A controlled trial of the effect of the 5-lipoxygenase inhibitor, zileuton, on lung inflammation produced by segmental antigen challenge in human beings

BACKGROUND

Segmental antigen challenge (SAC) and bronchoalveolar lavage (BAL) have been proven useful for investigating IgE-mediated lung inflammation in volunteers with allergies.

OBJECTIVE

This model was used to evaluate the pulmonary antiinflammatory effects of an experimental 5-lipoxygenase inhibitor (zileuton) in subjects allergic to ragweed. We hypothesized that decreased generation of leukotrienes by inhibition of the 5-lipoxygenase pathway of arachidonic acid metabolism would diminish the subsequent inflammatory response resulting from antigen challenge.

METHODS

Ten subjects with allergies received zileuton or placebo, 600 mg administered orally four times a day for 8 days, and then underwent bronchoscopy, BAL of a control segment, and SAC in the contralateral lung followed by BAL of the challenged segment 24 hours later in a double-blind, placebo-controlled, crossover protocol. Urinary excretion of leukotriene E4 induced by antigen challenge plus total and differential cell counts and the amount of total protein, albumin, urea, and eosinophil cationic protein in BAL fluid were determined.

RESULTS

A significant inhibition of leukotriene production (approximately 86%) was observed in subjects receiving zileuton. In addition, there was a statistically significant increase in eosinophils after antigen challenge (0.6 +/- 0.2 x 10(4) eosinophils/ml increasing to 49.0 +/- 25.0 x 10(4) in subjects receiving placebo, whereas the influx of eosinophils in subjects receiving zileuton was not statistically different from baseline (1.1 +/- 0.7 x 10(4) eosinophils/ml increasing to 16.5 +/- 4.1 x 10(4); analysis of variance for repeated measures with post hoc comparisons).

CONCLUSIONS

Treatment with zileuton altered the inflammatory response after antigen challenge. Products of the 5-lipoxygenase pathway appear to be important in recruiting eosinophils to the lung after SAC.

Proliferating cell nuclear antigen expression in Wilms' tumor: a comparative study of pre- and post-chemotherapy specimens

A total of 36 Wilms' tumors were immunohistochemically analyzed for proliferative (proliferating cell nuclear antigen-labeling) index (PI) with special reference to the effect of preoperative chemotherapy on the proliferative potential of tumors and differences in PI according to the histologic components (epithelial, blastemal and stromal). The cases were divided into two groups according to the status of chemotherapy at the time of surgical removal of the tumors. In group I (n = 12, cases with pre-operative chemotherapy), the mean PI +/- s.d. values of epithelial, blastemal and stromal types were 19.5 (n = 1), 10.1 +/- 5.28 (n = 8), and 16.2 +/- 13.49 (n = 3), respectively, and in group II (n = 24, cases without preoperative chemotherapy), 45.2 +/- 15.41 (n = 3), 28.5 +/- 16.92 (n = 10), and 23.2 +/- 4.45 (n = 2), respectively. The cases with mixed histology in group II (n = 9) had comparable PI values for each histologic component. The mean PI +/- s.d. was 12.1 +/- 7.76 in group I and 31.9 +/- 15.95 in group II. The PI value of group II was significantly higher than that of group I (P < 0.001). Alterations in the PI value following chemotherapy implied that the interpretation of tumor histology following chemotherapy should be more prudent because alteration of the PI, which reflects the proliferative potential of tumor cells, suggests modified biology of viable cells in pretreated cases as a consequence of chemotherapy.

Combination therapy with interferon-gamma and interleukin-2 for the treatment of metastatic melanoma

The toxicity and clinical response to treatment with the combination of interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) in patients with metastatic melanoma was evaluated. From May 1993 through February 1994, 20 patients were treated with 24 courses of IFN-gamma with or without IL-2. A 7-day course of subcutaneous IFN-gamma alone was administered to cohorts of two or three patients each at doses of 0.1, 0.2, or 0.3 mg/m2. Thirteen patients received escalating doses of IFN-gamma between 0.2 and 0.5 mg/m2 followed by the intravenous (i.v.) administration of IL-2 (720,000 IU/kg) given three times a day. A treatment course consisted of two cycles (maximum of 15 doses of IL-2 per cycle) separated by a 10-day interval. Five additional patients were treated with five courses of IFN-gamma, IL-2, and tumor-infiltrating lymphocytes (TILs). All patients treated had the diagnosis of metastatic melanoma. The maximal tolerated dose of subcutaneous IFN-gamma was established at 0.3 mg/m2 with dose-limiting hepatotoxicity. Immunohistochemistry analyses showed detectable upregulation of MHC class I alleles in one (8%) of 12 patients. Two of 20 patients who received the combination of IFN-gamma and IL-2 had responses, one partial and one complete response. The duration of response was 7 months for the partial response and 12 months for the complete response. IFN-gamma was tolerated with minimal side effects of nausea, vomiting, malaise, and decreased hematopoiesis. No increased toxicities were found with the combination treatment, as compared with IL-2 alone. One death occurred on the third day of treatment with IFN-gamma alone from hemorrhage into brain metastases. There were no responders in the five patients who received the combination treatment of TIL, IL-2, and IFN-gamma. From these findings, we conclude that further studies looking at this combination treatment are not warranted.

Benzastatins A, B, C, and D: new free radical scavengers from Streptomyces nitrosporeus 30643. I. Taxonomy, fermentation, isolation, physico-chemical properties and biological activities

In the course of screening for free radical scavengers, rare metabolites, benzastatins A and B having aminobenzamide skeleton and benzastatins C and D having tetrahydroquinoline skeleton, were isolated from the culture broth of streptomyces nitrosporeus 30643. They showed inhibitory activity against lipid peroxidation in rat liver microsomes. In the cell assay, benzastatins C and D inhibited glutamate toxicity in N18-RE-105 cells with EC50 values of 2.0 and 5.4 microM, respectively.

Cytotoxic benzyl dihydroflavonols from Cudrania tricuspidata

Three new dihydroflavonols, gericudranins A-C were isolated from the stem bark of Cudrania tricuspidata. They were identified as 6,8-di-p-hydroxybenzyltaxifolin, 8-p-hydroxybenzyltaxifolin and 6-p-hydroxybenzyltaxifolin, respectively, by means of spectral studies. These compounds were cytotoxic to human tumor cell lines, such as CRL 1579 (skin), LOX-IMVI (skin), MOLT-4F (leukemia), KM12 (colon) and UO-31 (renal) in culture, with ED50 values of 2.7-31.3 micrograms ml-1.

Patterns of bcl-2 expression in placenta

A total of 39 placentas, whose gestational ages ranged from 8 to 41 weeks, were analyzed for bcl-2 expression using immunohistochemistry and immunoblotting. Immunohistochemically, both intracytoplasmic and nuclear expression of bcl-2 was observed in villous and extravillous trophoblasts, villous mesenchymal cells and capillary endothelial cells, villous macrophages, intermediate trophoblasts, amnionic epithelium, and even in decidua and endometrial glandular epithelium in early gestational periods. The degree of expression significantly decreased in the placentas after the gestational period of 32 weeks which coincides with the declining phase of placental increase. On immunoblotting lysates of 10(4) cells from single cell suspensions of fresh placentas, bcl-2 was detected in the placentas of 22 and 33 gestational weeks, but it was negligible or absent in three term placentas. The results of the present study suggest two possible implications on the role of bcl-2 in placenta: 1) it may be a type of proliferation or maturation-related marker, especially of trophoblasts, which show decreased expression along with terminal differentiation and maturation, and 2) because the primary role of bcl-2 is the inhibition of programmed cell death (PCD), the decrease in placental bcl-2 around term may be a parturition-associated biological change.

Antibacterial substance produced by Streptococcus faecium under anaerobic culture

A facultative anaerobe isolated from Korean domestic soil produced an antibacterial substance under strict anaerobic conditions. Based on the morphological and biochemical tests, and cellular fatty acid profiles, the anaerobe was identified as Streptococcus faecium. An antimicrobial compound produced from the S. faecium was identified as 3,7,12-trihydroxy-24-cholanic acid methylester on the basis of its physico-chemical analysis. This substance had potent antibacterial activities against a test organism harboring multiple antibiotic resistance markers, and a variety of pathogenic bacteria. The isolated S. faecium produced lactic acid as well as the antibiotic compound under the anaerobic conditions.

The value of Helicobacter pylori IgG antibody in estimating the severity of gastritis in children

A serologic test for antibodies is useful for diagnosis of Helicobacter pylori(H.pylori) infection in children. We evaluated the reliability of H.pylori IgG antibody titer in grading the severity of infection in children. We surveyed the sero-prevalence of H.pylori infection in 300 healthy school children (13 to 15 years old). Thirty-four percent(102 of 300 children) were sero-positive for H.pylori. Of the 102 sero-positive children, 70 underwent gastroscopic examination. Ninety percent of sero-positive children(63 of 70 children) were proven to be H.pylori infected. All children with H.pylori infection had histologically proven gastritis, and its severity did not correlate with the IgG antibody titer. Although a serologic test is useful to identify H.pylori infection in children, it can not predict the severity of H.pylori associated gastritis.

An immunohistochemical analysis of mdr-1 and bcl-2 expressions in neuroblastoma

Among the differentiation-related changes in neuroblastoma are expressions of mdr-1 and bcl-2, which may be potentially related to the resistance to anticancer chemotherapy. In the present study, the authors performed an immunohistochemical analysis of mdr-1 and bcl-2 expressions in 30 neuroblastomas using monoclonal anti-P-glycoprotein(mdr-1 product) antibody and monoclonal anti-bcl-2 antibody to investigate the significance of their expression. The overall incidence of mdr-1 and bcl-2 expressions were 53.3% (16/30) and 93.3% (28/30), respectively. The expressions of mdr-1 and bcl-2 didn't seem to be related to the status of preoperative chemotherapy or stage of disease. The expression of mdr-1 was closely related to the differentiation of tumor cells (p < 0.01), especially to the neuronal differentiation. The bcl-2 expression was so common that it seemed to be indigenous to this neoplasm. The overall findings suggested that the expression of mdr-1 is one of the differentiation markers, while bcl-2 expression may partly explain the reasons for the relatively poor prognosis of neuroblastoma by the resistance to anticancer chemotherapy, which is a major therapeutic tool for this peculiar neoplasm.

Intracranial tuberculoma: comparison of MR with pathologic findings

PURPOSE

To compare the MR signal intensity patterns and enhancement pattern of intracranial tuberculomas with their histopathologic features.

METHODS

MR images of six patients with surgically proved intracranial tuberculoma were reviewed retrospectively and were compared with histologic findings of the resected specimen. Detailed histologic examination was performed to look for the extent and characteristics of caseation necrosis, fibrosis, and inflammatory cellular infiltrates at each area of different signal intensities and at the enhancing areas on MR. Signal intensities for T1- and T2-weighted images were compared with normal gray matter.

RESULTS

On T1-weighted images, the granulomas showed a slightly hyperintense rim surrounded by a complete or partial rim of slight hypointensity and central isointensity or mixed isointensity and hyperintensity in five patients and homogeneous isointensity in one patient. Histologically, the zone of central isointensity or mixed intensity corresponded to caseation necrosis plus adjacent cellular infiltrates. The hyperintense and hypointense rims corresponded to the layers of collagenous fiber and the layers of the inflammatory cellular infiltrates, respectively. On T2-weighted images, the entire portion of the granuloma showed slightly heterogeneous isointensity or hypointensity with small markedly hypointense foci in five patients, and a hyperintense center surrounded by a hypointense rim in one patient. Histologic layers were not discriminated on T2-weighted images. On postcontrast T1-weighted images, there were single or multiple conglomerate ring enhancements within a tuberculoma in all six patients, corresponding to the layers of both collagenous and inflammatory cells.

CONCLUSION

Combination of the described signal intensity patterns and conglomerate ringlike enhancing appearance of the lesion is characteristic of tuberculoma, and may play an important role in differentiating intracranial tuberculomas from other ring-enhancing brain lesions.

Bcl-2 expression in neuroblastoma is differentially regulated by differentiation inducers

Neuroblastoma is characterized by differentiation in vivo and in vitro, and the process is known to be associated with changes in various gene expressions, among which is the bcl-2 gene whose major function may be potentially involved in the resistance to anticancer chemotherapy. We investigated the changing patterns of bcl-2 expression in neuroblastoma cell lines according to differentiation to assess whether the expression patterns can be differentially modulated by different types of differentiation inducers. Differentiation was induced in two neuroblastoma cell lines [SK-N-SH, SK-N-BE(2)] using all-trans-retinoic acid, gamma-interferon and EHS laminin, respectively. The levels of expression of bcl-2 were analysed before and after differentiation using immunoblotting and subsequent densitometry. The expression patterns of bcl-2 differed according to the type of differentiation inducers. Its expression increased when treated with retinoic acid and EHS laminin along with neuronal differentiation, while differentiation with gamma-interferon treatment was associated with decreased bcl-2 expression. Decreased expression of bcl-2 despite neuronal differentiation induced by gamma-interferon was thought to be important in that a certain differentiation pathway without increased drug resistance-related factor expression exists, which in turn has implications for the clinical application of gamma-interferon, combined with chemotherapy.

Prospective, randomized, double-blind trial of BQ-123 and bosentan for prevention of vasospasm following subarachnoid hemorrhage in monkeys

Thirty-one monkeys were randomly divided into three groups to undergo baseline cerebral angiography followed by induction of subarachnoid hemorrhage by placement of autologous blood clot along the right-sided arteries of the anterior circle of Willis (Day 0). The monkeys were then given drug vehicle or one of two endothelin (ET) antagonists, BQ-123 (6 mg/kg/day) or bosentan (5 mg/kg/day) intracisternally. The BQ-123 was administered by continuous infusion from a subcutaneous pump and the bosentan was given by twice-daily injections into an Ommaya reservoir in the subcutaneous space with a catheter along the right middle cerebral artery (MCA). Seven days later (Day 7), angiography was repeated and the animals were killed. Comparison of arterial diameters shown on angiograms between Day 0 and Day 7 groups given placebo and bosentan showed significant reductions in the diameters of the right intradural internal carotid (28% +/- 6% and 30% +/- 6%, respectively, paired t-test, p < 0.05), anterior cerebral artery (29% +/- 8% and 32% +/- 6% respectively +/- 6%, respectively) and MCA (34% +/- 6% and 46% +/- 4%, respectively). Animals injected with BQ-123 had significant narrowing of the right extradural internal carotid artery (7% +/- 6%) and the basilar artery (11% +/- 3%), but not of the right MCA. Comparison of arterial diameters between groups at Day 7 showed significant variance in the right extradural internal carotid, both intradural internal carotid, right middle cerebral, and left anterior cerebral arteries; the animals injected with BQ-123 developed significantly less arterial narrowing these those receiving bosentan and placebo. Bosentan was not detected in the cerebrospinal fluid aspirated from the cisterna magna on Day 7, whereas BQ-123 was detected in two animals. We can infer from these results that BQ-123 prevents vasospasm following subarachnoid hemorrhage in monkeys, that further investigations of ET antagonists are warranted, and that ET may be an important pathophysiological mediator of vasospasm. The lack of efficacy of bosentan may be related to inadequate cerebrospinal fluid levels obtained by administration twice-daily through an Ommaya reservoir.

Genotype distribution and comparison of the putative envelope region of hepatitis C virus from Korean patients

Comparative nucleotide sequence studies of the genomes of hepatitis C virus (HCV) revealed that there are at least 6 different genotypes of HCV. The prevalence of HCV genotypes among the patients with liver diseases in Korea was investigated using the polymerase chain reaction (PCR) for the NS5 region. In the 75 HCV RNA positive samples, two genotypes, type 1b and type 2a, were the major causative agents which accounted for 60% and 33% of infections respectively, while 7% could not be assigned a genotype by the methods used. The nucleotide sequences of cDNAs encoding the putative envelope proteins from 10 type 1b and 5 type 2a genotype samples were analyzed. Approximately 31-42% of the nucleotide sequences of type 1b samples examined differed from those of different genotypes. In the case of type 2a samples, 36-42% of the nucleotide sequences differed from those of different genotypes. The diversities of the amino acid sequences were the same or greater than those of the nucleotide sequences. Two hypervariable regions (HVR1 and HVR2) were recognized in both HCV genomes of genotypes 1b and 2a. However, the sequence divergence within the HVR2 region of genotype 2a was less than that of genotype 1b.

Compressed donut-shaped tablets with zero-order release kinetics

PURPOSE

Simple uncoated compressed tablets with a central hole (donut-shape) are proposed to provide a constant drug release over a long period of time (> 20 hrs). The effect of hole size and drug solubility on the release kinetics is investigated.

METHODS

The donut-shaped polyethylene oxide (PEO, Mw = 4 x 10(6)) tablets (600 mg and 12 mm diameter) are bored with a drill bit (3/32", 7/64", 1/8", and 5/32").

RESULTS

The release of theophylline from the donut-shaped tablets is zero order (80-90% release) before rapidly decreasing. As the hole size is increased from 7/64" to 5/32", the release rate increases and the release time is shortened. However, the release of theophylline from the donut-shaped tablet with a hole size of 3/32" follows the same anomalous release profile from a tablet without a hole. As drug solubility increases, the duration of linear drug release is shortened to 65-70% release followed by a severe tailing at the later stage of the release.

CONCLUSIONS

Donut-shaped PEO tablets with a hole provide zero-order release kinetics because the effect of the releasing surface area on the release kinetics is reduced.

Insights into IgE-mediated lung inflammation derived from a study employing a 5-lipoxygenase inhibitor

We have recently reported that the 5-lipoxygenase (5-LO) inhibitor, zileuton, alters lung inflammation produced by segmental antigen challenge in ragweed-allergic human subjects. Specifically, zileuton inhibited the urinary excretion of leukotriene E4 produced by antigen challenge, and the significant increase in bronchoalveolar lavage (BAL) eosinophils observed in subjects on placebo was not seen in subjects on zileuton. In this manuscript, we report additional data obtained during that study which provide information about mechanisms important during IgE-mediated inflammatory reactions in the lung. Three different areas are addressed: 1) the time to recovery of the lung from an IgE-mediated inflammatory response; 2) mechanisms related to the generation of cyclooxygenase products in the lung after antigen challenge and the effect of 5-LO inhibition on the production of cyclooxygenase metabolites; and 3) mechanisms responsible for the production of peptide leukotrienes in the lung and lung injury (as shown by albumin influx into the alveolar air space) 24 h after antigen challenge. We observed the following: 1) a significant BAL eosinophilia and basophilia remained 31 days (range 21-48) after segmental antigen challenge and bronchoalveolar lavage; 2) a decreased quantity of BAL cyclooxygenase products, as well as lipoxygenase products, in the presence of 5-LO inhibition; and 3) correlative analyses which suggest that while eosinophils appear most important for the production of peptide leukotrienes and lung injury 24 h after antigen challenge in subjects taking placebo, other effector mechanisms, perhaps those involving basophils and the initial mast cell triggering event, appear to gain in importance when the IgE-mediated inflammatory reaction is blunted by 5-LO inhibition.

Spindle cell hemangioendothelioma--a case report

Spindle cell hemangioendothelioma is a rare vascular tumor which is presented with subcutaneous nodules and follows a benign indolent course but has a recurrent tendency, and is histologically resembling a cavernous hemangioma and Kaposi's sarcoma. We present a case of spindle cell hemangioendothelioma possessing clinical aggressiveness with painful bony erosion, histologic pleomorphism and mitoses. A 20-year-old man presented with a recurrent painful mass on the left ankle. The mass was dark brown and firm with irregular margins and measured 1.5 cm in diameter, which affected and eroded the underlying medial malleolus of the left tibia. Microscopically, the tumor was composed of cavernous endothelial-lined blood spaces and spindle cellular areas mimicking Kaposi's sarcoma. The spindle cells intermingled with plump epithelioid cells and showed a moderate degree of pleomorphism with occasional mitoses. Immunohistochemically, the spindle cells were focally positive for factor VIII-associated antigen and vimentin, and negative for S-100 protein, desmin, and epithelial membrane antigen.

NS3-4A of hepatitis C virus is a chymotrypsin-like protease

The polyprotein encoded by a single open reading frame of hepatitis C virus (HCV) is processed by host- and virus-encoded proteases. The viral protease NS3 is responsible for the cleavage of at least four sites (NS3/4A, NS4A/4B, NS4B/5A, and NS5A/5B junctions) in the nonstructural protein region. To characterize the protease function of NS3 and NS4 on various target sites, efficient cis- and trans-cleavage assay systems were developed by using in vitro transcription and translation. Deletion of the C-terminal two-thirds from NS3 in an NS3-NS4A-4B polypeptide (NS3 delta C-4A-4B) hampered cleavage of the NS3/4A junction but not that of the NS4A/4B junction. As a consequence, expression of NS3 delta C-4A-4B containing an internal deletion of NS3 results in an NS3 delta C-4A fusion protein. NS3 delta C-4A shows very efficient and specific trans-cleavage activity at NS4A/4B, NS4B/5A, and NS5A/5B junctions. In addition, the biochemical properties of HCV NS3 delta C-4A were further elucidated by adding known protease inhibitors in trans-cleavage reactions. The HCV protease NS3-4A is inhibited by chymotrypsin-specific inhibitors N-tosyl-L-phenylalanine chloromethyl ketone (TPCK), chymostatin, and Pefabloc SC but not by trypsin-like protease inhibitors antipain, leupeptin, and N-alpha-p-tosyl-L-lysine chloromethyl ketone (TLCK) or by the protease inhibitors E-64, bestatin, pepstatin, and phosphoramidon. This finding strongly suggests that HCV protease NS3-4A is a chymotrypsin-like serine protease.

Sequence and diversity of rabbit T-cell receptor gamma chain genes

The nucleotide sequences of one constant (C), six variable (V), and two joining (J) gene segments coding for the rabbit T-cell receptor gamma chain (Tcrg) were determined by directly sequencing fragments amplified by the cassette-ligation mediated polymerase chain reaction. The Tcrg-C gene segment did not encode a cysteine residue for connection to the Tcr delta chain in the connecting region, and two variant forms of the Tcrg-C gene segment were generated by alternative splicing, like the human Tcrg-C2 gene. Five of six rabbit Tcrg-V gene segments belonged to the same family and displayed similarity to five productive human Tcrg-V1 family genes as well as the mouse Tcrg-V5 gene. The remaining rabbit Tcrg-V gene segment displayed similarity to the human Tcrg-V3 gene. Both rabbit Tcrg-J gene segments displayed similarity to the human Tcrg-J2.1 and 2.3, respectively. These findings suggested that the genomic organization of rabbit Tcrg genes is more similar to that of human than of mouse Tcrg genes.

Drug release from compressed hydrophilic POLYOX-WSR tablets

Drug release from compressed tablets manufactured with a powder mixture of poly(ethylene oxide) (PEO), a drug, and magnesium stearate is presented. Several factors such as molecular weight, drug loading, drug solubility, the pH of the dissolution medium, and stirring rate are investigated. The drug release from the high molecular weight PEO tablets (MW = 2 x 10(6) and 4 x 10(6)) is governed by the swelling of the polymer rather than by the erosion of the polymer, leading to anomalous release kinetics. However, the drug release from the low molecular weight PEO (MW = 0.9 x 10(6)) is controlled primarily by the swelling/erosion of the polymer, resulting in front synchronization and a constant release rate. It is observed that drug loading and drug solubility do not influence the release of drugs from low molecular weight PEO tablets. The pH of the dissolution medium and the stirring rate do not affect the drug release regardless of the molecular weight of the PEO.

Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity

OBJECTIVE

Our purpose was to determine whether amniotic fluid concentrations of interleukin-6 are of value in the antenatal diagnosis of acute inflammatory lesions (histologic chorioamnionitis) of preterm placenta and in the prediction of perinatal morbidity and mortality.

STUDY DESIGN

The relation among placental histologic findings, perinatal outcome, and amniotic fluid interleukin-6 concentrations was examined in 50 consecutive patients who delivered preterm neonates within 72 hours after amniocentesis. Interleukin-6 was determined by enzyme-linked immunosorbent assays. Receiver-operator characteristic curve was used for analysis.

RESULTS

Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than patients without histologic chorioamnionitis (median 70.8 ng/ml, range 0.7 to 499.2 ng/ml vs median 2.9 ng/ml, range 0.8 to 16.0 ng/ml, respectively; p < 0.00001). An amniotic fluid interleukin-6 concentration > 17 ng/ml had a sensitivity of 79% (23/29) and a specificity of 100% (21/21) in the diagnosis of acute histologic chorioamnionitis and a sensitivity of 69% (18/26) and a specificity of 79% (19/24) in the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis) and mortality. These sensitivities were significantly higher than those of amniotic fluid culture (79% vs 38%, p < 0.005; 69% vs 27%, p < 0.01, respectively).

CONCLUSIONS

Amniotic fluid interleukin-6 is a sensitive test for the prospective diagnosis of acute histologic chorioamnionitis and the identification of neonates at risk for significant morbidity and mortality.

Variable-region sequences for T-cell receptor-gamma and -delta chains of rabbit killer cell lines against Shope carcinoma cells

A rabbit gamma delta killer T-cell line against Shope carcinoma cells was established from peripheral blood lymphocytes (PBL) of a human T-lymphotropic virus type I (HTLV-I)-infected rabbit bearing Shope papilloma and carcinoma. Southern hybridization analysis of this cell line with an HTLV-I probe showed that the cell line contained multiple clones of HTLV-I-transformed cells, and three sublines with different integration patterns of the HTLV-1 genome were isolated by cloning of the cell line. In all these sublines T-cell receptor (TCR)-gamma and -delta genes were rearranged and expressed. A PCR-based analysis of the expression of variable (V) genes showed that the killer cell line preferentially expressed V gamma 1.1 and V delta 1 genes, whereas V gamma 2 and V delta 1 genes were dominantly expressed in normal PBL. Analysis of the junctional sequences of TCR-gamma and -delta genes which dictate the fine specificities of epitope recognition revealed that all three sublines expressed V gamma 1.1/V delta 1 genes without the nucleotide diversity at the V-J junctions.

Detection of 17p loss in gastric carcinoma using polymerase chain reaction

BACKGROUND

The loss of heterozygosity (LOH) of 17p has been previously studied with conventional Southern blot-restriction fragment length polymorphism analysis, but the relatively low informativity was an obstacle to extensive analysis. To overcome this problem and to investigate the significance of 17p LOH in gastric carcinoma, we employed polymerase chain reaction and subsequent silver staining of DNA.

EXPERIMENTAL DESIGN

LOH of p53 gene and D17S5 locus on 17p was analyzed using polymerase reaction; the relationships between 17p LOH and conventional clinicopathologic parameters were evaluated.

RESULTS

The LOH of p53 gene and D17S5 was found in 36.5% (23 out of 63) and 63.3% (38 out of 60) informative cases, respectively. There was no significant correlation between LOH of these two loci, whereas the frequency of the D17S5 locus was significantly higher (p < 0.01), which suggested that there may be another putative tumor suppressor gene between the two loci or distal to D17S5. The LOH of p53 gene and D17S5 locus was not significantly associated with abnormal p53 expression, depth of invasion, histologic type of the tumor (Lauren's classification), or the status of lymph node metastasis.

CONCLUSIONS

The polymerase chain reaction and silver staining of DNA seemed to be a simple and excellent method for the evaluation of chromosomal allelic loss. The 17p LOH was frequently found in gastric carcinoma, but specific association with conventional clinicopathologic parameters was not found.

Short-term follow-up of stereotactic Gamma Knife radiosurgery in epilepsy

The efficacy of stereotactic Gamma Knife radiosurgery (STGKRS) for epilepsy was assessed in 9 patients followed up for more than 1 year. The mean duration of seizures was 9 years (range 1-22 years). In all 9 patients the epilepsy was classified as medically intractable. MRI showed nonprogressive focal cerebral lesions of less than 2.0 cm in size with or without calcification. After STGKRS, 8 patients had an excellent result (seizure free, single seizure episode, or auras only). In 2 of these patients antiepileptic drug therapy could be discontinued. One patient had no worthwhile improvement. Neither the anatomic distribution of the lesion on neuroimaging study nor extracranial EEG-recorded epileptiform activity appeared to be significant determinants of outcome. Radiation-induced edema did not seem to affect the outcome of seizure control. This preliminary report indicates that, in selected patients with medically intractable seizures associated with a focal cerebral lesion, STGKRS may be effective in controlling or greatly reducing the seizures.

Cystic intrapulmonary lymphangioma: HRCT findings

We report a rare case of cystic intrapulmonary lymphangioma involving the left lung, which presented with pneumothorax and respiratory distress in a 6-month-old infant. Chest radiographs showed a multicystic lesion in the left lung mimicking the features of congenital cystic adenomatoid malformation of the lung. The lesion appeared on high-resolution CT (HRCT) as a multiseptate, air-filled cystic lesion in the left hilar area. Associated HRCT findings were thickening of interlobular septa and bronchovascular bundles in the left lung and the presence of peripheral pulmonary vessels within cystic lesions in the apex of the left lung. HRCT findings correlated well with histopathologic findings. We suggest that these associated findings may be helpful in distinguishing this condition from other cystic lung diseases and that this entity should be included in the differential diagnosis of multicystic lung lesions.

Varied expression of major histocompatibility complex and oncogenes in Shope carcinoma cell lines derived from a single tumor

The cellular gene expression was compared in four Shope carcinoma cell lines, which were derived from a single tumor and possess various potentials for differentiation and tumorigenicity. The E6 and E7 transforming genes of cottontail rabbit papillomavirus were expressed in all these cell lines, highest level of expression being in the most tumorigenic and undifferentiated cell line, where the major histocompatibility complex (MHC) class I expression was the lowest. The MHC class II antigen, which is not expressed on normal epithelial cells, was detected in all the cell lines, but hardly, if at all, on the surface of these cells. The surface expression of the MHC class II antigen could not be induced by the culture supernatant of phytohaemagglutinin-stimulated splenocytes, which increased the surface expression level of the MHC class I antigen of the same cells. These findings suggest that the aberrant expression of the MHC class II antigen in these cells could not be implicated in the immune response against tumors. The c-fos, c-myc and c-H-ras oncogenes were variably expressed in these cell lines, but there was no correlation with tumorigenicity.

Eosinophils recruited to the lung by segmental antigen challenge show a reduced chemotactic response to leukotriene B4

Inflammatory cells, particularly eosinophils, are thought to be important in allergic airway disease. However, the mechanisms responsible for their recruitment to the lung have not been well established in humans, in vivo. In this report we demonstrate that eosinophils recruited to the lung of ragweed allergic volunteers by segmental antigen challenge have a decreased chemotactic response to leukotriene (LT) B4 ex vivo, in comparison with eosinophils isolated from peripheral blood (80% inhibition at 10(-8) M LTB4, the optimal concentration, p < 0.01). Their chemotactic response to formyl-methionyl-leucyl-phenylalanine (FMLP) was normal. Although the response to platelet activating factor also appeared to be reduced, this reduction was not statistically significant. These data suggest that lung eosinophils were exposed to LTB4 in vivo and are consistent with the hypothesis that LTB4 is important in the recruitment of eosinophils to the lung during IgE-mediated reactions in the lung in humans.

Effects of hormone replacement therapy on lipoprotein(a) and lipids in postmenopausal women

High concentrations of lipoprotein(a) [Lp(a)], an independent risk factor for atherosclerosis, cannot be managed by the usual lipid-lowering agents. It has been suggested that Lp(a) levels are related to female sex hormones. Estrogen replacement therapy makes the lipid profiles favorable for delaying atherosclerosis in postmenopausal women. The effects of the combination therapy of estrogen and progesterone on lipids are controversial. This study was designed to evaluate the effect of female sex hormones on the concentration of Lp(a) and to clarify the influence of progesterone on the effect of estrogen in postmenopausal women. Postmenopausal women (n = 184) were divided into four groups: control; 0.625 mg conjugated equine estrogen (CEE) plus 10 mg medroxyprogesterone acetate (MPA); 0.625 mg CEE plus 5 mg MPA; and 0.625 mg CEE only. Medication for 2 months lowered the concentrations of Lp(a) by 20% in all treated groups. The decrease was more pronounced in subjects with a relatively higher basal Lp(a) concentration. Estrogen replacement therapy raised the concentration of high-density lipoprotein cholesterol and decreased low-density lipoprotein cholesterol without changing total cholesterol. The combination therapy of estrogen and progesterone abolished the effect of estrogen on high-density lipoprotein cholesterol. Hormone replacement therapy lowered Lp(a) levels in postmenopausal women. The effect was prominent in subjects with high basal Lp(a) levels. This decrease may be one of the mechanisms of the cardioprotective effects of estrogen. The cardioprotective effect of estrogen cannot be applied to the combination therapy due to the adverse effect of progesterone on high-density lipoprotein cholesterol.

Patterns of p53 expression in phyllodes tumors of the breast--an immunohistochemical study

Authors performed an immunohistochemical analysis using monoclonal antibody to p53 protein on 15 cases of benign and malignant phyllodes tumor of the breast along with a review of other conventional clinicopathological parameters to investigate the meaning of p53 expression. The cases were composed of 8 benign and 7 malignant lesions. The pattern of p53 expression showed a statistically significant difference between these benign and malignant lesions (p < 0.005). None of the benign cases expressed p53 whereas 6 out of 7 malignant cases did. Among malignant phyllodes tumors, the pattern of expression was diffuse and strong in two cases while granular and relatively weak in the remaining 4 cases. p53 expression seemed to be a unique feature of malignant phyllodes tumors, thereby, one of the most significant parameters for the differentiation of benign and malignant phyllodes tumors of the breast.

Molecular typing of hepatitis C virus genome from sera and liver tissues of patients with anti-HCV positive chronic liver disease

The authors investigated the distribution of HCV genotypes in patients with various chronic liver diseases in Korea. Study population was 70 individuals, positive for second generation anti-HCV EIA, consisting of 37 cases with sporadic non-A, non-B (NANB) chronic hepatitis (CH), 12 NANB hepatocellular carcinoma, 16 post-transfusion NANB hepatitis, 4 non-B blood donors and 1 healthy family member of a patient with sporadic CH. Molecular typing was performed by RT-nested PCR with type-specific primer sets deduced from the NS-5 region of HCV. The prevalence of type II was 75.0% and type III was 25.0% in sera. In liver tissues, type II HCV was shown in 63.0%, type III HCV in 3.7% and co-infections with type II and III HCV were observed in 18.5% of 27 samples biopsied. In the sera of patients with chronic hepatitis, typing results were relatively well correlated with those in tissues (75%), but type III could not be observed. Among 12 HCC patients, type III HCV appeared only in tissues, not in sera. These results suggest that type II HCV may be the major HCV type in Korea, and co-infections with type II and-III HCV may not be rare in chronic liver diseases with HCV.

Primary malignant melanoma of the female urethra

BACKGROUND

Malignant melanoma is one of the rarest tumors of the female urethra. The prognosis of urethral melanoma is poor.

METHODS

A 59-year-old woman underwent total urethrectomy, bilateral inguinal lymph node dissection, and vesicostomy for Stage A primary malignant melanoma of the urethra. She received adjuvant therapy consisting of dacarbazine, vincristine, cyclophosphamide, and alpha-interferon. Two years later, repair of the parastomal hernia and interposition of an isoperistaltically ileum intussusception between the bladder and the abdominal wall were done.

RESULTS

Complete continence was achieved, and the patient catheterizes herself every 3-5 hours during the day and once at night without difficulty. She has survived 5 years without any evidence of tumor recurrence.

CONCLUSIONS

There have been only six case reports of women with primary malignant melanoma of the urethra surviving more than 5 years, including this case. Total urethrectomy with bilateral inguinal lymph node dissection should be done as the initial form of the treatment in patients with this disease who have no evidence of distant metastasis. The postoperative adjuvant therapy, consisting of alpha-interferon and chemotherapy, should be administered immediately; therefore, vesicostomy was done because it is a simple procedure. However, this type of urinary diversion requires an external appliance. Clinicians should consider the patient's quality of life, prognosis, and general condition and attempt to solve the problems of patients 2-3 years after the operation.

[A study on the establishment of a fee system for hospital based home nursing care]

This study was done in order to provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from general hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical-surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research instruments utilized for the study were a client selection criteria for Home Health Care developed by Choo (1991) and a check-list of nursing activity developed by researcher. The results of the study were as follows: 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multiplying the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the time of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were IM injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calculated at W 6136 per day. 4. Based upon the results of the study, a recommendation for a Home Health Care fee per visit based on the nursing activities provided could be formulated for a Home Health Care fee system. It could be formulated as following: 1) Home health Care fee per visit = [(direct nursing fee (direct nursing care time per activity x average nursing wage) + indirect nursing fee) x average nursing activity per visit] + management fee+materials fee+a travel fee. In this way a nursing fee could be calculated based upon the result of the study of the nursing fees per visit.(ABSTRACT TRUNCATED AT 400 WORDS)

Papillary muscle necrosis in neonates and infants--analysis of 209 autopsies

A total of 209 consecutive neonate and infant autopsies were reviewed with special attention to papillary muscle necrosis (PMN) of the heart. Associated major pathological findings were analysed for the evaluation of significant pathological accompaniments of PMN. PMN was found in 52 cases among 171(30.4%) neonates and major pathological accompaniments were bronchopneumonia, hyaline membrane disease, hypoxic neuronal change, sepsis, subarachnoid hemorrhage, disseminated intravascular coagulation (DIC) and acute tubular necrosis, among which hypoxic neuronal change and ATN had a statistically significant higher incidence when compared with the control group. (p < 0.005). PMN was found in 13 cases among 38(34.2%) infants and accompaniments were congenital heart disease, sepsis, bronchopneumonia, DIC and hypoxic neuronal change, all of which showed no difference from the control group in incidence. The results imply that PMN is a kind of organ damage in stressed subjects regardless of age, that it is not a special form of myocardial injury in any specific age group including the newborn period, and is possibly of different pathogenesis and significance.

An unusual combination of trisomy 21 and partial trisomy 5q

The authors describe a male newborn with multiple congenital anomalies; craniofacial dysmorphism, bilateral cleft palate and lip, ambiguous external genitalia with absence of phallus, ventricular septal defect, agenesis of olfactory bulbs, and presence of small round cells simulating migration defect in the cerebellar white matter. Cytogenetic study demonstrated a chromosomal constitution of 47,XY, +21, +5q. Its pathological significance compared with Down's syndrome and hitherto reported partial trisomy 5q is discussed.

Effect of loading on swelling-controlled drug release from hydrophobic polyelectrolyte gel beads

The effect of oxprenolol HCl loading on the kinetics of polymer swelling and drug release from suspension-polymerized poly(methyl methacrylate-co-methacrylic acid) (PMMA/MAA) beads has been studied in detail. Within the range of variables studied, the polymer swelling rate increases with buffer pH and concentration. And an ionization-controlled swelling mechanism (analogous to the relaxation-controlled mechanism) mechanism) seems to become more rate-limiting at higher buffer concentrations. At oxprenolol HCL loading levels below 17.8%, the drug release and associated dimensional changes (in pH 7.4) exhibit an extended quasi-linear region despite the inherent limitation of spherical geometry. At higher loading levels, the drug release becomes faster and first-order in nature. This is apparently a result of the transition from a dissolved to a dispersed system above a percolation threshold (15-18% loading in the present study). As a result of competition from processes such as the reduction of bead dimension due to drug release and the dimensional increase due to polymer swelling and osmotic contributions from the drug, the transient bead diameter increases monotonically during drug release at loading levels up to 25.6%, whereas upon further increasing the drug loading, the bead diameter goes through a maximum during the early drug release, which eventually increases again as a result of the slow but continuous increase in polymer swelling due to further ionization. In all cases, both the drug release and the dimensional changes approach completion as the penetrating ionization fronts meet at the center, indicating a true swelling-controlled behavior.

Sudden death in angiodysplasia of the gastroesophageal junction

A 22-year-old Korean soldier, who had received blows to the neck and epigastrium from an officer 10 h earlier, suddenly died after massive hematemesis. He had been in relatively good health except for episodes of blood-tinged vomiting approximately 5 and 7 months prior to this event. Postmortem examination revealed angiodysplasia involving the gastroesophageal junction, and the stomach was distended with blood. No abnormal findings were present around the whole viscera, and the duodenum was free of blood. The pathologic significance of upper gastrointestinal angiodysplasia as a potential source of bleeding and a chronologic correlation between the trauma and bleeding are discussed.

[A study of home care needs of patients at discharge and effects of home care--centered on patients discharged from a rural general hospital]

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 and March 1991. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions for these patients were analyzed in this study. The results of the study are summarized as follows: 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3%, health perception, 68.2% self concept, 62.5%, and sleep and rest 62.5%. Looking at the nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 63.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL score at discharge was 19.78 +/- 8.23, and after 3 months 19.01 +/- 8.12. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did not deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight but not statistically significant decrease in the quality of life scores between the two test times (147.83 at discharge and 143.02 at the three month period).(ABSTRACT TRUNCATED AT 400 WORDS)

CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients

The CT findings in cases of benign fibrous mesothelioma of the pleura have been described previously, but little attention has been given to a correlation of these findings with the pathologic appearance of the tumors. Accordingly, we analyzed the CT scans in nine proved cases in which pathologic studies were available and compared the pathologic findings with the CT appearance of the tumors. On enhanced CT scans (available in eight patients), the lesions showed significant enhancement in all cases. Pathologic examination showed that the enhancement could be explained by the vascularity of the tumor. Areas of myxoid (n = 7) or cystic (n = 3) degeneration and hemorrhage (n = 3) seen in the pathologic specimens correlated with round or tubular low-attenuation areas on unenhanced and enhanced CT scans. On unenhanced CT scans (n = 3), the tumor density was the same as that of the surrounding musculature. Calcification was seen in one patient. Large lesions showed lobulated borders, but no invasion into the lung parenchyma and chest wall was noted. There was no pleural effusion. Our experience suggests that intense enhancement of the tumors occurs because of the vascularity of the tumors. Areas of low attenuation in the tumors on CT were due to foci of myxoid or cystic degeneration and hemorrhage in the lesion.

Hydrophobic anionic gel beads for swelling-controlled drug delivery

Using oxprenolol HCl as a model drug, the effects of pH and buffer concentration on the swelling and drug release properties in cross-linked poly(methyl methacrylate-co-methacrylic acid) (PMMA/MAA) beads have been investigated. The kinetics of swelling of such hydrophobic anionic gel beads from the dehydrated state appear to be governed primarily by a diffusion-ionization process which becomes more ionization-controlled at higher buffer concentrations. Within the range of ionic compositions studied, the swelling rate increases and the initial swelling/ionization front penetration becomes increasingly linear in time with increasing pH or buffer concentration of the swelling medium. The corresponding swelling bead diameter appears to reach an equilibrium value as soon as the penetrating ionization fronts meet at the center, suggesting a swelling equilibrium in the ionized shell due to rapid mechanical readjustment in the gel phase. At oxprenolol loading levels up to 15%, both the transient drug release and swelling bead diameter exhibit extended quasi-linear regions despite the inherent limitation of decreasing surface area at the penetrating front in the spherical geometry. In addition, both the drug release and the dimensional changes reach completion when the penetrating ionization fronts meet at the center, suggesting a true swelling-controlled drug release behavior.

Composite poly(vinyl alcohol) beads for controlled drug delivery

A new method of preparing composite poly(vinyl alcohol) (PVA) beads with a double-layer structure has been developed, which involves a stepwise saponification of suspension polymerized poly(vinyl acetate) (PVAc) beads and subsequent stepwise cross-linking of the PVA core and shell with glutaraldehyde. This process results in PVA beads with thin, highly cross-linked outer shells and lightly cross-linked inner cores of different degrees of cross-linking. In addition to structural characterization of the polymer based on equilibrium swelling measurements, the kinetics of water swelling and drug release from these beads were studied at 37 degrees C using acetaminophen and proxyphylline as model drugs. The results show that the outer shell functions as a rate-controlling membrane upon increasing its cross-linking ratio, X, above 0.47. This aspect is reflected in the observed diffusional time lags and constant-rate regions during swelling and drug release. Based on observed time lags, the diffusion coefficient of water through the outer PVA shell with a high cross-linking ratio of X = 0.5 is estimated to be at least six times higher than that of acetaminophen and proxyphylline. In addition, drug diffusion coefficients in the lightly cross-linked PVA core appear to be at least 10 times larger than that in the highly cross-linked outer shell. At lower shell cross-linking ratios (X less than 0.4), the diffusional time lags appear to be absent and the diffusion profiles are apparently first-order (Fickian) in nature.

[Experimental study on intraoperative autotransfusion during urological operation]

The value of autotransfusion is widely recognized in the surgical community and may be of increasing importance in prevention of acquired immunodeficiency syndrome and hepatitis. The concern of possible contamination of the blood with urine, bacteria in urine or viable tumor cells has limited the wide use of intraoperative autotransfusion (IAT) in urological operation. There have been no experimental reports about protection of the blood from such contamination. To investigate separation of the blood from a contaminated mixture by using an autotransfusion machine, Haemonetic Cell Saver, a study composed of three experiments was performed. First, 200 ml of blood was mixed 200 ml of urine, and thereafter, the mixture was processed by the machine and the concentration erythrocytes were collected in a bag. Biochemical analysis of the collected erythrocyte solution (CES) was performed. Second, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain each 10(7)/ml of four bacterial strains. The bacteriological study of the CES was performed. Third, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain 10(7) cancer cells. Two cell lines, KK47 originated from human bladder cancer and ACHN originated from human renal cell carcinoma was used. The cytological study of the CES was performed. The results of these experiments were: Urine constituents were completely removed from the mixture. However, all strains of bacteria could not be separated, although the number of bacteria decreased. Cancer cells were found in the CES. In conclusion IAT should be done at urological operation in selected patients that have sterile urine and do not have tumor cells in the operation field.

Emphysematous cystitis: report of a case

Emphysematous cystitis is characterized by gas collection within the bladder wall and lumen. A case of emphysematous cystitis in a 74-year-old diabetic male is reported. Radiogram demonstrated an enlarged bladder with intraluminal gas.

[Tunica albuginea cyst associated with hydrocele testis: report of a case]

The patient is a 54-year-old male presenting with a chief complaint of a right intrascrotal mass. Ultrasonographic image of the right testis demonstrated a marginally located cyst, 5 mm in diameter, with hydrocele fluid. Partial orchiectomy and hydrocelectomy with Bergmann's method were performed without any morbidity. Histopathological diagnosis was tunica albuginea cyst. To date, this case is the sixth reported case in Japan.

[Effect of shift interval for the clinical nurse with respect to circadian rhythm]

Circadian rhythm is entrained in the 24-hour time interval by periodic factors in the environment, known as zeitgeber. But most rotating work schedules are outside the range of the entrainment of the pacemaker timing the human circadian sleep-wake cycle. It has been postulated that physiological and emotional disturbances occur in most human functions when the circadian rhythm is disturbed. So application of circadian principles to the design of shift schedules can aid in maintaining the temporal integrity of the circadian system and thereby minimize for the shift worker any detrimental consequences of circadian disruption. This study was a quasi-experimental study to test the effect of shift intervals for the clinical nurse on the circadian rhythm. Twenty nurses newly employed in general units of two hospitals were selected as an experimental group and twelve college nursing students as a control group. Both groups were selected according to an established criteria using a purposive sampling technique. Ten subjects were assigned to a weekly shift group and another ten to a biweekly shift group engaged in a semi-continuous shift schedule (sunday off) with a backward direction; that is, morning-evening-night shift. The control group worked a morning shift for 42 days. Oral temperature rhythm, waking time, sleep-wake cycle, fatigue, and mental performance were measured during the experimental period. The data collection period was from April 30, 1990 to June 10, 1990. MANOVA, paired t-test, ANOVA, and Student Newman Keuls method were used for statistical analysis. The results are summarized as follows. 1. Phase delay in the acrophase of temperature rhythm was shown according to the backward rotating shift. A complete adaptation to work on the night shift was achieved between the sixth and ninth day of the night shift. 2. There was no difference in either waking time or sleep-wake cycle according to the duration of the working day for every shift group. Significant difference was found in the waking time and the sleep-wake cycle for subjects on the morning, evening, and night shift in both of the shift groups (weekly shift group: lambda = 0.121, p less than 0.01, lambda = 0.112, p less than 0.01, biweekly shift group: lambda = 0.116, p less than 0.01, lambda = 0.084, p less than 0.01). 3. There was no difference in fatigue between the first working day and the last working day for the control group and for the biweekly shift group.(ABSTRACT TRUNCATED AT 400 WORDS)

Enzyme-linked immunosorbent assay for the detection of Salmonella enteritidis infection in chickens

An ELISA was developed and tested for its ability to detect antibodies against Salmonella enteritidis in chickens. Various features of the ELISA were evaluated and optimized. The outer membrane protein antigens selected by use of the protein immunoblotting method made the assay specific and sensitive. The assay was evaluated in chickens experimentally infected with S enteritidis. Blood samples collected at weekly intervals after experimental infection with S enteritidis were analyzed by ELISA. Results of the ELISA were compared with those of conventional serum plate and microagglutination tests. The ELISA was more sensitive and specific in the detection of S enteritidis infection than the other 2 conventional tests.