[Laboratory system for networks in infection control].

The goals of a surveillance for nosocomial infections are to observe the magnitude and characteristics of the infections, and to plan and evaluate policies and guidelines of infection control. In clinical laboratory, although it is most important to detect their causative pathogens, further to provide the surveillance study as a multicenter. Actually, we have just started an infection control room in our hospital. Thus this room may present various informations about infection and contribute to the networks with the area community.

Quantitative evaluation of cytomegalovirus DNA in infantile hepatitis.

We used a PCR method to develop a diagnostic assay for the detection of cytomegalovirus (CMV) DNA in infantile hepatitis, which has been suggested to be associated with CMV infection. CMV DNA was detected in 25 (58.1%) of 43 patients with elevated serum alanine aminotransferase (ALT) levels but no jaundice, and no hepatitis B or C as assessed by conventional PCR. None of the samples from 97 healthy infants tested positive for CMV DNA. We assayed CMV DNA quantitatively in blood using a real-time PCR system that allowed reproducible detection of at least 10 copies of CMV DNA. When 1 microg of DNA from each blood sample was used in this system, a good correlation was obtained between the calculated and measured copy numbers of CMV DNA. This system detected CMV DNA in 29 patients (67.4%) with liver dysfunction. Serial studies in patients with liver dysfunction revealed that CMV DNA copy number decreased, ultimately to below 10, as the ALT levels normalized. In contrast, no CMV DNA copies were detectable by the real-time system in any of the samples from control subjects. These results highlight the usefulness of detecting CMV DNA in the diagnosis of infantile hepatitis and indicate that the real-time quantitative PCR assay may be a valuable tool for monitoring CMV-associated infantile hepatitis.

Effect of tannic acid solution on collagen structures for dental restoration.

This study examined the effect of tannic acid solution on dissolution of dentine collagen and morphological aspects of tendon collagen. Using root dentine, which was cut off from bovine anterior tooth, dentine powders were obtained by the pulverization and lyophilization. They were subject to an application of 1, 3, 5 or 10% tannic acid (TA) solution for 1, 3, 6, 12 or 24 h. TA-treated dentine powders were treated with 40% phosphoric acid (PA) for 30 s at 20 degrees C and additionally with trypsin. Released hydroxyproline in Woessner's assay after a hydrolysis in 6 N HCl at 110 degrees C for 20 h was assumed to be dissolved dentine collagen. Released hydroxyproline in a control sample without acid treatment decreased from 100 to about 60% with increased TA concentration of 1 to 10%, and decreased with increased incubation times of 1 to 24 h when applied by 5% TA solution. Scanning electron microscopy results established the morphological effect of their surface characteristics due to such treatments as 40% PA for 30 s and 5% TA for 6 h, or 40% PA after 5% TA treatment, yielding collagen structures protected by TA to attack from phosphoric acid.

Adherent bacteria cells in five dental materials: sonication effect.

Adherent bacterial cells on the surfaces of two dental porcelain ceramics, three composite resins and human enamel were examined using four types of bacteria strains. Their adherent cells were counted on saliva-coated and uncoated material surfaces after sonication, and contact angle and zeta potential were measured for each adherent cell tested. A correlation between contact angle and bacterial cells on an uncoated surface was found to be higher in two Streptococcus sanguis cells than in S. mutans Ingbritt and S. sobrinus OMZ 176, whereas there appeared to be a higher correlation between S. mutans Ingbritt or S. sobrinus OMZ 176 and zeta potential on the uncoated surface. On the saliva-coated surface, a significantly high correlation was found between the adherent cells, with the exception of S. sanguis ATCC 10 557, and the zeta potential. Contact angle and zeta potential values were small when the surfaces of the materials were coated with saliva, as compared with those on the uncoated surface. The sonication condition (120 s) of adherent cells on the surface of the material significantly depended on the types of bacteria cells, showing that S. mutans Ingbritt (>50-60%) had a greater removal percentage than the others (<50%).

Dental application of polyfunctional urethane comonomers to composite resin veneering materials.

Urethane monomer/diluent monomer mixtures were used in dental composite resin veneering materials filled with various ratios of powder (filler)/liquid (comonomer), P/L. Hardness values of unfilled resins containing benzoyl peroxide only (BP0; 0.5 wt%), and filled resins (included trimethylol propane trimethacrylate (TMPT) composite filler) were tested. Significant increases in hardness were obtained with the use of TMPT composite filler in the resins. Also, their modulus values measured by bend test showed an increasing trend, compared to a commercial composite resin veneering material (a control sample; CONT) with a lower filler content (50 wt%). The DME-DPMDC/HPDM comonomer (dimethacryloxyethyl diphenylmethane-4,4'-dicarbamate/hydroxypropyl dimethacrylate), which showed a smaller fraction of surface porosity, gave greater mechanical strength values at P/L ratios of 0.55 (17.8 wt% filler content) to 1.20 (27.3 wt%) than a CONT resin. The coefficient of thermal expansion was smaller in urethane-based filling materials than a CONT resin. Also, greater activation energy of thermal decomposition was observed in the resin samples with P/L ratio 0.75 to 1.20 than in a CONT resin. Thermally-induced decomposition occurred with smaller weight loss in the experimental filled resins than in a CONT resin.

[A case of interstitial pneumonia induced by intravesical administration of bacillus Calmette-Guerin (BCG)].

A 61-year-old man with superficial bladder cancer, which was detected after he complained of hematuria, was treated three times with intravesical BCG administration. Since liver dysfunction was detected thereafter, he was admitted to our hospital. Three days after admission, he complained of dyspnea on exertion associated with severe hypoxemia, as well as abnormal findings on chest X-ray, i.e. extensive bilateral lung densities. We performed bronchoscopic examination and obtained bronchoalveolar lavage fluid (BALF) and lung biopsy specimens (TBLB). In the BALF, a marked increase in the total cell number, particularly lymphocytes with a high CD4/CD8 ratio was noted. TBLB specimens revealed the lesions to be numerous non-caseating granulomas. We failed to obtain definite evidence of BCG in the sputum, urine, blood, and BALF. Instead, we found that a lymphocyte stimulation test for BCG (DLST) was strongly positive. Based on these findings, severe interstitial pneumonia probably induced by hypersensitivity against BCG, was diagnosed. Anti-tuberculous agents, and steroid-pulse therapy followed by oral administration of relatively low dose of steroid ameliorated the abnormal conditions, including chest X-ray film findings and hypoxemia. The population of lymphocytes and CD4/CD8 ratio in the BALF were reduced as well. Serious interstitial pneumonia was induced by the intravesical administration of BCG, which resulted in transitional changes in the BALF cell component.

A new proposal for radical hysterectomy.

OBJECTIVE: The authors revised the surgical procedure for radical hysterectomy utilizing detailed observation of the venous system, connective fascial sheets, and neural pathways within the uterine supports. STUDY DESIGN: The anterior, middle, and posterior uterine supports were reclassified into two systems, supporting or fascial and drainage or areoral. Supporting system consisted of the superficial layer of the vesicouterine ligament, fascial part of the Mackenrodt ligament, sacrouterine ligament, and rectovaginal ligament, whereas drainage system consisted of the deep layer of the vesicouterine ligament, vascular part of the Mackenrodt ligament, and the so-called mesoureter. The operative procedure was planned according to the continuity of these ligaments and executed first by excising the fascia and then dissecting the denuded areoral tissue. RESULTS: Among the 15 patients who underwent surgery for uterine cancer during a 2-year period the mean (SD) time required for the operation was 305.5 +/- 30.5 min and the mean (SD) total volume of blood loss 592.0 +/- 238.2 ml. A mean (SD) period of 14.3 +/- 3.8 postoperative days was required until the volume of the residual urine decreased to less than 50 mL. CONCLUSION: The present operation has been structured more three-dimensionally and systematically than before. Further, safety of the operation was significantly improved including prevention of hemorrhage and preservation of bladder function.

Orthotopic liver transplantation for congenital biliary atresia. An 11-year, single-center experience.

OBJECTIVE: The authors analyze a single center's 11-year experience with 190 orthotopic liver transplants for congenital biliary atresia. SUMMARY BACKGROUND DATA: Hepatic portoenterostomy generally is the initial treatment for children with congenital biliary atresia. Despite multiple modifications of the hepatic portoenterostomy, two thirds of treated patients still develop recurrent cholestasis, portal hypertension, cholangitis, and cirrhosis. Therefore, the only hope of long-term survival in the majority of children with congenital biliary atresia is definitive correction with orthotopic liver transplantation. METHODS: The medical records of 190 consecutive patients undergoing orthotopic liver transplantation for congenital biliary atresia from July 1, 1984 to February 29, 1996 were reviewed. Results were analyzed via Cox multivariate regression analysis to determine the statistical strength of independent associations between pretransplant covariates and patient and graft survival. Actuarial patient and graft survival was determined at 1, 2, and 5 years. The type and incidence of post-transplant complications were determined, as was the quality of long-term graft function. The median follow-up period was 3.21 years. RESULTS: The liver grafts were comprised on 155 whole-organ, 24 reduced-size, and 11 living donor organs. Median pretransplant values for recipient age, weight, and total bilirubin were 1.4 years, 12.3 kg, and 13.8 mg/dL, respectively. One hundred sixty-four patients (86%) had undergone prior hepatic portoenterostomy. Eighty-seven patients (46%) were United Network for Organ Sharing (UNOS) status 1 or 2 at the time of liver transplantation. The majority (15/24, 62%) of reduced-size graft recipients were UNOS status I at the time of transplantation. One hundred fifty-nine patients (84%) received a single graft, whereas 31 patients required 37 retransplants. The 1, 2, and 5 year actuarial patient survival rates were 83%, 80% and 78% respectively, whereas graft survival rates were 81%, 77%, and 76%, respectively. Cox multivariate regression analysis demonstrated that pretransplant total bilirubin, UNOS status, and graft type significantly predicted patient survival, whereas recipient age, weight, and previous hepatic portoenterostomy did not. Current median follow-up values for total bilirubin and aspartate aminotransferase levels in the 154 surviving patients were 0.5 mg/dL and 34 international units/L, respectively. CONCLUSION: Long-term patient survival after orthotopic liver transplantation for congenital biliary atresia is excellent and is independent of recipient age, weight, or previous hepatic portoenterostomy. Optimal results are obtained in this patient population when liver transplantation is performed before marked hyperbilirubinemia, and when possible, using a living-donor graft.

[A case of adenomyelolipoma].

We report case of adenomyelolipoma. CT and MRI revealed a large, capsulated, septated adrenal mass with abundant fat tissue. However, enhancing components were demonstrated at the capsule and septations on angiography. On the pathological study, the capsule and septations consisted of adrenal adenoma and the tumor contained various forms of myelolipomatous tissues. These myelolipomatous tissues were classified into 4 groups. Type I: Scattering of fat cells and hematopoietic elements without coalescence. Type II: Collection of myelolipomatous tissue with unclear margin or small myelolipomatous tissue that cannot be classified as type I or III. Diameter of the lesion is less than 1 cm. Type III: Collection of myelolipomatous tissue with clear margin or replacement of cortical nodule. Diameter of the lesion is less than 1 cm. Type IV: Collection of myelolipomatous tissue. Diameter of the lesion is equal to or greater than 1 cm. We defined adenomyelolipoma as a lesion combining adrenal adenoma (or hyperplasia) and various forms of myelolipomatous tissues (type I-IV) in view of the strong relationship between adrenal adenoma (or hyperplasia) and myelolipomatous tissue.

Effects of post-curing by heat on the mechanical properties of visible-light cured inlay composites.

The aim of this study was to evaluate the effects of post-curing by heat on the mechanical properties of visible-light (V-L) cured three inlay composites and three posterior filling composites. One group was only photo-cured according to the manufacturers' recommended methods, while the other group was heat-treated at 100 degrees C for 15 min following initial cure by V-L. Knoop hardness, diametral tensile strength and compressive strength were measured to evaluate the mechanical properties. Cure performance was checked out by the solvent immersion test. Upon secondary-curing by heat, it was confirmed that the mechanical properties of the composites were increased moderately and the cure performance of the composites was also improved.

[Hereditary angioneurotic edema associated with DIC and treated effectively by nafamostat mesilate].

A 36-year-old woman with disseminated intravascular coagulation syndrome (DIC) was admitted to the Third Department of Internal Medicine of the National Defense Medical College Hospital. Even after she recovered from DIC, she had a low level of C1-inactivator. Her past history, family history and family study revealed that she and her family showed hereditary angioneurotic edema (HANE). There have been no reports of HANE associated with DIC. She had two HANE attacks after discharge. We used nafamostat mesilate, a strong inhibitor of activated first complement component, to treat the attacks. She obtained subjective relief and her serological data were improved. Nafamostat mesilate was considered effective for HANE attack.

[Cases of pulmonary tuberculosis found in the development of pneumothorax].

During the four-year period from 1987 to 1990, six cases of pulmonary tuberculosis, accompanied by the development of pneumothorax, were observed at our hospital. Distribution by sex was five males and one female. The mean age was 49.8 years-old. None of the patients suffered severe respiratory failure, and there were no deaths in this series. While many of the patients had bilateral exudative disease, five out of the six patients experienced pneumothorax on their right side. The realization of tuberculosis by both patients and doctor tended to be shorter than those cases without pneumothorax.

In-vitro and in-vivo wear profile of composite resins.

The aim of this study was to evaluate in-vitro wear by two types of slurry of 10 commercial composite resin materials (seven hybrid and three microfilled composites). There was great variation in the in-vitro wear pattern by two types of slurry. The wear rate of microfilled composites was greater than that of hybrid composites, and a negative correlation was observed between wear rate and Knoop hardness values among all materials when hydroxyapatite slurry was used. In contrast, the wear rate of hybrid composites was greater than that of microfilled composites when abraded by green carborundum slurry. These abraded surfaces were compared with SEM micrographs of in-vivo composites surface after 4 years of service. The profile of in-vivo wear surfaces was found to be similar to that of in-vitro wear surfaces abraded with hydroxyapatite slurry.

[Hepatic arterial infusion of farmorubicin (FARM) and 5-fluorouracil (5-FU) in a patient with massive hepatic metastasis from gastric cancer].

A patient with massive hepatic metastasis from gastric cancer was treated with hepatic arterial injection of FARM and 5-FU one month after total gastrectomy. Response rate was 88% at 3 months after arterial infusion therapy. Severe side effects were not seen during treatment. It is suggested that the hepatic arterial infusion of combined FARM and 5-FU is a useful method for treatment of hepatic metastasis of gastric cancer.

Streptococcal adherence to uncoated and saliva-coated restoratives.

The adherence of Streptococcus sanguis and S. mutans to seven restoratives in the presence and absence of an artificial salivary pellicle has been investigated. The physiochemical surface characteristics of the bacteria and of the restoratives were also measured, together with the effect of salivary coating of restoratives. Zeta potential of uncoated restoratives showed a positive correlation with the number of adherent S. mutans cells and S. sanguis cells. S. sanguis showed a positive correlation with the hydrophobicity of uncoated restoratives. The surface hydrophobicity was decreased upon saliva coating, whereas the zeta potential was slightly increased. The contact angles or zeta potentials of saliva-coated restoratives were positively correlated with those of uncoated restoratives. The number of adherent cells of both S. sanguis and S. mutans to saliva-coated restoratives were decreased after the coating. Zeta potential of saliva-coated restoratives showed a positive correlation with the numbers of adherent S. mutans cells, suggesting that non-specific electrostatic interactions have an important role in the adherence of this species.

[A statistical study on the orthodontic patients in Meikai University Hospital].

We analyzed statistically two thousand orthodontic patients in Meikai University Hospital (formerly Josai Dental University Hospital) who have undergone treatment since the establishment of the hospital (1970-1985). By classifying the data in various ways, we obtained the following statistics; 1) The number of new patients increased quickly after the first class graduated from our university; 2) The number of patients from six to fifteen years old was the largest, with the peak being nine years old; 3) For the time of the first visit, many new patients came during spring and summer vacations, and a few junior high school and high school students came just season before taking their entrance examination; 4) The female sex predominated in most age groups; however, among patients in their twenties, the male sex was predominant, and in recent years the male ratio tended to increase; 5) Most patients came from a radius of less than 20 km from the hospital (mostly from along Tohbu railway line), with few from beyond 30 km; 6) Anterior crossbite and anterior crowding cases were many, particularly, young patients comprised many of the anterior crossbite cases; and in adult patients large overjet cases increased with the advance of age.

Clinical evaluation of two posterior composite resins retained with bonding agents.

Two hundred thirteen carious cavities were restored with two brands of chemically adhesive posterior composite resins by totally etching both the enamel and dentin walls after removing only the caries detector-stainable tissue and with no mechanical retention form in the cavity preparation. Most cavities were extensive, involving more than two surfaces in 74%. The dentin floor was not covered with cement although a spot lining was placed when the cavity was deep. All restorations were examined, usually after 4 years, by photographs and scanning electron microscope observation of replicas, and by criteria established by the U.S. Public Health Service. The materials and the technique proved to be clinically useful.

In vitro color change of composite-based resins.

The adsorption of staining materials to resin restoratives was considered to be influenced by the physico-chemical properties of the resin-based monomers. To study the effects of the surface characteristics of resins on staining, we prepared five visible-light-cured experimental resins without fillers. Staining of these resins was colorimetrically measured. The staining solutions used were the Oil Orange and the Food Red 3 solutions. With the Oil Orange solution, the materials with higher hydrophobicity showed higher staining. With the Food Red 3 solution, the materials with higher water sorption showed higher staining.