BK virus subtype 1 infection associated with tubulointerstitial nephritis in a renal allograft recipient

The BK polyomavirus (BKV) infects most of the human population, but clinically relevant infections are usually limited to individuals who are in an immunosuppressed state. The significance of BKV infection was investigated in a 50-year-old man who underwent cadaveric kidney transplantation and was treated with tacrolimus, mycophenolate mofetil and prednisolone. By staining renal biopsy specimens with a monoclonal antibody against BK large T antigen, we were able to observe the relationship between the appearance of the BKV antigen and the extent of immunosuppression in this patient. We also determined that BKV belonged to genotype I by analysis of viral DNA from the patient's urine.     

Large cell carcinoma of the lung metastatic to nuchal muscle

Abstract Clinically apparent hematogenous skeletal muscle metastases from lung cancer are extremely rare. We present a 72-year-old man with a large cell lung carcinoma metastatic to nuchal muscle. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a well-defined mass in the left splenius capitis muscle. A percutaneous needle biopsy was performed to establish a diagnosis. Localized skeletal muscle swelling may rarely prove to be metastases in patients with lung cancer, but should be investigated in the case of muscle swelling.     

Immunopathogenesis of type C hepatitis: dendritic cell in HCV infection

Abstract   Dendritic cells (DCs) are professional antigen-presenting cells that enhance and regulate both innate and acquired immune reactions. It has been reported that several viruses actively down regulate DC function to escape from host immune system. To clarify the involvement of DC in anti-hepatitis C virus (HCV) immune reactions, we compared DC function between chronic hepatitis C patients and healthy donors. Monocyte-derived DCs generated from patients were relatively immature and were impaired in allostimulatory capacity and IL-12 p70 production when compared to that from donors. In addition, MDC and PDC in HCV-infected patients were reduced in number and impaired in their ability to promote Th1 polarization. These results demonstrate that DCs are numerically and functionally impaired in HCV-infected patients, which is critically involved in the pathogenesis and persistence of HCV infection.     

Circulating soluble selectins in Kawasaki disease

To investigate the significance of circulating adhesion molecules associated with leucocyte–endothelial cell interaction in Kawasaki disease (KD), serum levels of soluble E-, P-, L-selectin (sE-, sP-, sL-selectin), and vascular cell adhesion molecule-1 (VCAM-1) were measured in 16 patients with KD, eight with other febrile diseases, six with Henoch–Schönlein purpura (HSP), and 10 healthy children using an ELISA. Serum sE-selectin levels from patients in the acute phase of KD were significantly higher than from those in other groups (P<0.01). The levels of sP-selectin in the subacute phase of KD were significantly higher than in other groups (P<0.01). Serum sL-selectin levels tended to rise in the convalescent phase of KD. There were also significant correlations between sE-selectin levels and C-reactive protein (r=0.80, P<0.0001), and between sP-selectin levels and platelet counts (r=0.57, P<0.0001) in KD patients. These data indicate that circulating soluble forms of three selectins may have different kinetics during the clinical course of KD, suggesting that they may reflect its inflammatory process.     

Sarcomatoid renal cell carcinoma with a chromophobe component producing beta-human chorionic gonadotropin

We report a case of sarcomatoid renal cell carcinoma with a chromophobe component showing significant elevation of beta-human chorionic gonadotropin (beta-HCG) in the peripheral blood. A 35-year-old man was hospitalized because of a large tumor of the left kidney and elevated serum levels of beta-HCG. Extended nephrectomy was performed, after which the serum beta-HCG level decreased. However, 3 months later, masses were discovered in the left renal bed and in the lung in association with elevated serum levels of beta-HCG. The patient was rehospitalized and received combination therapy with interferon-alpha and doxorubicin-based multiple chemotherapy (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). The recurrent mass responded extremely well to treatment, and beta-HCG normalized. However, the patient died 14 months after nephrectomy because of eventual resistance to chemotherapy. Sarcomatoid renal cell carcinoma containing beta-HCG positive cells were pathologically diagnosed with immunohistochemical staining in the left kidney. Sarcomatoid renal cell carcinoma is a variant of renal adenocarcinoma which has a poor prognosis. This patient had an extremely rare sarcomatoid renal cell carcinoma associated with serum levels of beta-HCG which were elevated and strongly correlated with morphologic cancer activity. beta-HCG might be a useful serum marker for detecting and monitoring this renal cell carcinoma.     

Videomanometry of the pelvic organs: A comparison of the normal lower urinary and gastrointestinal tracts

BACKGROUND: Both the lower urinary tract (LUT) and the caudal part of the lower gastrointestinal tract (LGIT) are innervated by the sacral spinal cord. We aimed to compare the normal physiology of the LUT and LGIT using the same videomanometry method. METHODS: We recruited fifteen healthy volunteers (eight men and seven women; mean age, 60 years). The videomanometric measures included fluoroscopic images, subtracted bladder/rectal pressures, urethral/anal sphincter pressures, sphincter electromyography, and urinary/fecal flow. RESULTS: During the resting phase, the urethral/anal sphincter pressures showed almost the same values (mean, 70 cmH2O and 68 cmH2O, respectively). During the storage phase, the volumes at first sensation and maximum capacity for the LGIT (129 mL and 320 mL) were slightly smaller than those for the LUT (170 mL and 405 mL). Compliance of the LGIT (65 mL/cmH2O) was almost as high as that of the LUT (99 mL/cmH2O). However, the LGIT showed spontaneous phasic rectal contractions (SPRC) that were never seen in the bladder. None of the subjects experienced leakage during bladder/rectal filling. During the evacuation phase, rectal contraction on defecation (14 cmH2O) was present, but was weaker than bladder contraction on micturition (42 cmH2O; P < 0.01). Abdominal strain on defecation (70 cmH2O) was greater than that on micturition (25 cmH2O; P < 0.01). Sphincter pressure increase on defecation (13 cmH2O) was greater than that on micturition (-52 cmH2O). An illustrative case of SPRC that were seen during urodynamic recording was shown. CONCLUSION: SPRC and abdominal strain are features of the LGIT, whereas micturition bladder contraction is a feature of the LUT. These features can aid in understanding the possible rectal 'artifacts' of videourodynamics and neurogenic pelvic organ dysfunction.     

Chemical synthesis of dendrotoxin-I: revision of the reported structure

Dendrotoxin I (DTX-I) is a 60-residue peptide from the venom of the black mamba snake Dendroaspis polylepis, which binds to neuronal K⁺ channels. The structure reported previously for DTX-I was synthesized for the first time by a solution procedure. The synthetic product was confirmed to have the correct primary and disulfide structure determined by peptide mapping, sequence analysis and mass measurements. Comparison of synthetic DTX-I with the natural one by high-performance liquid chromatography and capillary zone electrophoresis, as well as by sequence analysis, revealed that the Asn residue at position 12 in the synthetic peptide was Asp in the natural product. Synthesis of DTX-I with Asp at position 12 gave a peptide identical with the natural product in all aspects. NMR analysis of synthetic [Asn¹²]. - and [Asp¹²]. -DTX-I also supported our findings that the Asn residue at position 12 in the DTX-I molecule should be revised as Asp. [Asn¹²]. - and [Asp¹²]. -DTX-I had very similar binding affinities when tested against radiolabeled dendrotoxin binding to rat brain synaptosomal membranes. © Munksgaard 1998.     

The Influence of Endoscopic Injection Sclerotherapy on Organs Surrounding the Esophagus

Abstract: Endoscopic injection sclerotherapy (EIS) is widely accepted as a means of treating esophageal varices. However, various complications of EIS have been reported. To investigate the cause of chest complications after EIS, chest CT and bronchofiberscopy (BF) were carried out in patients undergoing EIS. A contrast medium was added to the sclerosant in a 1: 4 ratio, and a chest CT examination was performed 30 minutes after the EIS procedure. BF was performed before and after EIS. CT findings were classified into four types, i. e., Type I : ring-enhanced esophageal wall, Type II : ring-enhanced paraesophageal wall, Type III : locally enhanced esophageal wall, and Type IV : beltlikeenhanced parietal pleura. The CT findings depended on the frequency of EIS rather than the total volume of sclerosant. After injection into the Paravariceal wall, the sclerosant unexpectedly moved beyond the local injection site during the first or second EIS procedures. During the third or subsequent procedures the sclerosant tended to abide locally in the esophageal wall. Before EIS, bronchial venous dilatation, present mainly in the left main bronchus, was noted and its degree was correlated with the form and location of the esophageal varices. Bronchial venous dilatation decreased in three patients after EIS. The change in venous dilatation seemed to reflect alterations in the esophageal variceal blood flow. After EIS bronchial ulceration was found in the main bronchus in 3 patients. This phenomenon was attributed to both the direct effects of the sclerosant and the physical effects of the endoscopic examination itself_: Minor complications such as pleural effusion, chest pain, and fever were not associated with either CT or BF findings. Patients undergoing EIS should be carefully monitored to facilitate the early detection and management of potential chest complications.     

The Transport Mechanism of an Organic Cation,Disopyramide, by Brush-border Membranes. Comparison Between Renal Cortex and Small Intestine of the Rat

Abstract— The characteristics of disopyramide uptake in brush-border membrane vesicles isolated from rat renal cortex and small intestine were investigated. Transport of disopyramide into an osmotically reactive intravesicular space was observed with notable binding to the membrane surface. An outwardly directed H⁺ gradient stimulated disopyramide uptake, resulting in a transient uphill transport in both brush-border membranes. As for the renal brush-border membrane, the H⁺ gradient itself appeared to be the driving force for this stimulation of uptake. These findings suggest that disopyramide-H⁺ antiport is the mechanism of disopyramide action in renal cell membrane. The initial uptake was saturable (K_m and V_max of 680 μm and 1·25 nmol (mg protein)^?1/30 s, respectively). The stimulation of disopyramide uptake by an outward H⁺ gradient in rat intestinal brush-border membrane was due to an interior negative H⁺-diffusion potential. A K⁺-diffusion potential (interior negative) enhanced disopyramide uptake. These results suggest that there are different mechanisms of disopyramide uptake for renal and intestinal brush-border membrane vesicles.