[The indications and results of laparoscopic cholecystectomy]

Laparoscopic cholecystectomy was successfully achieved in 93% of the patients, who required removal of the gallbladder, in our institution. Other reports have also shown that more than 90% of patients who required cholecystectomy, were candidates for laparoscopic cholecystectomy. Serious complications occurred in 2.1% of our series and in 2-4% of the literature. The complications included bile duct injury (around 0.5%) and visceral injury (0.2-0.4%). The incidence of complications resulting from technical failure seems to be higher in laparoscopic cholecystectomy than in conventional cholecystectomy but is acceptable for initial experience. Laparoscopic cholecystectomy will become the standard therapy of gallstone for its effectiveness and less invasiveness.

A new method for continuous measurement of platelet adhesion under flow conditions

Platelet adhesion to the subendothelial tissue or biomaterial surface is an initial step in the formation of the hemostatic plug or thrombus. To clarify the mechanism of platelet adhesion in vivo, a simple and reproducible method for quantitation of platelet adhesion under flow conditions is required. In this study, a mechanical device for continuous recording of platelet adhesion under flow conditions using a quartz crystal microbalance was developed, an extremely sensitive sensor capable of measuring mass changes in the nanogram range. The relationship between surface mass change (delta W) and resonant frequency change (delta f) for pie-zoelectric crystals is given by the Sauerbrey equation: delta f = -fo2 delta W/NA pi (fo; fundamental frequency (5MHz) A; the area of quartz plate undergoing oscillation N; frequency constant for AT-cut quartz crystal pi; density of quartz crystal). Although the perfusion of buffer solution alone or addition of washed red cell suspension (Ht 30%) and formaldehyde-fixed platelets have no effect on delta f, addition of washed platelets in the presence of red cells caused an increase in delta f. To confirm that the increase in delta f results from platelet adhesion to the material surface, adherent and subsequently aggregated platelets were visualized by fluorescence microscopy using fluorescein-isothiocyanate labeled antiplatelet membrane glycoprotein Ib monoclonal antibody. There was a good correlation between the increase in delta f and the extent of platelet adhesion and subsequent aggregation.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of doubling times of serum carcinoembryonic antigen produced by various metastatic lesions in recurrent gastric and colorectal carcinomas

The authors measured the serial serum carcinoembryonic antigen (CEA) levels in patients with recurrent gastric or colorectal carcinoma. Among the 45 patients with recurrent gastric carcinomas, those with lung metastases showed the most prolonged CEA doubling time (CEA-DT), followed by those with liver and peritoneal metastases, respectively. Of the 31 patients with recurrent colorectal carcinomas, those with local recurrence showed the most prolonged CEA-DT, followed by those with lung, liver, and peritoneal metastases, respectively. A positive correlation was observed for gastric and colorectal carcinomas between CEA-DT in patients with metastatic lesions and outcome (R = 0.84 and 0.93, respectively). The results of the current study suggest that postoperative measurement of CEA-DT is useful in the determination of region of recurrence of carcinoma, which would permit early surgery and chemotherapy. Measurement of CEA-DT also may be helpful for the accurate determination of prognosis.

Immunodeficiency with increased immunoglobulin M associated with growth hormone insufficiency

Growth hormone deficiency associated with hypogammaglobulinemia has been reported only in a few publications. Our patient was a male with recurrent episodes of infections. Serum immunoglobulin (Ig) G was extremely low although IgM concentration was much greater than the normal limit. Growth hormone responses to insulin, 1-Dopa and growth hormone-releasing hormone were low. The mean growth hormone concentration during sleep was less than the normal limit. These results are consistent with hyper-IgM immunodeficiency associated with growth hormone deficiency. The mode of transmission appears to be autosomal dominant. This combination has not been reported previously.

Functional properties of the allotypes of mouse complement regulatory protein, factor H: difference of compatibility of each allotype with human factor I

Three allotypes of mouse factor H, H.1, H.2, and H.3 were purified from the sera of mice with different factor H allotypes, and their functional properties were investigated. The three allotypes all bound to heparin, DNA, Con A, and methylamine-treated mouse C3 (C3(MA)mo) with similar affinities for each protein immobilized, showed identical mobilities on SDS-PAGE, and were reacted well with rabbit polyclonal antibody against H.1 and H.2. Factor I-cofactor activity of these factor H allotypes was measured using highly purified material of mouse, guinea-pig, and human origin. In a homologous system, these allotypes expressed indistinguishable mouse factor I (Imo)-cofactor activity for the cleavage of C3(MA)mo. Imo-cofactor activity was again indistinguishable in these allotypes when methylamine-treated human C3 (C3(MA)hu) or methylamine-treated guinea-pig C3 (C3(MA)gp) was substituted for the C3(MA)mo substrate. The cofactor activity of these factor H allotypes, however, was augmented 4-5 times if C3(MA)hu) was used instead of C3(MA)mo, and was barely detected if C3(MA)gp was employed. In contrast, differences in the potency of the cofactor activity for the three allotypes were revealed if human factor 1 (Ihu) was substituted for Imo: the order of the efficiency for the cleavage of C3(MA)hu was H.2 > H.1 = H.3. These results, taken together with the finding that the homologous combinations of mouse and human factors H and I expressed greater activity for the cleavage of C3(MA)hu than did the heterologous combinations of factor H and factor I, suggest that mouse factor H allotypes discriminate species of protease factor I but not those of substrate (C3(MA), and H.2 possesses the best compatibility for Ihu in C3(MA)hu inactivation.

[A case of chronic neutrophilic leukemia associated with polycythemia vera]

A 74-year-old male patient was seen on December 15, 1980 because of right shoulder pain and leukocytosis. The spleen and the liver were enlarged, and palpable, 3 and 4 fingerbreadths below the costal margin respectively. The red blood cell count (RBC) was 899 x 10(4)/microliters, hemoglobin (Hb) 20.6 g/dl, reticlocyte (Ret) 7/1000, platelets (Plt) 34.2 x 10(4)/microliters, the white blood cell count (WBC) 26,800/microliters with 86% neutrophils. A bone marrow aspiration showed the nucleated cell count (NCC) to be 16.5 x 10(4)/microliters, and the myeloid/erythroid ratio (M/E) 2.0. The patient was treated with venesection and later with carboquone. Since September 1990 he has not been treated with any agents because of erythrocytopenia. In July 25, 1991, the spleen was enlarged, and palpated 8 fingerbreadths below the costal margin. The RBC was 456 x 10(4)/microliters, Hb 12.5 g/dl, Ret 9/1000, Plt24.2 x 10(4)/microliters, the WBC41,500/microliters with 90% neutrophils. Bone marrow aspiration showed the NCC to be 16.5 x 10(4)/microliters, M/E14.3, with no atypical cells. Chromosome studies of marrow cells revealed no Ph1 chromosome. Many hematologic malignancies have been occasionally associated with polycythemia vera (PV), but chronic neutrophilic leukemia associated with PV is a very rare condition.

Phenotypic difference of normal plasma cells from mature myeloma cells

We have recently shown that two-color analysis with fluorescein isothiocyanate (FITC)-anti-CD38 antibody could clearly distinguish myeloma cells (plasma cells) from other hematopoietic cells in the bone marrow. Myeloma cells (plasma cells) alone were located at CD38strong positive (++) fractions. To further distinguish normal plasma cells from mature myeloma cells phenotypically, we examined immunophenotypes of normal plasma cells and myeloma cells by two-color flow cytometry with FITC-anti-CD38 antibody and phycoerythrin staining with antibody to VLA-4, MPC-1, CD44, CD56, CD19, CD20, CD24, or CD10. Normal plasma cells were all VLA-4+VLA-5+MPC-1+CD44+ CD19+CD56- in the bone marrows from seven healthy donors, tonsils from four patients with chronic tonsillitis, a spleen from one patient with idiopathic thrombocytopenic purpura, and lymph nodes from two patients with chronic lymphadenitis, respectively. On the other hand, mature myeloma cells (12 of 20 cases), VLA-4+VLA-5+MPC-1+, were all CD19- and most of them CD56+, and there were no myeloma cells with the CD19+CD56- phenotype in the 20 cases of myelomas we tested. Thus, as for the expression of CD19 and CD56, normal plasma cells from various tissues are all CD19+CD56-, whereas no myeloma cells have the CD19+CD56- phenotype. According to this finding, we investigated the expression of CD19 and CD56 on plasma cells (CD38++ fractions) in monoclonal gammopathy of undetermined significance (MGUS). Both CD19+CD56- and CD19-DC56+ plasma cells were found in all five cases of MGUS we tested, suggesting that MGUS consists of phenotypically normal plasma cells and myeloma cells. Therefore, it is reasoned that phenotypic analysis of plasma cells with anti-CD19 and anti-CD56 antibodies can distinguish normal plasma cells from malignant plasma cells (myeloma cells), and can detect malignant plasma cells even in MGUS or premyeloma states.

Normal levels of IgG subclass in childhood determined by a sensitive ELISA

Normal values of all IgG subclasses were determined using a sensitive ELISA in children aged from newborn to 14 years. The upper and lower limits of normal values of all IgG subclasses were obtained in all the age groups using 29 umbilical cord blood samples from full-term newborns and 308 venous blood samples from normal infants and children. The trends in the levels of IgG1, IgG2 and IgG3 with age were almost similar to previous reports. IgG4 levels decreased gradually until reaching the lowest level at 7 to 12 months and increased gradually with age, reaching a plateau at 12 to 14 years of age. Thus, the lower limit of serum IgG4 levels was determined using our method.

Norepinephrine prolongs tetracaine spinal anesthesia in surgical patients: a preliminary study

We conducted a double-blinded examination of the effects of norepinephrine as a vasoconstrictor on the onset and duration of tetracaine spinal anesthesia in 80 surgical patients. The patients were randomly allocated to four groups (n = 20 in each group). Each patient received 10 mg of tetracaine in a volume of 2.0 mL which contained either 0 micrograms/mL, 5 micrograms/mL, 10 micrograms/mL, or 15 micrograms/mL of norepinephrine. The onset of spinal anesthesia was determined by the time to reach Th-10 level as well as by the time required to obtain the highest level of sensory analgesia. The time for two-segment regression and full-motor recovery were defined as the duration of spinal anesthesia. The time to reach Th-10, the highest analgesia level, and the time to obtain the highest analgesia level did not differ among the groups. Two-segment regression was prolonged significantly by 175%, 103%, and 106% as compared with the plain tetracaine group, in 5 micrograms/mL, 10 micrograms/mL, and 15 micrograms/mL of norepinephrine groups, respectively. Motor recovery also was extended significantly by 111%, 152%, and 121% as compared with the plain tetracaine group, in 5 micrograms/mL, 10 micrograms/mL, and 15 micrograms/mL of norepinephrine groups, respectively. There were no differences in the changes of arterial blood pressure and heart rate associated with the addition of norepinephrine among the groups. We conclude that norepinephrine provides a clinically meaningful prolongation of the duration of tetracaine spinal anesthesia.

Influence of elastase and hyaluronidase on the ciliary interconnecting systems in frog vestibular sensory cells

Bullfrog vestibular end organs were incubated in frog Ringer's solution, hyaluronidase and elastase. When assessed by scanning electron microscopy, long-time incubation in frog Ringer's solution caused damage to side links. Elastase caused severe damage to tip links with a slight alteration to side links. The glycocalyx of the hair cells decreased after incubation in elastase or hyaluronidase. Electrophysiological measurements showed a remarkable decrease in compound action potentials after the elastase treatment, while no change was observed after the long-time incubation in frog Ringer's solution or hyaluronidase. The results are in agreement with the hypothesis that tip links are involved in mechanotransduction, and side links keep the cilia arranged in a bundle.

[Simultaneous operation of Cabrol's operation and sternal turnover with rectus abdominal flap]

We performed simultaneous operation of sternal turnover and Cabrol operation for a 28-year-old man, who had 3rd grade funnel chest and annuloaortic ectasia with 3rd grade aortic regurgitation. We think when both annuloaortic ectasia and funnel chest are indicated for operation, simultaneous operation is to be considered and the combination of Cabrol operation and sternal turnover with rectus abdominal flap is the best procedure.

Experimental study of a frog semicircular canal nerve: influence of the initial cupular position

The posterior semicircular canal of the frog was stimulated by mechanical endolymphatic flow toward either an ampullofugal (excitatory) or ampullopetal (inhibitory) direction. The magnitudes of the responses as the cupula was moved to various positions were compared. When the same amount of stimulus was given in the same direction, the responses were equal, regardless of the initial position of the cupula.

Detection of the degradation products of bradykinin by enzyme immunoassays as markers for the release of kinin in vivo

We developed an enzyme immunoassay (EIA) specific for Arg1-Pro2-Pro3-Gly4-Phe5 ([1-5]-BK) for determination of the levels of this peptide in biological fluids. Previously developed EIAs for bradykinin (BK) and for des-Phe8-Arg9-BK ([1-7]BK) were also used. Incubation of rat plasma with glass powder resulted in the transient appearance of BK. A degradation product, [1-7]BK, could be detected in the incubation mixture for a longer period of time. When compared with BK and [1-7]BK, a larger amount of [1-5]BK was detectable even longer. In carrageenan-induced pleurisy in rats, which was associated with a peak rate of plasma exudation 5 hr after administration of carrageenan, BK was undetectable (< 160 pg/rat) in the pleural exudates. By contrast, [1-7]BK was detectable over the entire course of the inflammatory response. A larger amount of [1-5]BK was detectable. The peak level of [1-5]BK was 6050 +/- 1050 pg/rat, 5 hr after administration of carrageenan. Inhibition of the generation of BK by intrapleural administration of soy bean trypsin inhibitor (0.3 mg/rat) 30 min before collection of pleural fluid resulted in significant reductions in the levels of both [1-7]BK (by 51-65%) and [1-5]BK (by 63-79%) in the exudates 3, 7 and 19 hr after administration of carrageenan. Intraperitoneal administration of captopril (10 mg/kg) caused a marked reduction (by 98%) in levels of [1-5]BK in exudates 3 hr after administration of carrageenan. The reduction was accompanied by an increase in the level of BK up to 1250% of that in untreated rats. These results indicate that the newly developed EIA for [1-5]BK might be a useful tool for verifying the release of kinin in vivo.

Heterogeneity in early and advanced gastric carcinomas by flow cytometric DNA analysis

We investigated 230 systematically sampled fresh specimens from 12 early and 26 advanced gastric cancer patients by DNA flow cytometry for heterogeneity in DNA content. Fifty-eight percent of the 12 early gastric cancers were uniformly diploid and 42% were uniformly aneuploid. Fifty-four percent of advanced cancers were uniformly diploid in superficial layers and 42% were uniformly diploid in deep layers, whereas 46% were uniformly aneuploid in superficial layers, and 50% were uniformly aneuploid and 8% were heterogeneously aneuploid and diploid in deep layers. Both diploid and aneuploid samples were obtained from 15% for advanced cancers, but ploidy heterogeneity did not occur in early cancers. Heterogeneity for DNA index (more than one aneuploid DNA index) occurred in 46% of whole thickness of advanced cancers, in 19% of superficial layers of advanced cancers, and in 8% of early cancers. We concluded that DNA ploidy determination using superficial layer specimens may be reliable in early gastric cancer but must be interpreted with care in advanced cancer.

The effect of protease inhibitor on reperfusion injury after unilateral pulmonary ischemia

Reperfusion injury is a large problem in the early stage after lung transplantation. Its prevention by protease inhibitor was evaluated experimentally. Warm ischemic models were made with the left lungs of adult mongrel dogs. The time for the warm ischemic procedure was set at 2 hr, and the lungs were reperfused for 2 hr. The experimental group was divided into a control group, a UTI (urinary trypsin inhibitor) group and a GM (gabexate mecilate) group. To the UTI group, 10,000 units/kg of UTI was administrated during reperfusion, and to the GM group, 20 mg/kg of gabexate mecilate was administrated similarly. In the control group, the pulmonary vascular resistance and the lung tissue wet and dry weight ratios (W/D ratios) increased significantly, and thickened interstitium and infiltration of neutrophils were observed histologically after reperfusion. In the GM group, W/D ratios increased significantly, and histological appearances were similar to the control group. In the UTI group, the pulmonary vascular resistance increased slightly, but the W/D ratio did not increase significantly, and no changes were seen histologically after reperfusion. In the survival experiment, only two of the five dogs survived for more than seven days in the control and GM groups, while all five dogs survived for more than seven days in the UTI group. These results indicate that UTI significantly attenuates reperfusion injury, perhaps by inhibiting neutrophil proteases.

Glycocalyx and ciliary interconnections in bullfrog vestibular end organs: normal structure and changes after incubation in frog Ringer's solution

The ultrastructure of ciliary interconnecting systems as well as changes after incubation in frog Ringer's solution of the bullfrog vestibular end organs were investigated by using a scanning electron microscopy. The plasma membrane of the sensory hairs showed rather rough appearance. Side links emerged from the plasma membrane and tightly connected neighboring cilia. The tip links stretched from the tips of the stereocilia to their taller neighbors. These tip links were arranged in a same direction towards the kinocilium. These findings indicate that the side links may keep the cilia arranged in a bundle and the tip links may be involved in sensory cell transduction system. Changes in the surface texture and ciliary interconnecting systems were detected 2 hrs after incubation in frog Ringer's solution. Such changes included an increase in granularity of the surface membrane, fracturing and disappearance of all types of ciliary interconnections, especially side links. The tip links were more durable than side links. This indicates that the physiological studies of bullfrog hair bundle are justified across a 1-hr interval from the time the temporal bones are removed from the animal.

Contribution of the vestibular primary neuron and the sensory cell to posture recovery

The right vestibular nerve of the frog was cut peripherally to the vestibular ganglion. The frog sustained a tilting posture toward the right side. This tilting disappeared and the frog returned to normal posture. Based on this finding, the following experiments were done: In experiment I, the right vestibular nerve was again cut after posture recovery. The tilting angle was smaller and the recovery period shorter than after the 1st neurectomy. In experiment II, the left nerve was cut after posture recovery. The tilting angle toward the left was greater than that of the 1st neurectomy. In experiment III, the frog underwent bilateral neurectomy. A piece of the bone was inserted into the cut ends of the right nerve to inhibit nerve regeneration. The frog slowly developed tilting toward the right side. The above results indicate that both reactivation of the endorgan and the central compensatory mechanism play essential roles, for postural recovery after vestibular neurectomy.

Three-dimensional observation of the Golgi apparatus in the vestibular (Scarpa's) ganglion cell

Ultrastructure of the Golgi apparatus and GERL was observed three-dimensionally from the functional view point of lysosome formation. GERL directly continues with rough endoplasmic reficulum. There are at least two systems for lysosome formation, i.e. dependent and not dependent systems on the Golgi stack respectively. GERL also continues with a trans Golgi saccule, indicating that GERL is a part of the Golgi apparatus.

Coupling between ATPase and force-generating attachment-detachment cycles of actomyosin in vitro

We have developed a high resolution force measurement system in vitro by manipulating a single actin filament attached to a microneedle. The system could resolve forces less than a piconewton, and has time resolution in the submillisecond range. We have used this system to detect force fluctuations produced by individual molecular interactions. We observed large force fluctuations during isometric force generations. Noise analysis of the force fluctuations showed that the force was produced by stochastic and independent attachment-detachment cycles between actin and myosin heads, and one force-generating attachment-detachment cycle corresponded to each ATPase cycle. But, the force fluctuations almost completely disappeared during sliding at the velocities of 20 to 70% of the maximum one at zero load. The analysis indicated that myosin heads produced an almost constant force for most (probably > 70%) of the ATPase cycle time, i.e., the duty ratio > 0.7. Since the myosin step size was given as (velocity) x (the duty ratio) x (the ATPase cycle time, 30 ms), it was calculated to be 40 to 110 nm, corresponding to velocities of 20 to 70% of the maximum one (9 microns/s), respectively. These values are much greater than the displacement by a single attachment-detachment cycle of actomyosin (10-20 nm), indicating that multiple force-generating attachment-detachment cycles correspond to each ATPase cycle during sliding at velocities of > 20% of the maximum one. In conclusion, the coupling between the ATPase and the force-generating attachment-detachment cycles of actomyosin is not rigidly determined in a one-to-one fashion but is variable depending on the load.

[The effect of calcium ion on ampullary nerve potential]

The effect of calcium ion (Ca2+) in the endolymphatic and/or perilymphatic space of the posterior semicircular canal (p.s.c.) nerve response was studied. When both endolymph and perilymph contained no Ca2+, no p.s.c. nerve response was observed. When only the endolymph contained Ca2+ and the perilymph was Ca2+ free, again no nerve response was observed. On the other hand, when only the perilymph contained Ca2+, p.s.c. nerve response was evoked. Therefore, Ca2+ in the perilymph was considered to be essential for maintaining the function of the p.s.c. as a mechanoreceptor.

[Tissue culture of guinea pig middle ear epithelium--morphological characterization and proliferative activities of cultured cells on fibroblast-reorganized collagen gels]

Long-term culture of the middle ear epithelium of guinea pigs was carried out on reconstituted floating collagen matrix. Fibroblasts established from the abdominal skin dermis of allogenic animals were used to reorganize hydrated collagen gels into a dermal-like matrix. The explants placed on the surface of these matrices were composed of pseudostratified columnar cells with polygonal flat outgrowth sheets, which could be maintained for up to one month. In contrast, with simple hydrated collagen gel, no lysis of the substrate was observed regarding this reorganized collagen gel. In order to examine the growth pattern of these culture cells, 5-bromodeoxyuridine (BrdU) was added to the medium during the entire culture period. The specimens were immunohistologically stained using monoclonal antibodies. Noticeable changes were observed in the marginal portion of the explant where the cell shape changed from cuboidal to squamous. In this transitional area, most cells showed positive staining and consequently high proliferative activity. In the central area of the explants, however, the number of positive cells decreased and the main observation was a few labeled basal cell nuclei. It was suggested that the same regenerative process which usually occurs in normal respiratory epithelia after mechanical injury or other insults, was replayed in this culture system.