Detection and analyses of ascorbyl radical in cerebrospinal fluid and serum of acute lymphoblastic leukemia

We have detected and analyzed a free radical in human cerebrospinal fluid (CSF) of acute lymphoblastic leukemia (ALL) for the first time using electron paramagnetic resonance (EPR) at ambient temperature. We have also introduced an alternative capillary method to measure the radical. EPR spectra of the radical show a characteristic doublet with hyperfine coupling value of 1.8 G and g = 2.005. Based on EPR measurements, computer simulation, and literature values, we have determined that the species is ascorbyl radical (AsR). The radical has been investigated in CSF samples from ALL patients having no therapy, undergoing chemotherapy, and following therapy. Determination of the ascorbyl radical concentrations in CSF and serum was attempted using known concentrations of a nitroxyl radical. In addition, comparison in CSF and serum for ALL has been made along with statistical analyses of the data obtained. We found that AsR in CSF and serum has a strong correlation in patients undergoing chemotherapy (n = 57, r = 0.57, P < 0.0001). Ascorbate in CSF and serum show good correlation in patients having therapy but not for patients after therapy.

Computed tomographic study of aged schizophrenic patients

The width of interhemispheric fissure, lateral ventricles and third ventricle were measured using cranial computed tomography (CT; linear method) in 45 elderly inpatients with chronic schizophrenia and in 28 age-matched control subjects. Twenty-three patients were men and 22 were women. In addition, Mini-Mental State Examination, Brief Psychiatric Rating Scale (BPRS) and a subclass of BPRS were undertaken in all patients. There is a significant enlargement of the maximum width of the interhemispheric fissure (in both male and female) and a significant enlargement of the ventricular system (more severe in men than in women) in aged schizophrenics, as seen with CT, compared with normal controls. These findings are consistent with previous studies of non-aged schizophrenic patients. Based upon the relation between the third ventricle enlargement and the positive and depressive symptoms in all patients. This result suggests that the advanced third ventricle enlargement may decrease these symptoms in aged schizophrenics.

[Clinical evaluation of a reagent for detection of DNA of Mycobacterium tuberculosis complex using the ligase chain reaction (LCR) method]

We evaluated the clinical efficacy of LCR MTB, a reagent developed by Abbott in the USA, in the full automatic ligase chain reaction (LCR) for detection of DNA of M. tuberculosis complex using a thermostable ligase. Using 458 samples isolated from patients with tuberculosis, LCR was compared with a smear method and with a culture method, and was also compared with two other methods of gene amplification, MTD and Amplicor, using 340 and 200 of the 458 samples, respectively. The LCR method detected M. tuberculosis in 49.8% (228/458) of the samples, and was superior to the smear method (31.9%, 146/458) and the culture method (39.1%, 179/458) in sensitivity. The LCR method was also superior to the MTD and Amplicor methods; sensitivity were 37.9% (129/340) for MTD vs. 47.6% (162/340) for LCR, and 56.5% (113/200) for Amplicor vs. 59.5% (119/200) for LCR. These favorable results and the convenience of the LCR method, which enables rapid detection of target genes with a high degree of sensitivity, strongly suggest that LCR MTB is useful as a reagent for detection of M. tuberculosis using nucleic acid amplification.

[Tuberous sclerosis associated with subependymal giant cell astrocytoma and renal angiomyolipoma: a case report]

We presented a case of tuberous sclerosis (TS) associated with subependymal giant cell astrocytoma (SEGC) and renal angiomyolipoma (RAML). A 19-year-old female, who had been diagnosed as TS since she was 3 months old, was admitted with complaints of headache, vomiting, and abdominal pain. At 10 years of age, a ventricular tumor was shown on CT, and at 16 years of age a ventricular peritoneal shunt was placed for obstructive hydrocephalus. On admission, an abdominal CT showed bilateral renal huge multicystic tumors with hemorrhage, which were diagnosed as RAMLs. CT and MRI showed an intraventricular tumor near the foramen of Monro, and this tumor was removed through a transcortical approach. The pathological diagnosis was SEGA. Large sized RAMLs were identified by CT. Although TS is often associated with additional tumors in the brain, heart, kidney, and other organs, the combination of SEGA and RAML is quite rare. If ventricular peritoneal shunt is placed in a TS patient, risk of shunt malfunction should be taken into account.

[The in vitro antifungal activities of fluconazole against pathogenic yeasts recently isolated from clinical specimens]

The emergence of Candida albicans resistance to azole antifungal agents have been reported in the U. S. and Europe. We examined the in vitro antifungal activities of fluconazole against clinical isolates collected by seven investigators in three years to examine if a tendency existed toward the development of azole-resistance among fungal isolates in Japan. The following results were obtained: 1. Sensitivities to fluconazole (FLCZ) were determined for yeast-like fungi, including 113 strains isolated in 1993, 149 strains isolated in 1994 and 205 strains isolated in 1995. No significant differences in sensitivities in the three years were detected. 2. Minimum inhibitory concentrations of FLCZ were 0.1-0.78 microgram/ml for C. albicans and 3.13-25 micrograms/ml for C. glabrata. Strains with 25 micrograms/ml of FLCZ's MIC were detected; two strains of C. krusei and one strain each of C. krusei, Trichospron beigelii and Hansenula anomala. No strains with higher than 50 micrograms/ml MIC of FLCZ were detected. 3. In vitro activities of FLCZ were compared between clinical strains isolated between 1993 and 1995 and clinical strains isolated before the marketing of FLCZ (up to December 1987) or clinical yeasts isolated between 1991 and 1992. No significant differences were observed, suggesting that no tendency existed toward azole resistance among fungal strains examined.

[Current status of clinical diagnosis and DNA test of von Hippel-Lindau disease in Japan]

An outline of the clinical diagnosis including the DNA testing in von Hippel-Lindau (VHL) disease is briefly explained. The current status of the diagnosis and treatment of VHL disease in Japan is also compared with those in European countries. According to the current experience in the world, DNA testing of VHL disease is regarded as one of the important references for the clinical diagnosis of this disease. We have to improve various points in the Japanese status of the clinical diagnosis, genetic counseling, treatment and follow-up in patients with VHL disease.

Frame shift mutation, exon skipping, and a two-codon deletion caused by splice site mutations account for pyruvate kinase deficiency

Three novel splice site mutations and two novel missense mutations were identified by molecular analysis of pyruvate kinase (PK) deficiency associated with hereditary nonspherocytic hemolytic anemia. A Nepalese PK variant, PK Kowloon, was found to have a homozygous transversion at the 5'-splice site of the seventh intervening sequence (IVS) of the L-type PK gene (Ivs7[+1]gt --> tt). Using a reverse transcription polymerase chain reaction (RT-PCR) assay, we showed that the R-type PK mRNA in the proband's reticulocytes included the seventh IVS between the seventh and eighth exon, introducing a stop codon 3 nucleotides downstream of the mutated site. Consequently, the translational product may lack 44% of the R-PK polypeptide. A transition at the last nucleotide of exon 9 (1269GCG --> GCA) was found in a Japanese PK variant, PK 'Kamata.' The mutation did not alter the amino acid sequence, but caused skipping of the ninth exonic sequence in the R-PK transcripts. As a result, the affected R-type PK lost 51 amino acid residues (373Met-423Ala del). A transversion at the splice acceptor site of the third IVS (Ivs 3[-2]ag --> tg) was identified in PK 'Aomori.' The mutation resulted in aberrant splicing at a cryptic splice site within exon 4, causing deletion of two codons in the aberrant R-PK transcript (95 Gly-96 Pro --> del). Both PK 'Kamata' and PK 'Aomori' had a missense mutation on the other allele, 1044AAG --> AAT (348Lys --> Asn) and 1075CGC --> TGC (359Arg --> Cys), respectively. Although both 348Lys and 359Arg were located in the sixth loop of A domain (beta/alpha)8 barrel, which has been shown to contain the substrate and cation binding sites, the degree of anemia was much more severe in PK 'Kamata' than PK 'Aomori,' possibly because the 51 amino acid deletion of PK 'Kamata' but the 2 amino-acid deletion of PK 'Aomori' may abolish PK catalytic activity.

Changes in corneal and lens autofluorescence and blood glucose levels in diabetics: parameters of blood glucose control

PURPOSE

We investigated corneal and lens autofluorescence in patients with proliferative diabetic retinopathy (PDR) to determine a correlation between the two parameters and blood glucose levels and HbA1c.

METHODS

Corneal and lens autofluorescence levels in 17 PDR patients and 8 healthy controls were measured with a fluorophotometer fitted with an anterior segment adapter. We measured the lower blood glucose level (BS1), corneal autofluorescence (CA1), and lens autofluorescence (LA1) simultaneously and the higher blood glucose level (BS2), CA2, and LA2 simultaneously on the same day. We defined parameter changes as: delta BS = BS2 - BS1, delta CA = CA2 - CA1, and delta LA = LA2 - LA1.

RESULTS

Corneal and lens autofluorescence significantly increased in the patients, compared with the controls (p < 0.001). Lens autofluorescence had a significant positive correlation with HbA1c (r = 0.656, p < 0.01) in the patients. delta CA (ngEq/ml) correlated significantly with delta BS (mg/dl) (r = 0.631, P < 0.01).

CONCLUSIONS

Results suggest that lens autofluorescence might represent the long-term control of diabetes, and corneal autofluorescence levels may represent short-term changes in the blood glucose level, because hyperglycemia accelerates with increasing corneal autofluorescence in PDR patients. Corneal and lens autofluorescence may be related to the breakdown of the blood-aqueous barrier.

[The quantitative expression of susceptibility and its clinical significance]

As for the methods for dilution antimicrobial susceptibility tests, the results are expressed quantitatively as minimum inhibitory concentration (MIC). MICs are useful index not only for the choice of antibiotics to the treatment of infectious diseases but the exact detection of resistant strains. Recently, the study for the mechanism of the bacterial resistance to antibiotics were made remarkable progress, the important point of MICs in the combination of species and antibiotics were become clear. To improve the quality of the susceptibility tests, it is necessary to come into wide use of the dilution antimicrobial susceptibility tests instead of the disk susceptibility tests which are popular in JAPAN.

Role of an immunosuppressive cytokine, interleukin-10, in the development of pyothorax-associated lymphoma

Malignant lymphoma frequently develops in the pleural cavity of the patients with long-standing pyothorax. Thus, the term pyothorax-associated lymphoma (PAL) has been proposed for this type of tumor. Most of PALs are diffuse lymphoma of B cell type and contain Epstein-Barr virus (EBV) DNA. We have established two lymphoma cell lines from the biopsy specimens of PAL cases, OPL-1 and OPL-2. Both cell lines contain EBV DNA, but only OPL-1 expresses Epstein-Barr virus nuclear antigen 2 (EBNA2) that works as a target molecule for cell-mediated immune response. In this study, we examined the expression of immunosuppressive factors in OPLs. Only OPL-1, not OPL-2, expressed interleukin-10 (IL-10) mRNA and secreted IL-10 into culture supernatant. Both OPL-1 and OPL-2 expressed transforming growth factor (TGF) beta 1 mRNA, however, neither expressed latent TGF beta binding protein (LTBP) mRNA at detectable level by Northern blot analysis. Because TGF beta expresses its functions in cooperation with LTBP, the biological functions of TGF beta 1 could be negligible. Neither cell lines expressed EBV BCRF1 mRNA at detectable level, a viral gene product which is partly homologous to human IL-10 and shares biological activities of IL-10. Since OPL-1 shows weaker proliferative activity than OPL-2 and expresses viral antigens, the production of an immunosuppressive cytokine, IL-10, might contribute to the development of overt lymphoma. The present study suggested that immunosuppressive cytokine plays a role in lymphomagenesis of immunocompetent patients.

Somatic mutations of the von Hippel-Lindau tumor suppressor gene and loss of heterozygosity on chromosome 3p in human glial tumors

Molecular genetic analysis of von Hippel-Lindau tumor suppressor gene (VHL gene) was performed on 38 tissues of human glial tumors (ependymoma, 1; astrocytoma, 6; oligodendroglioma, 1; oligoastrocytoma, 2; anaplastic oligoastrocytoma, 3; anaplastic astrocytoma, 14; glioblastoma multiforme, 11). Somatic DNAs extracted from frozen tumor specimens were examined by single-strand conformational polymorphism analysis and direct sequencing. In addition, loss of heterozygosity (LOH) on chromosome 3p in 15 glial tumor cases, lymphocyte DNAs of which were available, was examined by use of 10 microsatellite probes and two polymorphism markers for the VHL gene. Two cases of low-grade gliomas showed somatic sense mutations in exon 3 of the VHL gene, and 6 of 15 cases (40.0%) showed LOH of chromosome 3p. The VHL gene-mutated cases also showed LOH. The retention of heterozygosity and high pathological grade of glial tumors were correlated significantly. In addition, Kaplan-Meier survival analysis for patients with glial tumors showed that patients with LOH had a significantly longer survival time than those without LOH. These results suggest that somatic mutations on 3p, including the VHL gene, may be involved in tumorigenesis of some low-grade glial tumors.

[Quantitative analysis of the relationship between negative anoxic EP and the number of missing outer hair cells in the guinea pig]

It is thought that the integrity of the hair cell plays an important role in the production of the negative anoxic endcochlea potential EP, because the destruction of hair cells abolished the production of negative anoxic EP. However, the mechanism by which the negative anoxic EP is generated remains controversial although most investigators have regarded negative anoxic EP as diffusion potential across the organ of Corti. We hypothesized that negative anoxic EP was mainly produced by diffusion of ions through the outer hair cells from the scala media to the scala tympani or vice versa. The present study examined the negative anoxic EP and the reduction in the number of hair cells. Kanamycin (300 or 500 mg/kg) or gentamicin (100 or 150 mg/kg) were administered to albino guinea pigs (200 to 300 g) IM for 10 or 15 days in order to induce varying degrees of hair cell loss in the animals. EP was recorded using the round window approach and then hair cells were counted by scanning electron microscopy. The number of missing outer hair cells in the whole cochlea correlated well with the maximum negative EP value, which was defined as the lowest EP value during anoxia. The value of the correlation coefficient was 0.882. The EP value depends on the position at which the EP is recorded. Closer examination indicated that maximum negative EP was well correlated with the number of missing outer hair cells of upper turns, such as the second or third turn, rather than with that of the hook portion, although EP and negative EP was recorded at the hook portion. These results suggested that negative EP reflects the diffusion potential over the entire cochlea. The present results supported our hypothesis that some ions only pass through the outer hair cells in the organ of Corti.

[Pyothorax-associated lymphoma: EBV-positive lymphoma developing in immunocompetent patients]

Malignant lymphomas frequently develop in the pleural cavity of patients with long-standing pyothorax. Thus, the term pyothorax-associated lymphoma (PAL) has been proposed for this type of tumor. Most of PALs are diffuse lymphomas of B cell type and contain Epstein-Barr virus (EBV) DNA. We established two lymphoma cell lines from biopsy specimens of PAL cases, and examined their growth characteristics and the expression of EBV latent infection genes and oncogenes. The differences in growth rate and oncogene expression between the lines could not be adequately explained by the pattern of EBV latent gene expression. The subsequent genetic lesions might be necessary for the development of overt lymphoma. Furthermore, the mechanism of development of viral antigen-positive tumor in immunocompetent patients is discussed.

Thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor

This report introduces our new technique of thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor. A 68-year-old woman noticed a tumor palpable in the left supraclavicular fossa. The patient had no pain around the neck and shoulder. A radio-opaque shadow 6 cm in diameter was detected in her left apical lung field on chest roentgenogram. Chest CT and MRI showed that the tumor was located in the superior mediastinum, extending up to the thoracic inlet, and there was no invasion of the surroundings. At first, a thoracoscopic examination was performed to assess the possibility of the excision. After dissecting the tumor from the mediastinal tissue and the first costovertebrae as far as possible by thoracoscopic surgery, a supraclavicular approach was used to enter the thoracic cavity. Complete resection of the tumor was successfully performed by thoracoscopic surgery combined with a supraclavicular approach. The tumor was removed in a plastic bag through the supraclavicular defect. Postoperative histopathology revealed that the tumor was a benign neurogenic one. A satisfactory follow-up of 5 postoperative days was observed without any complications, and the patient was discharged. The procedure was safe, easy, and minimally invasive to perform. Moreover, the supraclavicular approach could be used to add trocar port if needed.

Risk of cytomegalovirus infection after peripheral blood stem cell transplantation

From 1992 to 1995, 105 patients received PBSCT in our hospitals and we observed no incidence of CMV-pneumonia. To clarify whether activation of CMV occurs in these patients shell vial cultures, CMV antigenemia and PCR (DNA-PCR and RT-PCR) were used as detection methods for CMV. Bronchoalveolar lavage (BAL) samples, MNC and PMN samples from peripheral blood leukocytes, and urine samples were taken from 17 patients on day 35 after PBSCT. CMV was detected in one urine specimen but not detected in any of the BAL, MNC or PMN specimens by shell vial culture. CMV antigenemia provided no positive data. Nine of the 74 samples taken from the 17 patients proved positive by DNA-PCR, but all CMV-mRNA results were negative by RT-PCR. We performed CMV antigenemia and PCR on MNC and PMN specimens from six patients every 1 to 2 weeks after transplantation to determine whether and when CMV was activated. Two patients tested positive transiently by DNA-PCR but negative throughout by both antigenemia and RT-PCR. These results suggest that the risk of CMV infection is low because the incidence of CMV activation in patients receiving PBSCT is low.

Production of the immunosuppressive cytokine interleukin-10 by Epstein-Barr-virus-expressing pyothorax-associated lymphoma: possible role in the development of overt lymphoma in immunocompetent hosts

Malignant lymphomas frequently develop in the pleural cavity of patients with long-standing pyothorax. Thus, the term pyothorax-associated lymphoma (PAL) has been proposed for this type of tumor. Most PALs are diffuse lymphomas of B cell type and contain Epstein-Barr virus (EBV) DNA. We have established two lymphoma cell lines from the biopsy specimens of PAL cases, OPL-1 and OPL-2. Both cell lines contain EBV DNA, but only OPL-1 expresses EBV nuclear antigen 2, which works as a target molecule for the cell-mediated immune response. As systemic immunodeficiency is unlikely to be present in PAL patients, PAL from which OPL-1 derived was not expected to be fully developed. In this study, we examined the expression of immunosuppressive factors in OPLs. Only OPL-1, not OPL-2, expressed interleukin-10 (IL-10) mRNA and secreted IL-10 into culture supernatant. Both OPL-1 and OPL-2 expressed transforming growth factor (TGF)-beta 1 mRNA; however, neither expressed latent TGF-beta-binding protein mRNA at a detectable level by Northern blot analysis. Because TGF-beta expresses its functions in cooperation with latent TGF-beta-binding protein, the biological functions of TGF-beta 1 could be negligible. Neither cell line expressed at a detectable level EBV BCRF-1 mRNA, a viral gene product that is partly homologous to human IL-10 and shares biological activities of IL-10. Although IL-10 is reported to promote the growth of activated or neoplastic B cells, OPL-1 did not respond to human recombinant IL-10 by growing faster. As OPL-1 expresses a target antigen for the host cytotoxic T-cell response, the production of an immuno-suppressive cytokine, IL-10, might contribute to the development of overt lymphoma by inducing locally immunosuppressive circumstances. The present study suggests that an immunosuppressive cytokine plays a role in lymphomagenesis of immunocompetent patients.

Laparoscopic reconstruction of vagina using sigmoid autograft

With the advent of advanced laparoscopic techniques in surgery, new applications have been found, which have expanded the role of laparoscopy in the gynecological field. The aim of this paper is to introduce our laparoscopic technique of taking a sigmoid colon autograft for colpopoiesis in a patient with congenital agenesis of the vagina. This technique is less invasive and is easy to perform, and it may be the best choice of operation in respect to the naturalness and the permanency of the vagina that results. The success of this laparoscopic technique of taking a sigmoid autograft for colpopoiesis suggests diverse possible applications in the future.

Molecular analysis of glucose phosphate isomerase deficiency associated with hereditary hemolytic anemia

We report here two new cases of glucose phosphate isomerase (GPI) deficiency associated with hemolytic anemia and present the results of molecular analysis of the five Japanese GPI variants. A Japanese girl (GPI Fukuoka) had an episode of prolonged neonatal jaundice and at 3 years of age was admitted due to acute hemolytic crisis occurring with upper respiratory tract infection. Red blood cell (RBC) GPI activity was decreased to 11.8% of normal and the reduced glutathione (GSH) level of RBCs was slightly decreased. A 54-year-old Japanese man (GPI Iwate) was hospitalized due to chronic active hepatitis, and compensated hemolysis was noted. RBC GPI activity of the proband was decreased to 18.8%, and the GSH content was about half of the normal mean value. Sequencing of the reticulocyte GPIcDNA showed homozygous missense mutations 1028CAG-->CGG (343Gln-->Arg), 14ACC-->A7C (5Thr-->lle), 671ACG-->A7G (224Thr-->Met), and 1615GAC-->AAC (539Asp-->Asn) in GPI Narita, GPI Matsumoto, GPI Iwate, and GPI Fukuoka, respectively. We also identified GPI Kinki as a compound heterozygote of 1124ACA-->AGA(375Thr-->Arg)/ 1615GAC-->AAC(539Asp-->Asn). Our findings, together with the previous results of other investigators, showed that the GPI gene mutations so far identified were heterogeneous, although most GPI variants had common biochemical characteristics such as heat instability and normal kinetics. Several amino acid substitutions were identified in the proximity of the catalytically important amino acid residues such as Ser/Asp 159/160, Asp341, and Lys518, which have been identified in the structural analysis of the pig GPI. The molecular characterization of human GPI variants, therefore, may provide new insights into the genotype-phenotype correlation of GPI deficiency as well as the structure-function relationship of this enzyme.

Inhibitory effects of lanostane-type triterpene acids, the components of Poria cocos, on tumor promotion by 12-O-tetradecanoylphorbol-13-acetate in two-stage carcinogenesis in mouse skin

Pachymic acid, 3-O-acetyl-16 alpha-hydroxytrametenolic acid, and poricoic acid B had been isolated from the sclerotium of Poria cocos Wolf. These compounds showed a strong inhibitory activity against 12-O-tetradecanoylphorbol-13-acetate-induced inflammation in mice. At 0.2 mumol/mouse, these compounds markedly inhibited the promoting effect of 12-O-tetradecanoylphorbol-13-acetate (1 microgram/mouse) on skin tumor formation following initiation with 7,12-dimethylbenz[a]anthracene (50 micrograms/mouse).

[Molecular basis and pathophysiology of red cell enzymopathies]

Recent progress in the molecular analysis of red cell enzymopathies showed over 160 mutations in the 10 distinct genes which were essential in red cell metabolisms. In addition, since three-dimensional structure of several enzymes including pyruvate kinase (PK) and glucose-6-phosphate dehydrogenase (G6PD) have been elucidated from X-ray crystallographic studies, the effect of amino acid substitutions on enzyme activity became predictable in some extent. On the contrary, the mechanism of hemolysis remains still unclear. To clarify the pathophysiology of red cell enzymopathies, establishment of an animal model have been long awaited. Recently we discovered the novel mice model of PK deficiency. The mutant mice with splenomegaly and nonspherocytic hemolytic anemia in an inbred colony of the CBA strain were enzymatically diagnosed as PK deficiency. A homozygous missense mutation was identified in the red cell (R)-type PKcDNA sequence of the mutant, and it caused a single amino acid substitution near the substrate binding site of PK. The erythroid-progenitor cell number increased in spleen of the mutant mice to a level approximately 66 times higher than in normal CBA mice, suggesting that compensatory extramedullary erythropoiesis in the spleen of the mutant mice might partly compensate the anemia. The mutant mice will be useful as an experimental model for understanding the pathophysiology of this disorder.

[Clinical studies on vancomycin in the treatment of MRSA infection]

We evaluated the effectiveness and safety of vancomycin (VCM) alone and in combination with beta-lactam antibiotics in the treatment of MRSA infections, and obtained the following results: 1. Effectiveness. (1) In cases of MRSA infections alone, the improvement rate was 71.4% (5/7 patients) with VCM alone and 77.8% (35/45) with VCM in combination with beta-lactam antibiotics. (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the improvement rate in combination use with beta-lactam antibiotics was 71.8% (28/39). 2. Bacteriological effect. (1) In cases of single infection with MRSA, the rate of bacterial eradication was 71.4% (5/7) with VCM alone and 68.2% (30/44) with VCM in combination with beta-lactam antibiotics. (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the rate of bacterial eradication in combination use with be ta-lactam antibiotics was 63.2% (24/38) against MRSA and 31.6% (12/38) against polymicrobial agents including MRSA. 3. Safety. Occurrences of adverse reactions and abnormal laboratory test values when VCM was used alone or when it is used in combination with another drug were about the same in these uses. As a whole, advance reactions were observed in 16 patients (9.5%). Main adverse reactions were whole body redness, drug eruption, and rash etc. Abnormal laboratory test values were observed mainly in hepatic functions, and renal functions. 4. VCM concentrations in blood was determined in 38 patients. Doses of 0.5 g and 1.0 g of VCM was administered by intravenous drip infusion over a period of 1 to 2 hours, and mean blood concentrations 1 to 2 hours after the completion of drip infusion were 25.4 micrograms/ml and 14.4 micrograms/ml, respectively. 5. Synergic effects between VCM and other antibiotics tested were observed in FIC index against all of the six MRSA strains isolated from six patients, and the clinical effects of improvement or better were obtained against five of them.