We describe a 77-year-old man with multiple myeloma (MM) who developed Burkitt type leukaemia (BTL) 16 months after the initial diagnosis of MM. MM was positive for CD10 with immunoglobulin (Ig) ...kappa, kappa Bence Jones protein (BJP) and a normal karyotype. BTL was positive for CD10, CD19, CD20 and HLA-DR with Ig mu and lambda, lambda BJP and a clonal abnormal karyotype of 46,XY,-13, t(8;14)(q24;q32),11q+,14q+, +mar. The patient died 9 d after diagnosis of BTL despite treatment with multiple agents. This is, to our knowledge, the first such case to be reported.
Premenopausal women are at a lower risk of coronary heart diseases relative to age matched men. However, the underlying mechanisms are not clearly understood. This article studies the effects of ...17β-estradiol (17β-E
2) at physiological concentrations on the cholesterylester metabolism in macrophages (J774 A.1 cells) with a particular focus on neutral cholesterol esterase (N-CEase). Cells were incubated with β-VLDL, 1-
14Coleic acid and 17β-E
2 (0.25 and 2.5 nM). 17β-E
2 dose-dependently reduced cholesteryl-1-
14Coleate (
14C-CO) at 36 h and 48 h relative to the control. It also stimulated hydrolysis of
14C-CO in foam cells on 36 h and 48 h incubation. In addition, 17β-E
2 markedly increased N-CEase activity at 24 h and 36 h. This increase preceded the enhanced hydrolysis of cholesterylester. 17α-E
2 (inactive isomer), estrone and estriol had no stimulatory action on N-CEase, whereas progesterone and testosterone inhibited it. 17β-E
2-treatment (24 h) increased the activity of cyclic AMP-dependent protein kinase (A-kinase). DEAE-cellulose column chromatography revealed that an isoform (type II) of A-kinase appeared in 17β-E
2-treated cells in addition to type I of A-kinase found in the control cells. These results suggest that inhibition of cholesterylester accumulation in macrophages by 17β-E
2 is mediated by an enhancement of N-CEase activity possibly through an increase in A-kinase.
The mechanism of platelet dysfunctions in stroke-prone spontaneously hypertensive rats (SHRSP) was investigated. Platelet aggregation was inversely correlated with blood pressure or heart weight/body ...weight ratios in various strains of spontaneously hypertensive rats (SHR), indicating genetic defects. Thrombin-induced 47 kDa protein phosphorylation was markedly reduced in platelets of SHRSP compared with that in Wistar-Kyoto (WKY) rat platelets, accompanying reduced aggregation and secretion, but in 20 kDa protein phosphorylation was unchanged. Ca2+ ionophore A23187-induced responses were also significantly decreased in SHRSP, and the degrees of the changes were greater than those by thrombin. However, 12-O-tetradecanoylphorbol 13-acetate-induced responses in SHRSP were similar to those in WKY rats, suggesting that protein kinase C activity and its substrate were normally present in SHRSP platelets. Phosphatidylinositol content in platelets of SHRSP was 20% less than that in WKY rat platelets, but the contents of other phospholipids, including phosphatidylinositol-4-monophosphate and phosphatidylinositol-4,5-bisphosphates, were unaltered. Thrombin-induced formation of diacylglycerols and phosphatidic acid did not differ from each other at the low concentrations. In the absence of Ca2+, thrombin-induced responses occurred to a similar degree in both platelets, whereas the enhancements by Ca2+ were much greater in WKY rats than in SHRSP. These results suggested that defective Ca2+ functions in receptor-mediated activation of protein kinase C and postkinase-mediated events appear to be an underlying mechanism for the hypofunctions in SHRSP platelets.
A 28-year-old man had an abnormal chest shadow 3 years preveously. Detailed check-up failed to give a definite diagnosis but he received tuberculosis treatment. However, the shadows did not ...disappear, and continuous cough and bloody sputum also appeared. The patient was then referred to our hospital. Chest X-ray and CT revealed multiple nodular and infiltrative shadows in both lung fields. TBLB, repeated 4 times did not yield a definitie diagnosis. Neither the lymphocyte percentage nor CD4/CD8 ratio in BALF was increased. The serum ACE level was normal but tuberculin test was negative. The results of cytology, fungal tests and general bacterial tests were negative. Lung biopsy under thoracoscopy for differentiation from other granulomatous diseases revealed specific pleural lesions and a diagnosis of sarcoidosis was established pathologically. Thoracoscopy appeared useful for diagnosis of sarcoidosis of the lung and to distinguish it from other diffuse lung diseases.
The usefulness of a critical pathway for patients undergoing vascular access surgery for maintenance hemodialysis was examined. Records on nursing charts and self-assessment of vascular access ...management were compared between 11 patients who had received surgery before the introduction of the critical pathway and 8 patients who received surgery after introduction of a critical pathway. Average rate of precise records on nursing charts rose from 18.8% to 93.2% after the introduction of the critical pathway (p<0.01). The usefulness of educational procedures for selfassessment of vascular access was evaluated by questionnaire when the patients were discharged from the hospital. Average rate of correct answer was 95% in the postpathway period, which was significantly higher than 43.5% in the pre-pathway period (p<0.01). A critical pathway is a good tool for coordinating high quality nursing care and self-assessment of vascular access management.
We report here a case of type 1 mesangiocapillary glomerulonephritis as well as a case of mesangial proliferative glomerulonephritis associated with streptococcal skin infection superimposed on ...atopic dermatitis. Both were endemic occurrences of postinfectious glomerulonephritis developed after repeated dirty-skin treatments for atopic dermatitis performed by unauthorized individuals under unsanitary conditions. Of 20 patients who were similarly treated and subsequently admitted to our hospital because of skin infection and fever, 8 (40%) showed urinary abnormalities. Four patients had renal dysfunction with acute nephritic onset. Almost all showed a decrease in CH50 values and an increase in levels of antistreptolysin O and IgE. In the 2 cases presented here, the disease eventually regressed in association with improvement of the skin infection. Although the occurrence of postinfectious glomerulonephritis has recently become uncommon, we must take care to note urinary abnormalities as early as possible in order to prevent the progression of glomerulonephritis.
米国感染症学会ガイドラインや日本感染症学会(the Japanese Association for Infectious Diseases: JAID)と日本化学療法学会(Japanese Society of Chemotherapy: JSC)共同編集のJAID/JSC感染症治療ガイド2011では，カテーテル関連血流感染(catheter-related bloodstream ...infection: CRBSI)治療には，分離菌に対して感受性を示す抗菌薬の投与が推奨されている．しかし，臨床ではカテーテル抜去のみしか行われなかったり，分離菌に対し感受性のない抗菌薬が投与されることがある．本研究ではCRBSIについて，分離菌と投与された抗菌薬を調査し，カテーテル抜去のみを行った症例と感受性のある抗菌薬の投与を行った症例，感受性がない抗菌薬の投与がされた症例の3群を比べ，その後の菌血症再発に対する影響を解析した．分離菌に対し感受性のある抗菌薬を投与した群の菌血症再発率は，カテーテル抜去のみの群(p=0.004)や，分離菌に対し感受性のない抗菌薬が投与された群(p=0.031)に比べて有意に低かった．この結果から，CRBSIが疑われる場合は適切な抗菌薬の使用が推奨され，このことがCRBSI再発リスクを低減することが示された．
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