Severe, widespread vasculopathy in late-onset group B streptococcal meningitis

Although improvements in antimicrobial therapy during the last few decades have decreased mortality in childhood bacterial meningitis, some patients are left with neurologic sequelae. Cerebrovascular complications are often associated with unfavorable clinical outcome of the disease. We report a 36-day-old infant with severe, widespread cerebrovascular complications due to group B streptococcal meningitis. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) contributed to a non-invasive demonstration of meningeal inflammatory changes and vascular lesions with the meningitis in this patient.     

Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students

Bulimia nervosa (bulimia) is often concomitant with alcohol and other substance abuse. To investigate the coprevalence of bulimia with alcohol abuse and smoking, we surveyed 2597 male and female Japanese high school students and obtained a group of bulimic students who fulfilled four of five DSM-III-R bulimia nervosa criteria and a control group who reported no binge-eating experience. Comparison of the groups showed significantly more alcohol abuse for both male and female bulimic students than for the non-bulimic control group. The male and female adolescents with symptoms of bulimia were similar in showing a high prevalence of alcohol abuse. The incidence of smoking was significantly higher among the bulimic females than among the female controls, but there was no significant difference between the male groups' smoking experiences.     

Cerebral infarction due to systemic necrotizing vasculitis in a patient with rheumatic heart disease, subacute bacterial endocarditis and status epilepticus

Systemic necrotizing vasculitis involving cerebral blood vessels is described in a 30-year-old man with rheumatic heart disease and subacute bacterial endocarditis. Fever, anaemia, splenomegaly and positive blood cultures for Gram-negative bacteria were found on admission. The fever resolved with antibiotic therapy on the third hospital day but he then developed hemiplegia and multifocal seizures. The seizures progressed to uncontrollable status epilepticus accompanied by congestive heart failure and the patient died 20 d after admission. At autopsy, exudative and necrotizing vasculitis involving medium- to small-sized arteries was seen in the brain, the heart and the skeletal muscles. Rheumatic myocarditis and endocarditis and old rheumatic mitral valve deformities were also present. In addition, verrucous endocarditis in the mitral valve and Löhlein's focal glomerulonephritis were noted. We discuss the possible mechanism of the systemic necrotizing vasculitis in relation to rheumatic fever.     

Nonsecretory Myeloma: Analysis of Two Patients by Immunoperoxidase Studies and Plaque-Forming Cell Assay

We studied the production and secretion of immunoglobulin bytumor cells in two patients with nonsecretory myeloma, by meansof an immunoperoxidase technique and plaque-forming cell assay.Immunoperoxidase staining of bone marrow cells revealed monoclonalproliferation of immunoglobulin-containing cells, and the plaque-formingcell assay of peripheral mononuclear cells and bone marrow cellsshowed secretion of monoclonal immunoglobulin from the myelomacells. These observations suggest that the secreted proteindisappears as a result of enhanced catabolism or rapid deposition.There has been speculation as to the existence of this typeof nonsecretory myeloma, but there had been no evidence. Wewere able to demonstrate it with the plaque-forming cell assay.     

Natural Killer Activity in Two Cases of Ataxia Telangiectasia

ABSTRACT. We report two cases of ataxia telangiectasia in which a small number of T cells and a slightly diminished response to phytohaemagglutinin or concanavalin A were observed. In one case, serum IgA was undetectable. In spite of T and/or B cell involvement, natural killer activity and the percentage of natural killer cells determined by monoclonal antibodies Leu 7 were normal in both cases.     

INHIBITION OF TUMOR GROWTH AND ANGIOGENESIS BY VITAMIN D3 AGENTS IN MURINE RENAL CELL CARCINOMA

Purpose

To investigate the effect of active vitamin D3(VD) agents on tumor growth and metastasis.

Materials and Methods

BALB/c mice were inoculated with murine renal cancer Renca and graded doses of 1,25-dehydrovitamin D3 or 1- hydrovitamin D3 were given intraperitoneally every other day beginning on day 1, 3, or 7 and ending on day 9, 11, or 15. Direct cytocidal activity and angiogenic activity were evaluated by 48-hour MTT assay and by the colorimetric method, respectively.

Results

Both VD agents inhibited tumor growth and prolonged the life span of Renca-bearing mice in a dose-dependent manner and both suppressed tumor growth in athymic mice and euthymic mice with eliminated NK activity. Marginal body-weight loss without appreciable hypercalcemia was observed in mice given VD agents. When treatment was delayed on day 7, the VD agents failed to inhibit tumor growth. The MTT assay showed no direct cytotoxicity of VD agents on Renca. Tumor angiogenesis was inhibited to 46 to 30% of the control level by VD agents. Furthermore, VD agents reduced pulmonary and hepatic foci in the metastatic models.

Conclusions

These results suggest that VD agents may be effective as a treatment for renal cell carcinoma, especially when micrometastases are involved.     

Analysis of psychogeriatric patients in the psychiatric emergency system

Background: To date, there have been few studies about elderly psychiatric patients using psychiatric emergency services. In the present study, we analyze data from the Tokyo metropolitan psychiatric emergency system and the Tokyo Metropolitan Matsuzawa Hospital to examine the clinical features and social factors of elderly psychiatric patients hospitalized in psychiatric emergency units. Methods: Over a 4 year period, from April 1998 to March 2001, there were 7971 patients (4520 men, 3451 women) who used the Tokyo Metropolitan Government's psychiatric emergency system. Of these 584 patients (337 men, 247 women) were elderly, over 60 years. Of these geriatric patients, 72 (45 men, average age 74.4 years; 27 women, average age 76.0 years) were received at Tokyo Metropolitan Matsuzawa Hospital from January 1999 to December 2001. The present study examines the reasons for hospitalization, legally mandated admission, diagnosis, psychiatric symptoms at admission, inappropriate behaviors, family status and disease complications. Results: Epidemiological data showed that the number of geriatric patients has increased annually and the distribution of elderly patients’ diagnoses is entirely different from that of younger or middle‐aged patients’. Almost all geriatric patients were under mandatory hospitalization by Law Related to Mental Health and Welfare of the Person with Mental Disorder. Psychiatric symptoms and inappropriate behaviors were considered to be highly severe, like those of younger patients. Conclusion: The importance of psychiatric emergency care for geriatric patients is strongly recognized by the present study. It is necessary to improve the present psychiatric medical system to develop a suitable and desirable system to care for geriatric patients.     

Immune response after hepatitis A vaccination in haemodialysis patients: Comparison with hepatitis B vaccination

This study evaluates the immune response of 20 haemodialysis (HD) patients vaccinated with hepatitis A (HA) vaccine and eight patients vaccinated with hepatitis B (HB) vaccine. Twenty patients and 22 healthy adults were immunized three times (months 0, 1 and 6) intramuscularly with a 0.5 μg dose. All members of both groups were positive for the antibody to hepatitis A virus (anti-HAV) after three vaccinations. The geometric mean titres at 7 months were similar in both groups. No serious side effects were observed. Eight of the HD patients with HA vaccination were injected with yeast-derived hepatitis B vaccine. The three doses of 10 μg were administered intramuscularly at 0, 1 and 6 months. The occurrence of antibody to hepatitis B surface antigen (anti-HBs) was late in HD patients and the anti-HBs level in HD patients was lower than that in healthy subjects. These results indicate that this HA vaccine has good immunogenicity compared with the HB vaccine and that the standard three doses of HA vaccine given at 0, 1 and 6 months are safe and effective even in HD patients.