Clinical significance of the serum surfactant protein D and KL-6 levels in patients with measles complicated by interstitial pneumonia.

UNLABELLED: To examine the value of surfactant protein D and KL-6 as markers for the diagnosis and the severity of interstitial pneumonia caused by measles infection, surfactant protein D, KL-6 and lactic acid dehydrogenase were measured serially in three patients with measles complicated by interstitial pneumonia as compared to ten measles infected patients without interstitial pneumonia. The serum surfactant protein D and KL-6 levels were higher in patients with measles and interstitial pneumonia as compared to those with measles without interstitial pneumonia. In patients with measles and interstitial pneumonia, the respiratory distress and the alveolar-arterial oxygen differences improved after steroid pulse therapy while the serum surfactant protein D level decreased dramatically under the cut-off level and earlier than the KL-6 level. On the contrary, the serum KL-6 level increased transiently and it took longer to decrease below the cut-off level as compared to the pattern observed for serum surfactant protein D. The serum lactic acid dehydrogenase level changes were between those of the surfactant protein D and KL-6 levels. CONCLUSION: Surfactant protein D and KL-6 are easily measured and useful markers for the diagnosis of interstitial pneumonia caused by measles infection. Early decrease of surfactant protein D contrasts with the transient increase of KL-6 levels after prednisolone pulse therapy.

Lingual cyst in infancy: importance of palpation for diagnosis.

Two infants, 5 and 12 weeks of age, with lingual cysts were presented. Histological findings were compatible with a salivary retention cyst in one and a thyroglossal duct cyst in the other. Both infants were admitted to our hospital because of severe stridor that had developed from one to two weeks of age. Their lingual cysts were easily recognizable by simple palpation and were confirmed by non-invasive imaging techniques, such as ultrasound sonography, computed tomography and magnetic resonance imaging. Lingual cyst in infancy may be large enough to cause stridor and dyspnea, and occasionally result in sudden infant death, although once diagnosis is made a radical operation can be easily performed. Therefore, it is important that palpation in the oral cavity should be performed with all infants with persistent stridor as a part of a physical examination.

Early ultrastructural changes in the dorsal mucosa of rat tongue after irradiation, with special reference to the microvasculature.

PURPOSE: To clarify the acute effects of irradiation on the ultrastructural conformation of the dorsal mucosa of the rat tongue, with special reference to the changes in microvasculature. METHODS: The proboscis of seventy rats were irradiated. The animals were then perfusion-fixed, followed by India ink-injection or resin casting at 3 to 7 days after irradiation. The bulk, frozen sections, or plastic embedded sections of the treated rat tongues were examined by light and electron microscopy. RESULTS: In the dorsal epithelium of the rat tongue, multi-nucleated cells appeared in the basal layer at 3 days after irradiation. At day 5, the thickness of the epithelial layer and connective tissue papillae decreased dramatically, concomitant with the shortening of the capillary loops. At day 7, lingual papillae and connective tissue papillae disappeared, leaving dissociated epithelial cells and numerous neutrophils migrating throughout the tissue. Subepithelial blood vessels displayed drastic dilation with a number of neutrophils adhering to the endothelial surface, but without ultrastructural abnormalities in its cellular components. CONCLUSION: Early changes in the dorsal mucosa of the irradiated rat tongue were limited to the basal epithelial cells, leading to a total disruption of the epithelial layer. Atrophic changes of the capillary loops is due to the loss of the connective tissue papillae. Dilation and conformational changes of the subepithelial capillaries appear to result from the inflammatory reaction, taking place secondarily to the loss of the epithelial barrier of the irradiated tongue. A difference in radiosensitivity among the epithelial, endothelial, and mesenchymal cell components of the rat tongue in vivo is suggested.

Human herpesvirus-6 (HHV-6)-associated hemophagocytic syndrome.

Virus-associated hemophagocytic syndrome (VAHS) is characterized by histiocytic proliferation and phagocytosis triggered by virus infections. Viruses in the herpes group, especially the Epstein-Barr virus (EBV), are well known to cause VAHS; however, the relationship between this syndrome and human herpesvirus-6 (HHV-6) infection has rarely been reported. In this study, we describe a 23-month-old girl who exhibited typical manifestations of VAHS associated with HHV-6 infection. To the best of our knowledge, this case is the fifth reported case in the English literature.

Effect of taurine on the fatty liver of children with simple obesity.

This study elucidated the effect of taurine on fatty liver in simple obesity. Taurine was orally administered to 10 children with fatty liver. During taurine administration, the CT numbers of the liver, which were low in the beginning, increased. Serum ALT levels were improved, especially in those children whose weight was well controlled. Even in those who failed in weight control, serum ALT levels were slightly recovered. Ratios of glycine/taurine-conjugated bile acids were decreased. Thus, taurine was effective in treating fatty liver of children with simple obesity regardless of the success/failure of weight control. Taurine administration is considered to be helpful as an adjuvant therapy for fatty liver.

[The effect of stellate ganglion block on the local and global cardiac uptake of 123I-metaiodobenzylguanidine].

To investigate the effect of stellate ganglion block (SGB) on the cardiac uptake of 123I-metaiodobenzylguanidine (MIBG), four patients without heart disease underwent SGB. Studies were done twice: once with SGB and once without SGB. Anterior planar images and myocardial SPECT images were taken at 10 minutes and 60 minutes after MIBG injection both with and without SGB. Cardiac uptake of MIBG on planar images estimated by heart/liver ratio was significantly higher with SGB at both imaging times (p < 0.01, p < 0.05) than without SGB. SGB had no effect on the local uptake of MIBG on SPECT images. In conclusion, SGB did not change the local cardiac uptake of MIBG, but it appeared to increase the global myocardial uptake of MIBG.

Bile salt sulphotransferase activity in the liver of cholestatic infants.

A simple assay of bile salt sulphotransferase activity in human liver was developed. The system used glycolithocholate and PAPS as substrates. Km values for glycolithocholate and PAPs were 2.8 microM and 11.5 microM, respectively. Furthermore bile salt sulphation capacity in infants with cholestasis was investigated by measuring the activity of the bile salt sulphotransferase in the liver. No significant difference was found between the sulphotransferase activity in cholestatic infants and non-cholestatic adults. In addition the magnitude of the bile salt sulphotransferase activity in as neonatal liver did not differ from the enzymatic activity in adult liver. It is thus considered unlikely that low degree of sulphation of bile salts in infants is due to reduced capacity of this enzyme system.

1 beta-hydroxylated bile acids in the urine of healthy neonates.

In order to clarify the metabolism of bile acids in neonates, 1 beta-hydroxylated bile acids in the urine of healthy newborns were examined by gas chromatography-mass spectrometry. The results showed that the percentage of total 1 beta-hydroxylated bile acids, 3 beta, 12 alpha-dihydroxy-5-cholenoic acid and hyocholic acid in neonates was significantly higher than in older children. The ratio of 1 beta-hydroxylated bile acids to their comparable primary bile acids was also higher in neonates than in older children. These results suggest that 1 beta- and 6 alpha-hydroxylation of bile acids are the predominant pathways of bile acid metabolism in neonates.

The effect of essential fatty acid deficiency on hepatic bile salt sulphotransferase in rats.

Hepatic bile salt sulphotransferase (BSS) activity and the contents of unconjugated oestradiol-17 beta (E2) and conjugated oestrone (cE1) in liver tissue was significantly lower in young essential fatty acid (EFA) deficient female rats than in female control rats. No corresponding differences were found between male EFA deficient and control rats. A significant sex difference, with higher values in females, was found for BSS activity and E2 and cE1 contents in control rats but not in EFA deficient rats. The decrease in hepatic BSS activity in female rats caused by EFA deficiency may be mediated via a decreased estrogenic action on the liver.

Vitamin D metabolism in pre-operative extrahepatic biliary atresia.

In order to clarify the pathogenesis of rickets in preoperative patients with extrahepatic biliary atresia, we evaluated baseline serum 25-OHD and 1,25(OH)2D levels and correlated serum 25-OHD levels with increase in age and season of birth in 16 preoperative patients. Further, parenteral vitamin D2 tolerance tests were performed in 5 cases. Serum 25-OHD and 1,25(OH)2D levels were significantly lower than those in 15 normal controls. There was a negative correlation between the serum 25-OHD levels and increase in age. The patients born during the winter had lower serum 25-OHD concentrations than those born in summer. The mean value of increased 25-OHD levels after the parenteral vitamin D2 tolerance tests did not differ from that of 6 controls. Since there was no impairment of vitamin D 25-hydroxylation, the reduction in serum 25-OHD may therefore be mainly due to disturbed intestinal vitamin D absorption. It was also concluded that season of birth and increase in age are pathogenic factors in the etiology of rickets in preoperative patients with extrahepatic biliary atresia.