Aspects of the natural history and virulence of S. agalactiae infection in Nile tilapia.

Streptococcus agalactiae is an emerging pathogen in Nile tilapia (Oreochromis niloticus) worldwide. To investigate aspects of the epidemiology, transmission and virulence of S. agalactiae infections, nine outbreaks of meningoencephalitis and septicemia in Nile tilapia farms in Brazil were analyzed. Records from the outbreaks revealed large variation in the weight of fish affected, high mortality, and disease occurrence at water temperatures above 26 degrees C. S. agalactiae was isolated from diseased fish from all farms, and 29 strains were identified by phenotypic tests and 16S rRNA gene sequencing. Five strains from different geographic origins were selected to determine the 50% lethal dose (LD(50)). All strains were highly virulent; for example, strain SA 20-06 had an LD(50) of 90 bacteria. To investigate S. agalactiae transmission, we conducted cohabitation assays with diseased and healthy fish and fish challenges using an immersion bath or gill inoculation. Strain SA 20-06 was used in all assays. The disease was reproduced with characteristic clinical signs and S. agalactiae was reisolated in all trials. The infection route studies were identified as by direct contact or through the water. In conclusion, S. agalactiae, a major pathogen of Nile tilapia in Brazil, exhibited high virulence, regardless of the geographic origin of the isolated strains.

Variation in CO2 assimilation rate induced by simulated dew waters with different sources of hydroxyl radical (*OH) on the needle surfaces of Japanese red pine (Pinus densifora Sieb. et Zucc.).

The hydroxyl radical (*OH) is generated in polluted dew on the needle surfaces of Japanese red pine (Pinus densiflora Sieb. et Zucc.). This free radical, which is a potent oxidant, is assumed to be a cause of ecophysiological disorders of declining trees on the urban-facing side of Mt. Gokurakuji, western Japan. Mists of *OH-generating N(III) (HNO2 and NO2-) and HOOH + Fe + oxalate solutions (50 and 100 microM, pH 5.1-5.4) simulating the dew water were applied to the foliage of pine seedlings grown in open-top chambers in the early morning. Needles treated with 100 microM N(III) tended to have a greater maximum CO2 assimilation rate (Amax), a greater stomatal conductance (g(s)) and a greater needle nitrogen content (Nneedle), suggesting that N(III) mist acts as a fertilizer rather than as a phytotoxin. On the other hand, needles treated with 100 microM HOOH + Fe + oxalate solution showed the smallest Amax, g(s), and Nneedle, suggesting that the combination of HOOH + Fe + oxalate caused a decrease in needle productivity. The effects of HOOH + Fe + oxalate mist on pine needles were very similar to the symptoms of declining trees at Mt. Gokurakuji.

Palmar fasciitis and polyarthritis associated with gastric carcinoma: complete resolution after total gastrectomy.

Palmar fasciitis and polyarthritis (PFA) is a rare paraneoplastic rheumatic syndrome characterized by flexion contractures of both hands and thickening of palmar fascia. Several reports have suggested that this syndrome is a tumor-associated autoimmune disorder. We report a 44-year-old Japanese man who presented with flexion contractures of both hands associated with thickening of palmar fascia and polyarthritis. These clinical pictures were suggestive of PFA associated with occult neoplasm. Upper gastrointestinal endoscopic examination revealed advanced gastric cancer. Resection of the cancer resulted in a gradual resolution of palmar fasciitis and polyarthritis. This clinical course suggests an underlying tumor-related immunologic process in this syndrome.

The relationship between serum immunoglobulin levels and pulmonary involvement in systemic sclerosis.

OBJECTIVE: To examine the relationship between serum immunoglobulin (Ig) levels and pulmonary function in patients with systemic sclerosis (SSc). METHODS: Twenty-four patients with SSc who had at least 2 sets of pulmonary function tests (PFT) at intervals of more than one year were eligible. Multiple linear regression models were constructed for prediction of the annualized rates of change of forced vital capacity (FVC), carbon monoxide diffusing capacity (DL(CO)), and DL(CO) per unit alveolar volume (K(CO)). RESULTS: The rates of change of FVC and K(CO) correlated with the annualized rate of change of IgG (p < 0.001 and p = 0.005, respectively), and the rate of change of DL(CO) correlated with the serum IgM level at the first PFT (p = 0.020) and with the annualized rate of change of IgG (p = 0.007). CONCLUSION: The rates of change of serum Ig levels are associated with those of pulmonary function in SSc. Use of this model may assist investigation of pulmonary involvement.

Necrotizing fasciitis caused by Streptococcus pneumoniae in mixed connective tissue disease.

Abstract A 42-year-old man was hospitalized because of chills, fever, and severe polyarthralgia. He had a 5-year history of mixed connective tissue disease (MCTD) with polyarthritis which had been treated with a nonsteroidal anti-inflammatory drug alone. On the second day of hospitalization, necrotizing fasciitis of the right leg developed. Streptococcus pneumoniae was later detected in a blood culture. Pneumococcal infections of the soft tissues are uncommon, and have been reported in immunosuppressed patients and patients with systemic lupus erythematosus. This is the first report of a case of necrotizing fasciitis caused by S. pneumoniae in a patient with MCTD.

Dieulafoy's lesion of the esophagus as a probable complication of Takayasu's arteritis.

Dieulafoy's lesion is an abnormal submucosal artery in the gastrointestinal tract characterized by massive gastrointestinal bleeding. We describe a patient who developed Dieulafoy's lesion of the esophagus in the course of isolated pulmonary Takayasu's arteritis. Angiographic findings indicated a relationship between pulmonary arterial involvement of Takayasu's disease and Dieulafoy's lesion of the esophagus. This observation represents the first report of the association between Takayasu's arteritis and Dieulafoy's lesion of the esophagus.

Enhanced interleukin 6 production by cultured fibroblasts from patients with systemic sclerosis in response to platelet derived growth factor.

OBJECTIVE: The pathophysiology of systemic sclerosis (SSc) is poorly understood, but recent studies indicate the involvement of cytokines in the functional changes of SSc fibroblasts. We investigated interleukin 6 (IL-6) production by dermal fibroblasts from patients with SSc. METHODS: Fibroblast cultures were established from affected skin of patients with SSc and from skin of healthy controls. IL-6 in supernatants from cultured fibroblasts was measured using a specific IL-6 ELISA. RESULTS: SSc fibroblasts, starved in serum-free medium, produced only a small amount of IL-6. However, IL-6 production by SSc fibroblasts dramatically increased when the cells were cultured in serum-containing medium. Human whole blood serum was more effective than human platelet-poor plasma derived serum in the enhancement of IL-6 production by SSc fibroblasts. Platelet derived growth factor (PDGF)-AA and PDGF-BB, a major growth factor in serum, induced significant IL-6 production by SSc fibroblasts. In contrast, in normal fibroblasts, much less response to PDGF-BB and almost no response to PDGF-AA were observed. Expression of PDGF receptors on SSc fibroblasts was not significantly different from normal fibroblasts. However, IL-1 receptor antagonist (IL-1ra), when added in the medium, significantly inhibited the PDGF-induced IL-6 production by SSc fibroblasts. CONCLUSION: PDGF stimulates IL-6 production by SSc fibroblasts. The enhanced IL-6 production in response to PDGF is due in part to autocrine IL-1 of SSc fibroblasts. These abnormalities of fibroblasts may play an important role in the inflammatory and immunological processes of SSc.

Predicting infection in hospitalized patients with systemic lupus erythematosus.

To identify the risk factors for infection and to develop a model for the prediction of infection in hospitalized patients with active systemic lupus erythematosus (SLE), we carried out a retrospective cohort study with clinical data collected from 121 consecutive patients with active SLE. Seventeen patients had infection within 6 months of beginning steroid therapy for active SLE. Independent multivariate predictors of infection were a decrease in the serum albumin value, an increase in the serum creatinine value, and prednisolone use in a dose of > or = 60 mg/day without methylprednisolone pulse therapy. The error rate of the model by 10-fold cross-validation method was 12%, sensitivity was 65%, specificity was 91%, and positive predictive value was 55%. Four nonsurvivors were correctly discriminated. Use of this model could contribute to earlier diagnosis of infection and may assist decisions regarding empiric antimicrobial administration in patients with SLE.

[A dual occurrence of endometrial and gastric adenocarcinomas in systemic lupus erythematosus].

The association of systemic lupus erythematosus (SLE) and solid tumors is infrequent. Furthermore, there has been no previous description of multiple occurrence of carcinoma in a single patient with SLE. We describe clinical picture of the patient who had dual occurrence of endometrial and gastric adenocarcinomas in addition to clinically active SLE and organ system involvement.

New interferometric fiber-optic gyroscope with amplified optical feedback.

A novel interferometric fiber-optic gyroscope with amplified optical feedback by an Er-doped fiber amplifier (EDFA) is proposed and theoretically investigated (the proposed gyroscope is named the feedback EDFA-FOG, FE-FOG in what follows). The FE-FOG functions like a resonant fiber-optic gyro (R-FOG) because of its multiple utilization of the Sagnac loop; however, it is completely different because a low-coherence light source is used. In addition, the gyro output signal is pulsed because the modulation frequency of the phase modulator placed in the Sagnac loop is selected to match the total round-trip time delay of the light, which includes the Sagnac-loop delay plus that of the feedback loop of the fiber amplifier. The sharpness of the output pulse can be adjusted by both the gain of an EDFA and the modulation depth of the phase modulator. When rotation occurs the peak position of the output pulse is shifted as a result of the Sagnac effect. The resolution of the rotation measurement depends on the sharpness of the output pulse. The techniques of both the open-loop and closed-loop methods are described in detail, which shows the great advantage of the proposed gyroscope over the to the conventional interferometric fiber-optical gyroscope (I-FOG).

Secondary-phase-modulation method for open-loop fiber-optic gyroscopes.

A proposed method of secondary phase modulation for open-loop fiber-optic gyroscopes is examined in general terms. To detect the rotation rate of a system through a beat-frequency channel, we employ linearly combined signals with different frequencies for the optical phase modulation. We find that the proper combinations of the modulation frequencies can optimize the sensitivity of gyroscopes. With this method we can employ a high-frequency band for optical phase modulations while keeping relative a lower-frequency band of the detection channel. The theoretically derived result is experimentally confirmed by using a lithium-niobate (LiNbO(3)) optical phase modulator. We also discuss the combination setup with an optical integrated-circuit device and digital signal processing.

[Nitroglycerin tape for Raynaud's phenomenon of rheumatic disease patients--an evaluation of skin temperature by thermography].

Topical nitroglycerin has been tried for the alleviation of Raynaud's phenomenon in rheumatic diseases, but its effect is not widely recognized. We evaluated the effect of nitroglycerin tape (NTG tape) for peripheral circulatory failure of 7 patients with rheumatic diseases (4 women and 3 men, aged 35-73 years). The underlying rheumatic diseases included: systemic sclerosis 4 patients, polyarteritis nodosa (PN) 1 patient, cutaneous PN 1 patient and digital microinfarction with pulmonary fibrosis 1 patient. An NTG tape (containing 2.5 mg of nitroglycerin) was applied unilaterally on one forearm or leg, and the change in skin temperature was evaluated by thermography. Skin temperature of the extremities significantly increased at 2 and 3 hours after the application of NTG tape. Feeling of cold and/or pain improved in all patients. Adverse effect was headache in one patient. These results suggest that NTG tape may deserve further use in the treatment of peripheral circulatory failure in patients with rheumatic diseases.

[Percutaneous removal of foreign bodies from the cardiovascular system: two experienced cases in addition to a review of 35 cases reported over the past 9 years in Japan].

From 1984 to 1992 in Japan, 37 cases, including 2 cases of our own, have been reported to involve the percutaneous removal of foreign bodies from the cardiovascular system by catheter. We reviewed the cases of these foreign bodies and the locations, approaches and types of catheters used for removal. The reported foreign bodies were usually iatrogenic in origin and were approximately two times larger than those found in patients who had self-dislodged catheters. The most common catheter approaches were from either the right femoral or saphenous veins.

Ankylosing spondylitis successfully treated with methotrexate.

A 37-year-old man with ankylosing spondylitis (AS) and psoriasis who was successfully treated with methotrexate (MTX) is reported. In 1980, he had low back pain, limited motion in the lumbar spine, radiological findings of bilateral sacroiliitis, and HLA-B27 positivity. In January 1991, he developed psoriasis and he had difficulty in performing desk work in spite of treatment with antirheumatic drugs. In May 1991, MTX 7.5 mg/week per os was started. Joint symptoms, psoriasis, and acute phase reactants improved within 1 month after the treatment and this improvement continued for more than 6 months after the treatment. After discharge he was able to return to his job.

Significance of plasma endothelin-1 levels in patients with systemic sclerosis.

Endothelin-1 (ET-1) is a novel potent vasoconstrictor peptide discovered in the supernatant fraction of cultured endothelial cells. We measured plasma levels of ET-1 using a sensitive sandwich enzyme immunoassay. Plasma concentrations of ET-1 in 31 patients with systemic sclerosis (SSc) (1.90 +/- 0.47 pg/ml) were higher than those (1.31 +/- 0.10 pg/ml) in 25 age and sex matched healthy subjects. Patients with SSc with diffuse scleroderma had higher levels of ET-1 compared with those with limited scleroderma. Plasma ET-1 levels correlated inversely with carbon monoxide diffusing capacity (DLco). Measurement of plasma ET-1 levels may be useful as a predictor of prognosis of SSc.

Anti-interleukin-6 autoantibodies in rheumatic diseases. Increased frequency in the sera of patients with systemic sclerosis.

OBJECTIVE: To investigate the presence and the roles of anti-interleukin-6 (anti-IL-6) autoantibodies in rheumatic diseases, and to further elucidate clinical and pathophysiologic significance of anticytokine autoantibodies. METHODS: Anti-IL-6 IgG autoantibodies were measured by the 125I-IL-6 binding activity of IgG, which was isolated from serum by protein A-Sepharose. RESULTS: Nine of 52 sera (17.3%) from patients with systemic sclerosis (SSc) contained anti-IL-6 antibodies, whereas only 1.9% of sera from normal subjects and 0-5% of sera from patients with other rheumatic diseases were positive for the antibodies. Moreover, anti-IL-6 autoantibodies were found predominantly among patients with the limited form of SSc (42.9%), compared with those with the diffuse form (7.9%). CONCLUSION: Anti-IL-6 IgG autoantibodies were detected in patients with SSc, particularly those with the limited form of the disease, at a significantly increased frequency compared with normal subjects and patients with other rheumatic diseases. These results suggest that the development of anti-IL-6 autoantibodies and IL-6 may have a role in the pathophysiology of SSc.

Sjögren's syndrome with hydronephrosis caused by pseudolymphoma.

A 67-year-old woman with Sjögren's syndrome was found to have left hydronephrosis and stenosis of the left ureter. Exploratory laparotomy disclosed a nodule at the ureteropelvic junction of the left ureter. Histopathological examinations of the biopsied specimen of this nodule showed lymphoid hyperplasia within the ureteral wall. Low dose prednisolone improved hydronephrosis and pseudolymphoma within several months. Hydronephrosis secondary to pseudo-lymphomatous infiltration of the ureter is a rare but, if properly treated, reversible complication of Sjögren's syndrome.