Cytomegalovirus ventriculoencephalitis in a reduced- intensity conditioning cord blood transplant recipient.

Cytomegalovirus (CMV) encephalitis most commonly occurs in patients with advanced human immunodeficiency virus infection and profound CD4 cell depletion and is rare in transplant recipients. We describe a patient with pathologically proven CMV ventriculoencephalitis that occurred after human herpesvirus-6 limbic encephalitis, following reduced-intensity conditioning cord blood transplantation (CBT). At approximately day 150 after CBT, the patient became acutely confused after steroid therapy for grade III acute graft-versus-host disease. Fluid-attenuated inversion recovery magnetic resonance imaging of the brain revealed a communicating hydrocephalus with abnormal periventricular hyperintensity. Neuropathologic examination of the brain at autopsy revealed necrotizing CMV ventriculoencephalitis, limbic encephalitis, and multifocal necrotizing leukoencephalopathy. This case represents the first report of CMV encephalitis following CBT and serves to highlight the interrelationship between viruses in transplant recipients.

The impact of subject/respondent characteristics on a proxy-rated quality of life instrument for the Japanese elderly with dementia.

The development of a quality of life (QL) instrument for evaluating quality of services requires extensive validation. This study examines the impact of subject/respondent characteristics on a newly developed quality of life instrument for the Japanese elderly with dementia (QLDJ) as a part of the validity examination. In the QLDJ, QL is defined as a three-dimensional construct: 'interacting with surroundings', expressing self', and 'experiencing minimum negative behaviors'. Thus the QLDJ is a multi-dimensional, 24-item instrument, and it is answered by a proxy, the formal caregiver (respondent) because the elderly with severe dementia cannot be directly interviewed. Altogether 623 elderly persons experiencing dementia from 37 institutions (e.g., nursing homes, day care centers) in Japan were assessed using the QLDJ by their formal caregivers. In addition to the levels of dementia and independence in activities of daily living, factors such as gender of the elderly person and respondent, elderly person's age, participation in recreational activities, qualification of the respondent were significantly associated with 'interacting with surroundings' and 'expressing self'. The levels of dementia and independence as well as qualification of the respondent were associated with 'experiencing minimum negative behaviors'. Possible reasons for these associations and how to deal with them are discussed. Careful control for those factors is needed when the QLDJ is used in future research.

Development of instruments to measure appraisal of care among Japanese family caregivers of the elderly.

The purpose of this study was to develop two instruments for the evaluation of positive and negative appraisal of care among family caregivers of elderly Japanese care recipients within the framework of caregiver adaptation. The positive appraisal of care instrument (PAC) includes domains of relationship satisfaction, role confidence, consequential gain, and normative fulfillment. The negative appraisal of care instrument (NAC) includes domains of role exhaustion, isolation, relationship difficulty, and symptom management difficulty. The PAC and NAC are self-administered questionnaires and were developed from data collected from 337 family caregivers of relatives aged 65 years and over who were using visiting nursing services from 21 organizations in multiple areas of Japan. Out of 87 items, 21 PAC items and 14 NAC items were selected based on content and construct validity and internal consistency examination. Results show evidence of validity and reliability for the PAC and NAC, although some NAC domains may benefit from further refinement. The PAC and NAC will be useful research tools for examining elder caregiving experience and evaluating nursing care for elders.

Coexistence of five Cercopithifilaria species in the Japanese rupicaprine bovid, Capricornis crispus.

The Japanese serow, Capricornis crispus (Bovidae, Caprinae, Rupicaprini), is parasitized by five Cercopithifilaria species: C. shohoi, recently described, and reexamined in this paper, C. multicauda n. sp., C. minuta n. sp., C. tumidicervicata n. sp., and C. bulboidea n. sp. Coinfections are frequent. The location (skin or subcutaneous regions) in the host of adult worms differed between the species, as did many morphological characters of both adults and microfilariae. The location (limbs, trunk, etc.) in the host of adult worms and dermal microfilariae seemed to differ depending on the species. Male and female worms of the same species had similar head shapes, buccal capsules, and, in four species, swellings in the anterior region of the body (because of the presence of a giant ventral pseudocoelomocyte). The Cercopithifilaria spp. from C. crispus were related to the primitive forms of the genus, parasites of Bovidae and Cervidae, presently recorded in Africa and Europe. C. bulboidea was particularly close to the most primitive species, C. ruandae and C. dermicola, in Africa, with the pairs of caudal papillae numbered 8 and 9 being distant from each other, but the species also had several specialized characters. Like C. rugosicauda in a European cervid, the four other species had pairs 8 and 9 close to each other; they reflect an evolutionary trend (hypertrophy of pair 6, and reduction and posterior migration of pair 7) that suggests diversification in the host.

Social isolation stress impairs the resistance of mice to experimental liver metastasis of murine colon 26-L5 carcinoma cells.

Our previous study has demonstrated that the exposure of male BALB/c mice to social isolation stress caused a suppressed immune response and enhanced liver metastasis of colon 26-L5 carcinoma cells. To more precisely understand the influence of psychosocial factors on the metastatic process, here we have investigated the effect of social isolation stress on the vulnerability of the host to develop liver metastasis of colon 26-L5 cells, including the time span and incidence of metastatic formation, survival time and chemotherapy response. Isolation stress decreased the time period required for the metastasis formation relative to that in controls. On day 7 after the tumor injection, the 75% incidence of tumor metastasis in the stressed mice was 5 times the 15% incidence in the unstressed mice. When exposed to the challenge of lower cell numbers (0.025, 0.05, 0.1 x 10(4)/mouse) of colon 26-L5 cells, mice subjected to isolation stress developed an elevated incidence of metastasis (33.3, 66.6, and 100%, respectively) as compared with the controls (0, 33.3 and 50%, respectively). The survival time following the tumor inoculation was also shorter in the stressed mice (21.83 +/- 1.59d) than in the control mice (24.08 +/- 1.68 d). Furthermore, the response of liver metastasis to chemotherapy consisting of 2 mg/kg cisplatin (CDDP) was worse in the stressed mice than that in unstressed mice. These findings suggested that social isolation stress could significantly impair the resistance of mice to the development of metastasis.

Inhibitory effect of berberine on the mediastinal lymph node metastasis produced by orthotopic implantation of Lewis lung carcinoma.

We examined the effect of berberine, a major component with anti-fungal properties contained in Coptidis Rhizoma and Phellodendri Cortex, on the lymph node metastasis of murine lung cancer. Oral administration of berberine for 14 days significantly inhibited the spontaneous mediastinal lymph node metastasis produced by orthotopic implantation of Lewis lung carcinoma (LLC) into the lung parenchyma in a dose-dependent manner, but did not affect the tumor growth at the implantation site of the lung. Combined treatment with berberine and an anti-cancer drug, CPT-11, resulted in a marked inhibition of tumor growth at the implantation site and of lymphatic metastasis, as compared with either treatment alone. Anti-activator protein-1 (anti-AP-1) transcriptional activity of non-cytotoxic concentrations of berberine caused the inhibition of the invasiveness of LLC cells through the repression of expression of urokinase-type plasminogen activator (u-PA).

Antifatigue effect of fresh royal jelly in mice.

We investigated the antifatigue effect of royal jelly (RJ), which had been stored at -20 degrees C from immediately after collection, in male Std ddY mice. The mice were accustomed to swimming in an adjustable-current swimming pool, then subjected to forced swimming five times during 2 wk, and the total swimming period until exhaustion was measured. They were separated into three groups with equal swimming capacity, which were administered RJ, RJ stored at 40 degrees C for 7 d (40-7d RJ), or the control solution including casein, cornstarch, and soybean oil before swimming. All mice were forced to swim for 15 min once; then the maximum swimming time to fatigue was measured after a rest period. The swimming endurance of the RJ group significantly increased compared with those of the other groups. The mice in the RJ group showed significantly decreased accumulation of serum lactate and serum ammonia and decreased depletion of muscle glycogen after swimming compared with the other groups, whereas there was no significant difference between the 40-7d RJ group and the control group in these parameters after swimming. A quantitative analysis of constituents in RJ showed that 5 7-kDa protein, which we previously identified as a possible freshness marker of RJ, was specifically degraded in RJ stored at 40 degrees C for 7 d, whereas the contents of various vitamins, 10-hydroxy-2-decenoic acid, and other fatty acids in RJ were unchanged. These findings suggest that RJ can ameliorate the physical fatigue after exercise, and this antifatigue effect of RJ in mice seems to be associated with the freshness of RJ, possibly with the content of 5 7-kDa protein.

Effect of a matrix metalloproteinase inhibitor (ONO-4817) on lung metastasis of murine renal cell carcinoma.

We examined the anti-metastatic effect of a newly developed inhibitor of synthetic matrix metalloproteinase (MMP), ONO-4817, on experimental pulmonary metastasis of murine renal cell carcinoma (Renca) cells and on tumor cell invasion, through reconstituted basement membrane (Matrigel) in vitro using the same cells. Oral administration of ONO-4817 (50-200 mg/kg/day) to Renca-bearing mice resulted in a dose-dependent inhibition of lung metastasis without a loss of body weight. ONO-4817 at the high dose of 200 mg/kg showed a tendency to prolong the survival of the mice. We also found that oral administration of ONO-4817 significantly inhibited the angiogenic response (number of vessels oriented towards the tumor mass) and the growth of tumors inoculated i.d. in syngeneic mice. In addition, ONO-4817, at non-cytotoxic concentrations of less than 10 microM, caused a marked inhibition of the invasion of Renca cells as compared to the vehicle control. Gelatin zymography revealed that ONO-4817 inhibited the enzymatic activity of MMP-2 produced by Renca cells in a concentration-dependent manner. In conclusion, ONO-4817 effectively inhibited lung metastasis of Renca cells through its anti-invasive and anti-angiogenic properties. These results suggest that use of the MMP inhibitor (MMPI) ONO-481 7 may provide a therapeutic basis for preventing lung recurrence and metastasis of renal cell carcinoma.

Effect of interferon-alpha A/D in combination with the Japanese and Chinese traditional herbal medicine juzen-taiho-to on lung metastasis of murine renal cell carcinoma.

Several studies have shown that the Kampo medicine Juzen-taiho-to (Si-Quan-Da-Bu-Tang in Chinese) has various biological activities, including anti-tumor effects when combined with surgical excision or with chemotherapeutic drugs. Here we investigated the effect of combined therapy with interferon (IFN)-alpha A/D and Juzen-taiho-to on experimental lung metastasis of murine renal cell carcinoma (Renca) cells. Five consecutive administrations of IFN-alpha A/D to Renca-bearing mice resulted in dose-dependent inhibition of lung metastasis. IFN-alpha A/D at the dose of 100,000 IU/mouse significantly inhibited the metastasis, but a marked loss of body weight was observed during and after the administration. In contrast, oral administration of Juzen-taiho-to (50 mg/mouse) alone tended to inhibit the metastasis, but the effect was not statistically significant. The combination treatment of suboptimal doses of IFN-alpha A/D and Juzen-taiho-to markedly augmented the antimetastatic effect without causing any loss of body weight, as compared with either treatment alone. Similar results were also obtained by treatment with IFN-gamma in combination with Juzen-taiho-to. Clinically, immunotherapy with IFNs has been primarily approved for the treatment of patients with metastatic renal cell carcinoma, but sufficient efficacy has not yet been obtained. Therefore, the combination of IFNs with Juzen-taiho-to may provide a means to increase the therapeutic potential of IFNs and to decrease their toxicity for the treatment of metastatic renal cell carcinoma.

Inhibitory effect of nitric oxide on the induction of cytochrome P450 3A4 mRNA by 1,25-dihydroxyvitamin D3 in Caco-2 cells.

Cytochrome P450 (CYP)-dependent drug metabolism decreases in vivo and in cultured hepatocytes under various immunostimulatory conditions. Nitric oxide (NO) released during inflammation is presumed to be involved in this phenomenon. CYP3A4, which is abundant in the liver and small intestine and participates in the metabolism of various drugs, is known to be induced by 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in the colon carcinoma cell line Caco-2. In this study we examined whether NO affected CYP3A4 gene expression induced by 1,25(OH)2D3 in Caco-2 cells. Induction of CYP3A4 mRNA by 1,25(OH)2D3 was suppressed in a dose-dependent manner by treatment with the NO donors NOR-4 (15-500 microM) or S-nitroso-N-acetylpenicillamine (30 microM-1 mM), which spontaneously release NO. These results indicated that NO has an inhibitory effect on the induction of CYP3A4 mRNA by 1,25(OH)2D3 in Caco-2 cells. Treatment with the guanylate cyclase inhibitor ODQ failed to prevent the inhibition of induction of CYP3A4 mRNA by 1,25(OH)2D3. 8-Bromo cGMP had no effect on 1,25(OH)2D3-induced CYP3A4 gene expression. Therefore, the suppression of CYP3A4 mRNA by NO might be mediated through a guanylate cyclase-independent pathway.

The attitude of Japanese family caregivers toward the elderly with dementia.

This research examined family caregivers' attitudes toward their elderly relatives living with dementia. A convenience sample of fifty-nine Japanese caregivers was used. Caregiver attitudes were investigated multi-dimensionally (negative attitude, attitude of acceptance, and attitude of active interaction) using a questionnaire developed specifically for this study. The dimensions did not correlate with one another but were associated with different caregiver/elderly characteristics: i.e., negative attitude with short stay use, length of time caregivers and elderly relatives were living together and problem behaviors; attitude of acceptance with sleeping pill use and the type of relationship; and attitude of active interaction with dementia diagnosis. The results have implications for nurses in facilitating constructive caregiver attitudes.

Regulation of activator protein-1 activity in the mediastinal lymph node metastasis of lung cancer.

Orthotopic implantation of a metastatic cell line of Lewis lung carcinoma (LLC-MLN), which was isolated by an in vivo selection method, resulted in greater metastatic growth in mediastinal lymph nodes as compared with that of the original LLC cells. LLC-MLN cells also had increased invasive ability and activator protein-1 (AP-1) transcriptional activity as compared with the original LLC cells. This is well consistent with the previously reported finding that overexpression of AP-1 is associated with lymphatic metastasis in lung cancer patients. Oral administration of curcumin, which downregulates AP-1 transcription, significantly inhibited the mediastinal lymph node metastasis of orthotopically implanted LLC cells in a dose-dependent manner, but did not affect the tumor growth at the implantation site. Combined treatment with curcumin and an anti-cancer drug, cis-diamine-dichloroplatinum (CDDP), resulted in a marked inhibition of tumor growth at the implanted site and of lymphatic metastasis, and a significant prolongation of the survival time. The downregulation of transcriptional AP-1 activity by curcumin as seen in the dual luciferase assay caused inhibition of LLC cell invasion through the repression of expression of the mRNAs for urokinase-type plasminogen activator (u-PA) and its receptor (u-PAR). Inhibition of AP-1 transcriptional activity may offer improved therapeutic efficacy for lung cancer patients with lymphatic metastasis.

Epstein-Barr virus infection of the colon with inflammatory bowel disease.

OBJECTIVE: Epstein-Barr virus (EBV)-infected cells can evoke severe host immune responses, as shown in infectious mononucleosis and EBV-associated gastric carcinoma. To investigate the possible pathological role of EBV in inflammatory bowel disease (IBD), we tested for the presence of EBV in the colon in IBD patients. METHODS: Surgically resected colonic specimens of 11 patients with Crohn's disease, five patients with ulcerative colitis, nine noninflammatory controls (disease-free area of the colorectal carcinoma), and 10 appendicitis cases were tested using highly sensitive in situ hybridization for EBV-encoded small RNA1 (EBER-1). RESULTS: EBER-1 was detected in 63.6% of Crohn's disease cases and 60% of ulcerative colitis cases, but not at all in noninflammatory controls and appendicitis cases. EBER-1-positive cells were very rare in the noninflammatory areas of colonic specimens from IBD patients. EBER-1-positive cells were nonepithelial cells (mainly B lymphocytes and a few histiocyte-shaped cells) located in erosive or ulcerative areas of the colonic specimens. CONCLUSION: The limited presence of EBV-infected cells in the diseased areas of IBD colonic specimens indicated that EBV infection may be related to such diseases.

Pyloric stenosis due to Crohn's disease.

Gastroduodenal involvement by Crohn's disease is relatively rare and occasionally causes pyloric stenosis, for which medical therapy may be ineffective and surgery may be required. We report on a 44-year-old man patient in whom corticosteroids had a marked effect in reducing pyloric stenosis caused by Crohn's disease. A proton-pump inhibitor was not effective, and Helicobacter pylori was negative.

Effectiveness of local endoscopic resection of rectal carcinoid tumors.

BACKGROUND AND STUDY AIMS: In the treatment of rectal carcinoid tumors, confusion arises in the choice between radical surgery and local endoscopic resection, since the malignancy of individual tumors differs widely. We investigated the appropriateness of using endoscopic therapy for this disease. PATIENTS AND METHODS: Twenty-two patients were diagnosed with rectal carcinoid tumors at the First Department of Internal Medicine, Yamaguchi University School of Medicine and its affiliated hospitals, from 1977 to 1994. The tumors were resected and examined regarding their size, depth of invasion, and histological atypia. The post-treatment course in patients whose tumors were completely resected without atypia was observed by colonoscopy and ultrasonography at yearly intervals. RESULTS: In 21 patients, tumor invasion did not extend beyond the submucosal layer, and there were no signs of atypia. The size of the tumor varied from 2.2 mm to 10.0 mm in diameter, with an average of 5.4 mm. After endoscopic resection of the tumors in 18 patients and surgical local resection in three patients, no local recurrences or liver metastases were experienced. The patients survived for a minimum of 29 months and a maximum of 237 months; the mean survival period was 72.8 months. In one patient, the tumor showed cellular atypia invading into the tunica muscularis, and measured 25 mm in diameter. The patient underwent surgery, but died ten months later due to liver metastasis. CONCLUSIONS: Endoscopic treatment of rectal carcinoid tumors was found to be appropriate when the tumor measured 10 mm or less in diameter, did not infiltrate beyond the submucosal layer, and had no histological atypia.

99mTc-HSA-D scintigraphy in the diagnosis of protein-losing gastroenteropathy due to secondary amyloidosis.

Secondary amyloidosis frequently involves the gastrointestinal tract and may result in ulceration, hemorrhage, and protein-losing enteropathy. We report a patient with severe hypoalbuminemia in whom endoscopy revealed widespread ulceration of the small intestine. The protein-losing site was detected by 99mTc-diethylene triamine pentaacetic acid human serum albumin (99mTc HSA-D) scintigraphy. This evidence suggests that the ulcers and mucosal lesions associated with amyloidosis contribute to abnormal protein loss from the gastrointestinal tract.

[A case of postoperative chylothorax successfully treated by chemical pleurodesis with OK-432].

Recently, cases of postoperative chylothorax have increased concomitantly with the increase in number of aggressive thoracic surgery. Chylothorax was complicated on the 6 th postoperative day in a 69-year-old male who underwent right lower lobectomy with mediastinal lymph node dissection for adenocarcinoma of the lung. After the leaking point from thoracic duct was confirmed by lymphangiography and chest CT, OK-432 1.5 KE was instilled into the intrapleural space through a intrathoracic tube. By this procedure, the chylous fistulas were completely cured. Application of OK-432, even in such a small dose as 1.5 KE, appeared very useful for the treatment of postoperative chylothorax.