A girl having congenital chloride diarrhea treated with spironolactone for seven years

We report on a girl having congenital chloride diarrhea (CCD) who has been followed for 7 years and 6 months sequentially. Dilated intestinal loops, marked enlargement of the abdominal circumference of the fetus and hydramnios were noted by ultrasound examination at 31 weeks of gestation. After delivery by cesarean section for hydramnios, she excreted profuse watery yellow green stools with marked abdominal distension. At 4 months of age, hypochloremia, hyponatremia and a high concentration of chloride in the stool were identified. She was diagnosed as having CCD. Because it was difficult to administer a large volume of potassium chloride (KCl), and sodium chloride (NaCl), we decided to administer spironolactone. After administration of spironolactone, we could generate correct serum electrolytes using less amounts of KCl. At 7 years and 6 months of age, her body size was within normal limits and her intellectual, mental and physical development had been normal. In spite of normal serum electrolytes, blood pH and the presence of chloriduria, secondary hyperaldosteronism was noted. We consider that spironolactone may be useful to decrease the amount of KCl administration in the neonatal period, but frequent measurements of renin, angiotensin and aldosterone would be necessary for adequate control in CCD cases.     

Oil-Depot Type Bleomycin in the Treatment of Malignant Lymphoma in Comparison with Regular Bleomycin

Oil-depot type bleomycin was originally intended to take advantageof not only concentration-dependent action, but also the time-dependentaction of bleomycin to obtain more efficient tumor cell kill.In this study, the effects of oil-depot type bleomycin and regularbleomycin on 81 patients with malignant lymphoma were compared.Both oil-depot type bleomycin and regular bleomycin were equallyeffective against Hodgkin's disease, with a complete remissionrate of 60% (6/10) and 54.5% (6/11), respectively. Non-Hodgkin's lymphoma in advanced stages responded better tooil-depot type bleomycin [complete remission (CR); 35.2% (6/17)]than to regular bleomycin [CR: 10.5% (2/19)]. In addition, thepatients were more responsive to smaller doses of oil-depottype bleomycin than regular bleomycin. Eleven out of 12 (91.6%)patients who responded to oil-depot type bleomycin, went intocomplete remission before receiving 45 mg in total dosage ofbleomycin, while five out of 10 (50%) patients who respondedto regular bleomycin reached complete remission after 60 mgin total dosage was administered. The toxic manifestations of oil-depot type bleomycin were almostthe same in quality and quantity as regular bleomycin. However,the average total dose of oil-depot type bleomycin used wasalmost half of that of regular bleomycin. ^* Present address: Cancer Chemotherapy Center, Cancer ResearchInstitute, Tokyo, Japan. ^** Present address: National Nagoya Hospital, Nagoya, Japan.     

Prognostic Factors and Therapeutic Results in Multiple Myeloma

Prognostic factors in 68 consecutive patients with myeloma treatedat the National Cancer Center Hospital from 1962 to 1984 wereanalyzed. Median survival time from onset was 100 months forstage I, 72 months for stage II, and 26 months for stage IIIof the Durie and Salmon's clinical staging system. It was 55months in patients with normal renal function and 18 monthsin those with abnormal renal function. All early deaths occurredin patients with stage III disease. Hemoglobin level, bone lyticlegions and presence of Bence Jones protein were also significantprognostic factors. On the other hand, heavy chain as well aslight chain subtypes of monoclonal immunoglobulin (M-component)and M-component production rate did not influence the survivalof myeloma patients. The analysis of chemotherapeutic responsesand survival curves according to the chemotherapy used in thisstudy (alkylating agent vs Vinca-alkaloid plus alkylating agent)did not disclose any significant difference between the twogroups. The overall response rate was 67%. The survival timefrom the initial chemotherapy of responding patients was significantlylonger than that of nonresponders.     

Small Cell Lung Carcinoma with Ectopic Adrenocorticotropic Hormone and Antidiuretic Hormone Syndromes: A Case Report

This report describes a 63-yr-old man with lung cancer accompanyinghypertension, hyperpigmentation, muscle weakness, psychosis,hypokalemia, hyperglycemia, hyponatremia, massive naturesisand lower serum osmolality than urine osmolality. Elevated levelsof plasma and urine corticosteroids and of plasma immunoreactiveadrenocorticotropic hormone (ACTH) were not altered by the administrationof large amounts of dexamethasone. Elevated plasma antidiuretichormone (ADH) values were also demonstrated. Postmortem examinationsrevealed small cell lung carcinoma with extensive metastasis,bilateral adrenocortical hyperplasia and Crooke's degenerationof the pituitary gland. Immunoradiological and immunohistochemicalstudies demonstrated the presence of immunoreactive ACTH, ADHand gastrin-releasing peptide in the tumor tissue. Beta-melanocyte-stimulatinghormone, calcitonin and carcinoembryonic antigen were also detectedby one of the methods. Hence, this is a rare case of lung cancerwith multiple hormone production and clinical and laboratoryevidence of both the ectopic ACTH and ADH syndromes. ^* Present address: Department of Internal Medicine, Keio UniversitySchool of Medicine, Tokyo, Japan     

CD21非依赖性EB病毒对人胃印戒细胞癌细胞系的感染

目的　探讨CD2 1非依赖性EB病毒 (EBV)对人胃印戒细胞癌细胞系 (HSC 39)的感染作用。方法　用Akata和P3HR 1EBV毒株感染HSC 39,有限稀释法对感染细胞进行克隆。结果　两种EBV毒株感染细胞中均可检测到EBV编码的小RNA(EBER)的表达 ,两种EBV毒株感染的亲代细胞及大多数细胞克隆表达EBV核抗原 (EBNA1) ,但不表达EBNA2、潜伏期膜蛋白 (LMP1)和LMP2A。表现为潜伏Ⅰ型感染。未感染的HSC 39细胞及P3HR 1感染的细胞克隆CD2 1表达阴性 ,而AkataEBV感染的部分细胞克隆CD2 1mRNA阳性。结论　EBV可能通过不依赖CD2 1受体的途径感染HSC 39,印戒细胞癌细胞系可用作EBV感染的靶细胞。     

Immunotoxicological Insignificance of Fenitrothion in Mice and Rats

Fenitrothion was administered orally to mice or rats in dailydoses of up to of the LD50 for 14 days, and numbers of splenic plaque-forming cells against sheep redblood cells (SRBC-PFC), one of the most common immune parameters,were measured. Splenic SRBC-PFC number was suppressed by fenitrothiononly in rats which received 30 mg/kg body weight (bw) of thecompound. Other immune parameters, including the arthus reaction,delayed-type hypersensitivity, and activities of macrophagesand natural killer cells in rats, were not influenced by fenitrothion.Adrenal hyperfunction manifesting as increased organ weightand elevated plasma corticosterone level was noted along withstrong cholinergic signs in rats which received 30 mg/kg bwof fenitrothion. At lower doses such as 3 or 0.3 mg/kg bw offenitrothion, rats had no strong cholinergic signs, adrenalhyperfunction, or evidence of immunosuppression despite significantsuppression of systemic cholinesterase (ChE) activities. Inmice, no suppression of SRBC-PFC number or mixed lymphocytereaction was noted even at the highest dose (40 mg/kg bw) offenitrothion, at which significant suppression of systemic ChEactivities but no cholinergic signs were noted. These findingsstrongly suggest that the im-munosuppressive effect of fenitrothionnoted in rats was due to systemic, potent cholinergic stressand that fenitrothion has no immunotoxicity in mice and rats.     

Intestinal-type mucinous adenocarcinoma arising from the prostatic duct

We present a case of mucinous adenocarcinoma of intestinal type arising from the prostatic duct in a 72-year-old Japanese man. The patient presented with macroscopic hematuria. Cystourethroscopy exhibited a mucus deposit at the 5 o'clock position of the verumontanum portion. A transurethral biopsy specimen revealed mucinous adenocarcinoma. A radical retropubic prostatectomy was performed. In the prostatectomy specimen, the cancer lesion mainly showed intraductal growth in the prostatic ducts with scattered mucin lakes in the prostatic stroma. There were no abnormalities in the urethral epithelium. The cancer cells resembled the intestinal epithelium rather than either the prostatic duct or the acinar epithelium, which showed diffusely positive immunohistochemical staining for carcinoembryonic antigen, but showed negative staining for prostate-specific antigen. Therefore, these findings suggest mucinous adenocarcinoma of intestinal type arising from the prostatic duct. A number of cases with mucinous adenocarcinoma arising from the prostatic urethra resembling the present case have been reported, but this is the first known case of carcinoma arising from the prostatic duct.     

Video analysis of gross body movements during sleep

Abstract Gross body movements (GM) during sleep, classified into four GM types by the involved parts of body, were evaluated using two-dimensional video analysis in five normal children aged 4–12 years. The rate of occurrence of all GM types showed apparent sleep stage dependency. Among four GM types, GM-1 (GM with axial rotation) was the most frequent. Averaged duration of GM-1 was the longest. A total of 77.2% of GM-1 started with the contraction of chin muscle and 35% of total sleep changes (tSC) were related to GM. A total of 5.6% of tSC following GM shifted to the deeper stage. Further evaluation is necessary in order to understand the physiological mechanism of GM.     

Increased Urinary Liver-Type Fatty Acid–Binding Protein Level Predicts Worsening Renal Function in Patients With Acute Heart Failure

Background

Urinary liver-type fatty acid–binding protein (L-FABP) is a potential biomarker for acute kidney injury, and it in turn increases cardiovascular mortality. We tested whether the urinary L-FABP level predicted short- and mid-term outcomes in patients with acute heart failure.