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The patient was a 61-year-old man who reported coughing and fever that occurred immediately after the work of breaking up a large refrigerator containing diphenylmethane diisocyanate (MDI). He was brought to our medical center with respiratory distress ten days after onset. Acute respiratory distress syndrome was diagnosed on the basis of a P/F oxygen ratio of less than 200 and chest CT findings of extended consolidation in both lung fields. He was intubated and ventilated mechanically. Steroid pulse therapy was started because of an elevated lymphocyte count found through bronchoalveolar lavage (BAL). After that, arterial blood gas and chest radiography findings improved gradually, and high-resolution chest findings on the 4th day of hospitalization showed centrilobular and uncleared shadows of marginated acini in both lung fields. The patient was extubated ten days after admission, the steroid therapy was withdrawn, and he was discharged from the intensive care unit on the 22nd day of hospitalization. Transbronchial lung biopsy on admission revealed alveolitis, Masson bodies and activated macrophages in the air spaces. The dismantled refrigerator was known to contain MDI, and because of the IgE and the IgG to MDI present in the serum, and of the IgG to MDI in the BAL fluid, we diagnosed hypersensitivity pneumonitis with acute respiratory distress syndrome due to exposure to dust containing MDI. There are many reports of painters with hypersensitivity pneumonitis following exposure to isocyanates, but care should be taken to avoid the possibility of acute respiratory distress syndrome arising because of the inhalation of dust mixed with isocyanates.

We report a case of septicemia type Vibrio vulnificus infection. The patient was a 74-year-old man who had liver cirrhosis and hepatocelluler carcinoma. He felt a pain in the right femoral lesion after eating raw shellfish (Japanese "Umitake") two days ago. He was admitted to our emergency center due to his shock status and thrombocytopenia two days after the onset. We diagnosed necrotizing fasciitis due to Vibrio vulnificus infection, his life was saved by emergency amputation of the right lower extremity. The culture of the blood and vesicle fluid showed Vibrio vulnificus. There are some reports that the debridement was effective to necrotizing fasciitis due to Vibrio vulnificus infection, but these reports are all about single upper extremity lesion. As far as we know, this is the second report of lower extremity necrotiaong fasciitis due to septicemia type Vibrio vulnificus infection rescued by extremity amputation in Japan. The mortality of septicemia type Vibrio vulnificus infection with necrotizing fasciitis is very high, this is quite a valuable report in making a decision for therapy of septicemia type Vibrio vulnificus infection.

The alimentary canal of typical anurans is remodeled during metamorphosis. We examined the tissue structure of small intestine in tadpoles of the treefrog, Rhacophorus owstoni. The cytoskeletal components of the smooth muscle cells were identified by immunohistochemically with alpha-smooth muscle actin antibody. Before metamorphosis, the smooth muscle fibers are arranged in two layers that are circular and longitudinal in orientation, and are stained markedly brown. During metamorphosis, there was concomitant increase in the number of muscle fibers per unit length of tract in both layers. By the end of the metamorphosis, the alimentary tract are transformed morphologically from the larval to adult form, and the smooth muscle cells are rapidly increasing in number. This study suggests that the structural change of musculature are formed in rearrangements of smooth muscle cells, but no proliferation of these cells with the metamorphosis.

Amphibians are divided into three orders: Gymnophiona, Urodela and Anura. We studied on the correlation between the liver structures in the three orders of amphibians by histological technique. Livers of thirty species of amphibian were fixed by perfusion with paraformaldehyde, and observed by light microscopy in special staining for elastic fibers. The cytoskeletal components of the hepatic stellate cells and myofibroblasts were identified by immunohistochemistry for glial fibrillary acidic protein and a-smooth muscle actin. Among the three orders of amphibians, Gymnophiona and Urodela were characterized the development of lymph vessels in liver capsules and Glisson's sheath. The present study indicates that there are differences in the pattern of hepatic histological components in the amphibians examined at this time. We discussed their diverged mode of living that can be categorized into three groups: aquatic, aqua-terrestrial and fully terrestrial group.

In order to investigate effects of addition of fentanyl epidurally on the onset of sympathectomy from epidural lidocaine, we have measured the toe temperature of 29 healthy patients undergoing elective lower extremity or lower abdominal surgeries. The latency of onset of the toe temperature was significantly shorter in patients receiving both epidural lidocaine and fentanyl compared with those receiving epidural lidocaine alone (258 +/- 135 vs 398 +/- 184 sec, P < 0.05 [mean +/- SD]). Osmolarity and pH of the epidural solutions were similar between the two groups. These results suggest, but do not indicate, that sympathectomy from epidural lidocaine is accelerated by the addition of fentanyl.

Recently, low dose and long term use of Macrolides (Mls) has been reported to be effective in treatment of chronic lower respiratory tract infections, however its mechanism is still obscure. We evaluated the effect of Mls (EM, AZM, RKM) on cytokine mRNA expressions. We preincubated the whole blood with several concentrations of Mls and removed the Mls and then stimulated human whole blood with LPS as an experimental vivo model. In order to examine cytokine mRNA expressions, we used the RT-PCR method. Cytokine mRNA expressions were suppressed significantly (p < 0.05) by pretreatment with EM, AZM; moreover, the suppression was peaked at low concentrations (0.04 approximately 0.2 microgram/ml). Although, Cytokine mRNA expressions were not suppressed by pretreatment with RKM. These results suggest that EM, AZM have suppression on Cytokine mRNA expressions, and consequently, this suppression has a reasonable effect for DPB patients.

We performed 8-methoxypsolaren and ultraviolet A (PUVA) therapy as a second line treatment for stage +3 cutaneous acute graft-versus-host disease (GVHD) in a 10-year-old girl who had undergone unrelated bone marrow transplantation. Although prednisolone as first line therapy was not effective, the cutaneous lesion began to improve after several times of PUVA treatment and completely disappeared following 11 times of irradiation without additive systemic immunosuppressive therapy. PUVA therapy was considered as a useful treatment for cutaneous acute GVHD.

Recently, the roles of inflammatory processes in the pathogenesis of asthma have been emphasized. To elucidate the roles of T lymphocytes in local inflammatory sites in asthma, we examined T cell phenotypes with flow cytometry and carried out cytokine message amplification phenotyping (MAPPing) of bronchoalveolar lavage (BAL) cells taken from patients with steady-state asthma (n = 11). The percentage of CD4+ T cells in total lymphocytes correlated significantly (r = 0.784, p < 0.005) with that of lymphocytes in total CD45+ BAL cells. The positivities of T cell activation markers (CD25, HLA-DR) in CD4+ T cells were inversely correlated with the ratio of CD3+ T cells to total CD45+ BAL cells (CD25, r = 0.648, p = -0.059, HLA-DR, r = -0.741, p < 0.05). Most CD4+ T cells were of the CD45 RO+ "memory" phenotype. With cytokine MAPPing, IL-2 or IFN gamma were detected in only 2 of 11 patients, but IL4 or IL-5 were detected in 8 patients. These results suggest that non-activated TH2 type memory CD4+ T cells accumulate in local inflammatory sites of the bronchi of patients with steady-state asthma, and that these cells releases cytokines (IL-4, IL-5) when activated by some stimuli, which can lead to an asthma attack.

We examined biological properties of strains of methicillin-resistant Staphylococcus aureus (MRSA) which were isolated in our ward in 1991 and 1992. A total of 47 MRSA strains were isolated in 1991 and 64 in 1992. The majority of these strains of MRSA were highly resistant to DMPPC, CEZ and IPM, and were intermediately resistant to MINO. All these strains were, however, sensitive to VCM. The number of coagulase type II strains increased from 22 (46.8%) to 51 (79.7%), and that of enterotoxin type A strains from 27 (57.4%) in 1991 to 47 (73.4%) in 1992. The number of strains which produce Toxic Shock Syndrome Toxin-1 (TSST-1) also increased from 19 (40.4%) to 45 (70.3%), and those strains that produce beta-lactamase decreased from 24 (51.1%) to 21 (32.8%). From the above results, we confirmed the recent change in types of the epidemic strains of MRSA. Namely, there was a marked increase in number of strains which produce type II coagulase type A enterotoxin and TSST-1. For the prevention of a patient to patient-, room to room- and ward to ward-spread, strict isolation was indicated both the infection patients, immunocompromised patients who were at high risk for the infection and the proved carriers. Treatment with VCM was started immediately if MRSA infection was thought plausible. These countermeasures seemed to succeed in reducing the incidence of the infection in our ward.

Recently, "low-dose and long-term" erythromycin (EM) has been reported to be effective in treatment of diffuse panbronchiolitis (DPB), but its mechanism is still obscure. We studied the effect of EM on cytokine mRNA expression by using LPS-stimulated human whole blood as an experimental vivo model. IL-8 mRNA was expressed in biphasic fashion with peak expression at 6 hours and 20 hours from the start of LPS stimulation. When whole blood was pretreated with EM (2 micrograms/ml) for 1 hours. IL-8 mRNA expression was depressed at 20 hours (p < 0.025) from the start of LPS (1 microgram/ml) stimulation. However, when pretreated for 12 hours, it was not depressed. EM (2 micrograms/ml) also depressed IL-1 beta (p < 0.025) and TNF alpha (p < 0.05) mRNA expressions at 6 hours from the start of LPS stimulation. From the above results, it was suggested that the direct inhibition of IL-1 beta and TNF alpha production by EM resulted in subsequent depression of production of IL-8 that is a potent chemotactic factor for neutrophil, and consequently, EM acts to protect the bronchiole tissues of DPB patients from destruction by proteolytic enzymes released from neutrophils. This assumption seems to be supported by our previous observation that when patients with DPB were treated with EM a marked decrease in number of neutrophil in bronchoalveolar lavage fluid (BALF) was accompanied by clinical and radiographic improvement.