Synthesis of 2'-deoxy-2'-fluoro-4'-thioarabinonucleosides using the Pummerer rearrangement and their biological evaluation

Searching for more effective antineoplastic and antiviral agents, we have prepared various 2'-deoxy-2'-fluoro-4'-thioarabinonucleosides. The glycosylation reaction of persilylated pyrimidine bases with a 4-thiosugar derivative was performed using SnCl4 as a catalyst. The same reaction between purines and the 4-thiosugar, catalyzed by TMSOTf, gave the corresponding purine 4'-thionucleosides. Pyrimidine derivatives (e.g., 5-ethyluracil, 5-iodouracil, and 5-iodocytosine) showed potent anti-HSV-1 activities, and guanine and 2,6-diaminopurine derivatives showed marked anti-HCMV activities.

Ultrasound bone densitometry of os calcis in elderly Japanese women with hip fracture

We evaluated 138 elderly patients (mean age 79 years) within 2 weeks after hip fracture (67 cervical and 71 trochanteric) using an Achilles ultrasound bone densitometer (Lunar Corporation, Madison, WI). The ultrasound variables of speed of sound (SOS in m/second), broadband ultrasound attenuation (BUA in dB/MHz), and stiffness (%) index were measured on the os calcis. Ultrasound densitometry also was done on 563 normal postmenopausal women to assess normal age changes. An elderly subgroup (n = 138) served as age-matched controls for the hip fracture group. Further subgroups of 33 patients and 33 controls were compared for lumbar spine and femoral neck BMD. There were no statistically significant differences between the hip fracture group and age-matched controls in height and weight, but each ultrasound variable was significantly lower for the hip fracture group (P < 0.0001). For the hip fracture group, SOS was 1470 +/- 19 m/second, BUA was 84.3 +/- 8.4 dB/MHz, and the stiffness index was 47.8 +/- 9.2%, whereas for the age-matched controls, SOS was 1486 +/- 27 m/second, BUA was 94.0 +/- 11.4 dB/MHz, and the stiffness index was 59.1 +/- 12.5%. There were no significant differences between cervical and trochanteric hip fracture groups. Logistic regression analysis showed that a change of the ultrasound values by 1 standard deviation (SD) changed the odds ratio for SOS, BUA, and stiffness index by 2.51, 3.24, and 3.60, respectively. Ultrasound variables, particularly stiffness, were good indicators of hip fracture risk.

Preoperative intra-arterial infusion chemotherapy for invasive thymoma: a case report

A 24-year-old man was diagnosed as having mixed-type thymoma by preoperative percutaneous needle biopsy. A chest computed tomogram showed a tumor measuring 12x9 cm. Selective intra-arterial infusion chemotherapy was first selected because invasion to the superior vena cava was suspected. Bolus injection of 50 mg/m2 cisplatin and 20 mg/m2 adriamycin was performed once into the right internal thoracic artery. The resulting decrease in tumor size was 81%. Neither complications due to the infusion procedure nor side effects due to the anticancer drugs were encountered. An extended thymectomy with partial resection of the mediastinal pleura was safely performed. The histological diagnosis of the resected tumor was thymic hyperplasia. The patient was transferred to a radiologist for additional radiotherapy. Selective intra-arterial infusion chemotherapy for invasive thymoma is an effective therapy, producing no significant side effects and allowing safe resection.

Differences in response of thyrotropin to 3,5,3'-triiodothyronine and 3,5,3'-triiodothyroacetic acid in patients with resistance to thyroid hormone

This study investigated the response of TSH secretion to 3,5,3'-triiodothyronine (T3) and 3,5,3'-triiodothyroacetic acid (Triac) in patients with resistance to thyroid hormone, and compared the responses with those in patients with TSH-secreting pituitary adenoma and normal subjects. A short-term administration of 75 microg of T3 daily for 7 days suppressed serum TSH concentrations almost completely in normal subjects, but suppressed TSH only partially in patients with resistance to thyroid hormone and TSH-secreting pituitary adenoma. A single-dose administration of 75 microg of T3 gave similar results in regard to TSH suppressibility in these three subjects groups. In contrast, a single-dose administration of 1.4 mg of Triac remarkably suppressed serum TSH concentrations after 2 hours in not only normal subjects (-34 +/- 11% [mean +/- SD] from the basal value) but also in patients with resistance to thyroid hormone (-31 +/- 9%), and this TSH suppression continued for 4 hours. After 24 hours, this TSH suppression persisted in normal subjects (-62 +/- 12%) but was relieved in patients with resistance to thyroid hormone (-23 +/- 14%). After the Triac administration, molar ratios of alpha-subunit to TSH in serum were decreased in patients with TSH-secreting pituitary adenoma but increased in patients with resistance to thyroid hormone. Because the Triac therapy for patients with resistance to thyroid hormone suppressed pituitary-TSH secretion during the early phase of drug ingestion, this drug should be given several times within a day to obtain continuous TSH-suppressive effects.

A novel gene family defined by human dihydropyrimidinase and three related proteins with differential tissue distribution

We have isolated cDNA clones encoding dihydropyrimidinase (DHPase) from human liver and its three homologues from human fetal brain. The deduced amino acid (aa) sequence of human DHPase showed 90% identity with that of rat DHPase, and the three homologues showed 57-59% aa identity with human DHPase, and 74-77% aa identity with each other. We tentatively termed these homologues human DHPase related protein (DRP)-1, DRP-2 and DRP-3. Human DRP-2 showed 98% aa identity with chicken CRMP-62 (collapsin response mediator protein of relative molecular mass of 62 kDa) which is involved in neuronal growth cone collapse. Human DRP-3 showed 94-100% aa identity with two partial peptide sequences of rat TOAD-64 (turned on after division, 64 kDa) which is specifically expressed in postmitotic neurons. Human DHPase and DRPs showed a lower degree of aa sequence identity with Bacillus stearothermophilus hydantoinase (39-42%) and Caenorhabditis elegans unc-33 (32-34%). Thus we describe a novel gene family which displays differential tissue distribution: i.e., human DHPase, in liver and kidney; human DRP-1, in brain; human DRP-2, ubiquitously expressed except for liver; human DRP-3, mainly in heart and skeletal muscle.

Benign tumors and tumor-like lesions of the lung

We detail an investigation of the diagnosis and operative method for benign tumors and tumor-like lesions of the lung. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. In tumor-like lesions, the correlation of preoperative and postoperative diagnosis was poor. Since 1986, no patient with benign tumors has undergone invasive methods, but this has been required in some tumor-like lesions. Malignant tumors are easily distinguished from benign tumors but difficult from tumor-like lesions, preoperatively. Therefore, open biopsy is necessary in cases of suspicious malignancy. Then small invasive procedure should be selected due to the possibility of benign tumors.

Cell kill kinetics of an antineoplastic nucleoside, 1-(2-deoxy-2-methylene-beta-D-erythro-pentofuranosyl)cytosine

The cytotoxic properties of 1-(2-deoxy-2-methylene-beta-D-erythro-pentofuranosyl)cytosine (DMDC) were compared with those of 1-beta-D-arabinofuranosylcytosine (ara-C), using SK-MEL-28(P-36) human melanoma cells. DMDC and ara-C were most cytotoxic to cells in the S phase of the cell cycle. Cell cycle progression in S phase was blocked by both compounds. Treatment with DMDC (1 microgram/mL) or ara-C (1 and 30 micrograms/mL) did not increase cytotoxicity against asynchronous cells when the exposure time was prolonged from 1 to 6 hr, but did increase cytotoxicity thereafter. These findings suggest that cells in S phase are rapidly killed by the treatment but are temporarily prevented or delayed entry into the drug-sensitive S phase. On the other hand, DMDC treatment at a higher concentration (30 micrograms/mL) increased cytotoxicity in a time-dependent manner. Intracellular DMDC 5'-triphosphate (DMDCTP) increased in proportion to exogenous DMDC concentration, which was not saturated by treatment with a maximum concentration of the compound at 80 micrograms/mL. In contrast, intracellular ara-C 5'-triphosphate reached peak level when the cells were treated with ara-C at 8 micrograms/mL. The cytotoxicity of DMDC treatment for 4 hr increased relative to the intracellular DMDCTP accumulated during the period. These findings suggest that in cells treated with DMDC at a high concentration, an effective DMDCTP level is maintained for an extended period after washing out the compound from the medium. Consequently, the cells would be killed in the same way as in the case of extended exposures over 6 hr to DMDC at low concentration or to ara-C, in addition to acute S-phase-specific cytotoxicity.

In vitro and in vivo antitumor activity of a novel nucleoside, 4'-thio-2'-deoxy-2'-methylidenecytidine

The in vitro and in vivo antitumor activity of a novel nucleoside, 4'-thio-2'-deoxy-2'-methylidenecytidine (4'-thio-DMDC), was examined. 4'-Thio-DMDC inhibited the growth of various cell lines established from human solid cancers, particularly the growth of lung and bladder carcinomas and melanomas. 4'-Thio-DMDC exhibited potent antitumor activity against subcutaneously implanted murine sarcoma S-180 and human fibrosarcoma HT-1080 xenografts. It was shown that 4'-thio-DMDC suppressed cell growth by inhibiting cellular DNA synthesis, and phosphorylation of the 5'-position of its deoxyribose by deoxycytidine kinase was needed for its antitumor activity. 4'-Thio-DMDC is a poor substrate for cytidine deaminase, thus it is a promising agent for the treatment of malignant solid tumors because it will not be converted into its inactive uridine form.

The effect of cyclosporin A administration on bone metabolism in the rat evaluated by biochemical markers

We investigated the effects of cyclosporin A (CsA), an immunosuppressive agent, on bone remodeling in 6 rats compared to 6 controls, using a histomorphometric technique and biochemical markers for bone metabolism. With an oral daily dose of 15 mg CsA/kg of body weight for 28 days, the trabecular bone volume in CsA administered rats was significantly lower than that in control rats, which indicates bone loss in CsA rats. In CsA rats, bone resorption increased, and urinary pyridinoline (Pyr) significantly increased on day 28 compared with control rats. In contrast, bone formation assessed by serum osteocalcin and osteoid volume had no remarkable changes. These results suggest that administration of CsA for 28 days induces bone loss due to uncoupling between bone resorption and bone formation.

[A retrospective analysis of the outcomes of patients with aneurysmal subarachnoid hemorrhages: a focus on the prognostic factors]

The authors report a clinical analysis of the outcomes of aneurysmal subarachnoid hemorrhages in 112 patients. Cerebral angiography was conducted on 85 patients. Clipping or wrapping of the aneurysm was performed on 81 patients. The overall good outcome (GR and MD in the Glasgow Outcome Scale) ratio and mortality rate were 43% and 34%, respectively. The good outcome ratio and mortality rate in operative cases were 59% and 12%, respectively. With regard to the timing of the operation, 77 cases (95%) underwent early operation and 4 cases (5%) underwent delayed operation. The good outcome ratio of patients with grade I to III at surgery using the Hunt and Kosnik grading system was 74%. There was no difference in outcome between the patients with a ruptured aneurysm in the anterior circulation and those with one in the posterior circulation. The retrospective analysis of the overall outcomes showed the risk factors as being: age over 70 years, cerebral atherosclerosis, poor grade on Hunt and Kosnik grading system and symptomatic vasospasm. Preoperative bleeding of the aneurysm, severe brain swelling at surgery, and postoperative symptomatic vasospasm were factors which worsen the outcome of surgically treated patients. Patients with more than 2 factors showed worse outcomes than those with only one factor. The utilization of these prognostic factors should be important to improve the outcome of patients with aneurysmal subarachnoid hemorrhage.

Molecular cloning and sequencing of a cDNA encoding dihydropyrimidinase from the rat liver

A cDNA encoding dihydropyrimidinase has been isolated from a rat cDNA library. The N-terminal and an internal amino acid sequences were determined, and PCR primers were designed based on these sequences. Using a cDNA fragment amplified by RT-PCR with these primers, three cDNA clones were isolated from a rat liver library. The clone with the longest insert of 2129 bp contained a 1557 bp open reading frame encoding a polypeptide of 519 residues with a molecular mass of 56,832 Da.

[Tumor imaging in nuclear medicine]

Tumor imaging in nuclear medicine has been improved by imaging instruments and newly developed radiopharmaceuticals. One of the imaging developments is a SPECT system using three-detector system. Its each detector rotates 120 degrees when SPECT projection data are acquired and we can save the scanning time and get a high resolution image which is less than 10 mm FWHM. About radiopharmaceuticals 99mTc MDP and 57Ga-citrate are used most commonly for detecting early metastatic lesions in the body. 201Tl chloride and 99mTc MIBI as used for cardiac imaging are also used for tumor detection. 111In-DTPA-D-Phe-octreotide are developed for detection of somatostatin receptor and will be used for many kinds of tumor such as small cell lung cancer, meningioma, malignant lymphoma and gastrointestinal hormone producing tumor.

[A clinical study on optimization of dose distribution in 60Co RALS for carcinoma of the uterine cervix using X-ray CT images]

From 1983 to 1992, 248 patients with carcinoma of the uterine cervix were treated with intracavitary radiation therapy using the 60Co remotely controlled high dose rate afterloading system apace (RALS). Five-year survival rates were 92,8 +/- 7 % for Stage I, 72.4 +/- 5% for Stage II and 52.1 +/- 4% for Stage III. The relations among the sequelae in surrounding organs, local control rates and the calculated dose in the rectum, sigmoid colon, bladder and small intestine were evaluated using X-ray CT images. The patients were treated with intracavitary radiation of 6 Gy/fraction at point A. A total of 5 fractions were delivered once a week. The dose calculation was performed by, and dose distribution shown on, a system developed in our hospital with a personal computer. The average values of maximum dose at certain points of the walls of the rectum and sigmoid colon were similar to point A dose. The incidence of late sequelae increased significantly in the group receiving a maximum dose to the rectum and sigmoid colon higher than 8 space Gy/fraction. This report describes the program for automatic optimization of dose distribution by modifying the hot spot (higher than 8 space Gy/fraction) and the cold spot (lower than 6 space Gy/ fraction).

Flow-dependent influence of high-O2-affinity erythrocytes on peak VO2 in exercising muscle in situ

To evaluate the influence of a high-O2 affinity of the erythrocyte and of flow rate on muscle's ability to extract O2 and develop force, we perfused dog gastrocnemius contracting isometrically at 4 Hz with normal-O2-affinity perfusate or high-O2-affinity perfusate at high and moderate flows (200 and 100 ml . min-1 . 100g-1, respectively). High-O2-affinity perfusate was prepared by incubating human citrate-phosphate-dextrose-stored erythrocytes with buffered saline containing cyanate (4 degrees C, 18 h) and normal-affinity perfusate by storing 2,3-diphosphoglycerate-rejuvenated erythrocytes in the same solution without cyanate. PO2 when blood is half oxygenated was 30.6 Torr for normal perfusate and 18.1 Torr for high-affinity perfusate. During 4-Hz stimulation, the tension developed by the muscle increased incrementally (positive staircase) to reach a peak value after 1.2-1.6 min for the normal perfusate and 0.6-0.7 min for the high-affinity perfusate (P < 0.05). The rate of decline during the early fatigue (measured from the onset of tension decline to 3 min) with high-affinity perfusate was significantly faster than it was with normal perfusate (P < 0.05). These findings suggest that both the staircase effect and the early fatigue are related to O2 availability, which is restricted when erythrocytes have a high O2 affinity. The peak O2 uptake values measured at 3 and 5 min were significantly lower (by 14-24%) with high-affinity perfusate than with normal perfusate at a given level of O2 delivery (arterial O2 content x flow) (P < 0.05). PO2 of venous effluent was proportionally related to peak O2 uptake. The present results indicate that neither blood flow nor O2 delivery is the sole determinant of the muscle's ability to extract O2.

Mixed disulphide formation in myoglobin of mouse (Mus musculus)

The myoglobin, isolated from murine skeletal muscles by chromatofocusing, showed the three components, one major and two minor, with different electrophoretic mobilities. The major component with the isoelectric point (pI) of 7.55 had one reactive SH/mole, while the others with pI of 7.32 and 7.16 showed none, which could be rendered fully reactive by treating the proteins with beta-mercaptoethanol. The three components were the same in their molecular weight (18 kDa), amino-acid composition with one Cys residue and oxygenation properties. By a sensitive high-performance liquid chromatography method, the occurrence of cysteine or glutathione mixed disulphide was verified in the two minor components. We conclude from these results and incubation experiments with low-molecular-weight thiols that the two minors were derived from the major by a mixed disulphide formation with either cysteine or glutathione of the cysteinyl SH at the 66th sequence.

Serial changes of plasma plasminogen activator inhibitor activity in acute myocardial infarction: difference between thrombolytic therapy and direct coronary angioplasty

The fibrinolytic system is impaired in patients with acute myocardial infarction (AMI). The primary regulatory element of fibrinolytic activity is plasminogen activator inhibitor (PAI). There are no reports, however, on the serial changes of PAI activity after thrombolysis or coronary angioplasty in patients with AMI undergoing emergency coronary angiography. This study was designed to examine the difference in the change of fibrinolytic activity between patients with AMI who underwent thrombolytic therapy with recombinant tissue-plasminogen activator (rTPA) and those who underwent direct percutaneous coronary angioplasty (PTCA). We measured the serial changes of PAI activity and tissue plasminogen activator (TPA) antigen after rTPA therapy or direct PTCA. Twenty-two patients received emergency coronary angiography and were treated with rTPA intravenously. Twenty patients underwent direct PTCA. Plasma PAI activity levels were increased on admission and further increased within 24 hours in patients treated with rTPA and in those treated with direct PTCA. In the thrombolysis group, there were two peaks in plasma PAI activity levels (IU/ml) at 4 hours (27.0 +/- 2.9) and at 16 hours (25.6 +/- 2.5) after the initiation of rTPA infusion. However, in the direct PTCA group, there was one peak of PAI activity (IU/ml) at 16 hours (23.9 +/- 2.7) after the initiation of direct PTCA. In conclusion, the PAI activity has two peaks in the thrombolysis group and one peak in the direct PTCA group.

Correlation between a sandwich ELISA and an in-vitro bioassay for erythropoietin in human plasma

A sandwich-type enzyme-linked immunosorbent assay (ELISA) for human erythropoietin (EPO) using two anti-EPO monoclonal antibodies has been compared with an in-vitro EPO bioassay based on CFU-E colony formation in fetal mouse liver cell cultures. In normal subjects and non-uraemic anaemic patients the plasma EPO values estimated with the ELISA correlated well with those by the bioassay, and also inversely with the values of blood Hb, PCV and RBC counts. Dose-response curves for plasma and standard recombinant human EPO in the ELISA were parallel to each other. These results further confirm the validity for the ELISA in measuring circulating human EPO.

Detection of an increase in ascorbate radical in an irradiated experimental tumour system using ESR

We measured Asc.- (ascorbate radical) produced by the reaction of AscH- (ascorbic acid) with HO. or O2.- after irradiation in mouse. It is possible to measure Asc.- easily using ESR and a dialysis method in which Asc.- was collected at room temperature in the interstitial fluid through the dialysis membrane. After irradiation, Asc.- increased in both normal muscle and tumour tissues (SCC-VII) in proportion to the radiation dose. Asc.- increased after treatment with the agents H2O2 and FeCl2, while it decreased after treatment with SOD and catalase. These results suggest that the amount of HO. and O2.- produced is reflected in the Asc.- production. Also, the increase in Asc.- production when WR-2721 was administered prior to irradiation was less than for experiments in which irradiation only was performed. This method is useful for the following reasons. First, no special treatment, such as freezing of the sample, and no administration of noxious agents are necessary to measure Asc.-. Second, irradiation using a dose of only a few Gy shows an increase in production of Asc.-. Third, this method does not require removal of organs. Using this method, Asc.- can serve as an indicator of the amount of HO. and O2.- produced by irradiation in vivo.

[Measurement of radical in irradiated experimental tumor: direct detection of ascorbate radical in mice using ESR]

We measured ascorbate radical (AR) produced by the reaction of ascorbic acid (Asc) with hydroxyl radical (.OH) or superoxide (O2-) after irradiation in normal muscle and SCC-VII tumor of C3H/He mice. AR can be measured using electron spin resonance (ESR) equipment and the dialysis method. The tube for collecting AR was inserted such that the dialysis membrane was in contact with the normal thigh or the center of the tumor lesion. The AR in the interstitial fluid around the membrane was collected through the dialysis membrane. After irradiation with 10 Gy, AR increased in both the normal muscle and tumor tissue; the percent increase was 53.1% for normal muscle tissue and 33.8% for tumor tissue. The maximum percent increases in AR in the normal muscle and the tumor tissue were 11.7 and 9.5% for 2.5 Gy, 28.5 and 18.5% for 5 Gy, 53.1 and 33.8% for 10 Gy, and 88.5 and 44.8% for 15 Gy, respectively. The amount of AR increased to maximums of 144.3% and 160.1% after treatment with H2O2 and FeCl2, respectively, while it decreased to minimums of 65.3% and 81.3% after treatment with superoxide dismutase (SOD) and catalase, respectively. These results suggest that the amount of .OH and O2- is reflected in the amount of AR production. This method is useful for the following reasons. First, no special treatment, such as freezing of the samples, and no administration of noxious agents are necessary. Second, irradiation using a dose of only several Gy shows an increase in the production of AR. Third, this method is less invasive.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal refractoriness to phosphaturic action of parathyroid hormone in a patient with hypomagnesemia

A 50-year-old tetanic woman with hypomagnesemia is described. She had partial resection of the stomach and the jejunum at the age of 20 years. Lack of parathyroid hormone (PTH) function was indicated by hypocalcemia, hyperphosphatemia and high tubular reabsorption of phosphate. However, both plasma concentration of PTH and nephrogenous cAMP were normal. Administration of magnesium sulfate completely normalized serum phosphate and tubular transport of phosphate with only a modest increase in nephrogenous cAMP. The present findings suggest that phosphaturic action of PTH is impaired in magnesium deficiency and that steps distal to cAMP production may be responsible for the renal refractoriness to the hormonal action.

Direct detection of ascorbyl radical in experimental brain injury: microdialysis and an electron spin resonance spectroscopic study

To examine the role played by free radicals in brain injury, we performed experiments to detect radicals in the frontal cortex of rats, using electron spin resonance (ESR) and microdialysis. A dialysis probe was inserted into the frontal cortex, and spin adducts in perfusates were immediately detected by ESR. We obtained a relatively stable doublet signal, with parameters of g = 2.0057 and aH = 0.17 mT. This signal corresponded with that of the ascorbyl radical. Ascorbyl radical in the perfusate collected from the frontal cortex was augmented by microinjection of H2O2 and FeCl2 adjacent to the dialysis probe. When the rats were challenged with cold-induced brain injury, ascorbyl radical and lactate dehydrogenase (LDH) level in the perfusate increased significantly. Pretreatment with superoxide dismutase and catalase attenuated the increase in ascorbyl radical and LDH level induced by the cold injury. Infusion of FeCl2 dissolved in perfusate caused a pronounced increase in ascorbyl radical and LDH level after the cold injury. We conclude that the direct detection of free radical formation further supports the hypothesis that free radicals play an important role in traumatic brain injury. Our findings also indicate that combined microdialysis with ESR spectroscopy is a useful in vivo method for monitoring free radical production in the brain.

Enhancement of randomness by flotation rest (restricted environmental stimulation technique)

This study was conducted to evaluate the positive effect of flotation REST on the production of random sequences, employing both behavioral and physiological measures. The subjects were 7 student volunteers who spent a 40-min. session lying alone on a bed in an isolation box and two 40-min. sessions floating in a commercially produced tank. Polygraph recordings (EEG, EOG, ECG and respiration) were made continuously. Randomness of orally generated sequences was measured by RIP scores based on the Pólya-Eggenberger distribution in three test sessions, e.g., pre-, during, and post-REST period. Randomness increased in the floating condition, while those parameters decreased in the bed condition. Sleep-stage analysis and EEG spectral analysis showed that the flotation REST induced a more hypnagogic state and light sleep than did in-bed REST. It is speculated that the hypnagogic state and light sleep induced by floating enhanced random generation.

Infections in patients with liver cirrhosis and hepatocellular carcinoma

Infections in immunocompromised hosts have been an important clinical problem. Patients with liver cirrhosis and/or hepatocellular carcinoma are at a high risk of infection due to multiple factors. Five hundred and two patients admitted with liver cirrhosis and/or hepatocellular carcinoma were evaluated for infection. The infection rate was not influenced by the etiology of hepatic diseases or the presence of hepatocellular carcinoma, however, it increased with the advance of clinical stages of liver cirrhosis and hepatoma. The respiratory tract and urinary tract were the most common sites of infection, being involved in 50% and 28% of cases, respectively. The major pathogens of respiratory tract infection were S. aureus, H. influenzae, and P. aeruginosa. Gram-negative bacteria was the common isolate from sputum and urine, and S. aureus was also common in gram-positive bacteria. The infection rate was high in patients who died although infections could rarely be implicated as the direct cause of death. These findings should be a guide for the clinicians in treating patients with liver cirrhosis and/or hepatocellular carcinoma who exhibit signs of infection.