A novel antimicrobial peptide from Bufo bufo gargarizans

A potent and structurally novel antimicrobial peptide was isolated and characterized from the stomach tissue of Bufo bufo gargarizans, an Asian toad. The 39-amino acid peptide, named buforin I, was purified to homogeneity by heparin-affinity column and reverse-phase HPLC. The amino acid sequence of buforin I was identical in 37 of 39 amino-terminal residues of Xenopus histone H2A. The buforin I showed strong antimicrobial activities in vitro against a broad-spectrum of microorganisms and was found to be more potent than magainin 2. In addition, a 21-amino acid peptide, named buforin II, which was derived from buforin I, showed more potent antimicrobial activities than buforin I.

Electronmicroscopic observation of the basement membrane zone in focal dermal hypoplasia

A 3-month-old boy had reticulated achromic and atrophic skin lesions on the right buttock and thigh, as well as partial syndactyly of the third and fourth toes of the right foot. With hematoxylin and eosin stain, an epidermal defect, abnormally located fat cell lobules, and absence of the upper and midportions of the dermis were observed, conforming to a typical histopathologic picture of focal dermal hypoplasia. Electron microscopic examination of the atrophic site showed loose collagen bundles, collagen fibers with loss of regular bands, abnormal fibroblasts, and disruption of the basement membrane zone. These defects in the basement membrane zone strongly suggest that abnormal formation of type IV collagen is associated with focal dermal hypoplasia, and that this abnormal formation of collagen is correlated with the clinical sign of skin atrophy.

Distribution of HLA class II alleles in Korean patients with epidermolysis bullosa acquisita

The distribution pattern of HLA class II alleles in 12 Korean patients with epidermolysis bullosa acquisita was examined. The major difference in the allelic frequency comparing with the controls was a higher DRB1*13 allele with these patients (p = 0.066).

Mechanical reliability of AMS hydraulic penile prostheses

The mechanical reliability of AMS hydraulic penile prostheses implanted in 203 patients from April 1985 to June 1995 were evaluated. AMS Hydroflex prosthesis showed the highest incidence of mechanical failure (18.8%; 6/32 patients) during a mean follow-up period of 94.5 (64-117) months. Mean functioning time of the prostheses until malfunction was 50 (0-100) months. Bilateral fractures at junction of rear reservior and inflation chamber were found in 3 patients. AMS Dynaflex had a failure rate of 2.4% (2/85 patients) for an average of 35.3 (1-59) months. One patient showed complete fracture of silicone ball covering the proximal end of rear reservior onto which rear tip extenders are snapped. Regarding 3-piece inflatable prosthesis, AMS 700, AMS 700CX and AMS Ultrex had failure rates of 11.1% (1/9 patients), 10.5% (2/19 patients) and 4.0% (1/25 patients) during a mean follow-up period of 116.4 (103-125), 79.0 (60-94) and 44.4 (22-57) months, respectively. The verified causes of the mechanical failures were a tiny rupture of the cylinder in one case of AMS 700, an incomplete fracture of input tube in one case of AMS 700CX and a pump malfunction in one case of Ultrex. However, none of 33 cases of AMS 700CXM showed mechanical failure for an average of 21.3 (2-43) months. Therefore, AMS 700CXM and Ultrex seem to be very reliable, and the reliability of AMS Dynaflex was much higher than that of AMS Hydroflex. However, the long-term reliability of these devices needs more time to be determined.

Conformation and activity of +H2-Pro-Leu-Gly-NH2 and its analogues modified at the leucyl residue

In order to investigate the relation between the conformation and the ability to modulate dopamine receptors, conformational free-energy calculations using an empirical potential (ECEPP/3) and hydration shell model were carried out on the tripeptide +H2-Pro-Leu-Gly-NH2 (PLG) and its analogues in which the Leu residue is replaced with Phe, Ahx (L-2-aminohexanoic acid), Ile, Abu and Ala residues in the unhydrated and hydrated states. PLG and two tripeptides possessing Phe and Ahx residues show dopamine receptor modulating activity, while the other tripeptides do not. Irrespective of activities, PLG and its analogues are found to have the high probabilities to form beta-bends of types II and I in the unhydrated state. However, in the hydrated state, the beta-bend probabilities of the PLG analogues decrease significantly compared with those in the unhydrated state. These results indicate that the beta-bend structure is a necessary factor for the PLG analogues to be active, but not a sufficient factor, and that the interactions of water molecules with the backbone may force the tripeptides to be more distorted or extended. The size and the orientation of the hydrophobic moiety of the second residue seem to be of consequence in eliciting the activity of the tripeptides.

Phenylketonuria screening: effect of early newborn discharge

OBJECTIVE

To determine the percentage of term newborns discharged by 24 hours of life and the actions taken by physicians and institutions to avoid false-negative phenylketonuria (PKU) screens in these infants.

DESIGN

Descriptive cross-sectional survey.

PARTICIPANTS

One hundred forty term nurseries and 157 pediatricians.

SELECTION PROCEDURE

Stratified sampling techniques were used to sample nurseries from the 1992 American Hospital Association guide to provide equal representation of each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state.

RESULTS

The response rates were 95% (n = 133) for term nurseries and 83% (n = 131) for pediatricians. Twenty-four percent of healthy newborns are discharged by 24 hours of life. Ninety-three percent of nurseries screen all infants for PKU before discharge. In states without laws mandating rescreening, only 48% of institutions that discharge the majority of their infants (> 50%) by 24 hours of life rescreen. Also, in states without rescreening laws, 64% of pediatricians rescreen. The timing of this repeat screen ranges from less than 72 hours of life to 4 weeks. Determining which infants to rescreen varies by practitioner; some rescreen all infants, whereas others rescreen those discharged early. Just more than half of all pediatricians, whether practicing in a state requiring repeat PKU screening, claim to be familiar with the American Academy of Pediatrics recommendations regarding repeated PKU screening of infants discharged by 24 hours of life.

CONCLUSION

Twenty-four percent of term newborns in the United States are discharged by 24 hours of life. Most hospitals screen all infants for PKU before discharge regardless of age. The majority of states do not mandate rescreening; rescreening policies among pediatricians and institutions in those states vary widely. A significant number of infants do not receive repeated screening and are therefore at risk for delayed or missed diagnosis of PKU because of insensitive initial screens. Pediatrician awareness of the need to perform repeated PKU screens on infants discharged by 24 hours is poor.

Discrepancy of recovery times related to potency between atracurium and mivacurium simultaneously administered in isolated forearms

Recovery from potent non-depolarising muscle relaxants is slower than from the less potent agents. However, recovery from mivacurium, which is more potent than atracurium, is faster than from atracurium following systemic administration. In an attempt to confirm this discrepancy we compared recovery times following simultaneous administration of equipotent doses of atracurium and mivacurium into the isolated forearms of human volunteers (n = 10). This method enabled us to study the interaction of muscle relaxants with receptors at the neuromuscular junction separated from the effects of plasma drug concentration. In these experiments, the recovery times from maximum block to 50% recovery of control twitch height were significantly longer with mivacurium than with atracurium (mean 25.2(SD 4.7) versus 22.6(3.1) min, p < 0.01). We found that the evidence that mivacurium has a slower recovery than the less potent atracurium may be true using the bilateral, isolated forearm technique and that the discrepancy might be due to a difference in the pharmacokinetic variables of the two drugs.

Universal hepatitis B immunization

OBJECTIVE

To determine the practices of US nurseries, neonatal intensive care units (NICUs), and pediatricians regarding universal hepatitis B vaccination.

DESIGN

Descriptive cross-sectional survey.

PARTICIPANTS

One hundred forty term nurseries, 152 NICUs, and 157 pediatricians. Selection procedure. Nurseries and NICUs were systematically sampled from the 1992 American Hospital Association Guide to provide equal sampling from each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state.

RESULTS

The response rates were 95% (n = 133) for term nurseries, 95% (n = 144) for NICUs, and 83% (n = 131) for pediatricians. Sixty-two nurseries (47%) provide routine hepatitis B vaccine (HBV) to their infants. Eighty-five NICUs (59%) routinely vaccinate their preterm infants; 62 (73%) initiate the series just before discharge; and 11 (13%) do so at birth. Principal reasons for not vaccinating include cost and a preference to allow the primary-care physician to initiate the series. One hundred ten (85%) pediatricians provide universal hepatitis B vaccination. Principal reasons for not vaccinating include cost and parents opting against vaccination.

CONCLUSIONS

More than half of NICUs provide HBV routinely to their preterm infants, predominantly just before hospital discharge. A minority of NICUs are initiating vaccination at birth, which may provide suboptimal seroconversion. Although less than half of participating term nurseries are routinely vaccinating before discharge, 85% of pediatricians do initiate HBV by two months of age. The principal reasons for not providing vaccine are financial.

Ichthyosis bullosa of Siemens: report of a sporadic case

We report a sporadic case of ichthyosis bullosa of Siemens occurring in a Korean boy. In this report, the varied findings of the clinical features in one subject over five years are presented along with an investigation of the ultrastructural alteration. The patient had suffered from blistering, superficial peeling, and dark-grey colored lichenified patches on the extremities since infancy. As he grew older, the lesions were more localized to the elbows, knees, buttock and the dorsal aspects of the hands and feet, and were replaced by yellowish, lichenified plaques. Since the original report of Siemens in 1937, nine families including one sporadic case have been reported in the literature. To our knowledge, this is the second report of sporadic case of IBS.

Fatal vascular involvement in systemic lupus erythematosus following epidermolysis bullosa acquisita

Epidermolysis bullosa acquisita may be associated with various systemic diseases, including systemic lupus erythematosus. We describe the clinical and immunological findings in a 38-year-old women with epidermolysis bullosa acquisita and systemic lupus erythematosus. The epidermolysis bullosa acquisita preceded a dramatic flare of systemic lupus erythematosus and fatal cerebral vasculitis. If serologic evidence of lupus erythematosus develops during the course of epidermolysis bullosa acquisita, a thorough investigation is warranted to rule out potentially life-threatening systemic lupus erythematosus.

A giant ureteral stone

A 55-year-old woman suffered from right flank pain and had a right giant ureteral stone with hydronephrosis. Ureterolithotomy was performed. The ureteral stone was 11cm long and weighed 45gm.

A comparison of the relaxation responses of isolated cavernosal smooth muscles by endothelium-independent and endothelium-dependent vasodilators in diabetic men with impotence

This study was intended to explore the effects of endothelium-independent, direct smooth muscle relaxants(papaverine, verapamil) and endothelium-dependent vasodilators(acetylcholine, bradykinin, adenosine) on the isolated cavernosal smooth muscle strips taken from diabetic men with impotence. When smooth muscle contraction was evoked with norepinephrine for the study of relaxation to these vasodilators, the tension induced was similar in diabetic and non-diabetic men with importance. Papaverine showed the strongest relaxation response followed by verapamil, acetylcholine, bradykinin and adenosine both in non-diabetic and in diabetic men. Relaxation of the cavernosal tissues to endothelium-independent vasodilators was similar in non-diabetic and diabetic men. However, the relaxation response of the tissues to endothelium-dependent vasodilators was significantly reduced in the diabetic group compared with that in the non-diabetic group (p < 0.05). In conclusion, the impairment of endothelium-mediated relaxation of cavernosal smooth muscle seems to play a more important role in the pathogenesis of diabetogenic impotence rather than the problem of smooth muscle itself. This finding forms a rational basis for the use of intracavernosal injections of vasodilators to induce endothelium-independent relaxation of the cavernosal smooth muscle in the patients with diabetogenic impotence.

Antithrombogenicity of hydrophilic polyurethane-hydrophobic polystyrene IPNs. I. Synthesis and characterization

A series of interpenetrating polymer networks (IPNs) composed of hydrophilic polyurethane (PU) and hydrophobic polystyrene (PS) were prepared by the simultaneous polymerization method. The PU network was synthesized via the isocyanate-terminated PU prepolymer based on polyethylene glycol (PEG), a highly hydrophilic oligomer, and hexamethylene diisocyanate (HDI). The bulk and surface characteristics of these materials were analyzed by differential scanning calorimetry (DSC), tensile testing, scanning electron microscopy (SEM), attenuated total reflectance-Fourier transform infrared (ATR-FTIR), electron spectroscopy for chemical analysis (ESCA), and contact angle measurement. The PU/PS IPNs prepared in this study exhibited phase separated structures, which had dispersed PS domains in the continuous PU matrix, in both the bulk and surface showing two transition temperatures. The IPN containing 50 wt% of PS showed good mechanical properties. The enrichment of PU phase in the surface was revealed by SEM, ATR-FTIR, ESCA, and contact angle measurement.

Antithrombogenicity of hydrophilic polyurethane-hydrophobic polystyrene IPNs. II. In vitro and ex vivo studies

To investigate the effect of hydrophilic and hydrophobic surfaces with phase separated structure on their blood responses, interpenetrating polymer networks (IPNs) composed of hydrophilic polyurethane (PU) and hydrophobic polystyrene (PS) were prepared by simultaneous polymerization. In vitro protein adsorption, in vitro platelet adhesion, and ex vivo A-A shunt test were carried out to evaluate the blood compatibility of the PU/PS IPNs. The results of protein adsorption on the PU/PS IPN surfaces indicated that albumin preferentially adsorbed on the hydrophilic surface (PU), while fibrinogen preferentially adsorbed on the hydrophobic surface (PS). The PU/PS IPNs exhibited suppressive properties for both platelet adhesion and activation. The occlusion time of U50S50 IPN containing 50 wt% of PS was twice as long as that of the PU control (50 min), indicating enhanced blood compatibility, presumably due to the selective adsorption of plasma proteins and the suppression of the adhesion and activation of platelets.

Bilateral fractures of Hydroflex penile prostheses: an unusual complication

We report bilaterally fractured Hydroflex implants in 2 patients. One fracture was complete and three were incomplete. All the fractures occurred at the junction of the rear reservoir and the inflation chamber.

Conformation and sweet tastes of L-aspartyl dipeptide methyl esters

In order to investigate the conformational preferences to elicit tastes, conformational free energy calculations using an empirical potential (ECEPP/2) and the hydration shell model were carried out on the L-aspartyl dipeptide methyl esters, L-(+)HAsp(-)-L-Xaa-OMe, in the hydrated state, where Xaa includes sweet (Phe, Tyr, Met, and Gly), bitter (Ala, Trp, Val, Leu, and Ile), and tasteless (Ser, Thr, and Abu) residues. The refined preferred conformation of the Phe dipeptide (aspartame) with side chain chi 1/2 conformation g- is g-Fg- in the hydrated state, which is consistent with the structure deduced from 1H-nmr experiments. Irrespective of the Xaa and taste, all the dipeptides have the same conformation for the Asp residue, which is attributable to the hydrogen bond between protonated amino hydrogen and carboxylate oxygen and the favored hydration of the carboxylate group. This implies that the L-aspartyl residue is a necessary factor for the dipeptides to be sweet not a sufficient factor. The computed conformational preferences for sweet, bitter, and tasteless dipeptides in the hydrated state indicate to us that the conformation about the N--C alpha bond of the Xaa residue, i.e., the orientation of the hydrophobic moiety with respect to the AH/B functionalities in the aspartyl moiety, seems to be crucial to elicit the tastes. In addition, the hydrophobicity and the size of the Xaa residue are found to play a major role in determining the tastes. These well accord with the related works reported previously.

Prognostic significance of signet ring cell carcinoma of the stomach

A retrospective analysis of 3,702 gastric cancer patients operated on between 1981 and 1991 was carried out to compare the clinicopathological features of signet ring cell (SRC) gastric cancer with other cell types. Four hundred and fifty patients (12.2%) had signet ring cell gastric carcinoma. There was a tendency for patients with the signet ring cell gastric cancer to be younger and female, and of the middle-third part of stomach to be involved. The proportion of early gastric cancers in signet ring cell gastric cancers was 43%, which was significantly higher than in the other histological types [33% in well differentiated (WD) type, 23% in moderately differentiated (MD) type, and 13% in poorly differentiated (PD) type]. Early stage signet ring cell gastric carcinomas were less invasive in depth and had less lymph node metastasis. However, signet ring cell gastric cancers in advanced stage were more invasive and had more lymph node metastasis than other cell types. There was no significant difference in five year survival rates (5YSR) among patients with different histological cell types in early stage gastric cancers. But, in advanced gastric cancers, the prognosis for patients with the signet ring cell type was significantly worse than for the other types (SRC, 31.9% 5YSR; WD, 45.1% 5YSR; MD, 38.4% 5YSR; PD, 34.5% 5YSR) (P < 0.05), which can be explained by the finding that advanced gastric cancers with signet ring cell type have a larger tumour size, more lymph node metastasis, a deeper invasive depth and more Borrmann type 4 lesions than other histological types. This study suggests that signet ring cell gastric cancer may have a different biological behaviour.

Effects of ouabain on smooth muscle of the corpus cavernosum

The effect of ouabain, an inhibitor of the membrane Na+/K+ ATPase, on smooth muscle of the corpus cavernosum was investigated. In an in vivo study using dogs, the intracorporeal pressures (ICPs) were measured before and during electrical stimulation of the cavernous nerve, and during nerve stimulation following intracorporeal injection of ouabain (1 x 10(-7) M). There was a significant drop of ICP following intracorporeal injection of ouabain (P < 0.001). In the in vitro study, ouabain increased the basal tone of the isolated cavernosal strip from the rabbit. When the strip was pretreated with tetrodotoxin (5 x 10(-7) M), phentolamine (1 x 10(-5) M), propranolol (1 x 10(-5) M) and atropine (1 x 10(-5) M), ouabain was still capable of contraction of the strip. The ouabain partly inhibited the relaxation effect of acetylcholine (1 x 10(-6) M), VIP (vasoactive intestinal polypeptide: 1 x 10(-8) M) and 2-chloro-adenosine (1 x 10(-6) M). The ouabain acts directly on the smooth muscle of the corpus cavernosum, increases its basal tone and diminishes the relaxation effect of acetylcholine, VIP and adenosine.

Experiences and reflections of former pediatric chief residents

OBJECTIVE

To compare actual and ideal time commitments of pediatric chief residents between 1972 and 1992 and to determine if actual time commitments have changed.

DESIGN

Descriptive, cross-sectional survey.

PARTICIPANTS

One thousand two hundred eighty-four former pediatric chief residents.

RESULTS

Chief residents between 1972 and 1982 spent a greater percentage of time teaching and providing patient care than chief residents between 1983 and 1992. Chief residents between 1983 and 1992 spent a greater percentage of time scheduling and performing other administrative tasks. In general, chief residents desired more time to teach, to conduct research, and to provide outpatient care and desired less time for scheduling and for performing other administrative duties.

CONCLUSIONS

Although chief residents desire to spend more time teaching and less time performing administrative tasks, administrative duties have increased at the expense of teaching and patient care responsibilities over the past 20 years.

Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging

PURPOSE

To assess accuracy of magnetic resonance (MR) imaging in detection of pelvic node metastasis from uterine cervical carcinoma.

MATERIALS AND METHODS

In 136 patients (aged 26-71 years [mean, 49 years]) with uterine cervical carcinoma seen between October 1990 and July 1992, maximum axial diameter (MAAD), minimum axial diameter (MIAD), and signal intensity enhancement ratio of positive nodes were measured.

RESULTS

With MAAD of 1.0 cm, MR imaging had an accuracy of 90.4%, sensitivity of 62.2%, and specificity of 94.9% in detection of pelvic node metastasis. Mean MAAD and MIAD were 1.43 and 1.30 cm for true-positive nodes and 1.18 and 0.75 cm for false-positive nodes, respectively. Mean MAAD/MIAD was 1.09 for true-positive and 1.76 for false-positive nodes. With MIAD of 1.0 cm, MR imaging had an accuracy of 93.0% with 62.2% sensitivity and 97.9% specificity. No significant differences were noted in the degree of contrast enhancement between true-positive and false-positive nodes.

CONCLUSION

The accuracy of MR imaging was fairly high in detection of pelvic node metastasis from uterine cervical carcinoma, and MIAD was a more accurate size criterion than MAAD.

Non-visualization versus normal appearance of cavernous arteries on selective internal pudendal pharmaco-angiograms: comparison with duplex scanning, cavernosal artery systolic occlusion pressure and penile brachial index

OBJECTIVE

To determine whether selective internal pudendal pharmaco-angiography (SIPA) is the most reliable diagnostic procedure for evaluating the function of the cavernosal arteries.

PATIENTS AND METHODS

Both sides of the selective internal pudendal pharmaco-angiogram taken in 35 patients (70 cases), whose history was suggestive of post-traumatic arteriogenic impotence, were evaluated separately and compared to the corresponding side using the penile brachial index (PBI), duplex scanning and cavernosal artery systolic occlusion pressure (CASOP).

RESULTS

There was no significant difference in the peak flow velocity and diameter changes of the cavernosal arteries on duplex scanning, in pressure differences between the brachial artery systolic pressure and the CASOP, and in the PBI between the group with a normal appearance on SIPA and the other where the cavernosal arteries were not visualized. There was no significant difference in the results of these functional evaluations between the normal group and cases where the cavernosal arteries were not visualized accompanied by a completely obstructed internal pudendal artery or common penile artery visible on SIPA.

CONCLUSIONS

This study is unable to confirm the value of SIPA in evaluating the function of the cavernosal arteries as it provides only anatomical information.

Fate of clinically insignificant residual fragments after extracorporeal shock wave lithotripsy with EDAP LT-01 lithotripter

The stone-free rate of 248 cases of clinically insignificant residual fragments (CIRF) was 32.7% by 1 month, 73.0% by 3 months, and 92.7% by 6 months of follow-up. The stone-free rate decreased but not remarkably in accordance with the increment of the caliceal dilatation (92.9%, 94.9%, 85.7%, and 83.3% for no, mild, moderate, and severe dilatation, respectively) by 6 months of follow-up. The clearance of the CIRF was not influenced by their location, the pelviocaliceal angle, the infundibular length, or the number of the lower calices. Of 16 patients who had residual stone fragments at 6 months and underwent an additional session of extracorporeal shock wave lithotripsy (SWL), 12 became stone free by another 6 months of follow-up. Therefore, it is desirable to wait for clearance of CIRF for at least 6 months before offering further treatment, regardless of their location and anatomic variation of the calices containing CIRF. Repeated SWL, even for stone fragments of 3 to 4 mm in diameter found initially 1 month after the last session of SWL, might promote clearance of the CIRF, and additional SWL for persistent CIRF could be an appropriate adjunctive measure.

Neuromuscular and hemodynamic effects of mivacurium and succinylcholine in adult patients during nitrous oxide-propofol-fentanyl anesthesia

The neuromuscular and hem+odynamic effects of mivacurium 0.15 mg/kg and succinylcholine 1 mg/kg were compared in 26 adult patients (ASA I and II) during nitrous oxide-oxygen-propofol-fentanyl anesthesia. Neuromuscular block was monitored by recording the compound electromyogram of the hypothenar muscle resulting from supramaximal train-of-four stimuli applied to the ulnar nerve. Time to onset of over 95% block and duration to 25% recovery of control twitch after injection of mivacurium were significantly longer than for succinylcholine (201 +/- 37.6 vs 54 +/- 5.2 sec and 13.0 +/- 2.2 vs 8.4 +/- 2.1 min; mean +/- SD). Onset of mivacurium with priming technique was shortened (125 +/- 20.7 sec), but was also slower than that of succinylcholine. Although the recovery index during spontaneous recovery was significantly longer for mivacurium than for succinylcholine (6.9 +/- 1.3 vs 5.1 +/- 0.9 min), antagonism with neostigmine at 25% recovery of twitch height sufficiently facilitated the recovery index of mivacurium (4.5 +/- 1.0 min) to a level similar to that of succinylcholine with no statistical difference. The hemodynamic effects of mivacurium were few as compared to those of succinylcholine. In conclusion, mivacurium is considered to have additional advantages for short procedures when succinylcholine is undesirable.

The impact of intensified supervisory activities on tuberculosis treatment

A Health Subcentre-based randomized controlled trial was conducted in order to determine the importance of the motivation of the tuberculosis personnel in improving the results of a treatment programme. A total of 1300 newly detected tuberculosis patients from 7 Health Centres were divided into study and control groups using the Health Subcentre areas as sampling units. In the study group, worker motivation was intensified through special regular sessions and closer supervision, while in the control group the usual procedures were followed. Treatment performance was remarkably improved in the study areas: treatment completion rate was 78.8% in the study group, compared with 65.2% in the control group. Bacteriological conversions among those having completed the treatment were 91.9% and 62.2% respectively, and overall efficacy was 75.2% and 45.8%, respectively. In addition to improved treatment, the follow-up case examinations also showed markedly increased performance. Although this study was done in facilities using conventional regimens which have been replaced with short-course regimens more recently, the study results still clearly indicate the importance of motivating personnel in the field to attain better case management.

Corporeal blood gas changes according to duration of drug-induced prolonged erection

The corporeal blood gas changes in accordance with the duration of the prolonged erection which developed after intracorporeal pharmacotherapy with papaverine and phentolamine were investigated in 62 impotence patients. The picture of the corporeal blood taken from 15 psychogenic impotence patients (a control group) at 10 minutes after intracavernous injection when they showed full erections was arterial but there was pCO2 rise and pH drop compared to femoral artery blood taken simultaneously. As the erection lasted longer, significant gas changes of the cavernous blood began to appear (p < 0.0001): increase in pCO2 and decrease in pO2 from 4 hours, decrease in pH from 5 hours, decrease in O2 saturation from 6 hours. Erections lasting for more than 16 hours showed significantly worse hypoxia (p < 0.05). Therefore, to prevent hypoxia and metabolic acidosis, drug-induced prolonged erection would be better decompressed before it lasts for more than 4 hours.

Congenital giant pigmented nevus associated with angiolipoma

We report a 20-year-old-Korean woman with a congenital giant pigmented nevus and angiolipoma. She was admitted our department with a large, dark, pigmented lesion on the right flank and abdomen and a slowly growing mass on the right flank area since birth. On biopsy, the specimen taken from the giant pigmented patch showed typical findings of compound nevus. The right flank mass was surgically removed. The specimen was composed of mature fat cells with an increased vascular component. These findings are compatible with angiolipoma.

Pemphigus foliaceus induced by nifedipine

We report a case of pemphigus foliaceus caused by nifedipine. In this case casual rechallenge with nifedipine confirmed that this drug was the causative agent. The skin lesions cleared quickly after withdrawal of the drug and treatment with a short course of oral steroids. To our knowledge, this is the first reported patient with nifedipine-induced pemphigus.

A case of anaphylaxis by ant (Ectomomyrmex spp.) venom and measurements of specific IgE and IgG subclasses

Hypersensitivity to the stings of the Hymenoptera has been described since antiquity. The hypersensitive reactions to insect stings vary from minor skin reactions to severe and sometimes fatal anaphylaxis. Concerns about sting hypersensitivity have been increasing because of many incidents of allergic reactions of patients to the fire ant in the southern area of the United States as well as the harvester ant in some areas. We experienced one unique case with severe allergic reactions by ant of the Ectomomyrmex spp. of the subfamily Ponerinae, which is not a harvester ant. For three years the patient had been suffering from generalized allergic reactions such as anaphylaxis after the ant stings four-five attacks in a year. We determined that her reactions were due to specific IgE mediated type I hypersensitivity by the detection of a high level of specific IgE to the ant venom in her serum. The high level of specific IgG4 to the ant venom was also noted in her serum, however, the role of ant venom IgG4 was not clearly determined.

Norepinephrine involvement in response to intracorporeal injection of papaverine in psychogenic impotence

The levels of catecholamines in penile blood during a papaverine test were measured to investigate whether the secretion of endogenous catecholamines is involved in response to intracorporeal papaverine injection. The level of norepinephrine was higher in patients with psychogenic impotence than in the normal controls and patients with vasculogenic impotence (p less than 0.01), and it was significantly higher in negative responders than in positive responders in the psychogenic impotence group (p less than 0.001). There was no significant difference in the level of epinephrine among the groups. The false negative response to the papaverine test in psychogenically impotent men is believed to be derived from secretion of cavernous norepinephrine, which overwhelms the action of cavernous smooth muscle relaxation by papaverine.

PamI and PamII restriction endonucleases from Phormidium ambiguum

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Complementation by detached parts of GGCC-specific DNA methyltransferases

Individually inactive N- and C-terminal fragments of the m5C-methyltransferase M.BspRI can complement each other resulting in specific, in vivo methylation of the DNA. This was shown by cloning the coding regions for N- and C-terminal parts of the enzyme in compatible plasmids and co-transforming them into E.coli cells. The enzyme could be detached at several different sites, producing either non-overlapping or partially overlapping fragments capable of complementation. Reconstitution of the active methyltransferase from inactive fragments was demonstrated in vitro, as well. Another GGCC-specific methyltransferase, M.BsuRI, showed a similar complementation phenomenon. Moreover, interspecies complementation was observed between appropriate fragments of the two closely related enzymes M.BspRI and M.BsuRI. Fragments of structurally and functionally more different methyltransferases were unable to complement each other.

Mechanism of inhibition of dopamine beta-monooxygenase by quinol and phenol derivatives, as determined by solvent and substrate deuterium isotope effects

The mechanism of interaction of quinols and phenols with dopamine beta-monooxygenase (D beta M) has been investigated. The ratio of quinone formation (from catechol) to oxygen consumption rises from a value of 1 in the presence of phenethylamine substrate to 2 in the absence of substrate. These results implicate quinol oxidation at both the reductant- and substrate-binding sites of D beta M. In the presence of saturating ascorbate, catechol and p-hydroquinol behave as mechanism-based inhibitors of D beta M, with partitioning ratios of turnover to inactivation of 21:1 and 41:1, respectively. Phenol is found to inactivate the enzyme in a manner similar to p-cresol, suggesting that the methyl group of p-cresol is not an essential component of enzyme inhibition. Solvent isotope effects on inactivation and turnover have been measured for various inactivators. Although the majority of these inhibitors, including catechol, p-hydroquinol, aniline, phenethylenediamine, and benzylhydrazine, are characterized by relatively small solvent isotope effects (1.5-2.5) on the inactivation rate constant (ki), solvent isotope effects on ki for phenol and p-cresol are 5.7 and 7.4, respectively. By contrast, solvent isotope effects on the turnover of p-cresol are almost unity. Using p-cresol-d7 as substrate, we observe D(kcat) = 5.2 and D(kcat/Km) = 3.1, while isotope effects on inactivation are D(ki) = 0.95 and D(ki/Ki) = 0.59. These results lead us to propose that inhibitors fall into two mechanistic classes, involving either one-electron oxidation to form radical cation intermediates (quinols) or hydrogen atom abstraction (phenols).(ABSTRACT TRUNCATED AT 250 WORDS)

Membranous lipodystrophy: primary idiopathic type

A 20-year-old woman had a pea-sized, tender subcutaneous nodule on the leg. Histopathologically, the panniculus showed multiple microcysts lined by membranes and light brown granules in the histiocytes. Histochemical studies of the membranes of the microcysts and the granules in the histiocytes indicated that they were composed of ceroid. Electron microscopy revealed that the membrane of the microcyst was composed of electron-dense areas of a regular 18.6 nm lamellar array and reticulated vacuolated areas suggestive of degenerating fat cells of unknown origin. Membranous lipodystrophy has been associated with many local and systemic diseases, but it may be idiopathic, as in our patient.

Class-IIS restriction enzymes--a review

Class-IIS restriction enzymes (ENases-IIS) interact with two discrete sites on double-stranded DNA: the recognition site, which is 4-7 bp long, and the cleavage site, usually 1-20 bp away from the recognition site. The recognition sequences of ENases-IIS are totally (or partially) asymmetric and all of the characterized ENases-IIS are monomeric. A total of 35 ENases-IIS are described (80, if all isoschizomers are taken into consideration) together with ten related ENases (class IIT), and 15 cognate methyltransferases (MTases-IIS). The physical, chemical, and molecular properties of the ENases-IIS and MTases-IIS are reviewed and many unique applications of this class of enzymes are described, including: precise trimming of DNA; retrieval of cloned fragments; gene assembly; use as a universal restriction enzyme; cleavage of single-stranded DNA; detection of point mutations; tandem amplification; printing-amplification reaction; and localization of methylated bases.

A novel gene-fusing vector: construction of a 5'-GGmCC-specific chimeric methyltransferase, M.BspRI/M.BsuRI

A vector was designed to allow predetermined and precise fusion between two cloned genes by constructing a cassette with two unique class-IIS restriction sites, 5'-ACCTGC-3' (BspMI) and 5'-CCGGATG-3' (FokI overlapping with MspI), arranged back-to-back in a divergent manner and inserted at the HincII site of a multiple cloning site (MCS) in plasmid pUC18 or analogous vehicle. Two DNA fragments or genes to be precisely fused are cloned into the MCS parts located on each side of the cassette containing the two unique class-IIS restriction sites. The BspMI and MspI/FokI sites are used to generate unidirectional deletions of the genes as previously described [Hasan et al., Gene 50 (1986) 55-62; Pósfai and Szybalski, Nucleic Acids Res. 16 (1988) 6245]. The precisely trimmed genes are ligated after the cassette containing the unique class-IIS restriction sites are excised with BspMI + FokI and the termini were blunted with mung-bean nuclease. This method was used to construct a hybrid methyltransferase (MTase) from the M.BspRI and M.BsuRI MTases, which share a high degree of overall homology (about 65%) and have the identical sequence specificity (5'-GGmCC-3'). A hybrid MTase composed of the N-terminal part of M.BspRI and the C-terminal part of M.BsuRI was constructed and found to be fully functional.

Treatment of steinstrasse with repeat extracorporeal shock wave lithotripsy: experience with piezoelectric lithotriptor

Among 958 patients with renal stones who underwent extracorporeal shock wave lithotripsy (ESWL) monotherapy using an EDAP-LT01 piezoelectric lithotriptor steinstrasse developed in 55 (5.7%). Of these 55 cases stone fragments passed spontaneously in 35 (63.6%) and were treated successfully (no residual stone fragment in ureter) with repeat ESWL in 18 (32.8%). Only 2 patients (3.6%) required ureteroscopic management or open ureterolithotomy. Therefore, repeat ESWL is considered a good initial method to treat complicated steinstrasse.

Paraneoplastic pemphigus. An autoimmune mucocutaneous disease associated with neoplasia

BACKGROUND AND METHODS

We describe five patients with underlying neoplasms in whom painful mucosal ulcerations and polymorphous skin lesions developed, usually with progression to blistering eruptions on the trunk and extremities. Histologic examination showed vacuolization of epidermal basal cells, keratinocyte necrosis, and acantholysis. Immunofluorescence testing revealed atypical pemphigus-like autoantibodies in perilesional epithelium and serum from all five patients. We studied the antigenic specificities of the autoantibodies by indirect immunofluorescence and immunoprecipitation, using extracts of 14C-labeled human keratinocytes. IgG purified from the serum of one patient was passively transferred to four neonatal mice to test for pathogenicity.

RESULTS

Immunofluorescence testing showed that the autoantibodies bound to the surface of tissues containing desmosomes, including complex and simple epithelia, and myocardium. An identical and unique complex of four polypeptides with molecular weights of 250, 230, 210, and 190 was immunoprecipitated by all serum samples. The 250-kd polypeptide comigrated with desmoplakin I (a protein found in the desmosomes of all epithelia), and the 230-kd antigen comigrated with the antigen of bullous pemphigoid. Cutaneous blisters, a positive Nikolsky's sign, and epidermal and esophageal acantholysis developed in all mice into which the autoantibody was injected. Electron microscopy showed epidermal acantholysis similar to lesions of experimentally induced pemphigus vulgaris.

CONCLUSION

These five patients with cancer had a novel acantholytic mucocutaneous disease characterized by autoantibodies that were pathogenic after passive transfer. The autoantibodies from these patients reacted with an antigen complex composed of desmoplakin I and the 230-kd antigen of bullous pemphigoid and two as yet unidentified epithelial antigens. We suggest the term "paraneoplastic pemphigus" for this disease.

Prostacyclin-to-thromboxane A2 ratio in arteriogenic impotence

It has been suggested that penile hypercoagulability predisposes to aging penile vascular changes and impotence, and that elevated thromboxane A2 during erection may contribute to hypercoagulability and atherosclerosis. Since the ratio of the prostacyclin concentration to the thromboxane A2 concentration is constantly maintained in normal hemostatic responses, an imbalance between thromboxane A2 and prostacyclin may be a factor to initiate vascular diseases and decrease blood flow. We assess the usefulness of the prostacyclin-to-thromboxane A2 ratio in penile blood during erection for diagnosis of arteriogenic impotence. The ratio in the arteriogenic impotence group was significantly lower (p less than 0.01) than in the psychogenic and venogenic impotence groups. Therefore, the prostacyclin-to-thromboxane A2 ratio seems to be useful to diagnose arteriogenic impotence.

Diagnostic value of the radioisotope erection penogram for vasculogenic impotence

Radioisotope erection penography of 113 consecutive impotent patients (41 with psychogenic and 72 with vasculogenic impotence) and 15 normal potent men were obtained. Twenty minutes after intracavernous injection of 99mtechnetium-pertechnetate 40 mg. papaverine hydrochloride were administered into the corpus cavernosum to induce erection. A gamma camera with a pinhole collimator was used to monitor the radioactivity. Various penogram indexes were calculated from the time activity curve and their usefulness was evaluated. Index A1 was useful to differentiate vasculogenic and psychogenic importance. Indexes V1 and V2 were useful to differentiate arteriogenic and venogenic impotence. The radioisotope erection penogram is a simple, less invasive and valuable screening test in the identification of vasculogenic impotence, and is effective in differentiating arteriogenic and venogenic impotence.

Studies of the relationship of the 230-kD and 180-kD bullous pemphigoid antigens

In bullous pemphigoid (BP), autoantibodies from most patients recognize a high molecular weight 230-kD epidermal antigen (Ag) by immunoprecipitation. By Western immunoblotting, 50-70% of sera recognize the high molecular weight Ag, but 30-50% recognize a low molecular weight, 180-kD epidermal Ag. We examined the specificities of affinity-purified antibodies against these Ag. Antibodies specific for the 230- and 180-kD Ag were prepared by immunoaffinity against Ag immobilized on nitrocellulose and released by acid glycine. IgG eluted from the 230-kD Ag band retained its specific binding to the 230-kD Ag by immunoblotting, and bound to the epidermal basement membrane zone (BMZ) by indirect immunofluorescence (IF) and to hemidesmosomes by indirect immunoelectron microscopy (EM). IgG affinity purified by the 180-kD Ag band bound only the 180-kD Ag in immunoblotting, with no cross reaction to the 230-kD Ag, bound the epidermal BMZ by indirect IF, and also bound to hemidesmosomes in immuno-EM. IgG specific for the 230-kD Ag in immunoblotting immunoprecipitated only the 230-kD Ag, with no apparent precipitation of the 180-kD Ag. Surprisingly, IgG specific for the 180-kD Ag precipitated both the 180- and the 230-kD Ag in immunoprecipitation, and the 230-kD Ag band was much more intense than the 180-kD Ag band. This study shows that apparent cross-reactivity between these Ag by BP autoantibodies can only be detected in native conditions by immunoprecipitation, and cannot be demonstrated using denatured Ag in immunoblotting. The two proteins appear to be distinct Ag, closely associated in the epidermal hemidesmosome, but the exact relationship of these Ag to each other may not be clarified until complete structural data become available.

[Clinical application of intermaxillary traction for temporomandibular disorders]

Occlusal splint has been usually used for TMJ arthrosis as a conservative treatment, but the range of its application is narrow and less effective. This study is to evaluate the effect of the pivoting splint with intermaxillary rubber traction, to report the results of the pivoting splint with intermaxillary rubber traction which was used 24 patients.