Usefulness of 1% terbinafine HCl (Lamisil) cream for hyperkeratotic-type tinea pedis and its transfer into the horny layer

The usefulness of 1% terbinafine HCl (Lamisil) cream for hyperkeratotic-type tinea pedis and its transfer into the horny layer were evaluated. Of the 36 patients enrolled in the study, 35 were retained for analysis and one was excluded due to inappropriate drug application. Hyperkeratotic-type tinea pedis was classified into three types: true hyperkeratotic-type, partial hyperkeratotic-type, and quasi-hyperkeratotic type. The overall clinical improvement rate was 95.5% (100% for true-, 80% for partial- and 96.2% for quasi-hyperkeratotic type). The overall fungal eradication rate was 88.6% (75% for true-, 100% for partial- and 88.5% for quasi-hyperkeratotic type). The overall efficacy rate was 88.6% (75% for true-, 100% for partial- and 88.5% for quasi-hyperkeratotic type). No adverse reactions were reported. Drug concentrations in the horny layer were 170.3, 228.5 and 249.2 ng mg-1, respectively, 2, 4 and 12 weeks after starting the treatment. These concentrations are more than 50,000 times higher than the minimum inhibitory concentrations of terbinafine for dermatophytes. These findings indicate that terbinafine HCl (Lamisil) cream is very useful for refractory hyperkeratotic-type tinea pedis when administered alone. The pharmacokinetic data also support the clinical and mycological findings.

Caged and clustered structures of endothelin inhibitor BQ123, cyclo(-D-Trp-D-Asp--Pro-D-Val-Leu-)-Na+, forming five and six coordination bonds between sodium ions and peptides

BQ123 is a cyclic pentapeptide and a potent endothelin-1 inhibitor. The crystal structure of the BQ123 sodium salt was determined as the first example of an endothelin inhibitor. Four independent molecules and many solvent molecules were found in the asymmetric unit; the total weight was about 3000 Da. The precise structure including the solvent molecules was determined using high-resolution data collected on a synchrotron source. Sodium ions formed unique structures with five and six coordination bonds and their forms were distinguished into three classes. An ion was sandwiched by two BQ123 molecules. This peptide-sodium (2:1) complex showed a cage-like structure and octahedral coordination was observed. Sodium ions also formed a cluster composed of hydrated water molecules and peptides. Two sodium ions were contained in this cluster, making five coordination bonds. Despite having the same coordination numbers, these ions were distinguishable by differences in the polyhedra. One was trigonal bipyramidal (having six planes) and the other was square pyramidal (having five planes). Both shapes were very similar to each other, although the synchrotron data clearly revealed slight geometrical differences.

Dynamic and static 99mTc-ECD SPECT imaging of subacute cerebral infarction: comparison with 133Xe SPECT

99mTc-ethylcysteinate dimer (99mTc-ECD) SPECT imaging reportedly fails to show reflow hyperemia in patients with subacute stroke. This study attempts to determine the clinical usefulness of dynamic 99mTc-ECD SPECT in evaluating regional blood flow in subacute cerebral infarction and the kinetic behavior of 99mTc-ECD in infarct areas.

METHODS

133Xe and consecutive dynamic and static 99mTc-ECD SPECT studies were performed on 24 patients with cortical infarction in the middle cerebral artery territory 13-15 d after the onset of a stroke. Image contrast between infarct and contralateral control areas on 99mTc-ECD tomograms (ECD uptake ratio) was compared with that on cerebral blood flow (CBF) images obtained using 133Xe inhalation (CBF ratio).

RESULTS

In all cases, ECD uptake ratios from static images were lower than CBF ratios. This tendency was obvious when CBF in the infarct area increased above the normal control value, and no significant correlation was found between ECD uptake ratios from static images and CBF ratios. Only in the infarct areas with CBF below the normal control value, however, was a significant correlation between the two maintained (r = 0.795; P = 0.0011). A very strong correlation was found between CBF ratios and ECD uptake ratios on both the first dynamic scan (36 s after injection) (r = 0.991; P < 0.0001) and the second dynamic scan (72 s after injection) (r = 0.945; P < 0.0001). The correlation coefficient decreased in a time-dependent manner, with no significant correlation observed after the fourth dynamic scan (144 s after injection). On the other hand, significant correlations were observed on all dynamic scans only in the infarct areas with CBF below the control value.

CONCLUSION

Super-early images of dynamic 99mTc-ECD SPECT provide a close imaging contrast with CBF and reveal reflow hyperemia in areas with irreversible changes produced by subacute stroke, which static 99mTc-ECD SPECT images fail to show. Decreased retention of the tracer in the infarct areas with hyperperfusion causes an underestimation of CBF on static 99mTc-ECD SPECT images. Given these results, we believe that dynamic 99mTc-ECD SPECT is an effective clinical tool to evaluate regional blood flow in subacute cerebral infarction.

Effects of amino acids and chirality for molecular folding of desoxazoline-ascidiacyclamide derivatives: X-ray crystal structures of four cyclic octapeptides including unusual amino acids, cyclo(-Ile-aThr-D-Val-Thz-)(2), cyclo(-Ala-aThr-D-Val-Thz-Ile-aThr-D-Val-Thz-), cyclo(-Val-aThr-D-Val-Thz-Ile-aThr-D-Val-Thz-), and cyclo(-Ile-aThr-Val-Thz-Ile-aThr-D-Val-Thz-)

Desoxazoline derivative of ascidiacyclamide (1), cyclo(-L-Ile-L-allo-threonine-D-Val-thiazole-)(2), was modified to disturb the C(2)-symmetry. An Ile(1) residue of 1 was replaced for Ala (2) or Val (3), and the D-Val(3) residue was replaced for Val (4). The crystal structures of 1-4 were analyzed by x-ray diffraction methods. The molecules of all compounds were folded and this type of structure was not observed in x-ray structures of ascidiacyclamide derivatives so far except for patellamide D. The folding patterns of 1-4 were similar to each other and resembled that of patellamide. The asymmetric modifications at position 1 caused the conformational changes at local area, and these were related with the peptide-peptide and peptide-solvent interactions. Despite the diverse backbone conformation by the epimeric modification at position 3, the entire molecule of 4 was folded. These results mean that (1) the desoxazoline-ascidiacyclamides favored the folded structures and (2) the modifications of the side chain size at position 1 and the chirality at position 3 brought the local conformational changes to derivatives, suggesting that (3) the lack of the oxazoline block leads to conformational flexibility of 1-4, which accepts the conformational change with no drastic change on the entire structure.

Irreducible acute anterior dislocation of the shoulder caused by interposed fragment of the anterior glenoid rim

Failure of manipulative reduction of acute anterior dislocation of the shoulder is extremely rare. A 55-year-old man dislocated his right shoulder when he fell heavily. Initial radiographs and computed tomographs demonstrated an anterior dislocation with fracture of the glenoid rim. Several attempts at closed reduction were unsuccessful. At the time of open reduction, the cause of failure was found to be interposition of a fragment of the anterior inferior glenoid rim in the joint. To prevent redislocation, the fragment was held in place by two Herbert mini bone screws after anatomic reduction, and the ruptured subscapularis was reattached to the lesser tuberosity. Two and a half months after surgery, the shoulder was stable with full range of motion. To the best of our knowledge, this is the first reported case of interposition of a fracture-fragment of the anterior inferior glenoid rim causing failure of reduction.

Histopathologic abnormalities in rabbit retina after intravitreous injection of expansive gases and air

PURPOSE

To evaluate histopathologic retinal changes in rabbit eyes after injection of pure perfluoropropane (C3F8) gas, pure sulfur hexafluoride (SF6) gas, or air into the vitreous cavity.

METHODS

Air, C3F8 gas, or SF6 gas (0.4 mL each) were injected into rabbit vitreous cavities. Two, 4, and 6 weeks later, light and electron microscopic examinations were conducted, and the immunohistochemical localization of glutamate in the retina was studied. Noninjected eyes served as controls.

RESULTS

At all time points, thinning or disappearance of the outer plexiform layer in the superior retina in eyes that received C3F8 gas was found; the inferior retina was the same as in controls. In eyes that received SF6 gas or air, light and electron microscopy showed that the superior and inferior retina were the same as in controls at all time points. Immunohistochemical examination showed abnormal glutamate distribution of the superior retina in eyes injected with C3F8 gas, SF6 gas, or air. However, glutamate distribution was the same as in controls in the inferior retina in eyes injected with C3F8 gas, SF6 gas, or air.

CONCLUSIONS

Retinal tamponade using intraocular gases induces histopathologic retinal changes in the superior retina of the rabbit eye, where the gases are in continuous contact with the eye.

Histopathologic retinal changes with intravitreous fluorosilicone oil in rabbit eyes

BACKGROUND

Fluorosilicone oil (FSiO, 1,000-10,000 centistokes), which has a higher density (1.29 g/cm3) than vitreous gel, is useful as an operative tool and a tamponade for the inferior retina during difficult retinal detachment surgery. The occurrence of histopathologic retinal changes after injection of FSiO into the vitreous cavity is controversial.

METHODS

Retinas obtained from 18 rabbits were evaluated histopathologically within 8 weeks of injection into the vitreous cavity of purified FSiO or balanced salt solution as control in phakic eyes. The histopathologic retinal changes caused by FSiO were compared with those of previously reported high-density hydrophobic vitreous substitutes, such as silicone-fluorosilicone copolymer oil (SiFO) and perfluorocarbon liquids.

RESULTS

By light and electron microscopy, all retinas injected with FSiO were the same as control retinas within 2 weeks of the injection, but the outer plexiform layer disappeared from the inferior retina 4 weeks after injection. The receptor cell nuclei migrated to the photoreceptor layer in the inferior retina 8 weeks after injection. However, no preretinal membrane, including foam cells, was found in any eye injected with FSiO.

CONCLUSION

FSiO may be useful as a temporary vitreous substitute in difficult inferior retinal detachments.

Two cases of right ventricular ischemic injury due to massive pulmonary embolism

In general, massive pulmonary embolism induces severe right ventricular overload, but pathological changes in the right ventricle due to pulmonary embolism is rarely seen. In this report, we describe two autopsy cases of massive pulmonary embolism without pre-existing cardiopulmonary disease. Both cases were accompanied by myocarditis-like changes in the right ventricle and infiltration of a number of polymorphonuclear neutrophils and mononuclear cells into the dilated right ventricular wall. Transmural or subendocardial coagulation necrosis was not apparent. Almost all of the mononuclear cells were immunohistochemically revealed to be CD68-positive macrophages. We speculated that these findings resulted from ischemia due to massive pulmonary embolism.

Dinuclear calcium complex with weakly NH...O hydrogen-bonded sulfonate ligands

The novel intramolecularly NH...O hydrogen-bonded Ca(II)-aryl sulfonate complex, [Ca2(SO3-2-t-BuCONHC6H4)2(H2O)4]n(2-t-BuCONHC6H4SO3)2n (1), sulfonate anion, (HNEt3)(SO3-2-t-BuCONHC6H4) (2a), (PPh4)(SO3-2-t-BuCONHC6H4) (2b), (n-Bu4N)(SO3-2-t-BuCONHC6H4) (2c), and sulfonic acid, 2-t-BuCONHC6H4SO3H (3), were synthesized. The structures of 1, 2a, and 2b depict the presence of the formation of NH...O hydrogen bonds between the amide NH and S-O oxygen for a series of compounds as determined by IR and 1H NMR analyses both in the solid state and in the solution state. Thus, the NH...O hydrogen bonds with neutral amide groups are available for investigation of the electronic state of the O- anion. The combined data from the IR and 1H NMR spectra indicate that the sulfonic acid, sulfonate anion, and Ca(II) complex have a substantially weak intramolecular NH...O hydrogen bond between the SO3 oxygen and amide NH. In the detailed comparison with the intense NH...O hydrogen bonds for the carboxylate, weak NH...O hydrogen bonds for sulfonate is due to the strong conjugation of the SO3- group with the lower nucleophilicity.

Two cases of severe bronchopneumonia due to influenza A (H3N2) virus: detection of influenza virus gene using reverse transcription polymerase chain reaction

We report two cases of severe bronchopneumonia due to influenza A (H3N2) virus. The severity of the disease necessitated initiation of empiric therapy based on the present illness and clinical data on admission. Both patients were improved by artificial ventilation with positive end-expiratory pressures and administration of broad spectrum antibiotics and corticosteroids before confirming the diagnosis of viral bronchopneumonia using viral culture and serological tests. Within 24 hours, influenza A (H3N2) virus was identified by amplification of the pathogen genes by reverse transcription polymerase chain reaction (RT-PCR) using the stored bronchoalveolar lavage (BAL) fluids of both cases. This suggests that a combination of detection methods of pathogens using RT-PCR and BAL fluid will facilitate determination of rational treatment aimed at influenza A virus.

Clinical experiences of stenting in patients with esophago-bronchial fistula: report of four cases

The esophagorespiratory fistula is difficult to treat, and the patients' quality of life is generally poor due to suffering from dysphagia and dyspnea. We performed stent therapy in four cases of the esophagorespiratory fistula associated with esophageal cancer. Three of four patients showed improved symptoms, enabling oral liquid or food intake, although one died of dyspnea despite the therapy. The findings suggest that stent therapy is an effective method to close the esophagorespiratory fistula and to improve the patients' quality of life, although it is temporary and not a radical treatment.

Determination of optimal conditions for the immobilization of cells in a cell capture enzyme immunoassay (CC-EIA) by a simple Geimsa assay

To determine the optimal conditions for the immobilization of cells in a cell capture enzyme immunoassay (CC-EIA), the most suitable diluent, and the optimal pH, temperature and period of incubation were examined using WI-38, a human embryonic lung fibroblast cell line. For the evaluation, we devised a simple Giemsa assay method, in which immobilized cells on a microplate were stained with Giemsa solution, the stained dye was eluted with ethanol after washing the plate, and the optimal density (O.D.) was measured at wavelength 620 nm. The optimal conditions for the immobilization were determined to be treatment with 5% formalin in phosphate-buffered saline (PBS) (pH 7.2) for 15 minutes at room temperature, which were confirmed to be suitable for the measurement of cell associated collagen by CC-EIA. Additionally, we found that the simple Giemsa staining method was also useful for evaluating the number of immobilized cells on the microplate after CC-EIA.

Suppression of integrin alpha(v) expression by endothelin-1 in vascular smooth muscle cells

Both integrins and endothelins (ETs) are known to play important roles in vascular remodeling via proliferation, apoptosis, and migration of vascular smooth muscle cells (VSMCs), whose dysfunctions have been implicated in the pathogenesis of end-organ damage associated with hypertension and arteriosclerosis. However, whether there is any interaction between endothelin-1 (ET-1) and integrins remains unknown. Therefore, the aim of the present study was to elucidate whether ET-1 regulates the expression of integrin alpha(v) in rat VSMCs. ET-1 dose- and time-dependently suppressed the integrin alpha(v) messenger RNA (mRNA) transcripts, as quantified by a real-time quantitative polymerase chain reaction (PCR) method, and decreased the transcriptional activity of integrin alpha(v) gene, as demonstrated by integrin alpha(v)-luciferase assay. The inhibitory effect of ET-1 on integrin alpha(v) gene expression was abrogated by an ETA receptor antagonist (BQ123) but not by an ET(B) receptor antagonist (BQ788). ET-1 also suppressed the cell surface expression of integrin alpha(v)beta5 and the adhesion to vitronectin, but not to fibronectin. These results demonstrate that the adhesion of vitronectin to rat VSMCs is inhibited by ET-1 via the ET(A) receptors by suppressing integrin alpha(v) gene transcription, suggesting that ET-1 is involved in regulation of vascular integrin alpha(v) gene expression.

Prediction of acute embolic stroke outcome after local intraarterial thrombolysis: value of pretreatment and posttreatment 99mTc-ethyl cysteinate dimer single photon emission computed tomography

The aim of this study was to investigate the efficacy of pre- and posttreatment 99mTc-ethyl cysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT) for predicting the ischemic outcome of embolic middle cerebral artery occlusion after treatment with local intraarterial thrombolysis. The authors examined 28 patients with a moderately ischemic area (ratio of affected regional activity to cerebellar activity (A/C ratio) of 0.4 to 0.7) determined using pretreatment SPECT, and with complete recanalization within 6 hours. Posttreatment dynamic and static SPECT studies were performed immediately after thrombolysis. The extent of the affected area outlined on pretreatment SPECT was used for the posttreatment SPECT images, and A/C ratios were calculated. The relative retention ratio of 99mTc-ECD in the affected area was also analyzed using posttreatment dynamic SPECT. Fourteen patients either without infarction or with small subcortical and basal ganglial infarction, 11 patients with medium or large cortical infarction, and 3 patients with hemorrhage were identified by follow-up computed tomography. Ischemic outcome correlated with the relative retention ratio of 99mTc-ECD more closely than either the pre- or posttreatment A/C ratios. In particular, a threshold value for the development of hemorrhage was distinct only in the relative retention ratio of 99mTc-ECD. Pretreatment 99mTc-ECD SPECT did not always predict the occurrence of hemorrhagic transformation, whereas dynamic 99mTc-ECD SPECT performed immediately after thrombolysis allowed clear identification of patients at risk for hemorrhagic transformation.

Cytokine-activated p42/p44 MAP kinase is involved in inducible nitric oxide synthase gene expression independent from NF-kappaB activation in vascular smooth muscle cells

Recent evidence suggests the possible involvement of inducible nitric oxide synthase (iNOS) in the development and maintenance of hypertension in certain animal models. Inflammatory cytokines activate nuclear factor (NF)-kappaB, which plays a major role in transactivation of the inducible nitric oxide synthase (iNOS) gene. However, it remains unknown whether cytokine-mediated iNOS expression in vascular smooth muscle cells (VSMCs) requires signaling pathway(s) other than NF-kappaB activation. The purpose of this study was to determine whether the p42/p44 MAP kinase pathway is involved in cytokine-induced NF-kappaB activation and/or iNOS expression in cultured rat VSMCs. Nitrite/nitrate (NOx) production stimulated by interleukin (IL)-1beta or tumor necrosis factor (TNF)-alpha in VSMCs was markedly suppressed by inhibiting MAP kinase by pretreatment with a p42/p44 MAP kinase kinase (MAPKK)-1 inhibitor (PD98059) or by transfecting the dominant-interfering form of the nonphosphorylated MAPKK-1 expressing construct (MAPKK S222A). Inhibition of p42/p44 MAP kinase also antagonized the upregulation of iNOS mRNA and protein, as demonstrated by the quantitative RT-PCR method and Western blot analysis, respectively. Furthermore, rat iNOS promoter activity using an iNOS-luciferase construct stimulated by cytokines was inhibited by MAPKK-1 inhibition. However, kappaB-dependent transcription analysis revealed that cytokine-stimulated NF-kappaB activity was unaffected by MAP kinase inhibition. Western blot analysis using anti-IkappaB-alpha and anti-phospho-IkappaB-alpha antibodies showed that PD98059 had no effect on transient phosphorylation or degradation of IkappaB-alpha by cytokines. An electrophoretic mobility shift assay using synthetic oligonucleotide corresponding to the downstream NF-kappaB site of rat iNOS promoter as a probe showed that MAP kinase inhibition did not block cytokine-stimulated activation of NF-kappaB. These data suggest that the MAP kinase pathway is in part involved in cytokine-induced iNOS expression independent from NF-kappaB activation in rat VSMCs.

Intrathecal administration of thrombin inhibitor ameliorates cerebral vasospasm. Use of a drug delivery system releasing hirudin

The role of thrombin as a spasmogen after subarachnoid hemorrhage was evaluated using the intrathecally administered thrombin inhibitor hirudin, released from a drug delivery system (DDS) based on collagen in a canine vasospasm model. The DDS was implanted into the cisterna magna with autologous blood in the hirudin-treated group. The reduction in the angiographical diameter of the basilar artery was only 19% in the hirudin-treated group on day 7, showing a significant difference between hirudin-treated and nontreated groups (p < 0.01). These results suggest that thrombin is an important cause of vasospasm. The collagen DDS has great potential for treatment in the cerebrospinal fluid milieu.

Neurological grades of patients with poor-grade subarachnoid hemorrhage improve after short-term pretreatment

OBJECTIVE

Short-term pretreatment of patients with subarachnoid hemorrhage, but without hematomas causing mass effect, who presented in poor neurological condition at admission was evaluated as a protocol for the selection of candidates for radical surgery.

METHODS

One hundred-three patients were pretreated for 12 hours with control of blood pressure and intracranial pressure, using diuretic agents and/or ventricular drainage.

RESULTS

Neurological improvement was observed for 32 of 47 patients in Grade IV at admission and 23 of 56 patients in Grade V (P < 0.01). Hydrocephalus requiring drainage was more common (P < 0.05) and the interval between onset and admission was shorter (P < 0.01) for the improved group. Clipping surgery was performed for all patients in Grade III or better and for patients in Grade IV who were less than 75 years of age and without systemic complications, i.e., 38 of 47 patients in Grade IV and 16 of 56 patients in Grade V at admission. Good outcomes (defined as moderately disabled or better on the Glasgow Outcome Scale) were achieved by 34 of 38 patients in Grade IV and 10 of 16 patients in Grade V (P < 0.01). The proportion of patients in Grade IV after pretreatment was lower for Grade IV (2 of 38 patients) than for Grade V (9 of 16 patients) (P < 0.00001). However, none of the 49 patients who underwent nonsurgical treatment achieved good outcomes.

CONCLUSION

Our protocol may be beneficial for the selection of candidates for radical surgery among patients with subarachnoid hemorrhage but without hematomas who are in poor neurological condition at admission and for the improvement of postoperative outcomes.

[Inflammatory pseudotumor of the lung with infiltration identified radiographically and hemoptysis]

The patient was a 53-year-old man whose chief complaint was a dry cough and hemoptysis. Chest X-ray films and computed tomographic scans revealed a hazy shadow with unclear margins in the left middle lobe. A diagnosis of inflammatory pseudotumor was made because transbronchial lung biopsy specimens showed proliferation of plasma cells and lymphocytes. Initially, in response to steroid therapy, his clinical condition and pulmonary infiltration improved, but about 30 days after the start of steroid therapy, hemoptysis occurred and the shadow increased, and therefore left segmentectomy was performed. Histology revealed not only proliferation of acute and chronic inflammatory cells but also changes in the vessels. These pathologic findings were considered to be related to the infiltration shadows and the hemoptysis.