Effect of urinary protein C inhibitor on lipopolysaccharide-induced disseminated intravascular coagulation in rats.

The effect of urinary protein C inhibitor (uPCI) on disseminated intravascular coagulation (DIC) was investigated using an experimental DIC in rats. uPCI (0.5 and 1.0 mg/kg) was continuously administrated into the left femoral vein of the rats with lipopolysaccharide (50 mg/kg)-induced DIC. In all doses, uPCI significantly prevented the drastic changes in the parameters such as fibrinogen concentration, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrin/fibrinogen degradation products (FDP) level, aspartate amino-transferase (AST) level and alanine aminotransferase (ALT) level. Furthermore, uPCI significantly inhibited the increase in the levels of plasma kallikrein and thrombin which act not only as the procoagulant proteases but also as the chemotactic factors to neutrophils and monocytes. These results show that uPCI may prevent hypercoagulation, the induction of secondary fibrinolysis and organ failure in the DIC model. Therefore, uPCI may be a useful agent for the clinical treatment of DIC.

Corneal astigmatism after cataract surgery with 4.1 mm BENT scleral and 4.1 mm plus meridian corneal incisions.

PURPOSE: To determine whether the 4.1 mm BENT (between 9 and 12 o'clock) scleral incision or the 4.1 mm plus meridian corneal incision (PMCI) is better at minimizing postoperative astigmatism. SETTING: Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan. METHODS: This prospective study comprised 58 eyes of 29 consecutive patients with bilateral cataract. One eye was randomly assigned to have cataract surgery with a 4.1 mm BENT scleral incision and the other eye, with a 4.1 mm PMCI. Corneal astigmatism was measured before surgery and 1, 3, 10, 30, and 100 days after surgery. RESULTS: Mean astigmatism preoperatively and on postoperative days 1, 3, 10, 30, and 100 in the BENT scleral incision group was 0.99 +/- 0.66, 1.53 +/- 1.11, 1.12 +/- 0.72, 1.26 +/- 0.81, 1.16 +/- 0.73, and 1.09 +/- 0.64 diopters (D), respectively. Means in the PMCI group were 1.14 +/- 0.79, 1.38 +/- 0.98, 1.17 +/- 0.88, 1.31 +/- 0.77, 1.01 +/- 0.70, and 1.00 +/- 0.60 D. respectively. Astigmatism on days 1 and 10 postoperatively was significantly greater than preoperatively in the BENT group (P < .03) but not in the PMCI group. The changes in astigmatism were less in the PMCI group at every examination and were significantly different 30 days postoperatively (P < .05). The negative correlation between preoperative astigmatism and the final postoperative change was significant in both groups (P < .032); the value of x-intercept of the regression line was 1.37 D in the BENT scleral incision group and 0.82 D in the PMCI group. CONCLUSION: In cataract surgery using a 4.1 mm incision, the PMCI surpassed the BENT scleral incision in minimizing postoperative corneal astigmatism.

Unilateral exophthalmos due to orbital metastasis from a contralateral intraocular melanoma.

Progressive, left exophthalmos developed due to a left, retrobulbar mass in a 76-year-old Japanese woman. An open tumor biopsy was carried out, and both macro- and microscopic findings of the mass confirmed that it was a malignant melanoma. Orbital melanomas usually result from distant metastasis of cutaneous melanomas or from secondary extension of ipsilateral intraocular melanomas. Thorough physical, laboratory, and radiological examination, however, did not disclose any primary cutaneous or visceral melanoma, nor had the patient any previous history of excision or spontaneous regression of a pigmented lesion. Histopathologically, the left retrobulbar melanoma was rich in sinusoidal vessels which were surrounded by melanoma cells, oriented in a perpendicular array, a histological feature more characteristic of uveal melanomas than of cutaneous ones. The ophthalmological examination excluded development of a primary intraocular melanoma on the left side. Fundoscopic examination of the right eye was not feasible because of the complete opacity of the right vitreous body which had resulted from previous episode of idiopathic vitreous hemorrhage. Unexpectedly, CT and MR studies depicted retrobulbar masses of non-homogeneous densities in the bilateral orbits. These radiologic studies indicated the metastatic nature of the left retrobulbar melanoma, while suggesting the development of a primary, intraocular melanoma on the right side, extension into the right orbit, and involvement of the right optic nerve. All these clinical, radiological, and histological data suggested the development of a primary melanoma in the right eye and subsequent metastasis to the left orbit producing exophthalmos. The mechanism of such a peculiar mode of metastasis remains entirely unknown. This is a rare case of metastatic orbital melanoma, without visceral involvement, which originated in the contralateral eye. Development of the right ocular melanoma remained unrecognized due to atrophic degeneration of the right eyeball and complete opacity of the right vitreous body, until the contralateral orbital metastasis grew massive enough to cause exophthalmos.

Virus RNA persists within the retina in coronavirus-induced retinopathy.

The murine coronavirus, mouse hepatitis virus (MHV), JHM strain, induces a biphasic retinal disease in adult BALB/c mice. In the early phase, Day 1 to Day 7, a retinal vasculitis is noted which is associated with the presence of viral proteins and infectious virus. In the late phase, Day 10 to Day 140, a retinal degeneration is associated with the absence of viral proteins, infectious virus, and inflammatory cells. The purpose of this study was to determine if viral RNA persists within the retina during the retinal degenerative phase of the disease. BALB/c mice were inoculated by the intravitreal route with 10(4.0) TCID50/5 microliters of virus. The presence of viral RNA was detected by in situ hybridization with a viral cDNA probe and viral proteins were identified by immunocytochemical staining. During the acute phase of the infection, viral RNA was found in the retina, RPE, ciliary body epithelium, and the iris epithelium. During the late phase of the infection, viral RNA was almost exclusively found within the retina and RPE and not in the anterior segment of the eye. Within the retina, viral RNA was detected in the ganglion cell layer, the inner retina, the outer retina, and the RPE cell. Immunocytochemical staining identified viral protein within the retina only from Day 1 to Day 8. This ocular disease was also associated with a persistent systemic infection. Both viral RNA and viral proteins were identified within the liver during the first 8 days. However, only viral RNA was detected in the liver from Day 8 to Day 60. These studies demonstrate that MHV established an acute infection (Day 1-8) where infectious virus and viral proteins were identified. This was followed by a persistent infection within the retina and liver where only viral RNA were detected by in situ hybridization.

Purification and characterization of M3 protein expressed on the surface of group A streptococcal type 3 strain C203.

Monoclonal antibodies (mAbs) have been produced by immunizing BALB/C mice with whole M+ bacteria in incomplete Freund adjuvant and the resulting mAbs for M3 protein have been selected by an indirect immuno-fluorescent technique using formaldehyde-fixed M+ and M- bacteria. Four mAbs reacted with a 65 kDa protein in an extract obtained from the cell wall of M+ bacteria after treatment with N-acetyl muramidase and lysozyme. The purified 65 kDa protein neutralized the phagocytic activity of rabbit anti-M3 antibody. The N-terminal amino acid sequence of the 65 kDa protein was identical with that of protein generated by the M3 gene which has been previously cloned and sequenced. The evidence indicates that the 65 kDa protein is M3 protein. The M3 protein bound not only human fibrinogen but also human serum albumin (HSA). When the M3 protein was purified by gel-filtration and ion-exchange chromatography in the absence of phenylmethyl sulfonyl fluoride (PMSF), four fragments (35 kDa, 32 kDa, 30 kDa, and 25 kDa) in addition to the intact molecule appeared. N-terminal amino acid sequence analysis showed that 35 kDa and 25 kDa fragments were ANAAD and DARSV, respectively, being identical at positions 1-5 and 198-202 to the M3 gene derived protein. Therefore, the 35 kDa and 25 kDa fragments, which were presumed to be cleavage products, may be derived from the C-terminal part and N-terminal part of the intact molecule, respectively. When the effect of purified M3 protein in the bactericidal activity of normal human blood in the presence of M- bacteria was investigated, the M3 protein was responsible for the organism's resistance to attack by phagocytic cells.

[The effect of trabeculotomy on the day-time variation of intraocular pressure of the primary open-angle glaucoma].

We selected 34 eyes with primary open-angle glaucoma cases having glaucomatous visual field loss, but with relatively low base-line intraocular pressure (average intraocular pressure at normal office hour, below 20mmHg) and with one or more episodes of intraocular pressure over 21mmHg in a diurnal fluctuation estimated at 8:30, 9:30, 11:30, 13:30, 15:00 and 17:00. They were treated with trabeculotomy ab externo and we compared the pre- and postoperative diurnal fluctuation pattern of the intraocular pressure. The mean of the base-line intraocular pressure decreased from 18.4 to 16.3mmHg. The mean values of the maximal pressure of the diurnal estimation and of the diurnal difference (maximum minus minimum) also decreased, from 23.4 to 17.9 and from 7.4 to 3.9mmHg, respectively. In 31 eyes (91%) the individual maximal value did not exceed 20mmHg postoperatively. From these findings, it was speculated that trabeculotomy can be effective on primary open-angle glaucoma with relatively low intraocular pressure.

Treatment of pathologic emotionality with thyrotropin-releasing hormone.

Thyrotropin-releasing hormone (TRH) has been reported to be effective in some neuropsychiatric diseases. We examined the effect of TRH on the syndrome of pathologic laughing or crying in four patients with multiple cerebral infarction and one with olivo-ponto-cerebellar atrophy (OPCA). We found a marked therapeutic effect of the peptide on pathologic laughing with a slight improvement in ataxia in a patient with OPCA. A marked diminution in frequency of their pathologic crying with TRH was achieved in two patients with multiple cerebral infarction. The two other patients did not respond to TRH. Levodopa was administered to these patients to compare with TRH in therapeutic efficacy on the symptom and was effective in only one of four patients. The concentration of homovanillic acid in cerebrospinal fluid had diminished in two of the four patients. The results suggest that the tripeptide is effective in the control of this syndrome. We discuss the underlying mechanism(s) of the syndrome and the mode(s) of action of TRH.

[Three patients with hypopituitarism accompanied by primary empty sella presenting mental symptoms].

We report here three patients with hypopituitarism accompanied by primary empty sella, whose first manifestations were various mental symptoms. Endocrine studies revealed that two patients showed panhypopituitarism and the other had isolated adrenocorticotropin (ACTH) deficiency. Although several different types of pituitary dysfunctions have been described in a mild form, empty sella is usually asymptomatic. Their first manifestations were mental symptoms; consciousness disturbance, psychomotor agitation, visual hallucination and delusion. Isolated ACTH deficiency is an uncommon disease which etiology is still undetermined. A case with isolated ACTH deficiency associated with an empty sella has been reported before. It is suggested that empty sella might have a role in pathogenesis of isolated ACTH deficiency. The empty sella was confirmed by metrizamide cisternography and magnetic resonance imaging (MRI). These imaging studies are good tools to disclose empty sella. Replacement with cortisone and levothyroxine resulted in an improvement in the mental symptoms in two patients with panhypopituitarism. No alteration was observed following cortisone administration in the patient with isolated ACTH deficiency. Delusion and visual hallucination in this patient poorly responded to treatment with neuroleptics.

[A case of tuberculous encephalopathy with multiple intracranial tuberculomas].

A case of 56-year-old man with tuberculous encephalopathy following pulmonary tuberculosis was reported. Computed tomography (CT) revealed low density virtually confined to the white matter of the cerebral hemisphere. Contrast enhanced CT demonstrated intracranial multiple spotted lesions, all of which were homogeneously enhanced, supporting multiple intracranial tuberculomas. Magnetic resonance miss spelling imaging (MRI) suggested brain edema and demyelination of the white matter. Clinically this case was characterised by evidence of diffuse cerebral involvement in the form of convulsions, abnormal behavior and consciousness impairment without significant signs of meningitis. Antituberculous chemotherapy improved both clinical symptoms and intracranial lesions on CT and MRI. These findings strongly suggested the diagnosis of tuberculous encephalopathy with multiple tuberculomas. No adult case of tuberculous encephalopathy with multiple intracranial tuberculomas has been previously reported.

[The threshold of pupil-blocking force].

The purpose of this study was to quantitate the dynamic changes which take place in the anterior eye segment during the prone position test. The pupil-blocking force was measured before and after the prone position test (PTT) by a method of image analysis using a computer. The changes in the magnitude of pupillary block were evaluated. The mechanics of this provocation seems to be both pupillary block and direct lens block angle-closure. Pupil-blocking force standardizes the assessment of the eyes with relative pupil-block. The present results provide valuable information in the analysis of the mechanism of primary angle-closure glaucoma and also contribute to the determination of a real value for the threshold of the pupil-blocking force (approximately 0.1 or greater), followed by a clinically significant elevation of intraocular pressure.