Two cases of methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> keratitis after Epi-LASIK

Background  We describe two severe cases of methicillin-resistant Staphylococcus aureus (MRSA) keratitis following Epi-LASIK surgery. Cases  One patient was a 23-year-old man who underwent Epi-LASIK surgery in both eyes. He developed an infectious corneal ulcer in one eye 2 days after surgery and was referred to us 7 days post-surgery with corneal perforation, for which we performed therapeutic penetrating keratoplasty. The other patient was a 32-year-old man who developed infectious keratitis in one eye 4 days after bilateral Epi-LASIK and was referred to us 2 days later. Observations  Microbial testing revealed MRSA infection as the cause of the keratitis in both patients which was successfully treated with vancomycin eyedrops. Conclusion  Infectious keratitis after refractive surgery is uncommon; it is important to diagnose this condition, identify the causative agent, and initiate treatment with appropriate antibiotics as soon as possible.     

Establishment of an ovarian metastasis model and possible involvement of E‐cadherin down‐regulation in the metastasis

Clinical observations of cases of ovarian metastasis suggest that there may be a unique mechanism underlying ovarian‐specific metastasis. This study was undertaken to establish an in vivo model of metastasis to the ovary, and to investigate the mechanism of ovarian‐specific metastasis. We examined the capacity for ovarian metastasis in eight different human carcinoma cell lines by implantation in female NOD/SCID mice transvenously and intraperitoneally. By transvenous inoculation, only RERF‐LC‐AI, a poorly differentiated carcinoma cell line, frequently demonstrated ovarian metastasis. By intraperitoneal inoculation, four of the eight cell lines (HGC27, MKN‐45, KATO‐III, and RERF‐LC‐AI) metastasized to the ovary. We compared E‐cadherin expression among ovarian metastatic cell lines and others. All of these four ovarian metastatic cell lines and HSKTC, a Krukenberg tumor cell line, showed E‐cadherin down‐regulation and others did not. E‐cadherin was then forcibly expressed in RERF‐LC‐AI, and inhibited ovarian metastasis completely. The capacity for metastasizing to the other organs was not affected by E‐cadherin expression. We also performed histological investigation of clinical ovarian‐metastatic tumor cases. About half of all ovarian‐metastatic tumor cases showed loss or reduction of E‐cadherin expression. These data suggest that E‐cadherin down‐regulation may be involved in ovarian‐specific metastasis. (Cancer Sci 2008; 99: 1933–1939)     

Combination chemotherapy with cisplatin and irinotecan in patients with adenocarcinoma of the small intestine

Background  Small-bowel adenocarcinoma (SBA) is a rare tumor that has a poor response to chemotherapy and a poor prognosis. Treatment strategies for SBA have not been clearly established. Methods  All patients with SBA treated using a combination of cisplatin and irinotecan (IP) as first-line chemotherapy at the National Cancer Center Hospital in Japan between January 1999 and February 2007 were studied retrospectively. Results  Eight patients received IP as first-line chemotherapy. The median follow-up was 9.5 months (range, 4.2–37.5 months). The median number of cycles of IP was three (range, 1–5). The overall response rate (complete or partial response) was 12.5% (complete response, n = 0; partial response, n = 1). The disease control rate (complete or partial response or stable disease) was 75%. The median time to treatment failure was 4.5 months (95% confidence interval, 0.9–5.8 months), and overall survival was 17.3 months (range, 1.9–21.3 months). The most common adverse events were neutropenia and anorexia. Conclusion  IP combination chemotherapy may be an acceptable option for patients with SBA. Further studies are warranted to determine the optimal chemotherapeutic regimen for SBA.     

Gonadotropin-releasing hormone agonists induce meiotic maturation and degeneration of oocytes in the in vitro perfused rabbit ovary

The present study was undertaken to assess the effects of gonadotropin-releasing hormone agonists (GnRH-a, buserelin and leuprolide acetate [LA]) on ovulation, oocyte maturation and degeneration, and steroid and prostaglandin production in the perfused rabbit ovary preparation. Ovulation did not occur in any of ovaries treated with buserelin or LA (10(2) to 10(4) ng/mL) in the absence of gonadotropin. Gonadotropin-releasing hormone agonists were associated with the resumption of meiosis in follicular oocytes in a dose-related manner. Furthermore, the addition of GnRH-a to the perfusate significantly increased the percentage of follicular oocytes that showed evidence of degeneration compared with contralateral untreated or human chorionic gonadotropin-treated controls. Prostaglandin E2 and prostaglandin F2 alpha production by the perfused rabbit ovaries were stimulated significantly by GnRH-a treatment. Exposure to GnRH-a failed to increase either progesterone or estradiol production by the perfused rabbit ovaries. These data demonstrate that GnRH-a act directly in the rabbit ovary to trigger meiotic maturation in oocytes within the follicles, concomitantly increasing oocyte degeneration.     

Bacteriological investigation of the pre- and postoperative transition of the pharyngeal flora in the patients received tonsillectomy

Several investigations have been reported on the interactive relation between the normal flora and the pathogenic micro-organisms in the human upper respiratory tracts (Thompson, Sanders, etc). It has also been known that some alpha-streptococci have inhibitory effect on the growth of group A beta-hemolytic streptococci. A study upon the role of alpha-streptococci in the throat (tonsil and pharynx) was performed using 73 culture specimens (throat swabs) obtained from 42 patients. Forty-four specimens were taken from the patients who received tonsillectomy, pre- and postoperatively, and 29 were from the patients who did not receive the operation. In the group of patients who received tonsillectomy, alpha-streptococci with inhibitory effect on the growth of group A beta-streptococci were detected less frequently preoperatively, when compared with the patients without tonsillectomy. On the other hand, postoperatively, marked increase of alpha-streptococci of these types was found in the normal flora of the throat. However, further detailed study on this subject is necessary because of the exceptional results in our observations.     

Dose response of thyrotropin-releasing hormone on pulmonary maturation in corticosteroid-treated preterm rabbits

The dose-response effect of thyrotropin-releasing hormone in enhancing pulmonary maturation was investigated with six dosing regimens. Pregnant does received thyrotropin-releasing hormone (5, 10, or 50 micrograms/kg every 12 hours for four doses or one dose of 20 micrograms/kg) in conjunction with betamethasone beginning on day 25 of gestation, with betamethasone alone or saline solution used as comparison treatment groups. Half of the newborn rabbits received supplemental surfactant therapy after delivery on day 27, and all were ventilated on a ventilator plethysmography system for 30 minutes. There were no differences among the four thyrotropin-releasing hormone doses in surfactant pool sizes, compliances, or proteins leak into or out of the air spaces. The groups that received multiple doses of thyrotropin-releasing hormone had significantly higher perinatal loss rates than the single-dose group. The lungs of the group treated with thyrotropin-releasing hormone plus steroid and the rabbits treated only with steroid were more compliant than the controls without surfactant therapy, and showed significant improvements in protein leak. The addition of thyrotropin-releasing hormone to betamethasone improved several of the protein leak measurements compared with use of betamethasone alone. These results question the necessity of multiple doses of thyrotropin-releasing hormone to induce pulmonary maturation, especially when the higher perinatal mortality and the theoretical long-term effects of fetal hyperthyroidism on thyroid axis function are considered.     

Attitudes toward Tuberculosis in Vietnamese Immigrants

OBJECTIVES: To explore Vietnamese immigrants' knowledge, attitudes, beliefs, and practices concerning tuberculosis (TB). METHODS: Three focus groups were conducted at community health centers in California as part of a nationwide research project on attitudes toward TB in Asians and Pacific Islanders. Vietnamese health workers mediated group discussions by asking 11 openended questions on the causes of TB, medical consequences of TB, TB treatment, and the impact of the disease on social relationships. The results of these groups were reviewed by a panel of Vietnamese health workers in Hawaii. RESULTS: The focus group participants attributed TB to malnutrition, stress, smoking, alcohol consumption, and hard labor. They expressed a belief in the extreme contagiousness of TB, that it can be spread through eating utensils or towels. Lung diseases and other organ complications were cited to be the chief problems of TB. The participants expressed belief that the use of Western medicine is more effective in treating TB than other form of treatment such as acupuncture or herbal medicines. A consequence of the extreme contagiousness of TB is social isolation, leading to mental anguish. CONCLUSIONS: An understanding of shared attitudes toward TB in Vietnamese may contribute to the treatment of patients with TB. Community education to rectify some common misconceptions may be of utility.     

Meningo-encephalitis associated with HHV-6 related exanthem subitum

We report a 10-month-old boy with acute meningo-encephalitis associated with exanthem subitum. It has recently been reported that human herpesvirus-6 is the causative agent of exanthem subitum, and to our knowledge our case is the first report of meningo-encephalitis associated with HHV-6 infection.