Colorimetric MTT assessment of antifungal activity of D0870 against fluconazole-resistant Candida albicans

The in vitro antifungal activity of D0870 against eight isolates of fluconazole-resistant Candida albicans was compared with that of itraconazole, ketoconazole and miconazole. The colorimetric MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide] assay was used to assess the antifungal activities. The 50% minimum inhibitory concentration (MIC50) of D0870 was below 0.031 microgram ml-1 for seven isolates and 0.25 microgram ml-1 for one isolate. The activity of D0870 was superior to that of the other azoles. Ketoconazole was the most effective azole next to D0870. Therefore, the new bis-triazole, D0870, is expected to be promising for the therapy of fluconazole-resistant candidosis. The present data also confirmed that the MTT assay may be useful for evaluation of resistance and detection of resistant C. albicans.

[Treatment of nonresectable cardiac cancer]

Methods and strategies for the treatment of surgically nonresectable cardiac cancer are discussed. Among the 185 patients with cardiac cancer encountered to date in our department, five (2.7%) had nonresectable disease. All of these patients had at least two unfavorable prognostic factors, and chemotherapy was administered but with poor results. In one patient with Barrett's esophageal cancer including the cardiac region, a self-expandable metallic stent (SEMS) was applied temporarily. The patient progressed from being unable to swallow saliva to being able to ingest food orally. Patients with surgically nonresectable progressive cardiac cancer generally have a poor general condition and are immunodeficient. In the case of surgical bypass surgery for highly invasive cancer, complications often occur and great care must be exercised. However, because of the improvements made in and increasingly widespread use of stenting devices and delivery systems, early introduction of SEMS is considered to be an effective strategy against the symptoms caused by obstruction and development of aspiration pneumonia. There have also been reports of the effectiveness of laser therapy, local injection of immunotherapeutic agents, and radiotherapy to the tumor. A good outcome can also be expected using a multidisciplinary treatment involving a combination of systemic chemotherapy and immunotherapy. However, because of the poor prognosis, timely introduction of home total parenteral nutrition and palliative therapy after receiving informed consent from the patient and/or the family is necessary to avoid prolonged and unnecessary hospitalization.

[Analysis of pathological vocal fold vibrations using high-speed digital imaging]

There have been various methods devised to monitor vocal fold vibration. Stroboscopy provides clinically-celevant information concerning pathology of the vocal folds. However, slow motion observation is based on the regularity of the vibration, and this ignores the role of irregularity of the vocal fold vibration in pathological cases. In order to know more about the nature of the vocal fold vibratory pattern, it is essential to monitor the vibration on a cycle by cycle basis. We analysed vocal fold vibrations of 22 pathological larynges using a computer-assisted high-speed digital imaging technique. Observed items included symmetry, regularity, phase difference, glottal closure, amplitude, mucosal wave and periodicity difference. Vibratory patterns were classified by location of lesion, severity of disease, expiratory pressure and laryngeal modulation. Analyses of pathological vocal fold vibrations using high-speed digital imaging techniques are providing the theoretical support for voice therapy and elucidating the causes of hoarseness.

Damage to yeast cells of Cryptococcus neoformans by voriconazole and fluconazole: a culture and microscopic study

A systematic cultural, cytological and microscopic study of voriconazole (VCZ) and fluconazole (FCZ) damage to Cryptococcus neoformans over time was made. When haemocytometer counts were compared with colony-forming units (cfu) viability decreased with increased drug concentration and prolonged treatment time up to 48 h. Percentage viability by vital staining correlated with cfu. Concentrations of VCZ were found to be 10-fold more potent than FCZ. At 72 h, percentage viability increased in cultures with lower drug concentrations, indicating outgrowth of surviving yeast cells. Drug treatment resulted in a cytological change in a large percentage of yeast cells characterized by a large central vacuole easily observed microscopically. Vital staining showed that there was no direct relationship between cytological changes and non-viability. These novel findings add a new approach for studying the antifungal action of VCZ and FCZ against C. neoformans and provide a new perspective on their antifungal action.

The identification and phylogenetic relationship of pathogenic species of Aspergillus based on the mitochondrial cytochrome b gene

To study the identification and phylogeny of pathogenic isolates of Aspergillus, we designed primers from known cytochrome b amino acid sequences. Using these primers, 426 bp fragments of a mitochondrial (mt) cytochrome b gene were amplified by polymerase chain reaction (PCR), directly sequenced, and compared among Aspergillus fumigatus, A. flavus, A. niger, A. terreus and Emericella nidulans. Except for E. nidulans, all strains produced the 426 bp fragment by PCR. The E. nidulans strains demonstrated both an intron-presence fragment ( approximately 1500 bp) and intron-absence fragment (426 bp). Species-specific nucleotides were found in each of the five species. Based on sequence analysis, the strains were further divided into several groups within each species. When a 142-amino-acid sequence was estimated from the 426 bp nucleotide sequence using the yeast mt genetic code, the amino acid sequences showed no difference among strains of the individual species. DNA-based phylogenetic and amino acid-based trees were constructed. In conclusion, the DNA sequences of the cytochrome b gene may be of use in identification of pathogenic Aspergillus species and the amino acid-based tree suitable for discussing their phylogenetic relationships.

Isolation of Paracoccidioides brasiliensis from armadillos (Dasypus noveminctus) captured in an endemic area of paracoccidioidomycosis

Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis (PCM), was first isolated from armadillos from the Amazonian region where the mycosis is uncommon. In the present study, we report on the high incidence of PCM infection in armadillos from a hyperendemic region of the disease. Four nine-banded armadillos (Dasypus novemcinctus) were captured in the endemic area of Botucatu, Sao Paulo, Brazil, killed by manual cervical dislocation and autopsied under sterile conditions. Fragments of lung, spleen, liver, and mesenteric lymph nodes were processed for histology, cultured on Mycosel agar at 37 degrees C, and homogenized for inoculation into the testis and peritoneum of hamsters. The animals were killed from week 6 to week 20 postinoculation and fragments of liver, lung, spleen, testis, and lymph nodes were cultured on brain heart infusion agar at 37 degrees C. Paracoccidioides brasiliensis was isolated from three armadillos both by direct organ culture and from the liver, spleen, lung, and mesenteric lymph nodes of hamsters. In addition, one positive armadillo presented histologically proven PCM disease in a mesenteric lymph node. The three armadillos isolates (Pb-A1, Pb-A2, and Pb-A4) presented thermodependent dimorphism, urease activity, and casein assimilation, showed amplification of the gp43 gene, and were highly virulent in intratesticularly inoculated hamsters. The isolates expressed the gp43 glycoprotein, the immunodominant antigen of the fungus, and reacted with a pool of sera from PCM patients. Taken together, the present data confirm that armadillos are a natural reservoir of P. brasiliensis and demonstrate that the animal is a sylvan host to the fungus.

Variant angina in isolated adrenocorticotropin deficiency, inappropriate vasopressin secretion and Hashimoto's thyroiditis

We report a 62-year-old male patient who had variant angina and isolated adrenocorticotropic hormone (ACTH) deficiency. His serum sodium concentration was low and vasopressin was inappropriately high for the low plasma osmolality. Serum free thyroxine (FT4) was low and thyroid stimulating hormone (TSH) was high with positive anti-thyroperoxidase antibodies, compatible with Hashimoto's thyroiditis. Treatment with Amrodipine and hydrocortisone relieved chest symptoms and hyponatremia, and hypothyroidism was also normalized. It is suggested that coronary artery spasm may be related to cortisol deficiency and/or inappropriately high vasopressin secretion and that hypothyroidism was ameliorated because the reduced responsiveness to TSH returned to normal due to hydrocortisone supplement.

Immunotherapy and combined assay of serum levels of carcinoembryonic antigen and acute-phase reactants

Our previous studies have revealed that gastric and esophageal cancer patients with abnormal sialic acid levels had a better response than those with normal levels if they received polysaccharide K (PSK), a nonspecific immunomodulator. Serum levels of carcinoembryonic antigen (CEA) and acute-phase reactants (APR) such as immunosuppressive acidic protein, acid-soluble glycoproteins, alpha1-antichymotrypsin, and sialic acid were analyzed in 872 gastric cancer patients who had undergone resection from March 1979 to September 1993 at the Department of Surgery of Tokai University. The patients were categorized into four groups according to the preoperative serum levels: group A had normal levels of both CEA and APR, group B had abnormal CEA and normal APR levels, group C had a normal CEA level and normal levels of one or more APR, and group D had abnormal levels of both CEA and of one or more APR. Patients in group D who received PSK showed significantly better survival than those without PSK (29.3% versus 6.9%; log-rank test, P = 0.0015; Breslow test, P = 0.0042). CEA-positive patients receiving PSK therapy exhibited a significantly better survival rate than those without PSK (38.1 % versus 18.6%; log-rank test, P = 0.0136; Breslow test, P = 0.0125). Cox's regression analysis showed that PSK therapy was significantly related to survival in group D, but not in the other groups. We conclude that the combined assay of tumor-associated factors (such as CEA) and various nonspecific reactants to the presence of cancer (such as immunosuppressive acidic protein, alpha1-antichymotrypsin, acid-soluble glycoproteins and sialic acid) provides a good set of preoperative indicators on which to base the selection of treatment for individual gastric cancer patients.

[Cure by THP-COP therapy in patients with perforated T-cell type malignant lymphoma of the jejunum]

A 52-year-old man had suffered abdominal pain from Dec. 15, 1992. On Jan. 1993, he was admitted to our hospital for a diagnosis of T-cell malignant lymphoma of stomach of diffuse large cell type by gastroendoscopical biopsy. On the following day, he underwent emergency an operation with a diagnosis of panperitonitis. A perforation site had been found at the jejunum 60 cm distant from the Treitz ligament. It was resected and sutured concomitant with omental patch. The pathological diagnosis was the same. After the operation, we started THP-COP therapy on Jan. 25, 1993. During the admission, he was given THP-COP therapy 6 times, and had a complete remission. He was discharged Feb. 26, 1994, and shows no evidence of disease at this writing.

Antigenic similarities to Paracoccidioides brasiliensis in thermo-dependent dimorphic fungi isolated from soil in Botucatu, SP, Brazil

We compared the antigenic characteristics of two thermo-dependent dimorphic fungi isolated from soil in Botucatu, an endemic area of paracoccidioidomycosis (PCM) and Paracoccidioides brasiliensis. The soil isolates grew as cerebriform colonies at 37 degrees C (yeast form) and as cottonous colonies at 25 degrees C (mycelial form). No pathogenicity for ddY mice or hamsters were observed. In immunodiffusion test, there were precipitation bands between the 2 soil isolates and pooled PCM patient sera. There were also common precipitation bands at 21, 50 and 58 kDa between the soil isolates antigens and PCM patient sera by Western-blotting, but no gp43 kDa band. No gene for gp 43 kDa protein was detected in the soil isolates by PCR. The fact that these isolates were obtained from an endemic area of PCM and there were some antigenic similarities between the soil isolates and P. brasiliensis in immunodiffusion test and Western-blotting may have some importance in epidemiological surveys done with paracoccidioidin as well interfering with the immune response of the exposed population.

[Effect of intraperitoneal therapy in gastric cancer with peritoneal dissemination]

Eighty gastric cancer patients with peritoneal dissemination were analyzed to evaluate the effect of intraperitoneal chemo- and/or immunotherapy on abdominal ascites. Among them, 19 were treated with intraperitoneal chemo- and/or immunotherapy, and 21.1% of them showed decreased ascites and better QOL. Patients treated with intraperitoneal administration with OK-432 showed good survival. Among patients with OK-432 administration, those receiving postoperative chemotherapy showed better survival than those given immunochemotherapy. Conversely, among patients with chemotherapy, those given postoperative immunochemotherapy showed better survival than those on chemotherapy. Patients with HLA-type I and III, and those with preoperative normal immune status showed good response when they received intraperitoneal therapy.

Histopathological and electron microscopical studies on experimental Penicillium marneffei infection in mice

Experimental Penicillium marneffei infection in mice was investigated histopathologically and by electron microscopy. Viable conidia (5 x 10(6) cells) of P. marneffei were inoculated into each mouse of group A (BALB/c mice) and group B (BALB/c-nu/nu-SIc mice) through the tail vein. All the mice were sacrificed at intervals and the livers were examined. In group A, the conidia were phagocytosed by Kupffer cells soon after inoculation, and proliferated by fission in the cytoplasm. Marked proliferation of yeast cells was observed 7 and 14 days after inoculation. With proliferation of the fungus, the number of lysosomes in Kupffer cells increased, and numerous granulomas were formed in the liver. These granulomas consisted mainly of macrophages with yeast cells, together with a few polymorphonuclear leukocytes, lymphocytes and giant cells. From 28 days on yeast cells were gradually cleared from the granulomas, and 56 days after inoculation almost all the granulomas disappeared. In group B, at an early stage of infection, similar pathological changes to those seen in mice of group A were observed. However, as the infection progressed, the number of granulomas continued to increase and yeast cells continued to proliferate although lymphocytes did not infiltrate these granulomas. With proliferation of yeast cells the liver tissue was replaced with both yeast cells engulfed by macrophages and extracellular yeasts, and dissemination occurred.

Dietary diosgenin attenuates subacute intestinal inflammation associated with indomethacin in rats

We investigated the effects of dietary diosgenin (Dio), a plant-derived sapogenin, on indomethacin (Indo)-induced intestinal inflammation and alterations in bile secretion in rats. In anesthetized rats, bile secretion, intestinal inflammation, and blood chemistry were assessed 3 days after two subcutaneous injections of Indo given 24 h apart. Dio (> 80 mg.kg-1.day-1) pretreatment significantly inhibited weight and food intake decreases and intestinal inflammation. This protective effect was confirmed by examination of gross and histological findings and intestinal myeloperoxidase activity. Dio significantly increased biliary cholesterol (Chol) output and prevented the decreases in bile flow, bile acid output, and biliary alpha-muricholic acid and the increases in biliary hyodeoxycholic acid, deoxycholic acid, and hydrophobicity index of bile. Significantly more biliary Chol and phospholipids were present in macromolecules separate from bile acids and Indo in Dio-treated rats. Dio significantly increased the elimination constant of Indo and reduced plasma Indo levels at 3 and 12 h but did not influence biliary secretion of Indo for 3.5 h after injection. Although Dio dose-dependently attenuated subacute intestinal inflammation and normalized bile secretion in this model, it may also compromise the anti-inflammatory action of indo.

The effect of methyl linoleate hydroperoxides and radical initiator 2,2'-azobis (2-amidinopropane) dihydrochloride on antibody production by mouse spleen cells

Methyl linoleate hydroperoxides (MLHPO) and 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH), a widely used free radical initiator, were examined for effects on antibody production by spleen cells using plaque-forming cell response against sheep red blood cells (SRBC). The in vitro primary antibody response was enhanced in the presence of MLHPO at a concentration range of 2-20 microM or AAPH at 0.1 microM, but was suppressed with higher concentrations of these compounds. In the in vitro secondary antibody responses, both MLHPO and AAPH failed to increase plaque-forming cell response above that of the control culture. Following the oral administration of MLHPO (2.29 g/kg) four times to mice, in vivo primary plaque-forming cell response was significantly suppressed. After, a single intraperitoneal injection of AAPH (60 mg/kg) to mice, in vitro primary plaque-forming cell response was also suppressed. These findings suggest that primary antibody response can be affected by lipid hydroperoxides and oxygen radicals in vivo.

Interleukin-6 is a useful marker for early prediction of the severity of acute pancreatitis

Twelve patients with acute pancreatitis admitted to our department between January 1993 and December 1994 were studied prospectively and classified into two groups (severe group, five patients; mild group, seven patients), according to the criteria for grading severity of acute pancreatitis proposed by the Research Committee for Intractable Diseases of the Pancreas, Japanese Ministry of Health and Welfare (1990). To evaluate markers for early estimation of the severity of acute pancreatitis, we measured serum changes in various parameters. In the severe group interleukin-6 (IL-6) levels were increased significantly 5, 24, 72, and 120 h after the onset (p < 0.01), compared with the mild group. C-reactive protein (CRP), thrombin antithrombin III, and alpha 2-plasmin inhibitor plasmin complex levels were significantly increased only at the 72-h time point. Peak values of interleukin-8 (IL-8) and soluble human E selectin were observed at 5 and 72 h, respectively, after the onset. There was a significant correlation between IL-6 at 5 h and both pancreatic secretory trypsin inhibitor (r = 0.85) and CRP (r = 0.94) at 72 h. We therefore conclude that IL-6 is a useful marker for assessment of the severity of acute pancreatitis in its early stages.

Association between serum gastrin levels, gastric acid secretion and age in early gastric cancer

This study evaluated the effect of gastric acid secretion and serum gastrin response on tumor differentiation for early gastric cancer according to patients' age. We investigated the association between serum gastrin levels, gastric acid secretion and the histologic types of 335 early gastric carcinomas limited to the mucosal and submucosal layers in comparison with 450 gastric and 197 duodenal ulcers. The preoperatively examined basal acid output, maximal acid output and peak acid output after administration of tetragastrin and serum gastrin levels before and after ingestion of a test meal were determined. Patients with differentiated cancer and duodenal ulcer showed a significant negative correlation between gastric acid secretion and age, while the former group also had a significant positive correlation between serum gastrin levels and age. On the other hand, patients with undifferentiated cancer did not show any such correlation between gastric acid and age, but showed a significant positive correlation between serum gastrin, integrated gastrin response and age. Patients with gastric ulcer did not show any such correlations. These data suggest that both low acid secretion and endogenous hypergastrinemia, especially in the elderly, may play an important role in differentiated and undifferentiated gastric carcinomas.

NAP-I is a functional homologue of TAF-I that is required for replication and transcription of the adenovirus genome in a chromatin-like structure

BACKGROUND

For the activation of replication and transcription from DNA in a chromatin structure, a variety of factors are thought to be needed that alter the chromatin structure. Template activating factor-I (TAF-I) has been identified as such a host factor required for replication of the adenovirus (Ad) genome complexed with viral basic core proteins (Ad core). TAF-I also stimulates transcription from the Ad core DNA.

RESULTS

Using mutant TAF-I proteins, we have demonstrated that the acidic stretch present in the carboxyl terminal region is essential for the stimulation of transcription from the Ad core. A genomic footprinting experiment with restriction endonuclease has revealed that TAF-I causes a structural change in the Ad core. TAF-I has been shown to have significant amino acid similarity to nucleosome assembly protein-I (NAP-I), which is involved in the formation of the chromatin structure. We have shown that TAF-I can be substituted by NAP-I in the activation of the cell-free Ad core transcription system. Two of the tripartite acidic regions and the region homologous to TAF-I in NAP-I are required for the maximal TAF-I activity of NAP-I. Furthermore, TAF-I has been shown to have NAP-I activity, and the acidic region of TAF-I is required for this activity.

CONCLUSIONS

Since TAF-I causes the structural change of the Ad core and thereby activates transcription, TAF-I is thought to be one of the proteins which is involved in chromatin remodeling. NAP-I is structurally related to TAF-I and functionally substitutes for TAF-I. Furthermore, TAF-I has NAP-I activity. These observations suggest that this type of molecule has dual functions, possibly by participating in facilitating the assembly of the chromatin structure as well as perturbing the chromatin structure to allow transcription to proceed.

Isolation of fungi from nature in the region of Botucatu, state of São Paulo, Brazil, an endemic area of paracoccidioidomycosis

In an attempt to isolate Paracoccidioides brasiliensis from nature 887 samples of soil from Botucatu, SP, Brazil, were collected cultured in brain heart infusion agar supplemented with dextrose, in potato dextrose agar and in yeast extract starch dextrose agar, all with antibiotics, at 25 degrees and 37 degrees C. Five thermo-dependent dimorphic fungi morphologically resembling P. brasiliensis were isolated; two from armadillo holes; further studies of the biology, antigenicity and genetic features of the five dimorphic fungi are necessary to clarify their taxonomy and their possible relation to P. brasiliensis. In addition, 98 dematiaceous fungi and 581 different species of Aspergillus spp. were also isolated. Our findings emphasize that armadillos and their environment are associated with thermo-dimorphic fungi and confirm the ubiquity of pathogenic dematiaceous fungi and Aspergillus spp.

Ubiquinone systems of the genus Cladosporium and morphologically similar taxa

The ubiquinone (coenzyme Q) systems of 14 species of Cladosporium were determined. The genus was divided into two groups based on the distribution of the major ubiquinones, Q-10 and Q-10(H2). The group containing Q-10 consisted of six species, four of which were human pathogens, whereas the group containing Q-10(H2) consisted of eight plant pathogenic and/or saprophytic species. The results presented here agree with phylogenetic and physiological studies which have shown that the human-pathogenic species of Cladosporium represent a homogeneous, cohesive group.

Security implementation issues in Japan

A survey was conducted in the year 1994 among medical school hospitals in Japan to know whether there are some written rules or regulations about the use of medical information, and whether they are well matched both to secure patient's privacy and to promote the adequate use of the information. A questionnaire was mailed to 80 medical school hospitals in Japan and 65 of them responded. Besides copies of rules, questioners were also requested for detailed investigation. Twenty nine hospitals responded to our request. The security implementation issues in Japan will be discussed using data thus obtained.

Paracoccidioides brasiliensis infection in nude mice: studies with isolates differing in virulence and definition of their T cell-dependent and T cell-independent components

Athymic and euthymic BALB/c mice infected with highly (Pb18) or slightly (Pb265) virulent Paracoccidioides brasiliensis isolates were compared regarding mortality, presence of viable yeasts, specific immunoglobulin M (IgM) and IgG titers, and the antigen recognition patterns of these antibodies. Isolate Pb18 caused a more severe disease in athymic mice, as supported by higher number of infected organs and shorter survival times. These animals, however, were resistant to Pb265 infection. High titers of antibodies were found only in euthymic mice, seven weeks after Pb18 infection. At this time, euthymic animals presented IgG antibodies to numerous protein bands that were not detected at four weeks postinfection or after Pb265 inoculation. In contrast, antibodies from athymic mice always reacted with few antigen bands. Although the majority of P. brasiliensis antigens are T cell-dependent, the immunodominant gp43 and also the 41.5- and 27.5-kD antigens are here, for the first time, characterized as T cell-independent antigens of P. brasiliensis.

Determination of ploidy in Cryptococcus neoformans by flow cytometry

We determined the ploidy of Cryptococcus neoformans (28 strains) isolated from patients and nature. The cellular DNA content of these strains, which stained with propidium iodide in comparison to that of two authentic haploid strains, was determined by flow cytometry. All the strains exhibited diphasic histograms. In case of the authentic haploid strains, the first peak was centred around channel 9, and the second peak around channel 18. Most strains exhibited this type of histogram. Some strains exhibited another type of histogram: the first peak was centred around channel 18, and the second one around channel 35. In flow cytometry, the channel number is correlated with the intensity of fluorescence, namely, in proportion to the channel number the DNA content in the cells increases. The cellular DNA content of the second type of histograms showed twice that of the authentic haploid strains, and thus, five of 28 isolates were concluded to be diploid, and the others haploid.

Enhancing effects of vasoconstrictors on bile flow and bile acid excretion in the isolated perfused rat liver

The effects of vasoconstrictors on bile flow and bile acid excretion were examined in single-pass isolated perfused rat livers. Administration of norepinephrine (NE), 4 nmol/min, plus continuous infusion of taurocholate (TC) (1.0 mumol/min) rapidly increased bile flow in 1 min, and from min 5 until the end of NE administration (late period) bile flow remained above the basal level (111.7 +/- 2.2%), as did bile acid output (114.6 +/- 1.8%). Without TC infusion, administration of NE produced no increase in the late period. Administration of NE plus taurochenodeoxycholate (1.0 mumol/min) increased bile flow and bile acid output in the late period to 121.9 +/- 7.0 and 137.1 +/- 6.8%, respectively. With NE plus taurodehydrocholate, the respective values were only 105.4 +/- 1.6 and 104.1 +/- 4.0%. When horseradish peroxidase (HRP) (25 mg) was infused over 1 min with continuous NE, the late peak (20-25 min) of HRP elimination into bile significantly exceeded that of untreated controls (P < 0.01). These observations suggest that vasoconstrictors enhance biliary excretion of more hydrophobic bile acids, in part by stimulating vesicular transport.

Histopathology of paracoccidioidomycotic infection in athymic and euthymic mice: a sequential study

We report the comparative and sequential histologic analysis of lesions developed by Paracoccidioides brasiliensis-infected athymic and euthymic BALB/c mice, using conventional and specific stain to characterize the morphology of fungi and inflammatory cells as well as the extracellular matrix patterns. In both groups, neutrophils and macrophages were the predominant cells; macrophage transition to giant and epithelioid cells was observed. Degenerated fungi and fungal dust were associated with local neutropil infiltration and the presence of pseudoxantomatous macrophages. Paracoccidioides brasiliensis are always found within an extracellular matrix microenvironment. The main differences between lesions developed by nu/+ and nude (nu/nu) mice resided in the more pronounced encapsulating tendency in the former ones. In both groups of animals, lesions in several organs were associated with extensive hemopoiesis. At the first week of infection, there was evidence of fungal destruction and control of its proliferation in both mouse groups. At the fourth and seventh weeks, nu/+ mice maintained the control of the infection, as shown by the scarce numbers of budding yeast cells, while experimental nu/nu mice showed a tumor-like progression of the disease with a striking increase in fungal load in many organs (e.g., omental and mesenteric milky spots, lymph nodes, spleen), some of which present their structure replaced by granulomatous lesions.

Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones

OBJECTIVES

We performed extracorporeal shock wave lithotripsy (ESWL) as the treatment of first choice on 32 chronic pancreatitis patients with main pancreatic duct (MPD) stones prospectively to establish more convenient and safer treatment.

METHODS

All patients were treated in a prone position, and shock waves were discharged from the ventral side. ESWL was performed once or twice a week, and no other treatments before ESWL had been applied.

RESULTS

Disintegration of all MPD stones to 3 mm or less in diameter could be achieved in all treated patients. Complete clearance of the stones was obtained in 24 patients (75%) without the necessity of endoscopic extraction of fragments. Reduction of MPD diameters after ESWL was statistically significant (p < 0.01). Epigastric and/or back pain complaints before ESWL were completely alleviated in 79% (periods of follow-up: 16-63 months, mean 44), and the pancreatic exocrine function also improved in 61%. No severe complications occurred in any of the patients.

CONCLUSIONS

ESWL, which is comparatively easy to perform, is a safe and efficient approach that changes endoscopy's status as an indispensable pretreatment. Therefore, ESWL can be recommended as the first choice treatment for patients with chronic pancreatitis accompanied by MPD stones that should be tried before consideration of either surgical or endoscopic procedures.

[A case of advanced gastric cancer with liver metastasis with no recurrence and long survival]

A 61-year-old male was admitted after detecting gastric lesion by gastrography in a medical health examination. The patient was diagnosed as Borrmann 2 advanced gastric cancer with remarkable intraperitoneal lymph node metastasis and liver tumor of lateral segment. Relative non-curative gastrectomy was performed with combined partial hepatectomy. The liver tumor measured 1.5 x 1.5 cm and was intraoperatively diagnosed as metastasis of gastric cancer. Mitomycin C 26 mg was given intravenously on the day of operation and 5-fluorouracil (5-FU) 150 mg/day orally since postoperative 14th day as adjuvant chemotherapy. The administration of 5-FU was continued for 5 years. As a result of such combination therapy, the patient still has had no recurrence 8 years following operation.

Phylogeny of Epidermophyton floccosum and other dermatophytes

Eleven strains of Epidermophyton floccosum were compared with 5 Microsporum and 5 Trichophyton species with respect to the restriction fragment length polymorphism (RFLP) of the mitochondrial DNA to reveal their phylogenetic relationships. The phylogeny of 11 species showed that the three dermatophyte genera could not be separated from each other and could be considered to be congeneric. This result is not inconsistent with the results from ribosomal RNA sequences.

Bile secretion in rats with indomethacin-induced intestinal inflammation

The objective of this study was to characterize the bile secretion, including the composition of biliary bile acids, bile salt pool size, and transcytotic vesicle transport, in a rat model of subacute intestinal inflammation induced by indomethacin. Indomethacin treatment significantly decreased bile acid-independent bile flow and biliary secretion of bile acid and cholesterol, while increasing biliary phospholipid output in vivo. Although indomethacin treatment did not change the bile salt pool size in vivo, alpha- and beta-muricholic acids were significantly deceased and hyodeoxycholic and deoxycholic acids were increased in bile. Bile flow and the transport maximum of taurocholate did not decrease, and biliary horseradish peroxidase output was significantly enhanced in isolated perfused livers from indomethacin-treated rats. Endotoxin in the portal blood was significantly increased in rats treated with indomethacin. Clindamycin slightly reduced intestinal inflammation but significantly prevented decreases in bile flow, bile acid output, and transport maximum of taurocholate. We conclude that, although biliary secretory function was apparently decreased in vivo, that of hepatocyte function was maintained in this model.

A new type of growth exhibited by Trimmatostroma abietis

Trimmatostroma abietis initially grew as hyphae when grown in various media containing yeast extract or bactopeptone. It grew as segmented elements (lumbricoid elements) characterized by bidirectional growth, when grown in Czapek-Dox broth or yeast nitrogen base supplemented with 1% glucose. A lumbricoid element usually was 10-70 microns in length, with transverse septation only and contained 3 to 15 cells. Growth and propagation, as revealed by time-lapse photomicrography occurred as follows. Elements usually grew by apical elongation without widening; after simple apical elongation adjacent parts of two central cells eventually started to grow, resulting in the separation of the element into two.

Mitochondrial DNA analysis of Sporothrix schenckii in Costa Rica

Mitochondrial DNA (mtDNA) types using restriction patterns with HaeIII were investigated in 21 clinical isolates of Sporothrix schenckii in Costa Rica. Nineteen isolates were found to be a new mtDNA type (Type 14), while the remaining two were Type 3 and Type 6. Based on the phylogeny of 14 mtDNA types constructed by estimating sequence divergences of mtDNA, S. schenckii were clustered into two main groups: Group A and Group B, with Type 14 and Type 3 included in Group A, and Type 6 in Group B. The results suggest that isolates of Group A may exist mainly in Central America including Costa Rica.

Different rifampicin inactivation mechanisms in Nocardia and related taxa

Mycolic acid-containing bacteria inactivate rifampicin in a variety of ways such as glucosylation, ribosylation, phosphorylation and decolorization. These inactivations were found to be a species-specific phenomena in Nocardia and related taxa. Gordona, Tsukamurella and fast-growing Mycobacterium modified rifampicin by ribosylation of the 23-OH group of the antibiotic. Such ribosylation was not observed in Rhodococcus and Corynebacterium, but phosphorylation of the 21-OH group of rifampicin was observed in one strain of Rhodococcus. Nocardia modified the antibiotic by glucosylation (23-OH group) and phosphorylation, but ribosylation was not observed.

Effect of methyl linoleate hydroperoxides on murine natural killer cell-mediated cytotoxicity

Methyl linoleate hydroperoxides (MLHPO), a model for lipid hydroperoxides, suppressed murine natural killer (NK) cell-mediated cytotoxicity to YAC-1 cells. When NK cells were cultured with MLHPO, the conjugation of NK cells could not lyse YAC-1 cells. These findings suggest that NK cell-mediated cytotoxicity can be suppressed by lipid hydroperoxides.

Cell-surface hydrophobicity and lipolysis as essential factors in human tinea nigra

Hydrophobic adhesion of cells of the black yeast Hortaea werneckii (Horta) Nishimura & Miyaji, causative agent of human tinea nigra, was established by microbial adhesion to hexadecane (MATH) and adhesion to polystyrene, and compared with adhesion of other species of black yeasts. Additional ecophysiological tests were performed. Hortaea werneckii cells proved to have a high degree of hydrophobicity (98.5% MATH). The species is unable to degrade keratin, but shows significant lipolytic activity. It is concluded that H. werneckii is a commensal, that shows lipophilic adhesion to human skin and survives by the assimilation of excretion products.

A human isolate of Exophiala (Wangiella) dermatitidis forming a catenate synanamorph that links the genera Exophiala and Cladophialophora

A strain of the black yeast Exophiala dermatitidis displayed a hydrophobic synanamorph consisting of acropetal chains of lemon-shaped conidia, morphologically similar to those of Cladophialophora bantiana. The occurrence of the two conidial types in a single strain suggests a taxonomic affinity between Exophiala and Cladophialophora and provides support to the supposition that Cladophialophora, a possible anamorph genus of Herpotrichiellaceae, is related to black yeasts rather than to Cladosporium, which has teleomorphs in the Mycosphaerellaceae.

Mitochondrial DNA analysis of Exophiala spinifera

Restriction fragment length polymorphism (RFLP) of mitochondrial DNA (mtDNA) was examined in 36 isolates of Exophiala spinifera (8 isolates from Brazil, 9 from China, 15 from Columbia, 1 from the United States and 2 from Venezuela). E. spinifera isolates displayed a high degree of mtDNA diversity in RFLP patterns and were clustered into six genetically heterogeneous groups (Group 1 through Group 6). Isolates of Group 2 including the type strain seemed to have a worldwide distribution. RFLP patterns of E. spinifera were also distinct from those of other dematiaceous fungi, such as E. jeanselmei, E. moniliae, E. dermatitidis, Fonsecaea pedrosoi, Cladosporium carrionii and Phialophora verrucosa. These results indicate that E. spinifera may be a taxonomic complex and that RFLP patterns will be useful in the identification, typing and epidemiology of the E. spinifera variants.

Rifampicin inactivation by Bacillus species

The ability of strains of Bacillus, Staphylococcus, Pseudomonas, and Escherichia coli to inactivate rifampicin was tested. Most Bacillus strains were found to inactivate rifampicin. Two modes of inactivation were identified; one was phosphorylation and the other involved decolorization. Presence or absence of either mechanism appeared unrelated to the phylogenetic relatedness of strains. None of the other organisms could inactivate this antibiotic.

Conidial surface ultrastructure of human-pathogenic and saprobic Cladosporium species

Freeze-fracturing of outer wall layers of Cladosporium conidia revealed two types of ultrastructure, coinciding with taxonomic characteristics. The outer conidial layers were essentially smooth in the human pathogenic species, C. bantianum, C. carrionii, and C. trichoides. In contrast, mosaic arrays of rodlets on conidia were observed with freeze-fracturing in the saprobic species, C. cladosporioides, C. coralloides, C. herbarum, C. sphaerospermum, and C. variabile. Conidia of C. elatum were an exception among the saprobic species as they had smooth surfaces. The present study supports the suggestion that the human pathogenic Cladosporium species should be transferred to another genus.

Unbudded G2 as well as G1 arrest in the stationary phase of the basidiomycetous yeast Cryptococcus neoformans

Stationary-phase cells of Cryptococcus neoformans displayed two morphological characteristics: virtually all the cells were unbudded even in the early stationary phase and even when grown in rich media, and average cell size increased from that of exponential-phase cells. DNA contents for small and large stationary-phase cells were determined by quantitative fluorescence microscopy after DNA staining with propidium iodide or DAPI. Small cells contained G1 DNA, whereas large unbudded cells had either a G2 or G1 DNA content, indicating that Cr. neoformans can enter into the stationary phase from either the G1 or G2 period.

[An outbreak of acute pulmonary histoplasmosis among travelers to a bat-inhabited cave in Brazil]

Histoplasmosis is known to be endemic in various parts of the world, especially in North and Latin America. In Japan, Histoplasma capsulatum has rarely been isolated from the natural environment. To date, only seven cases of histoplasmosis have been reported in Japan including some that were contracted in foreign countries. Herein, we report the occurrence of acute histoplasmosis among Japanese travelers who were exposed to bat guano in a cave near Manaus, Brazil. A group of 8 Japanese travelers entered a cave for a total of 2 hours in March, 1993. All the visitors had been healthy and had no history of abnormal chest roentgenograms. From 10 to 20 days after the exposure, 7 (87.5%) of the 8 individuals developed abnormal symptoms including fever, malaise, loss of appetite, myalgia, arthralgia, chest pain and dry cough. Five (62.5%) had nodular infiltrative shadows with or without hilar lymphadenopathy in the chest roentgenograms. Eight (100%) of the individuals showed serologic evidence of histoplasmosis. Despite the small number of subjects, this high rate of infection may be related to the fact that the subjects stayed in an enclosed area where air exchange was minimal, at the end of a deep cave infested with numerous bats. The cave involved has never been documented as being endemic for histoplasmosis. The threat of H. capsulatum infection in bat-inhabited caves should be emphasized to travelers and also to physicians.

Ribosylation by mycobacterial strains as a new mechanism of rifampin inactivation

Several fast-growing Mycobacterium strains were found to inactivate rifampin. Two inactivated compounds (RIP-Ma and RIP-Mb) produced by these organisms were different from previously reported derivatives, i.e., phosphorylated or glucosylated derivatives, of the antibiotic. The structures of RIP-Ma and RIP-Mb were determined to be those of 3-formyl-23-[O-(alpha-D-ribofuranosyl)]rifamycin SV and 23-[O-(alpha-D-ribofuranosyl)]rifampin, respectively. To our knowledge, this is the first known example of ribosylation as a mechanism of antibiotic inactivation.

Comparative studies on bile flow and biliary lipid excretion after bile-acid loading in normal and partially hepatectomized rats

This study was performed to investigate sequential changes in bile secretion and biliary lipids after taurocholic acid (TCA) loading of regenerating rat liver. TCA was administered intravenously at stepwise-increasing doses to groups of non-operated control and partially hepatectomized rats, 24, 72 and 168 h after surgery. Bile flow, bile-acid output (BAO) and phospholipid output (PLO) (expressed per gram of liver) in partially hepatectomized rats increased more than in the controls. Using an isolated perfusion rat-liver system, TCA infusion was also carried out on groups of non-operated control and hepatectomized rats 72 h after operation. Again bile flow, BAO and PLO (expressed per gram of liver) were significantly higher in the partial hepatectomy case, mirroring the results obtained in vivo. When horseradish peroxidase (HRP) was pulse-loaded in isolated perfusion preparations, the second peak of biliary HRP secretion in hepatectomized rats was significantly higher than in controls. We conclude that increased bile-acid flow in partially hepatectomized rats is dependent upon acceleration of vesicular transport accompanying or following proliferation in regenerating livers.

[Two cases of thymic cyst]

Thymic cysts were diagnosed by thoracotomy in two women with leprosy, both 64 years old, within 12 months. Both were asymptomatic and an abnormal mediastinal shadow on an annual screening chest radiograph was a clue to the diagnosis in both cases. According to retrospective studies it took at least six or seven years for the thymic cysts to become large enough to be detected. Real-time echography was effective in the diagnosis of a cystic lesion in one case. Thymic cysts are important cystic lesions rarely found in the anterior mediastinum. A resective operation is thought to be indispensable to differentiate them from thymomas accompanied by large cystic degeneration and from thymic cysts accompanied by malignancies.