Genetic diversity of enterovirus 71 isolated from cases of hand, foot and mouth disease in Yokohama City between 1982 and 2000.

Enterovirus 71 (EV71) is known as one of the major causative agents of hand, foot and mouse disease (HFMD) and is also associated with neurological manifestations such as aseptic meningitis, polio-like paralysis and encephalitis. Recently, large HFMD outbreaks, involving severe neurological complications, have been experienced in Malaysia, Taiwan and some other countries in the Western-Pacific region. To investigate the genetic diversity of EV71 isolates in a single community in Japan, nucleotide sequences of the VP4 region of 52 EV71 isolates in Yokohama City from 1982 to 2000 were determined and the phylogenetic relationship was compared with other referential EV71 strains in Japan and in the world. There were two major genotypes of EV71 in Yokohama City through the 1980's and 1990's. Six EV71 isolates in the early 1980's in Yokohama City were closely related to those from HFMD outbreaks in Japan and from outbreaks of polio-like paralysis in Europe in the 1970's. During recent HFMD outbreaks in 1997 and 2000, two distinct genotypes of EV71 were co-circulating in Yokohama City as in HFMD outbreaks in Malaysia and Taiwan. However, the genetic diversity of EV71 in Yokohama City was not directly correlated with the severity of HFMD. The results confirmed the circulation of two distinct genotypes of EV71 over the past 20 years in Japan.

[Evaluation of immunochromatography method for rapid detection of influenza A and B viruses].

We have evaluated a new rapid detection kit for influenza A and B viruses, known as the QuickVue Influenza test (Quidel Coporation, USA); which is based on immunochromatography using virus isolates and clinical specimens. Twelve strains of influenza A and B were tested for evaluate the reactivity and detection limits of this test. The QuickVue Influenza test showed a positive result for all twelve strains of influenza virus and a negative result for fourteen different kinds of other respiratory viruses. The detection limits for six strains were 5 to 30 pfu/ml for a cell culture, 1.0 x 10(3) to 6.0 x 10(4) pfu/ml for 1st PCR, 1 to 50 pfu/ml for nested PCR, 3.0 x 10(5) to 6.0 x 10(5) pfu/ml for the QuickVue Influenza test, 1.5 x 10(5) to 1.0 x 10(6) pfu/ml for the Directigen Flu A, and 7.5 x 10(5) to 5.0 x 10(6) pfu/ml for the FLU OIA. Furthermore, the QuickVue Influenza test were clinically evaluated using 92 throat swab specimens collected from patients with influenza-like illnesses. By cell culture, influenza viruses were detected in 49 of the 92 specimens (AH1N1: 20, AH3N2: 7, B: 22); the titers of the influenza viruses were between 2.5 pfu/ml and 7.0 x 10(5) pfu/ml. Compared to cell culture, the QuickVue Influenza test showed a sensitivity of 75.5%, a specificity of 93.0%, a positive predictive value of 92.5%, a negative predictive value of 76.9%, and an efficiency value of 83.7%. On the other hand, influenza viruses were detected in 54 of the 92 specimens (AH1N1: 19, AH 3N2: 10, B: 25) by RT-PCR. Compared to RT-PCR, the QuickVue Influenza test showed a sensitivity of 72.2%, a specificity of 97.4%, a positive predictive value of 97.5%, a negative predictive value of 71.2%, and an efficiency value of 82.6%. Overall, only one throat swab specimen produced a false positive result using the QuickVue Influenza test; thus, this test appears to have a high specificity. We conclude that the QuickVue Influenza test is a simple one-step test with a sensitivity and specificity equivalent to those of other conventional diagnostic kits. The test is useful and suitable for the diagnosis of influenza and for identifying influenza patients requiring antiviral therapy.

Phylogenic analysis of echovirus type 30 isolated from a large epidemic of aseptic meningitis in Japan during 1997-1998.

During 1997 to 1998, a nationwide epidemic of aseptic meningitis occurred in Japan. More than 4,500 isolates from patients with aseptic meningitis were identified as echovirus type 30. To investigate the character of these isolates, we examined the nucleotide sequences of thirty-seven geographical representatives and compared them with 50 strains isolated during the past 20 years. The phylogenic analysis used partial sequences from either the VP1 or VP4-VP2 region of the viral capsid. This analysis revealed that the isolates were divided into six genomic groups. All isolates identified during 1997-1998 belonged to only two genomic groups; these two groups are thought to be the causative viral agents involved in the recent epidemic.

A rare case of spontaneous esophageal rupture (Boerhaave's syndrome) associated with pulmonary rupture.

Spontaneous esophageal rupture (Boerhaave's Syndrome) is a life-threatening condition that requires early diagnosis and effective treatment. The authors describe a rare case of spontaneous rupture of the esophagus associated with pulmonary rupture in a 54-year-old man. The anatomical basis for the occurrence of a spontaneous esophageal rupture associated with pulmonary rupture is discussed.

[An experience with omentopexy for the repair of postoperative bronchopleural fistula].

Postoperative bronchopleural fistula has been the most troublesome complications in the thoracic surgery. In this report, we presented a case of bronchopleural fistula successfully closed by omentopexy. A 51-year-old man had undergone left upper lobectomy and S6 segmentectomy for primary lung cancer. Bronchopleural fistula due to postoperative pneumonia was developed and completion pneumonectomy with the intercostal-musclo-pexy was performed. Post-re-operative course was unsuccessful, bronchopleural fistula remained, so we tried re-closure of the bronchial stump by omentopexy without thoracoplasty or muscle flap plombage. About a half year after 3rd operation, he relapsed into bronchopleural fistula. Then fibrin gluing was performed via a flexible fiberoptic bronchoscope without hospitalization, and the omental flap was fixed completely to the bronchial stump. We believe the omentopexy a useful procedure for treating postoperative bronchopleural fistula which can't make any chest-wall deformation.

[An experimental study of blood supply to the bile duct under arterio-portal shunting].

The aim of this study is to show whether arterio-portal shunting (APS) improves the blood supply to the bile duct (BD) subsequent to clamping of the arterial blood supply to the liver and the BD. A constant flow APS model was undertaken using beagles. The procedure involved arterio-portal shunting by performing a bypass from the femoral artery to the portal vein (PV) following clamping, assisted by a roller-pump. In one group (Clamp group: n = 6) the shunt flow was kept at 0 ml/min/kg resulting in a reduction in the tissue oxygen saturation level of the BD (%BDISO2) to 28%, and a reduction in the tissue blood flow of the BD (%BDBF) to 17%, of the pre-clamped values. The %BDISO2 and %BDBF were measured by a Tissue-Spectrophotometer and Laser Doppler Flowmeter, respectively. The %BDISO2 and %BDBF decreased rapidly and thereafter were constant. In the other group (Shunt group: n = 6) the shunt flow was kept at 14 ml/min/kg. An increase in the %BDISO2 and %BDBF to 57% and 47%, respectively, was observed. A flow-controlled APS model was also carried out (n = 6). It was found that by periodically increasing the shunt flow from 0 to 7, 14, and 28 ml/min/kg, the %BDISO2, %BDBF, PVSO2 (PV oxygen saturation), and PVF (PV flow) all gradually increased. Statistically, positive correlations were found between the %BDISO2 and PVSO2 (p < 0.0001) and the %BDBF and PVF (p = 0.0002). Twenty additional beagles were divided into a Control group (n = 9) and an APS group (n = 11). In the Control group, a choledochojejunostomy was performed. In the APS group however, in addition to a choledochojejunostomy, one end of the hepatic artery was anastomosed to the side of the PV following ligation of the common hepatic artery, the gastro-duodenal artery and the right gastric artery. The survival ratio, concentration levels of serum total bile acid, total bilirubin, ALP, LAP, and gamma GTP, as well as, histological findings were not significantly different between the Control and the APS group. This study indicates that the blood supply is significantly improved by APS accompanied by clamping of the arterial blood supply to the liver and the BD. This procedure would therefore be useful in the preservation of the bile duct's viability and the bilioenteroanastomosis in clinical practice.

[A case of aortic valve replacement and aorto-coronary bypass with left lung collapse due to thoracoplasty].

A 64-year-old woman was attacked cardiac and respiratory failure in 3 times within a year. Aortic regurgitation (III degrees) and left anterior descending coronary artery 90% stenosis was recognized. %VC: 33% and %FEV1.0 75% were established. Aortic valve replacement (SJM 23 nm) and coronary arterial bypass grafting (SVG) were performed with cardiopulmonary bypass. Post operative course was no trouble and patient was discharged within 60 days.

[Successful repair of right ventricular rupture due to blunt trauma].

Successful repair of blunt traumatic rupture of ventricle due to traffic accident is reported. Patient was a 73-year-old woman who was driving and had seated with seatbelts at the traffic accident. Arriving at our hospital, her blood pressure was under 50 mmHg and she had clouding of consciousness, although no brain injury was recognized. No heart beating was visible in X-ray television and pericardial effusion was recognized in the echocardiogram. The diagnosis of acute cardiac tamponade was established within 7 minutes of arrival. The pericardiectomy was performed immediately, then blood pressure was improved to 70 mmHg. The ruptures of right ventricle were repaired without cardiopulmonary bypass via median sternotomy. Post-operative course was without trouble and patient was discharged within 2 weeks.

[A study on wounds caused by cats as basic materials of cat scratch disease].

Between October, 1992 and March, 1993, the incidence of bite or scratch by the cat, was surveyed by questionnaire in 1,619 peoples who were veterinarians, veterinary technicians, students and the general population (male 652, female 967). The wound rate by cat: Veterinarians, veterinary technicians, students of veterinary college, students of veterinary technician school were significantly higher than the general population. Incidence of bite or scratch in the cat owner were significantly higher than the non cat owner, and the incidence of wounds in cat owners was more than 90%. Most injuries for veterinarians were of the occupational nature. Their injuries clearly differed from those of the other groups. In our survey 33 cases were suspected to have CSD; 19 of 102 veterinarians, 4 of 45 veterinary technicians, 2 of 517 students of veterinary college, 1 of 400 students of veterinary technicians, 7 of 555 in the general population. Of the seven cases suspected for CSD among the general population, four were proven to have cat-scratches, suggesting that injuries can be prevented by clipping the cat's nails at home. However, most of the injuries suffered by veterinarians are caused by bites, prevention poses a more serious problem. It is therefore important to educate people in all fields to fully understand sanitation and zoonosis including CSD, and teach them to handle their pets appropriately.

[A case of cat scratch disease: from the clinical pathological point of view].

We described a forty-four-year-old female who was scratched by her cat, and developed lymphadenopathy. Cat scratch disease skin-test was positive. Cat scratch disease is well known, but there are not many reports in Japan. Reports of cat scratch disease will increase as the pathogen was recently detected. Attention must be drawn to zoonosis containing cat scratch disease.