A procedure to elongate the stomach tube in the esophageal replacement

When the stomach tube has to be lengthened in case of antethoracic esophageal replacement, a circumferential seromuscular incision is made and the lesser curvature side of the tube is cut through, in the same line of incision. The rent produced is longitudinally suture-closed, by which a definite elongation (about 2 cm by each incision) is obtained. In our department the antethoracic use of the stomach tube has been carried out since 1968, the elongation procedure was started in 1973 as a trial, then its application became more frequent since 1978 and was performed whenever the tube seemed to be deficient in length. The stomach tube was used in 40 cases, of which 17 underwent the elongation procedure. With regard to the suture leak at the site of the antethoracic esophagogastric anastomosis, the incidence was 50 per cent from 1968 to 1972, 54 per cent from 1973 to 1977 and 22 per cent in the last 5 years. Thus, a distinct improvement has occurred with time.

Beta-glucuronidases of clostridium perfringens

GAM broth was cultured for 5 days at 37 degrees C to obtain maximum yields of extracellular beta-glucuronidase from smooth colonies of Clostridium perfringens (Hobbs' type 4) isolated from the feces of a patient. A crude enzyme preparation was obtained by 20-80% ammonium sulfate precipitation of the broth. The beta-glucuronidase was purified using DEAE cellulose column chromatography, gel filtration on Sephadex G-200, and affinity chromatography on Sepharose 4B-bound glucuronolactone. We obtained two kinds of beta-glucuronidase. Properties of the purified beta-glucuronidase I were an optimum pH of 7.2, a pH stability range below 7.0, and a molecular weight of 115,000. The purified beta-glucuronidase II had an optimum pH of 6.0, pH stability at around 6.0, and a molecular weight of 195,000. Cu++ and Hg++ were strong inhibitors, which inhibition was restored by cysteine. EDTA did not influence enzyme activity. The Michaelis constants of beta-glucuronidase I and beta-glucuronidase II for p-nitrophenyl glucuronide were 1.25 X 10(-3) M and 4.17 X 10(-4) M, for naphthol AS-BI glucuronide 1.35 X 10(-4) M and 1.14 X 10(-4) M, and for phenolphthalein glucuronide 7.46 X 10(-5) M and 2.50 X 10(-4) M.

Pyruvate dehydrogenase subcomplex with lipoamide dehydrogenase deficiency in a patient with lactic acidosis and branched chain ketoaciduria

The overall and three component activities of pyruvate dehydrogenase complex were measured in the liver and muscle from a patient who died at 1.9 years with increased concentrations of serum lactate, alpha-ketoglutarate and branched chain amino acids. The component activities of both lipoate acetyltransferase and pyruvate dehydrogenase were similar to those of normal controls, but the overall pyruvate dehydrogenase complex activity was 11 to 30% of controls and lipoamide dehydrogenase activity was not detected. The overall activity was significantly increased by the addition of lipoamide dehydrogenase purified from human liver. Immunochemical studies carried out with antibody prepared against lipoamide dehydrogenase from rat liver, could detect no immunoreactive material in liver and muscle homogenates from the patient, suggesting that the deficiency of lipoamide dehydrogenase activity was due to the lack of enzyme protein.

Karyotypes of Brugia pahangi and Brugia malayi (Nematoda: Filarioidea)

Using air-dried preparations of the testis and ovary, karyotypes were analyzed and compared to each other in two species of filarial parasites, Brugia pahangi and B. malayi. Both species had a diploid number of 10 chromosomes and were karyotypically very similar. C-banding analyses disclosed that the sex-determining mechanism of these species was of the XY-XX type, where the X chromosome was the largest, and the Y chromosome was of medium-size.

Studies of urinary organic acid profiles of a patient with dihydrolipoyl dehydrogenase deficiency

Using gas chromatography-mass spectrometry (GC/MS), urinary organic acid profile studies were carried out on a patient with dihydrolipoyl dehydrogenase (E3) deficiency. Elevated levels of 2-hydroxyglutaric acid, 2-hydroxyisocaproic acid and 2-oxoisocaproic acid were observed in addition to lactic acid, 2-oxoglutaric acid, 2-hydroxyisovaleric acid and 2-hydroxybutyric acid previously described in patients with E3 deficiency. The 2-oxoglutaric acid levels were significantly lowered after branched-chain amino acid restriction. In an acute period, the patient was slightly ketoacidotic and excreted larger amounts of 2-oxoglutaric acid and lactic acid than in a static period. It was shown that, prior to confirmatory enzyme studies, patients with E3 deficiency who were suspected to have atypical maple syrup urine disease or chronic lactic acidosis can be rapidly identified by GC/MS analysis of urinary acids.

Studies on the beta-glucuronidase production of Clostridia

We investigated the beta-glucuronidase-producing capacity of 197 strains of 19 different species of Clostridia, using the procedure described by Kilian and Bülow (8). Most of the Hobbs' serotyped strains of Clostridium perfringens (104 out of 109 strains) were found to produce beta-glucuronidase, whereas non-serotyped strains (21 out of 32 strains) did not. Some strains of other species such as Clostridium beijerinckii (C. beijerinckii), C. clostridiforme, C. difficile, C. limosum, and C. ramosum were found to produce beta-glucuronidase, while all strains of 13 other species which we examined did not.

[Efficacy of paromomycin sulfate in the elimination of Diphyllobothrium species and Taenia saginata in clinical cases]

Recently it has been known that paromomycin sulfate had marked anthelmintic activity against some species of tapeworms. In this investigation, paromomycin sulfate was used for treating 6 cases of diphyllobothriasis and 1 case of Taenia saginata infection. Paromomycin sulfate was administered orally in a single dose or 2 divided doses of 40--60 mg/kg, being followed by a purge about 1.5 hours later. Strobila or fragments of proglottids were expelled from 5 cases, of which only 1 scolex was found in a case of infection with marine species of Diphyllobothrium. In 1 case of diphyllobothriasis no worm or worm-fragment was found in the stool even after the second challenge of treatment. Nevertheless follow-up examination for more than 1 month showed no evidence of remaining infection in all cases. Transient dizziness was observed in only 1 case, disappearing within about 30 minutes. Serum- and urine-examinations detected no abnormal signs in all cases excepting 1 case of diphyllobothriasis with suspected hepatitis. It was concluded that paromomycin sulfate is effective therapeutic agent for the treatment of taeniasis and diphyllobothriasis including marine species.

Clostridium perfringens and other anaerobes isolated from bile

Clostridium perfringens was isolated from bile in 13 cases of 150 patients examined. The serotypes of C perfringens strains isolated from bile and faeces were investigated using antisera to Hobbs' type 1-17. Two or more serological types were often found in a single specimen, but in the same patient the serotypes of C perfringens strains isolated from the bile were identical with those from the faeces. Beta-glucuronidase production in these C perfringens serotypes was tested with the API-Strep system. Strains agglutinated with Hobbs' antisera produced beta-glucuronidase, but non-agglutinated strains did not.

Separation of cathepsin D-like proteinase and acid thiol proteinase of squid mantle muscle

When the proteinases of the squid mantle muscle were extracted in the presence of dithiothreitol (DTT), the acid proteinase activity increased, indicating that the squid mantle muscle contains a considerable amount of the acid thiol proteinase. The crude extract hydrolyzed neither alpha-N-benzoyl-D,L-arginine-p-nitroanilide (BAPA) nor azocasein, thus refuting the presence of cathepsins B and L in the mantle muscle. The cathepsin D-like proteinase and the acid thiol proteinase were separated by Sephadex A-50 column chromatography. Each of the above partially purified proteinases was able to degrade carp actomyosin at pH 2.5 and 5.0, respectively.

[Experimental study on synergism between cefotaxime and ampicillin against Streptococcus D group]

Cefotaxime (CTX) disks and ampicillin (ABPC) disks exhibited synergism against 24 strains of Streptococcus D group isolated from various sources in our hospital. We were interested in these synergism effects and compared them with the combination index. Twenty-two out of the 24 strains examined exhibited synergism, and were identified as Streptococcus faecalis by the API strep system. We divided them into 4 groups (combination index: 19, 15, 11, 9) according to the degree of synergism. Another 2 strains showed additive effects (combination index: 1), and were identified as Streptococcus faecium. Among these 24 strains, beta-lactamases were produced by only 1. There was no direct connection between beta-lactamase production and synergism. The mechanism of synergism between CTX and ABPC has not yet been studied.

X-ray tomographical observations of the interrelationships among structures of the nasal airway

In order to elucidate upon the interrelationships among the different structures in and around the nasal cavity, the noses of 95 adults without severe rhinitis, paranasal sinusitis, cysts or tumors were examined by means of X-ray tomography. The results indicate a close correlation between the width of the nasal cavity and 1) the width of the maxillary sinus, 2) the size, form and height of the inferior turbinate, 3) the size of the middle turbinate or 4) the nasal septal deviation; between the height of the nasal cavity and the length and height of the inferior turbinate or the length of the middle turbinate, and also between the degree of septal deviation and the width of the nasal cavity, the nasal meatus or olfactory slit or the form of the inferior turbinate. In conclusion, it is recognized that correction of the abnormal interrelationships among the different structures is important for functional nasal surgery.

Creutzfeldt-Jakob disease with demonstration of virus-like particles

Two kinds of virus-like particles, doughnut-shaped particles and particles with dense core, were discovered in a brain tissue from a patient with Creutzfeldt-Jakob disease. The two types of virus-like particles are similar to immature type C and type C particles. although no direct relationship between Creutzfeldt-Jakob disease and these virus-like particles can be established, these facts may suggest that viruses play some role in the pathogenesis of Creutzfeldt-Jakob disease.

Antigenicity of desamido-insulin and monocomponent insulin

No consensus about the antigenicity of monocomponent insulin has yet been reached. We have therefore administered different insulin preparations to rabbits and rats to determine IgG and IgE antibody production. The preparations used were porcine monocomponent insulin, conventional bovine and porcine insulin powders, porcine b-component and synthesized porcine mono-desamido-insulin and hexa-desamido-insulin. In rabbits, porcine b-component was the most antigenic preparation, followed by conventional bovine and porcine insulins. No antibody production was observed with the other preparations. In rats the 60 h passive cutaneous anaphylaxis test showed virtually no insulin IgE antibody production in response to porcine monocomponent insulin. However, if porcine b-component or porcine hexa-desamido-insulin was employed both for sensitisation and as the challenging antigen, positive skin reactions were observed with demonstration of insulin IgE antibodies. Our results confirm the low antigenicity of the pharmaceutical preparation of porcine monocomponent insulin and suggest that porcine hexa-desamido-insulin and porcine b-component administration may result in the production of reagin-type antibodies.

The use of aceto-orcein-stained squash preparations for enumeration of nuclei in microfilariae of various filarial parasites

The nuclear numbers of situated between the cephalic space and the nerve ring (CS-NR) in the microfilariae of six filarial species were examined. For the counting of nuclei, aceto-orcein squashing preparations were used. This procedure revealed nuclei clearly visible under the phase-contrast microscope. The mean number of nuclei in the CS-NR region was very similar between Brugia pahangi and B. malayi, but was statistically different between Onchocerca volvulus and O. gutturosa. In the microfilariae of O. volvulus, two types of nuclei were clearly shown in this region. The procedure described is useful in the anatomical study of microfilariae.

[Treatment of whooping cough and whooping cough syndrome by cefoperazone (author's transl)]

Clinical trial of cefoperazone (CPZ) for the treatment of whooping cough and whooping cough syndrome was performed and the following results were obtained. 1) In 18 cases suffering from whooping cough, CPZ was given 47 approximately 106 mg/kg/day (average 72 mg/kg/day) by intravenous route. The clinical efficacy rates judged by doctors in charge were 44% on the 3 rd day, 75% on the 7 th day, 86% on the period day. And in these cases, the clinical efficacy rates judged by committee members were 56%, 83% and 86%. 2) In 6 cases diagnosed as whooping cough syndrome, CPZ was given 49 approximately 96 mg/kg/day (average 59 mg/kg/day) by the same route. The clinical efficacy rates judged by doctors in charge were 67% on the 3 rd day, 80% on the 7 th day and 75% on the period day. And in these cases, those judged by committee members were 83%, 80% and 100%. 3) In 1 case, Bordetella pertussis was searched and showed 0.012 mcg/ml of MIC. It was eliminated on the 1 st day after administration. 4) Doctors in charge judged the utility of CPZ for whooping cough. Twelve cases were useful and 6 cases were slightly useful. 5) No side effects were observed except for elevation of GOT and LDH. These results suggest that CPZ might be useful drug against whooping cough.

Application of immobilized enzymes to clinical analyses : use of co-immobilized glucose oxidase and peroxidase in column form

Glucose oxidase from Aspergillus niger and peroxidase from horseradish were simultaneously immobilized onto alkylamine glass beads which were then packed into a 1.5 x 20 mm column and integrated in the flow system of an AutoAnalyzer I. Glucose in serum, up to 5.0 g/l, was continuously determined at a rate of 60 samples per hour. The co-immobilized enzyme column gave better sensitivity as compared with an enzyme column which contained a mixture of two kinds of individually immobilized enzymes. The enzyme column was sufficiently stable while in use for two months. The results correlated satisfactorily well with those obtained by other well established methods for glucose assay.

Determination of purity and identification of animal sources of insulin in various insulin preparations

Prolonged administration of insulin leads to the formation of insulin-binding antibodies due to contaminant peptides and the animal source of the insulin. It follows that quantitation and identification of these factors are of significant importance in pharmaceutical insulin preparations. The assay and test procedures stipulated in the current pharmacopoeia of various countries, nevertheless, cannot determine either of these effects. In the present study, the content of impurities in insulin preparations was measured by polyacrylamide gel disc electrophoresis and the animal source of insulin identified by amino acid analysis. Assays of 17 commercial insulin preparations by these techniques revealed diversity in purity and animal sources of insulin. The present results suggest potential usefulness of these assay methods and advisability of their adoption not only by the manufacturers but also by the official pharmacopoeia as well.

Dirofilaria in the abdominal cavity of a man in Japan

A case of human dirofilariasis of the abdominal cavity is reported from Japan. The patient, a 74-year-old man, died of liver cancer; postmortem examination revealed a granulomatous mass on the mesentery. In histologic sections there were cross-sections of a mature female nematode identified as a Dirofilaria. The cuticle had a smooth surface and consisted of four distinct layers. The inner cuticular layer had internal lateral longitudinal ridges, and the musculature of the body wall was of the high polymyarian type. On the basis of morphology of the worm, it is suggested that this may represent the first human case of Dirofilaria immitis occurring in the abdominal cavity.