[Primary pulmonary cryptococcosis with pleural effusion, and clinical studies of five cases]

A 35-year-old man was admitted with fever and right-sided chest pain. A chest X-ray film showed an apple-sized mass shadow in the right lower lobe and minimal pleural effusion Cryptococcus neoformans was identified by culture of the pleural effusion. Transbronchial lung biopsy was done, and pulmonary cryptococcosis was diagnosed. The patient's condition improved after treatment with fluconazole and miconazole. Two months after discharge he was readmitted with a massive ipsilateral pleural effusion. The serum cryptococcal antigen titer was almost normal, and examination of the effusion for cryptococcal antigen was negative. The effusion resolved with thoracic drainage and administration of imipenem. The second effusion was believed to have resulted not from cryptococcosis, but from another bacterial infectin. This case indicates that determination of cryptococcal antigen in serum is useful for diagnosis of pleural effusion and for monitoring pulmonary cryptococcosis. Clinical studies of five patients with pulmonary cryptococcosis indicated that symptoms and abnormal laboratory data were positive only in those with rather large lesions. In all cases the diagnosis was made after transbronchial lung biopsy, and treatment with antifungal agents including fluconazole was successful.

Amino acids and peptides. XXVI. Laminin-related peptide poly(ethylene glycol) hybrids and their inhibitory effect on experimental metastasis

Laminin-related peptide poly(ethylene glycol) hybrid, Tyr-Ile-Gly-Ser-Arg-aminopoly(ethylene glycol) was prepared by the solution method and carboxylated poly(ethylene glycol)-Tyr-Ile-Gly-Ser-Arg was prepared by the solid phase method. Their inhibitory effects on experimental tumor metastasis were examined in mice. The inhibitory effect of Tyr-Ile-Gly-Ser-Arg was significantly potentiated by hybrid formation with poly(ethylene glycol) either at amino- or carboxyl terminals of the peptide. Of the hybrids, Tyr-Ile-Gly-Ser-Arg-amino(polyethylene glycol) #6000 hybrid exhibited about 10 times more potent anti-metastatic effect than the peptide itself. The inhibitory effect of a mixture of the carboxylated poly(ethylene glycol) hybrid and Arg-Gly-Asp-aminopoly(ethylene glycol) hybrid also exhibited an inhibitory effect.

[Characteristics of early carcinomas and precancerous lesions in the urinary bladder]

Early transitional cell carcinomas of the urinary bladder are morphologically classified into papillary and non-papillary types, carcinoma in situ (CIS). Severe dysplasia is considered as a precancerous lesion for CIS which can be distinguished from the morphological appearance of its AgNORs. The conversion from severe dysplasia to CIS appears to require a longer time than that needed for invasive lesion to develop from CIS. It is postulated that mild or moderate dysplasia results in G1 and 2 grade papillary transitional cell carcinomas. Molecular analysis of different types of dysplasia is therefore clearly warranted to assist in diagnostic classification.

[Epidemic of influenza in Kyushu-Okinawa District (April 1994-March 1995)]

The prevalence of influenza in Kyushu-Okinawa District in April 1994- March 1995 was studied as the prevalence of influenza virus, to determine the sero-type of influenza viruses isolated in Kyushu- Okinawa District prefectures and cities. As a result, three sero-types of influenza viruses, i.e. type A/H1N1, type H3N2 and type B, were isolated in Kyushu-Okinawa District in this season, but most of the isolates were type A/H3N2 and type B. Weekly changes of reported influenza patients and period of virus isolation at local public health institutes revealed that influenza epidemics of the earlier part in this season was caused by type A/H3N2 and the latter part due to type B. Type A/H3N2 spread all over Kyushu-Okinawa District in a shorter period (about 2 weeks) through the westside of Kyushu and down south, and type B stayed about one month in northern Kyushu and took about 7 weeks to spread all over Kyushu-Okinawa District. Based on these results, the spread of influenza virus in Kyushu-Okinawa District was visualized on the isopleth maps.

Induction of cyclooxygenase type-2 (COX-2) in rat endometrium at the peak of serum estradiol during the estrus cycle

We investigated the induction of cyclooxygenase (COX) in rat endometrium during the estrus cycle. The estrus cycle was divided into five stages (proestrus, estrus, diestrus-1, diestrus-2, diestrus-3) by cytological observation of vaginal smears. COX-1 was detected in the endometrium during all five stages of the estrus cycle. In contrast, COX-2 in the endometrium was detectable only in three stages (diestrus-3, proestrus, estrus) and showed a peak at diestrus-3, coinciding with the peak in serum estradiol level, suggesting the estradiol-dependent induction of COX-2.

Delayed herpes zoster pseudodendrites. Polymerase chain reaction detection of viral DNA and a role for antiviral therapy

BACKGROUND

The late-onset pseudodendrites, delayed corneal mucous plaques, of herpes zoster ophthalmicus are reported to be of mechanical or immune origin and to be worsened by antiviral therapy.

OBJECTIVE

To study pseudodendrites to ascertain a viral presence in the lesions and their response to antiviral therapy.

DESIGN

Prospective clinical study.

SETTING

Outpatient and inpatient hospital-based corneal specialty referral practice; molecular virology laboratory.

PATIENTS

Six patients, aged 33 to 89 years, four with delayed herpes zoster ophthalmicus pseudodendrites and two with herpes zoster ophthalmicus neurotrophic ulceration. One patient was immunosuppressed.

MAIN OUTCOME MEASURES

Findings from clinical evaluation; polymerase chain reaction assays of lesions and tear film of six patients; polymerase chain reaction and light and electron microscopy of the corneal button from one patient; and the clinical response of four patients to various antiviral drugs.

RESULTS

In contrast to reports in the current literature, delayed pseudodendrites may also be infectious, as they are positive for zoster DNA by polymerase chain reaction and appear responsive to certain antiviral therapy. The corneal button from an immunosuppressed patient had mature and immature viral particles in the basal cells within 2 weeks of transplantation.

CONCLUSIONS

To our knowledge, this is the first report of viral DNA in delayed zoster pseudodendrites. Recurrent viral infection may play a role in this form of zoster keratopathy and warrant antiviral therapy.

[Surgical problem of lung cancer with coexisting acute pulmonary tuberculosis]

Four patients with coexistent lung cancer and acute pulmonary tuberculosis were operated during recent 5 years. All were males and cigarette smokers (B.I. > 600). Adenocarcinoma were recovered from 3 patients, while the remaining 1 had squamous cell carcinoma. Only 1 curative resection was performed for lung cancer. In most cases, late stage of the disease was alleged to be a factor contributing to the poor prognosis.

A histologically distinctive interstitial pneumonia induced by overexpression of the interleukin 6, transforming growth factor beta 1, or platelet-derived growth factor B gene

Interstitial pneumonia is characterized by alveolitis with resulting fibrosis of the interstitium. To determine the relevance of humoral factors in the pathogenesis of interstitial pneumonia, we introduced expression vectors into Wistar rats via the trachea to locally overexpress humoral factors in the lungs. Human interleukin (IL) 6 and IL-6 receptor genes induced lymphocytic alveolitis without marked fibroblast proliferation. In contrast, overexpression of human transforming growth factor beta 1 or human platelet-derived growth factor B gene induced only mild or apparent cellular infiltration in the alveoli, respectively. However, both factors induced significant proliferation of fibroblasts and deposition of collagen fibrils. These histopathologic changes induced by the transforming growth factor beta 1 and platelet-derived growth factor B gene are partly akin to those changes seen in lung tissues from patients with pulmonary fibrosis and markedly contrast with the changes induced by overexpression of the IL-6 and IL-6 receptor genes that mimics lymphocytic interstitial pneumonia.

Partial purification and characterization of the porcine brain enzyme hydrolyzing and synthesizing anandamide

Anandamide (arachidonylethanolamide) is known as an endogenous agonist for cannabinoid receptors. An amidohydrolase, which hydrolyzed anandamide, was solubilized from the microsomal fraction of porcine brain with 1% Triton X-100. The enzyme was partially purified by Phenyl-5PW hydrophobic chromatography to a specific activity of approximately 0.37 mumol/min/mg of protein at 37 degrees C. As assayed with 14C-labeled substrates, the apparent Km value for anandamide was 60 microM, and anandamide was more active than ethanolamides of linoleic, oleic, and palmitic acids. Ceramidase and protease activities were not detected in our enzyme preparation. The purified enzyme also synthesized anandamide from free arachidonic acid in the presence of a high concentration of ethanolamine with a specific activity of about 0.16 mumol/min/mg of protein at 37 degrees C. On the basis of cochromatographies, pH dependence, heat inactivation, and effects of inhibitors such as arachidonyl trifluoromethyl ketone, p-chloromercuribenzoic acid, diisopropyl fluorophosphate, and phenylmethylsulfonyl fluoride, it was suggested that the anandamide amidohydrolase and synthase activities were attributable to a single enzyme protein.

Frequent mutations of the p53 gene and infrequent H- and K-ras mutations in urinary bladder carcinomas of NON/Shi mice treated with N-butyl-N-(4-hydroxybutyl)nitrosamine

To elucidate whether common genetic events in human urinary bladder carcinogenesis also occur in rodent models, we investigated the presence of p53, H- and K-ras mutations in 18 urinary bladder carcinomas induced by various concentrations of N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) in male NON/Shi mice. Histopathologically, all were invasive, 11 being squamous cell carcinomas (SCCs) and the remaining seven being transitional cell carcinomas (TCCs). Using polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis followed by DNA sequencing, p53, H- and K-ras mutations were observed in 14 (78%; exons 5-7), two (11%; one each on exons 1 and 2) and one (5.6%; exon 1) animals respectively. The frequencies of mutations in p53 exons 5, 6 and 7 were 7 (39%), 4 (22%), and 9 (50%) respectively, and no mutation was found in exon 8. All mutations involved one base-pair substitution with or without amino acid changes and the types of base-pair substitution were random. No evident association was observed between mutation sites and the histological phenotypes. In conclusion, p53 mutations are frequent in BBN-induced mouse invasive urinary bladder tumors, at similar levels to those observed for human high-grade invasive carcinomas, and this plus their distribution suggests their possible participation in this model of urinary bladder carcinogenesis.

Chronological changes of arterial diameter, cGMP, and protein kinase C in the development of vasospasm

BACKGROUND AND PURPOSE

We hypothesized that nitric oxide exerts a negative feedback control on protein kinase C (PKC) activation, and the disturbance of the feedback control after subarachnoid hemorrhage results in vasospasm due to PKC activation. This study was undertaken to verify this hypothesis.

METHODS

Different dogs were prepared for three separate experiments: measurement of the angiographic diameter of the basilar artery and determination of cGMP and PKC activity in vascular smooth muscle cells. In each experiment, two models were used: the single-hemorrhage model for mild vasospasm and the two-hemorrhage model for severe vasospasm. In both models, chronological changes of these three parameters were examined from day 1 until day 7.

RESULTS

In the single-hemorrhage model, mild vasospasm and a slight decrease of the cGMP level were noted on day 4, then both returned to the baseline levels on day 7. PKC activity was slightly enhanced throughout the study period. In the two-hemorrhage model, severe vasospasm and a significant decrease of the cGMP level were observed on day 5 and persisted until day 7. PKC activity was remarkably enhanced from day 5 until day 7. The differences between the two models with regard to the three parameters were statistically significant.

CONCLUSIONS

The decrease of cGMP level and the enhancement of PKC activity were obviously associated with the development of severe vasospasm. We conclude that subarachnoid hemorrhage disturbed the feedback control exerted by nitric oxide on PKC activation, leading to PKC-dependent vasospasm.

Demonstration of a ferric vibrioferrin-binding protein in the outer membrane of Vibrio parahaemolyticus

Under iron-restricted conditions, Vibrio parahaemolyticus produces a siderophore, vibrioferrin, accompanying expression of two major outer membrane proteins of 78 and 83 kDa. Autoradiographic analysis of nondenaturing polyacrylamide gel electrophoregrams of outer membrane preparations previously incubated with [35Fe]ferric vibrioferrin revealed a single radiolabeled band, in which the 78-kDa protein was detected predominantly by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The antiserum against the purified 78-kDa protein partially inhibited Fe-VF binding to isolated OMPs. The 78-kDa protein was cleaved by the treatment of whole cells with proteinase K, indicating that a portion of this protein is exposed on the surface of the outer membrane. The treated cells lost most of their iron uptake activity mediated by vibrioferrin. These results suggest that the ferric vibrioferrin-binding protein of 78 kDa may function as the receptor for ferric vibrioferrin involved in the initial step of vibrioferrin-mediated iron uptake. Immunoblot analysis using the antiserum against the 78-kDa protein demonstrated that the molecular mass and antigenic properties of the protein were highly conserved among V. parahaemolyticus strains examined. The antiserum also recognized an iron-repressible outer membrane protein of 78 kDa from iron-restricted V. alginolyticus strains, some of which appeared to produce vibrioferrin.

Body fat distribution in women with polycystic ovary syndrome

OBJECTIVE

To investigate body fat distribution in women with polycystic ovary syndrome (PCOS).

METHODS

Body weight, body mass index (BMI), and six indices of body fat measured by dual-energy x-ray absorptiometry were compared in 40 women with PCOS and 97 age-matched controls. The possible correlations between the body fat characteristics and serum androgen levels were evaluated in the 40 PCOS women. Body fat distribution was classified into upper- (N = 24) and lower-half body type (N = 16), and androgen levels and the incidence of hirsutism were compared in the two types.

RESULTS

The BMI, body fat ratio, upper-half body fat ratio, and upper-half/lower-half body fat ratio were significantly higher in PCOS women than in controls. After adjustment for age, height, and body weight, the upper-half/lower-half body fat ratio was still significant (P < .001). The PCOS subjects exhibited a significant positive correlation between the upper-half/lower-half body fat ratio and dehydroepiandrosterone-sulfate (DHEA-S) levels (r = 0.607, P < .01) as well as testosterone levels (r = 0.585, P < .05). Dehydroepiandrosterone-sulfate and testosterone levels were significantly higher in those with the upper-half body type than in those with the lower-half body type (P < .001). After adjustment for confounding variables, only DHEA-S was still significantly higher in this body type (P < .05).

CONCLUSION

Serum DHEA-S levels seem to be associated with upper-half body fat distribution in women with PCOS, irrespective of body weight.

Tenodesis of extensor digitorum in treatment of brachial plexus injuries involving C5, 6, 7 and 8 nerve roots

Restoration of motor function in the hand is difficult in brachial plexus injuries in which the C5, 6, 7 and 8 roots are involved, because there are insufficient motors available for transfer to restore the extensors of the fingers and wrist. We have used extensor digitorum tenodesis in 11 cases and found it effective and simple.

Detection of urovirulence factors in Escherichia coli by multiplex polymerase chain reaction

Primers to amplify the genes encoding the virulence factors of uropathogenic Escherichia coli, such as pilus associated with pyelonephritis (pap), haemolysin (hly), aerobactin (aer) and cytotoxic necrotizing factor 1 (cnf1) genes, were designed. The above primers along with previously reported primers for S fimbriae (sfa) and afimbrial adhesin I (afaI) genes were combined to develop a multiplex polymerase chain reaction (PCR) for detection of the respective virulence factors and for the identification of uropathogenic E. coli. The multiplex PCR to detect pap, sfa, afaI, hly, aer and cnf1 genes was highly specific and the sensitivity was found to be about 5 x 10(3) colony forming units of E. coli per ml. A total of 194 E. coli strains isolated from patients with simple acute cystitis were examined by the multiplex PCR and the results were in complete agreement with that obtained by DNA colony hybridization test. The multiplex PCR developed was, therefore, concluded to be a useful, sensitive and rapid assay system to identify uropathogenic E. coli.

CD14 enhances cellular responses to endotoxin without imparting ligand-specific recognition

Binding of the lipid A portion of bacterial lipopolysaccharide (LPS) to leukocyte CD14 activates phagocytes and initiates the septic shock syndrome. Two lipid A analogs, lipid IVA and Rhodobacter sphaeroides lipid A (RSLA), have been described as LPS-receptor antagonists when tested with human phagocytes. In contrast, lipid IVA activated murine phagocytes, whereas RSLA was an LPS antagonist. Thus, these compounds displayed a species-specific pharmacology. To determine whether the species specificity of these LPS antagonists occurred as a result of interactions with CD14, the effects of lipid IVA and RSLA were examined by using human, mouse, and hamster cell lines transfected with murine or human CD14 cDNA expression vectors. These transfectants displayed sensitivities to lipid IVA and RSLA that reflected the sensitivities of macrophages of similar genotype (species) and were independent of the source of CD14 cDNA. For example, hamster macrophages and hamster fibroblasts transfected with either mouse or human-derived CD14 cDNA responded to lipid IVA and RSLA as LPS mimetics. Similarly, lipid IVA and RSLA acted as LPS antagonists in human phagocytes and human fibrosarcoma cells transfected with either mouse or human-derived CD14 cDNA. Therefore, the target of these LPS antagonists, which is encoded in the genomes of these cells, is distinct from CD14. Although the expression of CD14 is required for macrophage-like sensitivity to LPS, CD14 cannot discriminate between the lipid A moieties of these agents. We hypothesize that the target of the LPS antagonists is a lipid A recognition protein which functions as a signaling receptor that is triggered after interaction with CD14-bound LPS.

[Dissection-like artifact on one-second scanning time CT]

Dissection-like artifact (DLA) is noted only on one-second scanning time CT image. It is usually observed in the ascending aorta, and less commonly in the superior vena cava and right pulmonary artery. We evaluated 136 cases of thoracic CT (including 20 cases of heart failure), and examined how often and where the artifact is noted and why it is produced. DLA was noted in the ascending aorta in 99 cases. Among the 99 cases, the same artifacts were also shown in the superior vena cava in 26 cases, and in the right pulmonary artery in 10 cases. DLA was never observed in other great vessels, such as the descending aorta and inferior vena cava. This artifact was not demonstrated in patients with heart failure. We presume that DLA is produced by pulsation of the ascending aorta and pulmonary artery. If the artifact is observed, the patient does not have severe cardiac impairment.

Lithium addition to neuroleptic treatment in chronic schizophrenia: a randomized, double-blind, placebo-controlled, cross-over study

We studied the effect of lithium addition to neuroleptic treatment in chronic schizophrenia, for which contradictory results have been produced in previous studies. Twenty-one chronic schizophrenic inpatients received lithium in a study with randomized, double-blind, placebo-controlled, cross-over design consisting of 8 weeks each of treatment with lithium capsules and identical placebo capsules. The total Brief Psychiatric Rating Scale (BPRS) scores at week 8 of the lithium treatment were improved significantly compared with those at week 8 of the placebo treatment. Of the BPRS subscales, however, only anxiety-depression improved, whereas none of the subscales for anergia, thought disturbance, activation and hostile-suspiciousness improved. There was no significant difference between the total Scale for the Assessment of Negative Symptoms (SANS) scores at any time during lithium and placebo treatment. These results suggest that the addition of lithium to neuroleptic treatment improves anxiety-depression in chronic schizophrenia.