Meniscal cyst in the posterior intercondylar space found by magnetic resonance imaging.

We report a rare case of meniscal cyst from the posterior horn of the lateral meniscus, extending in the posterior intercondylar space of the right knee of a 15-year-old boy, in whom magnetic resonance imaging was very useful for evaluation. A cyst in this location has not been reported previously. The cyst was removed surgically, while preserving the lateral meniscus. A good result was obtained, and no recurrence has been seen in 12 months.

[Necrotizing fasciitis due to invasive group A streptococcal infection: a case report].

Necrotizing fasciitis is a relatively rare but potentially fatal soft tissue infection. We report a case of invasive group A streptococcal necrotizing fasciitis. Patient was a 55-year-old healthy male who presented an expanding suppurative lesion over the left lower extremity within one day. Streptococcus pyogenes was a sole microorganism isolated from the infection site. The key to successful treatment in this case was suggested to be early diagnosis combined with aggressive debridement followed by open drainage and high dose administrations of piperacillin before complications such as liver dysfunction and renal failure became serious.

[Detection of immune complex by C1q solid phase enzyme immunoassay].

We have developed a new and improved method for detecting immune complexes (IC) by C1q solid-phase enzyme immunoassay (CSP-EIA). The sensitivity of this method was between 0.62 micrograms/ml and 1.25 micrograms/ml, and values in normal individuals were 1.8 micrograms/ml and less. The positive rate of IC of sera in which abnormal values were detected by autoimmune disease associated laboratory examinations was 50.0% in RA (2+), 20.4% in ANA (+), 60.0% in CH50 (less than 10), 41.7% in LE latex (+). In sera of RA (2+), the higher the value of CRP detected by a semi-quantitative analysis was, the higher the frequency having abnormal high IC values was. The number of IC positive sera, in which enzyme-linked immunoglobulins were detected, was 18 of 68 (positive rate 26.5%). The number of IC positive samples in asymptomatic carriers of sera, whose titer of anti-HTLV-I antibody was positive by gelatin particle agglutination assay (PA), was 14 of 67 (pos. rate 18.4%). All of these 14 samples were high positivity of anti-HTLV-I antibody (titer greater than or equal to 256 times). In urine of some patients with urogenital diseases, IC-like substances to show positive reaction by our CSP-EIA were detected. However, any positive reaction was not detected either by an anti-C1q- or an anti-C3d method. Studies are in progress to elucidate detailed characterization of the IC-like substances.

Enhancement of depressed lymphokine activated killer cell activity in patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) patients can be divided into two groups according to the degree of lymphokine activated killer (LAK) cell activity; a high LAK activity group (H-LAK-HCC) and a low LAK activity group (L-LAK-HCC). Interferon-gamma (IFN-gamma) production is severely defective in L-LAK-HCC but not defective in H-LAH-HCC. IFN-gamma production is suppressed with the addition of anti-Tac in dose dependent manner, though LAK activity is suppressed only in the presence of high concentration of anti-Tac. LAK activity is suppressed with the addition of anti-IFN-gamma, which is most prominent when the antibody is present during the first 12 hr of incubation. LAK generation is enhanced with the addition of recombinant IFN-gamma, which is most prominent when it is present during the first 12 hr of incubation. However, this enhancing effect is less prominent in L-LAK-HCC as compared to normals, liver cirrhosis, and H-LAK-HCC. This enhancement is regarded to depend on the presence of Leu7+ and Leu11+ subset, as this enhancement is abandoned and IFN-gamma production is inhibited when either of these subsets is deleted. These data suggest that IFN-gamma production and the participation of Leu7+ and Leu11+ subsets is important in sufficient LAK generation, and that poor IFN-gamma production and insufficient response to IFN-gamma may be the cause of severely defective LAK generation in L-LAK-HCC.

Adoptive immunotherapy with lymphokine-activated killer cells plus recombinant interleukin 2 in patients with unresectable hepatocellular carcinoma.

Ten patients with hepatocellular carcinoma, three of whom had pulmonary metastasis, were treated with adoptive immunotherapy using autologous lymphokine-activated killer cells plus recombinant interleukin 2. Patients received 15 micrograms per day of recombinant interleukin 2 consecutively (for 14 to 64 days), from Day 7 prior to the first leukapheresis, and received 10(9) to 10(10) lymphokine-activated killer cells once or twice per week intravenously; the lymphokine-activated killer cells had been generated from mononuclear cells obtained through leukapheresis. Preadministration of recombinant interleukin 2 prior to the first leukapheresis resulted in a remarkable increase of lymphokine-activated killer activity in seven of nine cases in whom lymphokine-activated killer activity had been poorly inducible even at high concentrations of recombinant interleukin 2. At the end of the treatment, liver tumor regression (34 and 63%, respectively, of two-dimensional size) was observed in two of two patients with a solitary tumor; no increase of liver tumor size was observed in seven patients with massive or multiple tumors, and no changes in the size or number of pulmonary metastatic tumors in any patients were observed. More than a 35% decrease in serum alpha-fetoprotein level was noted in four of nine alpha-fetoprotein-positive patients. However, Child's grades, performance status and lymphokine-activated killer activity on entry into the study could not be used as parameters to predict therapy responsiveness. Neither serious side effects nor significant changes of serum bilirubin, ALT and creatinine were noted. Thus, this treatment seems to be well tolerated even in advanced hepatocellular carcinoma with poor liver function reserve, and tumor regression could be expected in small-burden hepatocellular carcinoma. The assessment of the therapeutic effects and application in hepatocellular carcinoma awaits the development of this trial.

Defective function of lymphokine-activated killer cells and natural killer cells in patients with hepatocellular carcinoma.

Lymphokine-activated killer activity and natural killer activity in hepatocellular carcinoma patients were assessed. Maximum lymphokine-activated killer activity was induced at 3 to 5 days of incubation, and lymphokine-activated killer activity tended to increase in a manner dose dependent of recombinant interleukin-2. However, the maximum increase of lymphokine-activated killer activity in hepatocellular carcinoma was not as high as that of normal subjects or liver cirrhosis patients. Lymphokine-activated killer activity was impaired in hepatocellular carcinoma as compared to that in normal subjects. Hepatocellular carcinoma seemed to consist of two groups: i.e. a high-lymphokine-activated killer activity group and a low-lymphokine-activated killer activity group. Reduction of natural killer activity was also observed in hepatocellular carcinoma as compared with that in normal subjects and patients with liver cirrhosis. No correlation could be demonstrated between natural killer activity and lymphokine-activated killer activity in normal subjects, liver cirrhosis patients and hepatocellular carcinoma patients. With regard to the presence of HBsAg or alpha-fetoprotein concentration in the sera, there was no significant difference in natural killer and lymphokine-activated killer activity in hepatocellular carcinoma patients. Patients with a small mass lesion showed a low lymphokine-activated killer activity, and depressed lymphokine-activated killer activity was not necessarily related to tumor size. In comparison with the high-lymphokine-activated killer group, the low-lymphokine-activated killer group showed a significant decrease in gamma-interferon production and a preserved function of indocyanine green clearance.

[Experimental polymicrobial osteomyelitis produced by both aerobic and anaerobic opportunistic pathogens].

Experimental models of polymicrobial osteomyelitis were prepared using clinical isolates of Staphylococcus epidermidis and Enterococcus faecalis as aerobes and Bacteroides fragilis and Bacteroides bivius as anaerobes. These pathogens were used because of their opportunistic properties. Two 8 mm long silk threads with the microorganism were inserted into the bone marrow of a rat. The microorganism inoculated was about 10(5) c.f.u. for aerobes and 10(6) c.f.u. for anaerobes. Infected parts observed in the roentgenograms, histopathological changes, and bacterial counts all showed the evolution of osteomyelitis. It was found that our models caused osteomyelitis both when each of S. epidermidis, E. faecalis, B. fragilis, and B. bivius was implanted individually and in their combinations. The patterns of the radiological and the histological observations were almost similar in all cases examined, but their characteristics differed depending on the kinds and combinations of the pathogens.