Background and Purpose-A small centrum ovale infarct (SCOI), caused by occlusion of the white matter medullary arteries, is often equated with a lacunar infarct. We sought to clarify the clinical characteristics of a SCOI visualized by diffusion-weighted MRI (DWI) compared with those of a small basal ganglia infarct (SBGI). Methods-Patients with a SCOI (SCOI group; nϭ38) or SBGI (SBGI group; nϭ68) Յ15 mm in diameter on conventional MRI and DWI were selected from 582 consecutive patients with acute ischemic stroke. Sex, age, neurological symptoms, vascular risk factors, emboligenic heart disease, arterial occlusive disease in the ipsilateral carotid system, and recurrent stroke within the initial 30 days were compared between the 2 groups. Results-Only 47% of SCOIs but 87% of SBGIs could be identified with the use of conventional MRI, whereas DWI could detect them all. Age, sex, and vascular risk factors were not significantly different between the 2 groups. The SCOI group had more frequently an abrupt onset of symptoms (63% versus 26%; Pϭ0.0002), emboligenic heart diseases (34% versus 12%; Pϭ0.0054), occlusive carotid and/or middle cerebral artery diseases (53% versus 19%; Pϭ0.0004), and recurrent stroke (13% versus 1%; Pϭ0.0216) but less frequently a classic lacunar syndrome (50% versus 81%; Pϭ0.0009) than the SBGI group. On a multivariate analysis, both arterial and heart diseases were independently associated with the SCOI group. Conclusions-Symptomatic SCOIs detected by DWI may be associated with large-vessel and heart diseases and should be distinguished from lacunar infarcts.

Two new extracellular nucleases, nucleases SM1 and SM2, were purified from the culture fluid of S. marcescens kums 3958, a fresh clinical isolate. The purification was carried out by the following steps; ammonium sulfate precipitation, and DEAE-cellulose and Sephadex G-100 column chromatography. At the final step, nucleases SM1 and SM2 were purified about 3,700- and 1,000-fold, respectively. They were free from phosphomonoesterase and phosphodiesterase activities. The pIs were 8.1 and 7.5 for nucleases SM1 and SM2, respectively. The molecular weight was estimated to be 35,000 for both enzymes by SDS-polyacrylamide disc gel electrophoresis. The results of amino acid analyses showed that both the threonine and serine contents were higher in nuclease SM2 than in SM1. Furthermore, nuclease SM1 was more stable than nuclease SM2 at 4 degrees C. The other properties of the two enzymes were similar; pH optimum (8.0), Mg2+ or Mn2+ for activation, and inhibition by chemical reagents such as EDTA and pyrophosphate. No significant difference was found in base specificity between nucleases SM1 and SM2. Both enzymes specifically degraded double-stranded homopolymers, especially poly(I). poly(C), as well as yeast RNA and calf thymus DNA. They hardly degraded, however, single-stranded homopolymers such as poly(dA), poly(G), and poly(U).

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A 60-year-old woman with a two-year history of rheumatoid arthritis (RA) developed recurrent two- to three-day attacks of fever (>38 °C) accompanied by monoarthritis of the right hip joint. The first attack occurred two months after beginning anti-tumor necrosis factor-α therapy. Since a diagnosis of infectious arthritis was suspected, the therapy was discontinued. Thereafter, the patient repeated similar episodes; however, oral colchicine effectively controlled the attacks. The patient was diagnosed to have familial Mediterranean fever (FMF). The clinical manifestations of FMF mimic infectious complications during anti-RA therapy. Clinicians should therefore consider the possibility of FMF development in RA patients exhibiting recurrent febrile attacks.

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