Severe impairment in early host defense against Candida albicans in mice deficient in myeloperoxidase.

Myeloperoxidase (MPO) catalyzes the reaction of hydrogen peroxide with chloride ion to produce hypochlorous acid (HOCl), which is used for microbial killing by phagocytic cells. Despite the important role of MPO in host defense, however, MPO deficiency is relatively common in humans, and most of these individuals are in good health. To define the in vivo role of MPO, we have generated by gene targeting mice having no MPO activity in their neutrophils and monocytes. The mice without MPO developed normally, were fertile, and showed normal clearance of intraperitoneal Staphylococcus aureus. However, they showed increased susceptibility to pneumonia and death following intratracheal infection with Candida albicans. Furthermore, the lack of MPO significantly enhanced the dissemination of intraperitoneally injected C. albicans into various organs during the first 7 days. Thus, MPO is important for early host defense against fungal infection, and the inability to generate HOCl cannot be compensated for by other oxygen-dependent systems in vivo in mice. The mutant mice serve as a model for studying pulmonary and systemic candidiasis.

Gastric outlet syndrome caused by a gallstone: report of a case.

An extremely unusual case of gastric outlet syndrome, otherwise known as Bouveret's syndrome, caused by a large gallstone impacted in the duodenum due to a cholecystoduodenal fistula (CDF), is described herein. Another large gallstone impacted in the CDF itself was also detected. As endoscopic extraction of the gallstone from the duodenum proved unsuccessful, and a laparotomy was required. Our patient, being 88 years old, is probably the oldest patient recorded in the literature of this syndrome. The methods of establishing a correct diagnosis by endoscopy and recent therapeutic strategies are discussed following the case report.

Primary malignant lymphoma of the rectum with distant metastasis to the stomach: report of a case.

Primary extranodal malignant lymphoma frequently occurs in the gastrointestinal tract: however, it is rarely encountered in the rectum. We report herein the case of an 85-year-old man who underwent abdominoperineal resection for primary malignant lymphoma of the rectum, and 1 year later, developed hematemesis caused by gastric metastasis. To our knowledge this is the first case report of such distant metastasis developing from malignant lymphoma of the rectum.

Relapse of colon cancer followed by polymyositis: report of a case and review of the literature.

The direct causal relationship between dermatomyositis-polymyositis (PM) and malignancy remains controversial. We describe herein the case of a patient who underwent surgical treatment for colon cancer, which had preceded the onset of PM with tumor relapse. The PM markedly improved following the initiation of steroid therapy, and has remained under control, probably as a result of chemotherapy. The current concepts of variable clinical courses and the possible mechanism for the association of PM with malignancy are discussed following this case report.

Anorectal malignant melanoma: report of a case.

A 74-year-old woman presented with anal bleeding and a protuberant mass. A biopsy of the mass revealed the proliferation of spindle-shaped cells with melanin pigments, and an abdominoperineal resection was performed, the histology of which confirmed malignant melanoma. Surgery was absolutely noncurative because massive metastases were encountered in the pelvic and paraaortic lymph nodes. However, postoperative chemotherapy, composed of decarbazine (DTIC), vincristine (VCR), and nimustine hydrochloride (ACNU), achieved satisfactory results. The patient has been well without any evidence of recurrence for more than 3 years.

Ceruloplasmin concentration in human colostrum and mature milk.

The concentration of ceruloplasmin (CP) in human milk was obtained by measuring the increased absorbance of a solution containing apotransferrin and Fe2+ at 460 nm after adding the milk. The CP concentrations in colostrum and mature milk at less than 1 month after parturition were 4.45 +/- 1.23 mg and 4.09 mg +/- 1.47 mg/100 ml, respectively. In mature milk after more than one month, the CP concentration had decreased to 1.72 +/- 0.91 mg/100 ml.

Suppressive Effects of Lactoferrin on Bleomycin-dependent DNA Damage by the Iron Ion and Ascorbate.

The effects of the iron ion and reductones on bleomycin (BLM)-induced DNA degradation were observed by measuring the amount of malondialdehyde (MDA) formed. The formation of MDA was detected after adding Fe(2+) or Fe(3+) + Asc combined to a solution consisting of DNA and BLM, but not after adding Fe(3+) alone, catecholamines or phenolic compounds. Marked suppressive effects of lactoferrin (Lf) and ovotransferrin on MDA formation were observed in the solution with Fe(2+) or Asc. However, serum albumin, ß-lactoglobulin, α-lactalbumin, and ovoalbumin had no effect on suppressing MDA formation. The suppression by bovine Lf (bLf) of MDA formation decreased with increasing iron saturation at 1.0 mm Fe(2+), but at 100% iron saturation, 51.2% of apo-bLf remained suppression. In the solution with 0.25 mm Asc, 100% iron saturated bLf markedly enhanced MDA formation.

Unruptured aneurysm of the right coronary cusp.

A 44-year-old man with an unruptured aneurysm originating from the right coronary cusp is reported. The patient was asymptomatic and a heart murmur and abnormal electrocardiogram were discovered incidentally. Echocardiography and aortography showed an unruptured aneurysm of the right coronary cusp. Surgical correction was successful using a Dacron patch and aneurysmal wall.

Surgical treatment of a huge hepatic artery aneurysm--a case report.

A debilitated 68 year old woman with an epigastric mass previously identified as a hepatic artery aneurysm (HAA) by selective angiography, developed acute epigastric pain radiating to her back. Impending rupture was diagnosed, and the patient successfully underwent surgical repair using a prosthetic patch to close the orifice of the aneurysm. HAA is uncommon, but the risk of rupture is great, being 44 per cent and the mortality rate high, being 35 per cent. Abnormal ultrasonography and CT may suggest the diagnosis, but selective arteriography is definitive. Surgical treatment is indicated in most patients, although embolization is appropriate for intrahepatic aneurysm and extremely poor risk patients.

Acute left main coronary artery occlusion--a case report and review of the literature.

Acute left main coronary artery (LMCA) occlusion is rare and typically fatal. According to the recent literature, only three cases have been reported surviving emergent coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) caused by total LMCA occlusion. We report the case of a 52-year-old man presenting with total occlusion of the LMCA associated with acute anterolateral myocardial infarction and cardiogenic shock. The patient's dominant right coronary artery did not supply the collaterals to the left coronary system. After ineffective thrombolysis the patient underwent successful emergent CABG for the management of uncontrollable cardiogenic shock. Emergent CABG, though controversial, appears to be a feasible approach for patients with AMI in life-threatening situations, when other attempts at reperfusion have been unsuccessful.

Repair of an aortoiliac aneurysm associated with chronic disseminated intravascular coagulopathy--a case report.

We report herein an unusual case of a 77 year old man who developed chronic disseminated intravascular coagulopathy (DIC) caused by an aortoiliac aneurysm. After preoperative heparin therapy, the aneurysm was successfully replaced with a prosthetic graft despite heavy blood loss. Moreover, the infusion of platelet concentrate and autotransfusion proved helpful during the operation and his hypofibrinogenemia and thrombocytopenia became normalized immediately after surgery. Thus, although preoperative heparin therapy can help control DIC, surgical repair of the aneurysm is the definitive treatment in this kind of case.

[Management of coronary artery bypass grafting surgery by continuous ambulatory peritoneal dialysis in a patient with chronic renal failure under hemodialysis].

A 64-year-old patient with chronic renal failure underwent coronary artery bypass grafting (CABG) because of the frequent severe angina during hemodialysis. Intraoperative hemodialysis and extra-corporeal ultrafiltration method (ECUM) was used during cardiopulmonary bypass. Postoperative management was successfully performed by continuous ambulatory peritoneal dialysis (CAPD), which made hemodynamics stable and prevented postoperative bleeding, providing with adequate fluid removal and satisfactory control of serum chemistry.