Rectus hematoma secondary to vomiting: a complication of conditioning regimen for bone marrow transplantation

A 41-year-old woman with chronic myelogenic leukemia was scheduled to undergo transplantation of bone marrow. The patient complained of nausea and vomiting following the initiation of chemotherapy. One day prior to the planned termination of chemotherapy, the patient developed left-sided abdominal pain. Physical examination and imaging examination indicated the possibility of acute abdomen associated with bleeding or herniation. For therapeutic and diagnostic purposes, an emergency operation was performed. A 6 x 5 cm hematoma was detected within the left rectus abdominis muscle. It is suggested that the gastrointestinal symptoms should be carefully controlled in patients undergoing bone marrow transplantation.

p53 mutations occur in clinical, but not latent, human prostate carcinoma

To elucidate the role of the p53 tumor suppressor gene in prostate tumorigenesis, we probed for mutations in latent and clinical prostate cancers using single strand conformation polymorphism (SSCP) and restriction fragment length polymorphism (RFLP) analysis in combination with direct gene sequencing and immunohistochemical methodologies. Fifteen cases of subclinical and 32 cases of clinical carcinoma, the latter graded in stages A through D, were available for study. While p53 point mutations were detected in only 5 of 32 (16%) clinical cancers, no mutations were detected in latent disease. Of the carcinomas in stages B, C and D, 15% (2/13), 29% (2/7) and 9% (1/11) were positive for p53 mutations, respectively. Although no specific mutational patterns were observed, the aberrations found were predominantly single base missense substitutions. The data suggest not only an association of p53 mutation and progression of clinical prostate cancer, but also imply that some other mechanism(s) are at work in latent carcinoma.

[Phase I/II study of a combination regimen composed of cisplatin, carboplatin and etoposide against small cell lung cancer]

Phase I/II study of combination regimen composed of cisplatin (CDDP), carboplatin (CBDCA) and etoposide (VP-16) [CPVP] was conducted for small cell lung cancer. The dose level of VP-16 was fixed at 100 mg/m2, while the dosages of CDDP and CBDCA administered at each of the 4 steps were 50/200, 60/200, 60/250 and 70/250 mg/m2, respectively. Nine patients were allocated to each step dose group. Toxicities were evaluated in the first 2 courses to determine the maximum tolerated dose (MTD). As a result, step 3 dosages proved to be MTD, and the dose limiting factor (DLF) was hematotoxicity, but gastro-intestinal toxicity was tolerated. The response (CR+PR) was found in 21 out of 23 patients with evaluable lesions (91%). In the 22 patients who had not received pretreatment, median survival time (M ST) was 16.4 months. These results suggest that the recommended dose is step 2, and that the CPVP regimen is both more tolerable and more effective than the standard regimen. The CPVP regimen warrants further study in phase III trials.

Demonstration of derivation of rat urinary bradykinin from plasma low-molecular-weight kininogen: a study using kininogen-deficient rats

The origin of urinary bradykinin was defined by use of plasma kininogen-deficient B/N-Katholiek rats, whose ureter urine contains very low amount of urinary kinin. The kinin level increased after the rats received an infusion of normal plasma. Furthermore, the bradykinin content in the ureter urine of these kininogen-deficient rats increased more by infusion of partially purified rat- low-molecular-weight kininogen than by that of high-molecular-weight kininogen. Urinary kallikrein activity of B/N-Katholiek rats was enzymatically identical with that of normal B/N-Kitasato rats. These results indicate that urinary bradykinin found in the ureter urine of normal rats is derived from plasma low-molecular-weight kininogen by cleavage by urinary kallikrein.

[A case of congenital ventricular diverticula]

Congenital ventricular diverticula are classified into muscular type and fibrous type. Muscular diverticula may be associated with congenital midline thoracoabdominal malformations. Fibrous diverticula, also called congenital ventricular aneurysm, are often seen in black american and South African Bantus, but very few such cases have been reported in our country. A 33-year-old Japanese male was admitted to our hospital for evaluation of chest X-ray and ECG abnormalities. UCG and cineangiography revealed an outpouching of the left ventricle. As it increased in size during the four-year follow-up, surgical resection was performed. The left ventricular diverticulum was multilobular and had a thin wall, which was excised and reconstructed with a patch. There was another small diverticulum on the free wall of the right ventricle, which was directly closed with a mattress suture. A rare case of multiple congenital fibrous ventricular diverticula with successful surgical resection was reported.

[Clinical usefulness of the combined empirical therapy with flomoxef and fosfomycin for intractable respiratory tract infections. With a background of increasing MRSA incidence]

We conducted a multicenter trial to determine the clinical usefulness of the combined therapy with flomoxef (FMOX) and fosfomycin (FOM) (FF therapy) as an empirical therapy in the treatment of intractable respiratory tract infections, because FF therapy has clinically been proved to be very useful for the treatment of severe infections including MRSA infections. The overall efficacy rate of FF therapy was 69.2%. The efficacy rate for "pneumonia/lung abscess," which occupy the largest portions of respiratory tract infections, was 70.0%, showing a statistically significant difference from the efficacy rate for FMOX alone (56.7%) found in a previous study (P = 0.09 by chi-squared test). Although MRSA was eradicated in only 3 cases (37.5%) including superinfection cases, of 8 patients, from whom MRSA had been isolated as causative organisms, none of our patients were superinfected with MRSA. Thus it has been concluded that FF therapy is clinically very useful when used as an empirical therapy in the treatment of respiratory tract infections.

[Reoperation and PTCA after coronary artery bypass graft]

Since 1984, 1410 patients underwent coronary bypass grafting at Juntendo University Hospital. At the primary operation 797 patients had internal thoracic artery (ITA) graft and 613 patients received only saphenous vein graft (SVG). Reoperation was done in one pt. in ITA group and 10 pts. in SVG group. There were 2 deaths (reoperative mortality 18%). Percutaneous Transluminal Coronary Angioplasty to stenotic SVG was applied to 71 lesions in CABG patients. The primary success rate was 81.7% and restenosis rate was 38.9%. Urgent reoperation was performed on 3 pts. who had PTCA to diseased LAD or stenotic SVG to LAD. Reoperation is technically demanding and is associated with high mortality. Balloon angioplasty may provide a suitable alternative. But high restenosis rate (especially acute stenosis) remains a significant problem, particularly in the pts. with diseased LAD or stenotic vein graft to LAD. Reoperation is another option to relieve the ischemic symptoms in pts. with diseased LAD or stenotic vein graft to LAD.

[Establishment of a human colon cancer-derived cell line (KC-1) which produces CEA, CA 19-9 and sialyl SSEA-1(SLX)]

A human colon cancer-derived cell line, KC-1, was established from the surgical specimen of mucinous adenocarcinoma of the colon. The cells grew as monolayers, showing formation of irregular aggregation of cells and pleomorphic nuclei. The doubling time in vitro was 56.6 hours. The cells produced CEA, CA19-9 and sialyl SSEA-1(SLX). Chromosome numbers were distributed between 79 and 83 with many structural abnormalities. A point mutation of the Ki-ras gene in codon 61 (CAA-->CAT) was found. The cells have been subcultured 13 times during these three years. This cell line can be useful for investigations of colon cancer.

Molecular mechanism of kininogen deficiency in brown Norway Katholiek rats

1. The Brown Norway (B/N) Katholiek rat is a mutant strain of plasma kininogen deficiency. The plasma of B/N-Katholiek rats was shown to contain only 3-5% of high-molecular-weight and low-molecular-weight kininogens (HK and LK) of the normal level by specific RIA, and 30% of prekallikrein was detected by amidase activity. However, HK antigen in the liver microsomal fraction of B/N-Katholiek rats was about 60% of that of normal rats. 2. In this paper we compare and discuss synthesis and secretion of HK and LK by primary cultures of livers of deficient and normal rats. The deficient hepatocytes could synthesize HK and LK in the same way as normal cells but could not secrete mature forms of HK and LK in the medium. Examination of the subcellular localization of the mutant HK in the hepatocytes showed that a larger amount of mutant HK antigen, compared to normal rats, was found in the 10,000 g fraction, which is rich in lysosomes, suggesting that the mutant HK may be transported to the lysosomes. 3. We also analyzed sequence of the HK cDNA of B/N-Katholiek and B/N-Kitasato rats and found a point mutation of G to A at nucleotide 487, which locates at the heavy chain region of HK and LK. 4. We constructed five expression plasmids to transfect COS-1 cells to examine HK secretion. COS-1 cells transfected with the plasmids containing the G to A transition could not secrete and retained HK, while those cells transfected with the plasmids containing normal G released HK into the medium. 5. These results indicate that a point mutation G to A at nucleotide 487, resulting in an amino acid transition from alanine (163) to threonine, is responsible for the defective secretion of HK and LK by the liver of B/N-Katholiek rats. We also discuss other cases of secretion defect of plasma proteins reported in the literature.

[Laboratory and clinical studies on combined effects of fosfomycin plus sulbactam/cefoperazone for mixed infections of MRSA and Pseudomonas aeruginosa]

The time-lag/sequential/step by step chemotherapy by fosfomycin plus sulbactam/cefoperazone including a short time small dose of steroid was done for 27 severely infected patients suffered from various cancer or other severe basal diseases. And the staggered "intensive" chemotherapy with added arbekacin or vancomycin to the previous staggered chemotherapy was done against 13 severely infected patients having MRSAs among their infecting pathogens. 1. Bacteriological effects Pseudomonas aeruginosa 6/8, Staphylococcus epidermidis 5/5, Enterococcus faecalis 3/6, Acinetobacter calcoaceticus 2/2, Klebsiella pneumoniae 2/2, MRSA 2/2, Xanthomonas maltophilia 2/3 and other 10/10 were eradicated (84.2%) by the staggered chemotherapy and MRSA 7/13, P. aeruginosa 3/4, E. faecalis 3/5, A. calcoaceticus 2/2, X. maltophilia 1/1 and others 2/2 were eradicated (53.8% in MRSA, 78.6% in others and 66.7% in total) and 3 of MRSAs were colonized. 2. Clinical effects 1) Staggered chemotherapy: Excellent 18/27, good 8/27, fair 1/27, poor 0/27 (96.3%). 2) Staggered "intensive" chemotherapy: Excellent 6/13, good 4/13, fair 2/13, poor 1/13 (76.9%) in total: excellent 60.0%, efficacy rate 90.0%.

Amino acid-induced hyperfiltration--mediators and effect of captopril

Mediators and the effect of captopril on amino acid-induced hyperfiltration were studied. Acute intravenous L-arginine (arginine) infusion tests were performed twice, without captopril administration in 6 normal subjects (group I), before and after pretreatment with captopril in 10 normal subjects (group II) and 10 IgA nephropathy patients with slight renal dysfunction (group III). It was found that in all groups with and without captopril, arginine infusion led to a significant decrease in renal vascular resistance, and significant increases in renal plasma flow and plasma glucagon level. GFR was significantly increased in response to arginine only in normals without captopril pretreatment. Captopril pretreatment attenuated the rise in GFR following arginine infusion in normal subjects. Plasma renin activity and urinary cGMP were significantly increased in response to arginine only in normals without captopril pretreatment. No significant increase in urinary PGE2 was observed after arginine infusion in any groups. It was concluded that cGMP and glucagon are possible mediators for arginine-induced hyperfiltration and inhibition of renin-angiotensin system attenuates the arginine-induced rise in GFR.

Demonstration of high-molecular-weight kininogen in kininogen-deficient rat kidneys

Brown Norway Katholiek (B/N-Ka) is a mutant rat strain deficient in plasma high-molecular-weight (HK) and low-molecular-weight kininogen (LK). It has been reported that the deficiency, caused by defective secretion of HK and LK by the liver, is associated with a point mutation of alanine (163) to threonine in the common heavy chain. In this report we demonstrate by specific radioimmunoassay that the amount of immunoreactive HK antigen in the B/N-Ka kidney was almost the same as that found in the normal Brown Norway rat (Brown Norway Kitasato, B/N-Ki). HK antigen in the kidneys of both strains was immunohistochemically localized at distal tubules with similar intensity in both strains. Among the subcellular fractions of the kidney homogenates, HK antigen was predominantly found in the microsomal fraction of both strains. To see whether this HK antigen is derived from plasma HK or is synthesized in the kidneys, we examined uptake of HK by the tubular cells after incubation with 125I-HK. Only 0.6% of the radioactivity of added 125I-HK was found in the tubular cells of both strains after a 60-min incubation. Messages of HK mRNA from both strains of rats were visualized by PCR at almost the same intensity. These results suggest that HK antigen found in the kidney may be derived mainly from biosynthesis in the kidney itself and partly from uptake of HK from blood. There was no difference in these features of HK between the kidneys of the deficient and the normal B/N rats.

[A survey of Staphylococcus aureus for typing and drug-resistance in various areas of Japan during 1992 and 1993]

Data on Staphylococcus aureus strains isolated at various areas in Japan during 1992 and 1993 were collected and analysed. Among 7,033 strains examined, 60.3% were methicillin-resistant S. aureus (MRSA), 86% of which were isolated from inpatients. MRSA were isolated most often (38%) from departments of internal medicine, followed by departments of surgery (13%). The most frequent source of MRSA was sputa (38%), followed by pus (18%). As for coagulase types, 69% of MRSA were Type II and next most frequent was Type VII (24%). Among MSSA strains, Type VII (35%) and Type III (32%) were the most frequent. Frequencies of beta-lactamase-producing strains were 68% in MRSA and 59% in MSSA. More than 80% of MRSA strains were resistant to beta-lactams. The frequencies of resistance to fosfomycin, ofloxacin, minocycline and gentamicin were 88%, 72%, 19% and 66%, respectively. Less than 3% of MRSA strains were resistant to arbekacin or vancomycin.

[Nationwide investigation in Japan of the status of MRSA infections and usefulness of arbekacin]

A clinical investigation on MRSA infections, and the determination of the efficacy and usefulness of arbekacin (ABK) were performed an "MRSA Forum" composed of 18 groups including 115 institutions in Japan. Patients with infectious diseases clearly related with MRSA, a total of 348 (males: 237, females: 111), were evaluated, 74/274 patients were treated with ABK alone/combination with ABK. Most of them (94.6%/96.4%) had underlying diseases and they had pneumonia (38/175), sepsis (6/35) or other infections (30/64). Infections by MRSA alone were noted in 41/159 and polymicrobial infections including with MRSA were in 33/115. 53.6%/56.4% of MRSA were eradicated and bacteriological clinical efficacies were 75.6%/67.9% in single infections and 63.6%/71.3% in polymicrobial infections. The clinical efficacies were obtained in 70.3%/69.3% of total and in 60.5%/72.0% of pneumonia and in 90.0%/80.8% of the patients pretreated with other drugs within 3 days previously. Efficacy rates were 78.6%/71.4% in 30 minute's div and 63.2%/66.4% in 60 minute's div. Adverse effects were found in 4.76%/5.70% including renal function disorder (2/11) but no case was serious. Abnormal laboratory test results were noted in 15.4%. ABK is effective against MRSA infections.

[Questionnaires regarding MRSA in Japan]

Changes in properties of MRSA and the status of MRSA infections in the last two years were investigated by an MRSA Forum composed of 18 groups including 115 medical institutions in Japan. And an opinion poll regarding MRSA was taken by professional doctors (41) and general clinical doctors (323). Points of discussion: 1. Did properties of MRSA change? 2. Did the pattern of MRSA infections change? 3. Did the understanding of MRSA change? 4. What is the relationship between MRSA and the 3rd cephems? 5. How is MRSA related to polymicrobial infections? 6. Is ABK useful against MRSA infections? 7. What will be future trend in characteristics of MRSA and MRSA infections?

CONCLUSIONS

1. MRSA has become more resistant to methicillin however it seemed to have become less toxic. 2. Severe MRSA infections are decreasing and colonizations are increasing. 3. There were some differences in attitude against MRSA between professional doctors and general clinical doctors. 4. The 3rd cephem should be used reasonably. 5. MRSA infections should be treated with polymicrobial infections in consideration. 6. MRSA did not gain resistance against ABK and ABK is useful against MRSA infections. 7. Problems of MRSA will cool down but they should always be kept in our mind.

Establishment of pure neuronal and muscle precursor cell cultures from Drosophila early gastrula stage embryos

Primary cultures of Drosophila gastrula stage embryonic cells will divide and terminally differentiate into morphologically recognizable neurons and muscles. The phenotypically mixed nature of this primary culture system has made it difficult to effectively analyze various parameters of cell growth and differentiation for individual cell types. We report here a simple and economic method to separate early embryonic precursors for different cell types, using a shallow linear reorienting Ficoll gradient at unit gravity. The separated cells were collected into fractions, cultured, and analyzed for their growth and differentiation patterns. The larger and denser cells of the first fractions differentiated to yield pure neuronal cultures, as judged by morphologic, immunologic, and biochemical criteria. Cells in the last fractions differentiated into a predominantly muscle-enriched cell population, which also contained a very small percentage of neurons morphologically distinct from those in the pure neuronal fractions. Approximately 35% of the early gastrula stage embryonic cells differentiate into neuronal cells, and 65% of the non-neuronal lineage cells later develop into predominantly muscle population. The method is highly reproducible, can process 3 x 10(7) cells per procedure, and the recovery is > 90% of the input cells. The separated cells are suitable for cell biological analyses as well as for biochemical and molecular studies of neuron and muscle precursors.

[Laboratory and clinical study on combined effects of fosfomycin plus sulbactam/cefoperazone for mixed infections of MRSA and Pseudomonas aeruginosa]

Pseudomonas aeruginosa has been a major bacterial partner when MRSA (Methicillin-resistant Staphylococcus aureus) is isolated clinically. Hence, we studied the in vitro combined effect of fosfomycin (FOM) plus sulbactam/cefoperazone (SBT/CPZ) against mixed infections of MRSA and P. aeruginosa. The combined effect of FOM plus SBT/CPZ was observed through an FIC index using the checkerboard method, log reduction of colony counts on the time killing curve, and morphological changes observed using scanning electron micrography. Under serum concentration at 3 hours after administration in consider of pharmacokinetics, the combination effect was also evaluated. Furthermore, we evaluated a time-lag combination therapy in which FOM is administered 60 minutes before SBT/CPZ administration for mixed infections. Synergistic effects of FOM plus SBT/CPZ were clearly observed against mixed infections of MRSA and P. aeruginosa. Log reduction of colony counts on the time killing curve seemed to be an appropriate indicator in the evaluation of synergistic effects.

Sleep apnea and sleep-related breathing disorders in patients with craniofacial synostosis

Seventeen patients with craniofacial synostosis (CFS) have been treated at the Department of Plastic and Reconstructive Surgery at Osaka Medical College during the past 10 years. Six patients were thoroughly evaluated at the Department of Otolaryngology by polysomnography (PSG), cephalometric X-ray and nasopharyngoscopy during sleep. In 4 of the patients PSG showed obstructive sleep apnea syndromes (OSAS). Heavy snoring without apnea and paradoxical respiration were noted in the other 2 patients. Thus, all of the patients had sleep-related breathing disorders (SRBD). It is assumed that the incidence of SRBD in CFS is high. Cephalometric analysis and profilogram showed maxillomandibular hypoplasia in each patient, and it was assumed that the main cause of SRBD in CFS was stenosis of the upper airway tract caused by maxillo-mandibular hypoplasia. Nasopharyngoscopy was performed during sleep in 2 patients with OSAS secondary to CFS. One patient with adenotonsillar hypertrophy had nasopharyngeal obstruction and another patient whose posterior airway space (PAS) on cephalometric radiograph was 3 mm (normal value: 11 mm) had obstruction at the tongue base.

Fractional mean transit time in transplanted kidneys studied by technetium-99m-DTPA: comparison of clinical and biopsy findings

To determine the usefulness of fractional mean transit time (MTT) in the differential diagnosis of postrenal transplant complications, 99mTc-DTPA was used to evaluate differences in MTT between the outer zone (cortical nephron) and middle zone (juxtamedullary nephron, calcyces and cortical nephron) of the kidney. It is well known that acute rejection is characterized by delayed cortical transit time, whereas cortical nephron function is well maintained and juxtamedullary function is impaired after renal ischemia.

METHODS

Technetium-99m-DTPA fractional MTT was determined by deconvolution analysis of 89 renograms obtained within 5 days of the date of kidney graft biopsy and evaluation.

RESULTS

Outer zone MTT was significantly shorter than middle zone MTT in normals (2.7 +/- 0.4 versus 3.0 +/- 0.6 min, n = 22, p < 0.001), acute tubular necrosis (3.4 +/- 1.1 versus 3.6 +/- 1.4 min, n = 19, p < 0.01), chronic rejection (3.9 +/- 1.5 versus 5.0 +/- 2.3 min, n = 14, p < 0.001) and obstruction (4.1 +/- 0.6 versus 8.9 +/- 3.4 min, n = 13, p < 0.001). In contrast, outer zone MTT was significantly longer than middle zone MTT in acute rejection (4.8 +/- 3.2 versus 4.2 +/- 2.5 min, n = 21, p < 0.05).

CONCLUSION

Fractional MTT was demonstrated to be useful in differentiating acute rejection and ATN in transplanted kidneys.

[A case of middle ear adenoma]

Middle ear adenomas are rare and difficult to diagnose. Recent histological studies suggest the presence of a distinct disease entity known as a middle ear adenoma. A 16-year-old boy with a middle ear tumor was treated by partial temporal bone resection, and the tumor was removed by a combined method using the middle cranial fossa and infratemporal fossa approaches. Histological and immunohistochemical studies on this tumor showed the findings of a benign adenoma. Left facial palsy was noted postoperatively, but it subsequently recovered almost completely.

Immunohistochemical detection of p53 oncoprotein in human oral squamous cell carcinomas and leukoplakias: comparison with proliferating cell nuclear antigen staining and correlation with clinicopathological findings

Forty oral squamous cell carcinomas and 20 leukoplakias were examined for expression of p53 oncoprotein using an immunohistochemical technique with BP53-12 monoclonal antibody. Positive staining was found in 21/40 (52%) of the carcinomas and 2/20 (10%) of the leukoplakias. Furthermore, comparison of p53 expression with binding of PC10 monoclonal antibody to proliferating cell nuclear antigen (PCNA) and degree of histological malignancy in terms of invasion and histological differentiation of carcinomas demonstrated a positive correlation in both cases.

[Herpes zoster and malignancy]

A retrospective survey was conducted regarding the relationship between hospitalized patients with herpes zoster and malignancy based on clinical records. A total of 220 patient were hospitalized for treatment of herpes zoster during the past 15 years, and 23 of them had involvement with malignant tumors. Malignancy was found during hospitalization in 4 cases (1.8%). This was significantly higher than 0.27, the predicted number of malignancy cases. Three of the 4 cases were gastric cancer. The discovery rate of gastric cancer through screening at admittance was 2.4%, which was higher than 0.14%, the discovery rate in gastric cancer checkups in Hokkaido. Examination for malignant tumors should be required for all patients with herpes zoster who need to be hospitalized.