[Brain abscess ruptured into the lateral ventricle: the usefulness of treatment by intraventricular irrigation with antibiotics. A case report]

A case is reported of a brain abscess, which ruptured into the lateral ventricle and was treated using intraventricular irrigation with antibiotics. A 37-year-old man was suffering from a headache and high fever. Precontrast CT scan revealed a heterogeneous low density area in the left temporal lobe, and postcontrast CT scan showed a multilobular ring-like enhanced mass. Diagnosed as a brain abscess, intravenous administration of antibiotics was performed. On the sixth day the patient suddenly became drowsy. Postcontrast CT scan revealed an enhanced effect in the left lateral ventricular wall. Drowsiness was attributed to increased intracranial pressure and severe ventriculitis. Bilateral continuous ventricular drainage via the anterior horn of the lateral ventricle was performed. The drainage fluid from the left lateral ventricle was just like pus. Intraventricular irrigation with antibiotics between the bilateral anterior horns of the lateral ventricle, was performed in order to save the patient. The infusion fluid, Lactate Ringer's solution containing Cefazolin sodium, was infused into the right ventricle and CSF-like pus was drained from the left ventricle. The CSF reading gradually improved, and on the 14th day postoperatively irrigation was terminated. The postoperative course was uneventful. The diagnosis, treatment, and prognosis of patients with brain abscesses have improved dramatically as a result of more reliable methods of identifying infecting organisms, more effective antibiotic regimens, the development of microsurgical techniques and CT scan. However, despite these advances, the prognosis for brain abscess ruptured into the ventricle is usually very pessimistic.(ABSTRACT TRUNCATED AT 250 WORDS)

An artificial esophagus consisting of cultured human esophageal epithelial cells, polyglycolic acid mesh, and collagen

Previously, the authors successfully grafted collagen sheets covered with cultured human esophageal epithelial cells onto latissimus dorsi muscles of athymic mice. To make a tubular artificial esophagus they developed a polyglycolic acid mesh-collagen complex tube whose inner side was epithelialized in vitro by cultured human esophageal epithelial cells. Human esophageal epithelial cells were isolated from normal mucosa resected from specimens of esophageal cancer patients and cultured on the surface of the collagen gel in which polyglycolic acid mesh was embedded. After the culture reached confluence, polyglycolic acid mesh was sutured to create a tubular form lined with cultured cell layers (restructured mucosal tube). Such tubes were wrapped in the latissimus dorsi muscle flaps of athymic rats using a fibrin glue. The animals were killed 4, 8, 20, and 28 days after grafting and the grafted tubes were studied histologically. Up to 28 days after grafting, the luminal structure was maintained without structure. Eight days after grafting, rat fibroblasts infiltrated from the muscle and neovascularization appeared in the collagen layer. The grafted epithelium remained healthy and grew to 15 cell layers by 20 days, much like normal human esophageal epithelium. Staining by anti-laminin monoclonal antibody confirmed a basement membrane.

Combined therapy with arbekacin and fosfomycin for methicillin-resistant Staphylococcus aureus infections

We examined the clinical efficacy of a combination of arbekacin and fosfomycin in the treatment of various methicillin-resistant Staphylococcus aureus (MRSA) infections. The combination of arbekacin plus fosfomycin displayed 65.4% (17/26) clinical efficacy and 65.4% (17/26) bacteriological efficacy. This combination thus appeared to be an effective regimen for the treatment of MRSA infections. However, its bacteriological efficacy against concomitant Pseudomonas aeruginosa strains was only 16.7% (1/6). In addition, in 4 episodes of superinfection involving P. aeruginosa strains developed during the combination therapy.

Benign recurrent intrahepatic cholestasis: a long-term follow-up

We report on a case with a 50-year history of benign recurrent intrahepatic cholestasis, including 33 years of follow-up at our hospital. The attacks of jaundice began at the age of 1 year and have been repeated more than 14 times to date. During the follow-up period at our hospital, the patient has suffered 6 attacks of cholestasis. During the episodes of cholestasis, a dissociation between the serum level of bilirubin and that of bile acids was observed. The analysis of serum bile acids during cholestasis showed that cholic acid and chenodeoxycholic acid were the main bile acids, and no appreciable amounts of the secondary bile acids were detected. Between episodes the liver function tests, including serum bile acids, were normal. Despite multiple attacks of cholestasis over many years, no permanent liver damage has occurred. This case reaffirms the essentially benign nature of this disease.

Improved purification of arylsulfate sulfotransferase from human intestinal bacterium by using polyclonal antibody

Arylsulfate sulfotransferase (ASST) from a human intestinal bacterium stoichiometrically catalyzed the transfer of the sulfate group of phenylsulfate esters to phenolic compounds. Polyclonal antibodies against ASST were obtained from rabbit sera. These antisera did not inhibit ASST activity. ASST was recognized by the IgG fraction of the antisera, but rat liver phenol sulfotransferase did not show cross-reactivity to ASST on Western blot (immunoblot) analysis. The ASST was purified by an anti-ASST immobilized affinity column chromatography to homogeneity on SDS-PAGE. The NH2-terminal amino acid and partial sequence of the purified enzyme were serine and SVKYSFEDHIINRQYEAEQAMLAKF, respectively. We corrected the previous result that the NH2-terminal of ASST was arginine.

[A study on measurement of hardness of oral mucosal lesions]

This study was designed to estimate objectively the hardness of the oral mucosa which is not directly supported by the bone. A new, easy-to-use hardness-measurement apparatus for measuring the oral mucosa free of the underlining bone was manufactured for trial use. The hardness values of the oral mucosa were evaluated quantitatively, resulting from pressing 2 mm into the mucosa with a 2-mm-in-diameter hand-held probe coupled to the hardness-measurement apparatus. Experimental and clinical confirmation was made that practical errors in hardness values are quite permissible when using this apparatus. This fool-proof method was further examined in extensive clinical application. The normal mucous membrane of the tongue, the floor of the mouth, and the cheek respectively measure 4.45, 4.33, and 2.96 gf on average with this apparatus. Examining 26 cases of squamous cell carcinoma on the tongue, the floor of the mouth or the buccal mucosa (16.87-80.32 gf) revealed that the value of measurement of squamous cell carcinoma was as much as 2.31-19.06 times in comparison with the normal mucous membrane. Squamous cell carcinomas were ascertained to be statistically harder than the normal mucosa (p < 0.001) and the tumor margins may be far more precisely clarified with this apparatus than with the human finger alone.

Effects of CO2, acetate and lowering extracellular pH on cytosolic Ca2+ and pH in cultured glomus cells of the newborn rabbit carotid body

Microscopic fluorometry was used to examine the effects of CO2, acetate and low extracellular pH (pHo) on cytosolic Ca2+ ([Ca2+]i, fura-2) and on cytosolic pH (pHi, BCECF) in cultured glomus cells of the newborn rabbit carotid body. Applications of CO2 and acetate at a constant pHo of 7.4 rapidly produced a sustained increase in [Ca2+]i and a sustained decrease in pHi. A slightly lowered pHo of 7.0 slowly induced a small increase in [Ca2+]i and an exponential-like decrease in pHi. An approximately linear correlation was seen between the changed values of [Ca2+]i and pHi induced by the weak acidic stimuli. The speed of the initial pHi response to CO2 was faster than the response to low pHo. It is suggested that the induction of increased [Ca2+]i by hypercapnia and acidosis may be mediated by cytosolic acidification, in which exposure to CO2 causes a faster response than exposure to H+.

Localization of double, roentgenographically occult lung cancer. Cytologic findings from selective brushing of all segmental and subsegmental bronchi

Using selective brushing of all segmental and subsegmental bronchi, six patients were diagnosed as having synchronous, double, roentgenographically occult lung cancers. Experienced bronchoscopists failed to detect four "second cancer" lesions in six patients. The appearance of atypical cells as shown by cytologic examination indicated the probability of the presence of cancer in the examined bronchus. Single cancer cells or tiny clusters of cells with orangeophilic cytoplasm can appear in specimens obtained from all bronchi, and such cells should not be considered to have originated in the bronchi under examination. Medium-sized or large clusters of cancer cells without degeneration and with basophilic cytoplasm appear only in specimens obtained from bronchi in which a cancer lesion exists, and thus they should be considered to have originated in the bronchi under examination. Cancer cells with orangeophilic cytoplasm in clusters should be considered to have originated in unknown locations. To determine the origin of such cells, one must compare the specimens with those obtained from other segmental and subsegmental bronchi. Our findings suggest that selective brushing of all segmental and subsegmental bronchi is a useful method of detecting unrecognizable second cancers and that the method should be employed for all patients with positive sputum cytology.

[A case report of tricuspid replacement for the acquired tricuspid stenosis at the time of reoperation]

A 57-year-old woman, who underwent aortic valve replacement and open mitral commissurotomy nine years ago, was admitted with congestive heart failure due to mitral regurgitation and tricuspid regurgitation, for which we planned mitral valve replacement and tricuspid annuloplasty. Intraoperatively, the orifice of tricuspid valve was stenosed like fish-mouth, which we attempted to make commissurotomy and modified Kay's annuloplasty, but failed to decrease the central regurgitation. A CarboMedics 23 mm prosthesis was implanted in the mitral position and a Capentier-Edwards 29 mm in the tricuspid position. She had recovered from congestive heart failure postoperatively, no regurgitant flow was detected in right ventriculography.

Smooth pursuit eye movements and express saccades in schizophrenic patients

Abnormalities of saccades such as disinhibition have been hypothesized as one cause of smooth pursuit eye movement (SPEM) dysfunctions in schizophrenia. Thus, we studied saccadic eye movements in schizophrenics with SPEM dysfunction. Subjects were divided into three groups: 10 normal control subjects, 10 schizophrenic subjects without SPEM dysfunction and 10 schizophrenic subjects with SPEM dysfunction characterized by a cogwheel appearance. Visually guided saccades in gap and overlap paradigms (Saslow, 1967) were examined and saccadic reaction times (SRTs) were measured in all subjects. Only schizophrenics with SPEM dysfunctions tended to manifest excessive reflexive saccades, named express saccades (Fischer, 1987), in the gap paradigm. Moreover, most of them were also found to have express saccades in the overlap paradigm, whereas normal subjects and schizophrenic subjects without SPEM dysfunction did not show such phenomena under the same conditions. In particular, most express saccades in the overlap paradigm in schizophrenics with SPEM dysfunction, were found in movements to the right.

The effects of raloxifene on tibia histomorphometry in ovariectomized rats

Tissue-specific estrogen agonists may be useful in protecting against osteoporosis and the increased risk of coronary heart disease in postmenopausal women with minimal undesired effects on reproductive tissues. The actions of the mixed estrogen agonist/antagonist raloxifene on selected estrogen target tissues were determined in ovariectomized (OVX) rats immediately postovariectomy. Five groups of 75-day-old Sprague-Dawley rats were studied; baseline controls, sham-operated controls, OVX controls, OVX animals treated with estrogen (0.1 mg 17 alpha-ethynyl estradiol/kg.day), and OVX animals treated with raloxifene (3 mg/kg.day). Fluorochrome labels were given on days 1, 28, and 34. The baseline controls were killed on day 2, and the remaining groups on day 35. Ovariectomy increased tibial longitudinal growth rate as well as measurements related to radial growth and cancellous bone turnover. Ovariectomy decreased cancellous bone area and uterine weight, and increased serum cholesterol, bone elongation, and radial bone growth. Estrogen treatment prevented these changes in OVX rats. Raloxifene prevented cancellous osteopenia as well as the changes in radial bone growth, bone resorption, and blood cholesterol, but was less effective in reducing cancellous bone formation and did not prevent uterine atrophy. These findings suggest that raloxifene is a target-specific, mixed estrogen agonist/antagonist. At the concentration studied, raloxifene had potent estrogenic activity on bone resorption and serum cholesterol, a lesser effect on bone formation, and minimal activity on uterine wet weight.

Histopathological and morphometrical comparison of granulomatous lesions in BALB/c and C3H/HeJ mice inoculated with Mycobacterium paratuberculosis

Susceptibility to Mycobacterium paratuberculosis strain ATCC 19698 infection was compared histologically and morphometrically in BALB/c (Bcgs) and C3H/HeJ (Bcgr) mice. The granulomatous lesions, containing M. paratuberculosis, in the liver and spleen of BALB/c mice increased progressively until 32 weeks after intraperitoneal inoculation. In contrast, both the granulomatous lesions and number of bacteria decreased drastically in C3H/HeJ mice beginning at 6 weeks after inoculation. There were histological differences in granulomatous lesions between BALB/c and C3H/HeJ mice, indicating differing functional activity of cellular immunity. Intestinal lesions similar to those seen consistently in bovine paratuberculosis were observed first at 6 weeks after infection and later became disseminated widely, especially in BALB/c mice. Our results suggest that the innately susceptible BALB/c mice and the innately resistant C3H/HeJ mice may be useful and convenient models for further studies of immunoregulation and antimicrobial therapy of paratuberculosis.

Long-term results of primary closure for ventricular septal defects in the first year of life

The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 +/- 0.09 preoperatively to 0.42 +/- 0.12 by 1 month postoperatively, then to 0.27 +/- 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.4 l/min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.

Dual-energy x-ray absorptiometry of raloxifene effects on the lumbar vertebrae and femora of ovariectomized rats

A new potential therapeutic agent for postmenopausal osteoporosis, raloxifene, previously known as keoxifene, was evaluated by x-ray densitometry and more traditional techniques in quantitating the short-term (4-5 weeks) effects of ovariectomy on bones from 6-month-old rats. A Hologic QDR 1000/W and, to a limited extent, a Lunar DPXL, was used to quantitate ovariectomy, estrogen replacement, and raloxifene effects on vertebrae, femora, and tibiae. Both instruments performed well with precisions of 1.6% (Hologic) and 0.9% (Lunar) for anesthetized rats, which improved to 0.4% (Hologic) and 0.5% (Lunar) when the same rats were frozen. The lumbar vertebrae L1-4 showed a 12% decrease in bone mineral density 4 weeks after ovariectomy, compared with a 9% decrease for femora. Tibiae were also examined, but edge-detection problems prevented reproducible analysis of this site in vivo. The decrease in bone mineral density postovariectomy, especially for femora, was found to include both an increase in the projected area and a slight but not significant decrease in the bone mineral content of L1-4 and femora. These changes in density parameters of femora were supported by a decrease in dry weight and volume and a marginal increase in the second moment of inertia I for the identical femora examined ex vivo. Examination of individual lumbar vertebrae L1-5 suggested that the bone mineral density of L3 changes most dramatically in response to ovariectomy, but present techniques lack the spatial resolution and precision to quantitate bone changes reliably in individual vertebrae. 17 beta-Estradiol administered at 100 micrograms/kg/day subcutaneously inhibited ovariectomy effects on L1-4 bone mineral density, femoral moment of inertia, dry weight, and volume and to a lesser extent, femoral bone mineral density. A nonsteroidal compound, raloxifene HCl, at 1 mg/kg/day per os, had bone effects and effects on body weight that were largely indistinguishable from those of 17 beta-estradiol; however, raloxifene did not produce the uterotrophic effects observed with estrogen. The half-maximal efficacious dose of raloxifene on L1-4 bone mineral density was between 0.1 and 1.0 mg/kg/day per os. These data show that dual-energy x-ray absorptiometry compares favorably with traditional methods in quantitating bone changes caused by ovariectomy in small rodents, that L1-4 is a more sensitive region than whole femora in evaluating the effect of estrogen deficiency on bone loss, and the raloxifene may have promise as a treatment for conditions characterized by excessive bone loss after ovariectomy.

Clear cell sarcoma of the kidney in an adult

A 25-year-old woman with clear cell sarcoma of the kidney (CCSK) underwent computed tomography (CT), angiography, and a surgical operation. The clear cell sarcoma showed a cystic lesion with solid components on CT and a hypovascular tumor and rat-tail occlusion of the left renal artery on angiography. These findings in our adult case of CCSK corresponded with those of CCSK in childhood.

Changes in manganese content of mononuclear blood cells in patients receiving total parenteral nutrition

We measured the manganese content of mononuclear blood cells and the manganese concentrations in whole blood and plasma from 31 healthy volunteers and 25 patients receiving total parenteral nutrition (TPN) (i.e., no dietary manganese). The manganese content (mean +/- 2 SD) of mononuclear blood cells and the manganese concentration in whole blood and plasma in the healthy volunteers were 8.84 +/- 4.18 ng/10(8) cells, 11.21 +/- 4.68 micrograms/L, and 1.21 +/- 0.72 micrograms/L, respectively. The manganese content of mononuclear blood cells from patients receiving TPN gradually decreased, falling below the lowest limit of the normal range by 21 weeks (95% confidence limits, 13-30 weeks) after starting TPN. Manganese concentrations in whole blood and plasma were within normal limits during our study period. These results suggest that the manganese content of mononuclear blood cells may better indicate manganese nutritional status than whole-blood or plasma concentrations.

Changes in manganese content of mononuclear blood cells in patients receiving total parenteral nutrition

We measured the manganese content of mononuclear blood cells and the manganese concentrations in whole blood and plasma from 31 healthy volunteers and 25 patients receiving total parenteral nutrition (TPN) (i.e., no dietary manganese). The manganese content (mean +/- 2 SD) of mononuclear blood cells and the manganese concentration in whole blood and plasma in the healthy volunteers were 8.84 +/- 4.18 ng/10(8) cells, 11.21 +/- 4.68 micrograms/L, and 1.21 +/- 0.72 micrograms/L, respectively. The manganese content of mononuclear blood cells from patients receiving TPN gradually decreased, falling below the lowest limit of the normal range by 21 weeks (95% confidence limits, 13-30 weeks) after starting TPN. Manganese concentrations in whole blood and plasma were within normal limits during our study period. These results suggest that the manganese content of mononuclear blood cells may better indicate manganese nutritional status than whole-blood or plasma concentrations.

[Changes in physical disability among Japanese elderly]

In order to investigate the natural course of physical disability among the elderly, the ability to perform activities of daily living (ADL) was examined on a probability sample (N = 3384) of residents aged 65 years and over in Sendai City, Japan, in 1988 and 1991. Information on ability to perform four ADL tasks-dressing, eating, using the toilet, and bathing-were collected by self-report. In 1988, 7.2% of the males and 7.9% of the females reported at least one ADL dependency. The prevalence of disability was the highest in bathing, followed by dressing, using the toilet, and the lowest in eating. The Cox proportional hazard models on three-year mortality indicated that those who were ADL dependent at baseline had 4.1 times the mortality risk of those who were ADL independent. Among those who were ADL independent in 1988 and who were alive in 1991, 5.0% of the males and 4.8% of the females became dependent in at least one ADL task in 1991. The incidence of disability was the highest in bathing, followed by dressing, using the toilet, and the lowest in eating. Among those who were ADL dependent in 1988 and who were alive in 1991, about one-third of them improved in ADL functioning. Improvement was more common among those who were younger in age. These results suggest that levels of ADL functioning is highly dynamic, and that physical disability is, to a certain extent, reversible among the elderly.

Multicentricity in resected occult bronchogenic squamous cell carcinoma

The frequency and the treatment of multicentricity in 127 patients with resected roentgenographically occult bronchogenic squamous cell carcinoma were studied. The cumulative rate and the incidence of postoperative metachronous multiple primary lung cancer were 0.11 at 5 years after initial operation and 0.022 per patient-year, respectively. The cumulative rate and the incidence of second primary lung cancer, which includes synchronous and subsequent metachronous cancer in patients with initial lung cancer, were 0.17 at 5 years after the initial operation and 0.041 per patient-year, respectively. The cumulative rate and the incidence of third primary lung cancer in patients with second primary lung cancer were 0.47 at 5 years, which was significantly higher (p = 0.05) than that of second primary lung cancer, and 0.11 per patient-year, respectively. In all 12 patients with synchronous multiple primary lung cancer, no recurrence was observed after treatment, but 3 had subsequent multiple primary lung cancer. Among the 13 patients with postoperative metachronous multiple primary lung cancer, recurrence was observed in 1 of the 6 patients who underwent resection and in 2 of the 4 patients treated with laser or radiation therapy or both. The overall survival rate at 5 years after initial operation in patients with solitary and those with multicentric occult bronchogenic squamous cell carcinomas was 0.90 and 0.59, respectively.

Analysis of proliferative activity in renal lesions induced by N-nitrosobis(2-oxopropyl)amine (BOP) in male Syrian golden hamsters

Binding of a specific antibody to proliferating cell nuclear antigen (PCNA) and staining of argyrophilic proteins associated with nucleolar organizer regions (AgNORs) were investigated in proliferative lesions induced by N-nitrosobis(2-oxopropyl)amine (BOP) in the hamster kidney. Thirty male Syrian golden hamsters were given three weekly s.c. injections of BOP (10 mg/kg body wt.) and sacrificed for characterization of proliferative changes 30 weeks after the first BOP treatment. Morphologically, lesions of the tubular epithelia were classified either as tubular adenoma or dysplasia, the latter being further classified into small cluster, acidophilic cell, clear cell and cystic types. Immunohistochemistry for PCNA revealed significant increases of cell proliferation activity in adenomas and acidophilic cell types of dysplasia, along with significantly elevated mean numbers of AgNORs per nucleus. The results thus indicate that the acidophilic cell type of dysplasia may be of prime significance as the preneoplastic renal lesion induced by BOP.