Biological properties of aureobasidin A, a cyclic depsipeptide antifungal antibiotic

Aureobasidin A (AbA) is a novel cyclic depsipeptide antifungal antibiotic. The antifungal activity of AbA was studied in vitro and in vivo in comparison with clinically effective antifungal agents, amphotericin B and fluconazole. AbA was highly active in vitro against many pathogenic fungi, including Candida albicans, Cryptococcus neoformans, Blastomyces dermatitidis and Histoplasma capsulatum. The activity was superior to amphotericin B in most cases. AbA exhibited fungicidal action toward growing cultures of C. albicans. It was highly tolerated by mice and showed good efficacy in the treatment of murine systemic candidiasis when given orally or subcutaneously. AbA's fungicidal action in mice with candidiasis was more effective than fluconazole and amphotericin B.

[Propranolol for prophylaxis of first hemorrhage in cirrhotic patients with esophageal varices--a controlled study comparing with sclerotherapy]

To compare the efficacy of oral propranolol and sclerotherapy in the prevention of first hemorrhage from esophageal varices, 65 cirrhotic patients with moderate to large esophageal varices and no history of bleeding were included in the prospective controlled trial. After randomization, 33 patients received propranolol at a does reducing the heart rate by 25%; 32 patients were treated with intra-variceal and extra-variceal injection of ethanolamine oleate. On entry to the trial, the two groups were comparable in terms of clinical and biological parameters. The patients were observed for up to 60 months, with an average of 31 months. Nine patients bled (5 in propranolol and 4 in sclerotherapy) during follow-up. No significant difference were observed between propranolol and sclerotherapy in the cumulative bleeding rate and survival. The multivariate Cox model indicated that drug compliance in the propranolol group and high portal pressure in the sclerotherapy group were factors predictive of the first hemorrhage. These data support that propranolol and sclerotherapy are of comparable value in preventing the first hemorrhage in cirrhotic patients with esophageal varices.

[A case of verrucous carcinoma of the penis with detection of human papillomavirus using the in situ hybridization method]

A case of penile verrucous carcinoma is reported. The patient had a previous history of condyloma acuminatum of the penis. No signs of squamous cell carcinomas were observed in the histopathological findings. We also detected the histologic evidence of human papilloma virus (HPV) infection in the result of the study by in situ hybridization. The local positive reaction of HPV infection for type 6/11 was seen, and was related to the koliocytosis. However other types of HPV (16/18, 31/33, 51) were negative.

[A case of surgical treatment of patent ductus arteriosus using left heart bypass in an adult]

This paper describes a new operative method for patent ductus arteriosus using left heart bypass. A 57-year-old woman with patent ductus arteriosus associated with severe pulmonary hypertension was successfully operated upon. Because of aneurysmal dilatation and calcification of the aortic side of the ductus, PDA was divided under left heart bypass with centrifugal pump. Postoperative course was uneventful, and is now well.

[A case report of graft-versus-host disease caused by using stored blood after aortic valve replacement]

A 61-year-old man underwent aortic valve replacement and received transfusion of 8 units of stored blood. Erythema appeared on the entire body the 12th day after operation, and was followed by high fever, elevation of liver enzymes, progressive pancytopenia, aplastic bone marrow and diarrhea. He died due to septic shock on the 19th postoperative day. Skin biopsy showed the typical features observed in graft-versus-host disease (GVHD). Based on the clinical course, skin and bone marrow biopsy, we diagnosed as post-transfusion GVHD. Therefore, even when stored blood or stored red blood cells are used, these should be irradiated and transfused through the leukocyte removal filter.

[Surgical treatment of total left anomalous pulmonary venous connection to the coronary sinus without atrial septal defect]

Surgical repair of total left anomalous pulmonary venous connection to coronary sinus without atrial septal defect (ASD), a very rare situation, was recently conducted. A 13-year-old girl was diagnosed as ASD. Two-dimensional echocardiography, however, indicated enlarged coronary sinus preoperatively. During operation the absence of ASD and drainage of total left pulmonary veins into the coronary sinus were observed. The operation was conducted by the method of Van-Praagh. The coronary sinus was closed to divert pulmonary venous blood to the left atrium, while maintaining coronary venous return to the right atrium. The postoperative course was uneventful and cardiac catheterization showed satisfactory results.

[Surgical treatment of patent ductus arteriosus in the adult]

Ten patients over the age of 30 were operated on for isolated patent ductus arteriosus (PDA). Division was performed in 9 patients and ligation in only one. In two cases, the aorta had to be cross-clamped above and below the level of the ductus under normothermia because of massive bleeding. In another two patients with aneurysmal dilatation and calcification of the aortic side of the ductus, PDA was closed by aortic cross-clamping under LA-to-femoral-artery bypass with a centrifugal pump. Postoperatively, all patients are well and in NYHA class I. Therefore, in the adult, if the conventional method of division between ductus clamps is considered dangerous due to increased friability and atheromatous changes of the ductus and surrounding tissues, the ductus should be closed during aortic cross-clamping under assist circulation. In such a case, LA bypass is considered quite useful and safe.

[Metachronous bilateral testicular seminomas. A case report]

A case of metachronous bilateral testicular seminomas on a 36-year-old male is reported. He had a history of right testicular typical seminoma treated with right high orchiectomy and adjuvant irradiation therapy 6 years previously. He returned to our clinic complaining of painless left testicular enlargement in August 1990, and under a diagnosis of testicular neoplasm left high orchiectomy was performed. Histopathological examination revealed anaplastic seminoma. DNA histograms of both testicles revealed almost the same aneuploid pattern. The patient was diagnosed as stage I seminoma, has been followed up closely. Recently genetic factors as human leukocyte antigens (HLA)-A24, B14, DR5 and DR7, have been shown to be important in the development of metachronous bilateral testicular tumors. HLA antigens were determined in our case, and HLA-A24 shown in our case was compatible with the review.

ATP-dependent protein synthesis in isolated pea chloroplasts. Evidence for accumulation of a translation intermediate of the D1 protein

In the presence of externally added ATP, in the dark, isolated pea chloroplasts accumulate two proteins of molecular masses of about 22 and 24 kDa which precipitate with specific antibodies raised against the D1 protein. By chasing in the light, these proteins disappeared on the fluorogram concomitant with the appearance of the precursor- and mature-sized D1 proteins. Polysome analysis indicated that the 22-kDa component is associated with membrane-bound ribosomes and is thus ascribed to a translation intermediate of the D1 protein. On the other hand, the 24-kDa component could not be found in the polysome fraction under the experimental condition used, suggesting the possibility that this component is a degradation product of the D1 protein. The conclusion from this analysis is that the synthesis and/or stable accumulation of the D1 protein requires factor(s) caused by illumination, in addition to ATP, in isolated pea chloroplasts.

[A case of left atrial plication for mitral valvular disease with giant left atrium]

A case of plication of giant left atrium complicating mitral valvular disease is reported. The patient was a 44-year-old female with mitral stenosis and regurgitation, whose respiratory function was severely disturbed. Chest X-ray showed severe stenosis of the left main bronchus and widening of the tracheal bifurcation secondary to compression by the left atrium. Mitral valve replacement and left atrial plication was performed. Postoperative respiratory weaning was uneventful and respiratory function was improved. We concluded that plication is very beneficial in patients with giant left atrium who have signs of compression of the bronchus and lungs.

[Primary squamous cell carcinoma of the ureter: report of a case]

A case of squamous cell carcinoma of the ureter in a 63-year-old female is reported. Right hydronephrosis was found by examination of duodenal ulcer. Ureteroscopy and biopsy revealed squamous cell carcinoma (SCC) of the lower ureter. Total nephroureterectomy with a bladder cuff was performed. Pathological diagnosis was SCC pT3 G2 INF beta pL1 pV0 pR0. Three cycles of chemotherapy were performed postoperatively with bleomycin, methotrexate and cisplatin. Fifty-three cases of primary ureteral squamous cell carcinoma from the Japanese literature are reviewed and characteristic clinical figures of the tumor are discussed.

The reciprocal protective effects of magnesium and calcium in hyperkalemic cardioplegic solutions on ischemic myocardium

The cardioprotective effects of magnesium and calcium in hyperkalemic cardioplegic solutions were investigated in isolated rat hearts. Isolated rat hearts were arrested for 30 min at 37 degrees C in cardioplegic solutions containing magnesium and calcium in varying concentrations. In St. Thomas' Hospital cardioplegic solution, the magnesium and calcium concentrations were varied as follows: Mg 0; Ca 0.1, 0.3, 0.6, 1.2 mmol/l (mM)./ Mg 4; Ca 0.1, 0.3, 0.6, 1.2 mM./ Mg 8; Ca 0.1, 0.3, 0.6, 0.9, 1.2 mM./ Mg 12; Ca 0.1, 0.6, 0.9, 1.2 mM./ Mg 16; Ca 0.1, 0.6, 1.2, 1.5 mM. For each magnesium concentration, the percentage recovery of aortic flow generated dose-response curves depending on calcium concentration. The maximum percentage recovery of aortic flow was 76.0% +/- 2.7% (mean +/- SEM) in the Mg0-Ca0.1 mM group, 77.1% +/- 2.0% in the Mg4-Ca0.3 mM group, 78.5% +/- 2.3% in the Mg8-Ca0.6 mM group, 79.8% +/- 2.4% in the Mg12-Ca0.9 mM group and 80.0% +/- 3.4% in the Mg16-Ca1.2 mM (ST solution) group. Significant difference in the recovery of aortic flow has not been observed among these groups, and furthermore, significant differences in the recovery of other parameters of cardiac function and Ck leakage have not been observed among these groups. These results suggest that the cardioprotective effects depend on the relative combination of magnesium and calcium concentrations, and that it is important to maintain an appropriate balance of magnesium and calcium in hyperkalemic cardioplegic solutions.

Hemodynamic changes during dynamic exercise in patients after mitral valve replacement for chronic mitral regurgitation

To evaluate hemodynamic changes during dynamic exercise, we investigated 13 patients after mitral valve replacement (MVR) for chronic mitral regurgitation (MR) and 5 control subjects by right heart catheterisation during supine bicycle exercise. According to the sizes of the St. Jude Medical (SJM) prosthesis during MVR, patients were divided into group A (n = 8) with SJM 31mm and group B (n = 5) with SJM 29mm. Significant rise in cardiac index (CI) was noted during exercise in both groups A and B (from 3.3 +/- 0.8 to 5.5 +/- 0.9 l/min/m2, p < 0.01 and from 3.0 +/- 0.6 to 5.6 +/- 0.6 l/min/m2, p < 0.01 respectively) and also in control subjects (from 3.4 +/- 0.7 to 6.2 +/- 0.6 l/min/m2, p < 0.01). Mean pulmonary artery and pulmonary capillary wedge pressure were significantly higher during exercise in patients of both groups A and B than control subjects (p < 0.05 and p < 0.01 respectively). Total pulmonary vascular resistance was significantly higher during exercise in both groups A and B than control subjects (p < 0.05 and p < 0.01 respectively). No difference in hemodynamics were noted between the patients of group A and B during exercise. It is concluded that response of CI to exercise in patients after MVR for chronic MR was adequate in comparison to control subjects irrespective of two different valve sizes.

Possible involvement of Na(+)-H+ exchange in the early phase of reperfusion in myocardial stunning

Calcium overload during reperfusion after prolonged ischemia has been associated with the Na(+)-Ca2+ exchange system. It has been proposed that the promotion of Na(+)-Ca2+ exchange at reperfusion may be mediated by Na(+)-H+ exchange. To evaluate whether this hypothesis is applicable for stunned myocardium, we examined the influence of temporary suppression of Na(+)-H+ and/or Na(+)-Ca2+ exchange during early reperfusion in isolated rat hearts. Myocardial stunning was produced by global ischemia for 15 min at 37 degrees C. The initial reperfusate was given during the subsequent 10 min after ischemia, and followed by reperfusion with normal Krebs-Henseleit buffer solution for 40 min. Hemodynamic indices, creatine kinase in coronary effluent, and myocardial water content were measured during reperfusion. The functional recovery of stunned myocardium was improved with higher extracellular Na+ concentration and/or lower Ca2+ concentration of the initial reperfusate. Aortic flow recovery of group II (135 mM Na(+)-0.5 mM Ca2+) was 77.0 +/- 3.4%, which was substantially greater (P < 0.05) than that of other groups: group I (control, 135 mM Na(+)-1.5 mM Ca2+), 68.2 +/- 2.4%; group III (25 mM Na(+)-0.5 mM Ca2+), 48.7 +/- 2.9%; group IV (25 mM Na(+)-1.5 mM Ca2+), 21.6 +/- 1.5%. Administration of amiloride, an inhibitor of Na(+)-H+ exchange, in the initial reperfusate ameliorates cardiac damage and improved aortic flow recovery in a dose-dependent manner (10(-6) M, 70.1 +/- 3.7%; 10(-5) M, 77.3 +/- 1.7%; 10(-4) M, 82.0 +/- 2.1% vs control 68.2 +/- 2.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Mitral valve surgery for patients after undergoing percutaneous transvenous mitral commissurotomy (PTMC)--investigation on indication of PTMC based on the intraoperative findings]

Ten patients underwent open heart surgery for mitral valve after PTMC because of post PTMC MS (n = 4) and MR (n = 6) out of 150 patients undergoing PTMC in our hospital between June 1987 and October 1991. Intraoperative findings of 4 patients with residual mitral stenosis included severe thickening, stiffening and calcification on anterior and posterior leaflets, commissures and subvalvular apparatus. Mitral valve repair was possible in 2 and mitral valve replacement (MVR) was necessary in the other 2. In all 6 cases who massive mitral regurgitation after PTMC, in repairable tears in the mitral leaflets necessitated MVR. Since in these cases changes in the leaflets were less severe than those of the commissures or subvalvular apparatus, surgical repair could have been possible if open mitral commissurotomy (OMC) was done primarily. Patients selection for PTMC versus OMC based on precise morphological evaluation of mitral valve would reduce occurrence of massive MR resulting in surgical replacement.

[Development of constrictive pericarditis 20 years after closed mitral commissurotomy--a case report]

Pericardial constriction has emerged as an infrequent but well documented late complication of cardiac surgery. A rare case of constrictive pericarditis developed 20 years after closed mitral commissurotomy was observed. The patient had been treated for the poorly controlled ascites of unknown origin associated with crural edema and mild congestive liver cirrhosis. The long interval between the previous cardiac operation and the clinical manifestation of constriction made it difficult to establish the diagnosis. Extensive resection of the calcified pericardium through a median sternotomy with cardiopulmonary bypass standby relieved the ascites and crural edema.

[Retroperitoneal giant malignant fibrous histiocytoma: report of a case]

A case of histiocytoma in a 63-year-old woman with general fatigue is described. Ultrasonography and radiological examination revealed a large mass at the retroperitoneum displacing the right kidney to medial anterior abdomen. Exploration of the tumor with right kidney was done via a transperitoneal approach because the tumor had invaded the hilar fat tissue of the right kidney. The total resected weight was 3,200 g. Histological study showed malignant fibrous histiocytoma, storiform-pleomorphic type. Post-operative chemotherapy consisting of cyclophosphamide, vincristine, adriamycin, dimethyl triazeno-imidazole carboxamide (CYVADIC) was performed and the patient is doing well without any evidence of recurrence or metastasis.

Powerful solvent systems useful for synthesis of sparingly-soluble peptides in solution

Our maximum protection strategy for the synthesis of human parathyroid hormone(1-84) indicates that fully protected peptide segments in the form of Boc-peptide phenacyl (Pac) ester are relatively soluble in ordinary organic solvents such as DMF, NMP or DMSO, which are suitable for coupling segments. However, about 1% of such segments synthesized were found to be insoluble even in the most polar solvent, DMSO. Thus, a more powerful solvent which can be used for their peptide synthesis was pursued. Among the solvent systems tested, a mixture of trifluoroethanol (TFE) or hexafluoroisopropanol (HFIP) and trichloromethane (TCM) or dichloromethane (DCM) was found to be most powerful for dissolving such sparingly-soluble protected peptides. These solvent systems were confirmed to be useful for the removal reaction of the carboxy-terminal Pac esters from the sparingly-soluble segments. They were then tested for the coupling reactions of fully protected Boc-peptides with other sparingly-soluble peptide esters. The TFE/TCM or TFE/DCM system was extremely useful for coupling segments without danger of racemization and of trifluoroester formation, if WSCI was used as the coupling reagent in the presence of 3,4-dihydro-3-hydroxy-4-oxo-1,2,3-benzotriazine (HOOBt).

[Initial and follow-up results of PTCA and PTMC]

On the bases of the initial and follow-up results of patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and percutaneous transvenous mitral commissurotomy (PTMC), the proper applications of these interventional therapies were discussed. The efficacy of PTMC on valvotomy was comparable to open mitral commissurotomy and the procedural safety was noticed. Our results supported the use of PTMC for patients with plicable mitral valve. Despite the good and acceptable results of elective PTCA, low initial success rate and high incidence of major cardiac events including mortality was noted in the group of urgent PTCA for patients with multivessel lesions. The urgent use of PTCA for refractory unstable angina should be restricted to selected patients without high-risk multivessel lesions.

Sequence analysis of the 3'-terminal halves of RNA 1 of two strains of barley mild mosaic virus

DNA complementary to the 3'-terminal halves of RNA 1 of two strains of barley mild mosaic virus (BaMMV) from Japan, BaMMV-Ka1 and BaMMV-Na1, was cloned and sequenced. The sequences start within a single long open reading frame (ORF), and are followed by 337 and 338 3' non-coding nucleotides, for BaMMV-Ka1 and BaMMV-Na1 respectively. The two strains have 88% nucleotide identity in the ORFs and 92% identity in the non-coding regions. The putative ORF products contain the capsid proteins at the C termini, as indicated by amino acid sequence analysis, and two putative non-structural proteins are arranged in the same manner as in RNA 1 of barley yellow mosaic virus (BaYMV). The deduced capsid proteins of BaMMV-Ka1 and BaMMV-Na1 each contain 251 amino acids and have 94% sequence identity, which is compatible with their close serological relationship. Most of the sequence differences between the two capsid proteins are found in the N-terminal region, and might explain their serological differences. Significant sequence similarities of the capsid proteins of the two BaMMV strains (37 and 35% respectively) with that of BaYMV, and their marginal similarities (21 to 26%) to the capsid proteins of aphid-borne or mite-borne potyviruses support the classification of BaMMV and BaYMV as distinct members of the same virus group, which is separate from the group(s) containing aphidborne or mite-borne potyviruses.

Solution synthesis of calciseptine, an L-type specific calcium channel blocker

Calciseptine, an L-type specific calcium channel blocker consisting of 60 amino acid residues with four intramolecular disulfide bonds, was synthesized by the solution procedure applying our maximum protection strategy. The recently developed solvent systems used were a mixture of chloroform or dichloromethane and trifluoroethanol; they were useful for the synthesis of slightly soluble protected peptides. After removal of all the protecting groups by our two-step HF procedure followed by treatment with mercuric acetate, the peptide was folded into its native form by air oxidation, in which redox reagents were necessary to accelerate the correct disulfide bond formation. The product was purified to homogeneity and found to block contractions of the rat thoracic aorta induced by 40 mM K+ with the same potency as that of the natural product. In addition, this peptide was found to block contractions of various rat smooth muscle preparations as well as increase in cytosolic free calcium concentration induced by a high concentration of extracellular K+.

The effect of dopamine on rat gastric motility

The inhibitory mechanism of dopamine (DA) on rat gastric motility was investigated in association with DA receptors. Gastric movement was assessed according to the method of Jacoby et al and was expressed with the system of Ludwick et al. (1968). DA inhibited gastric movement in both the corpus and antrum in a dose-dependent manner. Domperidone, a specific antagonist of DA2 receptor, suppressed DA-induced inhibition of gastric movement in a dose-dependent manner. SCH23390, a specific antagonist of DA1 receptor did not affect DA-induced inhibition of gastric movement. LY171555, a specific agonist of DA2 receptor, inhibited gastric movement in both the corpus and antrum in a dose-dependent manner. SKF38393, a specific agonist of DA1 receptor, did not affect gastric movement. These results indicate that DA plays an important role in the inhibitory regulation of gastric motility, through DA2 receptor but not DA1 receptor.

Unexpected racemization of proline or hydroxy-proline phenacyl ester during coupling reactions with Boc-amino acids

When L-proline or O-benzyl-trans-4-hydroxy-L-proline phenacyl ester was coupled with Boc-amino acids in dimethylformamide using water-soluble carbodiimide (WSCI) in the presence of anhydrous 1-hydroxybenzotriazole (HOBt) as coupling reagents, extensive racemization was observed at the C alpha of the proline or hydroxy-proline residue. The extent of racemization was measured by HPLC after the coupling with Boc-L-Leu-OH in the presence or absence of HOBt. The extent of racemization increased when HOBt was added to the reaction mixture, but greatly decreased when it was not, indicating that HOBt was needed for inducing racemization. Almost no racemization was observed when the coupling reaction was carried out by the mixed anhydride procedure in tetrahydrofuran or by the carbodiimide method in dichloromethane without using HOBt. In the case of coupling reactions with ordinary L-amino acid phenacyl esters, no racemization was observed. Examination of some model systems yielded sufficient evidence to prove that HOBt is an efficient catalyst for racemizing proline or hydroxy-proline phenacyl ester not only in the stage of cyclic intermediate formation but also in the opening of the ring structure. Thus, the racemization reaction was found to be closely related to the formation of the cyclic carbinol-amine derivative.