Seventy imipenem-resistant clinical isolates of Pseudomonas aeruginosa were examined for resistance to various β-lactam antibiotics. The 70 strains were grouped on the basis of their resistance to imipenem and ceftazidime. Group A (20 strains) was resistant to 12.5μg/ml imipenem and sensitive to 1.5μg/ml or less of ceftazidime. Group B (49 strains) was resistant to 12.5 to 25μg/ml imipenem and 12.5 to 100μg/ml ceftazidime, Group C (1 strain) was resistant to 25μg/ml imipenem and ≥200μg/ml ceftazidime. The levels of β-lactamase activities to cephaloridine produced by group A, B and C strains were <0.05U/mg protein, <0.01 to 0.85U/mg protein, and 0.61U/mg protein, respectively. The β-lactamases of group A strains were inducible only by imipenem, while those of group B strains could also be induced by other β-lactam antibiotics. Group C strain, GN17203, produced a β-lactamase that could hydrolyze imipenem. This β-lactamase was encoded by the 31-Mda plasmid, pMS350, belonging to incompatibility group P-9. The plasmid conferred resistance to β-lactams, gentamicin and sulfonamide, and was transferable via conjugation to P. aeruginosa, but not to Escherichia coli. The molecular weight of the purified enzyme was estimated to be 28, 000, and the isoelectric point was 9.0. The enzyme showed a broad substrate profile, hydrolyzing imipenem, oxyiminocephalosporins, 7-methoxycephalosporins, and penicillins. The enzyme activity was inhibited by EDTA, iodine, p-chloromercuribenzoate, CuSO4, and HgCl2, but not by clavulanic acid or sulbactam.
Medulloblastoma is the most common primitive intracranial malignancy in childhood. We examined 28 cases (35 specimens) of medulloblastoma to elucidate the pathological features of this tumor. Although Homer Wright rosettes, pale islands, and dark and light areas characterize this tumor in most cases, several cases did not show any of these features. As the dark areas had more tumor cells than the light areas and were abundant in blood vessels and reactive astrocytes, they may have appeared darker. About one third of the specimens showed tumor cell immunoreactivities for neuronal markers, but only 2 reacted with glial markers. The light areas showed lower staining index values for proliferating markers than the dark areas. As cases showing Homer Wright rosettes and/or light and dark areas had good outcomes, these histological features are of potential prognostic importance.
The changes in serum levels of immunoglobulins G, A and M, number of circulating lymphocytes, lymphocyte subsets and responses of lymphocytes to phytohemagglutinin and concanavalin A with 2 months of conventional physical therapy were evaluated in ten patients with hemiplegia 2-3 weeks after the onset of cerebrovascular diseases classified into stage II-III by the criteria of Brunnstrom. Compared with the patients who discontinued physical therapy 3-4 weeks after the onset of stroke because of their own will, the ratio of CD4 +/CD 8+ and the responses of lymphocytes to mitogens were significantly increased, though the serum levels of immunoglobulins G, A and M, the number of circulating lymphocytes, HLA-DR, CD3+ cells and ratios of T and B cells were not changed. These observations suggest that physical therapy may enhance immune function in stroke patients.
We report a 31-year-old female with a granulomatous ureteral polyp. She had complained of pollakiuria and terminal miction pain. The preoperative diagnosis was a right low-ureteral polyp with calcification, and the polyp was successfully resected. Pathological findings were those of a granulomatous polyp with tissue eosinophilia at the polyp head. The postoperative course was uneventful and she has remained asymptomatic, to date.
Combined operation of coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) was performed for a 77-year-old man who had triple vessel with left main trunk coronary artery disease and severe left carotid artery stenosis. The left internal thoracic artery and three saphenous vein grafts were bypassed with a single proximal anastomosis as CABG, and CEA was done with vein patch plasty under selective cerebral perfusion using a cardiopulmonary bypass circuit. He recovered without complications and did not require no homologous blood transfusion. We consider elderly CABG patients high risk to be at arteriosclerotic complications, so careful management is needed for individual cases.
Supernumerary kidney is one of the rarest anomalies of the urinary system. We experienced a 62-year old male case in whom supernumerary kidney accompanied by vesico-ureteral reflux was highly suspected. Intravenous urography revealed completely duplicated ureters on the left side. On abdominal CT, a mass which was presumed to be a small and atrophic supernumerary kidney was depicted at the caudal and abdominal portion of the left major kidney. On cystography, vesico-ureteral reflux to the supernumerary kidney was observed and the pelvis of the supernumerary kidney showed hydronephrosis due to uretero-pelvic junction stenosis. Infection was controlled by oral administration of anti-bacterial drug. The patient remains under observation at our outpatient clinic. Extirpation of the supernumerary kidney will be carried out if infection becomes refractory to treatment.