Auscultation cannot distinguish esophageal from tracheal passage of tube

We quantitatively compared the acoustic characteristics of passage of an endotracheal tube into the trachea with those of passage into the esophagus by analyzing the loudness and frequency (90% spectral edge frequency) of the sounds when auscultated at the suprasternal notch. We found that there was a significant difference (P<0.01) in maximum loudness between esophageal and tracheal intubations (0.15±0.05 and 0.25±0.06 V, respectively). However, there were no significant differences between the 90% spectral edge frequencies. We conclude that, without directly comparing the maximal acoustic amplitude of tracheal intubation with that of esophageal in each patient, one cannot distinguish between the two types of intubation by means of auscultation.     

Lineage specificity of rearrangement and expression of genes encoding the T cell receptor-T3 complex and immunoglobulin heavy chain in leukemia

In acute lymphoblastic leukemia (ALL) diagnostic samples and cell lines with unequivocal B cell precursor (common) or T cell precursor immunophenotypes, there is inappropriate or cross-lineage IgH or T cell receptor beta gene (TCR beta) rearrangement in approximately 25% of the cases. The frequency of such rearrangements is lower in mature lymphoid neoplasms and acute myeloblastic leukemia. The most immature B lineage ALL ('null' ALL) has a much lower frequency of TCR gene rearrangement than the common variant of B cell precursor ALL and also has a high frequency of oligoclonal rearrangements of IgH genes. Non-T leukemic cells with inappropriately rearranged TCR beta gene did not necessarily have a rearranged TCR gamma gene. Inappropriately rearranged IgH or TCR genes are usually not expressed at the mRNA level, and the gene for the TCR associated protein T3 delta is not detectably expressed at the mRNA or protein level in leukemias classified unambiguously as non-T. Five cases of acute leukemia with ambiguous or mixed lineage immunophenotypes (myeloid + T or myeloid + B) are described. These five had diverse patterns of IgH, TCR beta, and TCR gamma rearrangement, and all expressed terminal transferase concomitantly with MY9 (CD33). The T3 delta gene was expressed in two cases, which also expressed other T cell markers indicating that coordinated lymphoid lineage programs had been initiated. The implications of these observations for lineage-associated regulation of genes during normal differentiation and leukemogenesis are discussed.     

Post-irradiation treatment with OK432 can prevent radiation-induced bone marrow death.

The radioprotective effect of OK432, a Streptococcus haemolyticus preparation, on bone marrow death was examined in mice. The LD50 value was increased from 7.55 Gy in controls to 8.45 Gy in mice treated once with OK432 immediately after irradiation. Multiple administrations of the agent further elevated the LD50 value to 9.56 Gy. The radioprotective effect was also apparent when multiple treatments were commenced as late as 72 h after irradiation.     

A new technique of laparoscopic obturator hernia repair: Report of a case

(Received for publication on Jan. 19, 1996; accepted on Mar. 4, 1997)     

Evidence of cartilaginous benefit of treatment with infliximab in rheumatoid arthritis using measurement of serum COMP]

Recently, it has become possible to measure the concentration of serum cartilage oligomeric matrix protein (COMP) in various arthritis, and it is expected to be a novel biomarker indicative of cartilage destruction. In this study, we evaluated the diagnostic effectiveness of serum COMP in rheumatic diseases and analyzed the inhibition of cartilage destruction in patients with rheumatoid arthritis who were prescribed with infliximab (IFX) for one year. The changes in the concentration of serum COMP and the joint narrow space of Sharp score (Delta Sharp-JNS) were evaluated. The level of serum COMP decreased from 23.04+/-7.14 U/l to 8.69+/-2.89 U/l (p<0.005) and improved Delta Sharp-JNS (-0.50+/-6.38 points). We believed that these results were influenced by the effects of methotrexate (MTX) that was prescribed together with IFX, and we analyzed the group that was administered only MTX therapy as a reference. However, the serum COMP concentration and Sharp-JNS in the MTX group did not decrease. The serological and radiological results revealed that IFX inhibited cartilage destruction, and it is possible that serum COMP is one of the novel biomarkers in RA patients treated with anti-tumor necrosis factor-alpha antibody therapy.     

Communicating triventricular hydrocephalus and its treatment with a lumboperitoneal shunt

With computed tomography, triventricular hydrocephalus shows enlargement of the 3rd and both lateral ventricles with a nearly normal size 4th ventricle. Triventricular hydrocephalus has been described as noncommunicating because of aqueductal stenosis or obstruction. The authors, however, have encountered three patients whose computed tomographic (CT) images were those of triventricular hydrocephalus despite a patent aqueduct. This condition may be suitably referred to as communicating triventricular hydrocephalus because in all cases metrizamide CT cisternography demonstrated the communication between the spinal subarachnoid space and both lateral ventricles. The authors discuss its treatment with a lumboperitoneal shunt.     

Preliminary study of the efficacy of xamoterol in bradycardia-tachycardia syndrome.

Following 4 weeks on placebo, eighteen patients with bradycardia-tachycardia syndrome (BTS) were treated with 100 mg xamoterol twice daily for 2-4 weeks. Ambulatory 24 h Holter electrocardiogram recordings showed that xamoterol decreased maximum heart rate from 140 +/- 5.1 to 107 +/- 6 beats min-1 (P < 0.001) during exercise, increased minimum heart rate from 43 +/- 1.7 to 51 +/- 2.4 beats min-1 (P < 0.005) at night and shortened maximum duration of sinus arrest from 3438 +/- 484 to 1767 +/- 202 ms (P < 0.005) in BTS. Symptomatically, patients reported that palpitations were improved and syncopal attacks disappeared. Although the study has the limitation of an open design, effects of treatment were objectively evaluated using Holter monitoring by investigators who reviewed the recordings in a blinded manner. The findings suggest that xamoterol may be useful in the treatment of BTS. Further studies are needed to evaluate fully its therapeutic potential in this condition.     

Neutrophil dysfunction in chronic neutrophilic leukemia without rearrangements of bcr and immunoglobulin heavy chain genes

A 67-year-old man was admitted to our hospital with abdominal distension due to hepatosplenomegaly. The peripheral blood revealed Hb content 6.5 g/dl, platelet count 4.7 x 10(4)/microliter, and WBC count 105.8 x 10(3)/microliter with 88% of mature neutrophils. The neutrophil alkaline phosphatase score was 421. Bone marrow aspiration revealed hypercellularity with increased megakaryocytes and myeloid hyperplasia. 46, XY, del 20(q 11) without Philadelphia chromosome was identified by cytogenetic study. The patient was diagnosed as having chronic neutrophilic leukemia and was successfully treated with busulfan, but he died of atypical mycobacteriosis about 20 months later. Analysis of neutrophil function demonstrated diminution of deformability, random mobility, and chemotaxis, but almost normal phagocytosis and bactericidal capacity. Southern analysis showed no rearrangements of breakpoint cluster region (bcr) gene and immunoglobulin heavy chain gene.