PCR detection of DNA specific for Aspergillus species in serum of patients with invasive aspergillosis

We investigated the possible presence of DNA specific for Aspergillus species in serum samples of patients with invasive aspergillosis (IA) by the nested PCR method. Fourteen strains of fungi including 5 strains of Aspergillus species and 10 strains of common bacteria were used for examination of specificity and sensitivity of the nested PCR. Two sets of oligonucleotide primers were derived from the sequence of the variable regions V7 to V9 of the 18S rRNA genes of Aspergillus fumigatus. The specific fragment was amplified from five strains of Aspergillus species in the single and nested PCR but not from other microorganisms. Target DNA was detected by the nested PCR with as little as 50 fg of the extracted DNA of A. fumigatus. We investigated the detection of DNA specific for Aspergillus species in serum samples of a murine model of aspergillosis and 20 patients with IA. The specific fragment was detected by the nested PCR in 71% of serum samples of infected mice and 70% of serum samples of patients with IA, while galactomannan antigen was detected in 43 and 60% of samples, respectively. The high sensitivity and specificity of the nested PCR indicate that the assay can provide early diagnosis with sufficient accuracy to be clinically useful for immunocompromised patients with IA.

[Endobronchial actinomycosis]

A 63-year-old man was admitted to our hospital with obstructive pneumonia. The chest X-ray film and computed tomogram showed an infiltrative shadow in the right lower lung field. Examination with a fiberoptic bronchoscope showed a mass in the right basal bronchus. These findings suggested the diagnosis of lung cancer with obstructive pneumonia. Histopathological examination of a specimen obtained by transbronchial biopsy revealed sulfur granules with infiltration of neutrophils, which led to the diagnosis of endobronchial actinomycosis. After three months of treatment with penicillin, the mass disappeared. Comparison of bronchoscopic findings before and after penicillin treatment clearly showed the efficacy of therapy.

[A case of contralateral pneumothorax after right pneumonectomy]

A 46-year old man, who had a history of right pneumonectomy for pulmonary tuberculosis 28 years ago, was referred to our hospital for surgical treatment of contralateral pneumothorax. The patient underwent multiple excisions of bullae and parietal pleurectomy through the median sternotomy in order to save pulmonary function. The postoperative course was satisfactory as he could maintain preoperative pulmonary function. He returned to his work soon. We consider that the median sternotomy would be the most useful approach to save pulmonary function of patients who plan to undergo surgical treatment of contralateral pneumothorax after pneumonectomy.

Malignant schwannoma metastasizing to the dura mater--case report

A 58-year-old female, with a previous history of radical resection of malignant schwannoma arising in the maxillary sinus, presented with a metastasis to the dura mater following lung metastases 15 years after the initial diagnosis. A large mass at the left temporal region was totally removed immediately after an intratumoral hemorrhage. She subsequently died of massive hemoptysis. Although the prognosis is poor for patients with malignant schwannoma, aggressive treatment including radical surgery combined with radiotherapy and chemotherapy is recommended.

Estrogen blocks parathyroid hormone (PTH)-stimulated osteoclast-like cell formation by selectively affecting PTH-responsive cyclic adenosine monophosphate pathway

Several lines of evidence have previously indicated that estrogen inhibits PTH-induced bone resorption in vivo and in vitro. However, its mechanism remains unknown. Therefore, the present study was performed to investigate the effect of estrogen on PTH-stimulated osteoclast-like cell formation and clarify its mechanism. 17 beta-estradiol (17 beta-E2) significantly antagonized osteoclast-like cell formation stimulated by 10(-8) M human (h) PTH-(1-34) as well as 10(-8) M hPTH-related peptide (PTHrP)-(1-34)in osteoblast-containing mouse bone cell cultures. The conditioned medium derived from osteoblastic SaOS-2 cells or MC3T3-E1 cells pretreated with both PTH-(1-34) (10(-8)M) and 17 beta-E2(10(-8)M) stimulated osteoclast-like cell formation from hemopoietic blast cells more weakly than conditioned medium from cells pretreated with PTH-(1-34) alone. Moreover, 10(-8) M 17 beta-E2 significantly blocked the formation of osteoclast-like cells stimulated by 10(-8) M hPTH-(1-34) in spleen cell cultures derived from 5-fluorouracil-pretreated mice. On the other hand, 10(-8) M 17 beta-E2 significantly inhibited osteoclast-like cell formation stimulated by dbcAMP (10(-4)M) and Sp-cAMPS (10(-4)M), as well as forskolin (10(-5)M) in mouse bone cell cultures. In contrast, 10(-8)M 17 beta-E2 did not affect PMA (10(-7)M)-, A23187 (10(-7)M)-, or BAYK-8644 (5 x 10(-6) M)-stimulated osteoclast-like cell formation. In conclusion, the present study demonstrated that estrogen inhibits PTH-stimulated osteoclast-like cell formation by directly acting on hemopoietic blast cells as well as by indirectly acting on them via osteoblasts. The inhibitory effects of estrogen on PTH-stimulated osteoclast-like cell formation seemed to be mediated through blocking the cAMP-dependent protein kinase pathway but not by blocking calcium/protein kinase C.

[Effect of (-)-N-[(S)-hexahydro-l-methyl-2, 6-dioxo-4-pyrimidinylcarbonyl]-L-histidyl-L-prolinamide (TA-0910), a new TRH analog, on plasma levels of TSH and thyroid hormones in rats]

The stimulatory effect of TA-0910 on the secretions of thyroid-stimulating hormone (TSH) and thyroid hormones was investigated in male and female rats. Single intravenous administration of TA-0910 at 8.3 nmol/body acutely elevated the plasma TSH level, with delayed and moderate increases of T3 and T4 in plasma. Similar increments of plasma TSH and thyroid hormones were observed when TRH was injected at the dose of 0.83 nmol/body. Oral administration of TA-0910 at 2.75 mumol/body was equally potent or slightly more potent to secrete TSH than TRH at 0.275 mumol/body. The elevated TSH by TA-0910 decreased to the control level within 2 hr after intravenous injection or within 6 hr after oral administration; on the other hand, the higher levels of the thyroid hormones were retained for up to 4 and 6 hr after intravenous and oral administration, respectively. These findings indicate that TA-0910 and TRH stimulate the secretion of TSH and thyroid hormones by a similar manner and that the TSH-secreting activity of TA-0910 is lower by an order of magnitude compared with that of TRH.

[Thoracic duct cyst--a case report]

The patient was a 59-year-old man with a 5-month history of cough, difficulty breathing, and palpitations while working. Initial examination at the internal medicine department of our hospital in August 1992 revealed a mass in the left side of the neck, and he was admitted for further examination and treatment. Preoperative investigations revealed a cystic lesion extending from the left neck area to the mediastinum. The mass was resected on August 13, 1992. Based on the intraoperative findings and postoperative histological examination, a diagnosis of thoracic duct cyst was made. The postoperative course was good and the patient was discharged after two weeks. This is extremely rare case, and the Trap door surgical approach proved useful for resection.

The influence of azithromycin on the biofilm formation of Pseudomonas aeruginosa in vitro

The influence of azithromycin on biofilm formation by Pseudomonas aeruginosa, a cause of refractory chronic respiratory tract infection, was investigated. Alginic acid produced by a mucoid strain of P. aeruginosa was quantified by high-performance liquid chromatography from colonies growing on an agar medium. Polysaccharides in the biofilm formed on silicon chips by a nonmucoid strain were determined by a tryptophan reaction. The effect of azithromycin was examined at concentrations below the minimum inhibitory concentration (sub-MIC) for each strain. Azithromycin significantly inhibited the production of alginic acid from the mucoid strain at > or = 1/256 MIC, and the production of exopolysaccharides from the nonmucoid strain at > or = 1/16 MIC. The inhibition of biofilm formation by azithromycin was also observed by scanning electron microscopy. These findings suggest that azithromycin inhibits biofilm formation by P. aeruginosa at concentrations well below the MIC.

[Prevention of infections in a case with myelodysplastic syndrome by an intermittent subcutaneous administration of G-CSF]

An 83-year-old male was admitted to our hospital because of pancytopenia and low grade fever on April 19, 1993. On admission, hematological data were as follows: WBC 1,000/microliters with 19% neutrophils, RBC 367 x 10(4)/microliters, Hb 9.5 g/dl and platelets 6.7 x 10(4)/microliters. Bone marrow examination revealed 6.6% myeloblasts and 33.5% erythroblasts. Morphological abnormalities included hypersegmentation, degranulation and pseudo-Pelger's nuclear anomaly in neutrophils. Based on these findings the diagnosis of refractory anemia with excess of blasts (RAEB) of the myelodysplastic syndrome (MDS) was made and therapy with low dose Cytarabine (Ara-C) was initiated in April 1993. The patient had two episodes of severe pneumonia in June and July. Therefore, 75 micrograms/day of G-CSF was given in addition to antibiotic therapy for the second episode of infection in July. Thereafter the severe infection subsided, and G-CSF administration was switched to an intermittent schedule (75 micrograms twice a week) since September. Cytarabine ocfosfate (100 mg/day) was added for 10-14 days at interval 1-2 months from October,1993. He has been well with no episode of infection for more than two year. One major concern regarding the clinical application of G-CSF in MDS patients is related to the possible stimulation of leukemic cell proliferation. Frequent hematological monitoring is necessary in patients with RAEB who are prone to develop acute myeloid leukemia. However, we administered G-CSF at a relatively low dose twice a week for over two year and could successfully prevent infections without inducing the leukemic changes.

Flow reserve capacity of left internal thoracic artery 23 years after Vineberg procedure

Graft flow volume and flow reserve were assessed by Doppler echocardiography 23 years after Vineberg left internal thoracic artery implantation. Angiography showed good patency of the left internal thoracic artery, and the flow velocity profile was as biphasic as that of the coronary circulation. Drug-stressed test showed a physiologic reactivity of the Vineberg left internal thoracic artery but less response than that of a directly anastomosed left internal thoracic artery.

Electrocardiographic diagnosis of left circumflex artery occlusion and the occlusion site

In patients with a posteroinferior acute myocardial infarction and both ST depression (in lead V1 or V2) and ST elevation in the inferior leads, it is difficult to differentiate a left circumflex artery occlusion from a right coronary artery occlusion. Furthermore, there is no useful method to identify the obstruction site in the left circumflex artery. In a study of 52 patients with single-vessel left circumflex artery disease, ST elevation in V6 was found to be a useful indicator for left circumflex artery occlusion in such patients. Furthermore, the sum of the ST changes in leads a VF and V2 is useful for identifying the occluded site in the left circumflex artery.

Molecular typing of Helicobacter pylori: differences in pathogenicity among diverse strains

Helicobacter pylori appears to be a species with strain diversity, according to studies carried out using various molecular biological techniques. Differences in pathogenicity caused by the strain diversity of H. pylori were therefore investigated. Two hundred and thirty strains were divided into four types by polymerase chain reaction-restriction fragment length polymorphism, and their relationship to endoscopic diagnosis, ammonia concentration of gastric juice, and urease activity were assessed. With regard to incidence by type, patients infected with type 1, type 2, and type 3 exhibited the highest incidences of gastric ulcer, duodenal ulcer, and gastritis, respectively. The urease activity of type 2 was significantly lower than that of types 1 and 3 (P < 0.05). These observations suggest differences in pathogenicity due to the strain diversity of H. pylori. However, the diversity of diseases related to H. pylori is also presumed to be caused by both the diversity of H. pylori strains and differences in the host immunological reaction. Future studies should be directed toward clarifying the entire pathogenic mechanism of H. pylori infection.

Cloning and sequencing of the spore germination gene of Bacillus megaterium ATCC 12872: similarities to the NaH-antiporter gene of Enterococcus hirae

The germination mutant TM-31 of Bacillus megaterium ATCC 12872, was isolated by transposon Tn917 insertional mutagenesis. Glucose, L-proline, L-leucine and KNO3 germinated TM-31 poorly. The DNA in the region of the Tn917 insertion was cloned, and its nucleotide sequence determined. One major open reading frame was present on the cloned DNA. The hydrophobic protein encoded is presumably membrane-associated. A homology search revealed that the gene encoded in the region of the Tn917 insertion is homologous to napA of Enterococcus hirae. napA codes for the NaH-antiporter. It is hypothesized that transport of cations must play an important role in spore germination in B. megaterium ATCC 12872.

Detection of specific bacterial cells with 2-hydroxy-3-naphthoic acid-2'-phenylanilide phosphate and fast red TR in situ hybridization

An in situ hybridization technique with HNPP (2-hydroxy-3-naphthoic acid-2'-phenylanilide phosphate) and Fast Red TR was used to detect specific bacterial cells at the single-cell level. By this technique, the fluorescent signals of target bacterial cells were up to eight times more intense than those of standard fluorescence in situ hybridization with mono-fluorescein isothiocyanate-labeled oligonucleotide probes. This novel HNPP-Fast Red TR whole-cell hybridization technique is available for the identification of small or low-rRNA-content bacterial cells in the natural environment.

[Acute lymphoblastic leukemia with marked morphologic abnormalities after chemotherapy for gastric cancer]

A 76-year-old man was admitted to our hospital in February, 1994 because of fever and general fatigue. The patient had received radical gastrectomy for gastric cancer in August, 1987 and was subsequently treated with adjuvant chemotherapy using UFT for 25 months. On admission, the leukocyte count was 57,700/microliters with 74% blasts. Bone marrow aspiration revealed proliferation of blasts with marked giant cells and polynucleolar cells. The diagnosis of T-lineage of acute lymphoblastic leukemia (ALL) was then made by analysis of surface markers and T-cell receptor rearrangement. Although combination chemotherapy was initially effective, blasts rapidly reappeared in the peripheral blood, and the patient died of pneumonia in August, 1994. In the presented case, blasts showed marked morphologic abnormalities. It is well known that most cases of therapy-related leukemia deviate from the myeloid lineage, and rarely from the lymphoid lineage. In addition, morphologic abnormalities are rare in de novo ALL. Since such abnormalities were demonstrated in our patient, and UFT was administered for a long period, it is possible that this leukemia occurred as a second malignancy related to UFT treatment.

Diverse inotropic effects of 5-hydroxytryptamine in heart muscles of various mammalian species

The inotropic effects of 5-hydroxytryptamine (5-HT) on mammalian heart muscles were investigated. 5-HT (10(-8)-10(-3)M) produced increases in the contractile tension of atrial and ventricular muscles isolated from guinea pigs, Japanese monkeys, and humans, but not in rat heart preparations. The maximum percent increase of contraction was largest in guinea pig ventricular muscles (142.0 percent), followed by monkey atrium (86.3 percent), human atrium (71.7 percent), guinea pig atrium (48.7 percent), and monkey ventricle (30.1 percent). The sensitivity to 5-HT, measured as the negative logarithm of the half-maximal inotropic molar contractions of 5-HT, i.e., -logEC(50), was highest in the human atrium (6.65 +/- 0.20), followed by guinea pig atrium (5.53 +/- 0.36), monkey ventricle (4.83 +/- 0.28), guinea pig ventricle (4.56 +/- 0.11), and monkey atrium (4.46 +/- 0.16). The inotropic effects of 5-HT seen in the atrial and ventricular muscles of guinea pigs were abolished in the presence of the beta-receptor blocker, pindolol (8 mu M), while these effects in human atrial muscles and monkey atrial and ventricular muscles were abolished only in the presence of both pindolol (8 mu M) and of prazosin (1 mu M), an alpha(1)-receptor blocker. 5-HT increased the V(max) of the slow response recorded from guinea pig ventricular muscles exposed to high K+ (27 mM) media, whereas this agent did not alter the calcium current of isolated guinea pig ventricular myocytes devoid of sympathetic nerve terminals. In reserpinized guinea pig hearts, 5-HT exerted no inotropic effect on ventricular muscle, yet it had an inotropic effect in the atrial muscle, although the latter effect was considerably depressed, compared to that seen in non-reserpinized atrial muscles. We conclude that the positive inotropic effects of 5-HT observed in the ventricular muscle of the guinea pig and in the atrial and ventricular muscles of the Japanese monkey can be attributed to the release of noradrenaline from sympathetic nerve terminals (indirect effect). In contrast, in human atrial muscles, the positive inotropic effect of 5-HT was apparently the result of stimulation of a specific membrane receptor for 5-HT (direct effect). In guinea pig atrial muscles, both direct and indirect effects of 5-HT were involved in the positive inotropism. An explanation for the lack of sensitivity of rat atrial and ventricular muscles to 5-HT awaits further studies.

[A case of cardiac herniation following intrapericardial pneumonectomy after induction chemoradiotherapy]

A case of cardiac herniation following left intrapericardial pneumonectomy after induction chemoradiotherapy has been presented. Curative resection after induction chemoradiotherapy for central bronchogenic cancer may require intrapericardial pneumonectomy. Cardiac herniation through the pericardial defect is a fatal complication after a pneumonectomy unless pericardial repair should be done immediately. Closure of the pericardial defect with prosthetic patch, regardless of defect size, is always necessary for the prevention of the cardiac herniation following intrapericardial pneumonectomy after induction chemoradiotherapy.

Clinical significance of inferior ST elevation during acute anterior myocardial infarction

OBJECTIVES

To clarify the genesis and clinical significance of inferior ST elevation during acute anterior myocardial infarction.

PATIENTS AND DESIGN

A total of 106 patients with first acute anterior myocardial infarction (< or = 6 h) were divided into two groups according to the presence (group A, n = 12) or absence (group B, n = 94) of ST elevation of > or = 1 mm in at least two of the inferior leads on the admission electrocardiogram.

RESULTS

On admission electrocardiograms, group A had a smaller summed ST deviation in the lateral limb leads than group B. On emergency coronary arteriograms, the incidence of a wrapped left anterior descending artery was higher in group A than in group B (100% v 27%, P < 0.01). The incidence of occlusion of a left anterior descending artery distal to its first diagonal branch was higher in group A than in group B (100% v 46%, P < 0.01). Peak serum creatine kinase activity and in-hospital mortality tended to be lower in group A than in group B. Group A had better left ventricular ejection fraction and regional wall motion in the anterobasal and anterolateral regions in the chronic phase than group B. In contrast, regional wall motion in the diaphragmatic region was reduced to a greater extent in group A than in group B.

CONCLUSIONS

Inferior ST elevation during acute anterior myocardial infarction appears only in the presence of a combination of a lesser degree of transmural ischaemic myocardium in the anterobasal and anterolateral wall together with transmural ischaemic myocardium in the inferior wall; in all cases there was occlusion of a wrapped left anterior descending artery distal to its first diagonal branch. Patients with such an ST elevation appear to have a better in-hospital prognosis than those without it.

Gas-phase stability of cluster ions SF m (+) (SF 6) n with m = 0-5 and n = 1-3

The gas-phase stabilities of cluster ions SF m (+) (SF6) n with m = 0-5 were determined by using a high pressure mass spectrometer. The bond energies of SF m (+) (SF6)1 were found to be less than 10 kcal/mol and to decrease with m = 0 → 5. There appear to be rather large gaps in the bond energies between n = 1 and 2 for the clusters SF m (+) (SF6) n with m = 0-4. The structures of SF 5 (+) , SF(+) (SF6)1 SF 3 (+) (SF6)1 and SF 5 (+) (SF6)1, were investigated by ab initio molecular orbital calculations. For SF 5 (+) , the D 3h geometry is found to be most stable and C 4v is a transition state of the Berry pseudorotation. For the ion-molecule complexes, the "on-top hat" models were found to be the most stable structures.

Inferior ST segment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute anterior myocardial infarction

To determine whether or not ST segment deviation on admission electrocardiograms can identify patients with anterior acute myocardial infarction due to proximal left anterior descending artery occlusion, the magnitude and location of ST segment elevation or depression were compared between patients with proximal left anterior descending artery occlusion (group A, n = 47) and those with distal left anterior descending artery occlusion (group B, n = 59). ST segment depression in each of the inferior leads was significantly greater in group A than in group B. The incidence of ST segment depression > or = 1 mm in each of the inferior leads (II; 81% vs 27%, III; 85% vs 54%, aVF; 87% vs 47%, P < 0.01) was significantly higher in group A than in group B. In addition, the incidence of ST segment depression > or = 1 mm in all of the inferior leads was significantly greater in group A than in group B (77% vs 22%, P < 0.01). In group A, maximal ST segment elevation was more frequent in lead V2 alone (43% vs 14%, P < 0.01). Group A had greater ST segment elevation in lead aVL than group B, and the incidence of ST segment elevation > or = 1 mm in lead aVL was significantly higher in group A than in group B (66% vs 47%, P < 0.05). ST segment depression > or = 1 mm in all of the inferior leads was most valuable for identifying group A patients (77% sensitivity and 78% specificity). In contrast, the maximal ST segment elevation in lead V2 alone or ST segment elevation > or = 1 mm in lead aVL had a low diagnostic value (43% sensitivity and 86% specificity, 66% sensitivity and 53% specificity, respectively). In conclusion, this study indicates that analysis of ST segment deviation in the inferior leads is useful for identifying patients with acute anterior myocardial infarction due to proximal left anterior descending occlusion.

[Serum pepsinogen response to therapy for Helicobacter pylori associated gastro-duodenal disease]

We investigated the effect of H. pylori therapy on serum concentrations of pepsinogens on 87 patients of gastro-duodenal disease. In addition, we intended to see whether serum pepsinogen can serve as markers of response to H. pylori eradication. In 48 successfully eradicated cases, there was a significant decrease in gastritis score, and was a significant fall in serum pepsinogen II (PG II) level, and was a significant increase in pepsinogen I/II ratio (PG I/II ratio). In contrast, no change in gastritis score, PG II, and PG I/II ratio were observed in 39 unsuccessfully eradicated patients. No change in serum pepsinogen I (PG I) level was observed in both groups. In provisional successfully eradicated cases in PG II of decrease greater than 30% in after treatment, there was a sensitivity of 83.3% and a specificity of 89.7%. For the PG I/II ratio of increased greater than 30% in after treatment, the sensitivity was 95.8%, and the specificity was 94.9%. These findings suggest that PG II, PG I/II ratio can be useful for clinical evaluation of eradication therapy.

The administration regimen of isepamicin in patients with chronic respiratory tract infection

A total of 34 patients with intractable chronic respiratory tract infections were treated with isepamicin and/or piperacillin in different dosage regimens. A comparison of the bacteriological effect using a cross over method showed a reduction in the count of Pseudomonas aeruginosa in sputum in the group receiving once-a-day isepamicin combined with piperacillin, compared with the twice-a-day combined administration. A comparison of the clinical and bacteriological efficacy between the different regimen groups revealed no noticeable difference. The clinical effect of this regimen is comparable to the conventional regimen, but has the advantages of a safer dosage and ease of administration.

Serum lipoprotein(a) concentrations are related to coronary disease progression without new myocardial infarction

OBJECTIVE

To examine the association between serum lipoprotein(a) and angiographically assessed coronary artery disease progression without new myocardial infarction.

PATIENTS AND DESIGN

85 patients with coronary artery disease who underwent serial angiography with an interval of at least two years were studied. Progression of coronary artery disease was defined as an increase in diameter stenosis of 15% or more. Vessels on which angioplasty had been performed were excluded from the analysis. The patients were classified into two groups: a progression group without new myocardial infarction (n = 48) and non-progression group (n = 37). Risk factors including lipoprotein(a) were evaluated to see how they were related to progression without myocardial infarction.

RESULTS

There were no differences between the two groups in the following factors: age, gender, the time interval between the angiographic studies, the distribution of the analysed coronary arteries, and history of well established coronary risk factors. Univariate analysis showed that serum lipoprotein(a) (P = 0.0002), cigarette smoking between the studies (P = 0.002), serum high density lipoprotein (P = 0.003), and serum low density lipoprotein (P = 0.01) were related to progression without myocardial infarction. Multivariate analysis selected two independent factors for progression without myocardial infarction: serum lipoprotein(a) (P = 0.003) and serum high density lipoprotein (P = 0.03).

CONCLUSIONS

Serum lipoprotein(a) concentrations are closely related to the progression of coronary artery disease without new myocardial infarction. Lipoprotein(a) lowering treatment may be needed to prevent disease progression in patients with coronary artery disease and high serum lipoprotein(a).

Myxoma of the mitral valve detected by echocardiography and magnetic resonance imaging

Myxomas of the mitral valve diagnosed during life are exceedingly rare. We employed transthoracic and transoesophageal echocardiography and magnetic resonance imaging enhanced by gadolinium-diethylene-triamine-pentaacetic acid in a patient with palpitations. After these examinations clearly demonstrated a myxoma on the atrial side of the posterior mitral valve leaflet, urgent surgery was performed. When a small tumour of the mitral valve exists, these examinations are useful not only for detecting and characterizing the tumour, but also for deciding the optimal surgical management.

Emergent coronary angiographic findings of patients with ST depression in the inferior or lateral leads, or both, during anterior wall acute myocardial infarction

In conclusion, the present study indicates that there are several distinctive differences in emergent coronary angiographic findings according to the presence or absence of ST depression in the inferior or lateral leads, or both, and location of the leads showing ST depression on admission electrocardiograms in patients with anterior AMI. The coronary angiographic features of patients with this ECG finding greatly support a poor prognosis. In patients with anterior AMI, analysis of ST depression on an admission electrocardiogram should be routinely performed because it is useful in predicting coronary anatomy, the extent of infarction, and its prognosis.

Significance of urinary fibrin/fibrinogen degradation products (FDP) D-dimer measured by a highly sensitive ELISA method with a new monoclonal antibody (D-D E72) in various renal diseases

To diagnose the abnormalities of coagulation-fibrinolysis in various renal diseases, we developed a new monoclonal antibody (D-D E72) against fibrin/fibrinogen degradation products D-dimer (FDP D-dimer) and established a highly sensitive enzyme-linked immunosorbent assay (ELISA) for its measurement. FDP D-dimer was assessed in 102 patients with various renal diseases, and the following results were obtained: 1. The mean level of urinary FPD D-dimer in 32 normal controls was 0.69 +/- 0.60 ng/ml (mean +/- SD). 2. The level of urinary FDP D-dimer was significantly higher in primary nephrotic syndrome group (NS), chronic renal failure group (CRF) and in the group of diabetic nephropathy (DM) than in the control group. However, no difference was observed in the level of urinary FDP D-dimer between non-nephrotic chronic glomerulonephritis group (CGN) and control group. 3. No significant correlation was revealed between D-dimer and urinary protein in CGN and NS groups. These results suggest that in addition to plasma filtration the urinary FDP D-dimer in NS, CRF and DM may be also related to abnormalities of secondary fibrinolysis in intra-glomerular fibrin deposits.

Peptic ulcer recurrence after Helicobacter pylori eradication: a 5-year follow-up study

OBJECTIVE

To investigate whether eradication of Helicobacter pylori prevents peptic ulcer recurrence in the long term.

PATIENTS AND METHODS

We treated 81 patients with endoscopically proven H. pylori-related peptic ulcers (39 with gastric ulcers and 42 with duodenal ulcers) with either amoxycillin or clarithromycin in combination with a proton-pump inhibitor or a histamine H2-receptor antagonist. The patients were followed for a recurrence of peptic ulcers for at least 5 years. Recurrence was assessed by endoscopy and the status of H. pylori was evaluated by culture, a rapid urease test and a histological examination.

RESULTS

After 5 years of follow-up, the rate of recurrence of H. pylori-related duodenal ulcers decreased significantly (P < 0.0001) in the H. pylori-eradicated patients compared with non-eradicated patients. However, in the gastric ulcer group, there was no significant reduction in the recurrence rate.

CONCLUSIONS

Our findings suggest that eradication of H. pylori significantly reduces the rate of duodenal ulcer relapse and that this relapse is associated with the presence of H. pylori. Therefore, H. pylori eradication may be considered a definitive cure for duodenal ulcers.

Influence of Helicobacter pylori infection and the effects of its eradication on gastric emptying in non-ulcerative dyspepsia

AIM

The aim of the present study was to clarify the effects of Helicobacter pylori infection and its eradication on gastric emptying.

SUBJECTS AND METHODS

Out of a total of 52 patients with non-ulcerative dyspepsia, 34 H.pylori-positive patients were enrolled. Antimicrobial drugs for the eradication of H. pylori were administered to 19 out of the 34 H. pylori-positive patients. Gastric emptying was evaluated according to the acetaminophen method. Inflammatory changes and intracellular periodic acid-Schiff-positive substances in the antral mucosa were examined in biopsy specimens.

RESULTS

Although gastric emptying was significantly prolonged in the patients with non-ulcerative dyspepsia compared with the control group (P < 0.01), there was no difference in gastric emptying between H. pylori-positive and -negative patients, with all patients showing significantly less gastric emptying than the control group. The H. pylori eradication rate was 58% (11 out of 19) and gastric emptying improved significantly in seven patients whose infection was eradicated and whose dyspeptic symptoms disappeared. The ammonia concentration in gastric juice, inflammatory changes in the gastric mucosa and the index of periodic acid-Schiff-positive substances improved significantly when H. pylori was successfully eradicated compared with patients in whom eradication was unsuccessful. As gut hormones may affect gastroduodenal motility associated with H. pylori infection, we also studied the levels of serum gastrin and cholecystokinin. In the patients whose infection was eradicated, serum gastrin decreased significantly, but the cholecystokinin level did not change significantly, although there was a non-significant trend for cholecystokinin to increase.

CONCLUSIONS

These results suggest that delayed gastric emptying is partly associated with H. pylori infection and that the infection may contribute to the development of non-ulcerative dyspepsia.

[Microbiological and clinical study of fungemia between 1981 and 1992]

Fungi were isolated from 113 (14.2%) of 789 patients with positive blood cultures at Oita Medical University Hospital between 1981 and 1992. The rates of fungemia increased in recent years, 13.9% (1981-1985), 12.1% (1986-1988) and 16.9% (1989-1992). The isolated fungi were Candida parapsilosis (25.7%), C. albicans (24.8%), C. tropicalis (14.2%), Trichosporon beigelii (10.6%), C. glabrata (8.0%) and so on. The major fungi were T. beigelii and C. glabrata in patients with hematologic malignancies, whereas they were C. albicans and C. parapsilosis in patients with non-hematologic diseases and C. glabrata increased in both groups. Prophylactic or emiric administration of antifungal agents probably influenced the difference of the causative organisms in the two groups.

Acute myeloblastic leukaemia without Philadelphia chromosome developing after interferon therapy for chronic myelocytic leukaemia with Philadelphia chromosome

We report a patient who developed Philadelphia chromosome negative acute myeloblastic leukaemia with trisomy 8 and trisomy 11 after receiving treatment with alkylating agents and interferon for chronic myelocytic leukaemia positive for Philadelphia chromosome. Leukaemic cells were positive for myeloperoxidase and expressed CD13, CD33 and DR; some expressed CD2, CD4 and CD34. The fluorescence in situ hybridization method revealed that bcr-abl fusion genes were absent from > 90% of the bone marrow cells. The major bcr rearrangement was not detected by Southern blot analysis. We conclude that the leukaemic cells negative for Philadelphia chromosome may have developed as a result of treatment with alkylating agents and interferon in the present case.

Effects of Helicobacter pylori infection on gastric mucosal defense factors in Japanese monkeys

The pathogenic role played by Helicobacter pylori in gastric mucosal defense was investigated in Japanese monkeys infected with H. pylori. Serum gastrin levels and ammonia concentrations in gastric juice were compared in H. pylori-infected (n = 6) and control (n = 7) groups. The gastritis score, the intracellular content of periodic acid-Schiff (PAS)-positive substance and hexosamine, and the bromodeoxyuridine (BrdU) labeling index in the gastric mucosa were compared in the two groups in the antrum and the corpus. The ammonia concentration in the gastric juice was significantly higher in the infected group (P < 0.01). The gastritis scores were significantly higher in the antrum and corpus in the infected group (P < 0.01, and P < 0.05, respectively). The content of PAS-positive substance and hexosamine was significantly decreased in the antrum of the infected group compared with that in the controls (P < 0.01, and P < 0.05, respectively), but there was no significant difference between the two groups in the corpus. The BrdU labeling indices were significantly higher in the antrum and corpus of the infected group (P < 0.01, and P < 0.01, respectively). Colonization by H. pylori injures the gastric mucosa by depressing the gastric mucosal defense factors, and, consequently, the cell kinetics are accelerated.

Trichosporon beigelii pneumonia in patients with hematologic malignancies

Trichosporon beigelii is a causative agent of hypersensitivity pneumonia in immunocompetent individuals and of invasive pneumonia in immunocompromised patients. The actual incidence and clinical manifestations of T beigelii pneumonia are obscure because the diagnosis is sometimes difficult. We studied eight patients with T beigelii pneumonia diagnosed by immunohistochemical investigation of lung tissue sections and/or isolation of the organism from the lung, sputum, or blood. All patients had underlying hematologic malignancies for which they had received cytotoxic chemotherapy, resulting in profound neutropenia. The clinical manifestations were persistent fever unresponsive to broad-spectrum antibiotic therapy, cough, bloody sputum, and rapidly progressive dyspnea. The chest radiographs showed diffuse alveolar infiltrates in four patients, diffuse interstitial infiltrates in one, patchy reticulonodular infiltrates in one, and focal alveolar infiltrates in two. Histopathologic examination demonstrated numerous centrally necrotic foci with minimal cellular inflammatory reaction, intra-alveolar hemorrhage, and edema. Trichosporon beigelii consisting of both yeast and hyphal forms was located predominantly in the alveolar vessels. In neutropenic patients with hematologic malignancies, this fungus appears to enter the lung not only through the airways but also via the hematogenous route. In vitro susceptibility testing indicated borderline susceptibility to amphotericin B and showed that some azoles were active against T beigelii at safely achievable serum concentrations.

[Is intraoperative monitoring of transesophageal echocardiography necessary for mitral valve repair?]

To clarify the clinical significance of the intraoperative monitoring for mitral valve repair by transesophageal echocardiography (TEE), we evaluated the correlation of color Doppler flow area of residual mitral regurgitation (residual MR area) between intraoperative and postoperative TEE. Subjects were 12 patients (average age was 54.7 years) underwent recently intraoperative TEE. These 12 patients were divided into two groups: Group A (MR area < 2.0 cm2; n = 8) and Group B (MR area > 2.0 cm2; n = 4). None of the 12 patients required second pump run. In all cases, residual MR area, as determined using intraoperative TEE, was less than 3.2 cm2. One month after surgery, the MR area did not showed an increase in Group A, while in Group B it decreased slightly in 2 cases, remained unchanged in 1 case and increased slightly in 1. Our findings do not support the usefulness of intraoperative monitoring with TEE. It seems difficult to predict the outcome of residual MR on the basis of the MR area alone. At present, we thought that, possibly, intraoperative monitoring with TEE is indispensable for mitral valve repair. A longer follow-up will be necessary to draw firm conclusions.

[Essential thrombocythemia transformed to minimally differentiated acute myeloid leukemia]

A 64-year-old female diagnosed for essential thrombocythemia was treated with MCNU 50 mg four times in the course of the disease. Six months after the last administration, in May 1991, she was admitted because of decreasing thrombocyte count and appearance of blasts in the peripheral blood. On admission, laboratory findings were as follows: WBC 700/microliters with 5% of blasts, RBC 331 x 10(4)/microliters, and PLT 17.9 x 10(4)/microliters. Bone marrow aspiration revealed hypocellular marrow with 39% blasts. About 5% of the blasts were positive for myeloperoxidase by electron microscopy analysis. Leukemic cells were positive for CD 7, 13, 33 and 34, negative for other lymphoid lineage markers, and demonstrated no rearrangement of TCR-beta, gamma and IgH genes. Although she was treated with low-dose cytosine arabinoside, no response was observed. Subdural hematoma and sequential pneumonia developed and the patient died eight months after leukemic transformation. In conclusion, we think that the leukemic transformation might have been developed in the natural course of essential thrombocythemia in the present case. However, we cannot exclude the influence of MCNU.

A case of nephrotic syndrome associated with ischemic colitis exhibiting thickening of the colon wall

The patient was a 54-year-old male with proteinuria, which was first noted in 1984. Recently, the patient experienced aggravation of the proteinuria, which resulted in nephrotic syndrome. Renal biopsy revealed findings compatible with membranous nephropathy. While being treated with prednisolone (30 mg/day), the patient experienced intense abdominal pain of sudden onset, diarrhea, and melena. A tumor was demonstrated by abdominal ultrasonography and CT scan. A diagnosis of ischemic colitis was made by colonoscopy. FDP and fibrinogen levels were elevated, and abnormalities of the coagulation and fibrinolytic factors were found at the onset of the symptoms.

[Mitral valve repair for infectious endocarditis]

Fourteen patients with mitral regurgitation resulting from infectious endocarditis underwent mitral valve repair between December 1988 and July 1994. There were nine males and five females aged from 14 to 70 years (mean 40.2 +/- 19.7 years). Three patients had active endocarditis. Time between the onset of endocarditis symptoms and surgery ranged from 1 to 24 months (mean 8.3 months). Bacterial findings were Streptococcus in eight patients, Staphylococcus in one, and unknown in five. All macroscopically infected tissue was excised in patients with active endocarditis. Carpentier's reconstructive techniques were mainly used. There were no hospital deaths. Mean follow-up was 29 months and complete. Thirteen patients were in New York Heart Association functional class I and one in class II. There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidity. We conclude that mitral valve repair is an attractive procedure in patients with mitral regurgitation resulting from infectious endocarditis.

Expression of osteopontin in a macrophage cell line and in transgenic mice with pulmonary fibrosis resulting from the lung expression of a tumor necrosis factor-alpha transgene

The expression level of osteopontin (OPN) mRNA was found to be increased in a macrophage cell line in the presence of recombinant tumor necrosis factor-alpha (TNF-alpha). OPN mRNA level was also explored in the lungs of transgenic mice which were expressing TNF-alpha in type II pneumocytes, a condition leading to pulmonary alveolitis and progressive fibrosis. OPN mRNA was significantly increased in the lungs of these transgenic mice. In situ hybridization showed that it was localized mostly in alveolar macrophages. Since OPN can be induced in macrophages by TNF-alpha stimulation and since on the other hand osteopontin appears to decrease the level of nitric oxide synthase, and thus the production of nitric oxide, osteopontin might also indirectly have an antifibrotic effect. The role played by osteopontin in fibrotic lesions resulting from the release of TNF-alpha deserves further study, since it may be involved in the balance of opposite effects eventually leading to local tissue damage ending in fibrosis.

Effects of ethanol on the pancreas of disulfiram-treated rats

To study the effects of ethanol on disulfiram-treated rats, we administered ethanol orally at a does of 2000 mg/kg, twice daily for 5 days. The administration of ethanol or disulfiram alone produced no recognizable changes in pancreatic acinar cells. Ethanol administration, in disulfiram-treated rats resulted in a decrease in the content of zymogen granules in acinar cells, and the appearance of intraplasmic vacuolization. Electron microscopically, these vacuoles appeared on the basal side of nuclei. In addition, similar vacuoles appeared in liver cells, and these vacuolizations seemed to show lipid inclusions. However, ethanol administration to disulfiram-treated rats did not cause inflammatory changes or edema in the pancreas. A comparison of blood ethanol levels in rats receiving ethanol alone and disulfiram plus ethanol showed no significant difference, but acetaldehyde levels in rats receiving ethanol plus disulfiram rats were significantly higher than those in rats receiving ethanol alone. These findings suggested that acetaldehyde caused a decrease of zymogen granules and the presence of lipid inclusions in pancreatic acinar cells.

[Treatment of aneurysm of aortic arch using selective cerebral perfusion]

The objective of this study is to evaluate safety and efficacy of the selective cerebral perfusion (SCP) for an adjunct to perform operation of aortic arch aneurysms. From November 1982 to June 1993, surgical treatment of aneurysm of aortic arch using SCP was performed in 22 patients. The hospital death was accounted in 5 cases (23%), the intraoperative stroke was observed in 3 cases (14%) and these patients died. The cause of intraoperative stroke was cerebral hypoperfusion due to multiple sclerosis of intracranial arteries or insufficient SCP. Variables of an increased operative risk seemed to be older age (over 70 y.o.) and rupture. SCP time more than 120 minutes did not promote the operative risk. Cerebral hypoperfusion was directly responsible for not only intraoperative stroke, but also operative death. Therefore, SCP seems effective and safe if hypoperfusion is prevented.

Early diagnosis and monitoring of human cytomegalovirus pneumonia in patients with adult T-cell leukemia by DNA amplification in serum

A nested polymerase chain reaction (PCR) was used to detect human cytomegalovirus (HCMV) DNA in serum of patients with adult T-cell leukemia (ATL). Serum samples were collected consecutively from 11 patients with HCMV pneumonia diagnosed histopathologically and 7 HCMV-seropositive patients without HCMV disease. Serum samples obtained from 24 HCMV-seropositive healthy volunteers were used as controls. The HCMV DNA was detected in serum a mean of 14 days before the onset of HCMV pneumonia, which suggests that DNAemia exists prior to the development of HCMV pneumonia. The amount of viral DNA in serum increased with disease progression and decreased with disease improvement. Thus, the detection of HCMV DNA in serum by nested PCR is useful for monitoring and the early diagnosis of HCMV pneumonia in patients with ATL. In addition, quantitation of HCMV DNA may be useful for monitoring HCMV infection, because it appears to correlate with the activity of the disease.

Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire. Comparison with saphenous vein grafts

OBJECTIVES

The purpose of this study was to assess flow dynamics and flow capacities of internal mammary artery and saphenous vein grafts to the left anterior descending coronary artery.

BACKGROUND

The postoperative flow capacity of internal mammary artery grafts to the left anterior descending coronary artery has been reported to be restricted compared with that of saphenous vein grafts in studies using radionuclide angiography. A recently developed Doppler guide wire has been used to analyze the flow dynamics of bypass grafts and to clarify the mechanism of this limited flow capacity.

METHODS

Phasic flow velocity recordings were obtained in the midportion of the bypass graft and within the native left anterior descending artery, using a 0.018-in. (0.046-cm) 12-MHz Doppler guide wire, in 53 patients: 27 patients with an internal mammary artery graft (16 with a new graft assessed 1 month postoperatively and 11 with an old graft assessed at 1 year) and 26 patients with a saphenous vein graft (13 with a new graft assessed 1 month postoperatively and 13 with an old graft assessed at 1 year). All patients were studied at baseline rest and during hyperemia induced by intravenous infusion of dipyridamole, 0.56 mg/kg body weight, over 4 min.

RESULTS

In the left anterior descending artery itself, systolic and diastolic peak velocities, the time average of the instantaneous spectral peak velocity (time-averaged peak velocity), vessel diameter and the calculated flow volume did not differ significantly among the four graft groups. The time-averaged peak velocity was significantly greater for new than for old arterial grafts or for new or old vein grafts (mean +/- SD 27 +/- 9 vs. 19 +/- 6, 11 +/- 5 and 12 +/- 6 cm/s, respectively, p < 0.01). However, because the diameter of new arterial grafts was significantly smaller than that of the other three grafts (2.4 +/- 0.1 vs. 2.9 +/- 0.2 [p < 0.05], 3.6 +/- 0.6 [p < 0.01] and 3.4 +/- 0.5 mm [p < 0.01], respectively), there was no difference in calculated flow volumes at rest (62 +/- 17 vs. 58 +/- 15, 61 +/- 18 and 58 +/- 19 ml/min, respectively, p = NS) between new arterial grafts and the other grafts. Although the maximal time-averaged peak velocity during hyperemia was significantly greater in new than in old arterial grafts or new or old vein grafts (47 +/- 17 vs. 40 +/- 7, 31 +/- 8 and 34 +/- 12 cm/s, respectively, p < 0.01), the flow reserve of new arterial grafts was significantly smaller than that of the other three groups (1.8 +/- 0.3 vs. 2.6 +/- 0.3, 2.8 +/- 0.5 and 3.0 +/- 0.6, respectively, p < 0.01) because the baseline time-averaged peak velocity of these new grafts was far greater than that of the other groups.

CONCLUSIONS

Internal mammary artery graft flow early after operation is characterized by a higher rest velocity than that of vein graft flow. This high velocity maintains flow volume at baseline condition in compensation for the smaller diameter. Although flow reserve does not differ significantly between new and old vein grafts, that for internal mammary artery grafts is significantly reduced soon after bypass surgery. This restricted flow capacity improves late postoperatively because of an increase in diameter and a decrease in flow velocity from baseline levels.

Mutations in the core promoter/enhancer II regions of naturally occurring hepatitis B virus variants and analysis of the effects on transcription activities

The regulatory regions for transcription and replication of several hepatitis B virus (HBV) genomes from 19 patients having various forms of HBV infection were sequenced. Predominant mutations were found to occur naturally in nucleotide positions 1762 (A to T) and 1764 (G to A) in chronic hepatitis patients and in asymptomatic carriers after seroconversion, but were not observed in HBeAg-positive healthy carriers. Since these positions were located in the basic core promoter and the overlapping enhancer II regions situated within the core upstream region, transcriptional activity was examined by chloramphenicol acetyltransferase assay to determine if there was a possible difference between the mutant and wild-type HBV. However, no significant difference was detected upon comparison of the promoter and enhancer activities between mutant and wild-type HBV.

Cytotoxic effects of Helicobacter pylori on guinea pig gastric glands

To study the cytotoxic effect of Helicobacter pylori on the gastric P3cosa, gastric glands harvested from guinea pigs were incubated with clinical isolates of H. pylori. H. pylori alone (H group), urea alone (U group), H. pylori plus urea (HU group), and H. pylori plus urea and the urease inhibitor acetohydroxamic acid (HUA group) were incubated with isolated gastric glands. The controls were incubated without additives. Incubation was for 30, 60 and 180 min at 37 degrees C in a microaerophilic atmosphere. The HU group showed an increase in the ammonia concentration and pH of the culture supernatant; release of lactate dehydrogenase (LDH) and glutamic oxaloacetic transaminase (GOT) into the supernatant owing to cell disruption was also increased. In the HUA group, since urease activity was inhibited, the ammonia concentration and pH were also significantly lower (p < 0.001), and LDH and GOT release into the supernatant was significantly reduced (p < 0.001-0.01). Observation by light and electron microscopy showed clear intracellular vacuolization of the gastric glands and adherence of H. pylori to the cell surfaces. These results suggest that ammonia, a metabolite of urea released by H. pylori urease, is one of the important factors in cytotoxicity in isolated gastric glands.

Postoperative flow characteristics of left internal thoracic artery grafts

Twenty patients whose left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery (LAD) underwent postoperative coronary angiography and Doppler ultrasound velocimetry. During angiography, the diameter of the LITA conduit was measured at three points: proximal, mid, and distal. The degree of left anterior descending artery stenosis proximal to the anastomotic site was evaluated by densitometry. The LITA flow velocity pattern was obtained at the three points to calculate the total, systolic, and diastolic flow volume. There were significant differences in the total LITA flow among the three points (proximal, 36.0 +/- 17.2 mL/min; mid, 29.9 +/- 15.2 mL/min; distal, 27.2 +/- 14.0 mL/min; p < 0.001 between the proximal and the mid or distal portions). The degree of left anterior descending artery stenosis affected the distal LITA flow and diameter (r = 0.823 and 0.811, respectively). There were significant differences in the systolic LITA flow among the three points (proximal, 13.2 +/- 6.5 mL/min; mid, 8.1 +/- 4.7 mL/min; distal, 5.6 +/- 3.4 mL/min; p < 0.001 between the proximal and the mid or distal portions). However, there was no statistically significant difference in the diastolic LITA flow among the three points (proximal, 22.9 +/- 11.0 mL/min; mid, 21.7 +/- 10.8 mL/min; distal, 21.6 +/- 10.8 mL/min). We conclude that a lower degree of LAD stenosis significantly reduces the LITA flow, inducing the string phenomenon. Additionally, during the diastolic phase, the LITA graft transports the blood primarily to the coronary artery but not to the side branches. Therefore, the steal phenomenon might not apply in the setting of an LITA graft.

Significance of urinary fibrin/fibrinogen degradation products in renal diseases measured by a highly sensitive ELISA

The urinary fibrin/fibrinogen degradation products (FDP), as sensitive indicators of various renal disorders, have been measured by several methods. For their determination, a new and highly sensitive enzyme-linked immunosorbent assay not requiring the urine concentration has been developed. The study comprised 42 patients with nonnephrotic chronic glomerulonephritis (CGN), 23 patients with primary nephrotic syndrome (NS), and 29 healthy adults. The results were as follows: (1) the content of urinary FDP in normal subjects was 10.30 +/- 9.08 ng/ml; (2) the mean level of urinary FDP in both CGN and NS groups was significantly higher than in normal subjects; (3) in the CGN group itself there was a tendency for an increase of urinary FDP during more active forms of the disease, and (4) there was a significant correlation between urinary FDP and urinary protein in the CGN group, whereas no correlation was observed in the NS group. These results suggest that the major part of urinary FDP in the CGN group derives from the increased filtration, while its origin in the NS group is not related to increased filtration only, but may also have involved intraglomerular coagulation abnormalities. The newly developed enzyme-linked immunosorbent assay can detect urinary FDP levels lower than 3.9 ng/ml. Therefore, this method can be of great value in determining the degree of abnormalities of intraglomerular coagulation and fibrinolysis in renal diseases.

Traditional Chinese medicines improve the course of refractory leukemic lymphoblastic lymphoma and acute lymphocytic leukemia: two case reports

A 34 year-old man with leukemic lymphoblastic lymphoma (LBL), who could not tolerate chemotherapy due to its side effects, was diagnosed to have an acute febrile disease by a traditional Chinese medical doctor, Lu Gan Fu. Zixuedan, a traditional Chinese remedy for dissipation of pathogenic heat and detoxification that could reduce WBC count including leukemic cells below 1000/microliters without intolerable side effects, was prescribed for treatment. A second case of acute lymphocytic leukemia (ALL) was a 41 year-old female who also could not tolerate chemotherapy. In her fourth recurrence, she started Chinese medicine including modified zixuedan, which gave her transient improvement followed by aggravation. Intake of previously ineffective cyclophosphamide in combination with Chinese medicine led to a dramatic improvement.

[Problems concerned with adult T-cell leukemia. 1) Causes of death and early diagnosis of cytomegalovirus pneumonia in adult T-cell leukemia. 2) Clinicopathological features of CD30 positive adult T-cell leukemia]

1) We studied the causes of death confirmed by autopsy or necropsy in 23 adult T-cell leukemia (ATL) patients. Of them eight showed involvement of tumor (35%), eleven infectious disease (47%) (nine cytomegalovirus (CMV) pneumonia, one varicella-zostervirus pneumonia, one pseudomonas aeruginosa pneumonia), and four others (17%). In seven recent cases treated with a new chemotherapy regimen in combination with G-CSF administration, survival was longer than in previous cases and tumor involvement as a cause of death decreased (one case, 14%). However, CMV pneumonia inclined to increase (six cases, 86%). Therefore, we tried to retrospectively detect CMV DNA in the serum of ATL patients using a nested polymerase chain reaction (PCR). CMV pneumonia was reliably diagnosed in eleven ATL patients, whereas CMV DNA was detected in all patients at the time of clinical onset of pneumonia and CMV DNA was detected only in eight patients from 7-35 days before the onset of pneumonia. These findings suggest that the nested PCR assay is a useful tool to early diagnosis CMV pneumonia in ATL patients. 2) Recently, several cases of ATL with CD30 antigen have been reported, but its clinical relevance remains unknown. Accordingly, we studied CD30 antigen expression in 36 ATL patients who had monoclonal integration of HTLV-I provirus in the tumor cells and demonstrated the immunohistochemical and clinical characteristics of these patients. CD30 antigen expression was evident in seven of these 36 patients (19.4%). A comparison of ATL cases with and without CD30 antigen expression revealed significantly large numbers of abnormal lymphocytes in the peripheral blood and lower serum calcium levels in CD30 antigen positive ATL.