Body image disturbance in body dysmorphic disorder and eating disorders. Obsessions or delusions?

At this time, the question posed by this article's title--body image disturbance in body dysmorphic disorder and eating disorders: obsessions or delusions?--is probably best answered "both." Both disorders appear to be characterized by obsessional and delusional thinking. In addition, it is likely that their nondelusional and delusional variants constitute a single disorder encompassing a spectrum of insight, with the entire spectrum characterized by obsessional thinking. This view represents a considerable departure from DSM-III-R, in which the psychotic disorders were encapsulated in a separate section of the manual and considered different disorders from their nonpsychotic variants. The one exception was the mood disorders, which were acknowledged to have psychotic variants that were classified in the manual's "nonpsychotic" section. In DSM-IV, on the basis of emerging empirical evidence about the dimensional nature of the psychotic/nonpsychotic boundary, the dichotomy between delusional and nondelusional disorders is less clear. The double coding allowed for BDD acknowledges that BDD and its delusional disorder variant may constitute a single disorder; that allowed for OCD acknowledges that OCD may be delusional. With regard to eating disorders, however, DSM-IV is surprisingly silent, perhaps because delusional preoccupations are less common than in BDD. These issues also may apply to other disorders. Like BDD, hypochondriasis is classified as a somatoform disorder, with its delusional variant a type of delusional disorder, somatic type. Do the delusional and nondelusional variants of hypochondriasis constitute the same disorder? Do other types of somatic delusional disorder, such as parasitosis and olfactory reference syndrome (the belief that one emits a foul body odor) have nondelusional variants? It is likely that a number of disorders span a spectrum from delusional to nondelusional thinking, with unlimited shades of gray in between. Future research may indicate that obsessional disorders such as BDD, anorexia, OCD, and hypochondriasis, as well as other disorders such as major depression, should have qualifiers or subtypes--for example, "with good insight," "with poor insight," and "with delusional (or psychotic) thinking"--with an implied continuum of insight embraced by a single disorder. Such an approach, which scatters psychosis throughout the nomenclature, ultimately may be shown to be a more valid and clinically useful classification approach. Answers to these questions will not only improve our classification system but also may have important treatment implications. For example, the preliminary finding that delusional BDD responds preferentially to SRIs but not to neuroleptic agents contradicts conventional wisdom about the treatment of psychosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Purification and characterization of an ATP-dependent amidohydrolase, N-methylhydantoin amidohydrolase, from Pseudomonas putida 77

N-Methylhydantoin amidohydrolase, an ATP-dependent amidohydrolase involved in microbial degradation of creatinine, was purified 70-fold to homogeneity, with a 62% overall recovery, and was crystallized from Pseudomonas putida 77. The enzyme has a relative molecular mass of 300,000. It is a tetramer of two identical small subunits (M(r) 70,000) and two identical large subunits (M(r) 80,000). The enzyme requires ATP for the amidohydrolysis of N-methylhydantoin and vice versa. Mg2+, Mn2+ or Co2+, and K+, NH4+, Rb+ or Cs+, were absolutely required concomitantly for the enzyme activity as divalent and monovalent cations, respectively. The Km and Vmax values for N-methylhydantoin were 32 microM and 9.0 mumol.min-1.mg protein-1. The hydrolysis of amide compounds and coupled hydrolysis of ATP were observed with hydantoin, DL-5-methylhydantoin, glutarimide and succimide in addition to N-methylhydantoin. 2-Pyrrolidone, 2-oxazolidone, delta-valerolactam, 2,4-thiazolidinedione, 2-imidazolidone, D-5-oxoproline methyl ester, DL-5-oxoproline methyl ester, and naturally occurring pyrimidine compounds, i.e. dihydrouracil, dihydrothymine, uracil, and thymine, effectively stimulated ATP hydrolysis by the enzyme without undergoing detectable self-hydrolysis.

Squatting following total knee arthroplasty

This prospective study was performed to investigate whether postoperative alternate flexion and extension splinting (daily change in position of immobilization by splinting) was useful in restoring full range of motion (ROM) after total knee arthroplasty as compared with continuous passive motion. The alternate flexion and extension splinting group and the continuous passive motion group were each composed of 34 knees. Final ROM was measured at an average of 3.5 years postoperatively. Squatting was possible in 31 knees (45.6%) of the alternate flexion and extension splinting group. The postoperative ROM of the osteoarthritic knees (131.8 degrees +/- 12.3 degrees) was significantly greater than that of the rheumatoid knees (121.9 degrees +/- 22.4 degrees) (p < 0.05). The postoperative ROM of the alternate flexion and extension splinting group (135.1 degrees +/- 11.9 degrees) also was significantly greater than that of the continuous passive motion group (120.0 degrees +/- 19.7 degrees) (p < 0.01). There was no statistically significant relationship between the posterior slope of tibial cutting and the postoperative ROM. It is suggested that alternate flexion and extension splinting is effective in restoring full ROM after total knee arthroplasty.

Ipsilateral synchronous renal cell carcinoma and transitional cell carcinoma

The simultaneous occurrence of renal cell carcinoma(RCC) and transitional cell carcinoma(TCC) in the same kidney is unusual. We report a 53-year-old man with ipsilateral synchronous renal adenocarcinoma and renal pelvic transitional cell carcinoma with severe hypercalcemia and a huge staghorn calculus in the opposite kidney. The patient was admitted to the hospital because of left flank pain and intermittent fever which he had had for 2 months. Computerized tomography revealed a huge stone in the right kidney and a mass in the upper pole with an irregular calcified pelvis in the left enlarged kidney. Left radical nephrectomy was done. A section of the specimen revealed a renal cell carcinoma located at the upper pole and a papillary transitional cell carcinoma arising from the renal pelvis. This is a rare case of combined renal malignancies.

Phorbol ester synergistically increases interferon-gamma-induced nitric oxide synthesis in murine microglial cells

The effect of phorbol ester on the synthesis of nitric oxide (NO) in murine microglial cells was examined. Phorbol 12-myristate 13-acetate (PMA), a protein kinase C (PKC) activator, alone had no effect, whereas PMA with recombinant interferon (rIFN)-gamma synergistically increased NO synthesis in murine microglial cells. The maximal effect of PMA on NO synthesis increase always fitted with the range for full activation of PKC in these cells. The increase of NO synthesis was reflected as increased amount of immunologic NO synthase (iNOS) mRNA detected by Northern blotting. Treatment with PKC inhibitors such as staurosporine or polymyxin B decreased rIFN-gamma-plus-PMA-stimulated NO synthesis. Further, prolonged incubation of the cells with PMA, which down-regulates PKC activity, abolished the synergistic cooperative effect with IFN-gamma. NG-monomethyl-L-arginine monohydrate, an analogue of L-arginine, and arginase inhibited rIFN-gamma-plus-PMA-induced NO production in murine microglial cells. On the basis of these observations, we conclude that PKC might not be involved in the expression of iNOS, but instead, might be involved in the posttranscriptional modification of iNOS mRNA.

Adenosine deaminase and carcinoembryonic antigen in pericardial effusion diagnosis, especially in suspected tuberculous pericarditis

BACKGROUND

Adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) have been measured in pleural fluid to help distinguish malignant from benign effusions, especially in tuberculous pleurisy. We investigated ADA and CEA levels in patients with moderate to large pericardial effusions of different etiologies.

METHODS AND RESULTS

We performed diagnostic and therapeutic pericardiostomy with drainage and biopsy. We measured ADA and CEA levels in the pericardial fluid in 26 patients with moderate to large pericardial effusion and 19 control patients. Patients were included in a prospective protocol from August 1991 to August 1993. Patients were grouped as follows: group 1, 9 patients with tuberculous pericarditis (TP) confirmed by bacteriologic culture or histology of pericardial biopsy; group 2, 5 patients with clinically strongly suspected TP; group 3, 12 patients with malignancy (8) and acute pericarditis (4); group 4, 19 control patients without pericardial disease. We treated patients with TP with isoniazid, rifampin, and either streptomycin or ethambutol for 12 months and pyrazinamide for 2 months. We observed for symptoms and signs of recurrent pericarditis or constrictive pericarditis on follow-up. In group 1 the ADA activity was significantly higher (101 +/- 14 U/L) than that in group 3 (22 +/- 5 U/L) or that in group 4 (17 +/- 2 U/L) (P < .05). There was no significant difference between ADA activity in group 1 (101 +/- 14 U/L) and that in group 2 (100 +/- 26 U/L). With a cutoff value for ADA activity of 40 U/L, sensitivity was 93% and specificity 97% in the diagnosis of TP. In benign diseases, the CEA level was significantly lower (1.0 +/- 0.3 ng/mL) than that in malignant diseases (135.1 +/- 79.7 ng/mL) (P < .05). With a cutoff value for CEA level of 5 ng/mL, sensitivity was 75% and specificity 100% in the diagnosis of malignant pericarditis. Follow-up study (mean, 12.9, 19.8, and 11.8 months in groups 1, 2, and 3, respectively, showed no symptoms or signs of constrictive pericarditis, except for 1 patient.

CONCLUSIONS

Pericardial fluid ADA and CEA are useful for the differential diagnosis of pericardial effusion of various causes. They also have great value in early diagnosis of TP, particularly when the results of other clinical and laboratory tests are negative.

Androgen and estrogen sulfotransferases of the rat liver: physiological function, molecular cloning, and in vitro expression

Cloning of the androgen and estrogen sulfotransferases has allowed studies on their spatiotemporal regulation and physiological function. These two enzymes appear to be involved in regulating target cell sensitivity for the androgenic and estrogenic steroids. Recombinant androgen sulfotransferase produced in insect Sf9 cells through a baculoviral expression vector is capable of transferring the sulfate from PAPS (phosphoadenosine phosphosulfate) to 3 alpha, 3 beta, 17 alpha, and 17 beta hydroxyl groups of a number of steroid substrates indicating a broad range of substrate specificity.

Nucleotide sequence of the pectate lyase gene from alkali-tolerant Bacillus sp. YA-14

The nucleotide sequence of the pectate lyase gene (pe lK) from alkali-tolerant Bacillus sp. was identified and analyzed. A 1,260-base pair open reading frame for the pe lK gene was observed and encoded for a protein of 420 amino acids. The signal peptide was composed of 21 amino acid residues. In the deduced primary structure of this enzyme, the three conserved regions of several pectate lyases were found and showed high homologies.

Involvement of protein kinase C in the inhibition of nitric oxide production from murine microglial cells by glucocorticoid

The effects of glucocorticoid on the production of nitric oxide (NO) by murine microglial cells were investigated. Stimulation of the cells with lipopolysaccharide (LPS) or phorbol 12-myristate 13-acetate (PMA) after the treatment of recombinant interferon-gamma (rIFN-gamma) resulted in the increased accumulation of nitrite in the medium. Concomitant incubation of the cells with dexamethasone (DEX) markedly inhibited the production of NO in a dose dependent manner. DEX also suppressed both rIFN-gamma and rIFN-gamma plus LPS-induced activity of the enzyme protein kinase C (PKC), a putative regulator of NO synthesis, but had only a modest inhibitory effect on basal activity. In addition, the inhibitory effect of DEX on NO generation was mimicked by the treatment of PKC inhibitors such as staurosporine (STSN) and polymyxin B. Our findings show that glucocorticoids have the potential to modulate central nervous system (CNS) NO production via the inhibition of PKC activity particularly under the conditions of stimulated production of NO, such as inflammatory and demyelinating CNS disorders.

A novel regulatory element associated with age-dependent expression of the rat androgen receptor gene

A large body of evidence indicates that the genetic program of aging has co-evolved with the sexual mode of reproduction (Partridge, L., and Barton, N. H. (1993) Nature 362, 305-311). Age-dependent changes in target cell sensitivity to reproductive hormones can be considered part of this evolutionary linkage. Here we describe a novel regulatory element in the rat androgen receptor (AR) gene promoter associated with its age-dependent expression in the liver. This element consists of two (19 and 25 base pairs) contiguous sites, one specifically binding an Age-dependent Factor (ADF) and the other an Associated Factor (AF). Both deletion and point mutations of the ADF site result in about a 5-fold decline in the AR promoter function. Unlike AF, which is relatively tissue specific, ADF appears to be ubiquitous. The ubiquitous and evolutionarily conserved nature of ADF suggests a fundamental role of this novel transcription factor in programmed gene expression.

Brain vessels near muscle autografts are sites for entry of isogeneic macrophages into brain

An autograft of skeletal muscle on rat dorsal medulla is a permanent opening in the blood-brain barrier to solutes. Is the graft also a site for the entry of exogenous, isogeneic leukocytes? Five weeks after inserting the graft, peritoneal macrophages (M phi) from inbred Fischer rats were activated by phorbol myristate acetate, labeled with a fluorescent dye, and infused as a bolus of about 2 x 10(6) cells into the axillary artery of Fischer hosts. The cells circulated for 2 h. The brains were then fixed, frozen, and sectioned. Only when M phi had been activated and a muscle autograft inserted did appreciable numbers of M phi enter the medulla. Nonactivated M phi invaded the grafts but very few entered the brain at 2 h. In rats with gel foam grafts, only a few activated M phi invaded gel and brain. Before entering tissues, M phi must adhere to the lumenal face of vessels. Cell adhesion molecules, e.g., I-CAM-1 and its ligand adhesion molecule, leukocyte function antigen (LFA-1), are known to mediate adhesion. I-CAM-1, detected immunohistochemically, increased in graft vessels and in nearby brain vessels. The rise may have been mediated by cytokines, interleukin-6, and tumor necrosis factor-beta, found in the grafts. LFA-1, however, assayed by fluorescence-activated cell sorting, was on both activated and nonactivated, exogenous M phi. Thus, M phi-endothelial attachment may have involved other adhesion molecules, e.g., selectins. The autograft also induced major histocompatibility complex class I on microglia and classes I and II on brain vessels near the graft. These vessels, by expressing adhesion molecules, are entry routes into brain for activated, isogeneic leukocytes that can then migrate for a limited distance of 1-2 mm in an otherwise intact brain.

[Comparative antigen analysis of Trichomonas vaginalis by enzyme-linked immunoelectrotransfer blot technique]

Analysis of six isolates of Trichomonas vaginalis was carried out with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and enzyme-linked immunoelectrotransfer blot (EITB). Trichloroacetic acid-treated antigens of the 6 isolates revealed 25 protein profiles ranging 12-170 kDa of molecular weight in SDS-PAGE. In EITB, the specific immunogenic bands were visualized at 51 kDa and 96 kDa when HY-1 antigen was probed with different mice sera immunized with 6 isolates of T. vaginalis. The banding patterns with different sera showed isolate-to-isolate variability. In EITB, homologous antigen (HY-1) did not show any enhanced response in reacting to homologous antiserum (HY-1) when 6 isolates of T. vaginalis were probed with a single serum (HY-1). It is assumed that the different banding patterns of six isolates show isolate-to-isolate variability and immunogenic common bands in 41, 47, 74 and 94 kDa on EITB may connote the important significance on immune response in T. vaginalis infection.

Marjolin's ulcer: immunohistochemical study of 17 cases and comparison with common squamous cell carcinoma and basal cell carcinoma

Formalin-fixed, paraffin-embedded biopsy specimens of 17 cases of squamous cell carcinoma of Marjolin's ulcer (SCC-MU), 6 cases of common SCC (SCC), and 5 cases of basal cell carcinoma (BCC) were stained with three monoclonal antikeratin antibodies (CAM 5.2, MAK-6, and MA-903), a monoclonal antivimentin antibody (V9), and a polyclonal anticarcinoembryonic antigen antiserum (A115). Neoplastic cells of SCC-MU, SCC, and BCC showed consistently negative staining for CAM 5.2. A wide range of reactivity, from negative to diffuse strong positivity, among neoplastic cells of SCC-MU and SCC was noted with MAK-6. Alternatively, neoplastic cells of SCC-MU, SCC, and BCC consistently showed diffuse moderate to strong reactivity with MA-903. These findings imply that SCC-MU has largely high-molecular-weight keratins. They also showed a wide range of reactivity with V9. However, neoplastic cells of five of the six SCC and five cases of BCC were negative for V9. These findings suggest that neoplastic cells of SCC-MU contain vimentin in higher frequency than in the more usual SCC.

Structure of the mouse IL-10 gene and chromosomal localization of the mouse and human genes

The nucleotide sequence of a 7.2-kb segment containing the mouse IL-10 (mIL-10) gene was determined. Comparison to the mIL-10 cDNA sequence (Moore, K. W., et al. 1990. Science 248:1230; 250:494) revealed the presence of five exons that span approximately 5.1 kb of genomic DNA. The noncoding regions of the mIL-10 gene contain sequences that have been associated with transcriptional regulation of several cytokine genes. The mIL-10 gene was mapped to mouse chromosome 1 and the human IL-10 gene was also mapped to human chromosome 1.

Structure of the mouse IL-10 gene and chromosomal localization of the mouse and human genes

The nucleotide sequence of a 7.2-kb segment containing the mouse IL-10 (mIL-10) gene was determined. Comparison to the mIL-10 cDNA sequence (Moore, K. W., et al. 1990. Science 248:1230; 250:494) revealed the presence of five exons that span approximately 5.1 kb of genomic DNA. The noncoding regions of the mIL-10 gene contain sequences that have been associated with transcriptional regulation of several cytokine genes. The mIL-10 gene was mapped to mouse chromosome 1 and the human IL-10 gene was also mapped to human chromosome 1.

Nerve sheath myxoma (neurothekeoma)--a case report

A case of nerve sheath myxoma also called as neurothekeoma in a 33-year-old woman is described. The lesion appeared as a painful, elevated nodule on the scalp for several months, without an appreciable increase in size. Microscopically, it showed typical histologic characteristics of nerve sheath myxoma, and tumor cells revealed strong, positive reaction for S-100 protein and negativity for epithelial membrane antigen (EMA) on immunohistochemical staining. These immunohistochemical findings of this case support the view that the origin cells of this tumor may be schwann cells rather than perineurial cells. The histogenesis and differential diagnosis of this tumor are discussed.

Mid dermal elastolysis with wrinkling. Report of two cases and review of the literature

BACKGROUND

We observed two patients who had mid dermal elastolysis with wrinkling.

OBJECTIVE AND METHODS

We reviewed the pertinent features of the four cases reported in the literature and of our two cases. We also compared mid dermal elastolysis with other disorders of acquired elastolysis, such as postinflammatory elastolysis and cutis laxa, anetoderma, and (regular) cutis laxa.

RESULTS

Our two patients with mid dermal elastolysis with wrinkling were middle-aged, white women. Physical examination showed widespread wrinkling, erythematous patches (macules), and papules. Histologic examination showed patchy loss of elastic tissue limited to the mid dermis. In one of our patients, elastolytic skin lesions appeared on areas not covered by a two-piece swimsuit. She used to sunbathe frequently. In our other patient, skin lesions were also more prominent on exposed areas.

CONCLUSION

We speculate that sun exposure is one of the main causative factors of mid dermal elastolysis with wrinkling.

Use of a persistent photoconductive array in the learning of an optoelectronic neural processor

Persistent photoconductors of npnp doping-modulated amorphous silicon multilayers are investigated for the implementation of variable analog and nonvolatile synaptic weights of an optoelectronic neural processor. The time dependence of the persistent photoconductance of the amorphous silicon multilayers is characterized in experiments. The learning performance of an optical pattern classifier with the persistent photoconductive array is analyzed by computer simulations.

Quadriceps dislocation medial approach for intraarticular and medial structures of the knee

To minimize possible complications such as patellar subluxation, quadriceps atrophy and skin tightness and slough which interfere with successful rehabilitation following knee surgery, the author employed a quadriceps dislocation medial approach for total knee arthroplasty and ligament (medial and both cruciates) surgery. The results of this approach (99 knees) were compared with a medial capsular incision approach (111 knees), a lateral capsular incision approach (114 knees), and Hughston's medial hockey stick incision approach (122 knees). The skin slough, patellar subluxation, and sense of tightness during rehabilitation occurred least with the quadriceps dislocation medial approach (P less than .05). The quadriceps dislocation medial approach was also the most convenient approach of the four.

A case of primary T-cell lymphoma of the duodenum

Primary malignant lymphoma located in the duodenum is a rarity. A case of primary lymphoma of the duodenum in a 27-year-old man, in which the 2 discrete masses of duodenal bulb and the second portion with pancreatic head invasion was found, is reported here. Immunohistochemical evaluation of the present case showed that lymphoma cells expressed the T-cell markers MT1 and UCHL1. Treatment consisted of pancreaticoduodenectomy followed by antineoplastic chemotherapy.

Rapid neutrophil adhesion to activated endothelium mediated by GMP-140

Granule membrane protein-140 (GMP-140), a membrane glycoprotein of platelet and endothelial cell secretory granules, is rapidly redistributed to the plasma membrane during cellular activation and degranulation. Also known as PADGEM protein, GMP-140 is structurally related to two molecules involved in leukocyte adhesion to vascular endothelium: ELAM-1, a cytokine-inducible endothelial cell receptor for neutrophils, and the MEL-14 lymphocyte homing receptor. These three proteins define a new gene family, termed selectins, each of which contains an N-terminal lectin domain, followed by an epidermal growth factor-like module, a variable number of repeating units related to those in complement-binding proteins, a transmembrane domain, and a short cytoplasmic tail. Here we demonstrate that GMP-140 can mediate leukocyte adhesion, thus establishing a functional similarity with the other selectins. Human neutrophils and promyelocytic HL-60 cells bind specifically to COS cells transfected with GMP-140 complementary DNA and to microtitre wells coated with purified GMP-140. Cell binding does not require active neutrophil metabolism but is dependent on extracellular Ca2+. Within minutes after stimulation with phorbol esters or histamine, human endothelial cells become adhesive for neutrophils; this interaction is inhibited by antibodies to GMP-140. Thus, GMP-140 expressed by activated endothelium might promote rapid neutrophil targeting to sites of acute inflammation.

Structure and regulation of the senescence marker protein 2 gene promoter

The liver-specific expression of the senescence marker protein 2 (SMP-2) in the male rat is markedly reduced during the androgen-sensitive state of young adulthood, whereas it is up-regulated during the androgen-insensitive phases of prepuberty and senescence. Nuclear runoff studies show that the age-dependent changes in SMP-2 expression are due to transcriptional regulation of the gene. In order to explore the mechanism of the regulatory process, we have cloned the upstream flanking regions of two distinct SMP-2 genes (SMP-2A and SMP-2B) and established their nucleotide sequence. These clones contain approximately 2.2 kb of the 5'-flanking sequence, exons 1 and 2, the first intron, and a portion of the second intron. The SMP-2 genes, as well as the upstream sequences, contain the sequence motifs for a number of cis-acting regulatory elements, such as the hepatocyte-specific element (HP1) and the androgen response element (ARE). S1 nuclease and primer extension analyses have established the transcription initiation sites for these genes. For functional analysis of the upstream sequences, we have constructed a hybrid plasmid containing the SMP-2A gene sequence (-1970 to +38 bases) fused to the structural gene for chloramphenicol acetyl-transferase (CAT). Upon transfection into rat hepatoma cells (FT02B), this construct was able to drive expression of the CAT gene. The same construct, however, failed to function in fibroblast-derived L cells, indicating tissue-specific regulation of the construct promoter.

Microbial enzymes for creatinine assay: a review

A novel metabolic pathway for the degradation of creatinine with N-methylhydantoin, N-carbamoylsarcosine and sarcosine as successive intermediates was found to operate in Pseudomonas putida 77 and many other microorganisms. Enzymes involved in this pathway were purified from cells of P. putida 77 and characterized. The first step, deimination of creatinine, is catalyzed by cytosine deaminase/creatinine deiminase. The following two steps, ring-opening of N-methylhydantoin and decarbamoylation of N-carbamoylsarcosine, are catalyzed by new enzymes, N-methylhydantoin amidohydrolase and N-carbamoylsarcosine amidohydrolase, respectively. The former requires ATP, Mg2+, and K+ for the hydrolysis and the reaction proceeds as follows: N-methylhydantoin + ATP + 2 H2O----N-carbamoylsarcosine + ADP + Pi. The latter catalyzes the following reaction; N-carbamoylsarcosine + H2O----sarcosine + NH3 + CO2. Sarcosine dehydrogenase was found to be the responsible enzyme for the oxidation of sarcosine to glycine in P. putida 77, but sarcosine oxidase was also found to be involved in this oxidation in several microorganisms. These enzymes were found to be useful tools for determination of creatinine.

Sensitivity to both vecuronium and neostigmine in a sero-negative myasthenic patient

We describe a sero-negative ocular myasthenic patient who showed exaggerated responses to both vecuronium and neostigmine. These hypersensitive responses were not anticipated because preoperative clinical and laboratory evaluations suggested a negligible impairment of somatic muscles by myasthenic processes. This case report re-emphasizes that, if neuromuscular blocking agents and their antagonists are administered to myasthenic patients, regardless of the degree of impairment, the dose should be titrated carefully with the aid of a neuromuscular transmission monitor.

Etiology of childhood diarrhea in Korea

To assess the role of recently recognized enteropathogens in childhood diarrhea in Korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of Hanyang University Hospital in Seoul, Korea, were evaluated during a 14-month period. Stools were cultured for bacterial pathogens, including enterotoxigenic (heat-labile and heat-stable enterotoxin-producing) and enteroadherent organisms. Only those stools obtained from patients with diarrhea were examined for rotavirus. All Escherichia coli isolates were screened for Shiga-like toxin (SLT) I, SLT-II, enterohemorrhagic E. coli fimbriae, and enteroinvasiveness by colony hybridization. One or more pathogens were identified in 75.8% of the children with diarrhea. Rotavirus was the most frequently identified pathogen, accounting for 47% of the cases. Other major enteropathogens were enterotoxigenic E. coli (22%), Clostridium difficile (16%), enteroadherent E. coli (15%), and enteropathogenic E. coli (6%). Shigella spp., Campylobacter jejuni, Salmonella spp., SLT-I-and enterohemorrhagic-E. coli-fimbria-probe-positive E. coli serotype O26:H11 and enteroinvasive E. coli were isolated from only a few patients. Aeromonas hydrophila and E. coli O157 were not isolated. Compared with those of the controls, the isolation rates of heat-stable-enterotoxin-producing E. coli (P less than 0.05), C. difficile (P less than 0.025), and enteroadherent E. coli (P less than 0.05) were significantly higher in the patients with diarrhea. The greatest number of rotavirus, enterotoxigenic E. coli, and C. difficile cases were identified during the cool, dry months of October and November.

Calorie restriction delays age-dependent loss in androgen responsiveness of the rat liver

We have shown that restricted calorie intake retards age-associated loss in androgen responsiveness of the rat liver. Sustained androgen receptivity delays age-dependent decline in the synthesis of the androgen-inducible alpha 2u globulin and derepression of the androgen-repressible senescence marker protein (SMP-2). Quantitation of mRNAs for alpha 2u globulin and SMP-2 in the liver of animals of various ages maintained on either ad libitum or restricted diets revealed that, although the 27-month-old ad libitum-fed rat had only 5% as much alpha 2u mRNA as the 6-month-old rat, the mRNA level was as high as 45% in the 27-month-old food-restricted rat. Conversely, the 27-month-old food-restricted rat had a much reduced amount (45%) of SMP-2 mRNA compared to the age-matched control that was allowed unlimited access to food. Furthermore, we have correlated the effect of dietary restriction on age-dependent changes in specific gene expression with the hepatic level of the immunoreactive cytoplasmic androgen-binding (CAB) protein. We observed that senescence in the male causes a substantial decrease in the circulating level of testosterone. However, dietary restriction does not retard the rate of decline in the plasma level of the male hormone during aging. These results indicate that age-dependent changes in the expression of androgen-responsive genes (alpha 2u globulin and SMP-2) reflect changing androgen sensitivity and that food restriction may directly influence the androgen receptivity of the liver.

Diagnostic usefulness of Vi-indirect fluorescent antibody test(Vi-IFAT) for typhoid fever--a prospective study

Although the confirmative diagnosis of typhoid fever is by culture of the causative organism, usually from blood, a serological test is still necessary to provide a more rapid method of diagnosis. The indirect fluorescent antibody test, using a Salmonella typhi Vi antigen and a FITC-conjugated rabbit anti-human polyvalent immunoglobulin, was evaluated for the diagnosis of typhoid fever. Serum specimens were collected from patients with febrile diseases on admission. Of the 32 patients with titers of 1:64 or more, 22 were confirmed to have typhoid fever by blood culture and 7 had fever of undetermined origin that was considered to be typhoid fever clinically. Three patients were diagnosed to have salmonellosis other than typhoid fever. Of the 121 patients with titers of 1:32 or less, 105 patients had non-typhoidal febrile disease, 15 patients had fever of undetermined origin, and one patient was confirmed to have typhoid fever by blood culture. When a Vi antibody titer of 1:64 or more was taken as serological evidence for the diagnosis of typhoid fever, the sensitivity and specificity were 95.7% and 97.2%, respectively. The incidence of positive test results following fever onset was 70.0% within 1 week of fever onset, 88.9% from 1 to 2 weeks, and 100% after 2 weeks. In conclusion, the Vi-indirect fluorescent antibody test(Vi-IFAT) can be employed as a useful serologic test in the diagnosis of typhoid fever.

Cloning, sequencing, and regulation of rat liver carnitine octanoyltransferase: transcriptional stimulation of the enzyme during peroxisome proliferation

Several complementary DNAs for the peroxisomal enzyme carnitine octanoyltransferase (COT), cloned in the expression vector lambda gt11, have been isolated. Together, these clones cover 2143 bp of the COT cDNA sequence with an open reading frame for 523 amino acids. Northern analysis showed the mRNA size for this enzyme to be 3.5 kilobases. The 523 residue long amino acid sequence amounts to a molecular mass of 60,269 daltons, indicating that the cloned cDNAs contain most or all of the coding sequence for COT (Mr approximately 62,000). Hybridization studies showed that the increased COT activity in the liver of rats, fed the potent peroxisome-proliferating drug Wy-14,643, is associated with a more than 40-fold rise in the steady-state level of the COT mRNA.

Molecular cloning of an endoglucanase gene from an alkalophilic Bacillus sp. and its expression in Escherichia coli

One of the cellulase genes from alkalophilic Bacillus sp. strain N-4 was cloned in pBR322. A recombinant plasmid, pYBC107, expressing carboxymethyl cellulase (CMCase) was isolated, and the size of the cloned HindIII fragment was found to be 5.5 kilobases. The restriction map of pYBC107 showed a different pattern from those of pNKI and pNKII (N. Sashihara, T. Kudo, and K. Horikoshi, J. Bacteriol. 158:503-506, 1984). When the HindIII fragment from pYBC107 was subcloned into pYEJ001, there was a 3.8-fold increase in CMCase activity over that observed with pYBC107. Plasmid pYBC108 constructed by treatment of pYBC107 with HindIII and EcoRI expressed the CMCase activity, although to a limited extent. To verify the originality of cloned pYBC107 from Bacillus sp., we analyzed the restriction digest by Southern blotting.

PvO2 changes in cutaneous veins during regression of spinal anaesthesia

Following transurethral resection of the prostate under spinal anaesthesia, 26 patients were divided into two groups according to the sensory levels measured in the recovery room: Group A: 20 patients with sensory level T10 or above, and Group B: six patients with sensory level T11 or T12. Through an intravenous catheter placed preoperatively in a superficial vein of the foot, serial blood samples were drawn to measure the PvO2. In Group A, the PvO2 increased significantly after spinal anaesthesia compared with preoperative control values, then decreased when the sensory level receded to T11 or T12. In Group B, the changes in PvO2 from control to postspinal and to motor recovery were not significant. The authors postulate that sympathetic denervation induced by spinal anaesthesia increases the PvO2 by the opening of arteriovenous anastomoses in the cutaneous circulation, and the PvO2 decreases with sympathetic recovery. These findings confirm that significant sympathetic denervation of the lower limbs can be expected at a sensory level of T10 or above, and sympathetic recovery begins when the sensory level recedes below T10.

Antimicrobial susceptibility of bacteria isolated in 1985--with special reference to prevalence of methicillin-resistant staphylococcus aureus and activities of cefazolin, cefotaxime and piperacillin

Antimicrobial susceptibility of nine species and one group of bacteria isolated from patients at the hospitals of Seoul National University, Severance, Hanyang University, and Kyungpuk University were tested by agar dilution method. S. aureus was most susceptible to cefazolin, methicillin and cotrimoxazole, and enterococci to ampicillin. Isolates of Enterobacteriaceae were most frequently susceptible to aminoglycosides and cefotaxime. Cefazolin susceptibility was markedly different from species to species. Aminoglycosides and piperacillin were more active than others against P. aeruginosa, and amikachin against A. anitratus. A large proportion of strains of several different species were conditionally susceptible to either tetracycline, ampicillin, cefazolin or cotrimoxazole suggesting the usefulness of these drugs for treatment of urinary tract infection. Activity of cefotaxime was highest against E. coli, and K. pneumoniae, while lowest against A. anitratus and P. aeruginosa. Decrease in the proportion of susceptible isolate was noted in E. coli and K. pneumoniae to cefazolin, K. pneumoniae, E. cloacae and S. marcescens to cotrimoxazole, and P. aeruginosa to tobramycin and gentamicin.

Amidohydrolysis of N-methylhydantoin coupled with ATP hydrolysis

A new enzyme, N-methylhydantoin amidohydrolase, was highly purified from Pseudomonas putida 77: it catalyzes the hydrolysis of N-methylhydantoin to N-carbamoylsarcosine with the concomitant stoichiometric cleavage of ATP to ADP and orthophosphate. The enzyme absolutely requires ATP, MG2+ and K+ for the N-methylhydantoin hydrolysis. The rapid and complete degradation of N-methylhydantoin during the cultivation of P. putida 77, which rapidly degrades creatinine via only N-methylhydantoin and which shows high activities of the enzymes involved in creatinine degradation (Yamada et al. (1985) FEMS Microbiol. Lett. 30, 337-340), seems to be due to the continuous ATP-generation during cultivation.