Activation of Complement System by Streptococcal Preparation OK-432 (Picibanil) in Patients with Malignancy

A streptococcal preparation, OK-432 (Picibanil), was administeredto two patients with gastric carcinoma and two with chronicmyelogenous leukemia. All the patients revealed an increasinglevel of serum complements CH50, C4 and C3, as well as FactorB by 40 days of the therapy. Fixation of C4, C3 and Factor Bappeared in the gastric carcinoma tissue and on the leukemiccell surface determined by fluorescent antibody technique, indicatingthat OK-432 might play a role as an immunopotentiator via thecomplement system.     

Rapid dipstick test for diagnosis of urinary tract infection

The rapid dipstick test of urine leukocyte esterase (LE) activity and nitrite has not been studied fully in pediatric clinical situations. We investigated the usefulness of the dipstick LE and nitrite test in the screening of urinary tract infection (UTI) in pediatric patients. Ninety-two fresh urine samples were obtained from children suspected of having UTI. Leukocyte esterase activity and nitrite were measured in the urine specimens read by a photometer. Leukocytes were also counted on a disposable slide. Urine samples were examined for bacteriuria by the standard culture method. The results of the urine dipstick test of LE showed a close relationship with leukocyte counts on a counting chamber. Leukocyte esterase (-) indicated leukocyte counts of less than 10/uL with a probability of 97% (58/60). Of the 22 urine samples with significant bacteriuria diagnosed by standard urine culture, the nitrite test did not detect bacteriuria in 10. While the sensitivities of the dipstick tests of nitrite (+) and LE ± or more for the diagnosis of significant bacteriuria were 55% (12/22) and 86% (19/22), respectively, the sensitivity and negative predictive value of the combined test were 100%. These results suggest that use of the dipstick test of LE and nitrite can avoid a large part of the cost incurred by urine culture and is useful for screening UTI in children.     

Stool decay-accelerating factor as a marker for monitoring the disease activity during leukocyte apheresis therapy in patients with refractory ulcerative colitis

Background and Aims:  We have shown previously that concentrations of stool decay-accelerating factor (DAF; CD55), a complement regulatory protein, in patients with ulcerative colitis (UC) are increased in relation to the severity of the colonic mucosal inflammation. In the present study, we evaluated the usefulness of stool DAF as a marker for monitoring disease activity in patients with steroid-resistant active UC being treated with leukocyte apheresis performed with a centrifugal cell separator.
Methods:  Twenty-one patients with active and steroid-resistant UC were treated with leukocyte apheresis once a week for 4 weeks, and stool DAF concentrations were determined weekly by immunoassay.
Results:  After treatment, 11 (52%) of the 21 UC patients went into remission. Stool DAF concentrations decreased promptly and steadily in the responsive group. The difference reached statistical significance as soon as after the second apheresis session ( P <  0.003), compared with values before the therapy and corresponding values in the non-responsive group ( P =  0.024). The reduction in stool DAF concentrations after the second apheresis session was significantly greater in the responsive group (median 90%, range 22–90%) than in the non-responsive group (median −13%, range −307–94%) ( P =  0.008). Hematological tests, that is, white blood cell (WBC) count and C-reactive protein, declined significantly during the apheresis therapy, but not in relation to therapeutic response.
Conclusion:  Stool DAF concentration is a useful marker in the clinical response of UC patients to treatment with leukocyte apheresis.     

Inappropriate ICD Discharges Due to Noise Oversensing as the First Sign of Repetitive Perforations of the Right Ventricular Lead

Acute lead perforation is one of the major complications associated with implantable cardioverter defibrillator (ICD) implantation. We describe a case with repetitive inappropriate ICD discharges due to noise oversensing as the first sign of lead perforation.     

Update on Extractional Thrombectomy Catheter, AngioJet™

Acute coronary syndromes are associated with intracoronary thrombus, which has been a risk factor for unfavorable outcome after percutaneous transluminal coronary angioplasty (PTCA). The AngioJet (Possis Medical, Inc. Minneapolis, MN, USA) catheter was developed to remove intravascular thrombus by hydrostatic suction without dilatation of the underlying plaque. It prepares the vessel for subsequent safe and uncomplicated intervention, including stenting. In acute total occlusion in acute myocardial infarction, the amount of thrombus, the severity of the underlying stenosis, or the tortuosity of the artery cannot be evaluated accurately, so there is a possibility of failure to pass the AngioJet catheter through the lesion. In spite of these limitations, the AngioJet still could be used successfully to remove thrombus from coronary arteries, and thrombus removal makes subsequent stenting uncomplicated. This successful experience supports a call for a larger scale prospective study of this thrombectomy approach.     

A case of ureteral reflux identified by ultrasound

Reflux nephropathy is known to be a major cause of renal failure in children. Vesico-ureteral reflux is usually diagnosed by voiding cysto-urethrography (VCG). However, it has been observed that conventional VCG is not always reliable for the diagnosis of ureteral reflux. In the case of a 5 year old girl with recurrent febrile urinary tract infection, VCG showed no ureteral reflux. Urodynamic study revealed a large bladder capacity and significant residual urine. Renal scintigram delineated a right renal scar. Simple ultrasound examination with videotape recording during voiding definitely demonstrated the presence of significant ureteral reflux when she voided, that is, there was marked dilatation of the right distal ureter and ballooning of the right renal pelvis on voiding, and quick refilling of the bladder concomitantly with the disappearance of the pelvic ballooning. Therefore, an ultrasound during voiding may be useful for diagnosing ureteral reflux in patients where a VCG does not reveal reflux.     

Retrograde Multiple and Multifiber Accessory Pathway Conduction in the Wolff-Parkinson-White Syndrome:

Retrograde Multiple Accessory Pathway Precipitating AF. Introduction : The determinants of susceptibility to atrial fibrillation (AF) and the existence of accessory pathway conduction have remained unidentified in the Wolff-Parkinson-White (WPW) syndrome. We tested the hypothesis that excitation inputs into the atrium over a retrograde multiple or multifiber accessory pathway during AV reentrant tachycardia (AVRT) could precipitate initiation of AF.
Methods and Results : Two hundred fifty consecutive patients with WPW syndrome underwent electrophysiologic study and radiofrequency catheter ablation. The patients were classified into two groups according to the study results: 29 with retrograde multiple or multifiber accessory pathway (MP) and 221 with retrograde single accessory pathway (SP). Compared with the SP patients, the MP patients showed a significantly higher incidence of clinical AF (MP vs SP: 19/29 vs 51/221, P < 0.01), induced AF (12/29 vs 32/221, P < 0.01), and initiated AF during ventricular pacing and AVRT (10/12 vs 17/32, P < 0.05). There were no differences between the two groups in incidence of clinical and induced AVRT (24/29 vs 200/221 and 25/29 vs 206/221, respectively), mean cycle length of induced AVRT, or electrophysiologic parameters of the accessory pathway. AF inducibility during AVRT or ventricular pacing was eliminated by partial ablation in 7 of 10 patients with MP. After total ablation, the incidence of induced AF was similar between the two groups (MP vs SP: 1/29 vs 11/221).
Conclusion : The existence of a retrograde multiple or multifiber accessory pathway in patients with WPW syndrome is associated with a higher incidence of clinical and induced AF. Successful ablation of the retrograde multiple or multifiber accessory pathway can eliminate the induction of both AVRT and AF.     

Progression of radiological changes in relapsing and chronic pancreatitis

Progression of radiological changes was noted in 19 (22.1%) of 86 cases of relapsing or chronic pancreatitis followed by serial pancreatograms. The initial feature of chronic pancreatitis was focal minimal pancreatitis, characterized by an irregular dilatation of several side branches on the pancreatogram. Some patients with focal minimal pancreatitis demonstrated progression of the extent and severity of changes only in side branches while others progressed further to moderate or advanced chronic pancreatitis showing changes in the main pancreatic duct. Most of the progressive cases were alcoholic, and some showed progression to advanced pancreatitis within 4 years. Rapid progression of radiological changes was associated with relapses of acute pancreatitis. No remarkable changes were observed in many non-alcoholic patients, whereas some cases complicated with gallstones showed progression of disease in the side branches during a follow-up period of 3-7 years.