Neurologic sequelae associated with foscarnet therapy

OBJECTIVE

To report three cases of possible foscarnet-induced neurologic sequelae.

CASE SUMMARY

We report two cases of seizures and one case of hand cramping and finger paresthesia after starting foscarnet therapy with no evidence of predisposing risk factors, such as serum laboratory abnormalities, renal dysfunction, or known central nervous system (CNS) involvement. All three patients had stable laboratory values during therapy and when the neurologic adverse effects occurred. All patients were receiving appropriate dosages of foscarnet.

DISCUSSION

The incidence of seizures in AIDS patients was reviewed. A history of CNS lesions, infections, and/or AIDS per se may increase the risk of a neurologic adverse effect while receiving foscarnet therapy. Acute ionized hypocalcemia may cause these neurologic adverse effects. Ionized hypocalcemia is transitory, is related to the rate of foscarnet infusion, and may not be reflected as a change in total serum calcium concentration.

CONCLUSIONS

Foscarnet probably contributed to the neurologic adverse effects reported here. Foscarnet may need to be administered at a slower rate than is recommended by the manufacturer. Electrolytes must be monitored closely; however, a neurologic adverse effect may not be foreseen.

Human papillomavirus in condyloma acuminata and other benign lesions of the female genital tract

PCR was used to detect (HPV) in condyloma acuminata (CA), pseudocondyloma whose cause is unclear, and the other benign lesions in female genital tract. The results showed that HPV prevalence rate in CA was 98.2%, type 6 was in 11 was 85.7%, and that in pseudocondyloma, cervical polyp, cervical erosion and chronic vaginitis was 40.4%, 76.2%, 77.3% and 16.0%, respectively. Even in normal vaginal tissue, there existed HPV subclinical infection. HPV prevalence rate in swabs from patient's underwears and normal vaginal tissues was 73.6% and 54.0% respectively. The investigation of estrogen receptor (ER) in CA tissue carried out by immunohistochemical method found that positive ER was achieved in most of CA, and few of normal vulvar tissues was found. This result indicated that the occurrence of CA is probably related to estrogen.

[Identification of fruits of Xanthium sibiricum Patr. and X. mongolicum Kitag]

The protein electrophorogram, tissue separation picture and complete powder characteristic picture of these two kinds of fruit of siberian cocklebur are made for the first time, and TLC chromatograms of different solvent extracts are also presented. All these present a scientific basis for crude drugs selling, breed identification and composition analysis of the fruit of siberian cocklebur.

Pulmonary artery involvement in aortoarteritis: an angiographic study

Angiographic findings of 47 patients with pulmonary artery involvement (PAI) in aortoarteritis are described together with the diagnostic evaluation of PAI and its clinical implications. Pulmonary arteriography was obtained by intravenous digital subtraction angiography in 133 patients with aortoarteritis; 45 (33.8%) were found to have PAI. Two patients with PAI, studied by conventional arteriography, are also included. Stenosis and/or occlusion of segmental and/or lobar pulmonary arteries, and subsegmental branches, were the basic angiographic findings in PAI. Pulmonary artery branches in the upper lobes were more commonly affected than those in the lower and middle (lingula) lobes. Bilateral lesions were more common than unilateral ones. Single lobar and segmental lesions were quite rare. Dilatation was uncommon. No main pulmonary artery involvement was detected. Pulmonary artery hypertension, a late complication of patients with PAI, was revealed in 9 of the 46 patients of the present series. If it occurs, PAI becomes a factor effecting the patient's clinical course and prognosis.

[Promotive action of sodium fluoride on precancerous lesions of hepatocellular carcinoma induced by diethylnitrosamine (DEN) in rats--stereologic study of enzyme histochemistry]

In 10 Wistar male rats, partial hepatectomy was performed and followed by intraperitoneal injection of DEN (30 mg/kg) once and giving drinking water containing 80 ppm sodium fluoride (36 ppm F) for 14 weeks. By stereologic method of enzyme histochemistry, it was observed for the first time that the foci of hepatocytic precancerous enzyme alterations (gamma-GT positive, ATPase negative and G-6-Pase negative) were significantly increased in number and size compared with the negative control group. The results suggest that sodium fluoride promoted the growth of precancerous lesions of the liver induced by DEN in rats, and this has provided some data to the understanding of the relationship between fluorosis and neoplasms.

[Studies on the hypoglycemic effect of Rhodiola sachalinensis A. Bor. polysaccharides]

Rhodiola sachalinensis polysaccharides (RSP) isolated from the root of Rhodiola sachalinensis was demonstrated to decrease the levels of blood sugar, liver glycogen and total blood lipid when injected peritoneally to mice at 50, 100 and 200 mg/kg once or for 7 successive days. In addition, RSP was found to decrease blood sugar and total blood lipid in various experimental hyperglycemias induced by injection of adrenaline, glucose and alloxan in mice. RSP exhibit inhibiting effect on the glycogen enhancement induced by glucose as well as strenghtening effect on the glycogen decomposition induced by adrenaline and alloxan.

Histamine content, synthesis and degradation in nasal mucosa and lung of guinea-pigs treated with toluene diisocyanate (TDI)

We have reported the presence of a histamine synthesizing enzyme, histidine decarboxylase (HDC), and histamine degrading enzymes, histamine N-methyltransferase (HMT) and histaminase (diamine oxidase, DAO) in human nasal mucosa and the histamine content of the mucosa. In this study, we demonstrate the influences of the toluene diisocyanate (TDI) treatment on the histamine content and these enzyme activities in guinea-pigs as an animal model of respiratory hypersensitivity. Application of TDI to the nasal vestibuli induced intense nasal allergy-like and mild asthma-like responses in TDI-sensitized guinea pigs. Increases in the histamine content and HDC and HMT activities were observed in the nasal mucosa and lung of TDI-sensitized guinea pigs. No apparent changes in the histaminase activities were observed in either the nasal mucosa or the lung. These data suggest that the turnover rate of histamine is increased in the nasal mucosa and the lung of guinea pigs with respiratory hypersensitivity.

[Morphometric analysis on the in vitro invasiveness of mouse lung adenocarcinoma variants with different metastatic potential]

The in vitro invasiveness of LA1, LAD, LA5 variants of mouse lung adenocarcinoma (LA795) with different metastatic potentials were examined. Precultured heart fragment (PHF) was used as the target organ, and spheroid aggregates of LA1, LAD, LA5 cells were prepared by cultivation of cell suspension on a gyratory shaker. The invasion-complex was formed by confronting of the PHF and cell aggregate. The invasion-complex was then examined at different time intervals histologically and morphometrically. The micro-computer-aided image analysis system was employed to measure the total area (TA) of the invasion complex and the tumor tissue area (subarea, SA). The ratio of SA/TA was used in estimating the invasion ability. It was shown that the invasion of LA1, LAD and LA5 was progressive in nature and the invasive capability of these three variants were correlative with their metastatic potentials.

[Indirect testimony of stress conduction from mandible to skull in maxillofacial trauma: morphological changes of temporomandibular joint disc]

There were cerebral injuries accompanied in maxillofacial high velocity projectile wound.Owing to the special anatomic relationship between skull and facial bones,the stress conduction of bone was an important factor of cerebral injury in maxillofacial wound.In this experiment,the canine mandibular regions were wounded by steel spheres,which weight 1.03g,impacting velocity at 1400m/s,to produce severely maxillofacial firearm wounds.The morphological and pathological changes of temporomandibular joint disc of wounded side were observed with light and electron microscopes.The microscopic injuries of disc,including arrangement disorder of figre,spotty edema and some fibrous dissolution,etc,were found.These results have provided an indirect evidence of injurous mechanism of the cerebral injury accompaning maxillofacial high enery misslle wound.

Genomic cloning of the rat histamine H1 receptor

A rat histamine H1 receptor gene which lacked introns was isolated from a rat genomic library using recently cloned bovine histamine H1 receptor cDNA [Yamashita et al., Proc. Natl. Acad. Sci. USA, 88, 11515-11519 (1991)]. The receptor protein deduced from this isolated gene was composed of 486 amino acids and showed characteristic properties of G protein-coupled receptors. At the 5'-flanking region of the receptor gene, we have located potential TATA box sequences and consensus sequences for the glucocorticoid response element and AP-2 element. After being subcloned into a mammalian expression vector, the isolated gene was transfected to C6 glioma cells. These cells showed significant binding toward [3H]mepyramine. The binding was inhibited by H1 antagonists or histamine. The mode of this binding was comparable to the binding of membranes derived from rat tissues toward [3H]mepyramine. Northern blot analysis detected a 3.0 kb nucleotide band for histamine H1 receptor mRNAs from rat brain and small intestine when these mRNAs were hybridized with the isolated rat H1 gene. The present results demonstrate the isolation of the rat histamine H1 receptor gene.

Didanosine-associated eosinophilia with acute thrombocytopenia

OBJECTIVE

To report a case of didanosine (ddI)-induced acute thrombocytopenia and to discuss the incidence of this occurrence.

CASE SUMMARY

A 42-year-old man was admitted to the hospital on November 21, 1991, with acute thrombocytopenia. The patient had an AIDS index diagnosis of Kaposi's sarcoma (KS) in 1988 and had been taking zidovudine (ZDV) for three years without any adverse effects. On July 26, 1991, he complained of increasing fatigue and weight loss. At that time, the therapy was changed from ZDV to ddI. Over the next four months the drug therapy was altered from ddI to ZDV and ZDV to ddI because of increasing fatigue and gastrointestinal symptomatology; all of the other chronic medications were maintained at the same dosages and frequency. All laboratory work remained stable and no new active processes were found during this period. The patient developed acute thrombocytopenia upon his last change to ddI and all of the chronic drug therapy was stopped. His platelet count returned to his baseline value three weeks after the discontinuation of ddI and reinstitution of his chronic medications.

DISCUSSION

A review of the literature showed two documented cases of thrombocytopenia with ddI on a dosage escalation study.

CONCLUSIONS

Close patient monitoring is essential while administering ddI.

Re-examination of [3H]mepyramine binding assay for histamine H1 receptor using quinine

[3H]Mepyramine, a potent antagonist of the histamine H1 receptor, has been widely used as a radioligand binding assay for the H1 receptor. Previously, we purified a mepyramine binding protein (MBP) from rat liver, but found that its partial amino acid sequences were very similar to those of debrisoquine 4-hydroxylase isozymes (P450 db1 and db2), which are members of the superfamily of cytochrome P450. Using cloned histamine H1 receptor cDNA, we found that [3H]mepyramine could bind only the H1 receptor and did not bind MBP in the presence of 10(-5) M quinine, an inhibitor of debrisoquine 4-hydroxylase isozymes. We developed a method to determine the contents of the H1 receptor and MBP separately using [3H]mepyramine and quinine and found that MBP is abundant in certain areas of bovine brain.

Acetylcholinesterase-containing neurons, substance P and enkephalin fibers in the ventral horns of developing human embryos and fetuses

The presence of the acetylcholinesterase neurons and substance P-like and enkephalin-like fibers in the various nuclear columns of the ventral horns of the spinal cords was studied in the developing human by acetylcholinesterase histochemistry and substance P and enkephalin immunohistochemistry. Acetylcholinesterase-positive neurons initially appeared in the lateral neuronal columns and eventually were also observed in the medial columns as well as the median columns at various levels of the spinal cord by 10 weeks' gestation. Acetylcholinesterase-positive neurons in the lower sacral levels were not detected until 11-12 weeks' gestation. Diffused substance P- and enkephalin-like fibers were demonstrated as early as 10 weeks' gestation but did not align with any particular nuclear column until after 15 weeks' gestation. These fibers further increased in length and adopted reticular branching patterns and many of these tended to surround the cell bodies of the nuclear columns. Possible interaction of acetylcholinesterase neurons and substance P and enkephalin fibers would commence by 15 weeks' gestation.

Special spectacles facilitating debridement. Report of use in 300 cases

According to the difference of light reflection of tissue with different degree of viability, spectacles were made from glass permitting light of certain wavelength to pass to help distinguish viable from nonviable tissue. They were used in debridement of wounds in 300 patients. The results showed that the quality of debridement was improved as evidenced by better healing and shorter healing time. These spectacles were helpful, especially for young and unexperienced operators to distinguish viable from nonviable tissue. They were also used to predict flap viability in plastic surgery.

Small-vessel pathology and anastomosis following maxillofacial firearm wounds: an experimental study

This experiment was designed to provide a biological basis for early reconstruction of maxillofacial defects caused by firearms using free vascularized flap transfer. The pathologic changes of small-vessel injury, injury mechanism, and the feasibility for early anastomosis of these vessels in the maxillofacial region following high-velocity missile wounds were studied. Dogs' faces were wounded by a steel sphere, weighing 0.7 g and 1.03 g, with an initial velocity of 1,300 m/s or 1,500 m/s. Angiography and high-speed x-ray photography were used to record the effect of injury to blood vessels and other tissues. The pathologic changes in the small blood vessels in the wounds were studied by light microscopy (LM) and electron microscopy (EM). Anastomosis of small vessels in the wound was performed at different times after injury. There were temporary cavity effects and small vascular injury in the wounds. The pathologic changes of the small vessels included microthrombus formation, endothelial loss, breaks in the internal elastic layer, and necrosis. Degeneration of cells was found to end 3 cm from the wound edge. Anastomosis of the vessels performed 3 days after injury provided good short-term patency. These results suggest that the operation for repairing facial defects should be performed 3 days after injury.

Intravenous digital subtraction angiography in patients with aorto-arteritis (Takayasu's)

Aorto-arteritis is one of the commonest vascular diseases in China as well as in Japan and other parts of Asia. The results of digital subtraction angiography (DSA) in 50 patients with aorto-arteritis are reported, and the merits and demerits of intravenous (IV) DSA in the diagnosis of this entity are evaluated. Among the 51 studies performed on 50 patients, IV DSA was used in 48, intraarterial (IA) DSA in 3, and good-to-excellent visualization was obtained in 96% of patients. Aorto-arteritis of varying severity and involving the thoraco-abdominal aorta, the iliac arteries, and other major branches was clearly demonstrated by IV DSA. IV DSA, as compared to our previous experience with conventional arteriography in this entity, may be substituted for conventional arteriography in most patients. A large dose of contrast media needed for a complete study is a major deficiency of IV DSA, and it also has limitations for showing the intrarenal arterial branches.

[A study of acute toxicity of mitoxantrone]

Acute toxicity of mitoxantrone (DHAQ) synthetized by Department of Organic Chemistry, School of Pharmacy, WCUMS was studied in mice and dogs. The toxic effects were compared with those of adriamycin (ADR). The LD50 were 6.6 +/- 1.3 and 7.1 +/- 1.6 mg/kg DHAQ, 7.9 +/- 2.1 and 10.7 +/- 2.2 mg/kg ADR (P = 0.95) respectively on observation with a single dose i.v. and i.p., for 21 days in Kunming mice. The toxicity appeared to be delayed with DHAQ and ADR. The earliest death occurred on 4th day after treatment in mice. In the third week still a few died. There were obvious decreases in WBC counts in the peripheral blood of mice receiving either 1-2.5 mg/kg DHAQ or 2.5-5 mg/kg ADR with a single dose i.p.. The WBC count could return to normality after 3 weeks with the withdrawal of the drugs. On electron microscopic examination of myocardial samples from mice 4 days after a single dose of 20 mg/kg DHAQ i.p., mitochondria swelling and vacuoles formation in some cells were shown. Besides the above-mentioned changes, some myocytes exhibited disorientation and loss of myofilaments in the mice which received equivalent dose of ADR. In dogs anaesthetized a temporary falling of blood pressure and slowing of heart rate were observed following 5-10 mg/kg DHAQ i.p.. When a dose of 50-100 mg/kg was given, the blood pressure dropped continuously until death.

[Studies on the mutagenicity of amrinone and milrinone]

The mutagenicity of domestic new drugs amrinone and milrinone were studied by Ames test, micronucleus test of mouse bone marrow and chromosome aberration assay in CHO cells. The results were as follows: neither amrinone nor milrinone was mutagenic in the Ames test; in chromosome aberration assay, both gave positive results; in mouse micronucleus test, amrinone gave a positive result when mice were exposed to 0.8 LD50 dose, but milrinone gave a negative result. These results suggested that amrinone and milrinone did not induce gene mutation, but amrinone induced chromosome damage both in vitro and in vivo, while the chromosome-damaging activity of milrinone in vitro may be minimized by biodetoxication in vivo.

Reactions of serum creatine kinase in early phase of spherical steel bullet injury

On the basis of experimental study on 17 dogs, this paper reports on the variation of serum creatine kinase (SCK) with time in the early phase of wounding by spherical steel bullets at three different velocities and its relation with the kinetic energy absorbed by the tissue and with the amount of the excised necrotic tissue surrounding the wound tracks. The results showed that the energy absorbed by the tissue and the amount of the excised necrotic tissue surrounding the wound tracks increased with increasing velocity. Within a period of 6 hours after wounding the SCK activity increased correspondingly.