[Isospora belli infection in a patient with adult T cell leukemia]

A 53-year-old man was hospitalized for the development of watery diarrhea associated with decreased appetite and progressive weight loss and was found to have leukocytosis. The white blood cell count was 14,600/microliters with 66 percent abnormal lymphocytes. Serum anti-HTLV-I was positive and monoclonal insertion of HTLV-I provirus into the atypical cell genome was confirmed with the southern blotting hybridization technique. A diagnosis of ATL was made. Examination of fresh stool specimens revealed Isospora belli (I. belli) oocysts. Initial treatment for I. belli consisted of oral trimethoprim 160mg and sulfamethoxazole 400mg given twice daily for nine days. Diarrhea ceased within 2 days of the start of treatment, but I. belli oocysts were again detected after 20 days. Trimethoprim 160mg and sulfamethoxazole 400mg were reinstituted four times daily for 10 days, and then twice daily for 21 days. The clinical response was again dramatic, with rapid clearance of oocysts from the stool. There has been no recurrence of diarrhea. The patient's leukemia was refractory to chemotherapy; the white blood cell count continued to rise, pneumonia developed, and the patient died. I. belli is a previously unrecognized opportunistic pathogen that must be considered in the clinical setting of chronic diarrhea in patients with ATL.

[Development of an enzymatic fluorescence method for detecting of cholesterols in circulating monocyte]

Since the infiltration of macrophage/monocyte into the arterial intima would be the first and most important step to developing the atherosclerosis, it is important to analyze the lipid composition not only in the circulating blood but also in the cell. We developed the high sensitive enzymatic assay method of total and free cholesterol and employed this assay to the measurement of monocyte cholesterol ester. Diabetic patients had high total cholesterol and cholesterol ester of monocyte. The elevated monocyte cholesterol ester was related to the LDL-cholesterol and Lp(a) concentrations in the plasma.

Expression and regulation of the leukemia inhibitory factor/D factor gene in human T-cell leukemia virus type 1 infected T-cell lines

The expression of the leukemia inhibitory factor/D factor (LIF) gene in human T-cell leukemia virus type 1 infected T-cell lines was examined. Human T-cell leukemia virus type 1 infected T-cell lines MT-1, MT-2, H89-59, H89-79, and H109 expressed LIF mRNA, but the T-cell lines MOLT-4 and TALL-1 did not. LIF mRNA expression was enhanced by interleukin 2 or 12-O-tetradecanoylphorbol-13-acetate in MT-2 cells. The biological activity of LIF was detected in culture medium enhanced by interleukin 2 in MT-2 cells. The expression of LIF mRNA was suppressed by 1 alpha,25-dihydroxyvitamin D3 and dexamethasone. These results imply that the expression of the LIF gene is involved in the development of hypercalcemia and abnormalities of the immune system observed in patients with adult T-cell leukemia.

[Laboratory and clinical studies on cefprozil in the field of pediatrics]

Laboratory and clinical studies on cefprozil (CFPZ, BMY-28100), a new cephem antibiotic, were carried out in the field of pediatrics. The results obtained are summarized as follows: 1. Serum concentrations, urinary concentrations and urinary recovery rates of CFPZ were determined upon oral administration of CFPZ after meal at doses of 4 mg/kg granules in a case, 7.5 mg/kg granules in 2 cases and 15 mg/kg granules in one. Peak serum levels of CFPZ were obtained at an hour in 3 cases and at 2 hours in 1 case after administration of the drug with a range of 2.7-8.6 micrograms/ml with half-lives of 0.69-0.95 hours. Urinary recovery rates in the first 6 hours after administration ranged from 59.4-71.3%. 2. MICs of CFPZ against 36 clinical isolates (Staphylococcus aureus 4 strains, Streptococcus pneumoniae 5, Streptococcus pyogenes 5, Escherichia coli 5, Haemophilus influenzae 12, Haemophilus parainfluenzae 4, and Branhamella catarrhalis 1) were compared with those of cefaclor (CCL) and ampicillin (ABPC). The antibacterial activity of CFPZ was superior to those of CCL against Gram-positive cocci, and to those of ABPC against E. coli, and was equal to those of CCL and inferior to those of ABPC against H. influenzae. 3. Thirty-seven pediatric patients with acute infectious diseases (pharyngitis/tonsillitis 17, bronchitis 7, pneumonia 3, skin and soft tissue infection 2, and urinary tract infection 8) were treated with CFPZ at daily doses of 10-47 mg/kg t.i.d. as a rule. The efficacy rates were 100% clinically and 56% bacteriologically. 4. Side effects or abnormal laboratory test values were not observed except for an increased platelet count in 1 case and elevated GOT, GPT values in 2 cases.

Altered distribution of motor neurons in experimental facial nerve paralysis

The alteration of motor neurons in the brainstem after recovery from experimental facial nerve paralysis was examined by the retrograde horseradish peroxidase (HRP) technique in the rabbit. Six months after nerve crush injury at the center of the vertical portion, HRP was injected into the zygomatic muscle on the recovered side. The distribution of labelled neurons in the brainstem was compared with that in the normal rabbit. In control animals, motor neurons in the facial nucleus were somatotopically organized, and there were no labelled neurons in other nuclei in the brainstem. In recovered animals, on the contrary, the somatotopic organization of the facial nucleus was obscure and multipolar neurons of varying size were labelled bilaterally in the reticular formation from the pons to the medulla.

[Evaluation of clinical features, cytopathological findings and prognosis of histiocyte proliferative disorders]

Clinicopathological analysis was performed in 19 patients diagnosed clinically with malignant histiocytosis. Ultimately, 9 patients died and 10 are still alive. All 19 had fever of unknown origin. Among the 10 surviving patients, 6 recovered with only supportive therapy such as antibiotic treatment. One recovered with steroid therapy and 2 with VP (vincristine and prednisolone) therapy. Complications due to immunodeficiency were detected in one surviving patient and 2 who died. All 9 patients who died had anemia, and 8 had thrombocytopenia. However, among survivors, only one had anemia and only 2 had thrombocytopenia. Chromosomal abnormality was detected in one patient who died. Histiocytic cells were classified morphologically into 3 types: immature, intermediate and mature. In 4 patients who died, histiocytic cells were immature, but in 4 others mature histiocytic cells were detected. In 5 of the 10 surviving patients, histiocytic cells were of the immature type. Immuno-histochemical analysis of the origin of histiocytic cells in 8 deceased patients showed T-zone histiocytes in one, T cells in one, monocyte phagocytic system (MPS) in 5, and histiocytes of unknown origin in one. Thus, malignant histiocytosis is a heterogenous entity including reactive histiocytic disorder, lymphocytic neoplasm and true histiocytic neoplasm. In histiocyte proliferative disorders, red blood cell counts and platelet counts are useful for assessing prognosis, while cytological findings only confuse this evaluation.

[Therapeutic effects of a combination treatment with flomoxef and tobramycin against infections complicated with hematological disorders]

The efficacy and safety of a combination regimen using flomoxef (FMOX) and tobramycin (TOB) were evaluated in the treatment of infections complicated with hematological disorders. The primary diseases in 40 patients included acute leukemia, malignant lymphoma and others. Complicated infections included 35 cases with suspected septicemia, 4 cases with septicemia and 1 case with pleuritis. Clinical responses were excellent in 10 (25.0%), good in 14 (35.0%), fair in 2 (5.0%) and poor in 14 (35.0%). The efficacy rate was 73.1% in patients with neutrophil counts higher than 501/microliters after administration, but it was 35.7% in patients with counts less than 501/microliters; the difference was statistically significant. No side effects were observed in any of the 40 patients. Abnormal laboratory data in liver functions were identified in 1 patient (2.5%). Degree of this abnormality was very slight, and the continuation of treatment was not disturbed. In conclusion, this combination therapy of FMOX and TOB thus appears to be useful and safe in therapies for infections complicated with hematological disorders.

Rare point mutation at codon 301 and 969 of FMS/M-CSF receptor in acute myelomonocytic and monocytic leukemia

We have investigated whether point mutations occurred at codon 301 or 969 of FMS (M-CSF receptor) in 19 patients with acute myelomonocytic (M4) and monocytic leukemia (M5). Nineteen peripheral blood and bone marrow blood samples collected from M4 and M5 patients were examined by using polymerase chain reaction and hybridization to allele specific oligonucleotide probes. Mutations at codon 301 and 969 of FMS were not detected in any samples. FMS gene mutations at codon 301 and 969 were rarely involved in M4 and M5 patients in Japan.

[An experimental study on the effect of laminin in vivo on promoting regeneration of axons]

Laminin has been shown to exert a stimulatory effect on neurite outgrowth in vitro, but this biological activity in vivo has not been clarified. The objective of this study was to examine the hypothesis that laminin can stimulate axonal regeneration in vivo. Intubation repair of the rat sciatic nerve was used as a model and the possibility that the maximum distance that axons can regenerate through a tubular nerve guide might be increased by the addition of laminin to the inside of the nerve guide was investigated. Most of the rats with the laminin-treated nerve guide displayed excellent axonal bridges across the 12-mm and 20-mm nerve gaps, while none of the rats with an untreated nerve guide had a developed bridge. Histological and electrophysiological findings supported successful long-term results. These findings suggest that laminin significantly hastens axonal regeneration in vivo.

[The effects of position and ventilation during thoracotomy on oxygen uptake and carbon dioxide elimination in humans]

The effects of position and ventilation were investigated in ten adult patients undergoing scheduled thoracotomy. Oxygen uptake (VO2) and carbon dioxide elimination (VCO2) in gas phase were measured continuously, while gas exchange ratio (R) and dead space ventilation ratio (VD/VT) were calculated with these results. VO2 and VCO2 during general anesthesia decreased about 60% from the normal values due to reduction of metabolism. Position and ventilation had no obvious effect on VO2 during surgery. VCO2 decreased slightly during bilateral ventilation with lateral decubitus position, because of mismatch of ventilation-perfusion distributions, and/or reduction of metabolism without surgical stress. The results suggest that carbohydrate calories are mainly metabolized under surgical stress, resulting in an R equal to 1.0. Continuous non-invasive monitoring of VO2 and VCO2 is one of the most effective parameters to evaluate the oxygen balance and systemic metabolism.

[Clinical evaluation of panipenem/betamipron in severe infections complicating hematological disorders]

Forty-three patients with severe infections which were complicating hematological disorders were treated with panipenem/betamipron, and the efficacy and the safety of the drug were evaluated. The results obtained are summarized below. 1. Out of 40 patients in whom efficacies are evaluable, the clinical responses were excellent in 17 patients, good in 4, fair in 7 and poor in 12, and the total clinical efficacy rate was 52.5%. 2. The efficacy rate in 7 patients who had failed to respond to prior treatment with other antibiotics was 57.1%. Thus, no significant difference was observed in efficacy rates between the patients who had failed to respond to prior treatment with other antibiotics and the patients who received no preceding antibiotics therapy. 3. Out of the 43 patients in whom the safety was evaluable, no side effects nor abnormal laboratory findings were found.

[Natural history and biologic mechanism of the transition from grafted bone to extra-cortical bone bridge over porous-coated segmental prostheses]

The biologic mechanism of extra-cortical bone bridge formation over a porous-coating segmental prosthesis was studied. A 6 cm segment of the femoral diaphysis was bilaterally resected and replaced by a segmental prosthesis in 32 adult dogs. A morselized autogenous bone graft mixed with marrow cells was applied around the prosthesis and the adjacent cortex. The animals were sacrificed at 2, 4, 8 and 12 weeks postoperatively. Tissue samples from the extra-cortical bone formation zone were analyzed by fluorescent and light microscopy and transmission electron microscopy. Active intramembranous new bone formation occurred appositionally. Osteogenic foci were formed in the fibrous tissue by the determined osteogenic precursor cell contained in the marrow cells. Woven bone formation occurred within the matured callus through endochondral ossification. Extra-cortical bone bridges depended on bone/marrow grafts with good vascularity and mechanical stability as important ingredients. Extra-cortical bone bridges were reduced in volume and matured with time.

Multiple point mutation of N-ras and K-ras oncogenes in myelodysplastic syndrome and acute myelogenous leukemia

We analyzed activating mutations of N-ras and K-ras by the polymerase chain reaction and oligonucleotide hybridization in hematological disorders. Activating mutations of these codons were detected in 4 of 20 cases of myelodysplastic syndrome (MDS) and 15 of 77 cases of acute myelogenous leukemia (AML). Our of 19 cases of MDS and AML who carried active mutations, 7 cases were found to have two or more distinct mutations in activating codons of N-ras and K-ras. Ras mutation was found preferentially in progressive disease such as refractory anemia with excess of blasts (RAEB) of RAEB in transformation (RAEB-t). A relatively high incidence of ras mutation was found in M5 AML (40%). No ras mutations were found in other hematological disorders, such as acute lymphoblastic leukemia and chronic myelogenous-leukemia. The most frequent amino acid substitution was that of an aspartate for glycine at codon 12 of N-ras resulting from G to A mutation (11/35). The survival of AML patients who carried ras mutations showed no significant differences from those without ras mutations calculated by Kaplan-Meier. Seven cases of MDS and 7 cases of AML patients could be investigated at various points during their clinical course. Among these 14 cases, we found 2 interesting cases of MDS. The first case lost multiple clones carrying ras mutations during disease progression, the second case acquired mutation of the ras gene during disease progression. These results suggested that multiple point mutations of ras genes may not be initiating events but may contribute to a clonal evolution of MDS and AML.

[Expression of CD56 antigen on acute nonlymphocytic leukemia]

CD56 antigen (detected by NKH-1) is distributed on NK cells, monocytes, and ectodermal neural cells. In this study, the blasts of 29.2% of 27 patients with acute nonlymphocytic leukemia (ANLL) expressed CD56 antigen, but not CD16, CD2, or CD3 antigen. Leukemic cells isolated from 3 patients with CD56-positive ANLL did not have NK activity. There were no significant differences between CD56-positive and CD56-negative ANLL in CD13-positive cases, CD33-positive cases, and HLA-DR-positive cases. These results suggest that CD56-positive ANLL could be so-called mixed-lineage leukemia (lymphoid-associated antigen in ANLL).

[Adult T-cell leukemia with CD3 (-), CD4 (-) and CD8 (-)]

A case of an adult T-cell leukemia (ATL) with double negative (CD4-, CD8-) phenotype is reported. A-57-year-old man was consulted by his home doctor with us because of leucocytosis, splenomegaly and systemic lymphadenopathy. On admission, white blood cell count was 87,500/microliters with 77% of convoluted atypical cells. Serum anti-HTLV-1 antibody was positive and monoclonal insertion of HTLV-1 provirus into the atypical cell-gene was proved with southern blotting hybridization technique. A diagnosis of an ATL was made. Immunophenotypic analysis of leukemic cells showed CD3 (-), CD4 (-), CD8 (-) and genes encoding both TCR alpha and beta chains were rearranged. Though the patient responded to some degree to the combination chemotherapies including VEPA, he died of infectious complications about 4 months after admission.

Ambulatory blood pressure monitoring in elderly hypertensives treated with the new calcium antagonist, nilvadipine

A newly developed calcium antagonist, nilvadipine, was administered to 7 hypertensive patients aged 75.6 y. Nilvadipine 4 mg b.d. decreased the average 24-h blood pressure significantly from 169/89 mmHg to 152/81 mmHg after 7 to 14 days without any change in the pulse rate. The circadian patterns of blood pressure and pulse rate were not affected by nilvadipine. Although the present study was a preliminary one done over a short period in a small number of patients, the results suggest that nilvadipine exerts an antihypertensive effect without altering the circadian pattern or the variability of blood pressure in elderly hypertensive patients.

[Adult T-cell leukemia lymphoma with metastatic calcification]

A 52-year-old man, who came from Kagoshima prefecture, was hospitalized because of lumbago and lymphadenopathy. On admission, mild anemia and leukocytosis with atypical lymphoid cells were seen in the peripheral blood. Flow cytometry of the abnormal lymphocytes showed that they expressed CD4, and CD25, but not CD8. Anti HTLV I antibody was expressed in the serum. Atypical lymphoid cells had proviral DNA with restriction enzyme EcoRI. Lymphnode biopsy was performed and the specimens of lymphnode showed diffuse infiltration of abnormal lymphocytes. So we diagnosed Adult T-cell leukemia lymphoma. The patient's serum calcium level was increased, so he lost consciousness and became oliguric and developed acute renal failure. Hemodialysis was required to control azotemia. During the time of hemodialysis, cardiac arrest was occurred and he died. Autopsy confirmed the presence of a metastatic calcification in various organs, such as myocardium, alveolar septa of the lungs, and gastric mucosa. A metastatic calcinosis was found in the myocardium, which was thought to be the cause of his heart failure. But at the ATLL cells didn't infiltrate in the myocardium. Calcinosis was a significant complication of neoplastic disease in these patients and contributed to morbidity and mortality.

Suppressive effect of 1,25(OH)2D3, and glucocorticoids on production of tumor necrosis factor-alpha by human peripheral blood adherent cells

Effect of 1,25(OH)2D3 and glucocorticoids on production of TNF-alpha by human peripheral blood adherent cells (HPBAC) was investigated. TNF-alpha was measured by ELISA method using monoclonal antibody against human recombinant THF-alpha. Maximal TNF-alpha production by HPBAC was observed in 4 to 8 hr after incubation when these cells were cultured for 24 hr with 10 micrograms/ml lipopolysaccharide (LPS), 10 ng/ml 12-o-tetradecanoyl-phorbol-13-acetate (TPA) and 10(-5) M indomethacin (INDM). When graded concentration of 1,25(OH)2D3 was added to HPBAC in the presence of above stated dose of LPS, TPA and INDM, a significant suppression of TNF-alpha production was first observed at the concentration of 10(-8) M (P less than 0.05). Similar significant suppressive effect was also observed by adding hydrocortisone and dexamethasone at the concentration of 10(-8) M (P less than 0.05) and 10(-7) M (P less than 0.05), respectively. These results may suggest that 1,25(OH)2D3 has the same inhibitory effect on monocyte/macrophage function as glucocorticoids.

[Ectopic salivary amylase-producing IgA- lambda-type multiple myeloma with expression of MDR-1/P-glycoprotein]

We report a case of ectopic salivary amylase-producing IgA- lambda-type multiple myeloma. A 70-year-old man was admitted because of anemia and renal failure. After chemotherapy for eight months, the serum amylase markedly increased. Amylase activity in the supernatant of cultured myeloma cells, which were obtained from the bone marrow, also increased. The myeloma cells expressed MDR-1/P-glycoprotein). The case implies the association of drug resistance and the ectopic amylase production in a case of multiple myeloma.

Suppression of rat deoxycorticosterone-salt hypertension by kallikrein-kinin system

Brown Norway kininogen-deficient rats had very low levels of plasma kininogens and lower levels of plasma prekallikrein, compared with those of normal rats of the same strain. Systolic blood pressure, determined by the tail-cuff method, of 5-week-old kininogen-deficient rats (106 +/- 0.4 mm Hg, n = 7) and the rate of systolic blood pressure increase with age were not different from those in normal rats. Weekly injections of deoxycorticosterone acetate (5 mg/kg s.c.) with 1% sodium chloride solution in drinking water after uninephrectomy at 7 weeks of age caused a gradual increase in the blood pressure of normal rats, reaching a plateau at 18 weeks of age, whereas that of deficient rats rose rapidly to 158 +/- 6 mm Hg 2 weeks after the start of treatment and continued to increase slightly, becoming significantly higher than normal rats at 8, 9, 10, 11, and 12 weeks of age (p less than 0.05 or 0.01). The levels of urinary prokallikrein and active kallikrein were slightly higher in deficient rats before deoxycorticosterone acetate-salt treatment but were not significantly increased after this treatment, whereas these levels in normal rats were increased 3.6- and 4.7-fold by this treatment. Urinary free kinin, collected from the ureter in untreated deficient rats, was below the detection limit. The plasma level of low molecular weight kininogen, the substrate of glandular kallikrein, was decreased in normal rats during the treatment. Continuous subcutaneous injection of aprotinin by an osmotic pump to normal rats induced significant increase in blood pressure. These results indicate that glandular kallikrein may play a suppressive role in deoxycorticosterone acetate-salt hypertension.

Endoscopic findings in carcinoid tumor of the duodenum

The endoscopic findings in six patients with carcinoid tumor of the duodenum were analyzed. Radiographic and endoscopic examinations revealed a smooth and round elevation (measuring 5-20 mm in diameter) in the duodenal bulb. In three patients, the lesion was accompanied by an irregularly shaped erythematous depression, a characteristic endoscopic finding of this tumor. Because the endoscopic forceps biopsy technique led to an accurate diagnosis, we wish to stress the clinical value of the endoscopic modalities.