Bacterial infection in cirrhosis, with and without hepatocellular carcinoma

OBJECTIVE

The extent and type of bacterial infection occurring with liver cirrhosis has remained unknown. Further, while hepatocellular carcinoma (HCC) is known to occur mainly in patients with liver cirrhosis, no report has yet investigated the incidence of bacterial infection in HCC. The purpose of the present study was to establish the prevalence of bacterial infection in patients with HCC.

METHODS

We have retrospectively investigated all 1140 patients with hepatic cirrhosis and/or HCC for any incidence of bacterial infection.

RESULTS

The incidence of bacterial infection was found to be 15.4%, in 740 patients with HCC. This was approximately equal to the incidence of bacterial infection in 400 patients with cirrhosis without HCC, which was found to be 15.3%. When the severity of cirrhosis was graded according to Child-Pugh classification, the incidences of bacterial infection in Child-Pugh class A, class B, and class C were 3.3%, 11.1%, and 31.2%, respectively, in cirrhosis, and 2.3%, 9.1% and 25.6% in HCC. The incidence of bacterial infection increased with the severity of cirrhosis and severe bacterial infections occurred in Child-Pugh class B and C patients.

CONCLUSION

The data suggest that the susceptibility of HCC patients to bacterial infection is mainly related to the underlying cirrhosis and not to the HCC.

The fungicidal effect of human lactoferrin on Candida albicans and Candida krusei

Five oral isolates each of Candida albicans and Candida krusei were studied for their sensitivity to the fungicidal effect of human lactoferrin. Significant inter- and intraspecies variations were observed and with most isolates the sensitivity of C. krusei to lactoferrin was greater than that of C. albicans. Fungicidal activity of lactoferrin was dose-dependent and observable only with the iron-free form of the molecule (apo-lactoferrin). Iron-saturated lactoferrin was ineffective against all isolates. Supernatant protein assays and scanning electron microscopy indicated cell surface alterations--leakage of proteins and formation of surface blebs--only in those Candida isolates that were sensitive to apo-lactoferrin. As lactoferrin is a common, non-immune, mucosal defence protein, its varying mode of action against C. albicans and C. krusei may be related to their different oral carriage rates.

Nucleolar organizer regions are independently associated with a shortened survival in patients with non-small cell lung cancer

We examined nucleolar organizer regions (Ag-NOR) in 102 patients with non-small cell lung cancer (NSCLC). Ag-NOR counts were generally higher in tumours from more advanced stages, or in poorly differentiated adenocarcinomas. Six potential-prognostic indicators included sex, age, year of operation, histology, stage and Ag-NOR count. Stage and Ag-NOR counts had a significant prognostic value in the univariate analysis for 79 patients who died of their lung cancer. In the multivariate analysis, high Ag-NOR counts as well as disease stage were independently associated with a poor prognosis. Furthermore we divided patients into three groups according to their Ag-NOR counts and found that in patients with stage I and II disease higher Ag-NOR counts were associated with shortened survival. This trend did not continue in patients with stage III and IV disease.

[A case of necrotizing scleritis associated with Epstein-Barr virus infection]

Recently Epstein-Barr virus (EBV) is often reported in association with ocular disease. But EBV has not been reported to cause necrotizing scleritis. A 71-year-old woman developed ciliary injection and peripheral corneal ulcer in both eyes. The lesions did not respond to topical steroid and systemic indomethacin. The sclera became transparent and perforated. EBV serologic antibody titers were strongly positive. Anti-viral capsid antigen (VCA)-IgG was 1: 1,280 and anti-early antigen (EA)-IgG was 1: 640. These serologic results suggested active EBV infection. Using immunofluorescence techniques, the squamous epithelial cells of the conjunctiva were stained with monoclonal antibody against EBV-VCA and strongly stained with antibody against IgG. The results of serologic test and the immunofluorescence techniques appeared to suggest that the necrotizing scleritis was caused by EBV.

[Neuropathological study of autosomal dominant ataxia linked to loci on chromosome 6p (SCA 1)]

We reported an autopsy case of hereditary OPCA genetically proved to be SCA 1. Clinically, he showed cerebellar ataxia from beginning to the end stage, and was characterized by slow eye movement with external ophthalmoplegia, pyramidal tract signs, generalized amyotrophy including facial muscle, mild bulbar paresis, mild dementia, and urinary disturbance. Neuropathologically, the degeneration and loss of neurons with gliosis were seen in the Purkinje layer, dentate nucleus of the cerebellum, inferior Olive nucleus, motor nucleus of cranial nerve, anterior horn of the spinal cord, and column of the Clarke. And the myelinpallor was revealed in the connecting nerve fiber of these lesions, posterior column and spinocerebellar tract of the spinal cord.

Detection of human T-cell lymphotropic virus type-1 proviral DNA in the saliva of an adult T-cell leukaemia/lymphoma patient using the polymerase chain reaction

We report a case of adult T-cell leukaemia/lymphoma (ATLL), in whom the polymerase chain reaction (PCR) on genomic DNA from saliva demonstrated the monoclonal integration of human T-cell lymphotropic virus type-1 (HTLV-1) proviral DNA in lymphocytes in the saliva. These results provided evidence of the possibility of saliva-borne transmission of HTLV-1.

[A case of alcoholism presenting pellagra and hypokalemic myopathy]

A 32-year-old man with chronic alcoholism over 10 years developed skin eruptions, dark-red tongue and severe watery diarrhea, followed by weakness of bilateral lower extremities. Physical examination revealed hyperpigmented skin eruptions with scales on the dorsa of his hands and extensor aspects of his forearms. Neurological examination showed proximal muscle weakness of both lower extremities, hyperactive knee and ankle jerks, positive Chaddock reflexes and stocking type sensory disturbances. Laboratory data revealed elevation of myolytic enzyme, hypokalemia and decrease of niacin level in the blood. Diagnosis of hypokalemic myopathy and pellagra was made. With the correction of serum potassium level, muscle weakness improved rapidly and with the supplement of niacin, other physical signs and symptoms improved. In this case hypokalemic myopathy could be attributed to the alcoholic malnutritional state such as pellagrous diarrhea, malnutrition, malabsorption and others.

Effect of somatostatin on circadian rhythms of firing and 2-deoxyglucose uptake in rat suprachiasmatic slices

In mammals, the suprachiasmatic nucleus (SCN) of the hypothalamus appears to act as a circadian clock. The SCN vasoactive intestinal polypeptide-like immunoreactive neurons, which may act to mediate photic information in the SCN, receive input from neurons immunoreactive for somatostatin (SST). Therefore we investigated the role of SST as a transmitter for entrainment by analyzing the phase-resetting effect of SST on the circadian rhythm of SCN firing activity. Perfusion of SST increased 2-deoxyglucose uptake at circadian time (CT) 18, but not at CT6. A 1-h or 15-min treatment with SST produced phase delays when it was administered at CT13-14 and phase advances at CT22-23. Thus SST-induced phase changes are similar to those for light pulses to animals under constant darkness. The present findings suggest that SST is a transmitter for mediating information of entrainment to circadian clocks within the SCN.

Acyclovir-resistant herpes zoster encephalitis successfully treated with vidarabine: a case report

A 78-year-old man developed herpes zoster virus (HZV) encephalitis. Initially, treatment with aciclovir (750 mg per day) improved CSF cell count and protein level. During the treatment, however, encephalitis in the patient deteriorated in spite of the treatment with aciclovir, suggesting that HZV in the patient had become resistant to aciclovir. Subsequent treatment with vidarabine (600 mg per day, for 15 days) resulted in dramatic improvement in CSF pleocytosis. About two months after the discontinuation of vidarabine, the CSF cell count was normal. The patient became alert gradually, but his amnestic syndrome remained unchanged. Vidarabine may be recommended in the treatment of HZV encephalitis when aciclovir is not effective.

T-cell receptor gene rearrangement in cells infiltrating skin eruptions specific to adult T-cell leukemia

We examined T-cell receptor gene rearrangement in skin lesions and peripheral blood from 6 patients with adult T-cell leukemia (ATL) using the Southern blot method and a c beta 1 probe. A rearrangement signal common to skin lesions of all 6 patients was observed. One patient (Case 4) exhibited another rearrangement signal in the skin lesion and an identical signal was detected in the peripheral blood. This is the first report describing a specific pattern of T-cell receptor gene rearrangement in ATL. The signal obtained is assumed to represent receptors of T cells involved in surveillance of HTLV-I infected T cells.

Angiosarcoma of the chest wall with a gastric metastasis

A rare case of chest-wall angiosarcoma with high tendency of local recurrence and with a solitary gastric metastasis is reported. The patient was an 84-year-old man who had a left lateral thoracic mass with a colic pain. The histological diagnosis of a biopsied specimen suggested an angiosarcoma. The first resection was performed, the resected specimen consisted of the 8th, 9th and 10th ribs including the tumor. However the tumor recurred around the primary site and the second resection was undertaken eight months after the first resection. Only three months after the second resection a second chest-wall recurrence together with a solitary gastric metastasis was found. Progressive emaciation, anemia and thrombocytopenia became evident, and the patient died the 40th day after the gastrectomy. Primarily a wide resection of the chest wall beyond the pathologically negative region around the tumor is thought to be necessary.

Acquired dermal melanocytosis of the hand: a new clinical type of dermal melanocytosis

We report a 22-year-old man with acquired dermal melanocytosis on the hand which developed without any history of previous inflammation. He had no history of contact with or oral administration of any drugs or metals which might have caused pigmentation. Histopathologically, spindle-shaped dermal melanocytes were observed running parallel to the collagen bundles and scattered in all portions of the dermis. The dopa reaction of these cells was positive. Ultrastructurally, dermal melanocytes containing numerous melanosomes (stages II to IV) which were surrounded by the extracellular sheath were observed. Differential diagnosis of other dermal melanocytosis was discussed.

Myoclonus and seizures in a patient with parkinsonism: induction by levodopa and its confirmation on SEPs

A 68-year-old woman with parkinsonism showed cortical myoclonus and seizures under antiparkinsonian medication. Myoclonus was induced and enhanced by L-dopa, developing into generalized seizures. EEG was abnormal and somatosensory-evoked potentials (SEPs) showed giant SEPs, transcortical reflex (C reflex) and jerk locked potentials. Myoclonus and seizures disappeared after discontinuation of L-dopa and the introduction of valproate sodium (VPA). We described the occurrence of L-dopa-induced myoclonus and seizures in a case of parkinsonism with its SEPs findings.

Color and pulsed Doppler ultrasonography of reversed umbilical blood flow in an acardiac twin

Prenatal diagnosis of an acardiac twin pregnancy was performed. At 30 gestational weeks, pulsed color Doppler ultrasound revealed polyhydramnios, reversed-pulsatile blood flow in the umbilical artery and vein of the acardiac twin, and artery-artery anastomosis on the placental surface. The total cardiac dimension, maximum blood flow velocity of the ascending aorta and the pulmonary artery in the alive twin were in the normal range.

Anticardiolipin antibodies in Japanese patients with multiple sclerosis

We evaluated circulating anticardiolipin antibodies (aCL) in 38 Japanese patients who fulfilled the criteria of clinically definite multiple sclerosis (MS), using a newly developed EIA system with aCL-cofactor. Two of 38 patients (5.3%) had a aCL-cofactor-dependent positive serology, and differences compared with findings in controls were statistically significant. The 2 aCL-positive patients had similar clinical features with acute transverse myelopathy (ATM), optic neuropathy (OPN), normal cranial MRI and negative oligoclonal IgG bands (OCBs) in the cerebrospinal fluid (CSF). Among the 38 patients, 3 had ATM, OPN, normal cranial MRI and negative OCBs, hence, in a significant number of the patients (2/3; 67%) with these distinctive features, serology for aCL was positive. Therefore, they may have another condition associated with aCL, masquerading as MS. Serological testing for aCL with aCL-cofactor is recommended for the patients with clinical diagnosis of MS, especially for those showing OPN and ATM during the clinical course, and in Asian peoples where the incidence of ATM and OPN is relatively high among the patients with diagnosis of MS.

Cerebrospinal fluid IgG profiles and multiple sclerosis in Japan

We analyzed the cerebrospinal fluid (CSF) IgG profiles of 46 Japanese patients with relapsing and remitting types of multiple sclerosis (MS). There were 12, 13 and 21 patients, with inactive, active and both clinical conditions, respectively. The values for IgG, IgG/Alb ratio, IgG index and IgG synthesis rate were significantly higher during active than during inactive stages, but the patients with high values for these IgG profiles during active stages tend to also have high values during inactive stages. None of 33 (0%) and 2 of 34 patients (5.9%) exhibited abnormal IgG levels, 3 (9.1%) and 8 (23.5%) an abnormal IgG/Alb ratio, 9 (27.3%) and 18 (52.9%) an abnormal IgG index, and 5 (15.2%) and 14 (41.2%) an abnormal IgG synthesis rate, during inactive and active stages, respectively. Some of HLA antigen frequencies were significantly different between the patients with and without abnormal CNS IgG profiles. Increased CSF IgG was of lesser diagnostic value for MS in Japan, and seemed to be a function of immunogenetics rather than clinical activity.

Nevus depigmentosus systematicus with partial yellow scalp hair due to selective suppression of eumelanogenesis

We report a Japanese patient with congenital hypomelanosis with a segmental pattern on the left abdomen, whorl-like pattern on the back; mosaic pattern on the chest, right abdomen, and proximal extremities; and with yellow hair on a portion of the scalp. Chemical analysis of the yellow hair revealed decreased eumelanin content, whereas the pheomelanin content was normal.

Mercury and selenium contents in amyotrophic lateral sclerosis in Hokkaido, the northernmost island of Japan

We evaluated the pathogenicity of mercury (Hg) and selenium (Se) which are supposed to be one of the risk factors in the development of amyotrophic lateral sclerosis (ALS). Hg and Se contents were measured in plasma, blood cells, scalp hair samples of 21 sporadic ALS patients and 36 controls, who included 19 patients with other neurological diseases, in Hokkaido, the northernmost island of Japan. Hg and Se levels in plasma and blood cells of ALS patients were significantly lower in advanced staged ALS patients than controls. Low Hg and Se contents in ALS, being correlated with their disabilities and nutritional conditions, would rather reflect the disease contracted states than the pathogenic roles in ALS.

Fatal acute hepatitis B virus infection while receiving immunosuppressants after renal transplantation

A 47-year-old man with acute hepatitis B virus (HBV) infection who had been receiving immunosuppressants after renal transplantation developed progressive liver failure. During the clinical course (approximately 7 months), anti-HBc IgM antibody and HBV-DNA polymerase levels remained high, but the serum alanine aminotransferase (ALT) level was consistently less than 150 K.U. Histopathologic examination of the liver showed submassive hepatic necrosis without significant inflammation accompanied by marked fibrosis. Most hepatocytes showed strong nuclear expression of HBc antigen by immunohistochemical staining and electron microscopy revealed numerous intranuclear core-like particles. Hepatitis B virus infection in immunosuppressed individuals occasionally insidiously progresses, resulting in liver failure. The clinical course of such patients thus merits close scrutiny.

Interactions between denture lining material, protein pellicles and Candida albicans

The interactions between pellicles derived from saliva, serum, mucin and lysozyme deposited on lining material (tissue conditioner) and Candida albicans were investigated by monitoring pH changes associated with protein-free and protein-coated lining material and by ultrastructural observations of yeast colonization. No significant differences in pH reduction between culture media in contact with the protein-free, control lining materials and those coated with saliva, serum or mucin were observed after 120 h of incubation. However, scanning electron microscopy revealed that much greater numbers of the yeasts colonized the saliva- or serum-coated lining material than the lysozyme-, mucin-coated or control material. Hyphal invasion was observed in saliva-coated lining material. These results suggested that denture pellicle derived from saliva and/or serum may potentiate candidal colonization of denture lining materials.

Effects of colchicine on the induction of ornithine decarboxylase and its gene expression by the phorbol ester tumour promoter

The activity and gene expression of ornithine decarboxylase (ODC, an indicator of tumour promotion) were induced by the phorbol ester tumour promoter, 12-O-tetradecanoylphorbol-13-acetate (TPA), in mouse skin. In the present study, the effect of colchicine, a microtubule-disrupting agent, on ODC activity and its gene expression were investigated. On administration of colchicine (100 micrograms) intraperitoneally 1.5 h before TPA treatment, ODC activity and ODC mRNA levels stimulated by TPA were suppressed to about 52 and 64%, respectively. These results suggest the involvement of a microtubule or colchicine-sensitive substrate in the signal transduction system for gene expression.

[Echocardiographic study in adult patients with Down's syndrome]

In Down's syndrome (DS) mental retardation accompanying chromosomal abnormalities is seen, and the incidence of associated congenital heart abnormalities is also known to recent years, the accelerated aging and premature senility associated with DS have attracted attention. In the present study, we examined cardiac lesions using echocardiography in a group of asymptomatic adult DS subjects discussed the relation between these lesions and premature aging. The subjects comprised 28 adult DS patients ranging in age from 20 to 46 years (mean +/- SD, 30.8 +/- 8.9 years) residing in 8 institutions in Fukui prefecture. The presence of DS was confirmed in all cases by chromosomal examination, which revealed 21-trisomy in 25 and mosaic type in three. Of indices of left heart function, the end diastolic volume index (EDVI) and end systolic volume index (ESVI) showed significantly reduced values, whereas indices of systolic function such as the ejection fraction (EF) and mean velocity of circumferential fiber shortening (mean Vcf) showed significantly elevated values. The results of early diastolic left ventricular function, which has been noted to be related to aging, did not show any significant difference as determined by observation of mitral valve dynamics. On the other hand, morphologically, mitral valve prolapse (MVP) was found significantly more frequently in the DS group (17.9%) as compared to a normal control group. Also, valvular calcification (14.3%) and aortic valve regurgitation (AR, 11%) were both frequently noted. Whether signs such as valvular calcification are findings related to accelerated aging will require further study.

Mechanism of chromosomal integration of transgenes in microinjected mouse eggs: sequence analysis of genome-transgene and transgene-transgene junctions at two loci

Production of transgenic animals is a key technique in modern biology, but the process of chromosomal integration of transgenes in microinjected eggs is still not fully understood. To gain information on the mechanisms involved in this process, we have cloned two transgene loci and their corresponding pre-integration sites and compared the junction sequences with the parental nucleotide (nt) sequences. No extensive DNA rearrangements were detected at these loci: only simple deletions (caused by the integration of the transgene concatemers) were present in the host genome. Analysis of three transgene-transgene junctions within the concatemers showed that 'nibbling' of ends (up to 3 nt) had occurred at some ends prior to joining. At all four genome-transgene junctions, short homologies of 1 to 3 nt were found, and at least three of these junctions were associated with the consensus sequence for topoisomerase-I cleavage sites. Moreover, three of the four integration junctions occurred in the terminal regions of the injected sequence, at positions only a few nt away from the ends. These results suggest that linear, but not circular, concatemers were preferentially integrated at their ends utilizing short homologies to the host genome.

[Spinocerebellar ataxia 1--clinical study of 17 patients in a large pedigree]

We studied a large pedigree with dominant spinocerebellar ataxia, genetically and clinically. At now, 27 members over 5 generations have been affected. Linkage study for the disease locus to D6S89 in a total of 44 individuals showed maximum lod scores of 3.99 at theta = 0.000. This result indicates that the disease locus of this pedigree locates near D6S89 on chromosome 6p (SCA 1). We studied 17 patients clinically. Mean age at onset was 37.7 +/- 8.6, and mean duration after onset was 11.3 +/- 6.8 years. Their clinical features were characterized by progressive ataxia, pyramidal involvement with hyperreflexia or spasticity, and mild posterior column involvement. Mild gaze nystagmus at early stage became unclear with the progress of illness. The frequent signs in the advanced stage were diffuse amyotropy, twitching of face or tongue, bulbar palsy, slow saccade, external ophthalmoparesis, mydriasis, coarse postural tremor, and dementia with emotional disturbance. There are so much clinical similarities between our pedigree and other SCA 1 pedigrees in the literature. Generally, SCA 1 shows hyperreflexia, spasticity, and terminal slow saccade. On the other hand, non-SCA 1 type OPCA is characterized by progressive hyporeflexia, slow eye movement from early stage, and frequent choreoathetosis. Gaze nystagmus, external ophthalmoparesis, amyotrophy, and spasticity are common in both SCA 1 and Machado-Joseph disease (MJD). However, they are more frequent in MJD than SCA 1. Moreover, extrapyramidal signs, such as dystonia, are rare is SCA 1. Based on these difference, SCA 1 could be clinically differentiated from other similar hereditary ataxias.