B-Lynch suture for the treatment of uterine atony

INTRODUCTION

Over 125,000 women die of postpartum haemorrhage (PPH) each year, with the commonest cause being uterine atony (75-90 percent). Failing conservative management, hysterectomy is usually the final resort. In 1997, Christopher B-Lynch devised an innovative technique to treat uterine atony, and it has been widely used around the world since its original report. However, there are hardly any reports of this technique being utilised in East Asian countries, including Singapore. Our study reviews the cases in which the B-Lynch suture was used to treat uterine atony, and the clinical outcomes of these cases.

METHODS

A retrospective study of data of all women who delivered between May 2004 and June 2007 was collected from the department's database, to identify patients who had undergone the B-Lynch procedure. Primary PPH is defined as a blood loss of more than 500 ml at or within 24 hours of delivery.

RESULTS

There were a total of 5,470 deliveries during this period, with primary PPH occurring in 100 cases. The B-Lynch procedure was performed in seven women, avoiding the need for a hysterectomy in five cases.

CONCLUSION

Our series of cases treated with the B-Lynch procedure showed that it is an effective method of containing PPH. It has the advantage of being applied easily and rapidly, and should be taught to all trainees and registrars in obstetrics. It should be attempted when conservative management of PPH fails and before any radical surgery is considered.

[Off-pump coronary artery bypass and right ventricular branch translocation for coronary aneurysm; report of a case]

The successful surgical treatment for a coronary artery aneurysm was reported. A 38-year-old female presented with angina pectoris due to right coronary artery stenosis. Angiography revealed a right coronary artery aneurysm and 90% stenosis at a site just proximal to the aneurysm, accompanied by the relatively large right ventricular (RV) branch originating from a mid portion of the aneurysm. Off-pump coronary artery bypass grafting (CABG) to the right coronary artery (RCA) #3, translocation of RV branch to RCA #3, and ligation of RCA proximal and distal to the aneurysm were successfully performed. Post-operative course had been uneventful with satisfactory angiographic results. Coronary translocation with CABG could be a treatment option for coronary artery aneurysms.

Flow interruption of the distal radial artery: treatment for finger ischemia in a matured radiocephalic AVF

PURPOSE

To establish an effective approach for diagnosis and treatment of hand ischemia in matured radiocephalic arteriovenous fistulae (AVF).

METHODS

One hundred and fifty end-stage renal disease patients (4% of our practice) presented to our outpatient vascular access facility complaining of a range of symptoms including coldness, numbness and pain in the fingers indicative of ischemia due to steal syndrome. In 15 patients the symptoms of steal syndrome were limited to the fingers, sparing the hand. Physical examination was indicative of steal syndrome caused by shunting of blood from the ulnar artery via the palmar arch, away from the fingers and into the fistula. To confirm the diagnosis, angiography was performed which demonstrated retrograde flow in the distal radial artery (DRA), a hypertrophied palmar arch, and a patent hypertrophied ulnar artery. Ischemia was treated with DRA flow interruption. Transcatheter coil embolization of the DRA (10 patients) was preferred because it proved to be a quick, safe and effective technique. Whenever embolization was not possible ligation of the DRA was performed in accordance with accepted surgical literature (five patients).

RESULTS

DRA flow interruption was effectively accomplished by either ligation or coil embolization in all cases. All patients had symptomatic improvement. Complete symptom resolution was experienced by 100% (10/10) of patients who received DRA embolization and by 3/5 patients who required ligation. The average follow-up period was 9 months. There were no complications during the procedure or during the follow-up period.

CONCLUSION

Diagnosis using physical examination, angiography and treatment with embolization or ligation of the DRA can be performed with great success in an outpatient setting.

[Ascending aortic dissection associated with pulmonary contusion caused by blunt trauma]

A 77-year-old female tumbled and struck her front chest wall twice. After the event, hemosputum was observed and she complained of slight chest discomfort. As chest pain continued to worsen a week after the event, she was transferred to our hospital. The computed tomography (CT) revealed an ascending aortic dissection and bilateral pulmonary contusion. In the intensive care unit (ICU), antihypertensive therapy was given immediately and delayed surgical repair was planned because of pulmonary contusion. Twenty days after the event, proximal hemiarch replacement was performed. Postoperative course was uneventful without any complication. She was discharged on the 23rd day after the operation.

[Open stent-grafting for the distal arch aneurysm using a new delivery sheath]

Surgical graft replacement of the distal aortic arch aneurysm has been known to have rather poor outcome. Open stent-grafting has been employed in many institutions, but several complications have been reported. Especially, embolism of the distal artery by debris of aneurysmal wall is a serious complication. Therefore we have developed and applied a new delivery sheath. The sheath is constructed with a ready-made delivery sheath and a part of a ready-made tracheostomy tube. That is called "balloon sheath". Five patients underwent distal arch stent-grafting using the device, all of whom had excellent result. The merits of the sheath are smooth delivery of stent-graft and less invasiveness for aortic wall. The new device is considered to be able to prevent aortic wall injury and peripheral embolic complication during insertion of stent-graft.

[Clinical evaluation of hydrocolloidal dressing in 147 patients undergoing cardiovascular surgery]

Recent evidence has suggested that a moist environment plays an important role in wound healing. Karayahesive, one type of hydrocolloidal dressing, contains natural karaya gum as a hydrophilic gel. We applied hydrocolloidal dressing to operative wounds in 147 patients who underwent cardiovascular surgery from April 2001 through August 2002 to evaluate its clinical usefulness. The dressing was kept on the wounds for 7 days after operation, but was immediately switched to conventional dressing with gauze if there was any problem. A total of 144 patients (98%) had no wound chest infections. Good wound healing was obtained with only 1 dressing, removed 7 days after operation, in 128 patients (87%). In 19 patients (13%), the hydrocolloidal dressing was switched to conventional dressing. In 13 of these patients the hydrocolloidal dressing dissolved naturally or exudation occurred; clinically, there were no local problems; however, 3 patients had infection, 2 had fat necrosis, and 1 had burn injury caused by electrocautery. No patients had skin problems caused by this dressing. We conclude that hydrocolloidal dressing can be used safely and effectively in patients undergoing cardiovascular surgery and reduce the workload of healthcare workers.

[Ruptured syphilitic ascending aortic aneurysm; report of a case]

Syphilitic cardiovascular disease has become a rarity today. It most commonly affects the ascending aorta and aortic arch. A case is reported of a 50-year-old female with a ruptured syphilitic ascending aortic aneurysm who underwent an emergency operation. The patient was emergently admitted with complaint of severe dyspnea, circulatory shock due to cardiac tamponade was observed in the emergency room. Bentall's procedure was performed. Intraoperative findings showed multi-cystic dilatation of an aortic root. Penetration was existed on right side posterior wall of an aortic root. Postoperative pathological examination of the aneurysmal wall revealed the characteristic finding of syphilitic aortitis. The postoperative course was uneventful and the patient has been doing well at period of 3 years after operation.

[Primary cardiac malignant lymphoma diagnosed intraoperatively during aortic valve repair; report of a case]

A 58-year-old male who complained of chest oppression on effort was diagnosed as aortic regurgitation by echocardiography. The cardiac catheterization was showed moderate aortic regurgitation. He was referred to our hospital for aortic valve replacement. We considered preoperatively that the aortic regurgitation is due to infective endocarditis or aortitis syndrome. We have not noticed cardiac tumor at all until aortic valve replacement. Postoperative pathological diagnosis of the tumor was malignant lymphoma. The tumor had a characteristic architecture of a cardiac MICE (mesothelial/monocytic incidental cardiac excrescence). After the operation, additional chemotherapy using doxorubicin and cysplatin was performed. The patient has been doing well for 5 years after operation.

[Combined operation for left ventricular aneurysm and ventricular septal perforation with normal coronary arteries; report of a case]

We experienced a rare case of left ventricular aneurysm (LVA) and ventricular septal perforation (VSP) with normal coronary arteries, and had a good outcome by undergoing Dor procedure and direct closure of VSP individually. A 68-year-old female was printed out cardiac systolic murmur. Echocardiogram revealed LVA and VSP, but coronary arteriogram showed no significant stenosis. The apex was incised longitudinally, lateral and parallel to the interventricular groove. VSP was directly closed by 2 pieces of 3-0 polypropylene suture with felt strip. Purse-string stitch with 3-0 polyester suture around the transitional zone between fibrotic tissue and viable tissue was secured to firm fibrous tissue. The residual orifice was closed with an elliptical composite patch of equine pericardial patch and polyester velour with 3-0 polypropylene suture. We considered based on the operative finding that myocardial infarction (MI) led to LVA and VSP. Coronary thrombosis rather than coronary spasm may have provoked MI because spasm provocative test was negative.

[Bilateral coronary ostial stenoses with aortic regurgitation in a patient with syphilitic aortitis]

Syphilitic aortitis is now rare in developed countries and is sometimes overlooked. A 61-year-old man with bilateral coronary ostial stenoses (#5:90%, #1:99%) and Sellers III/IV aortic regugitatioin (AR) induced by syphilitic aortitis presented with chest pain. Preoperative rapid plasma reagin titer and Treponema pallidum hemagglutination test were strongly positive, 256 fold and 191.25 C.O.I., respectively. Aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) with bilateral internal thoracic arteries (ITA) was performed successfully. The angiographic features as follows: 1) coronary artery stenosis is generally limited to the ostia, 2) the grade of stenosis is almost always more than 90%, 3) AR is frequently associated with coronary ostial stenosis. CABG should be performed with ITA, not saphenous vein grafts, to avoid occlusion of the ostium of the saphenous vein graft by syphilitic aortitis. Retrograde cardioplegia should be performed if ostial stenosis is severe.

[Surgical repair of left ventricular free wall rupture using layered fibrin glue sheet and fibrin glue; report of a case]

A 57-year-old man with acute myocardial infarction (#13:90%, #6-#8:75%) was admitted to our hospital after the administration of tissue plasminogen activator. Three hours' after emergent percutaneous transluminal coronary angioplasty, he developed left ventricular free wall rupture in the left circumflex artery area. After bleeding was completely controlled by aortic cross clamping, a three-layered of fibrin glue sheet (TachoComb) with fibrin glue was extensively applied to the ruptured site including the infarcted area. He was discharged on the 25th postoperative day and underwent coronary artery bypass grafting to the left anterior descending artery three weeks later. This experience suggests that the layered TachoComb and fibrin glue are effective for left ventricular free wall rupture.

Multiplex sequence-tagged site PCR for efficient screening of microdeletions in Y chromosome in infertile males with azoospermia or severe oligozoospermia

The multiplex STS-PCR method was used to detect microdeletions in the long arm of the Y chromosome (Yq) of cytogenetically normal men. One hundred infertile men with azoospermia or oligozoospermia were screened with the multiplex PCR method using 58 STSs, which are specific to Yq for detecting microdeletions on this chromosome. Correlations between the microdeletions on Yq and phenotypes of spermatogenetic disturbance were also examined. Ten patients (10%) had microdeletions on Yq. Seven of the 60 azoospermic patients (11.7%), and 3 of the 40 oligozoospermic patients (7.5%) had microdeletions on Yq. None of the patients showed microdeletions in the AZFa region, but 2 had deletions in the AZFb region, another 2 in the AZFc region, including DAZ, and 1 had deletions in both the AZFb and in the AZFc, including RBM and DAZ. Single microdeletions were found in 4 patients, all of them in the AZFc around DAZ, and 1 patient had 2 microdeletions in the AZFb. The improved multiplex STS-PCR method efficiently detected microdeletions in 10% of azoospermic or severe oligozoospermic men who were cytogenetically normal. All of these microdeletions were presented in the AZFb and/or AZFc regions. This suggests that these regions contain candidate genes for spermatogenesis.

[Effect of autologous platelet-rich plasma (PRP) in cardiac surgery]

Autologous platelet-rich plasma (PRP) was harvested before cardiopulmonary bypass (CPB). After heparin neutralization, it was returned to patients. The purpose of this study was to examine platelet function and the amount of blood loss and blood transfusion after transfusion of PRP. Twenty-eight patients undergoing elective coronary artery bypass grafting and other procedures were divided into three groups: group A; patients undergoing CAGB between May and October 1997 (n = 10), group B; patients undergoing other between May and October 1997 (n = 8), group C; patients undergoing CAGB before May 1997 (n = 10). Blood cell count, platelet aggregation in response to ADP, and platelet adhesion were measured before CPB, just after CPB, after infusion of protamine and PRP, 24 hrs after CPB and 48 hrs after CPB. Blood loss and blood transfusion in group. A and group C were examined after CPB. There was no significant difference in platelet count between group A and group B. There was significant difference in platelet aggregation in group A. There was no significant difference in blood loss after CPB between group A and group C, but there was a significant difference in blood transfusion between group A and group C. These results suggest that PRP was useful to preserve platelet function and to decrease blood loss after CPB in cardiac surgery.

Adrenal steroids in human prostatic cancer cell lines

Adrenal androgens function as an androgen source within prostate and androgen target tissue. This study compares the ability of three human prostatic cancer cell lines to metabolize the adrenal androgens, dehydroepiandrosterone (DHEA), and androstenedione under living culture conditions. Androgen-independent cell lines PC-3 and DU145 and androgen-dependent cell line LNCaP were investigated. The effect of glucuronide and sulfate conjugates was also investigated. There was a strong tendency in PC-3 or DU145 to convert androstenedione to DHEA or DHEA-S reservoir. On the other hand, LNCaP was capable of converting DHEA into androstenedione and subsequently into dihydrotestosterone (DHT). Moreover, androgens were converted into a glucuronide conjugate in LNCaP, but not in PC-3 or DU145. As a result, the metabolism of the adrenal precursor shifted to androgen formation in LNCaP. This could be confirmed by means of reverse transcription-PCR of uridine diphosphoglucuronosyl-transferase (UGT) 2B15. Kinetic properties of UGT activity in LNCaP revealed DHT to be a better substrate than testosterone. In conclusion, the findings show that the adrenal precursor pool has the potential to contribute to the regulation of prostatic cells. Moreover, the presence of UGT activities in LNCaP may have a regulatory effect on the active androgen level in the intracellular environment.

Mutations that affect dimer formation and helicase activity of the hepatitis C virus helicase

Interaction between viral proteins is necessary for viral replication and viral particle assembly. We used the yeast two-hybrid assay to identify interactions among all the mature proteins of the hepatitis C virus. The interaction between NS3 and NS3 was one of the strongest viral protein-protein interactions detected. The minimal region required for this interaction was mapped to a specific subdomain of 174 amino acids in the N terminus of the helicase region. Random mutations in the minimal region were generated by PCR, and mutants that failed to interact with a wild-type minimal fragment were isolated using the yeast two-hybrid assay as a screen. Three of these mutations resulted in a reduction or a loss of interaction between helicases. Analytical gel filtration showed that in the presence of an oligonucleotide, wild-type helicases form dimers whereas the mutants remain mostly monomeric. All three mutants were partially or almost inactive when assayed for helicase activity in vitro. Mixing a mutant helicase (Y267S) with wild-type helicase did not dramatically affect helicase activity. These data indicate that dimerization of the helicase is important for helicase activity. The mutations that reduce self-association of the helicase may define the key residues involved in NS3-NS3 dimerization.

[Clinicopathological study of the testicular microlithiasis]

PURPOSE

Testicular microlithiasis (TM) is a relatively rare condition characterized by calcific concref1p4 within the seminiferous tubules. Little has been reported on the incidence or the clinical implication of TM among Japanese. To address the problem, we evaluated pathologic specimens from biopsies and orchiectomies, of testes with various conditions.

MATERIALS AND METHODS

Pathologic specimens of the testes of 200 cases, 56 from orchiectomy and 144 from testicular biopsy, were investigated.

RESULTS

The pathological diagnosis of TM was confirmed in seven (3.5%) cases, four of which were associated with germ cell tumors and the other three were obtained from testicular biopsies performed for examination of infertile men. Of the 41 patients with germ cell tumors, four (9.8%) were found to have TM, and another three (2.5%) were identified among 122 patients with infertility. The prevalence of TM is significantly higher in specimen with germ cell tumors than those without germ cell tumors (p < 0.05).

CONCLUSIONS

Although TM is rarely encountered, this condition is relatively often accompanied by testicular malignancy. Further investigation would be fundamental to ascertain the relationship between TM and testicular malignancy.

Determination of sulfite in Oriental herbal medicines

Sulfite was detected in 7 varieties of Oriental herbal medicines (Pueraria radix, Zingiberis rhizoma, Platycodon radix, Adenophora radix, Pinellia tuber, Astragalus radix, and Paeonia radix) on the Korean market. Sulfiting of commercial Oriental herbal medicines by fumigation with burning bituminous coal was simulated, and the accumulation of sulfite was investigated by using fresh Platycodon radix roots obtained from a growing field. The sulfite level reached a plateau in 9 h, and the maximum sulfite level found by the Monier-Williams (MW) method (AOAC 990.28) was 1020 ppm. The sulfite content in the simulated Platycodon radix sample determined by alkali extraction followed by ion-exclusion chromatography with electrochemical detection (AOAC 990.31) was approximately 17% lower on average than the MW results. Free-sulfite levels determined by acid extraction and ion-exclusion chromatography with electrochemical detection were between 19 and 49% of the MW results. The advantages of different methods for sulfite determination and the significance of the results are discussed.

Fas-mediated apoptosis in adriamycin-induced cardiomyopathy in rats: In vivo study

BACKGROUND

The precise molecular mechanism of Adriamycin-induced cardiomyopathy (ADR-CM) is still unknown. We address the demonstration of apoptotic myocardial cell death and the apoptosis-inducing molecules in ADR-CM induced in rats.

METHODS AND RESULTS

Until 8 weeks after the first administration of ADR, there was no increase in the number of labeled cells by terminal deoxynucleotidyl transferase assay (TUNEL method). Apoptotic indices increased significantly at weeks 9 and 10 in hearts of the ADR-treated group but not in those of the control group (0.42+/-0.12% versus 0.10+/-0.02% and 0.86+/-0.11% versus 0.09+/-0.04% at weeks 9 and 10, respectively). DNA ladder formation was also observed in the myocardial tissues during the late stages of the ADR-CM of rats. There was no significant difference in expression of p53 gene between the ADR group and the control group at either the message or the protein level. An overexpression of Fas antigen was shown in myocardial cells of ADR-treated hearts at weeks 9 and 10 by both Western blotting and immunofluorescent staining. Furthermore, we confirmed that neutralization of anti-Fas ligand antibody inhibited ADR-induced apoptosis.

CONCLUSIONS

Apoptotic cell death was observed in the hearts of ADR-CM rats, and the number of apoptotic myocardial cells increased with the deterioration of morphological findings and cardiac function, indicating that apoptosis may be an important mechanism of loss of myocardial cells and cardiac dysfunction in ADR-CM. Apoptosis in ADR-CM rats is not p53-dependent but rather is executed through a Fas-mediated pathway.

A genetic screen to identify genes that rescue the slow growth phenotype of c-myc null fibroblasts

The c-myc gene is frequently over-expressed in human cancers and is involved in regulation of proliferation, differentiation and apoptosis. c-Myc is a transcription factor that acts primarily by regulating the expression of other genes. However, it has been very difficult to identify bona fide c-Myc target genes that explain its diverse biological activities. The recent generation of c-myc deficient Rat1A fibroblasts with a profound and stable growth defect provides a new system to search for genes that can substitute for c-myc in proliferation. In this study, we have attempted to identify genes that rescue the slow growth phenotype of c-myc null cells through introduction of a series of potent cell cycle regulatory genes and several retroviral cDNA expression libraries. None of the candidate genes tested, including SV40 T-antigen and adenovirus E1A, caused reversal of the c-myc null growth defect. Furthermore, extensive screens with high-complexity retroviral cDNA libraries from three different tissue sources revealed that only c-myc and N-myc rescued the c-myc null slow-growth phenotype. Our data support the notion that there are no functional equivalents of the myc family of proto-oncogenes and also suggest that there are no c-Myc-activated genes that alone can substitute for c-Myc in control of cell proliferation.

Determination of ethyl carbamate in some fermented Korean foods and beverages

Ethyl carbamate has been associated with cancer for several decades. It is mainly found in fermented foods and beverages. In view of the importance of fermented foods in the Korean diet and the significant level of ethyl carbamate expected, we determined ethyl carbamate concentrations in some of the staple food items and estimated the daily intake for the Korean population. Ethyl carbamate in commercial samples of kimchi, soy sauce, vinegar, soybean paste, and alcoholic beverages were determined by gas chromatography-mass spectrometry/selective ion monitoring (GC-MS/SIM). Homemade soy sauce and kimchi were also analysed. The maximum ethyl carbamate concentrations observed were 73 micrograms/kg in soy sauce, 7.9 micrograms/kg in soybean paste, 2.5 micrograms/l in vinegar, 16.2 micrograms/kg in kimchi and 15.4 mu/l in Korean traditional alcoholic beverages. Combining these values with the average daily food intake data, we estimated that the maximum daily exposure of Korean population to ethyl carbamate is 2.8 micrograms/day, which is not a negligible amount considering the 'virtually safe dose' derived by animal experiment ranges between 1.2 and 4.8 micrograms/day. It would be desirable to closely monitor ethyl carbamate levels in Korean foods and to find ways to reduce the daily intake.

Epistaxis: vascular anatomy, origins, and endovascular treatment

Embolization can play an important role in controlling epistaxis. However, one must be careful to avoid nontarget embolization via the dangerous anastomoses between the ECA branches, the carotid siphon, and ophthalmic arteries.

[Clinical study of serum S-100 beta protein as marker of brain injury in cardiovascular surgery]

There is no simple and specific marker of brain injury in cardiovascular surgery. S-100 beta protein is a specific protein of the central nervous system. S-100 beta protein detected in spinal fluid and serum is a reflection of brain injury. The aim of this study was to investigate the influence of extracorporeal circulation (ECC) on the brain, with reference to serum S-100 beta protein level and operative factors. Twenty-two patients (12 undergoing coronary artery bypass grafting (CABG), 2 mitral valve replacement, 2 left ventricular aneurysmectomy, 2 grafting of descending thoracic aneurysm, 1 aortic valve replacement (AVR), 1 CABG with AVR, 1 closure of atrial septal defect, 1 aorto-bifemoral and left subclavian artery bypass grafting) without symptomatic neurological complications underwent cardiovascular surgery using ECC. Serum S-100 beta level was measured by enzyme-linked immunosorbent assay before ECC and half an hour after the end of ECC in cardiovascular surgery. Carotid lesions, calcification of the ascending aorta, history of cerebral infarction, and pulsatile or nonpulsatile flow during ECC were evaluated as the operative factors. The correlation of S-100 beta level after ECC with age, duration of ECC and aortic cross clamp time was examined. Serum S-100 beta level was significantly increased after ECC (0.25 +/- 0.48 microgram/l vs. 0.99 +/- 0.64 microgram/l; p < 0.01). Calcification of the ascending aorta was the only significant operative factor that increased S-100 beta level after ECC (calcification 1.35 +/- 0.71 vs. non-calcification 0.68 +/- 0.37 p < 0.01). S-100 beta level after ECC was related to aortic cross clamp time (r = 0.54; p < 0.05, n = 20). It is suggested that brain injury, as reflected by serum S-100 beta protein, is more frequent in cases with calcification of the ascending aorta or a long aortic cross clamp time. It was concluded that serum S-100 beta is a simple potential marker of cerebral injury in cardiovascular surgery with ECC.

Differential expression of nitric oxide synthase in human stomach cancer

The level of expression and cellular localization of isoenzymes of nitric oxide synthase (NOS) was detected in human stomach tumor tissues. Tumor tissues showed 70% higher activity of NOS than that of normal tissues (P < 0.01). Poorly differentiated adenocarcinoma tend to have higher activity (P < 0.05) than well differentiated and moderately differentiated tumor tissues. Aminoguanidine (AG), 2-amino-5,6-dihydro-6-methyl-4H-1,3-thiazine (AMT), NG-monomethyl-L-arginine (L-NMMA), and Nomega-nitro-L-arginine (L-NNA) inhibited NOS activity in tumor tissues by 18, 14, 11 and 13%, respectively. The TNF-alpha mRNA expression was correlated with the inducible NOS (iNOS) level, which was high in adenocarcinomas and low in normal tissues. Tumor tissues showed higher expression of iNOS in gland epithelial cells but the level of eNOS was significantly decreased with an exception of concentrated localization in the proliferating capillary endothelium. These results revealed that isoforms of NOS might contribute differentially to growth and progression of human stomach tumor.

Spermatogenic ability is different among males in different Y chromosome lineage

It is a controversial question whether sperm concentrations in humans are changing. Several researchers have reported on environmental factors affecting sperm quality, but the influence of genetic factors is still not fully understood. In this study, we examined the relationship between Y chromosome haplotypes and sperm concentration in fertile males. In addition, we determined the haplotypes of azoospermic patients. The results show that the mean sperm concentration correlates with Y chromosome type. Moreover, the occurrence of azoospermia is related to one particular Y chromosome lineage. Thus, males with a certain haplotype are at a disadvantage for fathering children. The difference of spermatogenic ability among men is important not only in pursuing male competition as in the past but also as relates to the future of modern human males.

Long-term inhalation of nitric oxide for a patient with primary pulmonary hypertension

Primary pulmonary hypertension is a disease with a high mortality rate and for which there is no satisfactory medical treatment. The safety of long-term inhalation of nitric oxide (NO) as a treatment is described. A 9-year-old girl inhaled NO for 32 weeks, accompanied with oral administration of beraprost sodium. Although NO did not improve her long-term prognosis, it eased the patient's dyspnea and increased her blood oxygenation. At doses of 20 ppm or more, attempts to withdraw from inhaled NO seemed to lead to an immediate elevation of the pulmonary artery pressure. This rebound phenomenon did not happen at doses under 5 ppm. This case study suggests that long-term inhalation of NO is safe and effective, but that pulmonary hypertension may rebound following withdrawal at higher doses of NO.

[Successful surgical treatment of atrial septal defect with systemic lupus erythematosis in a 47-year-old female]

We report a case of surgical treatment of a 47-year-old female. She presented Atrial Septal Defect and Systemic Lupus Erythematosus. The operative procedure consisted of ASD's patch closure. Prednisolone was infused intravenously to prevent the acute deterioration of SLE after the operation. She was discharged from the hospital fifteen days after operation.

Five paediatric case reports of the use of adenosine in supraventricular tachycardia

The efficacy, safety and diagnostic usefulness of adenosine in the treatment of supraventricular tachycardia in children were prospectively studied over a 2-year period. Only patients who were stable and without hypotension were included. Adenosine was given at a dose of 0.1 mg/kg and increased to 0.2 mg/kg for the second and third doses if there was no response. Adenosine was used on 5 occasions in 5 patients. Adenosine was found to be effective in terminating supraventricular tachycardia in all 5 patients; 4 responded to a dose of 0.2 mg/kg while 1 responded to 0.1 mg/kg. Wolff-Parkinson White Syndrome was detected in 2 patients after termination of supraventricular tachycardia. Transient hypotension was noted in 1 patient lasting 45 seconds with no haemodynamic consequences. Two patients had transient ventricular ectopics lasting 3 to 5 seconds. One out of 3 patients who were old enough to report side-effects, experienced chest discomfort and dizziness lasting 5 seconds. All side-effects were transient and mild. We concluded that adenosine is effective and safe in terminating supraventricular tachycardia in children after vagal manoeuvres have failed.

[Disorders of sex chromosome]

Disorders of sex chromosome, X and Y, consist of abnormality of the number or structure of the sex chromosome. Because sex chromosomes have a variety of genes related to sexual differentiation, disorders of sex chromosome induce a variety of disorders of sexual differentiation. At first, in this title, the process of normal sexual differentiation is shown. Classical disorders of sex chromosome are Klinefelter syndrome, XX male, XYY male, Turner syndrome, XXX female, and XY female. True hermphroiditism, mixed gonadal dysgenesis, and pure gonadal dysgenesis are also included, because most of these disorders have abnormal sex chromosome. Molecular analysis of sex chromosome is clarifying disorders with a minute abnormality of sex chromosome. They include male infertility, premature ovarian failure, and fragile X syndrome. Explanations of the above disorders are given briefly.

[Successful surgical correction of incomplete endocardial cushion defect in a 65-year-old female]

We report a case of surgical correction of a 65-year-old female. She presented severe congestive heart failure and preoperative cardiac catheterization showed massive left to right shunt (87%), mild mitral regurgitation, severe tricuspid regurgitation and pulmonary hypertension. The operative procedure consisted of annuloplasty of mitral valve (Kay's method), patch closure of the ostium primum defect and annuloplasty of tricuspid valve. Postoperative examination showed complete competence of mitral valve and improved functional capacity. This is the fourth successful case report of surgical correction of incomplete endocardial cushion defect in patients older than 65-year-old in Japan to our knowledge. Surgical correction of incomplete endocardial cushion defect should be recommended even in elder patients.

Redistribution of intracellular Ca2+ stores after beta-adrenergic stimulation of rat tail artery SMC

beta-Adrenergic agonists induce the relaxation of vascular smooth muscle by a mechanism that activates the extrusion of Na+ and Ca2+ from the cell. A primary source of contractile Ca2+ resides in the sarcoplasmic reticulum (SR), which releases Ca2+ in response to vasoactive agents through inositol trisphosphate-mediated channels. To determine if smooth muscle relaxation induced by beta 2-adrenergic agonists involves the redistribution of intracellular Ca2+, we studied the effects of isoproterenol (Iso) on freshly isolated, single rat tail artery smooth muscle cells loaded with fura 2, using digital ratiometric fluorescence imaging. Stimulation with 1 microM phenylephrine (PE) or norepinephrine produced phasic and tonic increases in cytoplasmic intracellular Ca2+ concentration ([Ca2+]i) associated associated with cell shortening. Exposure to caffeine and to Ca2(+)-free solutions eliminated the phasic and tonic components, respectively, from the Ca2+ signal. Intermittent superfusion with PE or caffeine was used to evaluate SR Ca2+ stores after stimulation by Iso. Exposure to 1 microM Iso induced a time-dependent decrease in PE-activated peak and tonic [Ca2+]i without any change in resting [Ca2+]i. Intermittent stimulation with 10 mM caffeine revealed a similar decline in peak [Ca2+]i, indicating Iso-dependent depletion of SR Ca2+ stores. The Ca2+ that remained in the SR after prolonged exposure to Iso (30% of the pre-Iso level by 80 min at 22 degrees C) failed to elicit a contractile response. The cells, perfused with a Na(+)- and Ca2(+)-free medium to block Na+/ Ca2+ exchange, prevented depletion of the SR Ca2+ stores by Iso. We propose that Iso inhibits agonist-mediated Ca2+ influx through sarcolemmal Ca2+ channels and activates Ca2+ redistribution from storage sites in the SR to the extracellular compartment by a mechanism that involves Na+/Ca2+ exchange. These combined effects of Iso facilitate smooth muscle relaxation (and reduce vascular tonus) by reducing the increase in cytoplasmic Ca2+ evoked by vasoconstrictors.

[A case of video-assisted thoracoscopic surgery for patent ductus arteriosus under transesophageal echocardiography]

A six-year-old boy with patent ductus arteriosus was successfully treated by thoracoscopic surgery under transesophageal echocardiography, by which interruption of the ductal flow was confirmed. Postoperative course was uneventful and the patient was discharged on the 3rd postoperative day. The transesophageal echocardiography was effective to confirm disappearance of the flow in the operating room real-time. Video-assisted endoscopic surgery have reduced operative trauma in adult thoracic and general surgery, and can be safely applied to pediatric patients with patent ductus arteriosus. This technique may be an effective addition to the staged management of more complex forms of congenital heart disease.

[Coagulation disorders as early predictor of brain injury]

To identify early prognostic value of brain injury, a comparison was made between computerized tomography (CT) findings, coagulation abnormalities, and clinical features in 51 patients with closed head injury. The patients were divided into three groups according to their plasma level of fibrin-fibrinogen degradation product (FDP): normal group (FDP 10 micrograms/ml or less) in 20 patients; moderately abnormal group (FDP 10-40 micrograms/ml) in 15 patients; and highly abnormal group (FDP 40 micrograms/ ml or more) in 16 patients. Cases with a fatal clinical course were mostly associated with very high FDP level. Mortality rate in the highly abnormal group was 44% and 7% in the moderately abnormal group were dead cases, while no cases in the normal group turned out poor outcome. Injury severity, as assessed by Glasgow Coma Scale (GCS) score, correlated with the increase of plasma FDP level. Although severe head injury (GCS 8 or less) was found in 44% of the highly abnormal group and 13% of the moderately abnormal group, normal group only had one case (5%). Very high FDP concentrations were found to be associated with combined hemorrhagic lesions and mass effect on CT scan, but not with a specific localization of brain damage. In summary, the evaluation of coagulation and fibrinolytic function in patients following closed head injury might have both diagnostic and prognostic value.

[Experience of carperitide (synthetic human-atrial natriuretic peptide) after cardiovascular surgery]

Recently carperitide (synthetic human-atrial natriuretic peptide) in known to be useful for the care of acute heart failure. Stretch of the atrial wall has been suggested to be on one of the important factors involved in peptide release. The 8 patients were undertaken cardiac surgery. Carperitide was infused intravenously during postoperative period in these patients and the effects of carperitide were examined. Blood pressure (BP), central venous pressure (CVP), mean pulmonary arterial pressure (PA), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) were monitored by Swan-Ganz catheter, and urinary volume per body weight (UV/kg) were measured. The variables were determined before and after the intravenous infusion of carperitide at 0.1 to 0.2 microgram/kg/min. BP, CVP, PA, PCWP, SVR, and PVR were decreased, and CI and UV/kg were increased after administration of carperitide. These results suggest that carperitide is the useful agent for the postoperative care of cardiovascular surgery especially in the point of decreasing BP and increasing urination.

Detection of aberrations in androgen receptor gene by analysis of single-stranded conformation polymorphisms in polymerase chain reaction products

Analysis of single-stranded conformation polymorphisms in polymerase chain reaction (PCR) products (PCR-SSCP) is a sensitive method for detecting point mutations in genomic DNA. To investigate its utility in examining the androgen receptor gene, we analyzed data on a patient with the testicular feminization syndrome (TFS) with a known point mutation in exon C. We detected mobility shifts of fragments of the corresponding region. Since examination of the subject's brother (legally sister), who also has TFS, revealed an identical shift pattern, we sequenced the exon C of the sibling and detected a mutation identical to that in the former. We conclude that PCR-SSCP is available for screening mutations of the androgen receptor gene.

Lysophosphatidylcholine causes Ca2+ influx, enhanced DNA synthesis and cytotoxicity in cultured vascular smooth muscle cells

The effects of lysophosphatidylcholine (LPC), a vasoactive phospholipid, on intracellular free calcium concentration ([Ca2+]i), DNA synthesis and cytotoxicity of vascular smooth muscle cells (VSMC) were studied. LPC from 10(-7) to 10(-5) mol/l dose-dependently induced a sustained increase in [Ca2+]i. In contrast to the response of [Ca2+]i induced by angiotensin II, that induced by LPC was totally abolished when extracellular Ca2+ was removed, was not affected by pretreatment of the cells with islet-activating protein, and was not desensitized by repeated addition. 8-(N,N-Diethylamino)octyl 3,4,5-trimethoxybenzoic acid (TMB-8), an inhibitor of Ca2+ release from intracellular Ca2+ stores, 1-(5-isoquinolinesulfonyl)-2-methylpiperadine dihydrochloride (H-7), an inhibitor of protein kinase C, KT5823, an inhibitor of protein kinase G, and Ca2+ channel blockers failed to suppress the LPC-induced increase in [Ca2+]i. LPC at 10(-5) mol/l caused significant stimulation of [3H]thymidine incorporation into VSMC, and at concentrations of 10(-5) mol/l and higher dose-dependently stimulated release of lactate dehydrogenase in cell culture supernatants. Moreover, digitonin mimicked the effects of LPC on [Ca2+]i, and also caused similar effects to those of LPC on DNA synthesis and cytotoxicity in VSMC. These observations suggest that LPC causes both cell growth and cell injury of VSMC, at least partly, through its detergent action, causing membrane leakiness and resultant [Ca2+]i overload in vitro, thus indicating the possible participation of LPC in atherosclerosis and/or injury of the vascular wall.

Epstein-Barr virus nuclear protein 2 transactivation of the latent membrane protein 1 promoter is mediated by J kappa and PU.1

Expression of the Epstein-Barr virus (EBV) latent membrane protein 1 (LMP-1) oncogene is regulated by the EBV nuclear protein 2 (EBNA-2) transactivator. EBNA-2 is known to interact with the cellular DNA-binding protein J kappa and is recruited to promoters containing the GTGGGAA J kappa recognition sequence. The minimal EBNA-2-responsive LMP-1 promoter includes one J kappa-binding site, and we now show that mutation of that site, such that J kappa cannot bind, reduces EBNA-2 responsiveness by 60%. To identify other factors which interact with the LMP-1 EBNA-2 response element (E2RE), a -236/-145 minimal E2RE was used as a probe in an electrophoretic mobility shift assay. The previously characterized factors J kappa, PU.1, and AML1 bind to the LMP-1 E2RE, along with six other unidentified factors (LBF2 to LBF7). Binding sites were mapped for each factor. LBF4 is B- and T-cell specific and recognizes the PU.1 GGAA core sequence as shown by methylation interference. LBF4 has a molecular mass of 105 kDa and is probably unrelated to PU.1. LBF2 was found only in epithelial cell lines, whereas LBF3, LBF5, LBF6, and LBF7 were not cell type specific. Mutations of the AML1- or LBF4-binding sites had no effect on EBNA-2 transactivation, whereas mutation of the PU.1-binding site completely eliminated EBNA-2 responses. A gst-EBNA-2 fusion protein specifically depleted PU.1 from nuclear extracts and bound in vitro translated PU.1, providing biochemical evidence for a direct EBNA-2-PU.1 interaction. Thus, EBNA-2 transactivation of the LMP-1 promoter is dependent on interaction with at least two distinct sequence-specific DNA-binding proteins, J kappa and PU.1. LBF3, LBF5, LBF6, or LBF7 may also be involved, since their binding sites also contribute to EBNA-2 responsiveness.

Long-term effects of pravastatin on serum lipid levels in elderly patients with hypercholesterolemia

The purpose of this study was to evaluate the long-term efficacy and tolerability of pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, in elderly patients with hypercholesterolemia. Pravastatin was administered for 12 months at a mean final dose of 9.9 mg/d to 208 elderly patients (mean [+/- SD] age, 70 +/- 7 years) with levels of total serum cholesterol greater than 5.69 mmol/L. The mean total cholesterol level was significantly decreased from 6.85 +/- 0.80 mmol/L to 5.59 +/- 0.70 mmol/L after 3 months, and this decrease was maintained thereafter. A similar change was observed in the mean serum level of low-density lipoprotein cholesterol. Although the mean serum level of high-density lipoprotein cholesterol in all the patients did not change significantly, the level in 34 patients with a value lower than 1.03 mmol/L was significantly increased after 3 months and thereafter. The serum level of triglycerides in all patients was significantly decreased after 3 months and thereafter and the decrease was more marked in 101 patients with levels greater than 1.73 mmol/L. In 168 elderly patients receiving 10 mg/d of pravastatin, there were significant negative correlations between the percent decrease in total cholesterol and both baseline total serum cholesterol level (r = -.354, P < 0.001) and age (r = -.208, P = 0.007). No serious side effects were observed. These results indicate that long-term administration of pravastatin is beneficial in the treatment of hypercholesterolemia in elderly patients.

Partial DiGeorge syndrome at the age of thirty-four

A 34-year-old man with partial DiGeorge syndrome suffered from seizures and mental retardation from the age of three years. He was diagnosed as having primary hypoparathyroidism by the Ellsworth-Howard test at the age of 22. He was also found to have a right aortic arch. Immunological studies revealed the presence of immature T cells (CD 38+, OKT 9+), although the subsets and function of his T cells were almost normal. The facts that the cardiovascular anomaly and immunodeficiency were mild and the hypoparathyroidism was well controlled, may account for his survival to this age.

[Effects of pravastatin administration for 12 months on serum lipid levels in aged patients with hypercholesterolemia]

To evaluate long-term efficacy of pravastatin, we administered this HMG-CoA reductase inhibitor at a mean dose of 9.9 mg/day to 208 aged patients with serum levels of total cholesterol (TC) over 220 mg/dl (mean +/- SD aged of 70 +/- 7 years; 62 males and 146 females) for 12 months. The mean serum value of TC significantly decreased from the basal level of 265 mg/dl to 216 mg/dl in the 3rd month, and this decrease was maintained throughout the observation period. Similar change was observed in the serum level of low density lipoprotein-cholesterol (LDL-C). Although the mean serum level of high density lipoprotein-cholesterol (HLC-C) in all patients did not change significantly, the HDL-C level in 34 patients with a HDL-C level below 40 mg/dl significantly increased from the 3rd month. The mean serum level of triglyceride (TG) in all patients significantly decreased from the 3rd month, and this decrease in the TG was more prominent in 101 aged patients with TG levels higher than 150 mg/dl. In 168 aged patients on 10 mg/day of pravastatin throughout the period, there were significant negative correlations between the ratio of the decrease in TC in basal serum and each of the basal serum TC levels (r = -0.345, p < 0.001) and age of the subjects (r = -0.208, p = 0.007). These results indicate that long-term administration of pravastatin is effective treatment for lipid metabolism even in aged patients.

Effects of an angiotensin II receptor antagonist, CV-11974, on angiotensin II-induced increases in cytosolic free calcium concentration, hyperplasia, and hypertrophy of cultured vascular smooth muscle cells

The effects of CV-11974, a potent nonpeptide antagonist of the angiotensin II (AII) type-1 receptor (AT1), on cytosolic free calcium concentration ([Ca2+]i), hyperplasia, and hypertrophy of cultured vascular smooth muscle cells (VSMC) from rat aorta were studied. [Ca2+]i was measured by fura 2, and hyperplasia and hypertrophy were determined by incorporation of [3H]thymidine and [3H]leucine, respectively. CV-11974 had no effect on [Ca2+]i itself, but suppressed 10(-7) M AII-induced increase in [Ca2+]i dose dependently at concentrations from 10(-10) M and completely at 10(-7) M. CV-11974 suppressed both Ca2+ release from intracellular Ca2+ stores and Ca2+ influx from the extracellular space. However, CV-11974 had no effect on the increases in [Ca2+]i induced by prostaglandin F2 alpha (PGF2 alpha), a potent vasoconstrictor, or ionomycin, a Ca2+ ionophore. These results indicate that the suppressive effects of CV-11974 act on the binding of AII and its specific receptors. AII 10(-7) M increased the synthesis of DNA and protein to 1.5 and 1.7 times the control values, respectively. CV-11974 had no effect on synthesis of DNA or protein, but suppressed the AII-stimulated synthesis of DNA and protein dose dependently at concentrations > or = 10(-8) and 10(-10) M, respectively and completely at 10(-6) M. These results indicate that AII increases [Ca2+]i and synthesis of DNA and protein in VSMC through activation of AT1. CV-11974 showed no partial agonistic effects on AII. Thus, CV-11974 may act not only as an antihypertensive agent, but also as an inhibitor of vascular injury stimulated by AII.

Increased release of platelet-derived growth factor from platelets in chronic liver disease

The concentrations of platelet-derived growth factor in serum in 7 healthy controls (61 +/- 9 years; mean +/- SD) and 10 patients (62 +/- 8 years) with chronic liver disease (chronic hepatitis and/or liver cirrhosis) were compared. The plasma concentration of platelet-derived growth factor was below the detection limit (< 0.45 microgram/l) in all the subjects studied. The peripheral blood platelet count in patients with chronic liver disease was significantly lower than that in control subjects. However, the concentration of platelet-derived growth factor in serum, which was assumed to be released from platelet, was similar in patients with chronic liver disease and control subjects. These results indicate that the mean amount of platelet-derived growth factor released from the same number (10(9)) of platelets, calculated from the serum platelet-derived growth factor concentration and the peripheral blood platelet count, in patients with chronic liver disease (33 +/- 11 ng/10(9) platelets) was significantly (p < 0.01) higher than that in control subjects (14 +/- 5 ng/10(9) platelets). Moreover, the amount of platelet-derived growth factor released from 10(9) platelets inversely correlated with the serum concentration of pseudocholinesterase activity (r = -0.65, p < 0.01), and correlated positively (r = 0.91, p < 0.01) with the percent retention of indocyanine green in serum, in all subjects studied. These findings suggest that the amount of platelet-derived growth factor releasable from platelets of patients with chronic liver disease is higher than that in normal subjects and that it correlates with the severity of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Semiconductor laser-induced fluorescence detection in capillary electrophoresis using a cyanine dye

Cy5, an activated carboxyl cyanine fluorophore, was characterized by capillary electrophoresis (CE) using a semiconductor laser at 652 nm to induce fluorescence. Hydrolysis of the activated Cy5 in the presence of ammonia results in the formation of a mono- and diamide and a dicarboxylic acid. A Cy5-labeled oligonucleotide M13 primer for DNA sequencing (M13mp18 template) was synthesized with a purity of better than 95%. The labeled primer was analyzed by liquid chromatography, using UV-visible detection, and by CE, monitored by laser-induced fluorescence (LIF) detection. Analysis of the Cy5-labeled oligonucleotide primer by CE-LIF in a 9% polyacrylamide gel-filled capillary indicated the purity of the major Cy5-oligonucleotide primer was greater than 90%. The detection sensitivity for Cy5-based CE-LIF detection system with a 2.5-mW red semiconductor laser is about 10(-10) M.