early and late diastolic filling of the right ventricle were dependent on the increase in preload. We can therefore conclude that the redistribution of transtricuspid flow induced by the preload condition should be taken into account to interpret the transtricuspid velocity pattern in terms of diastolic function.

[Tumor necrosis factor alpha in bronchoalveolar lavage fluid and its production by alveolar macrophages with asbestos exposure]

It is generally accepted that asbestos exposure causes pulmonary fibrosis and carcinogenesis. Several studies have suggested that TNF alpha is produced principally by mononuclear phagocytes and that it may play a role in inflammation, fibrosis and anti-tumor activity. We studied TNF alpha production by alveolar macrophages and the TNF alpha concentration in bronchoalveolar lavage fluid harvested from asbestos-exposed subjects and healthy controls. TNF alpha production by alveolar macrophages was significantly higher in the asbestos-exposed subjects than in healthy controls (3696 +/- 1606, 1938 +/- 753 pg/ml; p < 0.01). The period from first exposure correlated inversely with TNF alpha production (r = -0.6; p < 0.05). The TNF alpha concentration in bronchoalveolar lavage fluid was also significantly higher in the asbestos-exposed subjects than in healthy controls. These results suggest that abnormal TNF alpha production by alveolar macrophages may be related to fibrosis and carcinogenesis due to asbestos.

Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries

BACKGROUND

We describe the first clinicoradiological report of acute bilateral cerebellar infarction confined to the territory of the medial branches of the posterior inferior cerebellar arteries.

CASE DESCRIPTION

A 65-year-old man with atrial fibrillation and hypertension had sudden onset of vertigo, followed by brief loss of consciousness. Three days later a cranial computed tomographic scan showed acute hydrocephalus and low-density areas in the cerebellar vermis on both sides. On transfer the patient showed mild dysarthria, dysequilibrium with retropulsion, symmetrical bilateral horizontal gaze-evoked nystagmus on lateral gaze, and marked gait ataxia without brain stem signs, followed by marked vertigo that was induced by motion. Cranial magnetic resonance imaging revealed abnormalities consistent with fairly symmetrical bilateral cerebellar hemorrhagic infarction that was confined to the territory of the medial branches of the posterior inferior cerebellar arteries, in addition to minimal high-intensity areas in the pons on T2-weighted images. The patient improved with conservative therapy, including intravenous administration of glycerol.

CONCLUSIONS

We speculate that our patient likely had initial transient occlusion of the right vertebral artery at the origin of the right posterior inferior cerebellar artery, which probably gave rise to the bilateral medial branches of posterior inferior cerebellar arteries. This caused infarction in the territory of the medial branches on both sides without remaining brain stem signs. Such an unusual pattern of cerebellar infarction accompanied by acute hydrocephalus posed a diagnostic challenge at the time of transfer to our care, and correct diagnosis was facilitated by cranial magnetic resonance imaging.

Small gliomas: metabolism and blood flow

Eight patients with small gliomas (6 low-grade and 2 high-grade) localized in a single gyrus or less than 2 cm diameter were investigated using positron emission tomography and single photon emission computed tomography. All three tumors examined demonstrated hypermetabolism of amino acids. High-grade gliomas demonstrated hypermetabolism of glucose and high blood flow, but normal or low oxygen metabolism. High-grade gliomas also showed accumulation of 201Tl chloride and high or low accumulation of 123I-isopropyl iodoamphetamine. These indications allow preoperative diagnosis of the malignancy of small gliomas, which is important because small gliomas with high-grade malignancy need more extensive removal and adjuvant therapy.

[Neovascularization in experimental retinal venous obstruction in rabbit]

Experimental retinal venous obstruction was produced in rabbit eyes by transadventitial instillation of thrombin for the purpose of studying the late stage of histopathological changes in the retina. Three months after the instillation, abnormal vessels and compensatory shunt vessels were observed by ophthalmoscopy. Capillary obstruction, blood leakage from venules and neovascularization were observed on gelatin-fluorescein injected flat preparations of the retina three months after the thrombus formation. Although venular lumina were first narrowed and restored to normal three months after thrombin instillation, the lumina of arterioles remained narrow and intraluminal fibrin thrombi were present in the arterioles more than three months later in light microscopy. In electron microscopy many ribosomes and large nuclei were observed in newly formed retinal vessels, and their basement membranes were thin and discontinuous. Ghost vessels penetrated by glial cell processes were also found in the proliferative tissues. These results suggest that neovascularization occurs when the intraretinal damages last more than 3 months after the onset of thrombogenesis.

[Trigeminal neurinoma in the cavernous sinus revealed by intratumoral hemorrhage: a case report]

A case of trigeminal neurinoma located in the left cavernous sinus and revealed by intratumoral hemorrhage is reported. Preoperatively, magnetic resonance imaging provided the accurate localization of the lesion, allowing precise planning of the surgical approach. The neurinoma inside the cavernous sinus wall was removed successfully, and the patient developed no new neurological deficits except for anesthesia in the 1st division of the trigeminal nerve. The characteristic findings of magnetic resonance imaging of the trigeminal neurinoma in the cavernous sinus are reported.

Left ventricular contractile state of early human neonates with patent ductus arteriosus

Using echocardiographic technique, we studied the left ventricular (LV) contractile state in 32 full-term infants within 24 hr after birth. They were divided into 2 groups based on the timing of the examinations; the group 1 (n = 17), < 3 hr after birth; the group 2 (n = 15), > 3 and < 24 hr after birth, and the additional examinations were performed on day 5. The patency of the ductus arteriosus and its internal diameter were determined by pulsed Doppler and two-dimensional echocardiography. The left atrial to aortic root ratio was obtained from M-mode echocardiography, and the LV contractile state was estimated by the relationship between heart rate-corrected velocity of circumferential fiber shortening (mVcfc) and end-systolic meridional wall stress (ESS). The ductus arteriosus was open in all cases of group 1 and in 83% of the cases of group 2, but the ductal diameter and the left atrial to aortic root ratio significantly decreased in group 2. The relationship between mVcfc and ESS showed no significant differences between 2 groups and the control. Afterload, represented as ESS, was significantly lower in group 1 than the control. We suggest that the low afterload condition helps the adequate LV contraction even under the increased preload through the left-to-right ductus arteriosus shunting after birth.

Factors affecting functional prognosis in survivors of primary central nervous system germinal tumors

We evaluated 79 patients of whom 62 survived treatment for intracranial germinal tumors between 1964 and 1992. The survivors were assessed for their Karnofsky scores and intellectual and reproductive functions to verify factors associated with better prognosis. Thirty-one tumors were pineal, 17 were suprasellar, and ten were in the basal ganglia. These included 50 germinomas, five teratomas, and seven tumors of extra-embryonic origin producing alpha-fetoprotein or human chorionic gonadotropin. Although patients with germinoma or benign teratoma had better Kaplan-Meier survival rates than those with extra-embryonic origin tumors, the mean Karnofsky scores of the survivors did not differ significantly among the three histologic groups. On the other hand, although survival rates did not differ significantly among different tumor site groups, the mean Karnofsky score of the pineal group was higher than that of the suprasellar or basal ganglia group. Intellectual and reproductive functions were severely affected in the basal ganglia and suprasellar tumor groups, respectively. The Karnofsky score of survivors treated after 1977 was higher than for those treated before 1977. The score of patients who received less than 55 Gy irradiation was better than those who received more than 55 Gy. No patient who received less than 45 Gy developed a recurrence, suggesting that a lower dose may suffice for pure germinomas. Tumors of extra-embryonic origin, however, should be treated with combined chemotherapy to minimize subsequent irradiation. Factors affecting survivors' capabilities are discussed.