[A case of pulmonary actinomycosis with recurrent hemoptysis diagnosed after right upper lobectomy].

The patient was a 58-year-old man who had been admitted in 1995 because of hemoptysis. Chest CT scans showed air-space consolidation with dilated bronchi and calcification in the right S3. He received a diagnosis of bronchiectasis with old tuberculosis. Bronchial arteriography showed arterialization in the right S3, and bronchial artery embolization was performed. But in 1996 hemoptysis reappeared. He was readmitted in May 1999 because of recurrent hemoptysis. Bronchial arteriography showed recurrence of arterialization in the same area, and chest CT scans showed growth of the mass shadow. Right upper lobectomy was performed, and the microscopic findings of the resected specimen showed sulfur granules in the dilated bronchus. We concluded that pulmonary actinomycosis should be considered in the differential diagnosis of abnormal chest shadows.

[Relapse of idiopathic chylothorax 17 years after remission of congenital chylothorax].

We report a case of chylothorax in a 17-year-old male. As a neonate, had had congenital chylothorax, and was successfully treated with medium-chain triglycerides; but recently presented with dyspnea after an episode of severe coughing. Radiographic examination disclosed abundant effusion in the right chest. The effusion was milky brown, had a creamy supernatant and a high triglyceride level (3085 mg/dl). This condition was diagnosed as idiopathic chylothorax. Lymphangiography showed a rupture of the right thoracic duct. Since the effusion was resistant to conservative therapy, we performed thoracoscopic clipping of the thoracic duct, which reduced the amount of pleural effusion. We speculated that coughing may have caused the rupture of a congenitally weakened thoracic duct.

Effect of mild hypoxia on airway responsiveness to methacholine in subjects with airway hyperresponsiveness.

STUDY OBJECTIVES: The inhalation of hypoxic gas has been reported to enhance the airway responsiveness to methacholine in some animal models. However, the data on humans have so far been conflicting. We attempted to examine the effect of hypoxic gas inhalation on the airway responsiveness to methacholine. DESIGN: We evaluated the airway responsiveness to methacholine by continuously measuring respiratory conductance with the forced oscillation method under normoxia or hypoxia in a single-blind, randomized, crossover fashion (2 days for each). PARTICIPANTS: Twelve asymptomatic male volunteers (mean +/- SD age, 27 +/- 4 years) with airway hyperresponsiveness to methacholine. Two of the 12 volunteers had a history of bronchial asthma. SETTING: The participants inhaled either normoxic or hypoxic gas with continuous inhalation of aerosolized methacholine in incremental doses with a sustained respiratory rate of 15 breaths/min. The arterial oxygen saturation was kept to 90% on the hypoxic days. RESULTS: There were no significant differences in any indexes of airway responsiveness to methacholine (the cumulative dose of methacholine at the threshold and the point of 35% decrease of the respiratory conductance, and the slope factor of the dose-response curve) between the hypoxic days and the normoxic days. CONCLUSION: The inhalation of mildly hypoxic gas does not enhance the airway responsiveness to methacholine in humans with airway hyperresponsiveness.

[Chronic pulmonary thromboembolism diagnosed on the basis of characteristic mosaic patterns on lung computed tomograms].

We report on a 59-year-old woman who presented with characteristic findings on lung computed tomographic (CT) scans and was therefore suspected to have chronic pulmonary thromboembolism. She visited our hospital because of worsening exertional dyspnea over the preceding year, and because she was dissatisfied with an earlier diagnosis made by another institution. Chest roentgenograms disclosed nonhomogeneous hyperlucency in both lungs associated with linear and bundle shadows, dullness of the right costophrenic angle, and dilatation of the descending branch of the right pulmonary artery. The patient experienced moderate hypoxemia even at rest. Pulmonary function tests demonstrated a restrictive ventilatory pattern associated with reduced diffusion capacity. The lung CT scans disclosed a mosaic pattern of attenuation in the lung parenchyma, which probably reflected scattered areas of low perfusion. The unique characteristics of such CT findings drew our attention to chronic pulmonary thromboembolism as a possible diagnosis. We eventually confirmed the diagnosis on the basis of enhanced CT scans, pulmonary perfusion and ventilation scintigrams, and digital subtraction angiography. In our view, chronic pulmonary thromboembolism should be kept in mind as a possible differential diagnosis of the mosaic patterns of attenuation on lung CT scans.

Technetium-99m-tetrofosmin imaging of lung cancer: relationship with histopathology.

Tc-99m-tetrofosmin is an agent to delineate cancer. To elucidate the usefulness of Tc-99m-tetrofosmin scintigraphy, we analyzed the relationship between the uptake of Tc-99m-tetrofosmin and histopathology in patients with lung cancer. SPECT studies were conducted twice: 15 minutes (early scan), and 60 minutes (delayed scan), after intravenous injection of 740 MBq Tc-99m-tetrofosmin. We calculated the retention index in order to evaluate the degree of Tc-99m-tetrofosmin retention in the primary tumor. The retention indices were significantly lower in squamous cell carcinoma than those of small cell carcinoma or adenocarcinoma. As the retention indices of Tc-99m-tetrofosmin were different in each histopathology, the index might play a part as a tumor marker of lung cancer.

Measurement of exhaled nitric oxide concentration using nasal continuous negative pressure.

Contamination of nasal nitric oxide (NO) is a major obstacle when one needs to sample exhaled NO originating only from the lungs. To eliminate nasal NO, we used the nasal continuous negative pressure (nasal CNP) technique which, we verified, caused closure of the vellum. Exhaled gas was sampled from six healthy volunteers into fraction 1 (initially exhaled 200 mL) and fraction 2 (remainder of the gas) under three conditions; while subjects were wearing a noseclip, using nasal CNP at -5, -10 and -20 cm H2O, and under endotracheal intubation. Exhaled NO concentration ([NO]) obtained with nasal CNP was significantly lower, regardless of the pressure applied, than that measured with a noseclip, and was similar to and closely correlated to that obtained under intubation (F1, r = 0.90; F2, r = 0.88; P < 0.05). Real-time recorded [NO] obtained with nasal CNP of -5 cm H2O was again lower than that measured with a noseclip at any expiratory flow rate examined, indicating nasal NO contamination was eliminated irrespective of the flow rate. In conclusion, because a nasal CNP of -5 cm H2O was easily tolerated without any discomfort, this technique is a simple, easy and effective technique to eliminate nasal NO which should be widely applicable for the measurement of exhaled [NO].

Plasma concentration of adenosine during normoxia and moderate hypoxia in humans.

Adenosine, a purine nucleoside, plays a variety of roles in cardiovascular and ventilatory control, and may be a marker of tissue hypoxia. There is, however, no direct evidence of an increase in plasma or in tissue levels of adenosine during moderate hypoxia in humans. We measured the plasma concentrations of adenosine in an artery and the median cubital vein simultaneously in 12 normal volunteers, and also in the internal jugular vein in seven of them during normoxia and moderate hypoxia (SaO2 = 80%, 20 min) with or without dipyridamole (0.6 mg/kg) pretreatment. Dipyridamole was expected to block reuptake of adenosine by red blood cells and vascular endothelial cells so that the plasma level of adenosine would more likely reflect the tissue level. Blood was sampled with an appropriate stopping solution, and adenosine was measured with a high-pressure liquid chromatographic (HPLC)-fluorometric technique. The plasma concentration of adenosine did not rise either in the artery or in the vein at any phase of hypoxia without the dipyridamole pretreatment. However, when subjects were pretreated with dipyridamole, the plasma concentration of adenosine increased significantly and markedly in a time-dependent manner during hypoxia in the vein, but not in the artery. The adenosine level rose from 20. 7 +/- 2.5 nM (mean +/- SE) during normoxia to 50.7 +/- 10.7 nM at 20 min of hypoxia, and returned to the baseline level in the recovery phase. The plasma concentration of adenosine in the jugular vein did not change during hypoxia either with or without dipyridamole pretreatment. These data provide evidence that in humans, the local production of adenosine increases during moderate hypoxia in forearm tissue, although this is not reflected in plasma unless the subject is pretreated with dipyridamole.

Bacillus horti sp. nov., a new gram-negative alkaliphilic bacillus.

Novel Gram-negative alkaliphilic strains were isolated from soil obtained from Atsuma, Hokkaido, Japan. The isolates were strictly aerobic rods that produced subterminally located ellipsoidal spores. Chemotaxonomic characteristics of the isolates included the presence of meso-diaminopimelic acid in the cell wall and a DNA G + C content of 40.2-40.9 mol%. The major isoprenoid quinone was menaquinone-7 and the cellular fatty acid profile consisted of a significant amount of 15-C branched-chain acids, iso-C15:0 and anteiso-C15:0. The growth rate was higher at pH 8-10 than at pH 7. Comparative sequence analysis of 16S rDNA of 14 alkaliphilic Bacillus strains indicates that the isolated strain has an equidistant relationship to three already defined rRNA groups of alkaliphilic Bacillus species. Based on the morphological and physiological characteristics, as well as phylogenetic position as determined by 16S rDNA analysis and DNA-DNA relatedness data, it is concluded that these isolates should be designated as a new species, for which the name Bacillus horti is proposed. The type strain is K13T (= JCM 9943T).

Influence of sporulation medium and divalent ions on the heat resistance of Alicyclobacillus acidoterrestris spores.

The influence of divalent cations on the heat resistance of spores of the thermoacidophilic spoilage bacterium Alicyclobacillus acidoterrestris was studied. The heat resistance of A. acidoterrestris spores was not affected by the presence of the different divalent cations (Ca2+, Mg2+, Ba2+, Mn2+ and Sr2+) in the sporulation medium, and by the demineralization or remineralization. And the Ca and Mn contents in A. acidoterrestris spores were scarcely changed by these treatments. However, the heat resistance of Bacillus subtilis spores was affected with the changes of Ca content in the spores. The Ca contents in A. acidoterrestris spores of the different forms were greater than the DPA content. In contrast, the DPA content in the B. subtilis spores was greater than the Ca content. These findings suggest that the presence of constant amount of Ca-DPA and a stronger binding characteristic of divalent ions, especially Ca and Mn, is reflected in the specific heat resistance of A. acidoterrestris spores.

Heart rate during obstructive sleep apnea depends on individual hypoxic chemosensitivity of the carotid body.

BACKGROUND: In patients with obstructive sleep apnea syndrome (OSAS), there are cyclic fluctuations in heart rate (HR), that is, bradycardia during apnea followed by abrupt tachycardia on resumption of ventilation. Although a previous study suggested that the degree of bradycardia observed during central apnea at high altitude was determined by individual hypoxic chemosensitivity of the carotid body, it is not known whether this is true for subjects with obstructive sleep apnea syndrome. METHODS AND RESULTS: First, we examined apnea-associated HR changes in II subjects with OSAS and analyzed the relationship of the HR change during apnea (delta HR, defined as the difference between the values at the beginning and the end of apnea) and apnea-induced nadir SaO2 in each subject. Second, we conducted an apnea-simulation study in 7 subjects to examine whether the individual pattern of delta HR could be simulated while they held their breath under different levels of arterial oxygenation. The delta HR was highly variable among subjects: 2 showed an increase in HR during apnea, 6 a decrease, and the other 3 a borderline-type response. The slope factor of the nadir of the SaO2-delta HR line obtained from each subject had a significant correlation with the HR change during breath-holding conducted under normoxia (Spearman's rank correlation coefficient, rs = 69, P < .05) or hypoxia (rs = .81, P < .05) but not under hyperoxia. Finally, we evaluated hypoxic chemosensitivity of the carotid body by measuring the ventilatory response to isocapnic progressive hypoxia in all subjects. The magnitude of the ventilatory response ranged from 0.05 to 1.89 L.min-1.%SaO2 fall-1 and showed a significant correlation with the slope factor of the nadir of the SaO2-delta HR line (rs = -.64, P < .05). CONCLUSIONS: The intersubject variation of the HR changes during sleep apnea can be explained in large part by individual hypoxic chemosensitivity of the carotid body regardless of the type of apnea.

Comparative sequence analyses of the genes coding for 16S rRNA of Lactobacillus casei-related taxa.

The primary structures of the 16S rRNA genes of the type strains of Lactobacillus casei and related taxa were determined by PCR DNA-sequencing methods. The sequences of Lactobacillus casei, Lactobacillus zeae, Lactobacillus paracasei, and Lactobacillus rhamnosus were different. The Knuc values ranged from 0.0040 to 0.0126. On the basis of the Knuc values and the levels of DNA-DNA relatedness among the strains of these species, the L. casei-related taxa should be classified in the following three species: L. zeae, which includes the type strains of L. zeae and L. casei; a species that includes the strains of L. paracasei and L. casei ATCC 334; and L. rhamnosus.

Specific primers for detection of Alicyclobacillus acidoterrestris by RT-PCR.

The reverse transcription-polymerase chain reaction (RT-PCR), after a short enrichment culture, was used to detect Alicyclobacillus acidoterrestris in acidic beverages. Two specific primers were selected from the region of V2 and V4 on 16S rRNA gene. With this primer set, 294-bp fragments from A. acidoterrestris could be amplified. The detection limit of the RT-PCR with the FHLP filters was about 10-1 fg of pure total RNA per reaction. Juice samples inoculated with 10(4) cfu of A. acidoterrestris per ml were RT-PCR positive without enrichment. However, after 15 h of enrichment, the samples inoculated with 2-3 cfu ml-1 were positive. This RT-PCR culture assay would enable rapid and specific detection of strains of A. acidoterrestris in acidic beverages.

Production of nitric oxide (NO) in intrathoracic airways of normal humans.

To gain insight into the source of exhaled nitric oxide (NO) in normal humans, we examined the effects of respiratory pattern on the concentration of NO in exhaled air while subjects were wearing a noseclip and then under endotracheal intubation, using a specially designed gas sampling system to separate exhaled air into two fractions: the initially exhaled 200 ml (Fraction 1; F1), and the remainder (Fraction 2; F2). We also examined the effect of hypoxic gas inhalation (F(I)O2 = 0.1, 3 min) on the concentration of exhaled NO. The concentration of exhaled NO measured with a chemiluminescence NO analyzer was significantly lower with intubation, by 59.2 +/- 10.6% (mean +/- SD) (F1) and 54.4 +/- 8.0% (F2), than without intubation. The concentration of NO in F1 was consistently higher than that in F2 with or without intubation. With breath holding, the concentration of NO increased markedly only in F1. In contrast, prolongation of the expiratory phase slightly but significantly increased the concentration of NO only in F2. Inhalation of hypoxic gas did not cause any significant change in NO concentration in either fraction. These data indicate that in normal humans wearing a noseclip, about 40 to 45% of NO in exhaled air originates from the lungs, particularly from intrathoracic airways. The concentration of exhaled NO collected from subjects wearing a noseclip is not affected by hypoxic gas inhalation.

Isolation and identification of Alicyclobacillus acidoterrestris from acidic beverages.

Thermophilic bacteria isolated from spoiled acidic beverages were identified on the basis of DNA-DNA homology and 16S ribosomal DNA sequence similarity to Alicyclobacillus acidoterrestris. This result suggested that the isolates were a new type of spoilage bacterium in acidic beverages in Japan.

[Usefulness of twenty-four-hour home monitoring of oxygen saturation in patients with chronic obstructive pulmonary disease].

The clinical usefulness of 24 hr home monitoring of oxygen saturation (SaO2) with pulse oximeter was studied in 48 outpatients with COPD. In addition, doppler echocardiography for measurement of acceleration time (AcT), which inversely correlates with mean pulmonary arterial pressure, a 6-minute walk test, and an exercise study on a bicycle ergometer were performed in 26, 17, and 14 patients, respectively. Nadir SaO2 and the total time during which SaO2 was below 90% were calculated to estimate diurnal and nocturnal oxygen desaturation (diurnal nadir SaO2, diurnal TSaO2 < 90%, nocturnal nadir SaO2, and nocturnal TSaO2 < 90%). Relations between the indices of desaturation measured during home monitoring and dyspnea grade (Fletcher-Hugh-Jones), awake PaO2, AcT, Hb, Ht, and oxygen desaturation during the exercise tests were also studied. Diurnal nadir SaO2 was lowest and diurnal TSaO2 < 90% was longest in the group with dyspnea grade IV. In the other groups, various degrees of oxygen desaturation were observed, even within groups. Diurnal nadir SaO2 and nocturnal nadir SaO2 correlated with awake PaO2, but not with diurnal TSoO2 < 90%. Diurnal nadir SaO2 was similar to nadir SaO2 during the exercise tests. AcT, hemoglobin, and hematocrit correlated with diurnal oxygen desaturation but not with nocturnal oxygen desaturation. From the above findings, we conclude that pulmonary hypertension may be associated with diurnal oxygen desaturation, and that home monitoring of SaO2 is useful for the detection of oxygen desaturation not predicted from dyspnea grade and PaO2 while awake.

Binding of lysozyme onto a cation-exchange microporous membrane containing tentacle-type grafted polymer branches.

Ion-exchange adsorption of lysozyme to the sulfonic acid (SO3H) group on polymer chains grafted onto microporous polyethylene hollow-fiber membranes was examined. The lysozyme solution was forced to permeate across the hollow fiber. Diversely anchored SO3H groups, i.e., SP and SS groups, were introduced into the membrane by reaction of the glycidyl methacrylate-grafted membrane with propanesultone and sodium sulfite, respectively. The resulting SP and SS group-containing membranes, designated as SP-T and SS-T fibers, respectively, had 95 and 77% water flux of the original membrane, respectively. The binding capacity of lysozyme as a function of the SO3H group density was compared between the SP-T and SS-T fibers from measurement of the ion-exchange breakthrough curves during the permeation of lysozyme solution across the SP-T and SS-T fibers. The binding capacity of lysozyme to the SP-T fiber remained constant, independent of the SP group density, whereas that to the SS-T fiber increased linearly with increasing SS group density. This difference was explained by means of a model whereby lysozyme adheres onto the SP group-containing grafted polymer branches, while the SS group-containing grafted polymer branches hold lysozyme in a tentacle-like manner.

Ion exchange of lysozyme during permeation across a microporous sulfopropyl-group-containing hollow fiber.

A microporous hollow fiber containing a sulfopropyl (SP) group as a strongly acidic cation-exchange group was prepared by radiation-induced graft polymerization of glycidyl methacrylate, followed by hydrolysis of the resulting epoxide group into a diol, and then conversion of the diol into the SP group. The SP group density of the resulting hollow fiber ranged from 0.21 to 0.84 mol/kg of dry fiber with a pure water flux of 2.7 m/h at a filtration pressure of 0.1 MPa. Lysozyme adsorption was examined during permeation of the lysozyme solution (pH 6) through the pores across a microporous cation-exchange hollow fiber. The lysozyme concentration of the effluent penetrating the outside of the hollow fiber did not change irrespective of the residence time of the solution across the hollow fiber, which was indicative of the negligible diffusional resistance of lysozyme to the SP group. The binding capacity of lysozyme to the fiber was constant in this range of SP group density. For comparison, the adsorption characteristics of a cupric chloride solution during permeation were also determined. The binding capacity of Cu to the fiber increased linearly with increasing SP group density, because cupric ions of a smaller size than lysozyme can invade the depths of the grafted polymer branches formed in the amorphous domain of the polymer matrix.

Inhibition of the electron transport system in Staphylococcus aureus by trimethylamine-N-oxide.

Trimethylamine-N-oxide (TMAO) inhibited the growth of Staphylococcus aureus but not of S. epidermidis, which is the main flora in ripening squid, the Japanese traditional sea food Ika-shiokara. This selective inhibition of S. aureus was based on the inhibition of the electron transport system. The cytochrome fraction isolated from S. aureus was converted from the reduced to the oxidized form by the addition of TMAO. It is suggested that the inhibition occurred between cytochrome B and cytochrome o.