Enterococcal bacteremia in a medical center

BACKGROUND

The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed.

METHODS

There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed.

RESULTS

One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself.

CONCLUSIONS

Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.

Mixed cellular population in primary and metastatic periampullary adenocarcinoma of the duodenum: report of a case

There are numerous reports on the mixed cellular population of primary tumors, especially in the gastrointestinal tract. However, reports of mixed cellular population in metastatic foci are rare. This is a report of a case of periampullary papillary adenocarcinoma of the duodenum with 4 types of cellular population. Metastases to the regional lymph nodes also contained 4 different cell types. The histogenesis of the mixed cellular population in the primary tumor and theories proposed to explain the pathophysiologic mechanisms of mixed cellular population in the metastatic foci are discussed.

Mutational effects of space flight on Zea mays seeds

The growth and development of more than 500 Zea mays seeds flown on LDEF were studied. Somatic mutations, including white-yellow stripes on leaves, dwarfing, change of leaf sheath color or seedling color were observed in plants developed from these seeds. When the frequency of white-yellow formation was used as the endpoint and compared with data from ground based studies, the dose to which maize seeds might be exposed during the flight was estimated to be equivalent to 635 cGy of gamma rays. Seeds from one particular holder gave a high mutation frequency and a wide mutation spectrum. White-yellow stripes on leaves were also found in some of the inbred progenies from plants displayed somatic mutation. Electron microscopy studies showed that the damage of chloroplast development in the white-yellow stripe on leaves was similar between seeds flown on LDEF and that irradiated by accelerated heavy ions on ground.

Purification and characterization of beta-glucuronidase from bull seminal plasma and its role in fertilization

Bull seminal plasma contains high levels of beta-glucuronidase. The present study describes the isolation and characterization of beta-glucuronidase, and its role in fertilization. beta-glucuronidase was purified by ion exchange chromatography, saccharolactone-agarose affinity chromatography, and gel filtration. The specific activity of the purified enzyme was 4,414 mumoles/mg protein/min. The purified enzyme showed a single band on 7.5% PAGE. On SDS-PAGE, the enzyme appeared to consist of four identical subunits of M(r) 75,000 each. The apparent Km and Vmax for beta-glucuronidase were 0.4 mM and 5.7 mumol/min using phenolpthalein mono-beta-glucuronic acid as the substrate. beta-glucuronidase appeared to accelerate the cumulus dispersion in vitro.

Severe isolated acute hepatic graft-versus-host disease with vanishing bile duct syndrome

A 28-year-old man with chronic myelogenous leukaemia in blastic transformation underwent allogeneic bone marrow transplantation from his HLA-identical brother. Severe, progressive cholestatic jaundice developed from day 25 and did not respond to repeated therapy with high-dose methylprednisolone. In addition to marked cholestasis, both liver biopsy (day 69) and autopsy (day 134) findings revealed total disappearance of interlobular bile ducts in all of the portal areas, although extrahepatic manifestations of GVHD were minimal. Isolated acute vanishing bile duct syndrome can occur as the most severe form of acute hepatic GVHD.

Ethnic variation in the CYP2E1 gene: polymorphism analysis of 695 African-Americans, European-Americans and Taiwanese

Human cytochrome P4502E1 (CYP2E1) is inducible by ethanol and is involved in metabolism of many known carcinogens including N-nitrosodimethylamine, butadiene, benzene, and carbon tetrachloride. A 50-fold variability in CYP2E1 enzyme activity in humans has been observed but it is unknown whether the basis for this variation is genetic or environmental. Recently, two restriction fragment length polymorphisms (RFLPs) within the CYP2E1 gene have been suggested as genetic markers of risk for cancer. The first was a Rsa I polymorphism in the 5' regulatory region that appeared to alter transcriptional activation of the gene and the second was a Dra I polymorphism located approximately 7000 bp downstream in an intron. Rare alleles at each of these loci have been associated with a reduced risk for lung cancer in Japanese and Swedish populations. We have used a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to determine the genotype frequency for each of these CYP2E1 RFLPs in 695 individuals of Taiwanese, African-American or European-American background. Genotype and allele frequencies for Taiwanese were significantly different from those of African-Americans and European-Americans at either Rsa I or Dra I sites (p < 0.0001). Allele frequencies for African-Americans and European-Americans were significantly different at the Rsa I site (p = 0.03). The rare alleles (c2 and C) occurred at frequencies of 0.28 and 0.24 in Taiwanese, 0.01 and 0.08 in African-Americans, and 0.04 and 0.11 in European-Americans. In addition, we describe three haplotypes common to all three population samples and a fourth haplotype that was only detected in the Taiwanese population sample. This fourth haplotype may have been caused by a recombination event between these markers.(ABSTRACT TRUNCATED AT 250 WORDS)

Concomitant chemoradiotherapy for advanced epidermoid carcinoma of the uterine cervix: a preliminary report

BACKGROUND

Because the prognosis of advanced carcinoma of the uterine cervix is poor, and has improved very little in the last 20 years, a prospective study was initiated to evaluate the feasibility, response and toxicities of concomitant chemoradiotherapy for such cervical cancer.

METHODS

From May 1992 to December 1992, 22 patients entered the study, 21 of them completed the entire treatment. Their ages ranged from 47 to 72 years, median 57. There were 16 FIGO stage IIIB, and 5 stage IIB. Radiotherapy was administered using 1.8 Gy/day, five days a week, to the whole pelvis (50.4 Gy/28 fractions) with or without parametrial boost according to the tumor response. Intracavitary brachytherapy 5 Gy x five to six times was given after one or two weeks of rest. Chemotherapy consisted of etoposide 100 mg/m2 day 1 + cisplatin 50 mg/m2 day 1 + bleomycin 25 mg/m2/day day 2-3, repeated every two weeks during external irradiation.

RESULTS

All 21 eligible patients achieved complete response, sustaining during a median follow-up time of 12 months. All the initially elevated tumor markers (SCC, CEA, CA-125) returned to normal range after treatment. The toxicity was well tolerated.

CONCLUSIONS

Concomitant chemoradiotherapy for advanced cervical carcinoma is both feasible and effective, with acceptable toxicities. Long-term follow-up is mandatory, and a randomized trial to confirm the superiority of this protocol will be started soon.

Neurological complications of varicella: a report of two cases

Varicella (chickenpox) is the primary infection of Varicella-Zoster virus, characterized by generalized vesicular eruption, fever and mild constitutional symptoms. Chiefly infecting children of 1 to 14 years of age, the disease has been almost neglected because of its inevitable and benign outcome. Adults are rarely infected with an incidence of less than 20%. These two cases are presented of normal adults with marked neurological complications 10 and 14 days, respectively, following typical skin eruption of varicella. The first case developed transverse myelitis and the second, an encephalomyelitis. Neurological complications are very rare post-varicella infection. Although prognosis is good and complete recovery is the rule, still some morbidity with neurological sequelae and mortality have been reported. The present cases had extensive neurological deficit, despite aggressive treatment, making a high index of suspicion for differential diagnosis in patients who present with encephalitis. Especially following the typical exanthema of varicella, this possibility is emphasized and the literature is reviewed.

Heavy-ion induced genetic changes and evolution processes

On Moon and Mars, there will be more galactic cosmic rays and higher radiation doses than on earth. Our experimental studies showed that heavy ion radiation can effectively cause mutation and chromosome aberrations and that high-LET heavy-ion induced mutants can be irreversible. Chromosome translocations and deletions are common in cells irradiated by heavy particles, and ionizing radiations are effective in causing hyperploidy. The importance of the genetic changes in the evolution of life is an interesting question. Through evolution, there is an increase of DNA content in cells from lower forms of life to higher organisms. The DNA content, however, reached a plateau in vertebrates. By increasing DNA content, there can be an increase of information in the cell. For a given DNA content, the quality of information can be changed by rearranging the DNA. Because radiation can cause hyperploidy, an increase of DNA content in cells, and can induce DNA rearrangement, it is likely that the evolution of life on Mars will be effected by its radiation environment. A simple analysis shows that the radiation level on Mars may cause a mutation frequency comparable to that of the spontaneous mutation rate on Earth. To the extent that mutation plays a role in adaptation, radiation alone on Mars may thus provide sufficient mutation for the evolution of life.

Development of human epithelial cell systems for radiation risk assessment

The most important health effect of space radiation for astronauts is cancer induction. For radiation risk assessment, an understanding of carcinogenic effect of heavy ions in human cells is most essential. In our laboratory, we have successfully developed a human mammary epithelial cell system for studying the neoplastic transformation in vitro. Growth variants were obtained from heavy ion irradiated immortal mammary cell line. These cloned growth variants can grow in regular tissue culture media and maintain anchorage dependent growth and density inhibition property. Upon further irradiation with high-LET radiation, transformed foci were found. Experimental results from these studies suggest that multiexposure of radiation is required to induce neoplastic transformation of human epithelial cells. This multihits requirement may be due to high genomic stability of human cells. These growth variants can be useful model systems for space flight experiments to determine the carcinogenic effect of space radiation in human epithelial cells.

The effect of vesical outlet obstruction on the protein secondary structure of the mucosa and serosa in rabbit bladder wall

The biochemical composition of physiologically moist mucosa and serosa of rabbit bladder before and after bladder outlet obstruction was determined by means of FT-IR spectroscopy with the ATR method and second-derivative analysis. A predominantly beta-sheet structure was found in the amide I band for mucosa and serosa before and after obstruction, but the random coil structure increased in both obstructed bladder samples. However, the major beta-sheet structure associated with some alpha-helical structure in the amide II band of mucosa and serosa for non-obstructed bladder changed into a predominantly alpha-helical structure after bladder obstruction. The obstructed bladder serosa was more pronounced. The amount of glycoproteins doubled in the obstructed bladder serosa, but did not change in the bladder mucosa.

Multidrug resistance-associated protein gene overexpression and reduced drug sensitivity of topoisomerase II in a human breast carcinoma MCF7 cell line selected for etoposide resistance

A human breast cancer cell line (MCF7/WT) was selected for resistance to etoposide (VP-16) by stepwise exposure to 2-fold increasing concentrations of this agent. The resulting cell line (MCF7/VP) was 28-, 21-, and 9-fold resistant to VP-16, VM-26, and doxorubicin, respectively. MCF7/VP cells also exhibited low-level cross-resistance to 4'-(9-acridinylamino)-methanesulfon-m-anisidide, mitoxantrone, and vincristine and no cross-resistance to genistein and camptothecin. Furthermore, these cells were collaterally sensitive to the alkylating agents melphalan and chlorambucil. DNA topoisomerase II levels were similar in both wild-type MCF7/WT and drug-resistant MCF7/VP cells. In contrast, topoisomerase II from MCF7/VP cells appeared to be 7-fold less sensitive to drug-induced cleavable complex formation in whole cells and 3-fold less sensitive in nuclear extracts than topoisomerase II from MCF7/WT cells. Although this suggested that the resistant cells may contain a qualitatively altered topoisomerase II, no mutations were detected in either the ATP-binding nor the putative breakage/resealing regions of either DNA topoisomerase II alpha or II beta. In addition, the steady-state intracellular VP-16 concentration was reduced by 2-fold in the resistant cells, in the absence of detectable mdr1/P-gp expression and without any change in drug efflux. In contrast, expression of the gene encoding the MRP was increased at least 10-fold in resistant MCF7/VP cells as compared to sensitive MCF7/WT cells. These results suggest that resistance to epipodophyllotoxins in MCF7/VP cells is multifactorial, involving a reduction in intracellular drug concentration, possibly as a consequence of MRP overexpression, and an altered DNA topoisomerase II drug sensitivity.

Transactivation of Ds elements in plants of lettuce (Lactuca sativa)

The maize transposable element, Activator (Ac), is being used to develop a transposon mutagenesis system in lettuce, Lactuca sativa. In this paper, we describe somatic and germinal transactivation of Ds by chimeric transposase genes in whole plants. Constructs containing either the Ds element or the Ac transposase open reading frame (ORF) were introduced into lettue. The Ds element was located between either the 35S or the Nos promoter and a chimeric spectinomycin resistance gene (which included a transit peptide), preventing expression of spectinomycin resistance. The genomic coding region of the Ac transposase was expressed from the 35S promoter. Crosses were made between 104 independent R1 plants containing Ds and three independent R1 plants expressing transposase. The excision of Ds in F1 progenies was monitored using a phenotypic assay on spectinomycin-containing medium. Green sectors in one-third of the F1 families indicated transactivation of Ds by the transposase at different developmental stages and at different frequencies in lettuce plants. Excision was confirmed using PCR and by Southern analysis. The lack of green sectors in the majority of F1 families suggest that the majority of T-DNA insertion sites are not conducive to excision. In subsequent experiments, the F1 plants containing both Ds and the transposase were grown to maturity and the F2 seeds screened on medium containing spectinomycin. Somatic excision was again observed in several F2 progeny; however, evidence for germinal excision was observed in only one F2 family.

Serodiagnosis of tuberculosis using the A60 IgG ELISA

The serodiagnosis of tuberculosis (TB) by using an enzyme-linked immunosorbent assay (ELISA) to detect IgG against mycobacterial antigen 60 (A60) was evaluated. Forty-three controls (10 healthy adults, 19 patients with non-tuberculous pulmonary diseases and 14 patients with non-pulmonary infectious diseases) and 63 patients with TB in different disease activity (50 patients with active TB and 13 patients with old pulmonary TB) were studied. When a cut-off value of 200 units was selected, the results obtained with controls were: 100% negative in IgG titers in healthy adults and patients with non-pulmonary infectious diseases, 89% negative in IgG titers in patients with non-tuberculous pulmonary diseases. The overall "false positive" rate was 5% in the control groups. The percentage of serologically positive cases of active TB was: 82% in smear-positive, 67% in smear-negative/culture-positive and 38% in culture-negative. Of the 13 patients with calcified pulmonary TB, four had a positive serological response (31%). Four out of eight patients with active TB showed an elevation in IgG titer 1 to 3 months after diagnosis and anti-TB chemotherapy. The positive and negative predictive values of the test may provide valuable information according to the prevalence of TB in different populations. When the TB prevalence is high, a positive IgG ELISA test may support the diagnosis of active TB.

Power spectral analysis of the electroencephalographic and hemodynamic correlates of propofol anesthesia in the rat: intravenous infusion

Based on the tail-flick response to noxious thermal stimuli, we determined in the present study that effective antinociception could be achieved in adult male Sprague-Dawley rats 15 min after intravenous infusion of propofol at 60 mg/kg/h. Simultaneous power spectral analysis of the electroencephalographic (EEG) and systemic arterial pressure signals further revealed a concomitant depression of the activity of all EEG frequency bands (delta, theta, alpha, beta), alongside hypotension, negative inotropic and chronotropic actions, and attenuated baroreceptor reflex and vasomotor activity. These effects were congruent with a plasma concentration of propofol in the arterial blood of 1.70 +/- 0.13 micrograms/ml, as determined by high-performance liquid chromatography.

Indocyanine green videoangiography of choroidal neovascular membrane in age-related macular degeneration

Fluorescein angiography is the traditional tool for the detection of choroidal neovascularization of age-related macular degeneration. However, some limitations exist which impede its efficacy in the detection of subretinal neovascularization. Indocyanine green videoangiography is a recently developed technique which differs from fluorescein angiography in many ways. We performed indocyanine green videoangiography in 18 eyes with occult choroidal neovascularization, demonstrated by fluorescein angiography. Sixteen of the 18 eyes showed an abnormal vessel loop in the early phase of indocyanine green videoangiography. In the late phase, all 18 eyes had abnormal dye retention around the suspected neovascular area; however, only 12 eyes revealed a distinct border of neovascularization. No side effects, such as nausea, vomiting, or allergic reactions, were noted in our patients. Advantages and drawbacks of indocyanine green videoangiography in comparison with fluorescein angiography are discussed.

Infrequent transposition of Ac in lettuce, Lactuca sativa

The maize transposable element Activator (Ac) is being used to develop a transposon mutagenesis system in lettuce, Lactuca sativa. Two constructs containing the complete Ac from the waxy-m7 locus of maize were introduced into lettuce and monitored for activity using Southern analysis and PCR amplification of the excision site. No transposition of Ac was detected in over 32 transgenic R1 plants, although these constructs were known to provide frequent transposition in other species. Also, no transposition was observed in later generations. In subsequent experiments, transposition was detected in lettuce calli using constructs that allowed selection for excision events. In these constructs, the neomycin phosphotransferase II gene was interrupted by either Ac or Ds. Excision was detected as the ability of callus to grow on kanamycin. Synthesis of the transposase from the cDNA of Ac expressed from the T-DNA 2' promoter resulted in more frequent excision of Ds than was observed with the wild-type Ac. No excision was observed with Ds in the absence of the transposase. The excision events were confirmed by amplification of the excision site by PCR followed by DNA sequencing. Excision and reintegration were also confirmed by Southern analysis. Ac/Ds is therefore capable of transposition in at least calli of lettuce.

Prenatal cytogenetic diagnosis by amniocentesis before 15 weeks' gestation

Three hundred and ten early amniocenteses before 15 weeks' gestation, including one set of triplets and four twins, were performed for prenatal cytogenetic diagnosis. There was a 100% success rate in obtaining amniotic fluid and 99.4% success rate in achieving amniotic cell cultures. The mean time from amniocentesis to cell harvest by the in situ culture method was 11.3 days. A total 13 abnormal fetal karyotypes were diagnosed. The total fetal loss rate (spontaneous abortion, elective termination and late loss) was 4.5%, while miscarriage within two weeks after amniocentesis occurred in three cases (1%). Early amniocentesis combined with in situ cell culture is a safe, rapid and effective technique for early prenatal cytogenetic diagnosis.

Effect of intravenous clonidine on prevention of postepidural shivering

The effects of intravenous clonidine, a central adrenergic alpha-2 agonist, on the incidence of shivering and hemodynamic changes after epidural anesthesia were assessed in patients undergoing extracorporeal shock wave lithotripsy (ESWL). Forty ASA class I or II patients were randomly assigned in a double-blind manner to one of two groups. Twenty patients received intravenous clonidine 150 micrograms/10 ml (clonidine group) and twenty patients received normal saline (control group) at 20 min before epidural administration of 1.5% lidocaine. Shivering was determined objectively by observing involuntary muscle activity. Arterial blood pressure, heart rate, respiratory rate and oxygen saturation were measured at 5-min intervals during the first 50 minutes following IV pretreatment. There was significant difference between clonidine and control groups in the incidence of shivering (5% vs. 55%, p = 0.002). Shivering began at an average of 16.8 +/- 9 min (range: 5-30 min) in control group and only one patient shivered at 18 min in clonidine group. The mean sensory level was T7 in both groups. There were no differences between the two groups in mean arterial pressure and respiratory rate, though there was a trend in reduction of MAP in clonidine group. Heart rate and oxygen saturation decreased slightly in clonidine group. The main adverse effect of clonidine pretreatment was drowsiness. In conclusion, intravenous clonidine 150 micrograms was effective in preventing shivering with minor hemodynamic changes in patients receiving epidural anesthesia.

Lymphoblast colony-culture assay in acute lymphoblastic leukemia: a quantitative approach

Lymphoblast colony-culture of adult acute lymphoblastic leukemia (ALL) was studied to explore its clinical implication. Among 13 marrow cultures from ALL patients with full-blown disease, 11 developed leukemic colonies. A type of colony, very similar to a lymphoblastic colony and possibly T-cell in origin, could be found in four cultures of the six control marrows. To minimize the difficulty in differentiating a leukemic blast colony and a normal lymphocyte colony, based solely on morphology, a quantitative approach was used. Since both the mean of blast colony count and the mean of blast percentage of leukemic marrow were significantly higher than those of the control group, mean value plus two standard deviations of the control group were defined arbitrarily as upper normal limits. The defined normal range was then used to examine the relationship between results of the cultures and clinical outcome for the ALL patients. Early relapse or incomplete remission following chemotherapy could be predicted in four patients by these quantitative colony-culture assays 0.5-2 months before full-blown disease. The low colony count and low blast percentage in the colony-culture assay of the fifth patient is compatible with the clinical observation of continuous remission. One culture, growing clusters only, had an increased blast percentage; this correlated well with cytogenetic relapse two months later. In summary, the quantitative colony-culture assay could detect morphologically unidentifiable leukemic cells in ALL patients with early relapse or incomplete remission. This quantitative colony-culture system, though not ultrasensitive in the detection of minimal residual leukemic cells, was of potential value as a prognostic assay.

Power spectral analysis of the electroencephalographic and hemodynamic correlates of propofol anesthesia in the rat: intravenous bolus administration

Based on the tail-flick response to noxious thermal stimuli, we determined in the present study that the minimal effective antinociceptive dose of propofol in adult, male Sprague-Dawley rats, given in an intravenous bolus manner, was 10 mg/kg. Simultaneous power spectral analysis of the electroencephalographic (EEG) and systemic arterial pressure signals further revealed a concomitant transient suppression of the EEG activity, primarily in the theta and sigma bands, alongside minor hypotensive and negative inotropic and chronotropic actions, but with maintained vasomotor tone. These alterations followed a time course that paralleled the plasma concentration of propofol in the arterial blood, as detected by high-performance liquid chromatography.

Prolonged haloperidol and reduced haloperidol plasma concentrations after decanoate withdrawal

Haloperidol and reduced haloperidol plasma concentrations were measured in twelve schizophrenic patients upon cessation of haloperidol decanoate (HLD) treatment. Each patient received HLD 100 mg every 4 weeks for five injections. After the fifth injection, HLD was discontinued. Haloperidol and reduced haloperidol plasma concentrations were obtained prior to cessation and at weeks 1, 3, 4, 5, 7, 9, 11, and 13 post-injection. Haloperidol and reduced haloperidol plasma concentrations were assayed by HPLC. Both haloperidol and reduced haloperidol plasma concentrations were detectable 13 weeks post HLD discontinuation. Maximal haloperidol plasma concentrations were observed at one week post cessation and gradually declined. The mean elimination half-life for haloperidol was 27.4 +/- 8.6 days (range 19.0-47.0 days). Reduced haloperidol plasma concentrations declined very slowly. Our results show that both haloperidol and reduced haloperidol plasma concentrations can remain for extended time periods after HLD is discontinued.

Calcified brain metastasis

Two patients with rare cases of calcified brain metastases are reported. The relatively benign clinical course and prolonged survival are stressed. The first patient had an adenocarcinoma of unknown origin with three calcified brain metastases. The patient underwent an incisional brain biopsy without radiotherapy and survived for 2 years and 9 months. The second patient had a squamous cell carcinoma of the lung with a large, solitary brain metastasis. The brain tumor was calcified and remained stable without progression for at least 4 months before surgical resection.

Prognostic significance of human papillomavirus detected with polymerase chain reaction in cervical cancer

In order to investigate the prognostic factors of cervical cancer and its association with human papillomavirus (HPV), we analyzed 50 specimens of cervical cancer with a DNA polymerase chain reaction (PCR) mainly to detect HPV types 16 (HPV 16) and 18 (HPV 18). The result showed that at least 74% (37/50) of the specimens had HPV DNA. Among them, 54% (20/37) of the cases were HPV 16 and 32% (12/37) were HPV 18. These HPV DNA positive patients had poorer differentiation in histology than the HPV DNA negative patients. We draw no conclusion about the prognostic significance of HPV DNA in cervical cancer. Perhaps more cases should be analyzed.

Role of copper resistance in competitive survival of Pseudomonas fluorescens in soil

A copper-resistant strain (09906) of Pseudomonas fluorescens that was isolated from a citrus grove soil is being investigated as a biological control agent for Phytophthora root rot. Since citrus grove soils in California are often contaminated with copper from many years of copper fungicide applications, the role of copper resistance in survival of strain 09906 was investigated. Three copper-sensitive Tn5 mutants were obtained with insertions in different chromosomal DNA regions. These insertions were not in the chromosomal region that hybridized with the copper resistance operon (cop) cloned from Pseudomonas syringae. A copper-sensitive mutant survived as well as the wild type in a sterile loamy sand without added copper, but with 10 and 15 micrograms of CuSO4 added per g of soil, populations of the copper-sensitive mutant were 27- and 562-fold lower, respectively, than that of the wild type after a 25-day period. In a sterilized citrus grove soil, populations of the copper-sensitive mutant and wild-type strain were similar, but in nonsterile citrus soil, populations of the copper-sensitive mutant were 112-fold lower than the wild type after 35 days. These data suggest that copper resistance genes can be important factors in persistence of P. fluorescens in soil contaminated with copper. In addition, these genes appear to play a role in competitive fitness, even in soils with a low copper content.

Reduced haloperidol/haloperidol ratios after oral haloperidol and decanoate administration in schizophrenics

1. Haloperidol and reduced haloperidol plasma concentrations were measured in thirteen stable schizophrenic patients that received both oral haloperidol and haloperidol decanoate. 2. Significant correlations between reduced haloperidol/haloperidol ratios from oral haloperidol and haloperidol decanoate occurred at week two and week 16, respectively. 3. The formation of RH was consistent during haloperidol decanoate treatment.

The nuclear-mitotic apparatus protein is important in the establishment and maintenance of the bipolar mitotic spindle apparatus

The formation and maintenance of the bipolar mitotic spindle apparatus require a complex and balanced interplay of several mechanisms, including the stabilization and separation of polar microtubules and the action of various microtubule motors. Nonmicrotubule elements are also present throughout the spindle apparatus and have been proposed to provide a structural support for the spindle. The Nuclear-Mitotic Apparatus protein (NuMA) is an abundant 240 kD protein that is present in the nucleus of interphase cells and concentrates in the polar regions of the spindle apparatus during mitosis. Sequence analysis indicates that NuMA possesses an unusually long alpha-helical central region characteristic of many filament forming proteins. In this report we demonstrate that microinjection of anti-NuMA antibodies into interphase and prophase cells results in a failure to form a mitotic spindle apparatus. Furthermore, injection of metaphase cells results in the collapse of the spindle apparatus into a monopolar microtubule array. These results identify for the first time a nontubulin component important for both the establishment and stabilization of the mitotic spindle apparatus in multicellular organisms. We suggest that nonmicrotubule structural components may be important for these processes.

[Transcervical resection of endometrium and submucous myomas]

Transcervical resection of the endometrium and submucous myomas using an unmodified urologic resectoscope has recently been developed as a treatment for menorrhagia and/or infertility when conservative management proves unsatisfactory but the patient desires to preserve the fertility or wishes to avoid hysterectomy. Through June 1990, 7 patients were treated with this procedure including one for endometrial ablation and six for transcervical myomectomy alone. No significant complication was seen and the results were relatively satisfactory in an average 7 1/2 months follow up. This approach seems a safe, effective surgical procedure and represents an attractive alternative to hysterectomy or abdominal myomectomy.

Crystallization and preliminary X-ray crystallographic analysis of lipase from Pseudomonas cepacia

Large crystals of lipase from Pseudomonas cepacia have been grown at room temperature from solutions containing 2-methyl-2,4-pentanediol and sodium citrate. They grow within two weeks to typical dimensions of 1.0 mm x 0.5 mm x 0.3 mm. The crystals belong to the monoclinic space group P2(1), with unit cell parameters a = 84.91 A, b = 47.33 A, c = 86.00 A, and beta = 116.09 degrees. And they diffract to about 1.6 A upon exposure to synchroton X-rays. X-ray data have been collected to 2.2 A Bragg spacing from a native crystal.

Correlation of contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction--an in vitro whole bladder study

The present study investigated the correlation between contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction. Mild bladder outlet obstruction was induced by placing silicone rings (7 mm. diameter) around the bladder necks of male New Zealand rabbits. The animals were sacrificed after 2 weeks of obstruction. Contractile function was evaluated by measuring the response of the in vitro whole bladder to 500 microM bethanechol administration. Passive properties was assessed by performing in vitro cystometry and stress-relaxation techniques utilizing six different infusion rates. When the intravesical pressure reached 30 cm. H2O the infusion was stopped, allowing the bladder to relax and intravesical pressure to drop to a steady state level. The results can be summarized as follows: 1) Although the intravesical pressure response to bethanechol was about the same in control (13.3 cm. H2O) and obstructed (12.4 cm. H2O) bladder, the obstructed bladder emptied significantly less than control (20.4 vs 89.3%); 2) the results of the passive properties study showed that bladder stiffness was significantly higher at all infusion rates in the obstructed bladder, 3) the obstructed bladder showed significantly less relaxation after rapid stretching of the whole bladder by high speed fluid infusion; 4) histological examination of obstructed bladders revealed marked fibrous thickening of the serosal layer, interstitial fibrosis of the muscle layers, and hypertrophic and/or degenerative changes of the muscle fibers. In summary, 2 weeks after mild outlet obstruction of the urinary bladder the emptying ability, but not pressure generation, was reduced along with increased bladder stiffness and diminished capacity for stress-relaxation. Interstitial fibrosis and changing the properties of the smooth muscle cells might be involved in the functional impairment and deranged viscoelasticity of the urinary bladder after outlet obstruction.

Alteration of folate analogue transport inward after induced maturation of HL-60 leukemia cells. Molecular properties of the transporter in an overproducing variant and evidence for down-regulation of its synthesis in maturating cells

Studies are described examining further the decline in folate analogue influx mediated by the one-carbon reduced-folate transport system in HL-60 cells following induction of maturation by cytodifferentiation agents. To facilitate the investigation of the underlying basis of this phenomenon, we derived a variant (HL-60/LCV) with 4-5-fold elevated influx capacity (Vmax) for folate analogues. A commensurate increase in the putative transporter for this system was documented by affinity labeling of these cells with N-hydroxysuccinimide-[3H]aminopterin. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the affinity labeled plasma membrane in HL-60/LCV cells delineated a protein peak at Mr = 75,000-80,000. This was substantially greater than the analogous transporter (Mr = 45,000-47,000) we had delineated (Yang, C.-H., Sirotnak, F.M., and Mines, L.S. (1988) J. Biol. Chem. 263, 9703-9709) with the same methodology in the L1210 cell plasma membrane. In addition, the rate of translocation of the Mr = 75,000-80,000 transporter in HL-60 and HL-60/LCV cells was 2-fold lower than the rate of translocation determined for the Mr = 45,000-47,000 transporter in L1210 cells. During induced maturation of HL-60/LCV cells toward the granulocyte pathway, [3H]methotrexate (MTX) influx capacity and the amount of the affinity labeled transporter decreased rapidly in a parallel fashion. The decrease in [3H]MTX influx and in affinity labeling and in the amount of the Mr = 75,000-80,000 transporter was 5-fold following exposure to 210 mM dimethyl sulfoxide (Me2SO) for 5 days during growth in culture. Moreover, during cycloheximide treatment, the decay in [3H]MTX influx at 37 degrees C and in amount of affinity labeled transporter was the same (t1/2 = 144-155 min) for both control and Me2SO-treated HL-60/LCV cells. These results, which reveal no difference in metabolic turnover for control and Me2SO-treated cells, suggest that the decline in folate analogue influx in HL-60/LCV influx cells is a very early event in the program of differentiation and probably occurs by down-regulation of synthesis of the transporter for the one-carbon reduced-folate transport system.

Bilateral macular coloboma and pigmented paravenous retinochoroidal atrophy

A patient had bilateral macular coloboma with aggregations of pigment clumps located perivascularly, predominantly paravenously, and in other parts of the retina. The Toxoplasma IgG antibody was negative. The diagnosis of bilateral macular coloboma with pigmented paravenous retinochoroidal atrophy was made and seemed to be a developmental abnormality in origin.

NuMA: an unusually long coiled-coil related protein in the mammalian nucleus

A bank of 892 autoimmune sera was screened by indirect immunofluorescence on mammalian cells. Six sera were identified that recognize an antigen(s) with a cell cycle-dependent localization pattern. In interphase cells, the antibodies stained the nucleus and in mitotic cells the spindle apparatus was recognized. Immunological criteria indicate that the antigen recognized by at least one of these sera corresponds to a previously identified protein called the nuclear mitotic apparatus protein (NuMA). A cDNA which partially encodes NuMA was cloned from a lambda gt11 human placental cDNA expression library, and overlapping cDNA clones that encode the entire gene were isolated. DNA sequence analysis of the clones has identified a long open reading frame capable of encoding a protein of 238 kD. Analysis of the predicted protein sequence suggests that NuMA contains an unusually large central alpha-helical domain of 1,485 amino acids flanked by nonhelical terminal domains. The central domain is similar to coiled-coil regions in structural proteins such as myosin heavy chains, cytokeratins, and nuclear lamins which are capable of forming filaments. Double immunofluorescence experiments performed with anti-NuMA and antilamin antibodies indicate that NuMA dissociates from condensing chromosomes during early prophase, before the complete disintegration of the nuclear lamina. As mitosis progresses, NuMA reassociates with telophase chromosomes very early during nuclear reformation, before substantial accumulation of lamins on chromosomal surfaces is evident. These results indicate that the NuMA proteins may be a structural component of the nucleus and may be involved in the early steps of nuclear reformation during telophase.

Glucose-6-phosphate dehydrogenase deficiency--report of 4 cases

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common hereditary enzyme disorder and more than 200 million people have a deficiency in this enzyme. It is a globally important cause of neonatal jaundice and causes life-threatening hemolytic crisis in childhood. At later ages, certain drugs such as antimalarials, and fava beans cause hemolysis among G6PD deficiency patients. The frequency and severity is influenced by genetic and cultural factors. It is common in Mediterranean, African, and some East Asian populations but rare in Korea. Four cases of G6PD deficiency which were first noticed in Korea are investigated with their clinical features.

Sociological and economic theories of suicide: a comparison of the U.S.A. and Taiwan

Time-series analyses were carried out to explore the importance of sociological and economic variables in accounting for the suicide rate in the U.S.A. and in Taiwan for 1952-1984. Sociological variables (divorce and female labor force participation) played similar roles in the multiple regressions for both nations while economic variables (GNP per capita/growth and unemployment) played a role only in the U.S.A.

Localization of one gene for tuberous sclerosis within 9q32-9q34, and further evidence for heterogeneity

Tuberous sclerosis (TSC) is an autosomal dominant disorder with both neurological and cutaneous manifestations often resulting in significant disability. Although it has been studied clinically and biochemically for many years, the underlying pathophysiology remains unknown. Genetic linkage analysis provides an alternative strategy for understanding the genetic etiology of this disease. Genetic linkage of a gene for TSC to loci in 9q32-9q34 has been reported but has not been a universal finding, since absence of linkage to 9q loci, as well as linkage to loci on 11q, have also been reported. We present here data on 22 families (21 previously unreported) segregating TSC. Our results strongly support a TSC locus in the 9q32-34 region for approximately one-third of families and provide significant evidence for genetic heterogeneity. Application of newly described highly polymorphic dinucleotide repeat marker loci in TSC greatly enhanced the informativeness of our pedigrees and was vital for detecting the heterogeneity. No clear evidence of linkage to chromosome 11q22 markers was found, suggesting that a still unidentified TSC locus elsewhere in the genome may account for the majority of TSC families.

Ocular pulse amplitude in myopia

We studied the ocular pulse amplitude of myopic patients by using Alcon Pneumotonography. One hundred and eighty-eight cases (376 eyes) were enrolled in this study. The results revealed that the higher the myopia the lower the ocular pulse amplitude. The pulse amplitude has high correlation with refractive error and axial length, but poor correlation with scleral rigidity, intraocular pressure and corneal curvature. As the ocular pulse amplitude is generated by the choroidal blood flow, these results may reflect circulatory disturbance in the development of myopia.

Bilateral Warthin's tumors in a Chinese--literature review and case report

Warthin's tumor is an unusual benign salivary gland tumor. It is predominantly found in Caucasians and is rare in non-Caucasians. The chief affected area of the tumor is the parotid gland. Of all salivary gland neoplasms, Warthin's tumor is the only lesion which is truly multicentric so it may have a second primary lesion, not a recurrence. The peak incidence is in the sixth decade of life. In sexual distribution, there is a male predominance but the incidence of female is progressively increasing. According to Lemelas's study, the increase in female incidence may relate to the increasing population of cigarette smoking of women. Bilateral parotid gland involvement is uncommon. The chief treatment of the tumor is surgical excision. The surgical methods include enucleation, superficial parotidectomy, total parotidectomy. It is very important to protect the facial nerves from injury during surgery. In this paper, we report a case of bilateral metachronous Warthin's tumors with cystic degeneration of parotid glands in a Chinese. Other than literature review and case report, four different methods to protect facial nerves from injury were briefly described.

Time spent and satisfaction of new out-patients in Department of Internal Medicine. Kaohsiung Medical College Hospital

To assess the time spent and the degree of satisfaction of new clinic patients, one hundred and nine new out-patients from the Internal Medicine Clinic of Kaohsiung Medical College Hospital were studied from January 30th to February 6th, 1985. Both accurate field recording and telephone interviews concerning the time spent for each procedure and satisfaction with the medical personnel and expense in their first visits were carried out. The total time spent was 152 +/- 65 minutes (mean +/- SD) from questionnaire and 126 +/- 56 minutes from field recording. According to field recording, time spent in waiting for registration was 39.8 +/- 42.9 minutes. Most (55%) of study patients spent more than one hour in waiting for consultation. The time spent in waiting for filling prescription was 17 +/- 6 minutes. The accessibility of the paramedical examination units was good. The degree of satisfaction was measured by a five point rating scale for series of questions. The response were "very satisfied" or "satisfied" with professional services but not medical expense and cashier attitude. According to our results, some of our attempts to innovate service have been done including an appointment system, colored directional arrowheads, and changing our schedule to opening 30 minutes earlier.

Preparation of nucleate and anucleate fragments of hamster and mouse eggs by centrifugation

Nucleate and anucleate fragments of hamster and mouse eggs can be prepared by centrifuging zona-free eggs in a Percoll gradient. These fragments are fertilizable and can be used for various studies of nucleus-ooplasm interactions.

Keratoconjunctivitis sicca with associated secondary uveitis elicited in rats after systemic xylazine/ketamine anesthesia

The systemic administration of an anesthetic dosage of a combination of xylazine and ketamine hydrochloride produced an acute exposure keratopathy which progressed into a syndrome resembling keratoconjunctivitis sicca. Within a few minutes corneal changes occurred that were characterized by viscous mucus, loss of corneal luster and dryness. Other acute but transient changes included development of cataracts, mydriasis and proptosis. Progressive changes were observed in the cornea within 4 days which lasted at least 8 weeks in some cases, and included punctate epithelial keratopathy progressing to devitalized or keratinized epithelial plaques. Polymorphonuclear cell infiltration of the corneal stroma associated with plaques occurred. Epithelial denudation and neovascularization of the cornea, dilation and engorgement of iridial blood vessels, as well as flare in the anterior chamber were also seen. The ocular lesions induced by xylazine/ketamine should be considered carefully when designing or interpreting research on the anterior segment. Ketamine hydrochloride with sodium pentobarbital produced excellent anesthesia without any significant ocular side-effects and may be preferred in many instances.

Morphology and fertilizability of zona-free hamster eggs separated into halves and quarters by centrifugation

When mature hamster eggs were freed from their zonae pellucidae and centrifuged in a Percoll gradient, each egg was separated into a light half and a heavy half. Chromosomes remained in their original position during centrifugation, resulting in the production of light and heavy halves with and without chromosomes. When the eggs were treated with cytochalasin D (CD) and then centrifuged, the chromosomes moved to the centripetal pole and were extruded rapidly before each egg separated into halves or fragments. In the eggs without CD treatment, the density of cortical granules was reduced in the centripetal region of the egg. In those treated with CD, the density of the granules was reduced in both centripetal and centrifugal regions of the egg. Both light and heavy halves were fertilizable. There was, however, a notable difference between light and heavy halves. Most of the heavy halves supported development of sperm nuclei into pronuclei, whereas only few of light halves could do so, suggesting that most of light halves were lacking or deficient in materials necessary for the development of a sperm (male) pronucleus. When the light and heavy halves were centrifuged further, each separated into two quarters. The lightest quarter, which was almost totally devoid of organelles, was buoyant and very fragile. Spermatozoa could fuse with it, but the incidence of the fusion was low. In this quarter, the sperm nucleus could decondense, but could not develop into a pronucleus. This was in marked contrast with other three quarters in which sperm nuclei could develop into well-formed pronuclei.

Higher order structure is present in the yeast nucleus: autoantibody probes demonstrate that the nucleolus lies opposite the spindle pole body

A panel of sera from 892 autoimmune patients was screened by indirect immunofluorescence on mammalian cells. Seventy-three sera were identified that recognize the nucleolus. Three of these sera appear to stain the nucleolus in yeast, suggesting that they recognize highly conserved antigens. These three sera also immunoprecipitate mammalian U3 snRNA-containing particles, which reside in the nucleolus and have been implicated in rRNA processing. Double immunofluorescence experiments with anti-nucleolus and anti-tubulin antibodies revealed a novel form of non-random nuclear organization in yeast. The spindle pole body and the nucleolus-both of which are associated with the nuclear envelope-preferentially localize at opposite ends of the nucleus. Organization of these and other components into specific regions of the nucleus may be important for optimizing their proper function.

Differences between mature ovarian and oviductal oocytes: a study using the golden hamster

To investigate whether mature ovarian oocytes are physiologically identical with recently ovulated oocytes, hamster oocytes collected from ovaries approximately 1 h before ovulation were compared with the oocytes which had been in the oviduct for 3-4 h. Although these two groups of oocytes were at the metaphase of the second meiosis, there were quantitative differences between the two with respect to (i) sensitivity of cumulus matrix to hyaluronidase and spermatozoa (oviductal greater than ovarian), (ii) size of the perivitelline space (oviductal greater than ovarian), (iii) viscosity of the ooplasm (ovarian greater than oviductal), (iv) responsiveness to Ca2+-ionophore (oviductal greater than ovarian), and (v) time needed in completing meiosis (ovarian greater than oviductal). The most prominent difference was found in the zona pellucida. The zona of the oviductal oocyte was 'heterogeneous' in its optical density and had a stronger acrosome-reaction-inducing ability than that of the ovarian oocyte. When cultured in artificial media (e.g. F-10 medium with serum) for 4 h, the ooplasm of ovarian oocytes became like that of oviductal oocytes. However, their zonae remained unchanged. Zonae of ovarian oocytes became like those of oviductal oocytes only when they were exposed to ampullary and/or isthmic fluids. The zona-altering factors in the oviductal fluid (oviductal glycoproteins), which are apparently integrated into the native zona, may act to enhance the various functions of the zona.

A comprehensive study of immunological abnormalities in Korean hemophiliacs

To determine laboratory evidence suggesting immunological abnormalities in persons with hemophilia, we evaluated the immunological status of 75 Korean hemophiliacs, seronegative for human immunodeficiency virus (HIV) antibodies, who have been treated only with Korean factor VIII concentrates. From this study, it was shown that Korean hemophiliacs had decreased CD4 levels, increased CD8 levels, and decreased CD4:CD8 ratios. Diminished lymphocyte response to the mitogens, phytohemagglutinin and concanavalin A, and decreased natural killer cell activity were observed in the hemophiliacs. In addition, production of interleukin-II in the hemophiliacs was lower than in the healthy controls. The percentage of B lymphocytes was significantly reduced but the serum levels of immunoglobulin (Ig) G were elevated. However, the serum Ig A and Ig M levels were normal. This study demonstrated a high frequency of immunological abnormalities in HIV antibody negative Korean hemophiliacs treated only with domestic factor VIII concentrates.