[A case of failure of mitroflow pericardial valve with severe hemolytic anemia]

A 49-year-old woman who underwent mitral valve replacement with 29 mm Mitroflow pericardial valve in 1985 started to have severe hematuria, anemia and icterus around May 1994. She was diagnosed to have mitral regurgitation with hemolytic anemia due to structural deterioration of the prosthetic valve. She underwent replacement of the prosthetic valve with 29 mm St. Jude medical mechanical valve, which alleviated the symptoms remarkably. The explanted valve showed an extensive cuspal tear and prolapse close to the commissure and poor endothelialization of the inflow surface of the frame. In our experience the rate of structural deterioration of the Mitroflow valve is so high that we discontinued using this bioprosthesis.

[HLA-DQB2 genotypes analyzed by PCR/SSCP method]

When the PCR products amplified by the primers prepared at the 11th HLA Workshop (DQBAMP-A, DQBAMP-B) were analyzed directly by the SSCP method, one or two pairs of characteristic bands were detected other than those attributed to DQB1, and a total of three kind of paired bands were detected. To confirm that these bands were allelic genes of DQB2, the corresponding bands were isolated by cloning, and their base sequences were determined. The base sequence of one of them was in agreement with that of DX beta, which has already been described, and the characteristic 3-base defect was noted by comparison with the base sequence of DQB1. The same 3-base defect was noted also in the other two kinds. One-base substitution was present in each of the three kinds of base sequence, and they were confirmed to be allelic genes of DQB2. In DQB1 typing by the PCR/SSCP method of Carrington et al., treatment with the restriction enzyme Alu 1 is needed to eliminate DQB2. However, the use of this enzyme was theoretically demonstrated to be inappropriate, because it degraded the DQB1*0401 gene.

Localization of advanced glycation endproducts in the kidney of experimental diabetic rats

Advanced glycation endproducts (AGE) have been proposed as a major mediator in the development of various diabetic complications. In order to evaluate the involvement of AGE in the development of diabetic nephropathy, we examined the localization of AGE in the kidney of the streptozotocin-induced diabetic rats immunohistochemically using a monoclonal antibody directed to AGE. In the diabetic rats, glomerular hypertrophy, thickening of the glomerular basement membrane, and expansion of mesangial matrix were observed. AGE was detected in expanded mesangial area and glomerular basement membrane in the kidneys of diabetic rats. The present results suggest that AGE may participate in the development of diabetic nephropathy.

High-level expression of the CD44 variant sharing exon v10 in renal cancer

To examine whether renal cell carcinoma displays altered CD44 expression we performed reverse transcription-polymerase chain reaction (RT-PCR) analysis of CD44 in 38 specimens from renal cancer, normal kidney and metastases of 19 patients and 6 renal cancer cell lines. To detect the CD44 variants, we utilized the RT-PCR Southern blot method. One out of 19 (5.3%) renal cancer specimens expressed a larger molecular weight band than 1 kb by RT-PCR analysis, in contrast to previous findings in colon and breast cancer. The band patterns in RT-PCR were different in 14/17 (82.4%) cases between normal kidney and tumors, and a band of about 700 bp was especially marked in 12/17 (70.6%) tumor specimens and 4/6 (66.7%) cell lines. By cloning and sequencing of the 700 bp band, we found that this variant is identical to the CD44 variant sharing only exon v10. Examination by Northern blot analysis has revealed that all tumors express a higher level of CD44 mRNA than paired normal kidneys. These findings suggested that the CD44 variants sharing exon v10 play some role in renal cancer.

[Early effects of intravenous steroid therapy on cell recruitment in sputum of chronic asthmatics]

Steroid is the key drug in the asthma therapy but not well known to play the role on the airway inflammatory cells. We examined sputum cells of acute excerbated 11 chronic adult asthmatics before and 2-3 hours after intravenous steroid and aminophylline therapy. There was no changes in the percent count of living cell, epithelial cell, metachlomatic cell, macrophage and neutrophil before and after treatment. Lymphocyte was 3.3 +/- 6.5% before and 2.6 +/- 2.0% after treatment. CD4 and CD25 double positive cell (CD4+/CD25+) was 0.7 +/- 0.5 and 1.2 +/- 0.9% and CD8+/CD25+ cell was 0.4 +/- 0.4 and 0.6 +/- 0.5% before and after treatment respectively. These changes were not significant. Eosinophil percent count did not decrease significantly but EG1+/EG2+ cell decreased from 6.7 +/- 7.8 to 4.3 +/- 5.2% significantly (p < 0.05). In the light of no decrease of activated T lymphocytes (CD25+ cells), we concluded that failure of tissue eosinophil response to lymphokines might result in a decrease in activated eosinophil count.

Detection of deiminated proteins in rat skin: probing with a monospecific antibody after modification of citrulline residues

We performed a systematic study on deiminated proteins present in rat epidermis. Proteins extracted from various epidermal samples were resolved by either one- or two-dimensional gel electrophoresis and Western blotted to nitrocellulose membranes. Deiminated proteins were detected by modification of citrulline residues followed by probing with an anti-modified citrulline monospecific antibody. The cornified layer of adult plantar skin gave multiple series of isoelectric variants, most of which were found to be differentially deiminated type II keratins (60 kDa, and 67 kDa or above). The whole epidermis of 5-day-old rat back skin showed isoelectric variants of 60-kDa keratin as major deiminated components, and deiminated 55-kDa keratin and deiminated filaggrin as minor spots. In addition, we found highly deiminated proteins (200-220 kDa) thought to be derived from trichohyalin. The immunoreactivity of deiminated proteins was mainly localized in the granular and cornified layers of epidermis. Co-localization of deiminated filaggrin and keratins in the granular layer suggests the possible role of protein deimination during the terminal stage of epidermal differentiation.

[Sequence polymorphism of mitochondrial DNA and its forensic application]

We have investigated polymorphism of mitochondrial (mt) DNAs in the Japanese population. In order to compare 288-bp sequences (nucleotide positions 16,111 to 16,398) in the noncoding region, a 452-bp segment elongated by 82 bp at both sides of the target was amplified by PCR and analyzed directly by Taq cycle sequencing with FITC-labelled primers. A survey of 100 Japanese individuals revealed the existence of 66 types of mtDNAs. Among them, 10 types including two frequent types were shared by more than one individual. During this investigation, it was found that 19 types (from 25 individuals) possessed a common nucleotide replacement of T by C at position 16,189, by which a "C-continuous stretch" was formed, and that clear reading of their sequences was restricted in the region lying ahead of the C stretch on either forward or reverse sequencing. Cloning analysis of PCR product possessing the C stretch demonstrated that the length of the C stretch was heterogeneous. Consequently, we propose the following rules for mtDNA sequencing and its forensic application: 1) the replacement of T by C at position 16,189 is acceptable as a variation factor. 2) The number of Cs in the C stretch is tentatively fixed at 10.

Age-related increase in peptidylarginine deiminase in the male rat pituitary

We have measured the activity of peptidylarginine deiminase (EC 3.5.3.15) in male Wistar rat pituitaries at various ages. Pituitaries obtained from 3- and 9-month-old rats showed negligible activities. The mean enzyme activity increased appreciably by 18 months and markedly by 24 months accompanied with actual increases in the enzyme content. The peptidylarginine deiminase mRNA content showed a similar but more gradual increase appreciable from 9 months. Many enzyme-positive cells were present in the pars distalis of 24-month-old male pituitaries. Most of the enzyme-positive cells coincided with lactotrophs. The pituitary prolactin content showed a gradually increasing profile resembling that of the enzyme mRNA, but the serum prolactin concentration did not increase significantly. Neither the serum 17 beta-estradiol content nor the pituitary estrogen receptor content showed significant variation that could account for the marked increase in the pituitary enzyme content between 18 and 24 months of age. These data suggest possible presence of other factors regulating the enzyme content in old male pituitaries.

Primary structures of two homologous subunits of PA28, a gamma-interferon-inducible protein activator of the 20S proteasome

The primary structures of two proteins that comprise PA28, an activator of the 20S proteasome, have been determined by cDNA cloning and sequencing. These protein subunits, termed PA28 alpha and PA28 beta, are about 50% identical to one another and are highly conserved between rat and human. PA28 alpha and PA28 beta are homologous to a previously described protein, Ki antigen, whose function is unknown. PA28 alpha, but neither PA28 beta nor Ki antigen, contains a 'KEKE motif', which has been postulated to promote the binding of proteins having this structural feature. PA28 alpha and PA28 beta were coordinately regulated by gamma-interferon, which greatly induced mRNA levels of both proteins in cultured cells. The mRNA level of the Ki antigen also increased in response to gamma-interferon treatment, but the magnitude of the increase was less than that for the PA28s, and the effect was transient. These results demonstrate the existence of a new protein family, at least two of whose members are involved in proteasome activation. They also provide the basis for future structure/function studies of PA28 subunits and the determination of their relative physiological roles in the regulation of proteasome activity.

Developmental expression of APEX nuclease, a multifunctional DNA repair enzyme, in mouse brains

Expression of the mammalian major apurinic/apyrimidinic (AP) endonuclease (designated as APEX nuclease, or HAP1, APE or Ref-1 gene product) during mouse brain development was investigated by in situ and northern blot hybridizations. The enzyme is known to be a redox factor (Ref-1) stimulating DNA binding activity of AP-1 binding proteins such as Fos and Jun as well as a multifunctional DNA repair enzyme having 5' AP endonuclease, DNA 3' repair diesterase, 3'-5' exonuclease and DNA 3'-phosphatase activities. In the embryonic and postnatal development, APEX mRNA was expressed at high levels in the proliferative zone of various brain regions, with showing temporal and spatial changes. Its expression decreased in association with brain development to the basal expression level which was observed even in adulthood, with the exception of its expression in the hippocampal formation. The growth-dependent expression of APEX gene suggests that it has some roles on cell proliferation and/or differentiation in developmental brain. Its expression on the hippocampal formation became significant from postnatal day 7 and then increased. The pyramidal and granule cell layers expressed it at a higher level than most other brain regions at postnatal day 21. The developmental change of APEX gene expression was not necessarily associated with the changes of expression of c-fos and c-jun genes measured by northern blot hybridization. However, the present results suggested that APEX/Ref-1 gene product can interact with AP-1 binding proteins in brain, especially in the hippocampal formation, to regulate some brain functions by redox-activation.

Long-lasting increase in protein kinase C activity in the hippocampus of amygdala-kindled rat

Previous studies have demonstrated that membrane-associated protein kinase C (PKC) activities in the right and left hippocampus of rats kindled from the left hippocampus increased significantly at 4 weeks [9] and 4 months [22] after the last seizure compared with those in matched control rats. In this study, we investigated the effect of kindling from the left amygdala on PKC activities in the amygdala/pyriform cortex and hippocampus at long seizure-free intervals (4 and 16 weeks) from the last amygdala-kindled seizure. Membrane-associated PKC activity of the kindled group increased significantly only in the left hippocampus compared with the left side control (the left hippocampus of rats subjected to a sham operation) at 4 weeks (by 34%, P < 0.03) and 16 weeks (by 24%, P < 0.05) after the last seizure. There was no significant alteration in the membrane-associated PKC activity of the kindled group in the right hippocampus or amygdala/pyriform cortex in any seizure-free interval after the last amygdala seizure. Cytosolic PKC activity did not differ between the kindled and control groups in any brain region examined in any seizure-free interval. At 16 weeks after the last seizure, the PKC activity in the P1 fraction of the kindled group increased significantly only in the left hippocampus (by 49%, P < 0.005), but not in the right hippocampus. Neither PKC activity in the P2 fraction nor that in the cytosolic fraction was altered in the kindled group after this seizure-free interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypertension in epileptic mice: a phenomenon related to reduction of Ca(2+)-dependent catecholamine synthesis in the brain

The possible complication of hypertension and epilepsy was investigated through the response in epileptic El mice. The systolic blood pressure in El mice (male, 8 weeks of age) and that in normal ddY mice (the parent strain of El mice) were compared by a tail-cuff method, using a programmed sphygmomanometer. The systolic blood pressure in El mice (120.5 +/- 5.6 mm Hg) was 28% (P < 0.01) higher than that in ddY mice (93.9 +/- 5.3 mm Hg). The higher systolic blood pressure in El mice was lowered by the acute intracerebroventricular administration of CaCl2 (10 mumol/kg, 30 min before measurement) or dopamine (30 nmol/mouse, 15 min before measurement), and was also improved by the chronic oral supplementation with 1.2% calcium (Ca2+) solution. Combining these results with those in our previous reports, where it is stated that lowering of Ca(2+)-calmodulin-dependent catecholamine synthesis increases the susceptibility to epileptic convulsions, we suggest that the increase in susceptibility to epileptic convulsion and occurrence of hypertension in El mice may be linked and that the two diseases may be associated.

Urinary detection of type IV collagen and its increase in glomerulonephritis

Type IV collagen is the major component of the glomerular extracellular matrix. The nature of type IV collagen antigens in the urine from various forms of glomerulonephritis was studied using enzyme-linked immunosorbent assay for monoclonal antibodies to the 7S domain and some of the non-7S and non-NC1 domains. The size distribution of antigenic material in urinary samples from a patient with IgA nephropathy was analyzed by gel filtration chromatography. The results demonstrated a single peak at 340 kDa, suggesting the measurement of almost intact type IV collagen molecules. The urinary concentration of type IV collagen in patients with membranous nephropathy and chronic renal failure was significantly increased compared with that of normal controls. Measurement of the urinary concentrations of type IV collagen is useful in the diagnosis of glomerular disease, particularly in cases where invasive methods are contraindicated and clinically membranous nephropathy is suspected.

cDNA cloning of a new putative ATPase subunit p45 of the human 26S proteasome, a homolog of yeast transcriptional factor Sug1p

The nucleotide sequence of a cDNA that encodes a new regulatory subunit, named p45, of the 26S proteasome of human hepatoblastoma HepG2 cells has been determined. The polypeptide predicted from the open reading frame consists of 406 amino acid residues with a calculated molecular weight of 45770 and isoelectric point of 8.35. The sequences of several fragments of bovine p45, determined by protein chemical analyses, spanning 27% of the complete structure, were found to be in excellent accord with those deduced from the human cDNA sequence. Computer analysis showed that p45 belongs to a family of putative ATPases which includes regulatory components of 26S proteasomes. The overall structure of p45 was found to be homologous to that of yeast Sug1p, which has been identified as a transcriptional factor. It is closely similar, but not identical to the sequence reported for Trip1, a functional homolog of Sug1p in human tissues. These results are consistent with the possibility that Sug1-like proteins with distinct sequence function in transcription and protein degradation in human cells. However, the alternative hypothesis, that the same gene locus encodes both p45 and Trip1, cannot be excluded on the basis of such closely similar sequences. In either case, both proteins are likely to function equivalently well in either transcription or protein degradation.

Ontogeny of behavioral sensitization to cocaine

The ontogeny of the behavioral effects of acute cocaine administration and behavioral sensitization to cocaine in rat pups was investigated. Acute behavior stimulating effects of cocaine were observed in pups as young as 7 postnatal days (PND) old, although they needed a higher dose of cocaine than adult rats to evoke the same motor effects. An adult dose-response curve pattern of stereotypy and locomotion to acute cocaine treatment was observed at PND 21, and of rearing at PND 28. Rats aged PND 7, 14, 21, 28, and 56 received repeated injections of saline or cocaine (15 mg/kg) twice a day for 5 consecutive days. After a 3-week period of abstinence, sensitization to a challenge dose of cocaine was assessed. Cocaine-induced stereotyped behavior was enhanced significantly only in rats in which cocaine pretreatment was initiated on PND 21, 28, and 56, but not earlier on PND 7 and 14. Adult female rats given repeated cocaine injections on PND 56-60 showed significantly greater sensitization than males, but no such sex difference was observed in pups given cocaine repeatedly on PND 21-25 or 28-32. These results show clearly that cocaine-induced behavioral sensitization in rats occurred only when subchronic cocaine administration was commenced on PND 21 or later.

Effect of cetylmannoside modification on the alternative complement pathway activation by liposomes in rat serum

Complement activation is important for removing foreign substances by the mononuclear phagocyte system in vivo. The interaction between liposomes and complement components is considered to affect the clearance of liposomes from the circulation. It has been previously demonstrated in our laboratory that multilamellar vesicles (MLV) with surfaces modified by cetylmannoside (Man) were eliminated from the circulation rapidly and showed an approximately 2-fold higher hepatic accumulation compared with control MLV (PC-MLV) (Yamashita et al., Int. J. Pharmaceut., 70, 225, 1991). In this study, we investigated the effect of Man-modification on complement system activation. As far as elimination from the blood is concerned, the initial values of blood liposome concentration were decreased and liposomes were removed from the circulation rapidly in accordance with the extent of the Man content into their membranes. The Man-modification also affected the organ distribution of injected liposomes and their stability in rat serum. Except for MLV containing 50 mol% Man, it was observed that the hepatic uptake of liposomes was enhanced according to the increasing Man content, whereas splenic uptake was decreased and the splenic clearance was comparable. The stability of liposomes in rat serum decreased with increasing Man content. Liposomal instability in rat serum was significantly reduced by preheating the serum at 56 degrees C for 30 min, the treatment with anti-C3 antiserum and with EDTA but not abolished in serum treated with EGTA/MgCl2. Thus, it is considered that the activation of the complement system through the alternative pathway is facilitated as a result of increasing the Man content in the liposomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in dopamine D2 and GluR-1 glutamate receptor mRNAs in the rat brain after treatment with phencyclidine

In situ hybridization of slide-mounted brain sections from rats subjected to acute and chronic phencyclidine treatment was carried out using synthetic oligonucleotides complementary to dopamine D2-receptor and non-N-methyl-D-aspartate (NMDA) glutamate-receptor-subunit (GluR-1) mRNAs. There was no significant difference in either the D2-receptor or the GluR-1 mRNA levels in any brain region of the acute phencyclidine (10 mg/kg)-treated and control groups. However, chronic administration of phencyclidine (10 mg/kg/day, 14 days) significantly decreased the dopamine D2-receptor mRNA level in the caudate-putamen (by 27%, P < 0.01) and significantly increased the GluR-1 mRNA level in the prefrontal cortex (by 29%, P < 0.001). These results suggest that the chronic pharmaco-behavioral effects of phencyclidine may involve expression of both dopamine- and non-NMDA glutamate-receptor mRNAs.

Cloning, sequence analysis, and chromosomal assignment of the mouse Apex gene

APEX nuclease (Apex gene product) is a mammalian multifunctional DNA repair enzyme possibly involved in the repair of apurinic/apyrimidinic (AP) sites and single-strand DNA breaks with 3' termini blocked by nucleotide fragments and also in transcriptional regulation via redox activation of the AP-1 transcription factors. We cloned a 15-kb DNA fragment containing the Apex gene from a mouse leukocyte genomic library and determined a 4-kb stretch of its nucleotide sequence, including the complete sequence of the mouse Apex gene. The gene consists of 5 exons and 4 introns spanning 2.21 kb, and the boundaries between exons and introns follow the GT/AG rule. Two major and one minor transcription initiation sites were assigned to positions +1 and +24 and position +14, respectively, by a combination of ribonuclease protection, primer extension, and 5' RACE analyses. Position +1 is located 312 nucleotides upstream from the ATG initiation codon. The translation initiation and termination sites are located in exon II and exon V, respectively. The sequenced 5' flanking region (1.32 kb) lacks a typical TATA box, but contains a CAAT box and putative binding sites for several transcription factors, such as ATF, NF-IL6, Sp1, and AP2. The 0.8-kb region from position -410 (5' flanking region) to position +386 (intron II) contains a CpG island. The Apex gene locus was mapped to mouse chromosome 14C2-D1 using in situ hybridization.

[Serial change of 123I-BMIPP SPECT imaging during recovery from stunned myocardium after acute myocardial infarction--correlation with 201Tl and two-dimensional echocardiography]

Using 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP), we investigated changes in myocardial fatty acid metabolism at recovery from stunned myocardium after acute myocardial infarction (AMI), correlation with recovery of regional wall motion and thallium-201 (201Tl) distribution in particular. The subjects were 15 patients who underwent successful reperfusion therapy after the first onset of AMI. None of the patients had multi-vessel disease or ischemic episode during their clinical course. Patients underwent 123I-BMIPP scintigraphy, 201Tl scintigraphy and two-dimensional echocardiography during the acute and chronic phases. Then, we compared regional wall motion with distribution of 123I-BMIPP and 201Tl. Regional wall motion and SPECT were evaluated by the established 16 segment model. In patients, showing serial improvement in regional wall motion, there was 80.0% (8/10) showed normal 201Tl distribution during the acute phase or normalized during the chronic phase. However, distribution of 123I-BMIPP normalized only in 10.0% (1/10) of this group. In examination of each segment that showed serial improvement in regional wall motion, 92.3% (24/26) of these segments showed normal distribution of 201Tl during the acute phase or normalized distribution during chronic phase, despite distribution of 123I-BMIPP improved in only 3.8% (1/26) of these segments. These indicate that, in the process of recovery from myocardial stunning after AMI, abnormal distribution of 123I-BMIPP continued longer than abnormal distribution of 201Tl.

Hepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitis

OBJECTIVE

Fulminant hepatitis B can be induced by hepatitis B virus (HBV) strains with mutations in the precore region that cannot encode hepatitis B e antigen (HBeAg). Such mutations are rarely seen in HBV DNA clones from patients with fulminant hepatitis B in the United States and France. Thus, the other mutations in HBV strains causing fulminant hepatitis B need to be identified.

DESIGN

Retrospective clinical, serologic, and molecular biological studies of patients with fulminant hepatitis B.

SETTING

University and city hospitals in Japan.

PATIENTS

43 patients with fulminant hepatitis B.

MEASUREMENTS

The precore region coding for a part of the HBeAg precursor and the core promoter regulating the transcription of precore messenger RNA were sequenced in HBV DNA clones.

RESULTS

A point mutation from G to A at nucleotide 1896 in the precore region was detected in 519 (98%) of 529 HBV DNA clones from 38 patients. Two point mutations in the core promoter, from A to T at nucleotide 1762 and from G to A at nucleotide 1764, were detected in all 130 clones from the remaining 5 patients, who did not have mutations in the precore region, and in 20 (63%) of 32 clones from a patient with chronic hepatitis B who had transmitted HBV to 1 of these other 5 patients. Mutations in the core promoter were also detected in clones from 26 (68%) of the 38 patients with the precore mutation at nucleotide 1896. Neither HBeAg nor antibody to HBeAg was detected in 37 (90%) of the 41 patients tested.

CONCLUSIONS

In Japan, fulminant hepatitis B is closely associated with HBV strains that do not produce HBeAg because of mutations in the precore region, which affect translation of HBeAg, or because of mutations in the core promoter, which affect transcription of the HBeAg coding region.

Biochemical studies of glycosaminoglycans in nanophthalmic sclera

BACKGROUND

Since Brockhurst reported the connection between uveal effusion in nanophthalmic eyes and their scleral alterations and treated them with vortex vein decompression or sclerectomy, many observers have found abnormal accumulation of glycosaminoglycans (GAGs) in nanophthalmic sclera. These GAG abnormalities were thought to effect the collagen changes, though it was not clear which GAGs were changed.

METHODS

GAGs were isolated and their contents were determined in scleral specimens from three nanophthalmic patients and five age-matched controls, using electrophoresis and the cetylpyridinium method.

RESULTS

Hyaluronic acid, dermatan sulfate and chondroitin sulfate were the major GAGs in both nanophthalmic and control samples. Nanophthalmic sclera showed 2.4-fold, 10-fold and 5.5-fold increases in hyaluronic acid, dermatan sulfate and chondroitin sulfate, respectively, compared with the controls.

CONCLUSION

The results suggest that increased levels of GAGs, particularly of dermatan sulfate and chondroitin sulfate may contribute to the abnormalities of collagen fibrillogenesis and be closely involved with the pathogenesis of nanophthalmos.

[Intermittent mini-dose vancomycin intravenous administration and closed continuous irrigation technique applied to mediastinitis caused by MRSA following mitral valve replacement]

Mediastinitis caused by MRSA (Methicillin-Resistant Staphylococcus aureus) remains an intractable infection producing high mortality even in these days of advanced chemotherapy. The authors report a case of mediastinitis due to MRSA complicated with acute renal failure following mitral valve replacement. The patient's mediastinum had been thoroughly cleaned with physiological saline solution with 0.2% povidone iodine, and underwent a chemotherapy regimen of mini-dose vancomycin. The patient made favorable progress and recovered completely. Our patient's progress confirmed that when chemotherapy using vancomycin is administered in a patient whose condition is complicated with acute renal failure, closely monitoring the vancomycin serum concentration is essential. Intermittent mini-dose intravenous administration is sufficient to maintain an effective vancomycin serum concentration. In our case, vancomycin serum concentration measured before and at completion of dialysis revealed no appreciable decline.