Acute lower respiratory infections in hospitalized children over a 6 year period in Tokyo

BACKGROUND: Acute lower respiratory infections are major causes of hospitalization in children and are mainly caused by respiratory viruses. In the present study, we investigated the etiologic agents responsible for acute lower respiratory infections from the period November 1986 to October 1992 in order to determine the seasonal pattern and different characteristics of age distribution of respiratory infectious agents, mainly virus infections. METHODS: A total of 1521 patients with lower respiratory infections was hospitalized in Saiseikai Central Hospital, Tokyo, Japan. Nasopharyngeal secretions were obtained for virus isolation and paired sera in the acute and convalescent phases were obtained for serological examination. RESULTS: Etiological agents were identified in 668 of 1521 patients (43.9%) by serological antibody responses, virus isolation and/or detection of virus antigen: 240 (15.8%) with respiratory syncytial (RS) virus; 62 (4.1%) with influenza virus type A; 26 (1.7%) with influenza virus type B; 86 (5.7%) with adenovirus; 81 (5.3%) with parainfluenza virus; 32 (2.1%) with measles virus; 20 (1.3%) with enteroviruses or Herpes virus other than respiratory viruses; 75 (4.9%) with Mycoplasma pneumoniae; 10 (0.7%) with pertussis; and 36 (2.4%) with mixed infections. In the remaining 853 patients (56.1%), etiologic agents were not identified. Respiratory syncytial (RS) virus was a main causative agent of respiratory infections in patients younger than 3 years of age. Influenza virus and M. pneumoniae were two main causative agents in patients with acute respiratory illness over 5 years of age. Parainfluenza virus type 3 was frequently observed in infants from 9 to 12 months of age. A distinct seasonal pattern of viral infections was consistently observed in each year during the study period; RS and influenza viruses were prevalent in winter, parainfluenza virus was prevalent in spring and M. pneumoniae was prevalent in summer and autumn. However, adenovirus infections were observed in all seasons. Serological responses were poor in patients younger than 1 year of age and they were mainly diagnosed by virus isolation or detection of virus antigen. CONCLUSIONS: Virological epidemiology provides useful information in daily clinical practice for the prediction of etiological agents based on patient age and the seasonal distribution of agents. We should examine virus isolation and the detection of virus antigen, along with serological examinations in patients with respiratory infections, especially in infants younger than 1 year of age because of poor serological responses.     

EXPRESSION OF MUC APOMUCINS IN NORMAL PANCREAS AND PANCREATIC TUMOURS

The epithelial expression of apomucins MUC1, MUC2, MUC3, and MUC5/6 was examined in normal pancreas and in pancreatic lesions, using immunohistochemical methods. In normal pancreas ( n =5), MUC1 apomucin was expressed in ducts and some acini, but there was no expression of MUC2, MUC3, or MUC5/6. In chronic pancreatitis ( n =5), MUC1 apomucin was expressed, but expression of the other apomucins was not noted. However, mucous hyperplastic foci of pancreatic ducts expressed MUC5/6 apomucin in 2/5 cases (40 per cent). In intraductal papillary-mucinous neoplasm (IPMN) of the pancreas ( n =9), MUC1, MUC2, MUC3, and MUC5/6 apomucins were expressed in 8/9 (89 per cent), 0/9 (0 per cent), 4/9 (44 per cent), and 9/9 (100 per cent) cases, respectively. In pancreatic mucinous cystadenoma ( n =8), MUC1, MUC2, MUC3, and MUC5/6 apomucins were expressed in 7/8 (88 per cent), 0/8 (0 per cent), (25 per cent), and 3/8 (38 per cent) cases, respectively. In invasive ductal adenocarcinoma of the pancreas ( n =25), expression of MUC1, MUC2, MUC3, and MUC5/6 apomucins was found in 25/25 (100 per cent), 1/25 (4 per cent), 20/25 (80 per cent), and 24/25 (96 per cent) cases, respectively. Atypical mucous duct hyperplasia near cancer cells consistently expressed MUC1 apomucin and occasionally expressed MUC3 and MUC5/6. In positive cases, MUC1 apomucin expression was noted in the cell membrane facing the ductal or neoplastic lumina, while expression of MUC2, MUC3, and MUC5/6 apomucins was found in the cytoplasm. These results suggest that MUC3 and MUC5/6 apomucins newly emerge during the neoplastic transformation of pancreatic mucinous cystadenoma and IPMN and during pancreatic ductal carcinogenesis, while MUC1 apomucin remains positive and MUC2 apomucin remains almost negative during neoplastic transformation.     

Antitumor Activity of D-Mannosamine In Vitro: Cytotoxic Effect Produced by Mannosamine in Combination with Free Fatty Acids on Human Leukemia T-Cell Lines

Cytotoxic effects of mannosamine and free fatty acids on humanmalignant T-lymphoid cell lines derived from patients with T-cellleukemia were investigated. The combination of mannosamine andan unsaturated fatty acid (oleate or linoleate) produced morestriking cytotoxic effects on malignant lymphoid cells thanon normal human lymphocytes. The amino sugars glucosamine ormannosamine in the combination caused a synergistic cytotoxiceffect, while the other carbohydrates (N-acetylmannosamine,N-acetylglucosamine, or mannose) had little effect. On the otherhand, the effect of saturated fatty acids (palmitate or stearate)in the same system was nil. An unsaturated fatty acid (oleate)caused an increase in lipid fluidity of the surface membranein MOLT-4 lymphoid cells, which possess higher lipid fluidityin combination with mannosamine, while saturated fatty acidshad no effect on the fluidity properties of the membrane lipids(even in the presence of mannosamine). The relationship betweenmannosamine and unsaturated fatty acids in cytolysis was discussed.     

Metanephric Adenoma Treated with Laparoscopic Nephrectomy

A 31-year-old-female presented with a left renal mass detected incidentally during an abdominal ultrasound examination. Computed tomography and angiography revealed a hypovascular solid tumor 4.5 cm in diameter at the middle portion of the left kidney. Laparoscopic left nephrectomy was performed and macroscopic examination of the specimen revealed encapsulated tumor with grayish yellow cut surface. Histological examination demonstrated that the tumor cells were small scant cytoplasms, containing round and regular nuclei, forming a glomerular-like structure. There was no mitosis nor cellular atypia indicating a malignant structure. The histological diagnosis was metanephric adenoma.     

Susceptibility genes for schizophrenia

Abstract  It is well known that genetic factors contribute to the susceptibility for schizophrenia. Recent advances in the molecular genetics of schizophrenia strongly suggest several susceptibility genes (e.g. dysbindin, neuregulin-1, DISC1, COMT, G72, RGS4 and Akt1). We discuss the evidence and biology of these genes. As glutamate transmission is especially implicated in these genes, neurobiological basis of schizophrenia might be elucidated by investigation of functional interactions between susceptibility genes for schizophrenia and the glutamatergic system.     

Erectile dysfunction in hemodialysis patients with diabetes mellitus: Association with age and hemoglobin A1c levels

Abstract Aim: Erectile dysfunction (ED) is common in patients with diabetes mellitus (DM) as well as those undergoing hemodialysis (HD). The purpose of this study is to investigate the frequency and severity of ED in HD patients with DM and those without DM. In addition, we examined the relationship between erectile function and several risk factors, including presence of DM and hemoglobin A1c levels in HD patients. Methods: This study involved 180 patients on HD, including 66 HD patients with DM (DM‐HD) and 114 patients without DM (non‐DM‐HD). We evaluated erectile function using an abridged five‐item version of the international index of erectile function (IIEF‐5). Logistic regression analysis was used to investigate the relationship between presence of ED and several risk factors. Results: The total score of IIEF‐5 in DM‐HD patients (9.5 ± 4.2) was significantly lower than in non‐DM‐HD patients (13.5 ± 5.7). The prevalence of severe ED was 42.4% and 18.4% in DM‐HD patients and non‐DM‐HD patients, respectively. Age, cardiovascular disease history, and DM were identified as independent risk factors for the presence of ED. Furthermore, age and elevated hemoglobin A1c levels were identified as independent risk factors for the presence of severe ED. Conclusion: DM‐HD patients are more likely to have ED, and particularly severe forms of ED, than non‐DM‐HD patients. DM and elevated hemoglobin A1c levels were associated with the presence of ED or severe ED, respectively. Aging was identified as an independent factor in both ED and severe ED.     

Spontaneous peripelvic extravasation of urine due to an inflammatory aneurysm of the abdominal aorta

A 71-year-old man presented complaining of severe left flank pain. A computed tomography scan of the abdomen disclosed a left peripelvic extravasation of urine and a 4.0-cm abdominal aortic aneurysm with a significant amount of perianeurysmal thickening and prominent left hydroureter. The patient was diagnosed as having an inflammatory aneurysm of the abdominal aorta (IAAA) with peripelvic extravasations of urine. We report the results of a patient with IAAA with ureteral obstruction successfully treated with steroid therapy and a ureteral stent.     

Recto-peritoneal fistula following transperineal prostate biopsy

A recto-peritoneal fistula is an extremely rare complication after prostate biopsy. We report herein on a peritonitis arising from a recto-peritoneal fistula 5 days after undergoing prostate biopsy. To our knowledge, this is the first case of recto-peritoneal fistula following transperineal needle biopsy of the prostate in the published literature.     

Asthenozoospermia: Possible association with long-term exposure to an anti-epileptic drug of carbamazepine

Little attention has been paid to infertility in men with epilepsy and little information exists about the mechanisms by which anti-epileptic drugs affect spermatogenesis or sperm function. We report a case of a male infertility patient with asthenozoospermia during long-term treatment with anti-epileptic drugs. A 29-year-old man had continued treatment with anti-epileptic drugs under the diagnosis of epilepsy for 13 years. He and his wife had been examined and treated as an infertile couple for 3 years. The patient was found to have no motile sperm with a normal sperm count, while taking a dose of 400 mg/day of carbamazepine. On suspicion of an adverse effect of carbamazepine, he was switched to phenytoin monotherapy. One month after that, sperm motility was vastly improved (65%) and they conceived a child 5 months after that. One must be cautious in extrapolating from a case report, but these findings strongly suggest a direct effect of carbamazepine on spermatic function.