[Microbiological and clinical studies of vancomycin resistant Leuconostoc spp. and Pediococcus spp. isolated from septicemia patients]

We described three septicemia cases in which blood cultures yielded gram-positive cocci identified as Leuconostoc spp. and Pediococcus spp. Patients were three male adults aged 63 to 71 years with severe underlying diseases, pancreatic cancer, esophageal cancer and diabetes mellitus with chronic renal failure. They had fever and chills at the onsets of septicemia with acute obstructive suppurative cholangitis, acute pneumonia, and infection complicated with invasion sites of esophageal cancer contagious to bronchus and subcutaneous tissue. Blood cultures yielded catalase and oxidase negative highly vancomycin-resistant (MIC: 1024 micrograms/ml <) gram-positive cocci showing alpha or gamma hemolysis on blood agar plates. Two cases were polymicrobial infections. In one case with esophageal cancer, clinical symptoms persisted after the start of antimicrobial chemotherapy and the patient died 10 days later associated with complications of esophageal cancer. Leuconostoc lactis, Leuconostoc mesenteroides subsp. dextranicum, and Pediococcus acidilactici wee identified by physiological reactions. These strains were also highly resistant to teicoplanin and fosfomycin, and tolerant to all rested beta-lactams such as benzylpenicillin. This is the first report in Japan to our knowledge on the identification of Leuconostoc spp. and Pediococcus spp. isolated from human infectious diseases.

Technetium-99m-HMPAO as a marker of chemical and irradiation lung injury: experimental and clinical investigations

We evaluated the ability of 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) to serve as a sensitive marker of lung injury.

METHODS

Two experimental rabbit models of minimal lung injury were designed using injections of a low dose (0.05 ml/kg) of oleic acid or 50 Gy of irradiation. In addition, we clinically investigated whether patients who received chemotherapy (n = 14) or radiotherapy (n = 13) for lung cancer showed high uptake of 99mTc-HMPAO in the lungs.

RESULTS

Despite the minimal endothelial lesions visualized by electron microscopy (edematous changes and blebbing), in both animal models, the lungs showed high uptake of 99mTc-HMPAO, which occurred rapidly within 1 min after injection. Clinically, the mean lung-to-liver ratio of 99mTc-HMPAO activity in the patients who received chemotherapy (0.649 +/- 0.185, p < 0.01) was significantly higher than that of the controls (n = 16; 0.387 +/- 0.108), and all 12 patients who received more than 30 Gy of irradiation showed abnormal uptake in the irradiated lungs, despite the lack of abnormal opacities on chest CT.

CONCLUSION

These findings suggest that 99mTc-HMPAO has the potential to be a sensitive marker of chemical and irradiation lung injury.

Toric intraocular lenses: correcting astigmatism while controlling axis shift

We evaluated the efficacy of toric intraocular lenses (IOLs) implanted in the eyes of 47 patients who had preoperative against-the -rule astigmatism. The lenses, which had a cylinder power of 2.00 diopters (D) (n = 26) or 3.00 D (n = 21), were implanted through a 5.7 mm incision after cataract extraction by phacoemulsification. Best corrected visual acuity three months postoperatively was 20/25 or better in 77% of eyes. The 3.00 D IOLs resulted in better correction than the 2.00 D IOLs when the axis shift of the lens was less than 30 degrees. A negative effect occurred in some eyes in which the lens axis rotated more than 30 degrees. The maximum acceptable axis shift seems to be less than 30 degrees.

Transcription-modulatory activity of full-length E6 and E6*I proteins of human papillomavirus type 16

The E6 gene of human papillomavirus type 16 (HPV16) has the potential to encode full-length as well as truncated E6 proteins (E6*I and E6*II) by alternative splicings. Spliced ORF E6*I is considered to facilitate the translation of the neighboring E7 ORF; however, the putative E6*I protein is suspected to be functionless. In this study, the transcription-modulatory functions of full-length E6 and E6*I proteins were examined using cDNAs from a cervical carcinoma cell line. E6*I cDNA was able to trans-activate the autologous P97 promoter and the heterologous adenovirus E2 promoter. Full-length E6 was found to trans-activate the heterologous promoter, but repress transcription from the autologous P97 promoter. The transcription-modulatory functions of full-length E6 and E6*I proteins suggested that transcriptional regulation of HPVs associated with mucosal malignant lesions is complex.

Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma

Vascular invasion and intrahepatic metastasis by hepatocellular carcinoma are important factors predisposing to tumor recurrence. Recurrences of this malignancy occur frequently in residual liver, and its prevention is one of the most important factors in obtaining better surgical survival. Fifty patients who underwent hepatectomy for invasive hepatocellular carcinoma with vascular invasion and/or intrahepatic metastases were studied to evaluate the effect of adjuvant bolus hepatic arterial infusion of iodized poppyseed oil (Lipiodol) containing anticancer drugs in preventing recurrence and in prolonging survival. Patients were assigned to two treatment groups. Twenty-three of the fifty patients received adjuvant bolus infusion of Lipiodol containing doxorubicin and mitomycin C, whereas 27 patients received no therapy. The disease-free survival rate for the patients who received adjuvant therapy was significantly better (p < 0.05) than that for those who did not when measured at 172, 516, 688 and 860 days after hepatectomy, and the disease-free survival curve for patients with adjuvant therapy was significantly (p = 0.0237) better than that without adjuvant therapy. The cumulative survival rates and curves were not significantly different between the two groups. While adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs was effective in improving disease-free survival, the effect was not satisfactory. Further trials of adjuvant chemotherapy are required to improve the surgical survival of hepatocellular carcinoma patients.

[Primary plasma cell leukemia complicated with high-output cardiac failure and hyperammonemia]

A 23-year-old male patient with plasma cell leukemia showed characteristic clinical features: accelerating heart failure and consciousness disturbance accompanied with an increase of plasma cells in peripheral blood. Evaluation of cardiac function revealed a hyperdynamic cardiac state with low somatic vascular resistance, indicating high-output cardiac failure. However no disorders causing high-output cardiac failure were found. Consciousness disturbance and hyperammonemia with serum amino acid abnormality of unknown origin were also demonstrated. After intensive combined chemotherapy (MVD + VAD), high-output cardiac failure and hyperammonemia improved with disappearance of plasma cells, suggesting that these symptoms were closely related with progression of plasma cell leukemia.

Permissive effect of VIP on the hyperglycemic response induced by 2-deoxy-D-glucose

We previously obtained evidence that in rats the neurons in the suprachiasmatic nucleus (SCN) receiving retinal neural inputs may be involved in the regulation of glucose metabolism. In this study we examined whether the SCN neurons containing vasoactive intestinal peptide (VIP)-like immunoreactive substance (VIP neurons) are involved in its regulation. We found that the hyperglycemic and hyperglucagonemic responses to intracranial injection of 2-deoxy-D-glucose (2DG) were synergistically enhanced by intracranial administration of VIP, and that these responses were significantly suppressed by treatment with anti-VIP antibody. These results suggest that VIP has a permissive effect on the hyperglycemic and hyperglucagonemic responses to 2DG, and thus that the VIP neurons in the SCN are probably involved in the regulation of glucose metabolism.

[Microbiological and clinical studies of infective endocarditis due to nutritionally variant streptococci]

We report four cases of infective endocarditis due to nutritionally variant streptococci (NVS) that occurred between 1981 and 1991. Three female and one male patients had underlying heart diseases. Causative organisms showed satellitism to staphylococci. Two strains were identified as S. adjacens and the other two were identified as S. defectivus by DNA-DNA hybridization. All strains had tolerance and one strain had resistance to benzylpenicillin (MIC 4 micrograms/ml). This penicillin-resistant strain also had tolerance to gentamicin. There was no synergism of benzylpenicillin and gentamicin against this strain by a killing curve in vitro. A 11-year-old female patient with infective endocarditis due to this strain, who had a transposition of great arteries, had large vegetations in external conduits by the Rastelli's operation. Some intensive antimicrobial chemotherapies were unsuccessful and a surgical replacement of the conduits must be done in this case. Since infective endocarditis due to NVS is not rare in Japan, NVS should be considered for the causative organisms in culture negative endocarditis.

Migration of genetically labeled glioma cells after implantation into murine brain

Murine RSV-M glioma cells were genetically labeled with a retroviral BAG vector carrying the Escherichia coli beta-galactosidase gene. The X-gal-positive stable cell line RSV-M/BAG was obtained by the FDG-FACS method. To examine the behavior of glioma cells in the brain, we homografted RSV-M/BAG cells into the brain of C3H/HeN mice as cell suspensions. Individual grafted glioma cells were easily detected by histochemical staining for B-galactosidase (beta-gal). Three days after grafting, the beta-gal-positive cells were mainly found in the subependymal zone of the lateral ventricle. In addition, some solitary labeled cells were found at locations distant from the injection sites. On the seventh day after implantation, tumor masses were observed and graft-derived glioma cells were migrating bilaterally along the fibers in the corpus callosum. Other labeled cells extended into the brain parenchyma via the perivascular (Virchow-Robin) spaces. Rapid and extensive migration of individual glioma cells was thus clearly demonstrated by intracerebral transplantation of RSV-M/BAG cells.

[A case report of angina pectoris associated with hypereosinophilia in a patient on continuous ambulatory peritoneal dialysis (CAPD)]

We report a case of hypereosinophilia which was associated with the onset of anginal attacks. A 64-year-old man progressed to end-stage renal failure due to diabetic nephropathy, and was treated with continuous ambulatory peritoneal dialysis (CAPD). He had no past history of angina pectoris nor hypereosinophilia. Three weeks after the initiation of CAPD, the eosinophil count in peripheral blood increased (up to 4093/mm3). Two weeks later, he suffered from an anterior chest pain attack, and angina pectoris was diagnosed. As a result of treatment with isosorbide dinitrate and prednisolone, hypereosinophilia disappeared rapidly and repeated episodes of anginal attacks also disappeared. After an interval of 3 months, however, hypereosinophilia (up to 15190/mm3) and anginal attacks recurred. He underwent coronary angiography, in which no stenotic change was observed. The administration of prednisolone was effective in the treatment of these episodes. Although a close relationship between hypereosinophilia and anginal attack has been reported, it has not been known in CAPD patients as described here. Attention should be paid to these relationships in CAPD patients, because hypereosinophilia is frequently observed in maintenance peritoneal dialysis patients.

[Clinical application of AW glass ceramic prosthesis in spinal surgery]

Bone prosthesis of apatite- and wollastonite-containing glass-ceramic (AW-GC), a new synthesized material, is known to be excellent in bonding directly with adjacent living bone tissue, in having strong mechanical strength and no toxic effects, in experimental studies. In spinal surgery, massive and strong bone grafts are required for reconstruction of the spinal column affected by a tumor, trauma, or a degenerative disease. However, utilization of bone allograft is not yet socially accepted in Japan and also there are other barriers against the supply of allograft bone. In the present study, AW-GC bone prosthesis was used for reconstructive surgery for various spinal diseases and follow-up studies were performed for an average of 14.9 months (range: 2-36 mo). The clinical results were satisfactory. Thirty patients (males: 17 and females: 13) with an age range of 40-75 years (mean: 55.3 years) were reviewed in this study. Preoperative diagnoses for which an AW-GC prosthesis was required were as follows; vertebral prosthesis: 15 with metastatic tumor of the spine, 3 with burst fracture of the thoraco-lumbar spine; vertebral spacer: 6 with degenerative spondylolisthesis, 2 with isthmic spondylolisthesis, 2 with lumbar intervertebral disc herniation, and one with spinal canal stenosis. Patient's satisfaction, roentgenographic evaluation, laboratory data on blood and urine, and toxic effects were examined in these patients. As a result, the patient's satisfaction for the AW-GC bone prosthesis was high, and the initial fixation and long term stability were excellent. For kyphotic deformity and scoliosis, postoperative correction could be maintained in two patients where correction was attempted, and the usefulness of AW-GC prosthesis as a spinal prosthesis was confirmed. Good bone formation around the prosthesis was observed with time. The clear zone (radiolucent line between ceramic and bone) tended to decrease or disappear. There were no systemic or local toxic side-effects considered to be due to the AW-GC bone prosthesis, or no abnormalities in the laboratory data. These findings suggested that the AW-GC bone prosthesis is a new biomaterial with excellent properties which can be successfully substituted for bone graft in reconstructive spinal surgery.

Evaluation of patients with lactic acidosis using microphotometric mitochondrial enzyme assay in single muscle fibers

Microphotometric enzyme assay in single muscle fibers was performed on two patients with lactic acidosis. Neither case showed ragged red fibers upon histochemical evaluation. Biochemical analysis of mitochondrial enzymes demonstrated low normal cytochrome c oxidase (COX) activity in Case 1 and deficient COX in Case 2. Quantitative single muscle fiber analysis in patients showed marked variation in COX activity in Case 1, reflecting mosaic distribution of fibers with near-normal COX activity and with defective COX activity. These data suggest that this microphotometric assay may be valuable for elucidating the significance of 'partial enzyme deficiency'. In addition, this assay method may be applied to needle biopsy specimens.

cDNA cloning and expression of Cry j II the second major allergen of Japanese cedar pollen

We have isolated and sequenced a cDNA clone coding for Cry j II, the second major allergen of Japanese cedar (Cryptomeria japonica) pollen. A 1.7-kilobase cDNA clone contained an open reading frame coding for a 514-amino acid protein, including a putative signal peptide of 54 amino acid and three potential glycosylation sites. The deduced amino acid sequence of the Cry j II shows significant identities to those of the polygalacturonases associated with fruit-ripening in tomato (40%) and avocado (43%) and found in pollen of maize (34%). Cry j II cDNA product expressed in E. coli was recognized by human IgE from patients suffering from cedar pollinosis, suggesting that recombinant Cry j II might be used as an allergen for the clinical diagnosis of cedar pollinosis.

An RNA-binding protein gene, TLS/FUS, is fused to ERG in human myeloid leukemia with t(16;21) chromosomal translocation

The t(16;21)(p11;q22) translocation is a recurrent chromosomal abnormality found in several types of myeloid leukemia. We have previously demonstrated that the breakpoints of this translocation are clustered in a specific intron of the ERG gene on chromosome 21, which has recently been reported to be involved in Ewing's sarcoma. We show here that the TLS/FUS gene on chromosome 16 is fused with the ERG gene to produce the TLS/FUS-ERG chimeric transcript by this translocation. The TLS/FUS gene has been identified as a translocated gene in myxoid liposarcoma by the t(12;16)(q13;p11) translocation and encodes an RNA-binding protein that is highly homologous to the product of the EWS gene involved in Ewing's sarcoma. Thus, the TLS/FUS-ERG gene fusion in t(16;21) leukemia is predicted to produce a protein that is very similar to the EWS-ERG chimeric protein responsible for Ewing's sarcoma.

[Clinicopathological studies on pseudosarcomatous lesion of the upper gastrointestinal tract]

Thirty-seven cases of pseudosarcomatous lesion (PSL) are studied clinicopathologically on the upper gastrointestinal tract. Majority of the cases showed polypoid tumor lesions, and only minority of them showed non-polypoid lesions. All showed surface erosion or ulcer. Atypical proliferating cells, easily mistaken for sarcoma, were observed in the stroma. The cellular atypia of the stromal cells was related on site and shape; polypoid or non-polypoid. The lesions with severe atypia were observed mainly in the esophago-cardiac junction, lower portion of esophagus and cardia. Non-polypoid lesions showed mild atypia. Immunohistochemically, atypical stromal cells were positive only for vimentin, so considered to be fibroblastic cells. In order to avoid over-diagnosis on biopsy of the upper gastrointestinal tract, recognition of the clinicopathological features of PSL is very important.

[A new liver support system composed of functional human cells and a radial-flow bioreactor]

An artificial liver will be useful for the treatment of acute hepatic failure and a bridge of liver transplantation. The current reports suggest that the hybrid type of artificial liver composed of functional human liver cells and a bioreactor is practical for clinical use. In the present study, we succeeded high density culture on a large-scale of human functional hepatoma (JHH-7) using a newly developed radial flow packed-bed bioreactor. Since the shear stress of this bioreactor is lower than the other type, high density culture without cell damage is possible. JHH-7 cells produced large amounts of human albumin and other liver specific proteins, and then have the function of ammonia metabolism in the system. This study suggests that a radial flow bioreactor will be developed as a new type of artificial liver.

[Evaluation of once-daily administration of arbekacin. Experimental study and determination of pharmacokinetic properties in man]

Experimental and phase I clinical studies were performed to evaluate the efficacy and safety of once-daily administration of arbekacin (ABK). The results obtained were as follows: 1. ABK displayed dose-dependent, excellent antibacterial activity and post-antibiotic effects (PAE) against MRSA. 2. No significant difference was found between once-daily and divided administration regimens in protection against an experimental MRSA infection in mice. 3. There was no significant difference between once-daily and twice-daily administration of ABK in ototoxicity in guinea pigs or in nephrotoxicity in rats. 4. In the phase I clinical study using 200 mg single daily administration of ABK, no abnormal laboratory test results or symptoms were observed. 5. In the phase I clinical study of 5-day repeated administration of 200 mg/day of ABK, headache and increase in WBC sediment in the urine was noted in 1 volunteer; however these were not confirmed to be attributable to ABK. No abnormal laboratory test results were obtained other than increases in beta 2-microglobulin, NAG and gamma-GTP levels, each of which returned to normal after the completion of ABK administration. No abnormality was observed in the audiometry examination. 6. Maximum serum concentration (Cmax), serum half-life (T1/2 beta) and urinary recovery rate (0-48 hours) after single administration of 200 mg of ABK, were 13.20 micrograms/ml, 2.30 hours and 86.75%, respectively. There were no significant differences in pharmacokinetic parameters or urinary recovery rates between day 1 and day 5 in the 5-day repeated administration study. These findings suggest that once-daily administration regimen of ABK may be as effective and safe as divided administration regimen for the treatment of MRSA infection. Further clinical evaluation is required, however.

Frequency translation of light waves by propagation around an optical ring circuit containing a frequency shifter: II. Theoretical analysis

Theoretical aspects of the frequency-translation ring circuit are considered through numerical simulations. We analyze the signal and noise propagation around an optical ring circuit that contains a frequency shifter, an erbium-doped fiber amplifier and a bandpass filter (BPF). The relations between the frequency-translation limit and some important parameters such as the BPF bandwidth and the polarization state are clarified. Numerical results for the frequency-translation limit are compared with reported experiments and a frequency translation of more than 100 GHz is predicted.

Efficient room-temperature CO laser with high specific output

Efficient room-temperature operation of a fast-axial-flow rf-discharge-excited CO laser is described. A steady-state laser output of 268 W has been obtained with a CO/N(2)/He/Xe/O(2) mixture from a 19-mm-diameter, 300-mm-long discharge. The corresponding electrical conversion efficiency and the specific laser output are as high as 13.5% and 3.15 W/cm(3), respectively. The role of Xe in the mixtures is discussed. The specific laser output achieved is comparable with those of the high-power industrial CO(2) lasers in which a similar excitation scheme is applied.

[Intraoperative monitoring in patients undergoing surgery of lesions involving the cavernous sinus]

We reviewed the intraoperative monitoring and anesthesia in 45 patients, who had undergone operation of lesions involving the cavernous sinus between September, 1990, and May, 1993. The patient was placed in a 30 degree of head-up position to reduce the bleeding from the cavernous venous plexus. However, air embolism during the operation has not been noted in any patients. In 13 of 45 patients, a transient or permanent internal carotid artery (ICA) occlusion was performed intraoperatively under the brain protection by thiopental and the monitoring of electroencephalograph, somatosensory evoked potentials, local cerebral blood flow, and oxygen saturation of internal jugular vein. There has been no complications related to the ICA occlusion. In 7 patients, intraoperative recordings of evoked extraocular muscle activities were undertaken to monitor ocular motor nerve function. Responses from the inferior rectus muscle to the oculomotor nerve stimulation, and from the lateral rectus muscle to the abducens nerve stimulation, were obtained in 5 patients and 1 patient, respectively. Intraoperative neurophysiological monitoring in the surgery of lesions involving the cavernous sinus is crucial to reduce the surgical complications, and a team approach, including neurosurgeons, anesthesiologists, and medical engineers, is important for the future progress.