Successful mitral valve repair for active infective endocarditis accompanied by anorexia nervosa

Infective endocarditis of the mitral area accompanied by anorexia nervosa is extremely rare. A 34-year-old Japanese woman presented with high fever and a heart murmur that had developed over the previous 2-month period. Echocardiography revealed mitral regurgitation and vegetation attached to the anterior mitral leaflet, which had markedly prolapsed to the left atrium. We removed the vegetation with a small part of the anterior mitral leaflet and successfully repaired the mitral valve. The patient showed good recovery, and the mitral regurgitation and left ventricular chamber size had satisfactorily decreased at 2 months after the operation.     

Optimum dosage of pergolide in patients with Parkinson's disease]

For the purpose of determining the optimal dose, pergolide was administered to patients with Parkinson's disease using a dose-escalation protocol up to the maximum dosage permissible in Japan. The study was completed in 16 subjects with Parkinson's disease. Prior to the start of the dose-escalation study, the daily dose of pergolide was 500 microg in 6 patients and 750 microg in 10 patients. The daily dose was raised by 250 microg at 4-week intervals up to the approved maximum dose of 1,250 microg/day, which was used as the final level. Just before the start of study and after administration for 4 weeks at each dose level, UPDRS-III and PDQ-39 assessments were performed. The mean UPDRS-III score was 28.6 +/- 7.9 before the start of the study and 17.3 +/- 8.3 after the end, indicating an improvement (improvement rate, 39.3%; p < 0.01). The mean PDQ-39 score was 45.2 +/- 21.8 before the start and 37.3 +/- 17.8 after the end, indicating an improvement (improvement rate, 17.5%; p < 0.05). Clinical conditions including their QOL improved significantly after dose-escalation up to the 1,250 microg.     

Surgical treatment for carcinoma of the papilla of vater

Eighty of 89 patients who underwent radical resection (resectability 89.9%) for carcinoma of the papilla of Vater between 1976 and 1992 were retrospectively reviewed. Seventy-three patients underwent pancreaticoduodenectomy (PD) and 7 underwent pylorus-preserving pancreaticoduodenectomy (PPPD). The postoperative mortality rate was only 3.8% (3 patients). The 3- and 5-year survival rates were 63.6% and 57.4%, respectively. Important factors influencing long-term survival were Stage (clinical stage = Stage), microscopic lymph node metastasis (n), duodenal wall invasion (d), vascular invasion (v), and the epithelium of origin. Early carcinoma of the papilla of Vater is defined as tumor in which invasion is limited within the papilla of Vater; in particular, carcinomatous invasion is within the muscle of Oddi (d₀) with n₀. PD and/or PPPD with radical lymph node dissection should be performed for carcinoma of the papilla of Vater, as these procedures can be performed with low morbidity and mortality.     

Bacterial superantigen enhances cytokine production by T-helper lymphocyte subset-2 cells and modifies glomerular lesions in experimental immunoglobulin a nephropathy

Background The purpose of this study was to examine the effects of bacterial suporantigens, which can derange the immune response and contribute to the renal lesions of immunoglobulin A (lgA) nephropathy. Methods Twenty-five micrograms of a bacterial superantigen, staphylococcal enterotoxin B (SEB), was injected into IgA nephropathy-prone ddY mice intrathymically when they reached 6 weeks of age. Evaluation included measurement of albumin excretion in urine, immunoglobulin concentration, and lymphokine production in vitro, as well as analysis of T-cell receptor expression in splenic T-cell subsets and examination of renal histology by light and fluorescence microscopy. Results At 40 weeks of age, the serum level of IgA in these mice was substantially increased and the number of Vβ8⁺ CD4⁺splenic T-cells was significantly decreased compared with measurements in untreated controls. Both control and SEB-treated mice excreted less than 30 μg/mL of urinary albumin. In mice given SEB, the amount of interleukin 2 (IL-2) and tumor necrosis factor-α (T helper 1 [Th1]-type cytokines) produced by the in vitro-stimulated lymphocytes significantly decreased. whereas that of interleukin 4 (IL-4) and interleukin 6 (IL-6) (Th2-type cytokines) markedly increased compared with measurements in control mice. At 40 weeks of age, mice given SEB showed marked glomerular hypercellularity and enhanced glomerular C3 deposition by renal histology, compared with control mice. Conclusion These results suggest that bacterial superantigen SEB may modify glomerular lesions through activating Th2 cells, while inducing deletion of Th1 cells in this experimental model.     

The antiviral drug amantadine has a direct inhibitory effect on T-lymphocytes

We investigated the effect of the antiviral drug amantadine (AmTd) on polyclonal activation of thymic-dependent (T) and thymic-independent (B) lymphocytes from normal mice. In the present studies, T-lymphocytes are defined by their response to concanavalin A (Con A) and B-lymphocytes by their response to lipopolysaccharide (LPS). Polyclonal activator-induced lymphocyte proliferation was assessed by quantifying cellular incorporation of tritiated thymidine. The results show that, in a dose-dependent manner, AmTd exhibits at least 2-fold greater inhibitory activity against Con A-responding T-cells than against LPS-responding B-cells. Further, several findings demonstrate that AmTd has a direct inhibitory effect on T-lymphocytes. First, AmTd pulse treatment of isolated T-cells, but not accessory cells, abolished the T-cell response to Con A. Second, AmTd pulse treatment of the cytotoxic T-lymphocyte line, CTLL-2, markedly reduced their ability to undergo IL-2-induced proliferation. Third, proliferation of T-cells which had already undergone activation by ConA was inhibited by AmTd. Further, the finding that addition of IL-1, IL-2 or both to cultures failed to reverse inhibition of the response to ConA argues that AmTd did not interfere with endogenous production of these lymphokines. Possible implications of these findings are discussed.     

Primary Adenocarcinoma in the Urethrorectal Fistula

A 60-year-old Japanese man was hospitalized because of urinary leakage from the anus on October 3, 1994. Retrograde urethrography detected a fistula between the bulbous urethra and the rectum. Urethrocystoscopy revealed a tumor on the urethrorectal fistula. Tumor biopsy showed a well differentiated adenocarcinoma. Cystourethrectomy with fistulectomy, and ileal conduit urinary diversion were performed. Pathological examination revealed primary adenocarcinoma in the fistula with invasion to the prostatic urethra and bladder wall. The patient showed no evidence of a recurrence as of August, 1996.