Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification

A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. Legionella pneumophila serogroup 6 was recovered from an intratrachial specimen and a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose prednisolone to treat organizing pneumonia shown by transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. When the extracted DNA of these two strains showed identical restriction fragments by pulsed-field gel electrophoresis, we had direct evidence that hot spring spas can be a source of Legionella pneumonia.     

Rapid regrowth of solitary subependymal giant cell astrocytoma--case report

A 48-year-old female presented with a subependymal giant cell astrocytoma (SEGA) without tuberous sclerosis manifesting as memory and mental disturbance. Magnetic resonance imaging showed a huge mass which was well-demarcated and extended from the anterior horn of the right lateral ventricle to the septal area on the right side. Surgery was performed with partial removal of the tumor. The histological diagnosis was typical SEGA. One year postoperatively, follow-up magnetic resonance imaging revealed marked regrowth of the tumor. Total resection of the tumor was performed. Microscopic and immunohistochemical studies could not identify the cause of the rapid regrowth. SEGA can regrow rapidly after partial removal of the tumor.     

Unique minithoracotomy assisted by videothoracoscopy facilitates a maximal view even with a minimal wound for resection of primary lung cancer

Resection for primary lung cancer with an unique minithoracotomy and use of videothoracoscopy is described. Through an incision of approximately 10 cm at an ausculatory triangle, the 5th intercostal thoracotomy is done following dissection of muscles. At the anterior and posterior portion of the 6th rib, the 6th intercostal vessels and nerve were dissected and the rib was resected. This approach makes feasible opening of a thoracic window without injury to the nerve and removal of the rib. Thoracoscopy is introduced through a midaxillary wound of 2 cm. We report nine patients in whom we achieved resection for primary lung cancer by using this approach. This technique facilitates a standard operation for lung cancer and an almost painless postoperative state.     

A successful resection and long-term survival of a patient with intrahepatic recurrences of combined hepatocellular-cholangiocarcinoma: report of a case

Because of the low incidence rate of combined hepatocellular–cholangiocarcinoma (combined HCC-CC), the clinicopathological features of a recurrent tumor of this disease remain to be elucidated. We describe a 47-year-old Japanese woman with a 5-cm diameter mass lesion in the liver. A hepatectomy and dissection of the local lymph nodes were performed and a histological examination of the resected specimen showed combined HCC-CC. After a follow-up of 15 months, intrahepatic recurrence was observed, and a hepatectomy was performed again followed by hepatic arterial infusion chemotherapy. A histological examination revealed that the recurrent tumors consisted of only cholangioacarcinoma. A disease-free survival was obtained for about 7 years after the recurrence. To improve the poor prognosis of combined HCC-CC, clinicopathological features of this disease and the therapy selection for recurrent tumors should be discussed. Received: March 12, 2001 / Accepted: November 20, 2001     

High metabolic function of primary human and porcine hepatocytes in a polyurethane foam/spheroid culture system in plasma from patients with fulminant hepatic failure

It has been demonstrated that plasma from patients with fulminant hepatic failure (FHF) interferes extensively with cellular function. We placed primary human and primary porcine hepatocytes in a polyurethane foam (PUF)/spheroid culture system and compared the metabolic functions in the plasma of patients with FHF in a 24-h stationary culture to those in a monolayer culture. The PUF/spheroid culture system using primary human and primary porcine hepatocytes significantly decreased ammonia content during 28-day culture. Fisher's ratio significantly increased at culture days 3 and 7. Tauroursodeoxycholic acid significantly increased and glycochenodeoxycholic acid and taurochenodeoxycholic acid decreased in the FHF patients' plasma at culture day 3. During at least a 24-h culture in the FHF patients' plasma, metabolic functions of primary human and primary porcine hepatocytes were almost identical. The present results indicate that the PUF/spheroid culture system using primary human or primary porcine hepatocytes demonstrated more advantageous metabolic functions in the plasma from patients with FHF than the monolayer culture.     

Effect of oestrone on membrane fluidity of erythrocytes is mediated by a nitric oxide-dependent pathway: An electron paramagnetic resonance study

1. It has been recognized that hormone replacement therapy (HRT) may have a beneficial effect on protection against cardiovascular diseases. Oestrone is the major component of conjugated equiline oestrogens, which are commonly used in HRT. The present study was performed in order to investigate the effects of oestrone on the membrane fluidity of erythrocytes by means of an electron paramagnetic resonance (EPR) and spin-labelling method. 2. In an in vitro study, oestrone significantly decreased the order parameter (S) for 5-nitroxide stearate (5-NS) and the peak height ratio (ho/h-1) for 16-nitroxide stearate (16-NS) obtained from EPR spectra of erythrocyte membranes. This finding indicated that oestrone may increase the membrane fluidity and improve the membrane microviscosity of erythrocytes. 3. The effect of oestrone was significantly potentiated by the nitric oxide (NO) donor s-nitroso-N-acetylpenicillamine and the cGMP analogue 8-bromo-cGMP. 4. In contrast, the change in membrane fluidity induced by oestrone was antagonized by the NO synthase inhibitors NG-nitro-l-arginine methyl ester and asymmetric dimethyl-l-arginine. 5. The results of the present study show that oestrone significantly increases membrane fluidity and improves the rigidity of cell membranes, which is partially mediated by a NO- and cGMP-dependent pathway. Furthermore, the data may be consistent with the hypothesis that oestrone could have a beneficial effect on the rheological behaviour of erythrocytes and have a crucial role in the regulation of the microcirculation.     

Detection of oxidant-induced slight chromosomal damage in cells by subsequent exposure to X-rays

We examined whether slight oxidative stress and/or damage in cells could be amplified by subsequent ionizing irradiation and thus become detectable as obvious chromosomal damage. WIL2-NS cells, a human B lymphoblastoid cell line, were pretreated with an oxidant and then exposed to X-rays at 0.25 or 0.5 Gy. The chromosomal damage in the cells was evaluated by cytokinesis-block micronucleus (CBMN) assay. Pretreatment with a superoxide-generating system (hypoxanthine (HX)/xanthine oxidase (XO), 1 and 2 mU/ml of XO), tert-butyl hydroperoxide (t-BuOOH, 10 and 100 microM) or H2O2 (5 microM) alone did not induce significant chromosomal damage, but the oxidant-induced damage increased significantly with subsequent irradiation. The tested dose of these oxidants did not induce significant changes in cell viability, the nuclear division index, and the concentration of antioxidants, indicating that only weak oxidative stress was introduced into the cells. These results suggest that low-dose oxidant-induced chromosomal damage becomes detectable as obvious chromosomal damage with subsequent ionizing irradiation in vitro.     

Dose-dependent effect of dietary conjugated linoleic acid on the growth of rat hepatoma dRLh-84 cells in vivo

In this study, the effect of varying doses of conjugated linoleic acid (CLA) on the growth of transplanted hepatoma dRLh-84 cells and the relationship between tumor growth and prostaglandin (PG) E2 production or cyclooxygenase (COX)-2 expression were examined. Donryu rats were fed an experimental diet containing 0, 0.1, 0.5, or 2 wt.% CLA for 3 wk, and then dRLh-84 cells were transplanted into the liver. Results show that dietary CLA (0.5 and 2 wt.%) significantly enhanced the growth of the transplanted hepatoma cells compared to the non-CLA diet group at 20 d after cell transplantation. Tumor weight at 10 d after transplantation was also significantly higher in the 2 wt.% CLA group than in non-CLA fed rats. Ten days after transplantation, the PGE2 level in the tumor tissue was shown to be depressed in a CLA dose-dependent manner. Cyclooxygenase-2 (COX-2) mRNA expression in the tumor also tended to be lower in the CLA group than in the non-CLA diet group 10 d after transplantation. Dietary CLA did not affect the tumor phospholipid arachidonic acid level, which is a substrate for PG synthesis. These results indicate that dietary CLA of at least 0.5 wt.% enhances the growth of transplanted dRLh-84 cells in vivo. It is believed that growth promotion of dRLh-84 cells in vivo by CLA cannot be clarified by the PG synthesis dependent mechanism.