Community acquired pneumonia (CAP) caused by Cryptococcus neoformans in a healthy individual

A 41-y-old male had been diagnosed as having community acquired pneumonia (CAP) with consolidations in the chest radiograph, fever and cough. Since clarithromycin and ss-lactam agents were not effective, bronchoscopic examination was performed. Indian ink staining of bronchial wash smears revealed yeast-like cells with a thick capsule, and Cryptococcus neoformans was isolated several d later. Serum glucuronoxylomannan antigen was > or = x 1024. The patient was treated with itraconazole for 16 weeks.     

Immunocytochemical localization of a neuron-specific diacylglycerol kinase beta and gamma in the developing rat brain

Diacylglycerol kinase (DGK) phosphorylates diacylglycerol (DG) to produce phosphatidic acid (PA) and is, therefore, a potential terminator of DG signaling. DG and PA are important intracellular second messengers. DG directly binds protein kinase C (PKC) then activates this multifunctional enzyme. Ca2+-dependent and brain-specific DGKs, alpha, beta, and gamma, are suggested to play pivotal roles in the central nervous system. To elucidate the DGK function in neuronal development, we studied the developmental changes of DGKalpha, beta, and gamma in the postnatal rat brain. By immunoblot analysis, DGKalpha and gamma subtypes were present at birth and then gradually increased, while DGKbeta was not present at birth or postnatal day 3, then increased rapidly from day 14 to reach maximum at day 28. Immunohistochemically, DGKbeta and gamma were distributed in different brain regions. In most brain regions, DGKgamma showed sustained expression throughout the postnatal developmental periods. Interestingly, a temporal expression of DGKgamma was observed in the medial geniculate nucleus during day 3 to 14, and a delay of DGKgamma expression was seen in Purkinje cells, which was coincident with dendritic growth of Purkinje cells. In the hippocampal pyramidal cell, both DGKbeta and gamma were abundant but subcellular localization was different. DGKgamma localized in the cytosol while DGKbeta localized along the membrane structure. These findings suggest that each DGK subtype has a spatio-temporally different function in the developmental neurons.     

Twenty-five years followup of patients who had valgus osteotomy for arthritic hips

We reviewed the long-term outcomes of intertrochanteric valgus femoral osteotomies in patients with arthritic hips to clarify any influencing factors. One hundred six patients (127 hips) were followed up during an average of 25 years. The average age of the patients at surgery was 42 years. The preoperative extent of degenerative change was classified radiologically into one of four grades according to the criteria of T?nnis. Radiographic measurements of acetabular coverage were made using AP radiographs obtained immediately after surgery. Thirty-eight patients (41 hips) had total hip arthroplasties; the 25-year survival rate was 69%. Radiologic evaluations of patients with mild preoperative degenerative changes (T?nnis Grade 1) improved and good clinical outcomes were obtained. In addition, radiologic evaluations of patients whose hips had better acetabular coverage (center-edge angle > 0 degrees, sharp angle < 50 degrees, or acetabular head index > 60%) also improved. However, radiographic measurements did not influence clinical scores. The mean score of patients younger than 50 years at surgery was higher than patients older than 50 years. The mean score of patients with unilateral hip involvement was higher than patients with bilateral involvement. Therefore, valgus osteotomies seem appropriate for younger patients with unilateral involvement.     

Solitary neurocysticercosis case caused by Asian genotype of Taenia solium confirmed by mitochondrial DNA analysis

A Japanese woman presenting with neurologic symptoms was presumptively diagnosed with neurocysticercosis based on imaging findings. Hooklets in the scolex of the resected lesion were not confirmed through histopathological observation. However, the illness was confirmed by mitochondrial DNA analysis to be a solitary neurocysticercosis case caused by the Asian genotype of Taenia solium.     

Combination chemotherapy (cyclophosphamide, doxorubicin, and vincristine with continuous-infusion cisplatin and etoposide) and radiotherapy with stem cell support can be beneficial for adolescents and adults with estheisoneuroblastoma

BACKGROUND: Adolescent-onset and adult-onset esthesioneuroblastoma is a rare disease and is considered incurable. In many patients, local resection and radiation are chosen as clinical therapy with or without chemotherapy. It was reported previously that local resection and radiotherapy led to temporary remission and, in many patients, recurrent disease. Although combination with chemotherapy has been regarded as promising, an effective regimen has not been established. In the current study, the authors investigated the effect and tolerability of the combination of chemotherapy, radiotherapy, and peripheral blood stem cell transplantation (PBSCT). METHODS: The study population included 12 patients with adolescent-onset and adult-onset esthesioneuroblastoma classified as Kadish Stage A-D. The patients received two cycles of combination chemotherapy, which consisted of cyclophosphamide, doxorubicin, and vincristine (CAD) with continuous-infusion cisplatin and etoposide (CVP). This was combined with radiotherapy with or without PBSCT. RESULTS: Nine of 12 patients (75%) obtained more than a partial response after only 2 cycles of chemotherapy. After radiation with or without PBSCT, six patients obtained a complete remission (CR). The longest survival was > 3 years. All patients who underwent PBSCT obtained a CR. The most severe side effects were loss of sodium and potassium induced by cisplatin-related renal tubular distress. Those abnormalities were temporary, and all patients recovered. CONCLUSIONS: The chemotherapy regimen with CADO and CVP does not require continuation for a long time and is very effective and tolerable for patients with adolescent-onset and adult-onset esthesioneuroblastoma. The combination with radiotherapy and PBSCT may lead to a CR without facial disfigurement. In this report, the authors discuss the feasibility and efficacy of this multidisciplinary approach.     

Role of hepatitis B virus genotypes Ba and C, core promoter and precore mutations on hepatocellular carcinoma: a case control study

The role of hepatitis B virus (HBV) genotypes, core promoter (CP) and precore mutants on hepatocellular carcinoma (HCC) is still controversial. We aimed to determine their role on the development and clinical features of HCC. HBV genotypes and CP/precore mutations were determined in 90 HCC patients and 180 matched control patients. In the 90 HCC patients, 22 (24.4%) and 68 (75.6%) had subtype Ba and genotype C, respectively. The prevalence of genotype C and CP mutations was significantly higher in HCC patients compared with controls (75.6 versus 57.8%, P = 0.004; 90.9 versus 74.8%, respectively, P = 0.007). Among carriers of genotype C, 91.8% of the HCC patients and 88.8% of controls had CP mutations. Among carriers of subtype Ba, HCC patients had a higher prevalence of CP mutations compared with controls (88.2 versus 54.5%, respectively, P = 0.02). By logistic regression analysis, the only factor associated with HCC was a mutation of the CP region (P = 0.032). There were no differences in the clinical features on presentation, the chance of receiving treatment and the cumulative survival rate for chemoembolization-treated patients between patients with subtype Ba and genotype C. There was too small a number of CP wild-type to do a similar comparison with CP mutants. In conclusion, there was a significantly higher prevalence of both genotype C and CP mutations in patients with HCC. The association between HBV genotype C and HCC was probably not genuine but was due to the high percentage of CP mutations in patients with genotype C.     

Examination of the change in plasma concentration of OH-flutamide in low-dose flutamide (250 mg/day) monotherapy for prostate cancer patients

An examination of the change in plasma concentration of OH-flutamide in low-dose flutamide (250 mg/day) monotherapy for 5 prostate cancer patients was performed. We treated 5 patients diagnosed with prostate cancer between September and November 2002. The plasma concentrations of OH-flutamide, PSA and AST/ALT were measured before and after low-dose flutamide monotherapy was started. The plasma concentrations of OH-flutamide were stable in the third day after medication was started, and even when compared with the plasma concentrations of OH-flutamide 375 mg/day, there was no significant difference. Although at the observation period was short, PSA fell favorably in all patients. The AST/ALT were in the normal range in all patients. The low-does flutamide therapy has been one of medical treatments if its safety and effectiveness has been demonstrated.     

Cysticercosis/taeniasis in Asia and the Pacific

Three taeniid tapeworms infect humans in Asia and the Pacific: Taenia solim, Taenia saginata, and Taenia asiatica. Although there is continuing debate about the definition of a new species, phylogenetic analyses of these parasites have provided multiple lines of evidence that T. asiatica is an independent species and the sister species of T. saginata. Here we review briefly the morphology, pathology, molecular biology, distribution and control options of taeniasis/cysticercosis in Asia and the Pacific and comment on the potential role which dogs may play in the transmission of T. solium. Special attention is focused on Indonesia: taeniasis caused by T. asiatica in North Sumatra, taeniasis/cysticercosis of T. solium and taeniasis of T. saginata in Bali, and taeniasis/cysticercosis of T. solium in Papua (formerly Irian Jaya). Issues relating to the spread of taeniasis/cysticercosis caused by T. solium in Papua New Guinea are highlighted, since serological evidence suggests that cysticercosis occurs among the local residents. The use of modern techniques for detection of taeniasis in humans and cysticercosis in humans, pigs and dogs, with the possible adoption of new control measures will provide a better understanding of the epidemiology of taeniasis/cysticercosis in Asia and the Pacific and lead to improved control of zoonotic and simultaneously meat-borne disease transmission.