Effects of subminimal inhibitory concentrations of ampicillin on hemagglutination of Escherichia coli

The hemagglutination (HA) activity of Escherichia coli was enhanced by subminimal inhibitory concentrations (sub-MICs) of ampicillin. One half of the MIC of ampicillin caused a bacterial filamentation and diminished bacterial piliation (as observed by light and electron microscopies) as well as an increase of HA activity. HA activity, however, decreased after separation of ampicillin-treated bacteria. These results indicate that the increase in HA activity by ampicillin is mainly due to filament formation.

Peduncular hallucinosis associated with ruptured basilar-superior cerebellar artery aneurysm--case report

A 65-year-old female developed peduncular hallucinosis 3 days after rupture of a basilar-superior cerebellar artery aneurysm. There were no neurological deficits except slight anisocoria when she first complained of hallucinations. Vasospasm of the perforating arteries to the upper brainstem, rather than direct brainstem damage caused by the bleeding, was probably the cause. Peduncular hallucinosis is possibly the only localizing sign of ruptured upper posterior circulation aneurysm.

Mode of antibacterial action of cefprozil, a new cephalosporin, on Escherichia coli, Serratia marcescens and Morganella morganii

The mode of antibacterial action of cefprozil (CFPZ, BMY-28100), a newly developed cephalosporin, was investigated using Escherichia coli K12, Serratia marcescens IFO 12648 and Morganella morganii IFO 3848 as test organisms, in comparison with the action of cefaclor (CCL). The minimum inhibitory concentrations (MICs) of CFPZ for these organisms were 1.56, 800 and 25 micrograms/ml, whereas those of CCL were 1.56, 800 and 100 micrograms/ml, respectively. The addition of a subinhibitory concentration (1/4 MIC) of ethylenediaminetetraacetic acid (EDTA), which damages the permeability barrier of the outer membrane, markedly reduced the MICs of CFPZ for E. coli and S. marcescens, compared with those of CCL, whereas the MICs of both antibiotics for M. morganii were hardly affected by the presence of EDTA. CFPZ was more stable to beta-lactamase activities from these organisms than CCL. The cross-linking reactions of peptidoglycan synthesis catalyzed by the ether-treated cells from these organisms were inhibited by a lower concentration of CFPZ than of CCL.

Balloon occlusion aortography

We review the validity of balloon occlusion aortography (BOA) on the basis of our personal experience with 18 patients with congenital heart disease (mean weight 4.55 g, including 8 neonates). Four of the 18 patients underwent aortic arch angiography using balloon occlusion of the descending aorta. Pulmonary angiography was also performed in 9 patients via a patent ductus arteriosus and in 3 patients via a Blalock-Taussig shunt. The remaining 2 patients underwent coronary arteriography by balloon occlusion of the ascending aorta. The information obtained was satisfactory in 17 of the 18 patients. However, in one patient with a double-outlet right ventricle and pulmonary stenosis, the pulmonary arteries were not clearly visualized because of dominant antegrade flow from the right ventricle. BOA is a safe and useful procedure which can be used to image the aortic arch, pulmonary artery, and coronary arteries in infants with congenital heart diseases. In children over 3 years of age, however, the balloon may not be able to occlude the appropriate site of the aorta, so selective angiography is required to obtain precise information.

Percutaneous transluminal coronary angioplasty for Kawasaki disease: a case report and literature review

A 31-month-old boy developed right coronary artery stenosis after Kawasaki disease for which he underwent percutaneous transluminal coronary angioplasty (PTCA). The narrowing of the right coronary artery was successfully dilated by angioplasty without apparent complication. This case suggests that PTCA may have a potential advantage as a temporary method to postpone the aortocoronary bypass surgery in a child with coronary artery stenosis due to Kawasaki disease. However, strict patient selection is recommended for coronary angioplasty.

Relationship between molecular structures of sugars and their ability to stimulate the release of glucagon-like peptide-1 from canine ileal loops

The structure-activity relationship of sugars inducing secretion of glucagon-like peptide-1 from the gut was examined using intestinal loops prepared from the terminal portion of the ileum of dogs. The plasma glucagon-like peptide-1 concentration in a mesenteric vein draining only the looped region of the intestine was increased after infusion of 139 mmol/l solutions of D-glucose, D-galactose, D-glucuronic acid, 3-0-methyl-D-glucose, maltose, sucrose or maltitol into the intestinal lumen, but not after infusion of solutions of D-fructose, D-fucose, D-mannose, D-xylose or lactose. The increases in plasma glucagon-like peptide-1 concentration correlated with the corresponding increases in glucagon-like immunoreactivity induced by these sugars. The plasma glucose level of the regional mesenteric vein increased significantly from the basal level after instillation of D-glucose, but not after instillation of other sugars. It is suggested that cells of the gut have a glucose sensor for release of products of the glucagon gene and that this sensor has specific steric requirements. The sugars that induced glucagon-like peptide-1 release share the molecular features of electron density near C(6), an equatorial hydroxyl at C(2), and an axial hydroxyl at C(1), which could account for their recognition by the glucose sensor to initiate the releases of glucagon-like peptide-1 and glucagon-like immunoreactivity.

[Clinical evaluation of isometric detrusor pressure in patients with benign prostatic hyperplasia]

The subjects chosen for this investigation were 88 patients with benign prostatic hyperplasia who proved not to have neurogenic bladder and 6 male volunteers without lower urinary tract disorders. In addition to the conventional preoperative urodynamic studies, isometric detrusor pressure was measured by the technique with balloon occlusion at the bladder neck. Although all 88 patients had undergone either transurethral resection of the prostate or subcapsular prostatectomy and routine postoperative examinations revealed sufficient canal formation in the prostatic urethra, in 23 patients (26.1%) a significant amount of residual urine was still observed and/or maximum urinary flow rate was considerably low. A retrospective analysis of the data from this study suggested that maximum isometric detrusor pressure is a useful parameter for the prediction whether or not micturition is improved after the removal of organic lower urinary tract obstruction, especially in cases with low detrusor pressure during urination. Furthermore, measurement of the maximum isometric detrusor pressure might be helpful in making the diagnosis of the clinical stage of benign prostatic hyperplasia, since several different stages could be defined by the value of maximum detrusor pressure during urination and maximum isometric detrusor pressure.

Coronary artery calcification in Kawasaki disease

To evaluate the angiographic features of coronary lesions in Kawasaki disease with coronary artery calcification, cinefluoroscopy and cineangiography were retrospectively reviewed in 116 patients who had undergone coronary angiography between 1982 and 1989. Angiographic abnormalities of coronary arteries were demonstrated in 55 of the 116 patients. In 5 (9.1%) of the 55 patients, 9 with calcification were identified by cinefluoroscopy and chest x-ray. Eight of the 9 calcified lesions showed a circular or ring-shape configuration. Coronary angiography revealed a total occlusion of the right coronary artery with collateral circulation from the distal left coronary artery in 2 patients and a severe stenosis of the right coronary artery in 2 patients, in whom anticoagulant therapy had not been continued during the follow-up periods. The remaining patient in whom anticoagulant therapy had been continued had bilateral aneurysms but no significant stenosis. These results indicate that a ring-shape calcification on chest x-ray in a patient with a history of Kawasaki disease may suggest an involvement by coronary artery stenosis even when anticoagulant drugs had been given. Therefore, coronary angiography should be performed to evaluate the stenotic lesions if this type of calcification is found by routine radiographic examination.

Clinical features of aortic arch anomaly with malalignment ventricular septal defect

The clinical features and outcome after various surgical procedures on 9 patients with coarctation or interruption of the aortic arch and malalignment ventricular septal defect (group 1) were compared with those of 9 patients with the arch anomaly without malalignment ventricular septal defect (group 2). Cardiomegaly and metabolic acidosis were prominent in group 1. Five of the 9 patients in group 1 died in the immediate postoperative period (56% mortality), but no operative deaths occurred among 8 patients in group 2 (p less than 0.01). The ratio of left ventricular outflow tract to ascending aortic diameter was 0.59 +/- 0.09 in group 1 and 1.03 +/- 0.11 in group 2 (p less than 0.01). Three of 4 patients with a ratio of less than 0.6 died, but no operative deaths occurred among the 6 patients who had a palliative operation and in whom the ratio was more than 0.6. These data suggest that left ventricular outflow tract obstruction is critical when the ratio of left ventricular outflow tract to ascending aortic diameter is 0.6 or less. The presence of severe left ventricular outflow tract obstruction necessitates modification of the present surgical strategy.

[A case of posttraumatic cerebral air embolism]

We report a case of cerebral air embolism that occurred after chest trauma. The diagnosis was confirmed by CT and skull roentgenogram which demonstrated air bubbles in intracranial arteries. It is well recognized that cerebral air embolism is caused by various diagnostic and therapeutic procedures, and trauma. But it may often be overlooked because it is diagnosed clinically and there are no characteristic symptoms nor signs. Although various ways of treatment have been reported, prevention and early diagnosis are the most important. It is very rare that air bubbles are detected in skull roentgenograms in cases of cerebral air embolism. Only three other cases have been reported. One of these cases reported by Westcott awakens our interest because the patient died within only several minutes after the onset and underwent cardiac massage before the roentgenogram was taken, in the same way as our case. We think some artificial force is necessary to push air into intracranial arteries to the extent that it is detected on a skull roentgenogram. Little has been reported on CT findings in cerebral air embolism. Roughly speaking, three kinds of abnormal findings have been reported. They are air, edema, and infarction. In only nine cases including ours, air bubbles were detected on CT. In those cases CT scans were performed soon after the onset, twelve hours at the latest. Abnormal findings were detected in either bilateral hemispheres or in the right hemisphere only. Almost all lesions are located in the territory of the cortical branches, but in one case bilateral, thalamic infarction was noted, which is thought to be caused by embolism of thalamoperforators.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemophilus influenzae adherence to and absorption from the nasal mucosa of guinea pigs

The adherence to and the absorption from nasal mucosal epithelium of type b and non-typeable strains of Hemophilus influenzae were studied in guinea pigs. H. influenzae bacteria were administered to the nose as 4 x 10(7) organisms in 1.0 ml saline. The outer membrane vesicles (OMV) of H. influenzae were used in the absorption study. Scanning electron microscopic studies showed that H. influenzae cells attached to both ciliated and non-ciliated cells of the nasal mucosa. Histological studies showed that OMV were absorbed through the nasal mucosa, mainly from ciliated cells. Further, penetration of OMV through the nasal mucosa of immunized animals was reduced when compared with that of non-immunized ones.

Leukocyte tissue-type plasminogen activator activity in dialysis patients

Plasma fibrinopeptide B beta 15-42 was significantly high in undialyzed and hemodialyzed chronic renal failure (CRF) patients, indicating that the fibrinolytic system as well as the coagulation system is stimulated. There are two kinds of plasminogen activators (PA) for the fibrinolytic system: urokinase (UK) and tissue-type PA (t-PA). PA activity of peripheral leukocytes from healthy volunteers, continuous ambulatory peritoneal dialysis (CAPD) patients and hemodialysis (HD) patients was measured and compared. Peripheral leukocyte PA in the euglobulin fraction was purified using zinc-chelate-Sepharose 6B column and Concanavalin A-Sepharose column chromatography. The different PA activity was quantitatively identified by electrophoretic enzymography and was confirmed using antibody against UK and t-PA. PA activity of peripheral leukocytes was significantly higher in HD patients on the cupro-ammonium processing membrane dialyzer than in CAPD patients and healthy volunteers. All PA activity in the three groups was UK, and t-PA was not detected. This suggested that the inflammatory response was continuously induced in HD patients, resulting in the induction of PA activity of the leukocytes and plasma, and that different mechanisms were involved for the synthesis or secretion of UK and t-PA.

Leukocyte Tissue-Type Plasminogen Activator Activity in Dialysis Patients

Plasma fibrinopeptide Bβ15–42was significantly high in undialyzed and hemodialyzed chronic renal failure (CRF) patients, indicating that the fibrinolytic system as well as the coagulation system is stimulated. There are two kinds of plasminogen activators (PA) for the fibrinolytic system: urokinase (UK) and tissue-type PA (t-PA). PA activity of peripheral leukocytes from healthy volunteers, continuous ambulatory peritoneal dialysis (CAPD) patients and hemodialysis (HD) patients was measured and compared.

Peripheral leukocyte PA in the euglobulin fraction was purified using zinc-chelate-Sepharose 6B column and Concanavalin A-Sepharose column chromatography. The different PA activity was quantitatively identified by electrophoretic enzymography and was confirmed using antibody against UK and t-PA. PA activity of peripheral leukocytes was significantly higher in HD patients on the cupro-ammonium processing membrane dialyzer than in CAPD patients and healthy volunteers. All PA activity in the three groups was UK, and t-PA was not detected. This suggested that the inflammatory response was continuously induced in HD patients, resulting in the induction of PA activity of the leukocytes and plasma, and that different mechanisms were involved for the synthesis or secretion of UK and t-PA.

Lymphocyte subsets of maxillary mucosa in chronic inflammation

Subsets of infiltrating lymphocytes within maxillary sinus mucosae of patients with chronic sinusitis were investigated by immunoperoxidase staining of frozen sections with the use of monoclonal antibodies. The most commonly observed infiltrating cell type was suppressor/cytotoxic T cells (CD8+) and smaller subpopulations of lymphocytes were helper/inducer T cells (CD4+) and B cells (CD20+). Variable numbers of HLA-DR+ cells were commonly observed in the lamina propria. The fibrous type of chronic sinusitis was found to have more suppressor/cytotoxic T cells (CD8+) and lower CD4/CD8 ratio than the other histopathological types.

Advanced atrioventricular block in a neonate with lupus erythematosus and anti-SS-A antibodies

Recent studies suggested that the involvement of anti-SS-A and anti-SS-B antibodies in the pathogenesis of neonatal lupus erythematosus and congenital heart block. We here describe a female neonate with lupus erythematosus, advanced atrioventricular block, and a positive test for anti-SS-A antibodies. The findings of His-bundle recordings are presented.

Progressive vascular lesions in Williams-Beuren syndrome

We report two patients with Williams-Beuren syndrome. The first patient showed no evidence of coarctation of the aorta at the first examination. Seven years later, she developed coarctation of the aorta. In the second patient, we found the progression of renal artery stenosis by serial angiography. We report that vascular lesions may be progressive in Williams-Beuren syndrome.

[One stage reconstruction of penis with free forearm flap]

One stage reconstruction of the penis using free tissue transfer was performed on a 43-year-old man who had total penectomy for carcinoma of the penis. A free forearm tissue flap was used to reconstruct urethra and for external skin coverage and Jonas silver penile prosthesis was used as a stent. Nutrient vessels (one artery and two veins) were anastomosed with a lateral circumflex femoral artery and two branches of the saphenous veins respectively and the nerve of flap was anastomosed with the pudendal nerve. We believe that this method is functionally and cosmetrically acceptable for reconstructing the penis, although unfortunately extrusion of the prosthesis ensued 63 days after the operation in our case.

Aortocoronary bypass surgery for Kawasaki disease

A case of Kawasaki disease with precordial pain in a 6-year-old boy is described. Coronary arteriography revealed large aneurysms with subtotal obstruction of the left anterior descending artery and long-segment narrowings of the right coronary artery. The left ventriculogram revealed an old myocardial infarction of the inferoposterior wall of the left ventricle. The patient was given aortocoronary bypasses using both a left internal mammary artery and a fresh saphenous vein graft to the left anterior descending artery. Serial angiographic study, performed 6 weeks after the operation, revealed these grafts were both patent. Using the two techniques together may have the potential benefit of the saphenous vein bypass graft functioning as a temporary measure to ensure survival with the hope that the internal mammary artery supply will continue to grow.

Studies in a model system on the effect of hydrogen bonding at hetero atoms of oxidized flavin on its electron acceptability

The effect of hydrogen bonding at hetero atoms of oxidized flavin on its electron acceptability was studied by the ab initio molecular orbital method. The calculations were carried out for all possible lumiflavin-H2O complexes and for some lumiflavin-formamide complexes. Calculated data showed that the magnitudes of hydrogen bonding energy at the hetero atoms are in the order of N(3)H greater than N(5) greater than O(12) greater than N(1) greater than O(14). It was found that the atomic orbital coefficient of the lowest unoccupied molecular orbital is the largest at N(5) and that hydrogen bonding at N(1), N(5), O(12), and O(14) increases the electron acceptability of the oxidized flavin at N(5), while hydrogen bonding at N(3)H decreases it.

Infantile hypertrophic cardiomyopathy with QT prolongation

An infant who died at 5 months with hypertrophic cardiomyopathy accompanied by QT prolongation was examined at autopsy. At the age of 16 days, serum IgM level was elevated (226 mg/dl). Microscopic examination revealed characteristics of hypertrophic cardiomyopathy with myocardial cell hypertrophy with disarray and healed myocarditis with patchy fibrosis and mononuclear cell infiltration. The histological findings were compatible with those of postmyocarditic cardiomegaly developing during the fetal period.

[Opsoclonus-polymyoclonia syndrome suppressed with reserpine]

A 38-year-old man was admitted to Iwakuni National Hospital on July 6, 1978, with the complaints of difficulty seeing and walking. Two weeks before admission, he first experienced dizziness and it slowly progressed to uncontrollable tremor-like movements of the whole body. On admission, he was alert, oriented and afebrile. He had not experienced nausea, vomiting nor headache. He showed irregular horizontal oscillations of the eyes. Electronystagmographic study showed that this jerky eye movement appeared especially with changes of fixation of the eyes. It was also recorded during conjugate eye movement, and while he closed his eyes. He was ataxic, unable to walk, but no other abnormalities in cerebellar functions were observed. Spinal tap was performed and yielded watery clear cerebrospinal fluid containing 9/mm3 mononuclear cells. Clonazepam was given, 1.5 mg per day, for three days followed by doses of 3 mg per day. Improvement in walking was observed one week after starting the medication, when reserpine was started at a dose of 1 mg per day and increased to a dose of 1.5 mg per day in three days. One week after starting reserpine, opsoclonus improved markedly and he became able to read again. He was discharged home on September 3, 1978. Six months after admission, reserpine was decreased to 0.5 mg per day. Difficulty in reading developed within a month. Reserpine was given 1.0 mg per day and the doses was continuously given for next three months. One year after admission, he is back to his former occupation without medication. He complains of slight difficulty in reading for more than an hour, and in watching TV.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant lymphoma of the testis: report of two cases and review of the literature]

Two cases of malignant lymphoma arising from the testis are reported. Case 1: A 70-year-old man presented with a painless swelling of the right scrotal contents. Right radical orchiectomy was done and histological examination revealed malignant lymphoma of the testis (diffuse lymphoma, mixed type). Bipedal lymphangiography and CT scan showed metastatic lesion in the right retroperitoneal lymph-nodes. Postoperative irradiation to the inverted Y field encompassing the para-aortic, pelvic and inguinal lymph-nodes bilaterally was given to a total dose of 5,000 rad, and treatment with anti-cancer agents was subsequently started. The patient, however, died of liver failure about 6 months after the operation. Case 2: A 74-year-old man presented with painless right scrotal swelling. Right orchiectomy was performed and the tumor histologically appeared to be anaplastic seminoma. The patient received 3,000 rad of irradiation to the retroperitoneal space. There was no evidence of metastasis, until he developed swelling of the right inguinal lymph-nodes about 5 months after the operation. Afterwards, multiple skin tumors in the legs appeared. Biopsy of the skin lesions showed metastasis of malignant lymphoma (diffuse lymphoma, large cell type). The right testis removed previously was then reviewed in detail, and primary malignant lymphoma of the testis was strongly suggested. The patient responded poorly to additional irradiation or cancer chemotherapy and died about one year and 3 months after the right orchiectomy. A statistical survey was made on 117 cases of malignant lymphoma of the testis reported in Japan and the discussion is focused on the significance of new histological classification in relation to the prognosis.

Subcutaneous abscesses caused by Nocardia brasiliensis complicated by malignant lymphoma. A survey of cutaneous nocardiosis reported in Japan

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.

[Clinical application of PPC for nonspecific chronic prostatitis]

The clinical effectiveness of PPC, amino acid preparation, on nonspecific chronic prostatitis was evaluated by the double-blind test method. A mixture of two pollen extracts which has been widely employed for the treatment of chronic prostatitis was used as a control. Neither antibiotics nor anti-inflammatory drug was administered during the investigation. A total of 76 cases was reported from six facilities but 14 of them were excluded or dropped out. In 32 cases in the PPC group, subjective symptoms such as discomfort after urination, discomfort in the perineal region, pollakisuria, sense of residual urine and dysuria were improved in 50.0 approximately 61.9% and 70.0 approximately 83.3% after 2- and 4-week administrations, respectively. Similar results regarding each subjective symptom were obtained in 30 cases of the control group and there was no significant difference between the two groups. In the overall clinical effectiveness concerning subjective symptoms, the effective rate including excellently, moderately and slightly effective was 81.3% with PPC and 83.3% with control drug. However when the effective rate was limited to excellently and moderately effective, PPC was slightly superior to the control drug (50.5% versus 36.7%). In regard to prostatic tenderness by the digital examination, both PPC and control drug induced relatively good improvement after 2-week administration. The degree of improvement, however, was not increased in the subsequent 2 weeks. Sclerotic change of the prostate was poorly recovered in both groups even after 4-week treatment. Swelling of the prostate was alleviated in 12.5% of the control group after 2 weeks and in 31.8% after 4 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of giant hydronephrosis and a review of 324 cases in the literature]

A case of giant hydronephrosis due to ureteropelvic junction obstruction in an 18-year-old boy is reported. The patient had been told to undergo an operation for the left hydronephrosis at 2 years of age. However, he stayed away from hospital until he presented at our clinic with nausea caused by a large abdominal mass. Radiological evaluation revealed a left giant hydronephrosis with no function and slight compensatory hypertrophy in the right kidney. Left nephrectomy was performed and the pelvic capacity was approximately 7,700 ml. Histopathological examination showed muscular hyperplasia at the ureteropelvic junction. The term giant hydronephrosis may be defined as a hydronephrosis the contents of which are greater than 1,000 ml. Three hundred twenty four cases of giant hydronephrosis in the literature are reviewed and the age, sex, side involved, pelvic capacity, etiology, and relation to hypertension are discussed.

[Preservation of the nipple and areola for breast cancer--histopathological study on cancerous involvement of the nipple and areola]

In 141 mastectomy specimens, performed for invasive or non-invasive carcinomas, histopathologic study was performed to assess the extent of nipple-areola involvement by the tumor. In this study, patients were excluded when 1) the tumor was located beneath the areola, 2) nipple and/or areola abnormalities were clinically present. Tumor involvement of the nipple and/or areola was found in 44 of 141 specimens (31%), with intraductal growth in 36 (82%) of 44, stromal invasion in 3 (7%) and ductal & stromal invasion in 5 (11%). Analysis of nipple-areolar involvement with consideration of the different variables indicates that it occurred in association with tumor size, tumor-areola distance and histological type. Such information provides clinically relevant guide lines in decision making for limited breast surgery.