Nephrotic syndrome due to immunologically mediated hypocomplementic glomerulonephritis in a patient of Waldenström's macroglobulinemia

A 72-year-old man was diagnosed as having nephritic syndrome complicated by Waldenstr?m's macroglobulinemia (WM). A monoclonal IgM lambda protein and decreased serum complements were observed. The renal biopsy disclosed the capillary occluded by thrombi which was stained with IgG, IgA, IgM, C4, lambda light chain and slight kappa light chain in a granular pattern. Electron dense deposits were noted in the subendothelial spaces. An unusual case of WM who developed nephrotic syndrome due to immunologically mediated hypocomplementic glomerulonephritis is described.     

Corrective osteotomy for malunited fracture of the glenoid cavity: a case report

Fractures of the glenoid cavity that are substantially displaced are rare. A patient with shoulder pain and dysfunction caused by a severely malunited fracture of the glenoid cavity was treated successfully with corrective osteotomy and bone grafting. Functional results 2 years after surgery were satisfactory, and radiographs showed no evidence of degenerative change. Although appropriate initial management should prevent the development of symptomatic malunion, results of the current study suggest that later reconstruction of the glenoid cavity restores satisfactory function, even if so much time has elapsed that glenoid osteotomy must be done to achieve reduction.     

A case of chronic obstructive pulmonary disease (COPD) followed by pulmonary rehabilition

We report a 75-year-old woman with chronic obstructive pulmonary disease (COPD) suffering from cough, sputum, high-grade fever and dyspnea on effort. Her chest radiograph revealed an infiltrative shadow in the right lower lung field and her laboratory data showed marked inflammatory changes. Her arterial blood gas analysis showed marked hypoxemia and hypercapnia. After her laboratory data and general condition improved, we performed pulmonary rehabilitation for the patient for about 6 weeks. The program consisted of pursed lip breathing, diaphragmatic breathing, muscle stretch gymnastics, and walking. The 6-minute walking test distance increased from 170 m to 280 m. The minimum SpO2 during the 6-minute walking test increased from 88% to 91%. (O2 3 L/m) After discharge, she continued to receive home care from a visiting nurse specialized in respiratory medicine and 24 hour-monitoring of O2-compliance at home. She has not experienced acute exacerbation or re-hospitalization for 1 year. We conclude that home care service is effective to maintain stable conditions such as state of breathing, SpO2, vital signs, and activities of daily living for elderly COPD outpatients.     

Analysis of survivorship after total hip arthroplasty using a ceramic head

To determine the clinical efficacy of an alumina ceramic head, 119 cemented total hip arthroplasties in 97 patients using an alumina head coupled with ethylene oxide gas sterilized polyethylene were reviewed. Eighty-two patients (101 hips) with greater than 10 years followup were evaluated clinically and radiographically (range, 10-17.6 years), and 97 patients (119 hips) were evaluated for survivorship analysis (range, 0.6-17.6 years). The average functional hip scores according to Merle d'Aubigné and Postel improved from 8.6 preoperatively to 15.0 at the final followup, and 57 patients (64 hips) had no pain. The average polyethylene wear rate was 0.15 mm/year (range, 0.04-0.34 mm/year). Patients with polyethylene wear greater than 3 mm showed significantly higher rates of acetabular loosening. Fifteen-year survival rates (with 95% confidence intervals) with radiographic evidence of aseptic loosening as the end point were 46.8% +/- 13.4% in acetabular components and 91.9% +/- 6.6% in femoral components. Fifteen-year survival rates of hip arthroplasties with revision because of aseptic loosening as the end point were 75.3% +/- 10.2% and 97.9% +/- 3.0%, respectively. Results of the current study suggest that using an alumina head instead of a metal head may not be beneficial when coupled with ethylene oxide gas sterilized polyethylene.     

Genetic characterization of the O4 polysaccharide gene cluster from Escherichia coli.

The Escherichia coli O4 serotype is among those commonly isolated from urinary tract infections. In order to study the genetics of the O-antigen, the O4 biosynthesis genes from a uropathogenic E. coli have previously been cloned into E. coli K-12. A subclone, GH58, has been identified which reacts with antisera against the O4 serotype. In contrast to the wild-type parental strain, lipopolysaccharide (LPS) from this clone is devoid of rhamnose and does not cross-react with O18 antisera. The recombinant plasmid from GH58, pGH58, was used to transform the rfb deletion strain HU1190. The resultant strain agglutinates in O4 antisera, but produces unpolymerized LPS. Escherichia coli K-12 strains HB101 and RC712 containing pGH58 produce polymerized LPS, indicating that the genetic background of the host can influence the LPS encoded by recombinant molecules. A cosmid, pGH84, has been identified which encompasses the entire pGH58 gene sequences and includes an additional 34 kilobases of DNA. HU1190 containing this cosmid agglutinates in O4 antisera and produces a polymerized LPS. By constructing several deletion subclones of pGH84, we have localized the genes necessary for polymerized LPS to a 5.5 kb ClaI-BamHI fragment. P1 transductants that make polymerized and unpolymerized O4 LPS have also been identified.     

A case of pulmonary alveolar proteinosis associated with fibrotic changes and alveolitis

A 62-year-old male, who had worked for 20 years as a farmer and who had been exposed to respirable agricultural chemicals apart from silica, was admitted in April, 1987, because of progressed exertional dyspnea. The chest X-ray film on admission showed irregularly-distributed infiltrative shadows in both lung fields. The chest CT also revealed irregular increase of densities in lung fields. Though the TBLB specimen from right B8 indicated only fibrotic changes, the tissues obtained by open lung biopsy from right S3 and S8 revealed PAS-positive proteinaceous deposits in the alveoli as well as alveolitis or fibrotic change of alveolar septum. Bronchoalveolar lavage fluid (BALF) contained phospholipids composed mainly of lecithin. According to these findings, the case was diagnosed as pulmonary alveolar proteinosis associated with alveolitis and patchy fibrotic changes. It is not completely clear whether fibrotic changes are induced by pulmonary alveolar proteinosis itself or fibrosis and proteinosis result coincidentally from direct response to fibrogenic agents. Inhaled agricultural chemicals may play a role for the pathogenesis of this case, for which further studies are required.     

Species differences in the tissue distribution of catechol and methylsulphonyl metabolites of 2,4,5,2',5'-penta- and 2,3,4,2',3',6'-hexachlorobiphenyls in rats, mice, hamsters and guinea pigs

Polychlorinated biphenyls (PCBs) are metabolized to phenolic or methylsulphonyl PCBs (MeSO(2)-CBs) in animal species. The study determined the species differences in the tissue distribution of persistent PCB metabolites in rats, mice, hamsters and guinea pigs 4 days after exposure to 2,4,5,2('),5(')-pentachlorobiphenyl (CB101) or 2,3,4,2('),3('),6(')-hexachlorobiphenyl (CB132). For CB101 metabolism, the hydroxylation in rats, mice and hamsters occurred primarily at the 3(')-position in the 2('),5(')-dichlorinated phenyl ring, whereas the hydroxylation in guinea pigs occurred preferentially at the 3-position. Metabolite profiles in tissues of hamsters were dominated by 3('),4(')-catechol-CB101, whereas metabolite profiles in rats and mice were dominated by 3(')- or 4(')-MeSO(2)-CBs. For CB132 metabolism, rats and mice produced 4(')- and 5(')-MeSO(2)-CBs at similar concentration ratios, whereas guinea pigs produced MeSO(2)-CBs at higher levels and selectively retained 5(')-MeSO(2)-CB in liver. In contrast, hamsters preferentially produced 4('),5(')-catechol-CB132 that was retained in serum. Consequently, hamsters produced catechols, whereas guinea pigs produced meta-substituted MeSO(2)-CBs, preferentially from CB132. These findings indicate that PCBs with 2,3,6-chlorine substitution are preferred substrates for the formation of catechols or MeSO(2)-CBs and the differences in metabolite profiles are related to species-dependent metabolic capacities.