Colonoscopic diagnosis of whipworm infection

Trichuriasis is an intestinal infection found in human beings which is caused by Trichuris trichiura, more commonly known as whipworm because of its whip-like appearance. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. It is prevalent throughout the world, especially in tropical areas. Its diagnosis is usually made by identification of the typical eggs in the stool; adult whipworm is rarely seen during colonoscopy. Colonoscopy can directly diagnose trichuriasis, confirming the threadlike form of worms with an attenuated end. The worms can be overlooked, particularly if colon preparation is imperfect. Attenuated whip-like ends of whipworms, which are embedded in the colonic mucosa, were removed with biopsy forceps. We report on 5 cases of whipworm infection that were diagnosed on total colonoscopy.

Evidence that a beta-1,4-endoglucanase secreted by Acetobacter xylinum plays an essential role for the formation of cellulose fiber

Cellulose-producing Acetobacter xylinum has been known to secrete a cellulose-hydrolyzing beta-1,4-endoglucanase (CMCax). When antibodies to recombinant CMCax were added to the culture medium, the formation of cellulose fiber was severely inhibited. Western blot analysis using the antibody showed that this enzyme was secreted into the medium even by a cellulose non-producing strain (Cel-). These results indicate that beta-1,4-endoglucanase in the medium plays a critical role in the formation of cellulose fiber by the microorganism.

Anterior labroligamentous structures of the glenohumeral joint: correlation of MR arthrography and anatomic dissection in cadavers

OBJECTIVE

The purpose of this study was to establish the accuracy of MR arthrography in depicting the morphology of the glenohumeral ligaments and the superior portion of the glenoid labrum.

MATERIALS AND METHODS

Findings on MR arthrography and those derived from careful dissection of gross specimens were compared in 15 cadaver shoulders, focusing on the morphology and size of the superior and middle glenohumeral ligaments and the morphology of the inferior glenohumeral ligament. The frequencies of sublabral recess and sublabral foramen seen on MR arthrography and at anatomic dissection were also compared.

RESULTS

For the superior and middle glenohumeral ligaments, moderate correlation of size was found between measurements made on MR arthrograms and at anatomic dissection, with the Spearman's rank correlation coefficient calculated as .69990 and .71133, respectively. Morphologic descriptions of the inferior glenohumeral ligament based on MR arthrography and on anatomic dissection also showed good association (Cohen's kappa = .8936). Dissection revealed that the sublabral recess was present in 11 specimens. Of these, 10 recesses were identified on MR arthrograms. MR arthrography also revealed a sublabral recess that was not found at dissection. Four sublabral foramina were identified by both MR arthrography and dissection, and two were revealed only by MR arthrography.

CONCLUSION

MR arthrography is useful in the evaluation of the glenohumeral ligaments and the superior portion of the labrum. Anatomic variations of these anterior intraarticular structures can be accurately shown by MR arthrography. In addition, estimation of the size of glenohumeral ligaments can be achieved with acceptable accuracy on MR arthrograms.

Biliary papillomatosis: clinical, cholangiographic and cholangioscopic findings

BACKGROUND AND STUDY AIMS

Biliary papillomatosis (BP) is a very rare disease and its clinical features and outcome are not well known. The aims of this study were to describe the characteristic cholangiographic findings and to define the role of cholangioscopic examination in the diagnosis and treatment of this disorder.

PATIENTS AND METHODS

Nine patients (six men and three women, mean age 57 years) were diagnosed as BP among 5361 cases of endoscopic retrograde cholangiography (ERC) from 1990 to 1997 in our institution. The cholangiographic and cholangioscopic findings as well as clinical features were retrospectively analyzed.

RESULTS

ERC findings showed multiple small, round-to-ovoid filling defects in the bile duct and ductal wall irregularity in all the patients. Seven out of nine patients underwent percutaneous transhepatic cholangioscopic (PTC) examination. Additional small papillary lesions in the intrahepatic bile duct were detected by cholangioscopic examination in four patients whose ERC findings only revealed the extrahepatic lesions. Two of these four patients underwent curative resection. In these two patients, the initial surgical plan was changed from Whipple's operation to hepatico-pancratico-duodenectomy after preoperative cholangioscopic examination due to the detection of new lesions in the intrahepatic bile duct.

CONCLUSIONS

ERC findings of BP were highly characteristic. When BP is suspected by conventional imaging including ERC, preoperative percutaneous transhepatic cholangioscopic examination is, however, strongly recommended. This procedure may be beneficial to precisely determine the ductal extension of the disease, hence to decide whether or not hepatic resection is needed as well as to confirm the histology.

Expression of MUC1 and MUC2 mucins in gastric carcinomas: its relationship with the prognosis of the patients

Our previous immunohistochemical studies for the expression of MUC1 mucin antigen (which was detected by monoclonal antibody DF3) and MUC2 mucin antigen (which was detected by polyclonal antibody anti-MRP) in pancreatic and intrahepatic bile duct tumors demonstrated that invasive carcinoma with poor outcome showed a pattern of MUC1+ and MUC2- expression, whereas many of the noninvasive tumors with favorable outcome showed a pattern of MUC1- and MUC2+ expression. To clarify the relationship between the expression of these mucin antigens and the biological properties of gastric cancers, the expression of MUC1 and MUC2 mucin antigens was examined immunohistochemically in 136 patients with gastric cancer invading the submucosa or the deeper layer, and the survival of the antigen-positive and antigen-negative patient groups was compared using the Kaplan-Meier method. For MUC1 mucin expression, different glycoforms of MUC1 were examined using four monoclonal antibodies (NCL-MUC-1-CORE, DF3, MY.1E12, and HMFG-1). The patients with MUC1+ mucin antigen staining in the carcinoma showed significantly worse survival than those with MUC1- mucin antigen staining. In contrast, the patients with MUC2+ mucin antigen staining in the carcinoma showed significantly better survival than those with MUC2- mucin antigen staining. In conclusion, MUC1 antigen expression was associated with a poor outcome in patients with gastric cancer, irrespective of its glycosylation status, and MUC1 is thus considered to be a useful prognostic factor for poor outcome in patients. In contrast, MUC2 antigen expression is a prognostic factor associated with a favorable outcome in patients. In addition, combined evaluation of the MUC1 and MUC2 mucin staining is clinically useful to predict outcome in patients with gastric cancer.

A gene cluster encoding malonyl-CoA decarboxylase (MatA), malonyl-CoA synthetase (MatB) and a putative dicarboxylate carrier protein (MatC) in Rhizobium trifolii--cloning, sequencing, and expression of the enzymes in Escherichia coli

A gene cluster consisting of three consecutive genes, matABC, was isolated using a probe prepared from amino acid sequence information of Rhizobium trifolii malonyl-CoA synthetase, and was subsequently sequenced. The sequences of matA and matB were overlapped by four base pairs, whereas the intergenic region between matB and matC had 95 base pairs. The upstream region contained DNA sequences which are typical for an Escherichia coli sigma70 promoter, and no other open reading frame was found within 400 bp downstream of matC. The ribosome-binding sites were found 7 to 12 base pairs upstream of each gene. MatA gene encoded a polypeptide of 462 amino acid residues, with deduced molecular mass of 51414 Da. A glutathione-S-transferase-MatA fusion protein has been purified and MatA was shown to have an intrinsic malonyl-CoA decarboxylase activity (Km = 0.47 mM; Vmax = 52 micromol x min(-1) x mg(-1)). MatB encoded a polypeptide of 504 amino acid residues with deduced molecular mass of 54612 Da. MatB was also purified from E. coli transformant carrying the gene cluster. The enzyme was essentially indistinguishable from the wild-type malonyl-CoA synthetase of R. trifolii by the criteria of polyacrylamide gel electrophoresis and biochemical properties. MatC encoded a 46453-Da protein with a high content of hydrophobic residues. The deduced amino acid sequences of matC showed identity to some extent with anaerobic C4-dicarboxylate carrier proteins from E. coli (25%) and Haemophilus influenzae (17%). MatC protein appears to be an integral membrane protein that could function as a malonate carrier. The formation of acetyl-CoA and malonyl-CoA from malonate was confirmed by thin-layer chromatographic analysis. These results strongly suggest that the gene cluster encodes proteins involved in the malonate-metabolizing system, malonate-->malonyl-CoA-->acetyl-CoA, in R. trifolii and that the metabolic pathway in the malonate-rich clover nodule might play an important role in symbiosis.

Steroid acne vs. Pityrosporum folliculitis: the incidence of Pityrosporum ovale and the effect of antifungal drugs in steroid acne

BACKGROUND

Steroid acne is a folliculitis that can result from systemic or topical administration of steroid, and has been described as showing a similar clinical picture to Pityrosporum folliculitis, but there have been few reports about the incidence of Pityrosporum ovale and the effect of antimycotic drugs in steroid acne and other acneiform eruptions. Our purpose was to describe the association between steroid acne and P. ovale, and to confirm the superior efficacy of oral antifungal drugs over anti-acne drugs in the treatment of steroid acne.

METHODS

The history, clinical features direct microscopy, histopathologic analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared.

RESULTS

Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of P. ovale in the lesional follicle. Furthermore, oral antifungal drug (itraconazole) showed significantly better clinical and mycologic effects than any other group of medications used in this study.

CONCLUSIONS

Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk and acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Pityrosporum folliculitis. In addition, oral antifungal drugs recommended for Pityrosporum folliculitis; however, it will require a larger case-control study to confirm the superiority of antifungal therapy over anti-acne treatment.

Expression of Tcf-1 mRNA and surface TCR-CD3 complexes are reduced during apoptosis of T cells

When a T cell hybridoma, 70.7, was treated with a Ca2+ ionophore (A23187), apoptotic cell death was induced. Interestingly, we observed that the expression of Tcf-1, a T cell-specific transcription factor, mRNA was reduced by approximately 5-fold in the A23187-treated apoptotic cells compared to an ethanol-treated control. The hybridoma cells, however, did not display such a reduced expression of Tcf-1 mRNA upon treatment with buthionine sulfoxide, which is known to induce a necrosis-like cell death. When another T cell hybridoma, KMIs-8.3.5, was treated with A23187 and phorbol myristate acetate, which leads to activation-induced apoptosis, Tcf-1 expression was again greatly reduced. However, a mutant line (KCIT1-8.5) derived from KMIs-8.3.5, which produces IL-2 upon activation and is resistant to apoptosis, did not show such reduction in Tcf-1 expression. We also showed that the reduced expression level of CD3epsilon mRNA and surface TCR-CD3 complex in apoptotic T cells is caused by the reduced expression of Tcf-1. When 70.7 cells were transfected with a plasmid DNA pSVtcf-1, in which Tcf-1 gene expression is driven by the SV40 promoter, such reduction of the Tcf-1 mRNA and the surface expression of the TCR-CD3 complex were not observed upon apoptosis induction. Our results suggest that the reduced expression of Tcf-1 is specific for the apoptotic, but not for the activating, process of T cells and is also responsible for the reduced surface expression of the TCR-CD3 in apoptotic T cells.

Subcapsular hematoma as a complication of acute pyelonephritis: a case report

A case of subcapsular hematoma, a rare complication of acute pyelonephritis (APN) is described. A 60-year-old diabetic woman was admitted with a 3 day history of fever and left flank pain due to acute pyelonephritis. On the third day in hospital, left flank pain worsened despite use of antibiotics available for the treatments of APN and hemoglobin rapidly decreased from 11.1 to 7.9 g/dL. Ultrasonography and abdominal CT showed left subcapsular hematoma. Renal angiography demonstrated an ovoid avascular zone between the capsular artery and parenchyme of the left kidney with no evidence of tumors or vascular abnormalities, such as arteriovenous malformation or fistula. Subsequent percutaneous drainage of this subcapsular hematoma was performed and showed old blood-colored drainage. Hereby, the possibility of subcapsular renal hematoma in the course of acute pyelonephritis is stressed as a rare complication.