[Two cases of pulmonary amebiasis]

CASE 1: A 74-year-old man having a week's fever and diagnosed with a liver abscess was treated with several antibiotics and percutaneous liver drainage. His respiration gradually worsened and chest computed tomography (CT) showed right pleural effusion and a left-lung mass. Percutaneous fine needle aspiration of the pulmonary mass detected Entamoeba histolytica. CASE 2: A 44-year old, zoo office worker admitted for fever and right chest pain was found in CT to have right pleural effusion and a mass with a liver abscess necessitating abscess drainage. Injected contrast medium detected a fistula connected to the right. Following surgical drainage, E. histolytica was detected from the resected lung. Both cases responded well to metronidazole.

[A case of severe radiation pneumonitis--a trial of plasma exchange]

A 77-year-old man underwent radiotherapy for the squamous cell carcinoma of the right lung. Two months after the 60Gy/30fr irradiation was completed, he complained of dyspnea and his chest X-ray showed ground glass opacities and reticular shadows in both lung fields. Severe radiation pneumonitis was diagnosed. Two grams of methylprednisolone did not improve his symptoms and on the next day his hypoxemia worsened. We then tried plasma exchange because of his critical status. His respiratory status improved rapidly after plasma exchange and his chest X-ray showed remarkable improvement 10 days later. We think this case suggests the effectiveness of plasma exchange for severe radiation pneumonitis.

Release of Short and Proline-Rich Antihypertensive Peptides from Casein Hydrolysate with an Aspergillus oryzae Protease

Angiotensin-I converting enzyme inhibitory activities were measured after hydrolysis of casein by 9 different commercially available proteolytic enzymes. Among these enzymes, a protease isolated from Aspergillus oryzae showed the highest angiotensin-I converting enzyme inhibitory activity per peptide. The A. oryzae peptide also showed the highest antihypertensive effect in spontaneously hypertensive rats when the systolic blood pressure was measured 5 h after oral administration of 32 mg/kg of various enzymatic hydrolysates. Significant antihypertensive effects were observed with dosages of 9.6, 32, and 96 mg of the A. oryzae peptide/kg of body weight (BW), and the effects were dependent on these peptide dosages. Analysis of peptide length showed the A. oryzae hydrolysate was the shortest of all tested casein hydrolysates; the peptide mixture had an average value of 1.4 amino acids (AA) in the sequence. To further characterize the A. oryzae hydrolysate, we analyzed the AA sequence of the whole peptide mixture. Various AA were detected at the first AA position, however, an increased number of Pro residues were observed at the second and third position of the A. oryzae hydrolysate. No strong signals were detected after the fourth AA position of the A. oryzae hydrolysate. These results suggest that the casein hydrolysate of A. oryzae, which expressed potent antihypertensive effects in spontaneously hypertensive rats, mainly contain short peptides of X-Pro and X-Pro-Pro sequences.

Obesity, weight change and risks for hypertension, diabetes and hypercholesterolemia in Japanese men

OBJECTIVE

To examine the effects of the degree of body mass index and weight gain as the risks for hypertension, hypercholesterolemia and diabetes in Japanese men, and to compare that to the corresponding effects in a Caucasian population.

DESIGN

Prospective cohort study.

SETTING

Cohort of all male employees at a company.

SUBJECTS

A total of 4737 male employees followed until retirement or for 4 y (longest term 4 y).

RESULTS

Increase of body mass index beyond 22 kg/m(2) related to an increased risk for hypertension even after being adjusted for possible confounding factors such as age, smoking status, alcohol intake, family history and baseline value of systolic blood pressure. The risks greatly increased in subjects with a body mass index above 27 kg/m(2) for hypertension, and 29 kg/m(2) for diabetes and hypercholesterolemia. Weight gain (more than 2 kg) was strongly related to an increased risk for hypertension and hypercholesterolemia after being adjusted for possible confounding factors. However, weight gain was not related to diabetes, and weight loss did not decrease the risks for any of the three diseases.

CONCLUSIONS

Among Japanese, the degrees of body mass index associated with risks for hypertension, diabetes and hypercholesterolemia were lower than those in Caucasians. The risks for hypertension and hypercholesterolemia were strongly associated with weight gain in a Japanese male population who showed a low prevalence of severe obesity, and the risks were similar to or somewhat higher than those in a Caucasian population with a high prevalence of severe obesity.

SPONSORSHIP

Health Science Research Grant by the Ministry of Health and Welfare of Japan.

The usefulness of 3D MR angiography in surgery for ruptured cerebral aneurysms

BACKGROUND

We have used magnetic resonance angiography (MRA) in screening for unruptured cerebral aneurysms since 1993. The development of high-resolution magnetic resonance (MR) imaging has led to a remarkable improvement in image quality. Three-dimensional (3D) MRA can be used for surgical simulation. Here, we report on the usefulness of and problems associated with 3D MRA for the surgery of ruptured cerebral aneurysms.

METHODS

Between June 1998 and June 2000, 106 patients with SAH diagnosed by 3D MRA underwent surgery. We compared 3D MRA images with operative findings and investigated the usefulness of this assessment tool.

RESULTS

In 48 of 106 cases (45.3%), we were able to perform surgery based on 3D MRA alone. By using the 3D images, we could easily detect the relative location of the aneurysm, its neck and the surrounding arteries. The remaining cases required further examinations because of uncertainty of diagnosis or insufficient information.

CONCLUSION

3D MRA is a safe and useful procedure for the diagnosis and surgery of ruptured cerebral aneurysms. However, in approximately half of all cases, 3D computed tomographic angiography (CTA) or digital subtraction angiography (DSA) is required in addition for the planning of surgery. It is important to use 3D MRA for surgery only after taking sufficient consideration of certain limitations peculiar to MRA.

Surgical outcome of intramedullary spinal cord ependymoma

Surgical outcome of intramedullary spinal cord ependymoma was investigated in order to define the treatment strategy. We have operated on 18 cases of intramedullary spinal cord ependymoma based on the principle of radical resection. The follow-up periods ranged from 10 months to 249 months with an average of 86.2 months. Postoperative neurological status in the long follow-up periods was compared to the pre-operative status and was correlated with the histological grade of malignancy. Total removal of the tumour was achieved in 17 cases, and subtotal removal followed by radiation therapy was conducted in 1 case. There was neither surgical mortality nor radiological evidence of recurrence in the long-term follow-up periods. The final outcome of the neurological condition was improved in 1 case, unchanged in 15 cases (including a case of subtotal removal) and deteriorated in 2 cases. The deterioration was in the form of gait disturbance due to the worsening of proprioception in 2 cases and dysaethesia in 1 case. Histological examination showed no evidence of anaplasia in 6 cases, evidence of early anaplasia in 10 cases, and moderate evidence of anaplasia in 2 cases. No relationship between the histological malignancy and clinical course was found. Intramedullary spinal cord ependymoma should be removed radically as early as possible while taking great care to avoid posterior column injury. Histologically malignant ependymoma might be a clinical exception.

[Intrascrotal fibrous pseudotumor accompanied by pelvic kidney with ectopic ureteral opening: a case report]

A case of intrascrotal fibrous pseudotumor accompanied by pelvic kidney with ectopic ureteral opening is reported. The patient was a 65-year-old man with the complaint of swelling of the right scrotal contents. Ultrasonography showed a heterogeneous mass with acoustic shadow from the right epididymis to right spermatic cord. Intravenous pyelography revealed a non-visualizing right kidney. Endoscopic examination was performed because of the right non-functioning kidney and right epididymectomy was performed. Endoscopic findings showed that the ureteral opening existed at 6 degrees of the bladder neck. Retrograde pyelography demonstrated the right kidney in the pelvic cavity. The tumor was stony hard and 30 x 50 mm in size. Pathological diagnosis of the tumor was a fibrous pseudotumor. We reviewed and discussed 22 cases of fibrous pseudotumor, including our case, in the Japanese literature.

[Study on free enzymes and proteins in the urine. Report IV: The effects of Iohexol on elderly patients with renal function disorder]

We assessed the nephrotoxicity of a non-ionic contrast medium, Iohexol, in 18 elderly patients. They were divided into two groups. Group 1 consisted of 12 patients with glomerular flow rate (GFR) above 60 ml/min/1.73 m2 (range 69-136; average 96) and group 2 consisted of 6 patients with GFR below 60 ml/min/1.73 m2 (range 38-59; average 49). Urine samples, collected before, immediately after, and on the third and sixth days after drip infused pyeloureterography (DIP) were analyzed for gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-MG) and albumin. In group 1, immediately after DIP, the urinary excretion of albumin, gamma-GTP and NAG were significantly increased (p < 0.01, p < 0.01, p < 0.01). In group 2, immediately after DIP, the urinary excretion of gamma-GTP and beta 2-MG were significantly increased (p < 0.01, p < 0.1). The gamma-GTP and NAG values in both groups suggest that the damage of proximal tubules cells will not continue for more than 4 days. However, as for the reabsorption of beta 2-MG on proximal tubules, in group 2 the value did not return to the pre DIP level until 6 days after DIP. We believe it is important to postpone injection of non-ionic contrast medium within 6 days of its last usage.

[A case of muellerian duct cyst treated with minocycline hydrochloride sclerotherapy under ultrasound control]

We present a case of a muellerian duct cyst in a 55 year-old man. A cystic lesion was incidentally found between the prostate and the bladder on transabdominal ultrasound examination. Computerized tomography revealed a low density area homogeneous and round with a clear margin. Both urethrocystgram and vesiculogram demonstrated no cystic lesion. On diagnosis of muellerian duct cyst percutaneous needle aspiration was performed under ultrasound control. The aspirated fluid was yellow, clear and negative for cytology. Microscopically no spermatozoa were found in it. Minocycline (100 mg) was injected into the cyst. No recurrence has occurred since the operation. The literature of the cyst was briefly reviewed.

[A case of surgical repair for combined septal perforation and cardiac rupture after myocardial infarction]

The successful surgical repair of the combination of septal perforation and cardiac rupture after myocardial infarction was underwent on a 73-year-old man. Complete correction could be performed under the fibrillated heart state employing cardiopulmonary bypass, resulted in the early postsurgical cardiac performance.

[An infantile case of cerebral infarction associated with thrombocytosis]

Cerebral infarction in children is often caused by intracranial vascular disorder, cardiac disease, head injury, or infection, and is rarely induced by blood disease. In this paper, we describe an infantile case of cerebral infarction associated with thrombocytosis. A female infant of eight months of age developed left hemiparesis after a slight head injury. Her CT and MRI demonstrated a cerebral infarction located from the right internal capsule to the right corona radiata. Laboratory findings revealed iron-deficiency anemia and thrombocytosis with a platelet count 107.5 x 10(4)/mm3. Although she had no disorder that had caused iron deficiency, serum Fe value of the patient was low with a count of 18 micrograms/dl. Her bone marrow was normal except for a slight increase in the number of megakaryocytes. One month later, her anemia was improved by means of oral iron replacement. However, her platelet count remained at more than 100 x 10(4)/mm3 as it had been before. Her condition of left-sided hemiparesis gradually improved by a program of rehabilitation, and did not recur after aspirin administration. Although the main cause of her thrombocytosis that led to a transient cerebrovascular accident is obscure, it is postulated that her iron deficiency anemia induced secondary thrombocytosis, or else the patient had essential thrombocytosis.

[Evaluation of the clinical effect of ceftazidime in the field of obstetrics and gynecology]

Ceftazidime (CAZ) was administered to patients with obstetrical and gynecological infectious diseases and we studied its clinical effect: CAZ was administered to 24 patients at a dose of 2--4 g per day (twice a day) by drip infusion over a period of 3--11 days (total 6--32 g). The subjects included 19 cases of intrauterine infection, 4 of adnexitis, and 1 of infection of the external genital organs. The overall clinical results were excellent in 6 cases and good in 18 cases, the efficacy rate being 100%. For bacteriological study, 26 strains were isolated from 16 patients. These included Gram-positive bacteria (10 strains), Gram-negative bacteria (6 strains) and anaerobes (10 strains). After CAZ treatment, 4 strains (S. mitis 1, E. coli 1, P. anaerobius 1, B. melaninogenicus 1) were eliminated, but as to the other 22 strains, the results were unknown, because we could not examine microbiology after administration. No clinical side effect or abnormality in laboratory findings was observed.