Gonadotropin levels in urine during early postnatal period in small for gestational age preterm male infants with fetal growth restriction.

OBJECTIVE: The objective of this study was to estimate gonadotropin concentrations in small for gestational age (SGA) male infants with the reactivation of the hypothalamic-pituitary-gonadal axis during the first few months of life that is important for genital development. STUDY DESIGN: We prospectively examined 15 SGA and 15 appropriate for gestational age (AGA) preterm male infants between 2013 and 2014 at Kyoto University Hospital. Gonadotropin concentrations (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) were measured in serial urine samples from the postnatal days 7 to 168 and compared between SGA and AGA infants using the Mann-Whitney test. RESULTS: A longitudinal analysis showed that SGA infants had higher LH and lower FSH concentrations (P=0.004 and P=0.006, respectively) than AGA infants. CONCLUSION: Male infants who are SGA at birth because of fetal growth restriction have gonadotropin secretion abnormalities in the first few months of life.

Factors influencing imitation of manipulatory actions in chimpanzees (Pan troglodytes).

The purpose of the study was to investigate what kind of factors determine the degree of difficulty for chimpanzees (Pan troglodytes) when they imitate actions. Five adult chimpanzees were instructed to perform 48 arbitrary manipulatory actions consisting of different bodily motor patterns and object directionality. Results showed that actions in which an object is directed toward another external location (another object and one's own body) were easier to perform than those that involved manipulating a single object alone. Actions involving unfamiliar motor patterns were more difficult to perform than those involving familiar motor patterns that were already present in the subject's repertoire. Error responses were characterized as perseverative repetition of previously instructed actions. These findings suggest that chimpanzees find the directionality of manipulated objects a more salient cue than details of the demonstrator's body movements performing the manipulation.

Imitation of intentional manipulatory actions in chimpanzees (Pan troglodytes).

In this study, the authors investigated the understanding of other's actions in 5 adult chimpanzees (Pan troglodytes). A human demonstrated an attempt to open different containers. Each container required a different motor pattern to open it. Along with the container, a 2nd object was made available. After a free play period in which the chimpanzees' natural behaviors toward the objects were recorded, the authors tested the following 2 phases: The demonstrator (a) tried but failed to open and (b) opened the container successfully, with 1 of 2 alternative strategies, either using an "irrelevant tool" or by hand. The chimpanzees did not reproduce the demonstrator's motor patterns precisely but did reproduce the demonstrated strategies in both phases. These results suggest that chimpanzees anticipate the intentions of others by perceiving the directionality and causality of object(s) as available cues.

[Four cases of acute myositis associated with influenza A infection in the elderly].

In nursing home belonging to our hospital, influenza like syndromes were recognized in 40 of 250 cases (16%) in 1994, and 5 cases were admitted to our hospital. On admission, three patients were unable to walk, and creatine phosphokinase levels were elevated in all patients, ranging from 337 IU/l to 20,672 IU/l. There were normal test findings for electrocardiography, ultrasonic cardiography. Three patients showed a significant antibody titer fall (Hemagglutinin Inhibition) in six months. The other patient did not show it, but his symptom was compatible with influenza. All patients recovered rapidly without sequelae. We reported four cases in the elderly of acute myositis associated with influenza A (H3N2) infection.

[Study on sepsis in the elderly at Nagoyashi-Koseiin Geriatric Hospital].

A study based on clinical analysis was conducted regarding the 125 episodes in the elderly 112 patients of sepsis who were 70 (average 83.8 +/- 7.5) years old at Nagoyashi-Koseiin Geriatric Hospital from 1985 through 1994. 1) The backgrounds of the elderly patients with sepsis were as follows: bedridden (72.8%), urinary catheter in place (61.2%), central venous catheter in place (48.8%), and prior antibiotic use (40.8%). All patients had an underlying disease. 2) Organisms isolated were Escherichia coli (21.2%), Staphylococcus aureus (18.4%); Coagulase-negative staphylococci (CNS) (17.4%) and Candida albicans (6.1%). Chronologically, the quantity of gram-positive cocci increased while that of gram-negative bacilli decreased. As the age of the patients increased, the frequency of infections by Methicillin-resistant Staphylococcus aureus (MRSA), E. coli, and/or multiple bacteria increased, while that of infections by CNS and gram-negative bacilli excluding E. coli decreased. 3) The primary infected sites were the urinary tract system (24.8%), central venous catheter (21.6%) and unknown (31.2%). 4) The primary clinical observations were fever exceeding 38.0 degrees C (88.0%), tachycardia (60.8%), shivering (44.0%) and cyanosis (32.8%). 5) Complications were multiple organ failure (33.6%), septic shock (26.4%) and disseminated intravascular coagulation (22.4%). 6) The prognosis indicated that 65.6% were survivors, and 34.4% were nonsurvivors. At the onset of sepsis, weight, blood pressure, serum albumin, and total cholesterol in the nonsurvivors were significantly lower than those in the survivors, whereas heart rate, GOT, LDH, and BUN in the nonsurvivors were significantly higher than those in the survivors.

[A case of itraconazole-induced hypokalemia with pulmonary aspergilloma].

A case of itraconazole-induced hypokalemia with pulmonary aspergilloma is reported. A 68-year-old female who had been followed for rheumatoid arthritis, gastric ulcer and pulmonary aspergilloma was admitted to our hospital because of a cough, low grade fever and hemosputum. She was treated with itraconazole (100 mg/day) for pulmonary aspergilloma of the left upper lobe. Fifty seven days after starting the treatment, her serum potassium was 2.33 mEq/l. Since there was no history of diarrhea, vomiting or abuse of drugs known to cause hypokalemia, itraconazole- induced hypokalemia was suspected. Thirty one days after the discontinuation of the treatment with itraconazole, her serum potassium increased to 3.57 mEq/l without potassium supplement. The lymphocyte stimulation test for itraconazole was negative. This case suggests that serum potassium should be monitored in the patients treated with itraconazole.

[Clinical isolates of group B streptococci from elderly patients].

The importance of Group B streptococcal infection in elderly patients has not been clearly defined. We studied the annual incidence of Group B streptococci (GBS) isolated from sputum and urine of elderly patients who were admitted to Nagoyashi Koseiin Geriatric Hospital. The percentage of GBS isolated has increased since 1988. The type distribution of GBS isolates shows predominantly types Ia, Ib and JM9. The major clinical factors in patients from whom GBS was isolated from sputum were bedridden status, feeding tubes and tracheostomy. We also investigated the antibody to GBS in these elderly patients. The titers of GBS antibody were significantly higher in the group with GBS isolates than in the group without these pathogens. These results suggest that GBS is one of the causative organisms of nosocomial infections in elderly patients.

[Antibody response of inactivated influenza vaccine in the elderly].

The antibody responses of 31 elderly persons (11 males and 20 females, mean 82.2 years) and 23 adults (mean 40.7 years) to inactivated influenza vaccine were studied. Participants were given twice the influenza vaccine containing A/Yamagata/32/89, A/Kitakyusyu/159/93, and B/ Mie/1/93. Serum specimens were obtained before vaccination, and 2 weeks and 3 months after the second vaccination. Antibody to influenza was determined by hemagglutination inhibition test (HI). The rates of fourfold or greater increases of HI antibody against the A/Yamagata, A/ Kitakyusyu, and B/Mie were 96.8%, 100%, and 74.2%, and there was no significant difference of the rates of fourfold or greater increases between elderly persons and adults. The rates of possession of HI antibody more than 128 in titer after vaccination were significantly higher than those of HI antibody before vaccination, and were maintained at high levels up to three months after the second vaccination. These results suggest that antibody response to the inactivated influenza vaccine is satisfactory in the elderly.

[An outbreak of influenza A (H3N2) in a nursing home].

In the nursing home belonging to our hospital, an outbreak of influenza A (H3N2) occurred in January 1995, and we studied 23 elderly residents with influenza A infection. Twenty three residents with influenza A (8 males and 15 females) ranged in age from 67 to 95 years (average 83.1 years), 91.3% of them were bedridden. And all had underlying medical conditions with neurologic, cardiac, orthopedic, being the most frequent. The most common complaints were fever (100%), followed by cough (95.7%), sputum (60.9%), but sore throat was significantly less frequent. Influenza A virus was isolated from throat swab specimens from 6 of 18 ill patients. Fourteen persons were hospitalized and 2 of them had pneumonia, but nobody died. The levels of CRP, WBC were significantly high in the influenza group, as compared to the non influenza group. So this result suggested that influenza A infection among elderly subjects was apt to cause bacterial infection such as bronchitis and pneumonia. This outbreak was caused by contact from the staff to residents, so we think the health care of the staffs and prevention of influenza should be a high priority in nursing homes.

[An outbreak of parainfluenza 3 virus infection in the elderly in a ward].

In the D ward of Nagoyashi-Koseiin geriatric hospital (36-beds), upper respiratory illnesses were recognized in all the inpatients between July and August in 1995, and we studied 7 elderly subjects with parainfluenza 3 infection diagnosed by serology and viral culture. The outbreak of upper respiratory illnesses occurred in the ward during the 17 days from July 21 through August 6, 1996. Fifteen of the 18 elderly persons with upper respiratory illnesses were tested by serology; parainfluenza 3 infection was identified in 7. One of the 7 patients, parainfluenza 3 virus was isolated. Seven elderly subjects with parainfluenza 3 infection were 2 males and 5 females and five of them (71.4%) were bedridden. The most common complaint was fever and coughing in 7/7 (100%), followed by sputum in 5/7 (71.4%), wheezing in 4/7 (42.9%). The pyrexial period in the parainfluenza-infected group ranged from 1 to 4 days (average 3.1 days), and was significantly shorter than that of the influenza group. The maximum recorded temperature in the parainfluenza-infected group ranged from 37.0 to 39.2 degrees C (average 38.1 degrees C), and was significantly lower than that of the influenza group. Two of the 7 patients with parainfluenza 3 virus infection had pneumonia, but nobody died, and all 7 patients recovered without sequele. It is possible that parainfluenza 3 virus infection among elderly subjects cause secondary bacterial infection, so we think that prevention of nosocomial parainfluenza infection should be a high priority in the case of outbreak of such an infection in a ward.

[A case of psoas abscess associated in the elderly].

A case of psoas abscess associated with diabetes mellitus in the elderly is reported. A 81-year-old male who had been followed for cerebral thrombosis, diabetes mellitus and basal cell carcinoma was admitted to our hospital because of high fever. Leukocytosis, a positive CRP test and pyuria were seen. Proteus mirabilis and Escherichia coli were detected by urine and blood culture, respectively. He was treated with antibiotic therapy for urinary tract infection and sepsis. After starting treatment, a low grade fever continued. On the twenty first hospital day he developed pyrexia again, and a large abscess was demonstrated in the right psoas muscle by pelvic couputed tomography. The abscess was drained and a specimen from it yielded E. coli on culture. Treatment with antibiotics and drainage resulted in symptomatic improvement. In Japan, 82 cases of psoas abscess have been reported from 1990 to 1994. Four cases of these reports were above eighty years old. The experience with this case indicates the necessity of adequate care in cases of elderly diabetes complicated by psoas abscess.

Respiratory viral infections in the elderly in a nursing home.

The purpose of this study was to investigate what viruses infiltrate into our nursing home, assess the related clinical symptoms in elderly subjects, and compare the incidence of infections with those in the general community. Between July 1994 and June 1995, 40 elderly persons dwelling in the nursing home were evaluated by clinical observation, serologic analysis, and viral culture of samples to determine the presence of viruses. Enteroviruses and herpes simplex I virus could be isolated from asymptomatic elderly subjects. Individuals with influenza B virus and RSV infections diagnosed by serology did have clinical symptoms. The prevalence of both influenza B virus and enteroviruses was related to that of such viruses in the general community. Our data suggest that respiratory viruses are readily transmitted from the community to nursing home residents.

[A case of brain abscess due to Streptococcus sanguis in association with multiple pulmonary arteriovenous fistulas].

A case is reported here of brain abscess due to Streptococcus sanguis in association with multiple pulmonary arteriovenous fistulas. A 19-year-old male who had been diagnosed in 1988 as pulmonary arteriovenous fistulas was admitted to our hospital for repeated epistaxis, headache, and vomiting. A brain abscess which was diagnosed using various roentogenologic examinations, worsened despite conservative therapy. Additional surgical drainage was performed; S. sanguis was isolated from the drainage fluid. After drainage, clinical symptoms gradually improved with no subsequent neurological deficits. We have formulated the following hypothesis regarding the mechanism of abscess formation in this case: S. sanguis invaded from a ruptured nasomucosal vein, forming a septic emboli in the blood flow, which passed through a pulmonary arteriovenous shunt and led to the formation of a brain abscess which established a metastatic presence in the cerebral tissue.

[Study of bacterial flora in the oral cavity and stomach of elderly patients receiving nasogastric tube feeding].

To investigate the significance of oropharyngeal flora and gastric flora in elderly patients receiving nasogastric tube feeding, throat secretions and gastric aspirates were cultured and the pH of the latter was measured. Of 116 bacterial isolates from throat secretions of 27 elderly patients, 30 were beta-streptococci and 28 were Pseudomonas aeruginosa. Bacteria isolated from gastric aspirates numbered 86 and 24 (27.9%) of them were the same species as those found in the throat secretions. Patients with gastric pH were below 3.5 had significantly lower concentrations of gram-negative bacili in gastric aspirates. We also studied oropharyngeal flora in 33 elderly patients who were admitted to Nagoyashi Koseiin Geriatric Hospital. The major bacterial isolates from throat swabs of bedridden patients were gram-negative bacilli and beta-streptococci, especially group B streptococci (GBS). We measured the level of antibody to GBS in these patients. Those from whom GBS were isolated had high titers. These results suggest that in elderly patients receiving enteral nasogastric) tube feeding, large numbers of bacteria colonize the oral cavity and stomach. The measurement of type-specific antibody to GBS may be useful in managing such patients.

[A case of myelodysplastic syndrome who died of septic pulmonary embolism].

A case of myelodysplastic syndrome (MDS) complicated by septic pulmonary embolism is reported. A 61-year-old female who had been followed for refractory anemia with excess of blasts suddenly died of acute respiratory failure. An autopsy revealed massive pulmonary emboli with gram-positive cocci gathered in the emboli and alveolar spaces. Staphylococcus aureus was also detected through a blood culture from the right atrium. We speculate that pulmonary embolism was the result of septicemia induced by the immunosuppressive condition associated with MDS.

[A novel diagnostic method for allergy "LUCICA HRT"].

We developed a novel glass microfiber-based histamine release test (HRT) which is characteristic of response of basophil leukocyte to allergens in vitro. It allows the determination of 20 allergens (10 for inhalation allergy, and the other for food allergy) at the same time using a small amount of whole blood. For 158 patients of inhalation allergy and 135 patients of food allergy, they were evaluated by HRT, CAP-RAST, skin test, and provocation test. The concordance of HRT, CAP-RAST, and skin test were 78%, 72%, and 62% in inhalation allergy, and 84%, 71%, and 81% in food allergy, respectively. The specificity of HRT, CAP-RAST, and skin test were 63%, 37%, and 19% in inhalation allergy, and 92%, 63%, and 83% in food allergy, respectively. The positive predictive value of HRT, CAP-RAST, and skin test were 79%, 71%, and 63%, respectively. The false positive ratio of HRT (14%) was lower than that of CAP-RAST (42%). The sensitivity of CAP-RAST was higher than that of HRT. In addition, we experienced a case of patient who showed significant improvement by treatment. At initial stage, not only the symptoms were erythema and scratching but also HRT, CAP-RAST, and skin test resulted in positive. Four months later, he had no allergic symptoms, HRT resulted in negative, but CAP-RAST and skin test resulted in still positive. From these results, we concluded that CAP-RAST is good for screening of etiological allergens and that HRT is a useful diagnostic method for the confirmation of a clinical allergy.

Constant AMP synthesis in aqueous solution by electric discharges.

An electric discharge was made through a gas mixture of N2 (7 cm Hg), H2 (14 cm Hg) and CO2 (14 cm Hg) over an aqueous solution (100 ml, pH 7.6) of adenosine (0.02 M) and phosphate (0.2 M) in a 5 liter vessel simulating primitive earth conditions. AMP was produced at a constant rate in the solution, and the yield reached about 2% in two months.

ATP-, K+-dependent heptamer exchange reaction produces hybrids between GroEL and chaperonin from Thermus thermophilus.

Chaperonin from Thermus thermophilus (Tcpn6014.Tcpn107) splits at the plane between two Tcpn607 rings into two parts in a solution containing ATP and K+ (Ishii, N., Taguchi, H., Sasabe, H., and Yoshida, M. (1995) FEBS Lett. 362, 121-125). When Escherichia coli GroEL14 was additionally included in the solution described above, hybrid chaperonins GroEL7.Tcpn607 and GroEL7. Tcpn607.Tcpn107 were formed rapidly (<20 s) at 37 degrees C. The hybrid was also formed from Tcpn6014 and GroEL14 but not from a mutant GroEL14 lacking ATPase activity. The hybrid formation was saturated at approximately 300 microM ATP and approximately 300 mM K+. These results imply that GroEL14 also splits and undergoes a heptamer exchange reaction with Thermus chaperonin under nearly physiological conditions. Similar to parent chaperonins, the isolated hybrid chaperonins exhibited ATPase activity that was susceptible to inhibition by Tcpn107 or GroES7 and mediated folding of other proteins. Once formed, the hybrid chaperonins were stable, and the parent chaperonins were not regenerated from the isolated hybrids under the same conditions in which the hybrids had been formed. Only under conditions in which GroEL in the hybrids was selectively destroyed, such as incubation at 70 degrees C, Thermus chaperonin, but not GroEL14, was regenerated from the hybrid. Therefore, the split reaction may not be an obligatory event repeated in each turnover of the chaperonin functional cycles but an event that occurs only when chaperonin is first exposed to ATP/K+.

[A case of eosinophilic granuloma associated with a brain lesion].

A 32-year-old man was hospitalized due to right pneumothorax. Chest X-ray showed interstitial shadows predominantly in the upper and middle lung fields. Eosinophilic granuloma was diagnosed by transbronchial lung biopsy. He had a history of paraesthesia in the right arm for 6 months prior to the pneumothorax. Initially, head CT showed an iso-dense area enhanced with contrast medium in the left temporal lobe. Two weeks after the onset of paraesthesia, head CT showed an iso-dense lesion surrounded by low density area. Subjective symptoms disappeared in a month, and no abnormalities on head CT were seen at 2 months. It is highly suspected; therefore, that the present case of eosinophilic granuloma was associated with a brain lesion.