A case of Evans syndrome combined with systemic lupus erythematosus successfully treated with rituximab.

Evans syndrome is a rare autoimmune disorder with unknown aetiology. Although corticosteroids and/or intravenous immunoglobulin (IVIG) are commonly used in its treatment, no standard strategy has been established. We report here a 44-year-old male with refractory Evans syndrome combined with systemic lupus erythematosus (SLE) who responded well to rituximab. He was admitted to our hospital with severe bleeding caused by worsening of Evans syndrome. Despite treatment with a high-dose corticosteroid and IVIG, his thrombocytopaenia and haemolytic anaemia did not improve. We started rituximab at a dose of 375 mg/m(2) once a week for a total of two doses. There was significant improvement in his thrombocytopaenia and anaemia 1 month after administration of rituximab. Although the total immunoglobulin G (IgG) level did not change, the titres of platelet-associated IgG (PA-IgG) and of an indirect antiglobulin test (IAT) decreased under the treatment with rituximab. It is suggested that rituximab would be a powerful candidate in the treatment of refractory Evans syndrome by depleting abnormal clone-producing autoantibody.

Nodular thickening of interlobar fissures: an early manifestation of malignant mesothelioma: a case report.

Two men with occupational exposure to asbestos were admitted to our hospital with minute pleural changes on their chest CT image. Conventional computed tomography (CT) scans of the chest showed slightly thickened interlobar fissures and a small amount of pleural effusion. In addition, high-resolution CT showed small nodular opacities on interlobar fissures. There were no intrapulmonary mass shadows, pleural plaques or other extrapulmonary mass shadows. These roentgenographical findings were very similar to each other. Hyarulonic acid values obtained from their pleural fluid were extremely high. Finally, we diagnosed them as having malignant mesothelioma using an immunocytochemical technique and electronmicroscopy. We conclude that HRCT is helpful in the diagnosis of malignant mesothelioma, particularly in its early manifestation such as nodular opacities of interlobar fissures.

Anti-proliferative effect of combined tumour necrosis factor-alpha and interferon-alpha on human pancreatic cancer in vitro and in vivo.

The anti-proliferative effects of tumour necrosis factor-alpha (TNF-alpha) and interferon-alpha (IFN-alpha), alone or in combination, on human pancreatic cancer cells lines (PANC-1, MIA PaCa-2 and BxPC-3) and human pancreatic cancer tumour (Exp-58), were investigated in vitro and in vivo. The anti-proliferative effect was determined using the dye uptake method and the subcutaneous tumour model. Combined TNF-alpha and IFN-alpha demonstrated marked synergistic and/or additive effects in comparison with their effects as single agents. These results suggest that combined cytokine therapy of TNF-alpha and IFN-alpha may make possible some improvement in the treatment of pancreatic carcinoma patients in the future.

Tetrazomine, a new antibiotic produced by an actinomycete strain. Taxonomy, fermentation, isolation and characterization.

A new antibacterial antibiotic tetrazomine was found from the fermentation broth of an actinomycete strain which was isolated from beach sand collected at Chichijima, Ogasawara Islands, Tokyo, Japan. The strain Y-09194L, was identified as Saccharothrix mutabilis subsp. chichijimaensis subsp. nov. The antibiotic exhibited broad antimicrobial activity against Gram-positive and Gram-negative bacteria in vitro. It also exhibited strong cytotoxic activity against P388 leukemia cells and showed antitumor activity against P388 leukemia. The apparent molecular formula of tetrazomine was determined as C24H34N4O5. It has a rare structure which consists of six rings including piperidine, piperadine, oxazole, and pyrrolidine.

Prolonged survival of mice with myeloid leukemia by subcutaneous injection of recombinant human G-CSF.

We studied the effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on leukemia development and survival of mice with leukemia by using a radiation-induced myeloid leukemia cell line (C2M) with A-type phosphoglycerate kinase (PGK) as marker isoenzyme. C3H/He mice with B-type PGK were inoculated with 2 x 10(6) C2M cells through the tail vein. From the next day, they received a daily subcutaneous injection of 1 microgram rhG-CSF or control solution. The survival of rhG-CSF-treated recipients of C2M was significantly longer than control-solution-treated recipients. In rhG-CSF-treated recipients, not only spleen weight but also the number of blasts in hemopoietic organs was less than those in control recipients. While there was a remarkable decrease in bone marrow content of CFU-GM in control recipients, the content in rhG-CSF-treated recipients was comparable to that in normal mice. A reduced bone marrow and spleen content of leukemic colony-forming cells (L-CFU) was observed in rhG-CSF-treated recipients in comparison with control recipients. The electrophoretic analysis of PGK phenotypes of hemopoietic organs indicated the delayed appearance of A-type PGK from C2M cells in rhG-CSF-treated recipients. From these findings, we concluded that the injection of rhG-CSF delayed the onset of leukemia and improved the survival and several hematological parameters by suppressing C2M cells in recipient mice.

In vitro studies on the antibacterial activities of YM-13115, a new broad-spectrum cephalosporin.

The in vitro antibacterial activities of YM-13115, a new parenteral cephalosporin, were compared with those of ceftazidime, cefoperazone, and cefsulodin. The compound was highly active against the common members of the Enterobacteriaceae and 2 to 256 times more active than cefoperazone. YM-13115 was as active as ceftazidime against Citrobacter freundii, Proteus vulgaris, and Morganella morganii and two to four times more active than ceftazidime against Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, and Providencia stuartii. The activity of YM-13115 against Pseudomonas aeruginosa (with MICs of 0.78 and 3.13 micrograms/ml for 50 and 90% of the isolates, respectively) was ca. 2 times that of ceftazidime, 4 times that of cefsulodin, and 16 times that of cefoperazone. Against Haemophilus influenzae YM-13115 was more active than ceftazidime. YM-13115 was less active than ceftazidime, cefoperazone, and cefsulodin against Staphylococcus aureus and Staphylococcus epidermidis. The concentrations of YM-13115 required to inhibit the growth of 90% of the isolates of Streptococcus pyogenes and Streptococcus pneumoniae were 0.78 and 1.56 microgram/ml, respectively, but concentrations above 100 micrograms/ml were required to inhibit Streptococcus faecalis. YM-13115 was not hydrolyzed by the common plasmid and chromosomal beta-lactamases. YM-13115 is extremely active against P. aeruginosa and members of the Enterobacteriaceae.