Chondrolysis of the glenohumeral joint following a color test using gentian violet.

Two patients developed chondrolysis following injection of 0.4% aqueous gentian violet into the glenohumeral joint to visualize a rotator cuff tear during surgery. In both cases, conventional radiographs revealed joint space narrowing 10-12 months after surgery. Histological examination of the humeral heads revealed loss of the articular cartilage.

Caspase-dependent apoptosis by ectopic expression of E2F-4.

E2F is a family of transcription factors which regulates cell cycle and apoptosis of mammalian cells. E2F-1-3 localize in the nucleus, and preferentially bind pRb, while E2F-4 and 5 have no nuclear localization signal and preferentially bind p107/p130. E2F-6 suppresses the transcriptional activity of other E2F proteins. DP-1 and 2 are heterodimeric partners of each E2F protein. Using tetracycline-responsive promoters, here we compared the effects of ectopic expression of E2F-1, DP-1 and E2F-4 on cell cycle progression and apoptosis in Chinese hamster cell lines. We found that E2F-4, as well as DP-1 and E2F-1, induced growth arrest and caspase-dependent apoptosis. E2F-4 did not have a marked effect on cell cycle progression, while E2F-1 induced DNA synthesis of resting cells and DP-1 arrested cells in G1. Ectopic expression of E2F-4 did not activate E2F-dependent transcription. Our results suggest that expression of E2F-4 at elevated levels induces growth arrest and apoptosis of mammalian cells through a mechanism distinct from E2F-1 and DP-1.

In vivo rapid reduction of alloantigen-activated CD8+ mature cytotoxic T cells by inhibitors of acidification of intracellular organelles, prodigiosin 25-C and concanamycin B.

Prodigiosin (PrG) 25-C and concanamycin B (CMB) are immunosuppressants that specifically inhibit the induction of cytotoxic T cells (CTL) without affecting the function of B cells and helper T cells in vivo. Both compounds inhibit acidification of intracellular organelles and induce destruction of cytotoxic granules and degradation of perforin in vitro. Here we show that a single intraperitoneal (i.p.) injection of PrG 25-C, and of CMB, into mice eliminates cytotoxic activity 7 days after alloantigen stimulation (when mature CTL activity has been detected in control mice), with minimal effect on the alloantigen-specific antibody titre in serum. FK506 did not suppress the cytotoxic activity with this administration schedule. Suppression was accompanied by a decrease in the CD8+ population and in perforin expression of spleen cells induced by alloantigen stimulation. The suppression of CTL activity and decrease in CD8+ cell number was detected as early as 7 hr after the injection of compounds. These results suggest that inhibitors of acidification of intracellular organelles suppress CTL activity in vivo by reducing the number of mature CD8+ CTL.

Methicillin-resistant Staphylococcus aureus (MRSA) isolation from pharyngeal swab cultures of Japanese elderly at admission to a geriatric hospital.

The isolation rate of the methicillin-resistant Staphylococcus aureus(MRSA) from pharyngeal swab cultures in Japanese elderly was studied at admission to a geriatric hospital. The subjects were 233 consecutive patients admitted to Kitakyushu Tsuyazaki Hospital from April 1994 to March 1996. The isolation rate of MRSA was 3.0% in the patients admitted from their own homes, 9.7% in those transferred from nursing homes and 14.0% in those transferred from other hospitals. The patients from their own homes were younger than those from nursing homes, the latter being older than those transferring from other hospitals. The patients from their own homes had better activities of daily living(ADL), higher levels of hemoglobin and serum albumin than those from nursing homes or other hospitals. The white blood cell counts, and the proportion of patients with positive c-reactive protein or with fever did not differ among the three groups. Multiple logistic regression analysis revealed that fever and ADL disability were independent risk factors for the isolation of MRSA, and hypoalbuminemia was a risk factor for MRSA isolation in the model using serum albumin instead of ADL score. These results suggest that the lower isolation rate MRSA among patients from their own homes may be partly due to better ADL and nutritional status compared with those from nursing homes or other hospitals.

Comparison of 99mTc-Technegas SPECT with 133Xe dynamic SPECT in pulmonary emphysema.

This study was undertaken to compare axial images of 99mTc-Technegas SPECT (Technegas) with those of 133Xe gas dynamic SPECT in patients with pulmonary emphysema. There were 20 patients, 19 males and 1 female. All patients except one ex-smoker were heavy smokers with a mean age of 68.1 years. For Technegas scintigraphy, the patients inhaled 505 MBq 99mTc-Technegas in several tidal volume breaths in the supine position without breath holding. For 133Xe gas scintigraphy, the patients inhaled 370 MBq 133Xe gas. 133Xe gas dynamic SPECT was performed in the equilibrium phase for the last minute of the 3 minute inhalation in a closed circuit, and in the washout phase for 6 minutes of inhalation in a semi-closed circuit, by means of a gamma camera with dual detectors (Picker model Prism 2000). Abnormal findings included heterogeneity, defects and hot spots on Technegas images and on retention images taken 3 minutes after 133Xe gas washout. In 2 of 20 patients, the degree of abnormal findings on Technegas images depended on the area of 133Xe gas retention in the washout phase. In 3 patients, the degree of abnormal findings on both Technegas SPECT and 133Xe gas dynamic SPECT images were equivalent. In the remaining 15 patients, more detailed findings and a greater area were shown by Technegas SPECT than 133Xe gas dynamic SPECT. We conclude that in patients with pulmonary emphysema Technegas SPECT can demonstrate ventilation impairment more easily than 133Xe gas dynamic SPECT.

Assessment of technetium-99m Technegas scintigraphy for ventilatory impairment in pulmonary emphysema: comparison of planar and SPECT images.

Pulmonary emphysema can be diagnosed easily by X-ray CT (CT) as a low attenuation area. Recently Tc-99m-Technegas (Technegas) has been used for ventilation scintigraphy. The present study was undertaken to assess the usefulness of planar and SPECT images by using Technegas scintigraphy in patients with pulmonary emphysema. Technegas scintigraphy, CT and pulmonary function tests were performed in 20 patients (males, age 32-78 years). We classified the findings of Technegas images into 4 grades. Comparing planar and SPECT images of Technegas, more detailed findings were shown by SPECT than by planar images in mild cases (6 cases, 30%). In more severe cases, findings of SPECT and planar images were equivalent (14 cases, 70%). The degree of abnormal findings obtained by SPECT was equivalent to that obtained by CT in severe cases (6 cases, 30%). SPECT should be excluded in advanced stages as indicated by planar images.

[Isolation of methicillin-resistant Staphylococcus aureus on admission to a geriatric hospital].

We studied the rate of isolation of methicillin-resistant Staphylococcus aureus (MRSA) from throat cultures obtained from elderly patients. The subjects were 151 consecutive patients admitted to Kitakyusyu Tsuyazaki Hospital from December 1994 to November 1995. MRSA was found more frequently in samples obtained from patients transferred from other hospitals or from nursing homes than in samples from those admitted from their own homes. Patients transferred from other hospitals or from nursing homes had lower levels of serum total protein, albumin, and hemoglobin, and also lower scores for activities of daily living than did those admitted from their own homes. Status prior to admission, nutrition, and the scores for activities of daily living may explain the differences in the rate of isolation of methicillin-resistant Staphylococcus aureus among patients admitted to geriatric hospitals.

A clinical comparison between Technegas SPECT, CT, and pulmonary function tests in patients with emphysema.

Pulmonary emphysema can be easily diagnosed by X-ray CT (CT) as low attenuation areas. Recently 99mTc Technegas has been used for ventilation scintigraphy. The present study was undertaken to assess the usefulness of SPECT images using Technegas scintigraphy and CT, as compared with pulmonary function tests in patients with pulmonary emphysema. Fifteen patients were examined. We classified and defined the score according to the findings of Technegas scintigraphy (Technegas) images into four grades, from Score 0 to Score 3, and those of CT into five grades, from Score 0 to Score 4, both from normal to severe. The right lung was divided into nine segments, and the left into eight. To obtain the average of the entire lung, the total score from both lungs was divided by 17. These average scores in for SPECT and CT were compared with the results of pulmonary function tests. The average score of Technegas correlated well with % forced expiratory volume in one second (%FEV1.0) (r = 0.87), and forced expiratory volume in one second % (FEV1.0%) (r = 0.83). These results were better than those provided by CT. The average scores of the upper and lower lung fields were also calculated. The score in the upper lung field was higher than that in the lower field. Technegas can assess ventilation impairment in pulmonary emphysema more easily than CT, especially in the upper lung field.

[Gold-induced severe cholestatic jaundice in rheumatoid arthritis patient and effect of repeated steroid pulse therapy].

A 32-year-old female with early stage of rheumatoid arthritis (RA) developed anorexia, pruritus, dark urine, pale stool and jaundice 3 weeks after initiation of chrysotherapy. She was administered a total of 35mg of gold sodium thiomalate (GST) intramuscularly and auranofin 6mg per day orally. Liver function tests and biopsy specimens showed severe cholestatic jaundice. Prednisolone 30mg per day and plasma exchange were started. No response however was obtained and the total bilirubin level gradually increased. Steroid pulse therapy, 1000mg methylprednisolone for successive 3 days as one therapy unit, was repeated 4 times. Liver functions were then gradually improved. Gold induced hepatotoxicity is a rare complication. We concluded that the hepatotoxicity in this case was caused by allergic reaction against GST and repeated steroid pulse therapy was very effective to these conditions.