In vitro and in vivo antibacterial activities of KRM-1648 and KRM-1657, new rifamycin derivatives

The in vitro and in vivo antibacterial activities of the new rifamycin derivatives KRM-1648 and KRM-1657 were compared with those of rifampin. Rifabutin, ciprofloxacin, and clarithromycin were also tested for reference. The respective MICs of KRM-1648 and KRM-1657 for 90% of the strains tested (MIC90S) were 0.016 and 0.0078 microgram/ml, respectively, for methicillin-susceptible Staphylococcus aureus, 0.016 and 0.0039 microgram/ml, respectively, for methicillin-resistant S. aureus, and 0.0625 and 0.016 microgram/ml, respectively, for methicillin- and quinolone-resistant S. aureus. These MIC90S of KRM-1657 were equal to or 2- to 64-fold lower than those of rifampin. KRM-1648 and KRM-1657 with MIC90S of between 0.002 and 0.078 microgram/ml were 2- to 128-fold more active than rifampin against Staphylococcus epidermidis and Streptococcus species, including Streptococcus pneumoniae and Streptococcus pyogenes. The MIC90S of KRM-1657 for Haemophilus influenzae and Neisseria gonorrhoeae were 0.25 and 0.1 microgram/ml, respectively; KRM-1657 was almost as active as rifampin and was 8- to 16-fold more active than KRM-1648 against these strains. The frequency of occurrence of spontaneous mutations to resistance to KRM-1648 and KRM-1657 was equal to that to rifampin. Against systemic infection with S. aureus in mice, the efficacies of KRM-1648 and KRM-1657 were comparable to that of rifampin.

Preparation and evaluation of suppositories for RK-28 (a new radiosensitizer) using rabbits

The pharmacokinetics of RK-28 [1-(4-hydroxy-2-butenoxy)methyl-2-nitroimidazole], a new hypoxic cell radiosensitizer, was studied following intravenous, oral, and rectal administration to rabbits. After an oral administration of RK-28 solution, the plasma concentration of RK-28 was considerably lower than that after intravenous administration through all time periods, and the absolute bioavailability was a mere 4.2%. It was presumed that a specific acid-catalized decomposition of RK-28 progressed in the stomach, and also, the absorbed RK-28 suffered first-pass effects in the liver. In contrast, the absolute bioavailability following the rectal administration of a solidified RK-28 suppository preparation was significantly increased in comparison with that obtained by other administration routes. Also, RK-28 emulsion suppositories were prepared by emulsifying various amounts of the drug with 1-hexadecanol and hydrogenated castor oil (HCO 60) at 80 degrees C, and these were administered into the rabbit rectum. The resulting absolute bioavailability was 91% for the RK-28 emulsion suppository and 86.9% for an RK-28 emulsion suppository containing small amounts of Eudispert hv. These values were better than those in rats. The rectal administration of the RK-28 emulsion suppository containing small amounts of Eudispert hv showed a preferable plasma concentration-time pattern that reflects on radiation therapy.

[Low concentrations of epinephrine can augment shear stress-induced platelet aggregation]

Platelet aggregation induced by shear stress is distinct from that induced by an agonist such as ADP or collagen. The physiological significance of shear-induced platelet aggregation was investigated by measuring the effects of the presence of physiological concentrations of epinephrine. Blood samples were taken from 10 normal volunteers who had received no drugs known to interfere with platelet functions for 1 month preceding the study. Blood was mixed with 1/10 volume of 3.1% sodium citrate solution. Platelet-rich plasma and platelet-poor plasma were prepared by centrifugation at 100 g for 15 min and 2,000 g for 15 min, respectively. The platelet count of platelet-rich plasma was adjusted to 3 x 10(5)/microliters. Shear-induced platelet aggregation in platelet-rich plasma was determined using a modified cone and plate viscometer controlled by a personal computer system. The intensity of light transmission was continuously recorded. The percent platelet aggregation was calculated according to the Lambert-Beer equation. Platelet aggregation occurred under both low (12 dyn/cm2) and high (108 dyn/cm2) shear stress. More significant aggregation was observed under high shear stress. The maximum percent platelet aggregation was 44.7 +/- 13.4%, which increased to 53.3 +/- 10.0% in the presence of 10 pg/ml epinephrine. With 100 pg/ml of epinephrine, shear-induced platelet aggregation induced by 12 dyn/cm2 shear significantly increased, but the effects on shear-induced platelet aggregation of 108 dyn/cm2 shear were not uniform. Shear-induced platelet aggregation is enhanced by physiological concentrations of epinephrine, which may be a cause of arterial thrombotic occlusion in sympathomimetic states.

Portosystemic shunt for orthotopic liver transplantation in the rat

Despite several technical improvements, orthotopic liver transplantation (OLT) in the rat remains the most difficult experimental microsurgical transplant to perform. The short anhepatic phase tolerated by the rat makes it difficult for beginners to perform the suprahepatic and portal vein anastomoses in the limited time available. To overcome this obstacle, we examined the ability of a portosystemic shunt, induced previously by subcutaneous transposition of the spleen (STS), to decompress the portal system during hepatic pedicle clamping and thus prolong the anhepatic phase of OLT in the rat. Effective drainage was shown by the ability of rats subjected to STS 3 weeks previously to survive portal pedicle clamping of 120 min, while normal rats all died after 90 min of clamping. We demonstrated that, in STS rats, OLT performed with an anhepatic phase of 1 hr had 100% survival at 1 week, while this procedure caused 100% death in normal rats. The ablation in STS rats of the drastic pH decrease and appearance of endotoxins seen in the portal blood of normal rats subjected to "OLT-like" clamping corroborated these results. This application of the STS model to the field of OLT has already proved in our laboratory to be extremely useful during the surgical learning phase of liver transplantation in the rat.

Regional changes in muscle mass and strength following 20 days of bed rest, and the effects on orthostatic tolerance capacity in young subjects

To this day, many studies have suggested that prolonged bed rest (BR) affects on muscle mass and strength not only in gravity muscles but also in ungravity muscles. However, it is still unclear whether the decrease in regional muscle strength after BR is due to the alterations in the corresponding muscle mass, or not. On the other hand, if BR decreases the mass of antigravity muscles (UGM) as well as muscle strength and then increases tissue compliance of the antigravity muscles, orthostatic tolerance capacity will be decreased by the reduction in cardiac output (CO) in spite of the increase in myocardial contractility because the more decrease in venous return due to the more increase in blood pooling within the compliant tissues of the lower body. However, this is also unclear. To make these questions clear, the present study investigated the regional muscle mass and strength and orthostatic tolerance capacity before and after 20 days of bed rest in young subjects.

Dissociation as a result of phosphorylation of an aggregated form of the small stress protein, hsp27

We have found that the small stress protein, hsp27, exists in extracts of U251 MG human glioma cells in two forms: a large or aggregated form (L-hsp27, 300-400 kDa) and a small or dissociated form (S-hsp27, < 70 kDa), as indicated by centrifugation on sucrose density gradients. Dissociation of L-hsp27 to S-hsp27 was enhanced by incubation of cells with phorbol 12-myristate-13 acetate, interleukin-1 alpha, tumor necrosis factor alpha, or okadaic acid, all of which are known to enhance or mimic the effects of phosphorylation of hsp27 without stimulation of its synthesis. Exposure of cells to chemical stressors, namely, NaAsO2 and CdCl2, also enhanced the dissociation of L-hsp27. hsp27 that had been labeled with [32P]H3PO4 in U251 MG cells was detected mostly in fractions that contained S-hsp27, and the incorporation of radioactivity to S-hsp27 was enhanced under conditions that stimulated the dissociation of L-hsp27. L-hsp27 present in the (NH4)2SO4 fraction (0-50% saturation) of cell extracts were dissociated to 32P-labeled hsp27 when incubated in the presence of [gamma-32P]ATP and Mg2+. These results indicate that the molecular configuration of hsp27 in cells is determined in part by phosphorylation and dephosphorylation of this protein by protein kinase(s) and phosphatase(s) and, moreover, that the rapid dissociation of the aggregated form of hsp27 by phosphorylation might be involved in a cellular defense mechanism for protection against stress.

Specificity of chitosanase from Bacillus pumilus

Partially (25-35%) N-acetylated chitosan was digested by chitosanase from Bacillus pumilus BN-262, and structures of the products, partially N-acetylated chitooligosaccharides, were analyzed in order to investigate the specificity of the chitosanase. The chitosanase produced glucosamine (GlcN) oligosaccharides abundantly, indicating that the chitosanase splits the beta-1,4-glycosidic linkage of GlcN-GlcN. The chitosanase also produced hetero-oligosaccharides consisting of glucosamine and N-acetyl-D-glucosamine (GlcNAc). Three types of the hetero-oligosaccharides purified by cation-exchange chromatography and HPLC were found to have GlcNAc residue at their reducing end and GlcN residue at their non-reducing end, indicating that the chitosanase can also split the linkage of GlcNAc-GlcN. The determination of the mode of action toward partially N-acetylated chitosan enables a classification of chitosanases according to their specificities and a more precise definition of chitosanases.

[Treatment results of radical nephrectomy for relatively confined small renal cell carcinoma--translumbar versus transabdominal approach]

We performed radical nephrectomy for 166 patients with renal cell carcinoma over 25 years period between 1967 and 1991. Among them, 49 patients had stage T1-3 NOMOVO tumors less than 6 cm in maximum diameter. Twenty-seven of them received radical nephrectomy by a modified translumbar approach whereas the conventional transabdominal approach was applied to the remaining 22 patients. We retrospectively studied treatment results of the 49 patients to evaluate the current translumbar approach. There was no significant difference in the age and sex distribution of the patients, and the size, stage, grade and histological subtype of the tumor between translumbar and transabdominal groups, although the incidence of venous invasion (pVla) was significantly greater in translumbar group. Statistical analysis revealed shortened operating time, decreased blood loss and quickened postoperative recovery (resuming oral intake or walking) in translumbar group as compared to those in transabdominal group. No major complication was observed in both groups. There was no significant difference in actuarial survival rate or disease-free survival period between the two groups. Actuarial three-year survival rate was 96% for translumbar and 89% for transabdominal group, respectively. Sites of metastasis were lung (2 patients) or bone (1 patient) in translumbar group and bone (1 patient) or unknown (1 patient) in transabdominal group. With the favorable prognosis comparable to that of transabdominal radical nephrectomy and the relatively small invasiveness, the current translumbar radical nephrectomy appears to be the choice for the patients with relatively confined small renal cell carcinoma.

Familial arteriovenous malformations of the brain--two case reports

Familial arteriovenous malformation (AVM) of the brain is an uncommon entity. A 24-year-old female presented with sudden onset of left hemiparesis due to an AVM with a hematoma in the right frontal lobe, which was surgically removed. Her 23-year-old younger sister presented with motor aphasia and right hemiparesis due to an AVM with a hematoma in the left frontoparietal lobes, which was surgically removed. Thirty-two patients in 15 families have been described in total. The mean age of these patients was 28 years, with 15 males and 17 females. Multiple AVMs occurred in four patients (12.5%), more frequently than in non-familial cases.

Serial changes in coagulant activities after thrombolytic therapy for acute myocardial infarction

Early reocclusion and bleeding complications are still unresolved problems in thrombolytic therapy for acute myocardial infarction (AMI). In the present study, 16 patients treated with either fibrin-specific tissue-type plasminogen activator (t-PA) or nonspecific urokinase (UK) were studied to determine the effects of thrombolytic therapy on serial hemostatic states. Hemostatic states of each patient were estimated by measuring various plasma markers at one- to two-hour intervals during the first six hours of therapy, daily during the next three days, and subsequently on day 7. Two markers of plasma thrombin generation, thrombin antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F 1 + 2), showed an activated coagulant state immediately after thrombolytic therapy. The amount of thrombin generation indicated by these markers showed significant positive correlation with direct markers of fibrinolysis such as fibrin degradation products (FDP), while it did not show any correlation with the markers for plasmin generation. The potential for coagulation as indicated by prothrombin time (%) decreased with thrombolysis using fibrin nonselective agents, owing perhaps to destruction of coagulant factors by free plasmin. Fibrinolytic activity induced by thrombolytic therapy for AMI caused transient activation of the coagulant system, which could contribute to early reocclusion. Fibrin nonselective agents decreased the potential for coagulation by destroying clotting factor through the generation of free plasmin. These data provide theoretical support for simultaneous administration of anticoagulant therapy with fibrin-specific thrombolytic agents.

Skin permeability of various drugs with different lipophilicity

The in vitro and in vivo skin permeability of 16 drugs with a wide span of lipophilicity (log P ranging from -0.95 to 4.40) was evaluated with an ethanol/panasate 800 (tricaprylin) (40/60) system as a lipophilic vehicle. The ethanol/panasate 800 (40/60) binary vehicle remarkably improved the in vitro skin permeability of the drugs across excised hairless mouse skin compared with ethanol or panasate 800 as single vehicles. The in vivo skin permeability of the large majority of the drugs across abdominal rat skin also showed high permeation rates and short lag times. The relationship between lipophilicity and skin permeability of the drugs from the ethanol/panasate 800 (40/60) binary vehicle indicated parabolic shapes with their peaks at much greater hydrophilic range (log P: -0.88 for in vitro, -0.83 for in vivo) compared with other past references (log P: 2-3). The results suggest that the lipophilicity of a drug is a main factor for prediction of the skin permeability of the drug and that the ethanol/panasate 800 (40/60) lipophilic binary vehicle would be a good candidate as a vehicle for future clinical application of hydrophilic drugs.

[Two case reports of recurrent mediastinitis with chronic mediastinal fistula successfully treated with muscle flap re-transposition]

We experienced two cases of recurrent poststernotomy mediastinitis with chronic mediastinal fistula. Both cases had already received muscle flaps for post operative mediastinitis. However, chronic mediastinal fistula appeared after nine months in the first case, and eleven months in the second case. We removed the infected tissue and the predgets, which were used on the ascending aorta. Then closed the wound by the muscle flap closure. The chronic fistula were closed, and the functional and cosmetic results were excellent.

Human monoclonal antibody [1-1-2D] against cancer of the uterine cervix

To obtain a human monoclonal antibody (h-MAb) against cancer of the uterine cervix, lymphocytes from the regional lymph nodes of 14 patients with cervical cancer were fused with a mouse-human heterohybridoma [II]. Of 6,419 hybridomas, 1,295 produced human immunoglobulins (IgG 670, IgM 737). We isolated clone [1-1-2D], which has produced human IgM with stability for more than a year. This antibody reacted with three of five cell lines of cervical cancer but not with normal fibroblasts. Histoimmunostaining showed positive responses to 9/15 specimens of cervical cancer and in 2/7 specimens from cases of cervical dysplasia. Most of the normal human and fetal tissues showed no positive immune response. The positive immune response of [1-1-2D] to the cell membrane observed by the fluorescence antibody method disappeared after periodate treatment and was weakened by trypsin. Neuraminidase did not affect immune reactivity. This antibody showed a positive response by the thin-layer chromatography immunostaining method and precipitated a glycoprotein having a molecular weight of 38 kD. These results suggested that the epitope of the [1-1-2D] antibody is present on a carbohydrate moiety not containing sialic acid that is carried on protein and lipid moieties.

Amniotic fluid enhances allogeneic cytotoxic T cell responses, whereas it suppresses mitogen-stimulated lymphocyte proliferation

Mouse amniotic fluid has been shown to suppress T lymphocyte proliferation and suggested to be important in regulating immunity during pregnancy. In allogeneic pregnancy, cytotoxic T cells in pregnant lymphocytes against paternal transplantation antigen are impaired. We examined the effect of amniotic fluid to the alloreactive CTL responses. Although the amniotic fluid suppressed Con A or LPS stimulated lymphocyte proliferation as previously reported, the amniotic fluid taken from syngeneic C57BL/6 pregnant mice or allogeneic C57BL/6 x BALB/c pregnant mice enhanced the anti-H-2d or anti-H-2k CTL responses dose-dependently. We speculate that amniotic fluid contains not only immunosuppressive factors but also immunoenhancing factors which upregulate the allogeneic CTL responses.

Histidyl phosphorylation and dephosphorylation of P36 in rat liver extract

Protein histidine kinase (Motojima, K., and Goto, S. (1993) FEBS Lett. 319, 75-79) and phosphatase in rat liver extract were characterized. The histidine kinase was recovered mostly in the membrane and the phosphatase in the soluble fraction. The kinase and its substrate 36-kDa protein (P36) were co-solubilized from the membrane under conditions in which most of the other kinases, and their substrate proteins were not solubilized. The solubilized kinase and P36 were co-eluted after high pressure liquid chromatography gel filtration, showing an apparent molecular mass of 70-75 kDa. They were also co-eluted after ion exchange chromatography. These characteristics, together with its complete resistance to genistein, indicate that the rat liver histidine kinase is not cognate to the yeast enzyme (Huang, J., Nasr, M., Kim, Y., and Matthews, H.R. (1992) J. Biol. Chem. 267, 15511-15515). The phosphatase that dephosphorylates histidyl-phosphorylated P36 was also studied using rat liver subcellular fractions and in vitro phosphorylated P36 as the substrate. The characteristics of the phosphatase, that is, 1) Mg2+ requirement for activity, 2) apparent molecular mass of 45 kDa by high performance liquid chromatography gel filtration, and 3) resistance to 100 microM okadaic acid, suggest that the primary phosphatase active in vitro is protein phosphatase 2C.

Targeted disruption of the CD3 eta locus causes high lethality in mice: modulation of Oct-1 transcription on the opposite strand

CD3 zeta and eta chains are components of the T cell antigen receptor (TCR) complex and are transcribed from a common gene by alternative splicing. TCR complexes containing the zeta eta dimer have been thought to mediate different functions than complexes containing the zeta 2 dimer. To analyze the role of eta in the development and function of T cells, we generated eta-deficient mice without affecting zeta by gene targeting in embryonic stem cells. Homozygous mutant embryos developed normally. Unexpectedly, however, these mice exhibited high mortality soon after birth for unknown reason(s). Analysis of surviving homozygous animals revealed that the development and function of T cells were normal in the absence of the eta chain. Recently, the zeta/eta locus was reported to encode a transcription factor, Oct-1, on the opposite DNA strand. Our targeting strategy resulted in modulation of Oct-1 transcription--reduction of the authentic Oct-1 mRNA and induction of aberrant transcripts. Although differences in tissue distribution and DNA binding capacity of Oct-1 between wild-type and eta-deficient mice were not evident from in situ hybridization and gel shift analysis, the high mortality in the eta-deficient strain may well be due to the disturbance of Oct-1 transcription by the mutation in the zeta/eta locus. Such possible complexities have to be taken into account in the interpretation of gene targeting experiments.

Three-dimensional motion of the upper cervical spine in rheumatoid arthritis

Rheumatoid arthritis frequently contributes to instability of the upper cervical spine. Rotational instability of the upper cervical spine was evaluated in rheumatoid arthritis patients using biplanar x-ray photogrammetry. Three-dimensional cervical motion and the instantaneous axis of rotation of the atlas relative to the axis were evaluated in normal and rheumatoid arthritis patients during axial rotation in the horizontal plane. Anterior atlantoaxial subluxation did not increase during axial head rotation in either the atlantoaxial subluxation or the vertical subluxation groups, while the instantaneous axes of rotation were distributed posteriorly in the dens in the RA-normal group, but were widely scattered in the atlantoaxial subluxation group.

Subdivisional ischemic injury of the unilateral striatum causes apomorphine-induced rotational behavior in rats

Behavioral and histological studies were performed on a reversible ischemia model in rats. At 60 days after unilateral transient middle cerebral artery occlusion for 30 min, the operated rats exhibited the ipsiversive rotational behavior elicited by systemic administration of dopamine receptor agonist apomorphine in a dose-dependent manner. Histologically, the ipsilateral striatum of the rats showed a subdivisional ischemic injury, while the nigral dopaminergic neurons appeared intact. The striatal lesions having a cell type-specific injury were located in the dorsolateral portion of the rostral striatum and in the lateral portion of the caudal part of the nucleus. Thus, the transient cerebral ischemia could successfully produce selective damage of a striatal subdivision, which causes an abnormality in motor controls in response to dopamine receptor stimulation. The present data may provide a part of functional and anatomical basis for understanding the movement disorders associated with basal ganglia dysfunction (e.g., parkinsonism), which may occur in patients with cerebrovascular disorders.

Disruption of the blood-cerebrospinal fluid barrier by transient cerebral ischemia

The influence of transient cerebral ischemia on blood-brain and blood-cerebrospinal fluid (CSF) barrier permeability was studied sequentially by magnetic resonance imaging (MRI) contrast enhancement using gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) in rats. The unilateral internal carotid and middle cerebral arteries were transiently occluded by inserting a nylon thread into the carotid artery and removing it following a variable interval of 5 to 60 min. Contrast enhancement of the lateral ventricle on the affected side was seen in the enhanced T1-weighted image at the early stage of reperfusion 6 h after the start of ischemia in most of the rats subjected to 30- and 60-min ischemia, and in 3 of 6 rats in the 15-min ischemia group. Autoradiograms of Gd-[14C]DTPA in rats subjected to 60-min ischemia demonstrated that the tracer strongly accumulated in the choroid plexus, the wall of the lateral ventricle and its surrounding brain tissue. On the other hand, parenchymal enhancement of the striatum was seen only in the 60-min ischemia group and appeared later on Day 1 or Day 7. These results indicate that ventricular enhancement on MRI in this model is caused by disruption of the blood-CSF barrier at the choroid plexus of the lateral ventricle. This is the first reported study to demonstrate blood-CSF barrier disruption by transient ischemia.

In vitro and in vivo changes of serotype in Pseudomonas aeruginosa isolates by anti-pseudomonal drugs

The present study was designed to clarify whether anti-pseudomonal drugs affected in vitro and in vivo changes in serotypes of Pseudomonas aeruginosa isolates. Forty-two isolates of P. aeruginosa belonging to different serotype groups were each incubated in Mueller-Hinton broth including piperacillin, cefsulodin, ceftazidime, imipenem, gentamicin or norfloxacin at 1 approximately 4 MICs at 35 degrees C for 20 hours. The bacterial cells in the media were serotyped after the incubation. In each experiment with these six drugs, serotypes of 4 (9.5%) to 8 (19.0%) of the 42 isolates changed to other different groups. There was no relationship between the serotypes of the variants formed with the anti-pseudomonal drugs and kinds of the drugs. In the case of P. aeruginosa TA-2 isolate, the different concentrations (1/2 MIC and 2 x MIC) of cefsulodin induced the distinct changes in serotypes such as the poly-agglutinable (M, G) and non-typable groups, respectively. The time course for the formation of the variant cells was investigated during the incubation of P. aeruginosa TA-2 isolate in the presence of cefsulodin, respectively. In this case, the variant cells appeared 6 hours after incubation and continued to grow together with the intact cells. On the other hand, the variant cells with anti-pseudomonal drugs (cefsulodin, imipenem and gentamicin) were also formed in the model infections in mice. The present results indicated that the co-existence of colonies with different serotypes in some isolates of P. aeruginosa was partially due to the alternation of serotypes with anti-pseudomonal drugs given to patients with infection.

Pharmacokinetics of RK-28 (a new radiosensitizer) and pharmaceutical design of a suppository form using rats

The pharmacokinetics of RK-28, a new hypoxic cell radiosensitizer, was studied in rats following its intravenous, intraportal, oral, and rectal administration. The pharmaceutical design of an RK-28 suppository form was also examined. After intravenous injection, RK-28 was rapidly removed from the plasma (biological half-life of 17 min) and its area under the curve (AUC) was proportional to the amount of RK-28 administered. The absolute bioavailability of RK-28 was 59.7% for intraportal administration and 36.9% for oral administration. Following oral administration of RK-28, it seems likely that specific acid-catalyzed decomposition of RK-28 takes place in the stomach and then the absorbed RK-28 undergoes first-pass metabolism in the liver. When "solidified RK-28 suppository," made by solidifying molten RK-28, was inserted into the rectum, hepatic first-pass metabolism could be avoided substantially. The resulting absolute bioavailability of RK-28 increased to 75%. Furthermore, "RK-28 emulsion suppository," prepared by emulsifying RK-28 with 1-hexadecanol and hydrogenated castor oil (HCO 60) at 80 degrees C, showed a plasma concentration-time curve very suitable for radiation therapy; the maximum plasma concentration was attained 30 min after rectal administration and then decreased within a short period. Administration of "RK-28 emulsion suppository," resulted in an absolute bioavailability of 76%.

[Efficacy of the "Gen-Probe Mycobacterium Tuberculosis Direct Test (MTD)" for detection of Mycobacterium tuberculosis in clinical specimens--comparison between the MTD and the test by culture on Ogawa's egg medium or in the MB Check System]

Three or more weeks are usually required for detecting Mycobacterium tuberculosis by the known culture methods, and therefore, the development of a rapid bacteriological diagnostic method for M. tuberculosis has been urgently awaited. Recently, Gen-Probe Inc. has developed the "Gen-Probe Mycobacterium Tuberculosis Direct Test (MTD)", which is based on amplification of the ribosomal RNA (rRNA) of M. tuberculosis in clinical specimens and hybridization of the amplified rRNA with a M. tuberculosis-specific DNA probe, as a rapid direct diagnostic method for tuberculosis. We therefore compared the sensitivity and specificity of the MTD in detecting M. tuberculosis with the culture methods on Ogawa's egg medium and in the MB Check System, using 107 clinical specimens as test material. The results obtained are as follows: 1. Of the 61 clinical specimens which were negative when cultured on Ogawa's egg medium, 13 (21.3%) were positive for M. tuberculosis using the MTD, and of the 48 clinical specimens which were negative when cultured in the MB Check System, 8 specimens (16.7%) were positive for M. tuberculosis using the MTD. 2. All of the specimens which yielded growth of M. tuberculosis (identified by the DNA probe) either on Ogawa's egg medium or in the MB Check System, except one, were positive for M. tuberculosis in the MTD. The only one exception was a specimen which was positive for M. tuberculosis in both Ogawa's medium and the MB Check System.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional motion analysis of the upper cervical spine during axial rotation

Rotational motion of the normal upper cervical spine was analyzed in 20 men using biplanar roentgenograms, a system digitizer, and a personal computer. To detect the bony landmarks of the atlas, the subjects' heads were fixed and their trunks rotated in the reference frame while these biplanar studies were obtained. Coupling motions observed included 10 degrees extension at C0-C1, with 11 degrees of lateral bending between C1-C2. Almost all (80%) cervical axial rotation took place at C1-C2, whereas only 4 degrees of rotation occurred at C0-C1. Furthermore, as C1-C2 axial rotation increased, so did rotation in the opposite direction at C0-C1 while less rotation was noted below C2. The instantaneous axis of rotation was located anterior to the foramen magnum at the C0-C1 level, in the central portion of the dens at C1-C2.

Two cases of Graves' disease with presentation of unilateral diffuse uptake of radioisotopes

We present two cases of Graves' disease whose initial thyroidal scintiscan with 99mTcO4- (Case 1) and 123I (Case 2) showed unilateral diffuse uptake of radioisotopes. Initial diagnosis was possibility of malignancy in Case 1 and Graves' disease or Plummer's disease in Case 2. Both cases underwent right hemithyroidectomy. Histopathology of the resected thyroid gland in both showed hyperplastic columnar epithelium and infiltrative lymphocytes which was compatible with Graves' disease. Twenty seven (Case 1) and eight months (Case 2) after operation, both presented with thyrotoxic symptoms associated with enlarged left lobe, increased serum free thyroid hormone concentrations, suppressed TSH concentration, increased thyroidal 123I uptake in the remaining left lobe, and positive thyrotropin receptor antibodies. Both cases were successfully treated with methimazole. It was concluded that initial radioisotope uptake as well as scintigram in rare subgroup of patients with Graves' disease could be similar with that of non-autoimmune autonomous goiter (Plummer's disease).