Recurrent exercise-induced acute renal failure in renal hypouricemia

We describe a male patient with four episodes of acute renal failure after strenuous exercise occurring between the age of 14 and 25 years. He was found to have low serum uric acid (0.4mgdl⁻¹ after recovery) and high fractional excretion of uric acid. A benzbromarone, pyrazinamide test suggested that renal hypouricemia was due to defective proximal tubular reabsorption of uric acid at a pre-secretory site. A renal biopsy revealed acute tubular necrosis, a renal computer tomography scan showed patchy contrast enhancement and a treadmill exercise test induced an immediate fall in creatinine clearance. These findings suggest that the cause of acute renal failure was renal vasoconstriction rather than obstruction by uric acid crystals.     

Chronic myelomonocytic leukemia derived from a possible common progenitor of monocytes and natural killer cells

The neural cell adhesion molecule, CD56, is expressed on acute myelogenous leukemia (AML) cells in 17-20% of the patients. However, the clinical and biological significance of its expression in AML has not been well analyzed from the standpoint of CD56 expression and its association with differentiation to a natural killer (NK) cell lineage. Here we present a 78-year-old patient with chronic myelomonocytic leukemia (CMML) whose leukemic cells had features of both monocytes and NK cells. We demonstrated that the leukemic cells were positive for CD4, CD56 and interleukin-2 (IL-2) receptor beta chain (CD112) in addition to myelomonocytic markers such as CD33, CD11b and CD11c. These leukemic cells proliferated well in vitro in response to 10-100 U/ml of IL-2, and functionally showed significant cytotoxicity against K562 target cells in a 4-hour (51) Cr release assay. All the above data indicate that these cells possessed at least some of the biological features of NK cells. Accordingly, we speculate that the leukemic cells in this patient may have been derived from a possible common progenitor of monocytes and NK cells.     

Whole-genome analysis of human astrocytic tumors by comparative genomic hybridization

Frozen sections of 35 astrocytic tumors of various histologic malignancies were analyzed by comparative genomic hybridization in an attempt to characterize the profile of genetic aberrations. Over 94% of the samples revealed DNA copy number aberrations, which increased with higher histological malignancy grades, and also involvement of more than one chromosome was seen in 85% of instances. The aberrations observed were mainly deletions and most frequently incorporated chromosomes 1p, 10, 19q, and 22q. On the other hand, gains or amplifications were detected only in glioblastomas. Additionally, such gains or amplifications were present in all tumor samples where the initial histopathological diagnosis was glioblastoma and immunohistochemical study disclosed p53 tumor suppressor protein negative and epidermal growth factor receptor positive immunoreactivity; such glioblastomas possessing p53 tumor suppressor protein positive and epidermal growth factor receptor negative immunoreactivity seldom displayed any gain. Thus, glioblastomas exhibiting two different profiles of genetic aberrations were recognized—one with and the other without any gains/amplifications. We speculate that the former variety is de novo glioblastoma.     

Comparative study on in vitro lymphocytotoxicity and mitogenicity of different antilymphocyte globulin (ALG) preparations

The lymphocytotoxicity and mitogenicity between six different ALG preparations on the clinical use world wide were compared. No significant difference in the lympholytic activity was observed between preparations and 100% cell lysis was achieved at a concentration of 50 micrograms/ml in the presence of complement. On the other hand, four preparations now in use in European countries and USA showed variable mitogenic activities on lymphocytes in the absence of complement, whereas two ALGs used in Japan did not. As the stimulatory effects of ALG on lymphocytes may contribute to the clinical outcome in the treatment of severe aplastic anemia (Kawano et al, 1988), these date can explain the poor clinical results of ALG therapy with those two preparations in Japan. Careful measures should be paid in the construction of treatment protocol and selection of ALG preparations to yield the best results.     

Effects of allergen controlled cosmetics on hyperpigmented dermatitis

Prior to the late 1970s, cosmetic dermatitis was quite common in Japan. Once sensitizers were established, in cosmetics, soaps, shampoos, and other commonly used substances, effective treatment was only possible if the cycle of recrudescence could be broken. The Allergen Controlled System accomplished this by preventing contact with the main contact sensitizers.Although the number of cases of pigmented cosmetic dermatitis has declined because of restrictions on the use of several major sensitizers, the Allergen Controlled System remains an effective treatment for the cases that still occur.     

Bacteriological study of cefminox in the field of obstetrics and gynecology

Cefminox (CMNX, MT-141), a new cephem antibiotic, was determined of its antibacterial activity against 304 clinical isolates with following results. CMNX was inferior to CEZ or CMZ in the activity against 78 isolates of Staphylococcus sp., but it was superior to these antibiotics in the activity against 104 isolates of E. coli. Against 53 isolates of Bacteroides sp., CMNX showed higher activity than CEZ or CMZ. In the activity against 69 isolates of Peptococcus sp. and Peptostreptococcus sp., CMNX was almost equal to CEZ.     

Evaluation of lumbar tap test combined with mean cerebral blood flow measurement and electroencephalographic topography on idiopathic normal pressure hydrocephalus patients

PURPOSE: To improve the diagnostic precision of the lumbar tap test (LTT). SUBJECTS AND METHODS: Thirty one patients (mean age, 65.4 years; male to female ratio, 12:19) suspected of having idiopathic normal pressure hydrocephalus (INPH) were used in the study. They underwent LTT (20-30 ml of cerebrospinal fluid was drained through a puncture with a 18 G needle; evaluation within 3 days after LTT). Based on changes in symptoms after LTT, including dementia (evaluated according to the duration of time needed to accomplish No. 7 items in the N method psychofunction test) and gait disturbance (evaluated according to the duration and the number of steps needed to walk 4 m in a straight line), mean cerebral blood flow (mCBF) monitored with 133Xe-CT, and electroencephalographic topography (EEG-T). The patients were divided into symptom-improved [LTT (+)] and no change [LTT(-)] groups. Changing patterns of EEG-T and mCBF after LTT and the efficacy of V-P shunt at 1 month after shunt administration (effective: E; non-effective: NE) were analyzed and compared. Changing patterns of EEG-T and mCBF after LTT were categorized as improvement of both parameters (type A), that of mCBF only (type B), that of EEG-T only (type C), and no change in either parameter (type D). RESULTS: (1) Twenty patients were classified as LTT(+) and eleven as LTT(-). (2) The false positive rate was 25% (5/20) for LTT(+); the false negative rate was 27.3% (3/11) for LTT (-). (3) In all the patients, in relation to changing patterns of EEG-T and mCBF, 100% of type A patients (9/9), 75% of type B (6/8), 42.9% of type C (3/7), and 0% of type D (0/7) responded to shunting. (4) Increased rates (IR) of mCBF in 17 patients with improvement of mCBF were 24.2 +/- 10.6% in E patients and 8.9 +/- 5.2% in NE patients, demonstrating a significantly higher percentage in E patients (p < 0.005). The borderline of IR between E and NE was around 15%. CONCLUSION: (1) Although quantitative evaluation of symptoms (dementia and gait disturbance) before and after LTT, 27.3% of false negative and 25% of false positive were recognized. (2) According to changing patterns of EEG-T and mCBF after LTT, all type A patients responded to shunting (E), whereas type D patients were all categorized as NE. (3) When the IR of mCBF was 15% or more after LTT, such patients all responded to shunting. (4) The diagnostic precision of LTT in efficacy evaluation is improved when this test is combined with EEG-T and mCBF, in addition to quantitative evaluation of symptoms.