Reversible bone marrow hypoplasia induced by alcohol

A 51-year-old man developed severe pancytopenia with bone marrow hypoplasia after consuming excessive amounts of alcohol for many years. After avoiding alcohol and eating normally for about 10 days, his blood cell counts promptly recovered to near-normal levels. Hematologic remission had lasted for 7 months until he began to drink alcohol excessively again, leading to a relapse of pancytopenia with marrow hypoplasia. His blood cell counts attained near-normal levels again after abstaining from alcohol for about a month. He developed thrombocytopenia following moderate ingestion of alcohol 7 months later, but he never developed severe pancytopenia after limiting alcohol ingestion. When bone marrow mononuclear cells from the patient and normal volunteers were cultured in the presence of ethanol, CFU-GM-derived colony formation of the patient was inhibited by much lower concentrations of ethanol than that of normal volunteers. The clinical course of the patient and the greater sensitivity of the patient's CFU-GM to ethanol toxicities indicate that massive intake of alcohol was responsible for bone marrow hypoplasia observed in this patient.

[A case report of multiple intracranial tuberculoma associated with miliary tuberculosis and review of the literature]

We reported a case of multiple intracranial tuberculoma associated with miliary tuberculosis and reviewed the cases reported as intracranial tuberculoma in the past 11 years. A 41-year-old diabetic man was admitted to our hospital for the treatment of miliary tuberculosis and respiratory insufficiency. On admissIon, he had no neurological deficits except mild consciousness disturbance due to respiratory failure. He developed headache and mental confusion three weeks after the beginning of antituberculous therapy with isoniazid, streptomycin, rifampicin, and ethambutol. Neurological examination revealed that he had progressive right hemiparesis and was in a confusional state. Enhanced CT showed multiple intracranial nodular lesions. During 6 weeks, he had progressive neurological manifestations in spite of his initial antituberculous treatment. He responded well, however, to the chemotherapy with combination of isoniazid, kanamycin, pyrazinamide and ethionamide that were sensitive to tuberculous bacilli separated from his sputum. He became minimally right-hemiparetic by 6 weeks after the change of antituberculous medication. Serial enhanced CT scan proved to be of great value in the diagnosis and follow-up study of intracranial tuberculoma. From 1978 to 1988, there were 72 reported cases of intracranial tuberculoma in Japan; 37 were male, 32 were female and 3 were uncertain because of no detailed document. The age of onset was distributed from 6 month to 81 years in age and 2 peaks were seen in the second decade and fifth to seventh decade. Thirty-three (48%) out of 69 cases had multiple intracranial lesions. A few reports commented that neurological complications tended to appear even if they were under antituberculous therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of chronic hepatitis B with recombinant leukocyte interferon and cyanidanol

Twelve male patients with chronic hepatitis B were treated by the combination of recombinant human alpha-interferon and cyanidanol. They received 3 million units of interferon twice a week and 2,250 mg of cyanidanol daily for 24 weeks. Four patients had sustained clinical improvement in which hepatitis B e antigen and DNA polymerase disappeared from sera and aminotransferase activities fell to normal levels. Elevated pretreatment aminotransferases were associated with the response to therapy. Also, decreased number of OKT4-positive cells prior to treatment were observed among responders. Side effects were minimal and all patients tolerated treatment on an outpatient basis. Twice weekly administration of recombinant leukocyte interferon with cyanidanol may be effective in treating chronic hepatitis when patients are appropriately selected.

Relationship between natural killer activity and development of hepatocellular carcinoma in patients with cirrhosis of the liver

Natural killer (NK) activities of peripheral blood lymphocytes (PBL) in 50 patients with non-alcoholic liver cirrhosis (LC) were prospectively studied in order to clarify the relation between the development of hepatocellular carcinoma (HCC) and impaired NK activities. Patients were divided into two groups according to their NK activities at the beginning of the study, namely, Group A with normal NK activity (n = 21) and Group B with decreased NK activity (n = 29). NK activities were serially determined in each patient for up to 40 months. During the observation period, the occurrence of HCC was identified in 12 patients (four to 36 months). Of the patients who developed HCCs, two belonged to Group A (9.5%) and 10 belonged to Group B (34.5%). These results suggest decreased NK activity in LC patients to be one of the critical factors increasing their risk of developing HCC, and serial determinations of NK activities to be important in predicting the occurrence of HCCs in following the clinical course of LC patients.

Improvement of proteinuria in a case of hepatitis B-associated glomerulonephritis after treatment with interferon

Disappearance of proteinuria was observed in a patient with hepatitis B-associated chronic glomerulonephritis after treatment with leukocyte interferon. The decrease of proteinuria was preceded by the disappearance of both deoxyribonucleic acid polymerase activity and hepatitis B e antigen from the patient's sera.

Surface markers of NK cells in peripheral blood of patients with cirrhosis and hepatocellular carcinoma

The surface markers and NK activity of blood lymphocytes in 38 normal controls, 57 cirrhotic patients and 22 cirrhotics with hepatocellular carcinoma were studied by the flow cytofluorometry using monoclonal antibodies. A reduction of OKM1+ cells was remarkable in cirrhotics, and a further decrease in HNK-1+ cells as well as OKM1+ cells was observed in cirrhotics with hepatocellular carcinoma, accompanied by depression of NK activity. We postulate that the decreased NK activity in these patients may result from the disturbed maturation of NK cells.

Deafness following mumps: the possible pathogenesis and incidence of deafness

Mumps is thought to be the most common cause of unilateral acquired sensorineural deafness in children. Mumps deafness is usually sudden in onset, profound or complete, and may be associated with vestibular symptoms. The authors' clinical survey of 55 patients with unilateral deafness which could reasonably be ascribed to mumps indicates that the hearing loss is exclusively unilateral, severe or total and permanent, and that approximately 45% of the patients experienced dysequilibrium of vestibular origin. An analysis of the present series of mumps deafness also suggests that the primary route of invasion of the virus is hematogenous, and thus the term "viral endolymphatic labyrinthitis" is proposed as the possible pathogenesis of the deafness, since both tympanogenic and meningogenic routes of viral invasion to the labyrinth can be excluded on the basis of the clinical and cerebrospinal fluid studies. This view of the pathogenesis, particularly that mumps meningitis is not associated with deafness, is supported by several reports including those of Vuori et al. (1962), Azimi et al., (1969), Lindsay (1973), Nadol (1978), etc. The incidence of deafness following mumps appears to be extremely low, approximately 1:20,000, as estimated by Everberg (1957).

A quantitative tear fluids determination of therapeutic efficacy for allergic conjunctivitis

A provocation test was conducted with volunteers in 10 cases with seasonal cedar pollinosis during a quiescent stage to determine quantitatively the therapeutic effect of 0.08% Ketotifen eye drops. The efficacy rate of this preparation was found to be 80%.

Release and rectal absorption of aminophylline suppositories prepared in a hospital pharmacy

In vitro release and in vivo rectal absorption of suppositories containing aminophylline and various bases prepared in our hospital pharmacy were investigated. The release tests were conducted using three methods: the cylindrical filter paper method, the Sartorius solubility simulator method and the disintegration test in J.P. IX. In all cases, release from PEG-containing suppositories was better than that from Witepsol-containing products. However, this tendency was not reflected in the blood level of theophylline after rectal absorption of these suppositories.

Evaluation of aminophylline suppositories prepared in a hospital pharmacy

Physical and chemical stability of suppositories containing aminophylline and various bases prepared in our hospital pharmacy was investigated. Ethylenediamine in aminophylline decreased, the melting points of the suppositories rose, and the disintegration and liquefaction times were prolonged in suppositories with Witepsol base when stored at room temperature. Thin-layer chromatography produced evidence supporting the assumption that ethylenediamine may react with Witepsol constituents to form an acid amide linkage. However, the suppositories were stable at lower temperatures. Suppositories prepared with PEG base were found to be satisfactorily stable at room temperature.

Therapeutic effects of a new, anti-allergic ophthalmic preparation

A 0.1% Ketotifen ophthalmic preparation was evaluated in 11 cases of conjunctivitis due to Japanese cedar pollinoisis (three cases also associated with vernal catarrh). The following results were obtained concerning the safety and the therapeutic efficacy of the preparation. (1) In the computation of the overall effects of the preparation, a marked therapeutic effect was noted in three out of 11 cases studied while one case remained unaffected. The overall effective rate was computed to be 91%. (2) The time required for the preparation to take effect was found to be 3 days or less in seven cases (70.0%) out of 10 in which therapeutic effects were noted. (3) In observations of the adverse effects of the preparation, transient irritation at the site of application was noted in seven cases. No other serious side effects were recorded. From the above results, it was concluded that the present preparation is an effective therapeutic agent for conjunctivitis caused by pollinosis.

Psychological correlates of stress-induced cortisol and growth hormone releases in neurotic patients

The mirror drawing test was performed in 23 neurotic patients and plasma cortisol (Fk) and growth hormone (GH) were measured serially throughout the test. The patient's personality was assessed by the Minnesota Multiphastic Personality Inventory and related to the endocrine findings. The results indicated that 1) Fk and GH have different personality correlates; 2) the Fk responders tend to be more "defensive" trying to maintain good "self-control" over inner mental processes; 3) high GH level seems to be associated with personality features such as exaggeration, hostility, and a distorted thinking process; 4) psychoendocrine control mechanisms for Fk and GH tend to offset, rather than enhance, each other.

Prolactin and growth hormone responses to psychological stress in normal and neurotic subjects

In order to study the response of plasma prolactin (PRL) to acute psychological stress and to compare it with that of growth hormone (GH), the mirror drawing test (MDT) was performed in 20 normal controls (11 male, 9 female) and 22 neurotic patients (12 male, 10 female). Plasma PRL and GH were measured serially before, during and after the test. In controls, the test caused no significant change in plasma levels of either hormone. In neurotic males, the response of PRL to the test was not consistent, whereas, in neurotic females, plasma PRL level rose significantly following the test. Increase of GH, on the other hand, was apparent in the neurotics of both sexes. The correlation between the responses of the two hormones in the neurotics was low and non-significant. The results indicate that although the psychoendocrine coping mechanism in the neurotics works less effectively for both PRL and GH, the two hormones may have different psychological correlates.

Growth hormone and cortisol responses to psychological stress: comparison of normal and neurotic subjects

The mirror drawing test (MDT) was performed to induce acute psychological stress in 9 normal controls and 10 neurotic subjects. Plasma growth hormone (GH) and cortisol were determined serially before, during, and after the test. In controls the MDT caused no significant change in plasma GH level, while in neurotics plasma GH increased progressively following the test. The increase of cortisol also tended to be greater in neurotics as a group, but there was considerable overlap in individual responses. The maximum increments of GH in neurotics correlated inversely with those of cortisol. The results indicate: 1) effective psychological coping mechanisms operate in normal man to keep the hormonal response minimum. 2) GH response is a more adequate indicator than cortisol response to psychological stress in neurotics. 3) GH and cortisol may have different psychological correlates in neurotics.