Massive subcutaneous emphysema, pneumomediastinum, and spinal epidural emphysema as complications of violent coughing: a case report

A 28-year-old man who manifested subcutaneous emphysema extending from the skull base and face to the chest, mediastinum and spinal epidural space following severe coughing caused by acute bronchitis is reported. Subcutaneous emphysema is a manifestation of non-surgical intrathoracic pathophysiology. In this patient percutaneous diagnostic peritoneal lavage resulted in the release of a large quantity of air and was negative for bleeding or contamination. No treatment other than antibiotics was prescribed. In this report, computer tomography study successfully demonstrated the areas of massive subcutaneous emphysema and the disappearance of the entrapped air, that might be absorbed into the tissues in the occupied sites within 7 days, except the air of epidural space, of a patient who manifested as a consequence of severe coughing caused by acute bronchitis.

Influence of pH of preservation solution on lung viability

Recently, various solutions for organ preservation have been introduced. Despite much debate regarding the composition of preservation solutions, the ideal pH of a preservation solution has not been determined. We investigated the effects of the pH of a lung preservation solution on viability using an isolated, ventilated lung perfusion model. Initially, we performed flush perfusion with solutions of five different pH groups (6.60, 7.00, 7.40, 7.80 and 8.20, measured at 10 degrees C). Lungs perfused with pH 6.60 solution had a significantly higher pulmonary vascular resistance than those perfused with pH 7.40, 7.80 and 8.20 solutions. Blood was washed out completely and uniformly with solutions of pH 7.40 and 7.80. After preservation the arterial oxygen tension was significantly greater in pH 7.40 and 7.80 groups than in pH 6.60, 7.00, or 8.20 groups. Moreover, pulmonary artery pressure, airway pressure, and wet/dry weight ratios in the pH 7.40 and 7.80 groups were lower than in the others. We conclude that for both pulmonary flush and storage preservation, solutions of pH 7.40 to pH 7.80 are optimal for lung preservation.

Effect of intermittent deep hypothermic circulatory arrest on brain metabolism

The effect of intermittent systemic reperfusion during deep hypothermic circulatory arrest was investigated in dogs to learn how the total arrest period may be prolonged. The animals were cooled on cardiopulmonary bypass to 18 degrees C and divided into the following three experimental groups: group I (n = 7), 60 minutes of uninterrupted circulatory arrest; group II (n = 7), 120 minutes of circulatory arrest with 10 minutes of intermittent systemic perfusion every 30 minutes during the arrest period; group III (n = 7), 120 minutes of circulatory arrest with 10 minutes of intermittent systemic perfusion every 20 minutes during the arrest period. Cerebral oxygen extraction rate increased significantly during the arrest periods (p < 0.05) and returned to normal after each 10-minute period of systemic reperfusion in every group. During circulatory arrest, cerebral excess lactate increased in a time-dependent manner after 20 minutes (r = 0.78; p < 0.001). Anaerobic metabolism did not increase throughout the circulatory arrest period in group III, although it increased significantly in groups I and II (p < 0.05). The present data demonstrate that cerebral energy metabolism becomes predominantly anaerobic within the first 20 minutes of deep hypothermic circulatory arrest. The present findings suggest that intermittent systemic recirculation for brief 10-minute periods every 20 minutes during circulatory arrest should prevent cerebral anaerobic metabolism during long periods of arrest that are required to complete complicated surgical repairs.

[A case of bilateral coronary-pulmonary artery fistula with multicystic saccular aneurysms]

A 71-year-old woman was admitted to our hospital for evaluation of a chest X-ray abnormality. Heart murmur was not heard. Chest X-ray showed a bulge with calcification at left third arch. Chest computed tomography revealed contrast enhancement of masses, which appeared to originate from the vascular system. Coronary angiography demonstrated multicystic aneurysmal dilatation of a coronary artery fistula originating from the proximal left descending and right coronary artery. Electrocardiography showed no remarkable findings and a treadmill exercise test showed no significant ST-T change. The size of the mass of 3 cm in diameter on chest X-ray remained the same for two years. We concluded that surgery was not necessary immediately. In Japan, nineteen cases of coronary-pulmonary artery fistula with multicystic saccular aneurysms have been reported in the literature, including our case. The majority of these cases are elderly women from fifty to sixty years old.

Isolation and characterization of mutations in the human holocarboxylase synthetase cDNA

Holocarboxylase synthetase (HCS) plays an essential role in biotin utilization in eukaryotic cells and its deficiency causes biotin-responsive multiple carboxylase deficiency in humans. We have cloned the human HCS cDNA and show that antiserum against the recombinant protein immunoprecipitates human HCS. A one base deletion resulting in a premature termination and a missense mutation (Leu to Pro) were found in cells from siblings with HCS deficiency. Human HCS shows homology to BirA, which acts as both a biotin-[acetyl-CoA-carboxylase] ligase and a biotin repressor in E. coli, suggesting a functional relationship between the two proteins. The human HCS gene maps to chromosome 21q22.1.

[A case of fistula-cancer response to arterial chemoembolization]

Arterial chemoembolization was performed three times preoperatively for cancer associated with fistula-in-ano for diminishing the postoperative surgical tissue defect of the perineum. Partial response of the tumor to this treatment was confirmed by computed tomography. A sixty-two-year-old male patient recognized a mass in the perineum one and a half years ago. He had suffered from fistula-in-ano for thirty years. The mass increased its size and formed a tumor in the bilateral buttocks (12 x 9 cm and 9 x 9 cm in diameter). Biopsy specimen showed a moderately differentiated adenocarcinoma. Angiography showed a hypervascular tumor stain. The main feeders to the tumor were the superior rectal artery and bilateral internal iliac artery. Arterial chemoembolization was performed three times through the right and left internal iliac artery with Gelfoam particle. Arterial infusion chemotherapy was added through inferior mesenteric artery and bilateral internal iliac artery with a total 120 mg of adriamycin and 1,500 mg of 5-FU simultaneously. The tumor decreased in size to 44% of the preoperative size by the treatment. A radical operation was performed following the preoperative treatment. Preoperative arterial chemoembolization for cancer associated fistula-in-ano was considered to be helpful for local control.

[Cooperation between clinical departments and tissue pathology department]

The author discussed some points where the staff in clinical departments could cooperate with the tissue pathology department to facilitate good quality control, (hereafter abbreviated as QC) from the stand point of a staff in internal medicine or gastroenterology. Remarks on general matters such as necessity of QC system at the ward where nurses are usually engaged in the treatment of the specimens for clinical laboratory. As to QC on tissue pathological diagnosis, inter-hospital surveillance is inevitably important. However, this has not been done because of defects in philosophy of Japanese medical insurance and in facts of medical education. At postmortem examination, the clinician would like to expect the pathologist to have a thoughtful consideration to convenience of the family of the dead. The tissue examinations of the biopsy specimens from GI endoscopy in the author's department are summarized as follows. In 1993, biopsy rates was 26.1% among 1726 patients done upper GI endoscopy. It was 42.4% in 536 patients done lower GI endoscopy. Group IV & V in the histological grade of malignancy account for 13.1% of 450 cases in upper GI specimens. Group 4 & 5 account for 16.3% of 226 cases in lower GI specimens. The frequency of specimens with malignancy taken by each endoscopist did not reveal any difference in the technical skill of each endoscopists, neither did the average number of specimens obtained in one occasion by each endoscopist. On 28 patients, biopsies were done in multiple occasions in a year. The rate of false negative in initial biopsy was 1.4% in 445 cases with which neoplasms were suspected.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and properties of bovine liver holocarboxylase synthetase

Holocarboxylase synthetase was purified 18,000-fold from bovine liver cytosol by a sequence of ammonium sulfate fractionation, alumina C gamma fractionation, DEAE-Sepharose CL-6B, EAH-Sepharose 4B, Sephacryl S-200 HR, Bio-Gel HTP, and Phenyl-Superose HR 5/5 chromatographies. Holocarboxylase synthetase activity was assayed using apopropionyl-CoA carboxylase from a patient with holocarboxylase synthetase deficiency as a substrate. Apopropionyl-CoA carboxylase was easily prepared from cultured lymphoblasts from this patient. Enzyme activity coincided with a 64,000-Da protein band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Additionally, the molecular mass of the native enzyme was estimated to be 60,000 Da by gel filtration on Sephacryl S-200 HR. These results suggest that purified holocarboxylase synthetase from bovine liver cytosol is a monomeric enzyme. Its Km value for biotin was estimated to be 13 nM.

Chronobiological analysis of a new clock mutant, Toki, in Drosophila melanogaster

We have isolated a new semidominant clock mutant Toki on the second chromosome in Drosophila melanogaster. This mutant differs from the wild-type Canton-S in several properties as follows. Larger values are obtained in the phase angle difference (phi, the time from lights-off in a 24-hr light-dark cycle to an activity offset), the ratio of activity time to rest time (alpha/rho) and the activity level. The free-running period (tau) is 25.3 hr, one hour longer than in the wild-type. In the phase response curve (PRC), the ratio between the delay and the advance portion is larger and the cross-over point occurs later, although there is no difference in amplitude of the mutant's PRC (Type I). The rhythm is more sensitive to the light intensity, becoming obscure in darker condition. Toki interacts with other clock mutations, pers, perL and And, in such a way that tau s associated with these three X-linked mutations are lengthened and phi values become smaller.

The significance of glutathione peroxidase on myocardial protection in the rat hearts: the key of clarify the cause of vulnerability to reperfusion injury in infantile cardiac operations

Selenium (Se) is an integral component of glutathione poeroxidase (GSHPx), and the serum selenium concentration is age-depend. We speculated that myocardial GSHPx had relation to reperfusion injury in open heart operations, especially in infants in whom GSHPx activity is low. This study correlated GSHPx activity with the serum and myocardial selenium concentrations in Wistar rats, which were divided into three groups, infants, Se-deficient rats, and control rats. Serum GSHPx activity in infant and Se-deficient rats (22.7 +/- 3.5 U/g protein, 24.6 +/- 22.2 U/g protein) was lower than that in controls (179 +/- 12.0 U/g protein). The serum selenium concentration in infant and Se-deficient rats (3.81 +/- 0.81 micrograms/g protein, 2.06 +/- 1.69 micrograms/g protein) was also lower than that in controls (7.32 +/- 2.96 micrograms/g protein). The myocardial GSHPx activity was significantly lower in infants and Se-deficient rats (4.76 +/- 1.05 x 10(-1) U/mg protein, 3.38 +/- 0.32 x 10(-1) U/mg protein) than that in controls (8.03 +/- 0.57 x 10(-1) U/mg protein). However, the myocardial selenium concentration in infants (1.42 +/- 0.24 x 10(-1) micrograms/mg protein) was significantly higher than that in the other groups (0.31 +/- 0.06 x 10(-1) micrograms/mg protein, 0.28 +/- 0.04 x 10(-1) micrograms/mg protein). Next, in Se-deficient and control rats, isolated hearts were perfused for aerobically with Krebs-Henseleit solution in the Langendorff mode for 15 minutes, followed by 60 minutes of global ischemia at 4 degrees C and then reperfused for 30 minutes in a working mode. The hemodynamic parameters were measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of antigen-induced airway hyperresponsiveness in rats: effects of ozagrel (a thromboxane A2 synthase inhibitor) and of CV-3988 (a platelet activating factor antagonist)

The effects of ozagrel, a thromboxane A2 (TXA2) synthase inhibitor, and CV-3988, a platelet activating factor (PAF) antagonist, was investigated on the repeatedly antigenic challenge-induced airway hyperresponsiveness (AHR) in rats. Rats were actively sensitized with DNP-Ascaris antigen and received 3 inhalations of antigen (challenges) or saline (sensitized control) every 48 hr. These animals were also pretreated with ozagrel (100 mg/kg, p.o., 30 min before), CV-3988 (3 mg/kg, i.v., 5 min before) or respective vehicle (water and saline, respectively) before each inhalation of antigen or saline. The in vivo airway responsiveness to cumulatively inhaled acetylcholine (ACh; 0.001-0.03%, each for 3 min) was measured 24 hr after the last inhalation of antigen or saline under anesthesia. A marked AHR was observed after repeated antigenic challenge when compared with the sensitized control group (5.5-9.5 times in order). This AHR was significantly, but partly, attenuated by pretreatment with ozagrel although this treatment alone had no effect on the airway responsiveness to inhaled ACh in sensitized control animals. On the other hand, CV-3988 had no inhibitory effect on this AHR. These findings suggest that TXA2, but not PAF, is one of the most important mediators participating in the pathogenesis of the antigen-induced AHR in rats.

Water-soluble carbodiimide for the fluorescent measurement of the carboxyl group produced by enzyme reactions

Fluorescent measurement of the carboxyl group was achieved using water-soluble carbodiimide, EDC (1-ethyl-3-(3- dimethylaminopropyl)carbodiimide). Detection of the active intermediate from the glucuronic acid-EDC reaction mixture using the OPA (o-phthalaldehyde) reagent described in a previous paper was greatly improved to about 4 ng/tube (17 pmol) glucuronic acid owing to a modification of the OPA cocktail. Moreover, fluorescent EDAN (N-1-ethylenediamino-naphthalene) labeling of the carboxyl group was also enabled by EDC catalysis. Quenching of the excess fluorescence of EDAN by OPA increased the sensitivity of EDC-EDAN to a level above the EDC-OPA method. In addition to the assay of enzymes concerning the uronic acid metabolism such as pectinase and pectinesterase, lipase and protease actions could be measured by the EDC-OPA and EDC-EDAN quenching methods, respectively. Thus, these two fluorescent means of detecting carboxyl groups seemed to have extensive application not only to acidic sugars but also to various carboxylic compounds regardless of their solubility.

Importance of anti-siphon devices in the treatment of pediatric hydrocephalus

The effects of an anti-siphon device (ASD) on shunt flow and intracranial pressure (ICP) in 16 children with hypertensive hydrocephalus were examined using quantitative radionuclide shuntography (99mTc) with the children in supine and sitting positions. The average age of these patients was 9.5 years. Results were compared with those recorded in 36 patients with adult normal-pressure hydrocephalus (NPH). The closing pressure levels of shunt valve used were low in 8 cases, medium in 7 and high in 1. Half the children (8) had shunt systems with, and the other 8 without, ASD. In the children who had the shunt system without ASD, sitting shunt flow was significantly greater than supine shunt flow, which indicated overdrainage. Conversely, in children who had the shunt system with ASD, supine shunt flow was greater than sitting shunt flow. Because ASD prevented overdrainage, ICP was higher with the shunt system with ASD than with the shunt system without ASD. Without ASD, sitting shunt flow of children was lower than that of adult patients with NPH because of the lower hydrostatic pressure, which correlated with their height. Conversely, in the presence of a shunt system with ASD, sitting shunt flow of children was greater than that of adults, because of the higher ICP and lower hydrostatic pressure. The effect of ASD was smaller in children than in adults, because positive pressure over the ASD was greater (hypertension vs normal pressure) and negative pressure under the ASD was less (short vs tall) in children than in adults. Thus, in children the ASD was effective in preventing overdrainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Multicystic aneurysmal dilatation of bilateral coronary artery fistula

Bilateral coronary artery fistula constitutes an uncommon subgroup of coronary artery fistulas that may have a distinct embryologic origin. Coronary artery fistulas usually show a tortuous arrangement upon coronary angiography, but aneurysmal dilatation is rare. We report here an extremely rare case of coronary artery fistula originating from both coronary arteries, which showed multicystic aneurysmal dilatation.

[Dose effects on vital parameters of guinea pig by continuous administration of cisplatin]

A wide used anti-neoplasmic agent, cisplatin (CDDP), injures normal organs dose-dependently by its toxicity. The mechanisms of organ injuries have been studied to prevent and rescue patient conditions. We analyzed the relation between CDDP doses and onset of organ injuries to clarify the mechanism of CDDP toxicity. The onset doses to cause organ injuries were calculated using weekly collected vital parameters of 18 male guinea pigs which were injected CDDP (2 mg/kg/day, 5 times/week) intraperitonealy until the death of animals. Correlations between the values of vital parameters and CDDP doses and applicative survival curve method were used to estimate the onset doses. Abnormal changes in iron metabolism and auditory organ were first noted at 10.2 mg/body and 10.8 mg/body of CDDP, respectively. The change in the salivary glands were noted at 15 mg/body. Renal injury started at 19.5 mg/body, and damages to the bone marrow started between 19.7 mg/body to 33.6 mg/body of CDDP. The minimal dose of liver dysfunction was 21.3 mg/body. It is concluded from these results that 1) the onset of organ injury depends on the dose of CDDP, and 2) the order of such injuries was iron metabolism, auditory organ, the salivary glands, kidney, the bone marrow, and the liver in guinea pigs, 3) Other organ injuries might be detected to clarify hearing levels during chemotherapy because those were noted following auditory damage except iron metabolism.

Synthesis and evaluation of novel thiazolidine derivatives as thromboxane A2 receptor antagonists

A series of 3-benzoyl or 3-phenylsulfonyl-2-substituted thiazolidine derivatives were synthesized, and evaluated for their thromboxane A2 (TXA2) receptor-antagonizing effect on (15S)-15-hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5(Z),13(E)-dienoic acid (U-46619)-induced aggregation of rabbit platelet-rich plasma (PRP). A simple 2-aryl-thiazolidine derivative, 3-benzoyl-2-(4-hydroxy-3-methoxyphenyl)thiazolidine (5a), showed mild TXA2 receptor antagonist activity. Modification of 5a led to 2-chloro-4-[3-(4-chlorophenylsulfonyl)thiazolidin-2-ylmet hyl]phenoxyacetic acid (29d), which showed 10 times more potent TXA2 receptor antagonist activity than 5a.

Nutcracker phenomenon: a case with surgical treatment and its diagnostic criteria

A surgically treated case of the nutcracker phenomenon is reported. Severe left flank pain and gross hematuria were relieved by direct renocaval reimplantation. We proposed the diagnostic criteria of the nutcracker phenomenon causing severe flank pain and/or renal hematuria.

Variability in circadian activity patterns within the Culex pipiens complex (Diptera: Culicidae)

Circadian activity was compared among four strains of Culex pipiens molestus Forskal from Iran, Egypt, two localities (Ebira and Yanagawa) in Nagasaki, Japan, and one strain of Cx. p. pallens Coquillett from Japan. Under a 16:8 (L:D) h photoperiod, all the strains showed peaks of activity at lights on and off, with additional activity during both light and dark periods; Egyptian females and both sexes of Cx. p. pallens were inactive during the photophase. Under 0:24 (L:D) h, the length of the free-running activity period was significantly shorter in the "Iran" (21 h) than in the other three Cx. p. molestus strains (range, 21-23 h) and Cx. p. pallens (approximately 24 h). Under 24:0 (L:D) h, the activity rhythm was obscured. The length of the period was shorter in 24:0 (L:D) h than in 0:24 (L:D) h, violating Aschoff's circadian rule. Furthermore, the circadian peak did not always occur every day under 24:0 (L:D) h but rather exhibited "day-skipping."