A case of immediate allergy to anisakis following saury intake]

We report here a 76-year-old male that presented with an immediate allergy to Anisakis following saury intake. Three and a half hours after eating pressed saury sushi, whole-body pomphus appeared including itching, facial dropsical swelling, and dyspnea. Diagnostic tests revealed specific IgE antibodies against anisakis simplex and a skin prick test was positive using an extraction of anisakis simplex. The results of skin prick tests using the body and internal organs of a saury were negative. Based on these results, we diagnosed the case as immediate allergy to Anisakis. Anisakis is parasitic to a diverse array of fish, and it seems rare that eating saury will induce an allergic response because the reported parasitic rate of Anisakis on saury is only 5%. In addition, as tropomyosin is currently considered to be the primary cause of allergies to Anisakis, renewed attention should be paid to other foods for which tropomyosin is also assumed to be a common antigen.     

Frequent premature ventricular contractions induced by itraconazole.

Itraconazole is widely used to treat onychomycosis because of its significant therapeutic effects. An otherwise healthy 30-year-old man treated with itraconazole developed frequent premature ventricular contractions (PVC). He presented with a dry cough and palpitation. The results of 12-lead electrocardiography (ECG) were essentially normal, but Holter ECG revealed 17,484 (18%) uniform PVC, including 4 short runs among 96,930 beats/day. Another Holter ECG after withdrawing itraconazole revealed 1,032 premature atrial contractions but no PVC. The corrected QT interval was 0.39 s without itraconazole, 0.41 s with itraconazole, and 0.43 s when multiple PVC were documented. Itraconazole inhibits the fungal cytochrome P450 that is involved in fungal cell membrane formation, interrupts human cytochrome P450A4 in the liver and causes adverse interactions with various drugs such as antiarrythmics, but its cardiac side-effects are obscure. Both patients and physicians should be aware that itraconazole can cause PVC as a side-effect.     

Double immunoelectron microscopic labelings of human chorionic gonadotropin and human placental lactogen in human chorionic villi

Simultaneous immunoelectron microscopic localization of human chorionic gonadotropin (HCG) and human placental lactogen (HPL) was examined on the same ultrathin section of human chorionic villi by means of the double labeling technique. Using specific rabbit antisera against HCG and HPL followed by goat anti-rabbit IgG-coated colloidal gold of different sizes (15 nm and 5 nm), immunoreactions of HCG were concentrated on middle-sized secretory granules of 200-300 nm and large dense bodies of 500-1000 nm, while those of HPL were exclusively located on small secretory granules of 80-180 nm. The present experiment provides direct evidence for our previous data that HCG and HPL seem to be stored in different granular components in the syncytiotrophoblast.     

Mizoribine in steroid-dependent nephrotic syndrome of childhood

We evaluated a 1-year course of a newly developed immunosuppressant, mizoribine (at a dosage of 3 mg/kg body weight per day), in nine children with steroid-dependent nephrotic syndrome. Steroid treatment could be discontinued in two patients and the maintenance dosage of steroid could be reduced to less than half of that given before mizoribine therapy in a third. There were no beneficial effects in the remaining six patients. No adverse effects of mizoribine were observed during the course of therapy. Received September 20, 1996; received in revised form and accepted April 24, 1997     

Effect of phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylcholine on the protein C/protein S anticoagulation system.

Phosphatidylserine is known to significantly accelerate the blood coagulation reaction. In a previous communication submitted for publication, we demonstrated that phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylcholine showed effects on the blood coagulation reaction using the factor Xa-prothrombin reaction system, and discuss a new function of membrane phospholipids. The present study examined the role of phospholipids in the blood coagulation regulatory reaction (anticoagulation system), by studying the effects of phospholipids on the protein C/protein S reaction. We have established quantitative methods for measuring activated protein C activity and protein S activity, and used them to measure their activity after the addition of liposomes with different phospholipid compositions. We found that phosphatidylcholine inhibited activated protein C and protein S activities in a dose-dependent manner, as in the factor Xa-prothrombin reaction system. On the other hand, phosphatidylethanolamine and lysophosphatidylcholine showed no effect on activated protein C activity. Phosphatidylethanolamine inhibited and lysophosphatidylcholine accelerated coagulation activity in the factor Xa-prothrombin system, but such effects were not observed in the protein C/protein S reaction system. The coagulation and anticoagulation reactions are exquisitely balanced by thrombin, with a role both as a procoagulant and anticoagulant. Therefore, it is understandable that phosphatidylethanolamine and lysophosphatidylcholine show different effects in the factor Xa-prothrombin and protein C/protein S reaction systems. It appears that coagulation and anticoagulation reactions are co-ordinated and controlled by changes in phospholipid composition of the cellular membrane where the coagulation reaction takes place.     

Downward deviation of progressive addition lenses in a myopia control trial

PURPOSE: To clarify how the downward deviation of progressive addition lenses (PALs) reduces their near-addition effect in schoolchildren participating in a myopia control trial. METHODS: Among 95 schoolchildren wearing PALs for 6 months (age range: 6-12 years; refractive error range: -6.00 to -1.25 D), facial images were captured with a digital still camera placed 60 cm in front of the eyes while he or she was looking ahead with natural head posture. The vertical deviations of PALs from their ideal position (mm) were evaluated by analysing these images. RESULTS: The mean (+/-SD) downward deviations of PALs for the right and left eyes were 3.7 +/- 2.3 and 3.7 +/- 2.0 mm, respectively, and the largest downward deviation was 10.2 mm. For simulations using the average downward deviation, the near-addition effect of PALs was reduced to 30 and 63% of the expected value at the 10 degrees and 20 degrees downward eye positions, respectively. CONCLUSIONS: The downward deviation of PALs is a significant factor in reducing their therapeutic effect for near-addition. To ensure the proper alignment of PALs in children, the conventional spectacle-frame-fitting procedure is not sufficient, and repeated confirmation using a testing method similar to that used in this study is required.     

A case of heparin-induced thrombocytopenia that worsened preexisting cerebral infarction]

A 75-year-old man was admitted to our hospital with dysesthesia of the right lip, dysphagia and gait disturbance. He presented with right Wallenberg syndrome and brain MR image showed a fresh infarction in the right lateral medulla. Therapy with heparin and ozagrel sodium was started. For a time his symptom improved a little, but after 8 days he developed re-infarction, thrombocytopenia and DIC, while being treated with heparin for cerebral infarction. Heparin was discontinued, and these symptoms improved quickly. The clinical course and the positive anti-platelet factor 4-heparin complex antibody suggested that these symptoms were caused by heparin-induced thrombocytopenia (HIT). HIT should be included as a differential diagnosis for progression of ischemic stroke under heparin therapy.