[Emergency coronary artery bypass grafting in patients with severe pump failure complicating acute myocardial infarction]

Thirty patients with severe pump failure (Killip's degree III or more) complicating acute myocardial infarction (MI) underwent emergency coronary bypass grafting (CABG). Average age was 66 years old and CABG was performed 2.6 days after the onset of MI. The patients were divided into two groups according to the mechanisms that can bring about severe pump failure: 19 patients had large MI alone (G-I). The other 11 patients had severe ischemia occurring either at areas distant from the site of coronary occlusion or in the previous area at risk (G-II). To estimate the ventricular wall motion quantitatively, the left ventricular wall was divided into 17 segments. Each segment was graded on a four-point scale: akinesis, 3; severe hypokinesis, 2; hypokinesis, 1; normal 0. Wall motion score was estimated by summing the number of asynergic segments score. In G-I, Cardiac index (CI (l/min/m2)) increased from 2.03 +/- 0.91 to 2.68 +/- 0.73 and pulmonary wedge pressure (PCWP (mmHg)) decreased from 28 +/- 5 to 15 +/- 5, 72 hours after the surgery (p < 0.01). In G-II, CI increased from 2.17 +/- 0.78 to 3.17 +/- 1.01 and PCWP decreased from 29 +/- 6 to 13 +/- 5 after the surgery (p < 0.01). There was no difference in preoperative and postoperative hemodynamics between two groups. The wall motion score at the risk area did not change postoperatively (from 16 +/- 7 to 17 +/- 9 in G-I, from 15 +/- 8 to 11 +/- 5 in G-II).(ABSTRACT TRUNCATED AT 250 WORDS)

[A 52-week chronic oral toxicity study of 6-amidino-2-naphthyl 4-[(4,5-dihydro-1H-imidazol-2-yl)amino] benzoate dimethanesulfonate (FUT-187) in dogs]

A chronic oral toxicity study of 6-amidino-2-naphthyl 4-[(4,5-dihydro-1H-imidazol-2-yl)amino] benzoate dimethanesulfonate (FUT-187), a new protease-inhibiting agent, was carried out using male and female beagle dogs. FUT-187 was orally administered to the dogs at dose levels of 7.5, 15, 30 and 60 mg/kg/day for 52 weeks, followed by 5 weeks' recovery period. Results are summarized as follows: 1. In general conditions, vomiting, salivation and the passage of mucousy stools were observed in dogs given 15 mg/kg/day or more, and diarrhea was observed at 30 mg/kg/day or more. One male given 15 mg/kg/day showed transient pallidity of the oral mucosa, and another male in the same group showed apnea and abdominal breathing. In addition, one male given 30 mg/kg/day was euthanatized due to extreme weakness, as weight loss and pallid oral mucosa, and another male in the same group died after showing acute toxic symptoms such as hyperpnea, tonic convulsion and ataxic gait. 2. Weight gain was slightly suppressed in females given 60 mg/kg/day. No significant changes in food consumption were observed. 3. Hematological examination revealed no statistically significant changes. Decreases in RBC counts, Ht values and Hb concentrations, and increased reticulocyte counts were observed in one male of 15 mg/kg/day group, which also showed pallid oral mucosa, and in one male of the 30 mg/kg/day group, which was euthanatized in a moribund state. 4. Blood biochemistry revealed increased GPT activity in males given 15 and 30 mg/kg/day and females given 60 mg/kg/day, which was accompanied by sporadic increases in GOT, A1P and/or gamma-GTP activities. Males given 30 mg/kg/day or more showed decreased total protein. 5. Hepatic function testing (ICG test) showed no statistically significant changes. One female given 60 mg/kg/day showed increased accumulating concentration of ICG. 6. There were no toxicological changes in urinalysis, fecal occult blood, renal function (PSP clearance), ophthalmological and electro-cardiographic examinations. 7. In pathological examination, inflammatory cell infiltration and microgranuloma formation in liver were noted periportally or perivenularly in both sexes given 15 mg/kg/day or more (except for 30 mg/kg/day males). In the some cases, atrophy, degeneration and necrosis of hepatocytes and/or fibrosis around inflammatory cells and microgranuloma were observed. In the spleen, one male given 15 mg/kg/day and one female given 60 mg/kg/day showed increased plasma cells in the red pulp. In the case sacrificed in a moribund condition, findings in the liver and spleen similar to those in surviving cases were detected, but were more severe, and the liver showed diffuse fibrosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Global left ventricular performance and regional systolic function after suture annuloplasty for chronic mitral regurgitation

BACKGROUND

In surgery for chronic mitral regurgitation, the mitral subvalvular apparatus, including annulus, may play an important role in preserving left ventricular (LV) performance. The suture annuloplasty for mitral regurgitation allows annular contraction of the mitral valve. The potential effects of suture annuloplasty on the postoperative LV performance have not been fully defined.

METHODS AND RESULTS

Global and regional LV function in 12 patients with suture annuloplasty were compared with 12 patients with conventional mitral valve replacement (MVR). Cineangiography and echocardiography were obtained before and 10.8 months after surgery. End-diastolic volume index and end-systolic volume index decreased significantly in both groups after surgery (p < 0.01). Ejection fraction remained unchanged in the suture annuloplasty group, whereas it decreased significantly in the MVR group after surgery (p < 0.01). There was a significant inverse relation between ejection fraction and end-systolic wall stress in the two groups after surgery (suture annuloplasty group, r = -0.69, p = 0.01; MVR group, r = -0.60, p = 0.04). The intercept on the y axis was significantly (p < 0.005) higher in the suture annuloplasty group than in the MVR group. In the suture annuloplasty group, cross-sectional area ejection fraction at the mitral valve level and at the papillary muscle level by LV two-dimensional echocardiography remained unchanged after surgery. In the MVR group, they decreased significantly after surgery (p < 0.01). There was a significant correlation between the cross-sectional area ejection fraction and the global ejection fraction at both levels after surgery. Therefore, the improvement of the regional wall motion can be attributed to the improvement of the global LV performance after suture annuloplasty.

CONCLUSIONS

These data suggest that suture annuloplasty can provide more desirable postoperative LV systolic performance than conventional MVR by preserving both the contraction of the mitral annulus and the mitral valvular-ventricular interaction.

Effects of isolation housing and timing of drug administration on theophylline kinetics in mice

ICR mice were grouped according to 1) housing environment: individual (I) or aggregated (A) and 2) timing of drug administration: midlight (L) or middark (D), i.e. I-L, I-D, A-L, A-D groups. Theophylline was orally administered at midlight or middark. The results showed that both social environment and timing of drug administration exerted significant influence on the pharmacokinetics of theophylline. These data may suggest the importance of considering many non-drug factors in toxicological studies with experimental animals.

Serial changes in myocardial beta-adrenergic receptor after experimental brain death in dogs

Early donor heart failure is one of the serious problems in heart transplantation. This heart failure may be related to myocardial change during brain death before implantation of the heart. Actually, a gradual increment in catecholamine requirement to maintain hemodynamics is not infrequently seen in patients with brain death. This may presumably be related to alterations in the myocardial beta-adrenergic receptor system. In this experimental study, we investigated the changes in myocardial beta-adrenergic receptors after brain death induced by intracranial hypertension in dogs. To maintain the mean arterial pressure higher than 60 mm Hg after brain death, massive crystalloid infusion (group A) or 0.4 to 1.3 micrograms/kg/min of adrenaline infusion (group B) was applied. Blood adrenaline levels and myocardial beta-adrenergic receptor (receptor number and affinity with [125I]iodocyanopindolol binding) were measured at 3 hours (group A-3H or group B-3H, n = 5, respectively) and 6 hours (group A-6H or group B-6H, n = 5, respectively) after brain death. Blood adrenaline levels reduced in group A-6H and elevated in group B-3H and group B-6H. Beta-adrenergic receptor affinity was not different among each group. Beta-adrenergic receptor number decreased in group B-6H. Myocardial beta-adrenergic receptor density decreased in the adrenaline group during 6 hours of hemodynamic maintenance after brain death, whereas myocardial beta-adrenergic receptors did not change in the crystalloid group. Our data suggest that the large doses of catecholamines used to maintain hemodynamics in donors with brain death may depress myocardial beta-adrenergic receptors.

[Pulsed Doppler echocardiographic observation of left ventricular filling dynamics after aortic valve replacement in patients with chronic aortic regurgitation]

The 23 patients who underwent aortic valve replacement (AVR) for aortic regurgitation (AR) from 1977 to 1990 were studied with pulsed Doppler echocardiography. The patients were divided into two groups. The A group consisted of 5 patients whose end-systolic volume index (ESVI) were more than 200 ml/m2 and/or left ventricular ejection fraction (EF) were less than 0.35 before AVR. The B group consisted of 18 patients whose ESVI were less than 200 ml/m2 and EF were more than 0.35 before AVR. A Doppler volume sampler was placed at the center of mitral orifice to measure the transmitral inflow velocity after AVR (mean 28 months). Left ventricular filling dynamics were assessed by the peak velocity in the rapid filling phase (R), the peak velocity in the atrial contraction phase (A) and the ratio of A by R (A/R ratio) of mitral flow velocity pattern. The deceleration rate of early diastolic rapid inflow (DeR) determined as the slope a straight line drawn between the peak of early diastolic inflow and a point at half peak velocity on the fall side of the envelope. Result was as follows; 1) The DeR showed significant correlation with the EF (r = 0.56, p < 0.01). The DeR showed significant inverse correlation with the ESVI (r = -0.52, p < 0.05). 2) The R velocity (mean 43.9 +/- 7.9 cm/sec) in group A was significantly lower than in group B (mean 61.4 +/- 18.6 cm/sec), (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Preoperative and postoperative right ventricular function during exercise in patients with mitral stenosis

To elucidate the effects of mitral valve surgery on right ventricular function in 11 patients with mitral stenosis, pre- and postoperative right ventricular function were quantified using gated equilibrium blood pool radionuclide ventriculography at rest and during exercise. The preoperative right ventricular ejection fraction was 39 +/- 4% at rest and 36 +/- 9% during exercise, which during exercise was lower than control values (51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction was lower during exercise than at rest, postoperative right ventricular ejection fraction during exercise was lower than normal values (42 +/- 3% versus 51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction did not decrease during exercise, the postoperative right ventricular ejection fraction was within normal limits during exercise (54 +/- 5%). In addition, postoperative right ventricular ejection fraction during exercise increased to normal values in patients whose preoperative right ventricular ejection fraction during exercise had been 40% or higher. Preoperative peak ejection rate was -1.81 +/- 0.19 EDV/sec at rest and -1.72 +/- 0.39 EDV/sec during exercise, which during exercise was lower than control values (-2.44 +/- 0.53 EDV/sec) (p < 0.01). Postoperatively, peak ejection rate during exercise (-2.50 +/- 0.37 EDV/sec) increased (p < 0.05) to normal levels. Preoperative peak filling rate was 1.61 +/- 0.47 EDV/sec at rest and 1.88 +/- 0.54 EDV/sec during exercise, which during exercise was lower than control values (2.58 +/- 0.62 EDV/sec) (p < 0.01). Postoperatively, peak filling rate during exercise (2.82 +/- 0.62 EDV/sec) increased (p < 0.05) to normal values in all patients. Preoperative changes in both right ventricular ejection fraction and peak ejection rate from rest to exercise inversely correlated with the preoperative pulmonary vascular resistance at rest (right ventricular ejection fraction, r = -0.79, p < 0.005; and peak ejection rate, r = -0.67, p < 0.05). In conclusion, right ventricular systolic function improved in about half of the patients with mitral stenosis, and diastolic function improved in all patients during exercise following surgery. When the preoperative pulmonary vascular resistance was elevated, the right ventricular systolic dysfunction persisted.

[Phrenic nerve palsy after open heart surgery--problems in post-operative respiratory management]

We clarified the problems in respiratory management in patients with phrenic nerve palsy (PNP) after open heart surgery. From December 1988 to March 1991, 248 adult patients underwent open heart surgery with topical myocardial cooling. In these patients PNP was diagnosed in 17 patients (6.9%). Age of these patients at operation ranged from 25 to 76 years with a mean age of 57 years. 9 patients were valvular heart disease (7 were reoperation), 7 were coronary artery disease, and one patient was aortic aneurysm. PNP was diagnosed by chest roentgenogram or percutaneous phrenic nerve stimulation test (PNST). Frequency of long-term intubation (> 14 days) was higher in complete PNP patients than incomplete PNP patients. 2 patients, who were observed effort dyspnea at the time of respiratory weaning, were extubated followed by respiratory and circulatory deterioration, and were reintubated. PNP were confirmed after reintubation by PNST. These patients died of pneumonia. Another 2 patients were observed effort dyspnea during respiratory weaning, and were doubted of PNP. PNP were confirmed by PNST before extubation. After hemodynamic stabilization and respiratory physiotherapy, these patients were extubated without any trouble. One patient, who required repeated intubation, was diagnosed PNP by PNST. This patient was extubated after confirmation of improvement of PNP by follow-up PNST. The incidence of PNP was higher in patients with previous open heart surgery than without previous operation. We supposed that the dissection around the heart might be one of major cause of postoperative PNP. So, in recent 4 cases of mitral reoperation, we attempted to reach mitral valve through atrial septum with minimum dissection.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of regional and transmural myocardial perfusion by means of intraoperative myocardial contrast echocardiography during coronary artery bypass grafting

By using intraoperative myocardial contrast echocardiography, we assessed regional myocardial perfusion and transmural blood flow distribution immediately after myocardial revascularization. A total of 62 revascularized myocardial areas were studied in 31 patients undergoing coronary artery bypass grafting. The revascularized areas were divided into three different areas: S area, supplied by significantly stenosed coronary arteries (43 areas); C area, supplied by coronary collateral situation associated with totally occluded coronary arteries (12 areas); MI area, preexisting transmural myocardial infarction (7 areas). Myocardial contrast echocardiography was obtained by direct injection of 2 ml of sonicated 5% human albumin into the saphenous vein grafts at rest and during atrial pacing. Each area was divided into two layers of endocardial and epicardial halves, and myocardial enhancement of peak intensity was measured for each half and endocardial/epicardial gray level ratio was calculated: (1) The peak intensity of myocardial enhancement in S area and C area was significantly higher than that in MI area at rest as well as during pacing after myocardial revascularization. There was no significant difference in the peak intensity between S area and C area both at rest and during pacing. In S area the peak intensity significantly increased during pacing (p < 0.01), whereas it did not change in C area and MI area. (2) S area demonstrated no significant change in endocardial/epicardial intensity ratio during pacing. In contrast, the ratio in C area significantly decreased during pacing. (3) In S area with preoperative percent increase of segmental wall thickening lower than 25%, there was a significant correlation (r = 0.84, p < 0.001) between the peak intensity of myocardial enhancement and the postoperative changes of percent increase of segmental wall thickening in the revascularized areas. Thus, immediately after myocardial revascularization, intraoperative myocardial contrast echocardiography could provide a quantitative assessment of regional myocardial perfusion as well as blood flow distribution in the areas with myocardial infarction and with coronary collateral situation and in the areas supplied by stenosed coronary arteries.

Evaluation of right ventricular function by regional wall motion analysis in patients after correction of tetralogy of Fallot. Comparison of transventricular and nontransventricular repairs

Right ventricular function was assessed by regional wall motion analysis and by global function in 62 patients after repair for tetralogy of Fallot. Its relation to surgical procedures, with special attention to right ventriculotomy, was investigated. Patients were classified as follows: group Ia (n = 17), transpulmonary-transatrial repair without right ventriculotomy; group Ib (n = 22), transpulmonary-transatrial repair with minimal right ventriculotomy and small transannular patch; and group II (n = 23), transventricular repair with or without transannular patch. For regional wall motion analysis, fractional area change was used for three anterior parts obtained from hemiaxis area analysis of the lateral right ventriculogram. Ejection fractions were used for global right ventricular function. Functional assessment was done both at rest and during isoproterenol infusion, which is a stress test to evaluate cardiac functional reserve. At rest, group Ia showed better right ventricular anterior wall motion as well as global ejection fraction than did group II. Group Ib showed a global ejection fraction comparable to group Ia, with better regional wall motion in the middle anterior part of the right ventricle despite the depressed upper and lower anterior parts of the right ventricle. Group II showed depressed wall motion of the middle anterior part and the resultant impaired global ejection fraction. During isoproterenol infusion, group Ia showed significant increase in fractional area change of all anterior parts and in global ejection fraction. Group Ib showed significant increases in fractional area change at the middle and lower parts and in global ejection fraction comparable with group Ia. Otherwise, group II showed no significant change in fractional area change, or in global ejection fraction, at the upper and middle parts. These results indicated that transpulmonary-transatrial repair for tetralogy of Fallot provided better postoperative global right ventricular function and its reserve, with less impaired regional wall motion, than did the transventricular repair.

New side-holed sheath for intraaortic balloon pumping to maintain limb perfusion

We developed a new side-holed shunt sheath for inserting intraaortic balloon pumps to maintain lower limb perfusion in patients with stenotic and tortuous aortoiliac arteries. This sheath has a large internal diameter and several side holes, which act as an internal shunt. It was useful and effective in 11 patients with severe aortoiliac occlusive lesions who required assistance by intraaortic balloon pumping.

Pituitary metastasis of thyroid follicular adenocarcinoma--case report

A rare case of pituitary metastasis of thyroid follicular adenocarcinoma occurred in a 62-year-old female manifesting as left retro-orbital pain and diplopia. Computed tomography and magnetic resonance imaging revealed a tumor in the pituitary fossa extending to the left cavernous sinus, sphenoid sinus, and prepontine cistern, destroying the upper portion of the clivus. An asymptomatic thyroid mass, probably malignant, was also found. She also had an incidental small meningioma in the posterior fossa. The pituitary tumor was partially removed, and the thyroid and posterior fossa tumors were totally removed in two operations. Both pituitary and thyroid tumors were verified to be follicular adenocarcinoma. Postoperatively, she developed panhypopituitarism for which cortisol and thyroxine replacement therapy was necessary. Three years after first therapy, she was alive but her symptoms did not improve.

Circadian changes of valproate kinetics depending on meal condition in humans

The objective of this study was to examine the effect of meal condition on circadian changes in valproic acid (VPA) kinetics. Two experiments were performed in 16 healthy men that were synchronized with diurnal activity and nocturnal rest as their routine life. In both experiments, four 200-mg tablets of VPA were given orally on two occasions in the morning (8:30 AM) or in the evening (8:30 PM). In each study, a randomized, single-dose, two-way crossover design was used, and 2 weeks elapsed between morning and evening trials. In experiment 1, eight subjects took a light meal as breakfast between 8:00 and 8:15 AM and a heavy meal as dinner between 6:00 and 6:30 PM to fit the subject's usual food amount. The mean peak plasma concentration (Cmax) was significantly higher (P less than .01), the time to peak concentration (tmax) was shorter (P less than .05), and the absorption rate (Ka) was larger (P less than .05) after the morning dose than after the evening dose. In experiment 2, the size and contents of meal in breakfast and dinner were prepared in the same manner as the standard breakfast for the subjects. Namely, eight subjects took the same light meal between 8:00 and 8:15 AM in the morning and between 8:00 and 8:15 PM in the evening. There was no significant circadian change in VPA kinetics under this same meal condition. These results suggest that the differences of meal condition between morning and evening in our daily life play a major role in the mechanism underlying the circadian changes of VPA absorption in man.

Relationship between pancreatic exocrine function and histological changes in chronic pancreatitis

To confirm correlation between function and histology of the exocrine pancreas in chronic pancreatitis, we compared exocrine pancreatic function, as estimated by cholecystokinin secretin test (CST), with histological findings in 108 patients. Exocrine pancreatic insufficiency was graded from 0 to 4 according to the number of abnormal CST parameters. Histological findings also were graded from 0 to 4. Results of CST in 108 patients were normal (grade 0) in 52, equivocal (grade 1) in 23, and abnormal (grades 2-4) in 33. Normal histological findings (grade 0) were observed in 54 patients, equivocal (grade 1) in 15, and abnormal (grades 2-4) in 39. We confirmed that there was a significant correlation between histological grading and overall scoring (tau = 0.59, p less than 0.01) or individual parameters (tau = -0.36 for volume, -0.45 for amylase output, and -0.54 for maximal bicarbonate concentration (p less than 0.01) of CST. Sensitivity of CST was 67% in 39 patients with histologically confirmed chronic pancreatitis, specificity was 90% in 69 patients without chronic pancreatitis, based on histological evidence, and efficiency was 81%. In conclusion, we confirmed a highly significant correlation between direct function test (CST) and histology of the exocrine pancreas.

[Clinical evaluation of endoscopic injection sclerotherapy and esophageal transection]

We investigated the effects of EIS and esophageal transection on treatment of esophageal varices and the late result of EIS treatment group with that of surgical treatment group. One hundred and forty-seven patients underwent esophageal transection and 244 patients injection sclerotherapy in our institute. 1. The 5-year cumulative survival rate in patients with EIS was 58%, while 62% in those with transection. 2. Judging from the findings of varices after treatment which showed the negative red color sign, or changes from F2 or F3 to F1, the effect of two methods were 72% in operation group and 73% in EIS group, respectively. 3. There was no significant difference in the rates of rebleeding between EIS (7.8%) and operation (10.2%) groups. 4. Prognosis of esophageal varices treated with EIS or operation was considered to depend on the Child's classification. We conclude that endoscopic sclerotherapy should be considered to be the first choice of treatment for esophageal varices.

[Infection of methicillin resistant Staphylococcus aureus (MRSA) in patients with cardiovascular operations: four years' clinical analysis of the effect of strategy of prophylactic and treatment]

To evaluate the effect of strategy to reduce the rate and outcome of MRSA infection, 940 patients with cardiovascular operations from 1988 to 1991 were analyzed in aspect of the infection rate and outcome per year. Prophylactics and treatments which have been done during recent four years were) to use the inhalation of vancomycin for MRSA carriers, to quit the intravenous administration of prophylactic antibiotics on third postoperative day, to limit medical staffs to treat the patient with MRSA infection, to choose the most susceptible combination of two antibiotics for MRSA in each patients by periodical checking of bacterial cultures. The percentages of patients with infection to all patients detected with MRSA per year were decreased from 80% in 1988, to 66% in 1989, 31% in 1990, and 30% in 1991. The numbers of patients who died from MRSA infection were 4 in 1988 and only one in 1989 and 1991. MRSA infection in cardiovascular surgery could be reduced by sophisticated methods of prophylactics and treatments.

Cerebrovascular reserve capacity in ischemia due to occlusion of a major arterial trunk: studies by Xe-CT and the acetazolamide test

Classifications based on clinical and radiographic criteria have proved to be inadequate predictors of the course of cerebral ischemia or its response to therapy. In this study the cerebrovascular reserve capacity (CRC) of 46 patients with symptomatic cerebrovascular ischemia was studied by stable xenon-enhanced CT (Xe-CT) combined with the acetazolamide test. Fifteen patients had internal carotid artery (ICA) occlusion, 10 had ICA stenosis, 10 had middle cerebral artery (MCA) occlusion, and 11 had MCA stenosis. In the patients with chronic cerebral ischemia due to occlusive lesions of the ICA and MCA, the CRC was reduced most in those with MCA occlusion, followed, in descending order, by those with ICA stenosis, MCA stenosis, and ICA occlusion. Our results indicate that measurement of the CRC elucidates cerebral hemodynamic factors that cannot be detected by angiography in patients with chronic cerebral ischemia and that Xe-CT combined with the acetazolamide test is useful for this purpose.

Proliferating cell nuclear antigen (PCNA) immunostaining as an alternative to bromodeoxyuridine (BrdU) immunostaining for brain tumours in paraffin embedded sections

Immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and BrdU using anti-PCNA and anti-BrdU monoclonal antibodies, respectively, was performed in 16 human brain tumours, including 3 glioblastomas multiforme, 2 anaplastic astrocytomas, 1 cerebellar astrocytoma, 2 recurrent meningiomas, 4 non-recurrent meningiomas, 3 neurinomas and 1 medulloblastoma. Patients with brain tumours received an injection of bromodeoxyuridine (BrdU) intravenously during surgery, and tumour specimens were fixed in 70% ethanol and embedded in paraffin. The percentage of positive cells for PCNA was compared with a BrdU labelling index using adjacent paraffin-embedded sections. The percentage of PCNA-positive cells was correlated with the BrdU labelling index and the histological malignancy of the brain tumours. The correlation coefficient was 0.84. This suggests that the immunohistochemical staining for PCNA in paraffin sections is a good alternative to the BrdU labelling index.

Pentasomy X mosaic in two adult sisters with diabetes mellitus

Pentasomy X mosaic in two adult sisters with non-insulin dependent diabetes mellitus is described. The younger sister had schizophrenia, and both were mentally retarded, but no apparent somatic abnormalities were found. Chromosome analyses revealed karyotype 45,X/46,XX/47,XXX/48,XXXX/49,XXXXX mosaic with a low frequency of aneuploidy on cultured peripheral lymphocytes and 46,XX on cultured skin fibroblasts in both sisters. The low frequency of X chromosome aberration may be responsible for the lack of somatic abnormalities and the long life in both sisters. The association of pentasomy X mosaicism and diabetes mellitus however appears to be coincidental.

Identification of new epitopes recognized by human monoclonal antibodies with neutralizing and antibody-dependent cellular cytotoxicity activities specific for human T cell leukemia virus type 1

We have generated a number of EBV-transformed B cell lines producing human mAb against human T cell leukemia virus type 1 (HTLV-1) from the peripheral blood B lymphocytes obtained from patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. Various synthetic peptides corresponding to antigenic regions of HTLV-1 gag and env proteins were used for the screening of antibodies in ELISA. In our study, four IgG mAb to the gag p19 amino acids 100 to 130, and 5 IgG mAb to the env p46 amino acids 175 to 199 were characterized. An immunofluorescence assay showed that all of these mAb specifically bound to the surface of HTLV-1-bearing cell lines. Among these mAb, one anti-gp46 mAb, designated KE36-11, neutralized the infectivity of HTLV-1 as determined by both the inhibition of HTLV-1-induced syncytium formation and transformation assays in vitro. An antibody-binding assay using overlapping oligopeptides revealed that KE36-11 recognized a new epitope locating between the gp46 amino acid sequence 187-193 (Ala-Pro-Pro-Leu-Leu-Pro-His). Another anti-gp46 mAb, designated KE36-7, showed antibody-dependent cellular cytotoxicity against HTLV-1-bearing cell line. KE36-7 bound strongly to the 10-mer peptide-gp46 187-196, and weakly to peptides containing the gp46 amino acid sequence 191-196 (Leu-Pro-His-Ser-Asn-Leu). These two epitopes, which are associated with HTLV-1 neutralization and antibody-dependent cellular cytotoxicity, are thus the first epitopes identified in human HTLV-1 infection. It is possible that passive immunization of humans with these two human mAb are effective on the protection of HTLV-1 infection in vivo.

A weight-lifting exercise model for inducing hypertrophy in the hindlimb muscles of rats

A new method for strength-training of rat hindlimb muscles, comparable to human weight lifting, is compared with sprint training by a treadmill. The new training apparatus that can induce rats to perform human squats was designed. Squat training was composed of isotonic high-intensity, short-duration, and graded overload exercises. After 60 min of one bout of all-out squat and sprint training, serum creatine kinase activities were markedly increased in the squat group (P less than 0.001), but no significant changes were observed in the sprint group. These responses were reflected in the histological sections of the muscles. Some splitting and small fibers were observed only in the squat group, suggesting that different stimulations were applied to the muscles of both the squat and sprint groups. At the end of 12 wk of both types of training, performed 4-5 d.wk-1, the number of fibers in the plantaris muscles of the squat group was greater by 14% than that in the control and sprint groups (P less than 0.001), suggesting hyperplasia following hypertrophy. These results indicated that the muscle strength-training model presented here may provide a new insight into the muscle hypertrophy associated with hyperplasia induced by heavy resistance training.

Chronopharmacological study of valproic acid in mice: comparison of oral and rectal administration

This study was performed to investigate the influence of the dosing route on chronopharmacological aspect of valproic acid (VPA) in mice, comparing the oral and rectal route. ICR male mice, housed under a standardized light-dark cycle (lights on from 0700 to 1900), were orally or rectally administered 400 mg/kg VPA each at the following scheduled time: 0900, 1300, 1700, 2100, 0100 and 0500. VPA concentrations in plasma and brain were determined by gas-liquid chromatography. There was a circadian rhythm in the electroshock seizure (ES) threshold 30 min after oral VPA administration, with the highest value at the midlight (1300) and the lowest at the middark (0100) (p < 0.01). A significant circadian rhythm was also found in plasma and brain VPA concentrations 30 min after oral administration (p < 0.01). This finding is related to the rhythm in the ES threshold. In contrast to oral administration, no circadian rhythm in the ES threshold, plasma and brain VPA concentrations was observed after rectal administration. These values after rectal dosing showed higher levels in comparison to those after oral dosing. Thus, the rectal route for VPA might have merit to eliminate the time-dependent changes in VPA pharmacologic action and kinetics. The timing of drug administration is an important factor that must be carefully controlled in drug pharmacokinetic and pharmacodynamic studies and must be considered in planning dosing routes.

[Phase III trial of 99mTc-rhenium colloid for lymphoscintigraphy]

A multicenter study was carried out on 191 patients (196 examinations) with lymphatic system disorders to evaluate the efficacy and safety of 99mTc-rhenium Colloid, a tracer for lymphoscintigraphy (TCK-17). Local pain and swelling occurred at the site of injection in 79.6% and 5.1% of patients, respectively, and 2 patients experienced mild fever. The accuracy was calculated on the basis of the results obtained by other diagnostic methods. Lymphoscintigraphy using TCK-17 was sensitive diagnostic procedures, but low specificity. The efficacy was classified into five grades: "Excellent", "Good", "Moderate", "Equivocal", and "Poor". 67.3% of all examination were evaluated as "Excellent" or "Good". This study revealed TCK-17 was a useful radiopharmaceutical for lymphoscintigraphy because of its safety and effectiveness.