Early diagnosis of tuberculosis by fibreoptic bronchoscopy

We carried out a retrospective study of the methods used to achieve an early diagnosis of 67 patients with pulmonary tuberculosis treated at our institute between 1984 and 1989. Sputum bacteriology was positive in 56 of the 67 patients, 22 were positive on microscopical examination of smears and on culture and 34 on culture alone. The 11 patients with negative sputum bacteriology were all diagnosed by fibreoptic bronchoscopy. In addition, 21 of the 34 smear-negative/culture-positive patients were examined by fibreoptic bronchoscopy and the initial diagnosis was made in 7 of these. Thus the initial diagnosis was made by sputum bacteriology in 49 cases and by fibreoptic bronchoscopy in 18 cases. The median number of days between obtaining a specimen and starting therapy was 7 days for sputum microscopy, 41 days for sputum culture, 7 days for microscopic examination of bronchoscopy specimens, 51 days for culture of the same and 19 days for biopsy. Fibreoptic bronchoscopy is therefore useful for the diagnosis of cases of tuberculosis in which tubercle bacilli are not detected in sputum and, in some instances, for an earlier diagnosis of smear-negative/culture-positive patients.

Synchronous cancer of squamous cell carcinoma of the lung and lymphocytic leukemia (B-cell type): a case report

The patient was an 82-year-old male who consulted us over a lymph node enlargement in the right side of his neck. The WBC was 23,700/microliters (lymphocytes 80%), and a diagnosis of chronic lymphocytic leukemia (CLL) was given based on the findings of a bone marrow puncture and lymph node biopsy. During the observation period, abnormal shadows accompanied by cavitation appeared in the right lower lung field, and CT-guided percutaneous biopsy findings indicated a squamous cell carcinoma of the lung. No metastatic lesions were noted. No aggressive surgical or internal treatments were performed in consideration of the patient's age. The patient was admitted again and died of respiratory failure due to lung carcinoma. Reports of CLL and other malignant tumors arising in one patient are rare in Japan, and those of their occurring concurrently are even rarer. In the present report, a case of synchronous cancer of squamous cell carcinoma of the lung and CLL is described, together with a review of the literature.

[MRSA ocular infections]

Staphylococcus aureus and Staphylococcus epidermidis are organisms that frequently cause conjunctivitis, keratitis and endophthalmitis. MRSA comprised about 25% of the S. aureus isolated from ocular infections; most were from compromised host. MRSA was resistant to penicillins, cephems and macrolides but was sensitive to amikacin, netilmicin, minocycline and ofloxacin. Ofloxacin-resistant strains, however increased rapidly. Topical vancomycin, arbekacin and minocycline were used when commercially available antibiotics were inadequate.

Metabolic responses of chicken embryos and hatchlings to altered O2 environments

The oxygen consumption (MO2) response over a 4 h period of exposure to altered ambient O2 (air, 10, 15, 40, 60, 80 and 100%), helium (He) and sulfur hexafluoride (SF6) environments was determined for young (12 days old) and late (16 and 18 days old) embryos, externally pipped (EP) eggs and just hatched chicks (hatchlings) of the domestic fowl. The young embryos were insensitive to hyperoxic gas mixtures and to He exposure, while the late embryos increase their MO2 in hyperoxic environments, independently of O2 concentration, and also in a He atmosphere. Both the young and late embryos responded to SF6 exposure with decreasing MO2, as SF6 reduces O2 diffusivity through the eggshell. The MO2 of EP eggs and hatchlings in He and SF6 varied very widely, the effects of altered diffusivity being insignificant. In hypoxic environments in which the MO2 decreased, the fall of MO2 became smaller as embryos developed and particularly after they pipped the shell and hatched. In an atmosphere of 10% O2, the MO2 of all embryos in the egg before hatching decreased to below 10% of the control after 4 h, while in hatchlings the MO2 remained above 80% of the control. As all embryos in situ in the egg depend entirely or partly on diffusion in order to obtain O2, this emphasizes the limitation of the diffusive process. A 4 h exposure to 10% O2 was lethal for embryos in the egg even if they had pipped the shell and were breathing air with the lungs.

Embryonic heart rate of the domestic fowl (Gallus domesticus) in a quasiequilibrium state of altered ambient temperatures

1. The heart rates (fH) of 12-day-old embryos (young), 16- and 18-day-old embryos (late) and of 20-day-old embryos (externally pipped eggs, EP) were measured noninvasively at a temperature of 38 degrees C and after a 5 hr exposure to an ambient temperature (Ta) within the range 34-46 degrees C. 2. All embryos survived the 5 hr exposure to Ta of 42 degrees C. The lethal Ta ranged from 44 degrees C (EP eggs) to 46 degrees C (young embryos). 3. The temperature coefficient (Q10) of fH became smaller than 2 in EP eggs as Ta was decreased or increased from 38 degrees C, implying an incipient homeothermic response of fH.

Cardiogenic ballistograms of chicken eggs: comparison of measurements

In the incubated avian egg, minute movements occur that are synchronised with embryonic cardiac contractions. We previously developed two systems to noninvasively record this cardiogenic ballistic movement of the egg (referred to as the ballistocardiogram, BCG); one was based on applying an audiocartridge and the other a laser speckle phenomenon. A third system, which detects the ballistic movement as the measurement of displacement (referred to as displacement BCG), is applied in the present study, together with the previous two systems, to the ballistocardiography of the egg. The BCG is measured with three systems simultaneously for comparison. The differentiation of the displacement BCG produces a pattern identical to the BCG recorded by the cartridge method, and the integrated pattern of the latter BCG is identical to the displacement BCG. This indicates that the cartridge system detects the cardiogenic movement as the measure of velocity and it may be referred to as velocity BCG. The BCG by the laser speckle method is not related to that recorded by the other two systems, which may be referred to as movement BCG.

[Informed consent of the family in the chemotherapy for lung cancer]

In Japan where the question of cancer notification has yet to be resolved, it is difficult to obtain an informed consent from the patient himself in clinical studies of the chemotherapies for cancer. In fact, the chemotherapy is administered while not enough explanation is given to the family let alone the patient. Such is the present situation. For the purpose of finding out the best possible method at present, we carried out a method whereby an informed consent of the family is substituted for a consent of the patient in phase II study of inoperable non-small cell carcinoma of the lung. As a result, the consent was obtained from 21 (91.3%) out of 23 families. This method should be taken into consideration as a feasible one under the present circumstances. It was in only one family (4.3%) that a consent on the notification of diagnosis from the family to the patient was obtained. In order for the informed consent to be established, efforts to form a social consensus on cancer notification are needed.

[Adherence of Pseudomonas aeruginosa to the rabbit corneal epithelium]

Adherence of bacteria to the corneal epithelium is the first step in the pathogenesis of corneal infection. Keratitis caused by Pseudomonas aeruginosa usually occurs among the contact lens wearers. Adherence of Pseudomonas aeruginosa to rabbit corneal epithelium, damaged by one week of hard contact lens wear, was examined histologically. The cornea was excised for scanning electron microscopy at 5, 15, 30 and 60 minutes after inoculation of Pseudomonas aeruginosa (0.2 ml, 10(8)CFU/ml). Pseudomonas aeruginosa did not adhere to the intact corneal epithelium, but traumatized cornea provided a site for adherence. In rabbits in which the eyelid was opened by lid retractors, large numbers of organisms were observed adhering to the injured cornea mediated by ocular surface mucin. Thirty minutes after inoculation, the adherent bacteria began to penetrate the epithelial cells and surface mucin by the formation of pockets surrounding the organism.

Comparative metabolic responses to prolonged cooling in precocial duck (Anas domestica) and altricial pigeon (Columba domestica) embryos

1. Embryos and hatchlings of the duck and pigeon were exposed to a lowered temperature for 6 hr. The oxygen consumption (MO2) was measured before and after cooling and the ratio of the two was compared with that predicted for a temperature coefficient of 2 (Arrhenius value). 2. Late prenatal ducks kept the MO2 above the Arrhenius value at 28 degrees C, while the MO2 of pigeon hatchlings became the same as the Arrhenius value even at 32 degrees C. 3. Thus, incipient homeothermic ability appears in the duck during prenatal development, but it is not evident in the pigeon even after emergence from the shell. The precocial chicken and semi-precocial noddy previously studied are intermediate in their metabolic response between the duck and the pigeon.

[Giant renal cell carcinoma: a case report]

Though renal cell carcinoma is a fairly common disease, it is extremely rare to encounter a case providing a resected mass as large as over 2,000 g in weight. We report a case in which a giant 2,200 g tumor was resected after renal arterial embolization and interferon treatment for reduction of its size. A forty-three-year-old woman was first seen at a certain hospital with a chief complaint of fever and right flank pain. Under suspicion of right renal tumor, nephrectomy by extraperitoneal flank incision was attempted. However, the tumor was too large to be resected. After transfer to our department, she was treated by renal arterial embolization with absolute ethanol and steel coil and by the administration of interferon (rIFN-alpha A). As the tumor shrank to 77% of its original size on CT measurements and became mobile, transperitoneal nephrectomy was performed. The resected mass was as large as 12 x 12 x 21 cm. Pathologically, it was a clear cell type tumor showing mucinous degeneration and hyaline degeneration of tumor cells. Interferon used amounted to as high as 864 x 10(6) units, but no particular side effect occurred. No recurrence has been detected so far.

Noninvasive heart rate monitoring system for avian embryos based on the ballistocardiogram

A noninvasive heart rate (HR) monitoring system for avian embryos has been developed based on the ballistocardiogram (BCG). The BCG was detected using a phonograph cartridge as a record of the velocity of the minute ballistic movements of the eggshell, which are generated by recoil and impact of heart contraction and blood ejection. The autocorrelation coefficients (ACCs) of the detected signal were computed to confirm whether the detected signal contained ballistic movement. An envelope of ACC was calculated by the monitoring system to measure the intervals between peaks and/or highly correlated parts in the ACC, and then the system obtained HR by measuring these intervals. To demonstrate the valid range of the detecting method, the BCGs of chickens and Japanese quail embryos of different ages were measured. The result of the experiment shows that the BCGs of chickens and quail embryos are detected fully after about two-thirds of the incubation period has passed. The monitoring system will enable us to perform long-term HR measurement for developing avian embryos up to hatching.

Simultaneous acquisition of ECG, BCG, and blood pressure from chick embryos in the egg

The applicability of the audiocartridge system to simultaneous measurements of the ballistic movements from multiple points of the egg was examined in late chick embryos. Despite direct contact between the cartridges and the egg, minute movements of the egg attributable to cardiac contractions of the embryo (ballistocardiogram, BCG) could be simultaneously detected from at least three points. The results showed that the amplitude of BCG waves was dependent on the site of detection, indicating that the BCG was a directional wave. The cartridge system for BCG measurement was incorporated in the electrocardiography and arterial catheterization to acquire simultaneously electrocardiogram (ECG), BCG, and blood pressure from the embryo confined in the egg. Isochronal comparison of these waves indicated that the ballistic movements of the embryo might be caused not only by the ventricular contraction but also by the atrial excitation, i.e., the BCG comprised waves appearing in the ventricular presystolic, contraction, and ejection periods. For wide changes in the heart rate, the approximate isometric ventricular contraction period remained almost constant.

[Microbiological and pharmacokinetic studies on flomoxef in ophthalmologic field]

Microbiological and pharmacokinetic studies were carried out on flomoxef (FMOX, 6315-S), a new oxacephem parenteral antibiotic, in the ophthalmologic field. The results obtained are summarized as follows. FMOX has a broad antimicrobial activity spectrum against Gram-positive and Gram-negative bacteria. The MIC distribution against Staphylococcus aureus isolated from clinical cases was less than or equal to 0.20 - greater than or equal to 100 micrograms/ml with the peak value of 0.39 micrograms/ml. Concentrations of FMOX in aqueous humor and ocular tissues were determined after intravenous injection of 50 mg/kg to rabbits. FMOX showed a peak level of 2.2 micrograms/ml in the aqueous humor at 1/2 hour after administration with the ratio to serum level of 3.4%. Levels of FMOX in external and internal ocular tissues were 12.7 - 76.5 micrograms/g, less than 0.8 - 34.4 micrograms/g (ml) at 1/2 hour after administration, respectively. From these results, we concluded that FMOX may be expected to be a useful and valuable agent against infections in the ophthalmologic field.

Metabolic responses of chicken embryos to graded, prolonged alterations in ambient temperature

1. Chicken embryos aged 12, 16, 18 and 20 (externally pipped) days of incubation were exposed to graded reductions (2 degrees C) in ambient temperature from 38 to 28 degrees C, exposure to each temperature lasting up to 9 hr. 2. Oxygen uptake was measured first at 38 degrees C and then in the quasi-equilibrium state at lowered temperatures. The temperature coefficient (Q10) was calculated for each egg. 3. For mild cooling (32 degrees C), the Q10 in 18-day-old embryos was about 1.5, while 12- and 16-day-old embryos had a Q10 value of about 2, indicating that a feeble homeothermic metabolic response to cooling appears in late prenatal embryos. It became more marked in externally pipped embryos and further augmented in hatchlings.

Oxygen consumption of brown noddy (Anous stolidus) embryos in a quasiequilibrium state at lowered ambient temperatures

1. The oxygen consumption (MO2) of the semi-precocial Brown Noddy embryos at different stages of development was measured at 36 degrees C and again after 5-hr exposure to lowered ambient temperatures (30 and 32 degrees C). 2. The MO2 measured in a quasiequilibrium state was equal to the value predicted by a temperature coefficient of 2. 3. In contrast to precocial chickens, the semi-precocial Noddy had no apparent metabolic response to cooling before hatching.

[A case of acute retinal necrosis syndrome caused by herpes simplex virus type 1]

A case of bilateral acute retinal necrosis syndrome accompanied by viral meningitis in a 46 year-old male is reported. The characteristic scattered yellowish-white retinal exudates and retinal detachment appeared in both eyes within 2 weeks, and after treatment with intravenous acyclovir and gamma-globulin, and encircling, scleral buckling, pars plana vitrectomy, 100% SF6 tamponade procedures, the retinal detachment was repaired and the yellowish-white retinal exudates disappeared. On virological examination, the complement fixation titer for herpes simplex virus (HSV) in serum increased more than eightfold in pair serum, and the quotient of antibody for HSV type 1 (HSV-1) IgG was high. HSV-1 was isolated and cultured from the subretinal fluid. From these results, it is concluded that HSV-1 infection was the cause of the meningitis and acute retinal necrosis in this case.

Metabolic responses to gradual cooling in chicken eggs treated with thiourea and oxygen

1. Late prenatal chicken embryos in eggs injected with saline showed a feeble homeothermic metabolic response to gradual cooling. This response was absent in thiourea-treated eggs. This suggests that the incipient homeothermic metabolic response before paranatal life may be attributed to thyroid development. 2. The compensatory metabolic response disappeared in embryos exposed to a hypoxic environment, while it was augmented in eggs in pure O2, decreasing as ambient temperature fell. 3. These results may indicate that the homeothermic metabolic response in late embryos is O2-conductance-limited and power-limited as previously suggested.

Short-term effects of altered shell conductance on oxygen uptake and hematological variables of late chicken embryos

The preceding report on the O2 uptake (MO2) of chicken embryos whose shell conductance (GO2) was altered from the beginning of incubation showed that the MO2 was decreased despite increased GO2 [Okuda, A. and H. Tazawa (1988) Respir. Physiol. 74: 187-198]. This was attributed to an excess water loss which reduced the growth of the embryos. The present study was designed to investigate the short-term effects of altered GO2, obviating the effect of excess water loss, on the MO2 and simultaneously on the hematological variables of embryos on days 16-17 and days 18-19 of incubation. The MO2 measured 5 h after increasing the GO2 was neither decreased nor increased significantly. The diffusing capacity of the chorio-allantoic membrane, which was estimated using the Bohr integration procedure, decreased as the GO2 was increased. When the GO2 was decreased, on the other hand, the decrease in MO2 was not so large as expected from the decrease in GO2, for both 16- and 18-day-old embryos. The effect of reduced GO2 on MO2 was more prominent in 18-day-old embryos than 16-day-old embryos. One-day-long hypoxia due to decreased GO2 induced erythropoiesis in 18-19-day embryos, but did not do so in 16-17-day embryos. The increase in hematocrit value of the latter group of embryos was attributed to an increase in cell volume due to concurrent hypercapnia.

Gas exchange and development of chicken embryos with widely altered shell conductance from the beginning of incubation

The O2 uptake of chicken embryos confined in the eggshell (MO2) is governed by a shell diffusive conductance (GO2) and PO2 difference between ambience and air space, suggesting that a relation between GO2 and air space PO2 (PAO2) is hyperbolic at constant MO2. Upon wide alteration of GO2 from the beginning of incubation, the MO2 was measured on day 16 of incubation and the relation between GO2 and PAO2 examined. The MO2 increased hyperbolically with increasing GO2, reached maximum at control conductances and decreased with further increase in GO2. From these changes in MO2 with GO2, an equation was derived predicting PAO2 as a quadratic function of inverse gO2 (mass-specific conductance, i.e., GO2 standardized by fresh egg mass), and the relation between air space PO2 and shell conductance was no longer hyperbolic. The arterialized blood PO2 (PaO2) of the allantoic vein measured individually was also expressed by a quadratic equation of inverse gO2. While for widely altered conductance the MO2 was little related to PaO2, the mass (embryo)-specific O2 uptake increased with PaO2. The excess water loss associated with increased conductance was involved in changes in these variables.

A blood-gas nomogram of the chick fetus: blood flow distribution between the chorioallantois and fetus

This paper presents equations for quantifying the relationships between the O2 and CO2 concentrations and tensions in the blood of the 18-day chick fetus. A blood-gas nomogram showing these relationships is presented. Starting with the reported chorioallantoic artery and vein gas tensions and using the blood-gas equations, the range of embryonic arterial and venous gas tensions as well as the distribution of the cardiac output and the degree of mixing between the chorioallantoic and embryonic circulations are explored. It is concluded that at least 65% of the blood in the chorioallantoic artery consists of blood of embryonic mixed venous composition. A model of the blood flow distribution is proposed in which chorioallantoic and embryonic flows are equal, with 70% of the blood returning from the tissues of the embryo going to the chorioallantois and vice versa.