Variant type of congenital stomatocytosis

A 52-year-old female with congenital stomatocytosis showed hemolytic anemia, an increased mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC), reticulocytosis and an increased osmotic fragility. Lipid and protein content of membranes, the activities of membrane-associated enzymes in erythrocytes and the elution pattern of hemoglobin were normal. Erythrocyte Na+ influx was moderately increased and Na+ efflux, particularly ouabain-insensitive Na+ "leak-out" was also increased. K+ concentration of erythrocytes was abnormally low with a slightly increased Na+ content. These phenotypes are very rare, and should be classified as a variant type.

Comparison of in vitro antifungal activity of itraconazole and hydroxy-itraconazole by colorimetric MTT assay

The in vitro antifungal activities of itraconazole and its active hydroxyl metabolite, hydroxy-itraconazole (R 63372), against Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans were compared by visual assessment of growth as well as by colorimetric MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide] assay using microtitre plates containing four different media. Minimum inhibitory concentration (MIC) end points determined by the colorimetric MTT assay correlated well with those obtained by visual assay. The two drugs showed different MIC values depending on the medium used. The activity of itraconazole was equal to or greater than the activity of hydroxy-itraconazole against most of the fungi tested. Both drugs showed lower MIC values against A. fumigatus and Cr. neoformans in brain heart infusion broth (BHI) medium than in yeast nitrogen base (YNBG) medium, Sabouraud glucose broth (SAB) or "synthetic amino acid medium, fungal" (SAAMF). However, the MIC end point of these drugs against C. albicans in BHI and SAB media was difficult to determine visually as well as by MTT assay. In C. albicans, the MTT assay method using SAAMF and YNBG media is recommended for the determination of MICs.

Occurrence of nivalenol, deoxynivalenol, and zearalenone in imported cereals in Papua, New Guinea

A preliminary survey for the natural occurrence of Fusarium mycotoxins--nivalenol (NIV), deoxynivalenol (DON) and zearalenone (ZEN)--in cereals imported mostly from Australia to Papua, New Guinea (PNG) in 1991 was carried out by TLC, GLC, and HPLC analysis. The data have revealed various kinds of cereals and cereal flours, such as wholemeal flour, millet meal, corn flour, brown trukai rice, and others, were significantly contaminated with these mycotoxins in various concentrations. Among these Fusarium mycotoxins, the level of ZEN was surprisingly high. This is the first report on the natural occurrence of Fusarium mycotoxins in PNG cereals.

Susceptibility of methicillin-resistant Staphylococcus aureus to minocycline and other antimicrobials

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) is on the rise, especially in nosocomial and intravenous-drug-abuse-related infections, with a concomitant increase in morbidity, mortality and health care costs. At present the drug of choice, vancomycin, which must be administered intravenously, is expensive and can cause serious side effects in vancomycin-intolerant patients. Recently, minocycline has received much attention as an antibiotic to combat the increasing frequency of MRSA-related infections. We tested 102 recent clinical isolates of MRSA from tertiary-care patients and found none to be resistant to minocycline, with minimum inhibitory concentrations of < 1-2 micrograms/ml. The only other drug that inhibited all the strains was vancomycin, followed by ciprofloxacin (87%), clindamycin (55%) and chloramphenicol (52%). Gentamicin, beta-lactams, tetracycline and trimethoprim-sulfamethoxazole had little or no activity against our isolates of MRSA.

Primary hepatic carcinoid tumor

A case of primary carcinoid tumor arising in the liver of a 69 year old woman with no endocrine symptoms is reported. Histopathologically, the tumor was diagnosed initially as a hepatocellular carcinoma in the biopsy specimen, and was shown subsequently to be a carcinoid tumor, demonstrating diffuse positive staining with Grimelius method. Mucin stained with periodic acid-Schiff (PAS), alcian-blue, and mucicarmine, and was shown partially in the glandular structures. Immunohistochemically, most of the tumor cells stained positively for chromogranin-A, epithelial membrane antigen (EMA) and neuron specific enolase (NSE). Ultrastructural examination revealed electron-dense core granules, measuring 40-120 nm in diameter in some of the tumor cells. Intensive and careful searches pre- and post-operatively revealed no other primary source of tumor other than the liver. The patient was reported well with no symptoms 3 1/2 years after the operation. This case is considered to be a primary hepatic carcinoid tumor. The recent literature is reviewed, and the possible histogenesis of hepatic carcinoid tumor is discussed.

Recurrent forearm thrombophlebitis after transvenous permanent pacemaker insertion

This report describes a 69-year-old Japanese woman with bilateral forearm thrombophlebitis that developed soon after transvenous permanent pacemaker insertion. Intravenous administration of urokinase and heparin rapidly resolved fever, painful forearm swelling and inflammatory findings. Digital subtraction venograms revealed a brachiocephalic vein thrombosis. A ten-month treatment with warfarin and ticlopidine resulted in the complete restoration of venous flow. Although thrombophlebitis associated with transvenous permanent pacemaker insertion has a relatively low incidence (0.3%), prompt diagnosis and treatment with anticoagulant and/or thrombolytic agents are important for the late clinical outcome in cases with deep venous thrombosis.

Anti-Brucella activity of Ro 23-9424, a dual-action antibacterial

The in vitro activity of dual-acting antibacterial Ro 23-9424 was determined by the agar dilution method against 126 clinical isolates of Brucella melitensis. It was compared with fleroxacin, ciprofloxacin and five conventional drugs. MIC50 and MIC90 for Ro 23-9424 were 1.0 and 4.0 mg/l, respectively, as compared with 0.25 and 0.5 mg/l for fleroxacin and ciprofloxacin. One strain which was resistant to other fluoroquinolones, with an MIC of > 8.0 mg/l, did not show cross-resistance to Ro 23-9424 and had an MIC of 4.0 mg/l. All the strains were susceptible to conventional drugs like gentamicin, streptomycin rifampicin, tetracycline and trimethoprim-sulfamethoxazole, with MICs ranging between 0.12 and 2.0 mg/l. Ro 23-9424 did not exhibit in vitro synergy with any of the conventional drugs.

Lymphomatous polyarthritis in patients with peripheral T-cell lymphoma

Direct involvement of the joints is a rare complication of malignant lymphoma and lymphoma cells in synovium or synovial fluid have been characterized in only a very few cases. We report two cases of CD4-positive, HTLV-I-negative peripheral T-cell lymphomas that manifested polyarthritis infiltrated with lymphoma cells which we further characterized. Patient 1, with a prior 7-year history of cutaneous T-cell lymphoma (mycosis fungoides) and polyarthralgia, developed pain and swelling in the right knee joint and right femoral region. Patient 2 was initially diagnosed with immunoblastic lymphadenopathy, later rediagnosed as the prodromal stage of T zone lymphoma. Seven years later she developed skin eruptions, cervical lymph node swelling, polyarthritis, and pleural effusion. Synovial fluid analysis in both cases showed predominant CD3+ or cytoplasmic CD3+, CD4+, and CD8- atypical lymphoid cell infiltration. In both cases the T-cell receptor beta and gamma chains were rearranged in the synovial fluid mononuclear cells. Analysis of these two cases and a review of the literature suggest that lymphoma cell infiltration of synovium occurs preferentially in patients with CD4+ peripheral T-cell lymphoma.

A modified method of mixed lymphocyte reaction: establishment of the assay system and its application to extracts of fungal cultures

A modified mixed lymphocyte reaction (MLR) assay was developed to screen immunosuppressive agents. In the MLR, irradiation of splenocytes with UV light was employed for the preparation of stimulator cells, and the highest response was observed with the combination of splenocytes of C3H/He mice as a stimulator and those of C57BL/6 as a responder. The blastogenesis of the responder cells was quantified by a colorimetric method using MTT in 96-well microculture plates. For screening immunosuppressive substances, the MLR in combination with a cytotoxicity test can distinguish immunosuppressors from cytotoxic agents. The applications of this assay system to extracts of fungal culture was also described.

[Recent advances in the study on the mechanism of brain injury]

A cerebral contusion and DAI (diffuse axonal injury) are practically very important in a medico-legal case of the closed head injury. In this paper, we will report the epitome of the recent advances in the study on the mechanism of them. Coup contusion can be mainly attributed to the skull inbending and/or the skull fracture which develop in the impact region. As to the mechanism of the contrecoup contusion, several theories are reported. During rotational movement of the head, intracerebral shear strains would be produced because of brain lag (Holbourn's rotation theory). Anatomical features of the skull plays an important role (Gurdjian). Relative movement between a brain and a skull induces intracranial cavitation due to pressure gradient (Gross's cavitation theory). Brain is injured by deformation pressure induced by skull deformation and acceleration one done by a movement of the head (Lindenberg). The last one is Courville's transmitted waves of force theory. As to DAI, there is Gennarelli's theory. During a rotational movement of a brain caused by high rate of angular acceleration operating for a long period, intracerebral shear strains occur and injure a brain. As to the brain injuries which include a cerebral contusion and DAI, two theories are reported. Centripetal progression of strains to the core of a brain injuries the brain (Ommaya). Natural frequency of impact determines the nature of resulting injury to the brain (Willinger).

Histo-pathological findings of abraded skins in the cases of automobile dragging

We histologically examined skin which had been abraded by automobile dragging. In the first case, the victim was a 57-year-old drunken male. He was hit by a passenger car while walking on a road and dragged for a distance of 30 m. He soon died from the pelvic bone fractures. Extensive and deep abrasions were observed on both shoulders and the back. In the second case, a 20-year-old drunken male was lying on a road. He was run over by a passenger car and dragged for a distance of 800 m. During the dragging the car's underbody strongly compressed his thoraco-abdominal region and killed him by causing insufficiency in breathing. Deep abrasions were found in the right temporal region and right back at the waist. In the third case, when a 50-year-old woman was riding a moped it collided with a passenger car at an intersection and she fell to the ground. Soon after, she was run over by another passenger car and dragged for a distance of 718 m. The cause of death was profuse bleeding from the crushed right axillary artery and vein. Autopsy revealed very extensive and severe abrasions in the right upper arm, right axilla, lateral surface of the right chest and abdomen, right back, back pelvic region, and lateral surface of the right lower leg and foot. Especially in the arm, axilla and chest, the skin and soft tissues were worn away, muscles and bones were exposed, and the right axillary artery and vein were crushed.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro activity of Ro 23-9424, a dual-acting cephalosporin-quinolone antimicrobial agent

In vitro activity of new dual-acting antibacterial Ro 23-9429 was tested against 1294 bacterial isolates from patients in a major tertiary care referral hospital in Saudi Arabia. Its activity was compared with that of ciprofloxacin, fleroxacin, ampicillin, cephalothin, cefoxitin, cefotaxime, ceftazidime, piperacillin, oxacillin, gentamicin, amikacin, imipenem, and vancomycin. Of the 621 members of Enterobacteriaceae tested, every single isolate was inhibited by Ro 23-9429 at minimum inhibitory concentration ranging between < .03 and 8 micrograms/mL. No other antimicrobial tested was as active as this dual-acting cephalosporin-fluoroquinolone. Similarly, all of the 255 isolates of Acinetobacter, Aeromonas hydrophila, Pseudomonas aeruginosa, and Xanthomonas maltophilia were susceptible to Ro 23-9429. It inhibited all the 120 isolates of methicillin-resistant Staphylococcus aureus. Its in vitro activity against coagulase-negative staphylococci and enterococci was superior or comparable to that of other drugs that are commonly used in clinical practice.

Luteoskyrin, an anthraquinoid hepatotoxin, and ascorbic acid generate hydroxyl radical in vitro in the presence of a trace amount of ferrous iron

Luteoskyrin is a bis-dihydroanthraquinone mycotoxin produced by Penicillium islandicum Sopp. By using EPR spin-trap techniques we investigated whether .OH is formed in a model system containing ascorbic acid and the toxin. In the presence of DMSO and DMPO, we found signals of DMPO-CH3, a more specific and reliable signature of .OH than DMPO-OH, together with the signals of ascorbyl radical. DMPO-CH3 signals increased with time of incubation up to 5.5 min. The DMPO-CH3 formation depended completely on both luteoskyrin and ascorbic acid, and deferoxamine, an iron-chelator, inhibited its formation. The signals disappeared in the presence of excess amount of catalase whereas SOD showed no effect. These results suggest that .OH is formed from ferrous ion present in the mixture of H2O2 generated from ascorbic acid and luteoskyrin.

[The relation between the attitude toward humor, aggression and altruism]

This study investigated the attitude towards humor and the relationship among the attitude, aggression and altruism. Four hundred and seven subjects answered the questionnaires consisting of (1) items about attitude toward humor, (2) items about aggression and altruism, and (3) items about humorous statements, frequently heared in negative situations. Factor analysis revealed that the attitude toward humor consists of two factors; (a) preference for aggressive humor and (b) preference for playful humor. The former is related to aggression and altruism, while the latter is related to altruism only. The items about humorous statements frequently heard in negative situations suggested that preference for aggressive humor is related to aggressive behavior, while preference for playful humor is related to moderation of the atmosphere.

Fusarium poae and Fusarium crookwellense , Fungi Responsible for the Natural Occurrence of Nivalenol in Hokkaido

To determine the reasons for the natural occurrence of nivalenol in the northernmost area of Japan, scabby wheat was harvested from 19 crop fields in Hokkaido. Mycological surveys and analysis for mycotoxin contamination were performed. Among 13 wheat grain samples harvested in seven locations, 9, 2, and 6 samples were positive for deoxynivalenol, nivalenol, and zearalenone, respectively, at levels ranging from 0.03 to 1.28 μg/g, 0.04 to 1.22 μg/g, and 2 to 25 ng/g, respectively. The predominant Fusarium species of the scabby wheat examined were F. sporotrichioides, F. avenaceum, F. poae , and F. crookwellense. Fifteen of 48 F. poae isolates and all four F. crookwellense isolates were screened for the production of seven derivatives of trichothecenes and zearalenone respectively, on rice culture. One isolate of F. poae produced diacetoxyscirpenol alone (4.3 μg/g); seven produced nivalenol (1.3 to 23.8 μg/g), 4-acetylnivalenol (0.1 to 4.6 μg/g), and diacetoxyscirpenol (0.9 to 99.5 μg/g); and five produced nivalenol alone (0.4 to 3.5 μg/g). The remaining two isolates produced no trichothecenes. Zearalenone production was not found in any isolate of F. poae tested. All isolates of F. crookwellense produced nivalenol (0.9 to 22.5 μg/g), 4-acetylnivalenol (0.5 to 25.0 μg/g), and zearalenone (1.4 to 162.5 μg/g). From these results, it is apparent that deoxynivalenol and zearalenone, and occasionally nivalenol, occur naturally throughout Hokkaido, and it is suggested that nivalenol-producing F. poae and F. crookwellense strains are responsible for the natural contamination with nivalenol found in the northernmost area of Japan. Furthermore, it was found for the first time that several isolates of F. poae distributed in Hokkaido possessed the ability to produce both type A and type B trichothecenes.

[Transvenous monitoring of left atrial and central venous pressure with a double-lumen catheter]

We developed a new method to monitor left atrial pressure in the patients undergoing open heart surgery. The advantages of our method are 1) freedom from complications relating its removal (eg. bleeding) because of its transvenous insertion, and 2) simultaneous monitoring of both right and left atrial pressures by a single catheter. We designed to place the second port of a two-lumen central venous catheter 5 or 7 cm proximal to the tip. The catheter is inserted into the right atrium before surgery and the tip is advanced in the left atrium through the foramen ovale intraoperatively. We used this catheter in 16 infants and children, and found that effective hemodynamic monitoring was obtained without any complications. We recommend this method for the postoperative management of open heart surgery in the pediatric patients.

Studies on the synthesis of nucleotidyl-peptides. II. The preparation of a nucleotidyl-peptide having a 5'-nucleotidyl-(P-O)-serine phosphodiester bond

The preparation of a nucleotidyl-peptide having a thymidine-5'-yl-(P-O)-serine phosphodiester bond, [H-Ala-Ser(pTpT)-Phe-OH](24) is described. After condensation between the phosphorylated peptide component and an oligonucleotide component, all protecting groups could be removed under neutral conditions without beta-elimination of the pTpT from the serine moiety.

Susceptibility of Salmonella typhi and Brucella melitensis to the new fluoroquinolone rufloxacin (MF 934)

The antimicrobial activity of the new fluoroquinolone rufloxacin (MF 934) was evaluated by a standardized agar dilution method against recent clinical isolates of Salmonella typhi (67 strains) and Brucella melitensis (108 isolates). The results were compared with 5 other commercially available or investigational fluoroquinolones. All the isolates of S. typhi were inhibited by 1.0 mg/l of rufloxacin as compared to 4-8 mg/l for B. melitensis. Minimum inhibitory concentrations of rufloxacin against both S. typhi and B. melitensis were 4-16 times higher than those of other fluoroquinolones.

Increase in T cells bearing the gamma/delta receptor associated with lymphoproliferative disease of granular lymphocytes in an infant with intractable diarrhea

A two-year-old infant with intractable diarrhea and lymphoproliferative disease of granular lymphocytes attributed to a persistent cytomegalovirus infection showed an increase in cells bearing the gamma/delta T-cell receptor (TCR), which accounted for approximately 20% of total peripheral blood lymphocytes and 40% of CD3+ T cells. Of the gamma/delta TCR+ cells, two-thirds were double negative (CD4-/CD8-) and the other one-third CD8 positive. The majority of gamma/delta+ cells were delta TCS 1 positive. The predominance of delta TCS 1 positive cells was also confirmed on biopsy of lymphoid tissues from the colon. After improvement of watery diarrhea and malnutrition following three-month hyperalimentation, the number of gamma/delta TCR+ cells decreased. The patient subsequently died of pneumonia at the age of 2 years and 11 months. A possible site-specific role for the gamma/delta TCR+ cells, particularly delta TCS 1+ cells, in the human intestine is discussed.

Effects of beraprost on the transmembrane potentials of guinea-pig ventricular muscles during normoxia and hypoxia-reoxygenation

1. The present study was performed to determine whether beraprost, a new stable analogue of prostacyclin, may exert beneficial effects on the transmembrane action potentials during normoxia and hypoxia-reoxygenation in isolated right ventricular muscles of the guinea-pig. 2. Under normal oxygenation, beraprost (0.01-100 mumol-1) had no effects on the electrophysiological parameters. 3. Hypoxic conditions induced a decrease in action potential duration (APD) without affecting other action potential parameters. Beraprost inhibited this hypoxia-induced decrease in APD. However, beraprost had no effect on the decrease in contractile force induced by hypoxia, whereas it significantly improved the recovery of contractile force after reoxygenation. 4. Pinacidil-induced shortening of APD was not antagonized by beraprost. 5. Hypoxia significantly decreased the myocardial adenosine triphosphate (ATP) level, which was also prevented by beraprost. 6. These results suggested that beraprost may inhibit the hypoxia-induced shortening of APD by some mechanisms which contribute to the maintenance of muscle ATP level.

Effects of nivalenol on hepatic drug-metabolizing activity in rats

Effects of nivalenol (NIV), a trichothecene mycotoxin, on hepatic drug-metabolizing activity and aflatoxin B1 (AFB1) metabolism were investigated in male rats. In rats fed the diets containing 6-12 ppm NIV for 2 or 4 wk, decreases in initial feed uptake, terminal weight gain and organ weights were evident. An increase in cytochrome P-450 activity was observed in the hepatic microsomes, and Western blot analysis revealed a transient increase in P4502B1/2, together with a slight induction of P4501A2. The activity of cytosolic glutathione S-transferase (GST) enzymes was also enhanced in the rats, and Western blot analysis demonstrated an elevation of GST 1-2. The formation of aflatoxin B1-DNA adducts (AFB1-DNA) was increased in experiments using hepatic microsomal preparations from rats fed the NIV diet, whereas supplementation with cytosol prepared from NIV-treated rats reduced the microsomal potential for adduct formation. In in vivo experiments, the AFB1-DNA concentration in NIV-treated rats was lower than that in the controls. These results suggest that activities of cytochrome P-450 and GST enzymes were increased in rats fed NIV for several weeks. Alteration of these phase I and phase 2 enzyme levels resulted in the modulation of AFB1 adduction to DNA in vitro and in vivo.

Recombinant human granulocyte colony-stimulating factor accelerates regeneration after T-2 toxin-induced hemopoietic injury and lessens lethality in mice

The effects of rhG-CSF on T-2-induced leukopenia and lethal toxicity in mice were investigated. First, T-2 was administered by gavage to adult male mice at a dose of 3 mg/kg b.w. daily for 7 days, and rhG-CSF was given i.p. in daily dose of 10 or 30 micrograms/kg b.w./day, beginning on the 2nd day, for 5 days. The peripheral WBC of mice receiving T-2 alone was decreased to one fourth of control counts, and bone marrow (BM) cell counts were also markedly diminished. The administration of rhG-CSF prevented those T-2-induced depressions. Histologically, the delation of the hematopoietic cells from BM and spleen of mice given T-2 was remarkably counteracted by administration of rhG-CSF. In the other experiment, rhG-CSF was injected i.p. for 5 days beginning on the next day of the 7-day T-2 administration. The recovery of WBC and BM cell counts was hastened by rhG-CSF reaching the control level in 6 days, and differential leukocyte analysis revealed an increase of neutrophils. Furthermore, simultaneous administration of rhG-CSF depressed the T-2-induced lethal toxicity, dose-dependently. The results revealed that rhG-CSF possesses a potent ability to protect T-2-induced leukopenia and lethality in mice, and it could be as an antidote against T-2 and related trichothecene-induced acute intoxication.

A case of drug-induced ductopenia resulting in fatal biliary cirrhosis

A 50-year-old woman suffered from a diffuse skin rash, high fever and jaundice immediately after a second injection of glutathion and Stronger Neo-minophagen C which contains glycyrrhizin. Liver biopsy performed 11 months after the onset showed mild spotty hepatocyte necrosis, marked cholestasis in parenchyma, and some lymphocyte infiltration in the portal area. Interlobular bile ducts had undergone vacuolar degeneration or were absent in some portal tracts. In her hospital course, unremitting jaundice persisted and biliary cirrhosis developed with signs of portal hypertension; she died from liver failure 26 months after the onset. A liver specimen at her death revealed that most of the interlobular bile ducts had vanished. Based on the clinical course and pathology, drug-induced ductopenia, possibly due to an adverse reaction to glycyrrhizin, is the most likely diagnosis. While drug-related biliary cirrhosis is rarely fatal, this case presented an unusually rapid course of fatal biliary cirrhosis.