Beneficial hemodynamic effects of oral prostacyclin (PGI2) analogue, beraprost sodium, on a patient with primary pulmonary hypertension--a case report

A 65-year-old woman was admitted to our hospital because of exertional dyspnea in 1987. A diagnosis of primary pulmonary hypertension was confirmed by right heart catheterization. She had received conventional therapy in the outpatient clinic. She was readmitted with the deterioration of exertional dyspnea in 1995. Stabilization of pulmonary hemodynamics, while not achieved with conventional therapy, was achieved with additive administration of an oral prostacyclin (PGI2) analogue, beraprost sodium.

Effects of pH and osmolality on phlebitic potential of infusion solutions for peripheral parenteral nutrition

In this study, we investigated the phlebitic potentials of several infusion solutions for peripheral parenteral nutrition to clarify the effects of pH and osmolality on the development of infusion phlebitis. A 10% glucose solution with electrolytes (GE, pH 4.93, 727 mOsm/kg), a 10% amino acid solution (AA, pH 6.95, 929 mOsm/kg), or a 5:2 admixture of GE and AA (GEAA, pH 6.46, 779 mOsm/kg) was infused into the rabbit ear vein for 6 hr at 10 mL/kg/hr, and the infused veins were examined histopathologically. Both GE and AA caused phlebitic changes, such as loss of venous endothelial cells, inflammatory cell infiltration, and perivascular edema. However, their admixture, GEAA, caused scant phlebitic changes. These results were as follows: 1) rabbit peripheral veins could tolerate the pH (6.46) and the osmolality (779 mOsm/kg) of GEAA under the conditions of this study; 2) GE caused phlebitis due to its acidity (pH 4.93); 3) AA caused phlebitis due to its hyperosmolality (929 mOsm/kg); and 4) mixing GE and AA eliminated the factors causing phlebitis in each solution. The admixture of GE and another 10% amino acid solution (AB, pH 6.04) at the ratio of 5:2 (GEAB, pH 5.76, 758 mOsm/kg) caused phlebitic changes. Since its osmolality was lower than that of GEAA, it was considered that GEAB caused phlebitic changes due to its acidity (pH 5.76), which was attributed to the acidic amino acid solution used as a component.

Activation of 1-nitropyrene by nitroreductase increases the DNA adduct level and mutagenicity

1-Nitropyrene (1-NP) is a mutagenic nitro compound in the environment. We studied correlations between the mutagenicity of 1-NP for three strains of Salmonella typhimurium, the activity of bacterial nitroreductases and the amount of 1-NP-derived DNA adducts. Bacterial strains used in this study were S. typhimurium strains TA98, nitroreductase-less mutant TA98NR and YG1021 carrying a nitroreductase-producing plasmid. The mutagenicity of 1-NP was measured using the Ames assay, and the nitroreductase activities of these strains were assayed by quantification of 1-aminopyrene produced from 1-NP. The DNA adducts were measured by the 32P-postlabeling method. Among the three bacterial strains, strain YG1021 was the highest in mutagenicity of 1-NP, the nitroreductase activity and the DNA adduct level. However, S. typhimurium strain TA98NR had the lowest values of these three parameters. Nitroreductase activity, DNA adduct level and mutagenicity were strongly correlated with each other. These results indicate that bacterial nitroreductase plays an important role in forming the DNA adducts, and that the higher the adduct level the higher the level of mutagenicity.

Dilution is effective in reducing infusion phlebitis in peripheral parenteral nutrition: an experimental study in rabbits

To clarify conflicting clinical results that had been reported as to whether dilution is effective or not in reducing infusion phlebitis, this study was undertaken. We undertook two experiments with the different infusion conditions in rabbits to confirm the generality and the reproducibility of the results. To test the effect of dilution, 120 mL/kg of solution A (784 mOsm/kg) was infused into rabbit ear veins at 10 mL.kg-1.h-1 for 12 h, and 144 mL/kg of 1.2-fold-diluted solution A (648 mOsm/kg) was infused at 12 mL.kg-1.h-1 for 12 h. Similarly, 120 mL/kg of solution B (718 mOsm/kg) was infused at 5 mL.kg-1.h-1 for 24 h, and 168 mL/kg of 1.4-fold-diluted solution B (514 mOsm/kg) was infused at 7 mL.kg-1.h-1 for 24 h. The infused veins were sampled 24 h after the end of the infusion and examined histopathologically. After the 12-h infusion, phlebitic changes were observed in six of eight rabbits given solution A but in only one of eight rabbits given diluted solution A, although the same quantities of the same nutrients were infused. Also, after the 24-h infusion, phlebitic changes were observed in six of eight rabbits given solution B but in no animals given diluted solution B. The same result that dilution reduced or eliminated phlebitic changes was confirmed in the different conditions. These results suggest that osmolality of the infusion solution is an important factor in the development of phlebitis regardless of infusion volume or infusion rate and that dilution is effective in reducing the phlebitic potential of infusion solutions.

Culture supernatants of Lactobacillus acidophilus and Bifidobacterium adolescentis repress ileal ulcer formation in rats treated with a nonsteroidal antiinflammatory drug by suppressing unbalanced growth of aerobic bacteria and lipid peroxidation

A nonsteroidal antiinflammatory drug, 5-bromo-2-(4-fluorophenyl)-3-(4-methylsulfonylphenyl) thiophene (BFMeT), induced ileal ulcers in rats after oral administration, while no ulcers were observed after subcutaneous injection. The ileal ulcer formation in BFMeT-treated rats was examined to correlate the administration of cultures of Lactobacillus acidophilus or Bifidobacterium adolescentis with intestinal bacteria in the ileal contents and lipid peroxidation of the small intestinal mucosa. Ileal ulcers were observed in more than 85% of the rats treated with BFMeT at a dose of 1,000 mg/kg when they were given tap water as drinking water. The incidence of ulcer formation was repressed by giving culture supernatants of L. acidophilus or B. adolescentis as drinking water, but not by giving the cell suspension as drinking water. Gram staining of the ileal contents of normal rats revealed that 97% of the stained bacteria were gram-positive rods and only 1.5% were gram-negative rods. The percentage of gram-negative rods 72 hr after BFMeT administration was 49.8% and increased over 30-fold in BFMeT-treated rats. However, the percentage of gram-negative rods was 9.7 % or 16%, respectively, in rats taking culture supernatants of L acidophilus or B. adolescentis. In addition, thiobarbituric acid-reactive substances in the ileal mucosa increased significantly in the rats given tap water for 72 hr after BFMeT treatment, but not in rats given the culture supernatants of L. acidophilus or B. adolescentis. Since BFMeT induced an unbalanced intestinal microflora, the effect of antibiotic treatment on ulcer formation in rats was examined. The magnitude of the ulcer formation in the antibiotic-treated rats was, in decreasing order, metronidazole >none > kanamycin > a mixture (bacitracin, neomycin and streptomycin). These results suggest that the intestinal microflora plays an important role in ulcer formation and that a metabolite(s) of L. acidophilus and B. adolescentis inhibits ileal ulcer formation by repressing changes in the intestinal microflora and lipid peroxidation in BFMeT-treated rats.

[Traditional remedy-induced Chinese herbs nephropathy showing rapid deterioration of renal function]

A 19-year-old female was referred to our hospital for azotemia and anemia. She had been taking a health food for atopic dermatitis for about three years. Urinalysis showed proteinuria, glycosuria and microscopic hematuria. Generalized aminoaciduria was observed. Moreover, severe anemia, azotemia, hypokalemia and hypophosphatemia were also observed. Renal biopsy specimen disclosed hypocellular interstitial fibrosis and degeneration of the proximal tubular epithelial cells. No remarkable changes were observed in the glomeruli. Aristolochic acid was detected in the health food. From these findings, she was diagnosed as having Chinese herbs nephropathy (CHN). Although consumption of the food intake was stopped, her renal function deteriorated rapidly. Previously, we reported that certain kinds of Chinese herbal drugs contain aristolochic acid and that the drugs should be prohibited if aristolochic acid is identified. However, we experienced a patient of CHN arising from traditional remedy, which was not proved to be safe. It should be awared that health foods may contain aristolochic acid.

Kidney-specific expression of a novel mouse organic cation transporter-like protein

Using the signal sequence trap method, we have cloned a novel 12-membrane-spanning transporter-like protein, termed renal-specific transporter (RST), from the mouse kidney. RST is a 553-amino-acid protein highly homologous to recently cloned organic cation transporters, e.g. it is 30% identical to rat organic cation transporter I at the amino acid level. Northern blot analysis has revealed that the RST gene is expressed abundantly and specifically in the kidney. In situ hybridization analysis has shown that RST gene expression is restricted to the renal proximal tubule, where various organic cations such as endogenous catecholamines and choline or clinically used cationic drugs are known to be actively excreted.

Quantitative analysis of myocardial ischemia by technetium-99m sestamibi exercise scintigraphy: a new method for change rate mapping

In order to quantitatively assess the extent and severity of myocardial ischemia by Tc-99m sestamibi exercise myocardial scintigraphy, we developed a new method of change rate (CR) mapping and examined its efficiency. CR was calculated to divide the counts per pixel in the stress polar map by that in the rest polar map at each corresponding pixel. The CR map showed the CR values at each pixel. To correct the differences between the stress and rest images for the dose of Tc-99m sestamibi administered, the mean counts per pixel in the stress polar map and the rest map were adjusted to the same level. Regarding the regions in which the CR value was less than 1 as ischemia, we compared the abilities of the CR map and the polar map to detect coronary artery stenosis in 5 patients with angina pectoris. The sensitivity for coronary artery stenosis was 80% in the CR map, and 40% in the polar map. The specificity for both was 75%. We concluded that the CR map was effective in assessing the extent and severity of myocardial ischemia in Tc-99m sestamibi exercise myocardial scintigraphy.

Effect of intestinal bacteria on formation of azoxymethane-induced aberrant crypt foci in the rat colon

The effect of intestinal bacteria on formation of azoxymethane (AOM)-induced aberrant crypt foci (ACF) and DNA adducts in the rat colon was investigated. Male Sprague-Dawley rats were administered cultures of Lactobacillus acidophilus, Bifidobacterium adolescentis, Bacteroides fragilis, Escherichia coli and Clostridium perfringens for five weeks and given injections of AOM at 15 mg/kg body weight at the first and second weeks. The number of ACF five weeks after the start of the experiment was decreased in the rats treated with the cultures or culture supernatants of L. acidophilus and C. perfringens. The half-life of O6-methylguanine (O6-meG) in the L. acidophilus group was shorter than that in the GAM broth group. The half-life of 7-methylguanine did not differ among the groups. These results suggest that the metabolite(s) of L. acidophilus and C. perfringens inhibit(s) the ACF formation in rats treated with AOM and that the inhibitory effect of L. acidophilus is due to the enhanced removal of O6-meG from the colon mucosal DNA.

A 41-year-old woman with protein S deficiency and diffuse proliferative lupus nephritis: is protein S deficiency associated with a hyperinflammatory response?

A 41-year-old woman with complete protein S (PS) deficiency who developed diffuse proliferative lupus nephritis is reported. She was referred to our hospital with nephrotic syndrome and thrombocytopenia. Her medical history included colorectostomy and amputation of the extremities because of repeated thrombotic episodes during her teens without any evidence of systemic lupus erythematosus. The diagnosis of PS deficiency was made from the patient's clinical course, undetectable serum PS in either the active or inactive form, normal protein C activity, and no evidence of the antiphospholipid syndrome. However, there was no definitive family history. A depressed level of complements and a positive antinuclear acid antibody suggested a diagnosis of systemic lupus erythematosus. The patient had a rapidly progressive course and died of disseminated intravascular coagulation. An autopsy showed generalized thrombotic lesions and diffuse proliferative lupus nephritis on both ordinal light and immunoperoxidase microscopy. Our observations suggest that PS-deficient patients may have a hyperinflammatory response.

[Chinese herbs nephropathy in the Kansai area: a warning report]

In 1993, Vanherweghem and his associates reported cases of rapidly progressive renal interstitial fibrosis in young women who were administered a slimming regimen including Chinese herbs. Subsequently, similar cases have been reported. In Japan, especially in the Kansai area, several cases of Chinese herbs nephropathy have already been reported. We experienced a patient suffering from Chinese herbs nephropathy (CHN), and further detected aristolochic acids from the Chinese herbs taken by the patient. Aristolochic acids are known to be causative agents of CHN. The danger of CHN should be noted as soon as possible and drugs containing aristolochic acids should be prohibited.

Genome analysis of Bacteroides by pulsed-field gel electrophoresis: chromosome sizes and restriction patterns

The chromosomal DNAs of nine strains of seven Bacteroides species including B. fragilis, the type species of the genus Bacteroides, were digested with rare-cutting restriction enzymes I-Ceu I, Not I, and Asc I and analysed by pulsed-field gel electrophoresis. The genome sizes of B. fragilis, B. distasonis, B. eggerthii, B. ovatus, B. thetaiotaomicron, B. uniformis, and B. vulgatus were determined to be 5.3, 4.8, 4.4, 6.9, 4.8, 4.6, and 5.1 Mbp, respectively. B. distasonis and B. vulgatus, and also B. uniformis and B. eggerthii, showed similar I-Ceu I restriction profiles. I-Ceu I cut B. uniformis and B. eggerthii genomes into four, B. ovatus into five, B. fragilis and B. thetaiotaomicron into six, and B. distasonis and B. vulgatus into seven fragments. On the basis of genome size, restriction profile, and I-Ceu I fragment number, a phylogenetic tree of the Bacteroides species was proposed. This was in overall agreement with the previous phylogenetic tree obtained by 16S rRNA data, with the exceptions of B. distasonis and B. ovatus.

[A Rathke's cleft cyst with a moving mass in the cyst]

We reported a case of Rathke's cleft cyst (RCC) with a moving mass in the cyst. A fifty-eight-year-old woman complaining of headache was admitted to our hospital. She suffered from hyponatremia, hypothalamic hypopituitarism, but did not show any neurological deficits, nor visual field nor visual acuity disturbance. MRI revealed an intrasellar cyst including a mass shadow and the cyst did not compress the hypothalamus. Interestingly, this mass moved gradually from the floor to the posterior wall of the sella turcica according to changes in position from standing to supine. We operated to remove the cyst partially by transsphenoidal approach. Xanthochromic fluid flowed out from the cyst. In addition, a brownish globular mass, 6 mm in diameter, existed within the cyst without connection to the surrounding tissue. Pathological findings showed that the capsule consisted of cuboid epithelium and was partially stratified, which confirmed the diagnosis of Rathke's cleft cyst. However, the mass was homogeneously stained with H.E., containing no cells, cellular debris, nor connective tissue. PAS stain was negative. Though we could not clarify the material in the cyst, this case is very rarely one of Rathke's cleft cyst. This case demonstrated the possibility of hypothalamic hypopituitarism in spite of the cyst being almost located in the sella turcica. We surmise that a cyst near the stalk of the pituitary gland, even if it is not so large, might compress the portal vein, and thus the function of hypothalamus-pituitary axis.

[Mitral prosthetic valve replaced twice due to repeated prosthetic valve endocarditis: a case report]

A 38-year-old man was admitted to our hospital for detailed examination of fever, cough and yellow sputum. At the age of 32, be had mitral prosthesis for the first time, because of mitral regurgitation due to mitral valve prolapse. Four years previously, he had again undergone mitral prosthetic valve replacement due to prosthetic valve endocarditis due to staphylococcus epidemidis. This occasion, staphylococcus aureus was isolated by arterial blood culture. Transesophageal echocardiography detected vegetation attached to the mitral prosthetic valve and paravalvular leakage. The diagnosis was prosthetic valve endocarditis. He underwent a third mitral prosthetic valve replacement. Detection of the source of infection was difficult only by transthoracic echocardiography, and immediate transesophageal echocardiography seemed mandatory to diagnose bacterial endocarditis.

[A case of fluminant septic shock due to Streptococcus agalactiae in a patient with MPO-ANCA related glomerulonephritis]

Recently group A Streptococcus toxic shock like syndrome (TSLS) has been reported, but as for group B streptococcus (S. agalactiae) infection, there have been little documentation in the literature. We report a case of fluminant septic shock due to Streptococcus agalactiae (S. agalactiae). A 72-year-old male was admitted to our hospital because of general fatigue and azotemia. He was diagnosed as having MPO-ANCA related glomerulonephritis and treated with steroid therapy. Gradually he was doing well. On the 228th hospital day, he suddenly had tachypnea, transient conscious disturbance, and profound hypotension. About 16 hours later, he died despite intensive treatment. S. agalactiae was isolated from the blood. Autopsy revealed bilateral bronchopneumonia and shock liver. To our knowledge, this is the first report of septic shock caused by S. agalactiae.

Life-threatening cardiac involvement throughout life in a case of Costello syndrome

Costello syndrome is characterized by poor postnatal growth, mental retardation, curly hair, coarse face, loose skin of the hands and feet, and nasal papillomata. Patients with Costello syndrome have a high incidence of cardiac involvement, such as arrhythmias, hypertrophic cardiomyopathy, or congenital anomalies. The importance of cardiac involvement in Costello syndrome has not been strongly emphasized thus far, although arrhythmia and hypertrophic cardiomyopathy are both serious forms of cardiac involvement. We report the case of a Japanese girl with Costello syndrome, who experienced life-threatening cardiac involvement throughout her life.

[A 66-year-old woman with a patent ductus arteriosus and no significant progression of pulmonary arterial pressure over 17 years]

We report the case of a 66-year-old woman with a patent ductus arteriosus and no significant progression of pulmonary arterial pressure over 17 years. She was admitted to our hospital in 1978 because of palpitations on exertion and chest discomfort. Cardiac catheterization was done, and she was given a diagnosis of patent ductus arteriosus. Because the left-to-right shunt was small (15%) and because there was no evidence of pulmonary hypertension (38/18 mmHg), she was treated medically. In 1995 she was admitted again, to determine the cause of a cerebral infarction. The cerebral infarction was believed to have been caused by an embolism due to atrial fibrillation. She underwent cardiac catheterization again. The left-to-right shunt had increased to 41%, but the pulmonary artery pressure had not changed (27/14 mmHg). Intravascular ultrasound imaging was used to evaluate the ductus arteriosus. The diameter of the ductus was 4.4 mm and calcification was not observed. During the 17 years of follow-up, heart size increased slightly, but pulmonary artery pressure did not change. In addition, intravascular ultrasound was very useful for evaluating the condition of the ductus arteriosus.

Ossifying fibromyxoid tumor of soft parts of the back

We report a first case of ossifying fibromyxoid tumor of soft parts of the back, a 10 x 9.5 x 6 cm well-circumscribed elevated subcutaneous tumor demarcated by an incomplete fibrous capsule with bone formation at its base. The tumor was composed of both myxomatous areas with spindle tumor cells and pseudoalveolar structures with oval tumor cells. The tumor cells had evenly sized, oval nuclei without atypia and slightly eosinophilic cytoplasm with intracellular vacuoles. Immunohistochemical studies revealed positivity for vimentin and focal positivity for S-100 protein. Ultrastructural examination revealed a few filopodia-like processes, discontinuous basal lamina and a few primitive cell junctions. Based on these immunohistochemical and ultrastructural results, this tumor may be related to Schwann's cells. There has been no recurrence 5 years after wide local excision.

Effect of continuous passive motion on the results of TMJ meniscectomy. Part I: Comparison of chewing movement

In order to evaluate the therapeutic effect of continuous passive motion (CPM) on the outcome of TMJ meniscectomy, chewing movement was analyzed before surgery and six months after surgery in 31 patients receiving CPM (CPM group), 26 patients without CPM (non-CPM group), and in ten normal subjects. The surgical procedure consisted of either total meniscectomy or partial meniscectomy with disk repair. It was found that chewing in patients receiving CPM was closer to the normal range than for patients in the non-CPM group. The results from the CPM group demonstrated chewing parameters for patients with partial meniscectomy returning to the normal range. However, for the patients with total meniscectomy, some parameters remained out of the normal range. From these results, we conclude that CPM has a positive influence on the outcome of TMJ surgery.

Experimental infusion phlebitis: importance of titratableacidity on phlebitic potential of infusion solution

The titratable acidity of infusion solutions has never been taken into account in infusion phlebitis. This study aims to clarify the importance of titratable acidity on the phlebitic potential of infusion solutions. Solutions with different titratable acidity (from 0.16 to 12 mEq/L) were infused into the ear veins of 6 rabbits for 6 h at 10 mL/kg/h, and the veins were later examined histopathologically. Even at pH 4.0, a commercial 10% glucose solution scarcely caused any changes because of its very low titratable acidity (0.16 mEq/L). A 10% glucose solution with its titratable acidity adjusted to 3 mEq/L (pH 4.3) with citrate and NaOH, however, caused phlebitic changes in all 6 rabbits, and adjusting the titratable acidity to 12 mEq/L (pH 4.4) increased the degree of phlebitis. On the other hand, a 10% glucose solution with a pH of 5.4 and a titratable acidity of 6 mEq/L caused slight phlebitic changes in half the rabbits. These results suggest that 1) the titratable acidity of infusion solutions is important to the phlebitic potential when the pH is low, 2) when the pHs are similar, the phlebitic potential of infusion solutions depend on the titratable acidity, and 3) the phlebitic potential of infusion solutions can not be estimated by pH or titratable acidity alone.

Detection of Bacteroides fragilis by PCR assay targeting the neuraminidase-encoding gene

Oligonucleotide primers were designed on the basis of the sequence of the neuraminidase-encoding gene (nanH) of Bacteroides fragilis and used for the specific detection of this anaerobe by the nested PCR assay. Fifty-nine of 60 representative strains of Bact. fragilis were detected, while none of 45 strains of other species generated visible PCR products. The detection limits of Bact. fragilis cells and DNA by the nested PCR were 10 colony-forming units and 10 fg of chromosomal DNA, respectively. The PCR assay targeting the nanH gene has the potential for the detection of Bact. fragilis.