Comparison of in vivo binding of aromatic nitro and amino compounds to rat hemoglobin

The hemoglobin (Hb) binding of five nitroarenes, i.e. nitrobenzene (NB), 4-nitrobiphenyl (4-NBP), 1-nitropyrene (1-NP), 2-nitronaphthalene (2-NN) and 2-nitrofluorene (2-NF), and the corresponding amines, administered p.o. to male S.D. rats, was determined by HPLC, to evaluate the extent of in vivo reductive and oxidative activations of these compounds to N-hydroxylamines, which covalently bind to Hb to form acid-labile sulfinamides. Hb binding of the nitroarenes, except for NB, was significantly lower than that of the corresponding amines. Among the aromatic amines, 4-aminobiphenyl exhibited extremely high Hb binding. Hb binding of NB and 4-NBP decreased markedly after pretreatment with a mixture of antibiotics, but the binding of the others did not decrease appreciably. 1-Aminopyrene and 1-NP bound abundantly to plasma proteins, although the Hb binding was slight. Based on the Hb binding and the in vitro metabolism by liver microsomes and intestinal bacteria, the extent of in vivo reductive activation of nitroarenes is discussed.

[Mitral valve prolapse in patients with surgically-closed atrial septal defect]

To evaluate the prevalence, causes and clinical significance of mitral valve prolapse (MVP) associated with surgically-closed atrial septal defect (ASD), 90 patients (M: 41, F: 49) were studied using two-dimensional and color-coded Doppler echocardiography. Among the 90 patients, preoperative echocardiograms were available in 27. MVP was found in 21 of the 27 patients (78%) preoperatively, but it was found in 59% (16/27) postoperatively. In total, MVP was detected in 50 of the 90 patients (56%) postoperatively. The postoperative MVP group had higher pulmonary-to-systemic flow ratios (3.6 +/- 1.9 vs 2.8 +/- 1.1, p less than 0.05) and higher mean pulmonary arterial pressures (21 +/- 11 vs 13 +/- 5 mmHg, p less than 0.01) at the time of surgery. Between the two groups with or without MVP postoperatively, there was no difference (p less than 0.05) in age at surgery, the postoperative duration and left ventricular (LV) deformity index both in pre- and postoperative states. A mitral regurgitant (MR) murmur was recorded in seven patients postoperatively. However, only two had clinically severe MR. It was concluded that MVP is frequently detected in patients with closure of ASD and it is related neither to degree of the LV deformity nor to age at operation; rather, it is related to the severity of the preoperative hemodynamic state. Clinically significant MR is rare in the postoperative period.

[Venous hum and innominate vein flow velocity in chronic anemia: a pulsed Doppler echocardiographic study]

To assess the hemodynamic correlates of the cervical venous hum in patients with chronic anemia, 14 patients (mean age; 49 years, mean hemoglobin (Hb); 7.3 g/dl) and 14 control subjects (mean age; 50 years, mean Hb; 14 g/dl) without cardiac disease were studied by auscultation, phonocardiography and Doppler echocardiography in two positions (supine and sitting). Venous hum was detected in the sitting position in 11 of the 14 anemic patients whose Hb was less than 9 g/dl, and in six anemic patients in the supine position, while venous hum was absent in the control subjects in both positions. Pulsed Doppler echocardiography with the transducer in the supraclavicular fossa revealed significantly (p less than 0.01) higher peak velocity in the innominate vein in the 11 anemic patients with venous hum (supine; 71 +/- 12, sitting; 111 +/- 24 cm/sec, mean +/- SD) than in the control subjects (supine; 46 +/- 15 sitting; 76 +/- 27 cm/sec) in both positions. Intensity of venous hum increased concomitantly with increased innominate vein flow velocity when the body position was changed from supine to sitting. Peak velocity in the innominate vein correlated significantly with Hb in all study subjects (r = 0.65, p less than 0.01). In conclusion, the cervical venous hum in patients with chronic anemia is related to the hemoglobin concentration and flow velocity in the innominate vein.

Aortic regurgitation associated with hypertrophic cardiomyopathy: a colour Doppler echocardiographic study

The frequency, severity, and cause of aortic regurgitation were assessed by colour Doppler and cross sectional echocardiography in 87 patients (mean SD) age 57 (12) years) with hypertrophic cardiomyopathy, and 48 age matched controls (57 (8) years). Aortic regurgitant murmurs were recorded in only three of 87 patients and in none of the controls. Colour Doppler echocardiography showed an aortic regurgitant signal in 20 (23%) of the patients and three (6%) of the 48 controls. The colour Doppler signals typical of aortic regurgitation were limited to the left ventricular outflow tract. There were no significant differences between patients with hypertrophic cardiomyopathy with and without aortic regurgitation in terms of age (59 years v 56 years), blood pressure (140/84 mm Hg v 136/80 mm Hg), aortic diameter (34 mm v 33 mm), or frequency of calcification of the aortic valve (15% v 10%) and of systolic anterior motion of the mitral valve with mitral-septal contact (25% v 16%). On cross sectional echocardiograms, the degree of septal protrusion into the left ventricular outflow tract during systole was significantly more prominent (15 v 10 mm), and the portion of the basal septum that protruded most deeply into the left ventricular outflow tract was significantly closer to the aortic annulus in patients with aortic regurgitation than in those without it (11 v 14 mm). Mild aortic regurgitation was found in almost a quarter of patients with hypertrophic cardiomyopathy. The regurgitation was related to the morphological abnormality of the left ventricular outflow tract.

The usefulness of systemic administration of recombinant human tissue-type plasminogen activator in femoral arterial thrombolysis of rabbits

The thrombolytic effect of locally or systemically administered recombinant human tissue-type plasminogen activator (rt-PA) was investigated in comparison with the effect of tissue culture urokinase (TCUK), using a model of femoral artery thrombosis in rabbits. An 125I-labeled fibrinogen thrombus was formed in the femoral artery following injury of the intima by diluted sulfuric acid, and thrombolytic activity was evaluated one hour after the end of infusion of the agents. Local infusion of rt-PA (500-10,000 IU/kg) and TCUK (10,000 IU/kg) induced a marked thrombolysis. When rt-PA and TCUK were injected systemically in a high dose (200,000 IU/kg), rt-PA but not TCUK had a significant thrombolytic activity. In these cases, rt-PA was not accompanied by systemic activation of the fibrinolytic system, as evaluated by unaltered levels of alpha 2-antiplasmin in the plasma, while TCUK led to a substantial decrease in the alpha 2-antiplasmin level. These results suggest that systemically administered rt-PA but not TCUK induce a significant thrombolysis without systemic activation of the fibrinolytic system in cases of peripheral artery thrombosis.

Nonsurgical management of epidural hematoma in neonates

We successfully treated 4 neonates with epidural hematoma by nonsurgical methods. In 3 of these infants, epidural hematoma was complicated by cephalohematoma and skull fracture; however, the epidural hematoma disappeared after aspiration of the dark red blood in the cephalohematoma, resulting in complete recovery without sequelae. In the remaining infant, epidural hematoma was complicated by intraventricular and subarachnoid hemorrhage and disseminated intravascular coagulation; the patient was successfully treated by conservative therapy, including exchange transfusion and repeated lumbar puncture with only mild motor difficulties remaining. Some patients with neonatal epidural hematomas can be managed by nonsurgical, conservative procedures, including cephalohematoma aspiration.

Pulmonary alveolar microlithiasis in Afghan pika (Ochotona rufescens rufescens)

Lung lesions of 60 Afghan pikas (Ochotona rufescens rufescens) were examined histologically; 38 cases of pulmonary alveolar microlithiasis were found. Neither sex was predominantly affected, and there was no predilection for age.

Results of stereotactic aspiration in 175 cases of putaminal hemorrhage

Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of mitral valve prolapse in patients with premature ventricular contractions and the relationship between the prolapse and the types of premature contractions]

To assess the prevalence of mitral valve prolapse (MVP) in patients with premature ventricular contractions (PVCs), 109 patients with PVCs (M: 69, F: 40, 42 +/- 20 years; mean +/- SD) and 50 control subjects (M: 38, F: 12, 47 +/- 10 years) were studied by echocardiography. MVP was diagnosed by two-dimensional echocardiography. The criterion for mitral valve prolapse by two-dimensional echocardiography is extension of the mitral leaflet to the left atrial side beyond the plane of the mitral annulus. In addition, 60 patients with PVCs were examined by 24-hour Holter ECG and scored by the Lown's classification. Results were as follows: 1) MVP was detected more frequently in patients with PVCs than in the control subjects (22/109, 20% vs 3/50, 6%, p less than 0.05) by echocardiography. 2) PVC patients with MVP were significantly younger than patients without MVP (34 +/- 14 vs 47 +/- 21 yrs, p less than 0.05), but there were no significant differences between these two groups as to sex, left atrial diameter and left ventricular dimension. 3) The 24-hour Holter ECG revealed that the high grade PVCs (Lown grade III & IV) was more closely related to the absence of MVP (20/45, 44% vs 4/11, 36%), though this trend did not reach statistical significance. It was suggested that MVP is not a major determinant of PVC, and life-threatening arrhythmias are more likely related to cases without MVP.

Stimulated otoacoustic emissions in children with sensorineural hearing loss

Our previous studies of stimulated oto-acoustic emissions (OAEs) have revealed that the OAE threshold indicates the grade of inner ear impairment. The present study is a survey of OAE in children of school age. The mean OAE threshold values of 113 ears with normal hearing and 45 ears with functional deafness were 5.9 dB nHL and 6.2 dB nHL, respectively. In sensorineural loss the value was noted to increase according to its grade, classified into four groups, measuring 37.2 dB nHL in the group with severe loss higher than 91 dB. The findings suggest that the OAE threshold is useful for an indicator of inner ear function in children. There still remains the problem to be solved by a contrivance of noise removal for application of OAE to hearing tests in children of pre-school age.

[A study on the protective mechanism of phenytoin in transient global ischemia]

Ischemia gives rise to severe energy depletion and imbalance of Ca2+ homeostasis. This condition leads to activation of phospholipases A2, A1 and to attenuation of ATP dependent reacylation. As a result, free fatty acid (FFA) especially arachidonic acid accumulates. Phenytoin has been reported to blockade the various Ca2+ channels. In this study, we could investigate the effect of phenytoin on the liberation of FFA, energy metabolites, various nucleotides metabolism, Na+, K+-ATPase activity, and water and electrolyte contents in the ischemic brain. Inhibitory effects of phenytoin against FFA accumulation in the ischemia, and increase of parietal cortex water content in the recirculation were brought about. In addition, Na+,K+-ATPase activity in the ischemia was accelerated by phenytoin. Phenytoin may reduce intracellular Ca2+ by blocking the Ca2+ channel into the cytoplasma, or by activation of Na+-Ca2+ exchange transport system following the acceleration of Na+,K+-ATPase activity. Another conceivable way for this acceleration of Na+,K+-ATPase may be derived from the preservation of the energy state, protein metabolism, and lipid metabolism.

Alteration of catalytic properties of chymosin by site-directed mutagenesis

Artificial mutations of chymosin by recombinant DNA techniques were generated to analyze the structure--function relationship in this characteristic aspartic proteinase. In order to prepare the mutant enzymes in their active form, we established procedures for purification of correctly refolded prochymosin from inclusion bodies produced in Escherichia coli transformants and for its subsequent activation. Mutagenesis by linker insertion into cDNA produced several mutants with an altered ratio of milk clotting activity to proteolytic activity and a different extent of stability. In addition to these mutants, several mutants with a single amino acid exchange were also constructed by site-directed mutagenesis and kinetic parameters of these mutant enzymes were determined by using synthetic hexa- and octa-peptides as substrates. Exchange of Tyr75 on the flap of the enzyme to Phe caused a marked change of substrate specificity due to the change of kcat or Km, depending on the substrate used. Exchange of Val110 and Phe111 also caused a change of kinetic parameters, which indicates functional involvement of these hydrophobic residues in both the catalytic function and substrate binding. The mutant Lys220----Leu showed a marked shift of the optimum pH to the acidic side for hydrolysis of acid-denatured haemoglobin along with a distinct increase in kcat for the octa-peptide in a wide pH range.

Transvenous copper wire insertion for dural arteriovenous malformations of cavernous sinus

Therapeutic embolization by means of transvenous copper wire insertion was performed in five patients with dural arteriovenous malformations (AVM's) of the cavernous sinus. In each case, angiograms had shown that the AVM's were supplied from both internal and external carotid arteries, which was thought to render complete transarterial embolization difficult. A No. 2.5 French Teflon catheter was introduced into the affected cavernous sinus through the superior ophthalmic or internal jugular vein with the aid of a flexible mini guide wire. Copper wires were pushed by the guide wire into the cavernous sinus until the disappearance or a sufficient decrease in the arteriovenous shunt was noted. The patients' symptoms resolved or improved without any severe complications. Angiography revealed complete disappearance of the lesion immediately after treatment in three cases and follow-up angiography taken within 8 months showed no arteriovenous shunt in any patient. This method is a promising treatment for dural AVM's when conventional transarterial embolization is thought to be difficult.

Relationship between mitral regurgitation and left ventricular outflow obstruction in hypertrophic cardiomyopathy

To clarify the relationship between mitral regurgitation and left ventricular outflow obstruction, Doppler and two-dimensional echocardiographic studies were performed in 62 patients with hypertrophic cardiomyopathy (22 with and 40 without obstruction caused by mitral systolic anterior motion with septal contact). Pulsed Doppler echocardiography with color Doppler flow imaging demostrated that in 20 of the 22 patients with obstruction, mitral regurgitation occurred mainly during midsystole from the onset to the end of mitral-septal contact. Such midsystolic mitral regurgitation was not observed in patients without obstruction, except in three of 25 patients with mild mitral systolic anterior motion without septal contact. Furthermore, that regurgitation developed or disappeared together with the obstruction during follow-up periods or pharmacologic interventions. Two-dimensional echocardiography showed that in 21 of the 22 patients with obstruction, a distal residual portion of the "anterior" mitral leaflet moved anteriorly in early systole and protruded into the outflow tract during midsystole to cause the obstruction. In the other patient with obstruction, who had only early systolic mitral regurgitation, a distal residual "posterior" leaflet moved similary. These results may indicate that the midsystolic mitral regurgitation is hydrodynamically induced by the midsystolic pressure gradient across the protruding distal residual anterior mitral leaflet.

Covalent structure of a low-molecular-mass protein, meleagrin, present in a turkey (Meleagris gallopavo) ovomucoid preparation

A low-molecular-mass protein, tentatively named meleagrin, was isolated from a commercial preparation of turkey (Meleagris gallopavo) ovomucoid. This 40-amino acid protein contains 3 disulfide bonds and high concentrations of aromatic residues (2 tryptophans and 3 tyrosines). It lacks threonine, methionine, phenylalanine, and arginine residues. The complete amino acid sequence was determined to be the following: less than Glu-Val-Leu-Lys-Tyr-Cys-Pro-Lys-Ile-Gly-Tyr-Cys-Ser-Ser-Lys-Cys-Ser-Lys- Ala- Glu-Val-Trp-Ala-Tyr-Ser-Pro-Asp-Cys-Lys-Val-His-Cys-Cys-Val-Pro-Ala-Asn- Gln-Lys - Trp. One of the three disulfide bonds exists between Cys12 and Cys28, and the two others links Cys32-Cys33 with Cys6 and Cys16. The amino acid sequence of meleagrin shows a strong homology to a similar basic protein, cygnin (Simpson, G.R. & Morgan, F.J. [1983] Int. J. Pep. Protein Res. 22, 476-481), of a rather distantly related aves, black swan (Cygnus atratus), suggesting some vital role of this protein in avian eggs. Similarity to a part (exon 9) of transferrins was also recognized.

Kidney fatty acid-binding protein: identification as alpha 2U-globulin

A fatty acid-binding protein was purified from male rat kidney by the method of Fujii et al. [(1987) Arch. Biochem. Biophys. 254, 552-558]. Based on the close similarity of amino acid composition and the identity of the amino acid sequence in the amino-terminal region, the fatty acid-binding protein was identified as alpha 2U-globulin, which is the major male-specific protein in rat urine. The amino-terminal residue of the isolated kidney protein corresponds to residue 10 of alpha 2U-globulin, suggesting that the protein has been proteolytically processed in the kidney. This fatty acid-binding protein could not be immunologically detected in female rat kidney.

Effects of interocular blur suppression ability on monovision task performance

Suppression of anisometropic blur induced by monovision contact lenses was examined in 18 presbyopic subjects. Suppression ability was quantified by reducing the contrast of a bright test target, viewed by subjects wearing a monovision correction, until the blurred image was suppressed. Subjective success with monovision was evaluated using a patient survey and no correlation to blur suppression ability was found. Objective success was evaluated in terms of performance at three near work tasks, each requiring a different level of stereoscopic localization. A significant correlation was found between card filing performance (requiring a moderate level of stereopsis) and blur suppression ability. Correcting either the dominant or non-dominant eye for near in the monovision correction did not significantly affect blur suppression ability. There was no evidence for adaptation to monovision in terms of increasing blur suppression ability over time.

Surgical treatment of multiple aneurysms. Review of experience with 372 cases

We review the surgical results in 372 cases of multiple intracranial aneurysms over a 25-year period in which one of us (JS) performed 2,000 direct operations for aneurysms. All patients were classified into four groups according to the location of the aneurysm: Group 1: multiple aneurysms including anterior communicating artery aneurysm (157 cases); Group 2: multiple aneurysms of unilateral anterior circulation (72 cases); Group 3: multiple aneurysms of bilateral anterior circulation (110 cases); Group 4: multiple aneurysms including vertebro-basilar artery aneurysms (33 cases). In multiple aneurysm cases, our policy has been to treat all aneurysms, ruptured and unruptured, in a one-stage operation whenever possible. About 90% of patients in both Group 1 and 2 were treated by one-stage operations, while 60% of patients in Group 3 and 42% of patients in Group 4 were operated on in the same manner. Excellent and good results in from 73% to 81% of cases were obtained in patients in Group 1, Group 2 and Group 3. Morbidity was 14-19% and mortality was 6-8%. These results were comparable to the results with a single aneurysm of the anterior circulation. On the other hand, the surgical results in Group 4 were poor with a mortality of 27%. Poor results were attributable to the postoperative rebleeding from the untreated vertebro-basilar aneurysms, which were thought to be unruptured aneurysms preoperatively. Furthermore, it was clarified that the results of early one-stage operations (within one week from onset) in patients with multiple aneurysms were satisfactory. In this group, there was good recovery in 84% of patients, 7% were disabled and 9% died.(ABSTRACT TRUNCATED AT 250 WORDS)

[In vitro study on decolorization effect of argon ion laser]

Many experimental treatments for oral pigmented lesions with several kinds of lasers have been applied and consequently, the argon ion (Ar+) laser is used clinically as one of the most effective lasers for decolorizing. This in vitro study was carried out to clarify the depigmentation mechanism by low energy Ar+ laser irradiation. Each cultured human melanotic malignant melanoma cell colony was irradiated by the laser at 0.31 J/cm2. Each colony was fixed in time sequence and examined microscopy and ultramicroscopy. The present study disclosed the tyrosinase inactivation and decrease in the number of melanosomes of the laser melanoma cells. Subcellular degeneration was very mild and the mature melanin granules markedly decreased concomitantly with the increased secretion of the granules. These findings suggest that Ar+ laser irradiation evokes decolorization effect by the mechanism of 1) organelle-specific injury, 2) hypersecretion of melanosomes and 3) maturation arrest of melanosomes, related to its photoactivity.

Beta and alpha adrenergic reactivity elicitable stress study with special reference of electrocardiographic T-wave amplitude

Twenty-six healthy young Caucasian males were defined into high hostile (Hi-Ho) group and low hostile (Lo-Ho) group assessed by Cook-Madley's Hostility (Ho) scale. Mental arithmetic task (MA) and forehead cold stimulus task (FCS) were loaded to both Hi-Ho and Lo-Ho groups. Electrocardiographic T-wave amplitude (TWA), heart rate (HR) and coefficient of variance of 100 R-R intervals (CVR-R) were measured continuously during MA and FCS task periods. Greater TWA attenuation was found in Hi-Ho group (p less than 0.05). Although no significant intergroup difference was represented in HR and CVR-R, HR increased significantly (p less than 0.01) in whole subjects and CVR-R was tend to be suppressed during MA period. In addition, comparison of these physiological responses were performed between Type-A and Type-B groups classified by Jenkins' Activity Survey Form-T (JAS-T). There was no significant difference in reactivity of TWA, HR and CVR-R to both two tasks between high and low Type-A scored groups. Previous data suggested that the TWA reactivity in Hi-Ho subjects to cognitive stress showed similar pattern in Type-A individuals. However, autonomic nervous interaction could not be clarified in Hi-Ho subjects. The differentiation of method for assessment of behavioral pattern was also discussed.

[A case of intramedullary spinal cavitation after minor trauma]

A case of surgically treated intramedullary spinal cavity which appeared 1 year after a minor injury was presented. A 15 year-old boy developed nuchalgia and muscle weakness of his right arm and leg. On admission, he had right hemiparesis and sensory disturbances in the right C6-C8 and left T1-S5 dermatomes. Metrizamide-CT scan and MRI disclosed an intramedullary spinal cavity between C4-C5 vertebral levels. A myelotomy and a biopsy of the cavity wall were carried out in order to communicate the cavity with the subarachnoid space, and to make a definite diagnosis. The microscopic examination of a biopsy specimen revealed no tumor findings but inflammation. Taking into account the location of the cavity, a site corresponding with the site of a previous trauma, the authors finally diagnosed the cavity as intramedullary spinal cavitation after minor trauma. His symptoms improved remarkably after the operation.

Analysis of optokinetic nystagmus in patients with localized lesions of unilateral visual cortices

Optokinetic nystagmus (OKN) asymmetry in 4 patients with localized lesions of the unilateral visual cortices (2 in the right hemisphere and 2 in the left hemisphere), confirmed at autopsy or by CAT scan, was detected by computer analysis. The ENG recordings showed typical asymmetry of OKP: lower amplitude in the contralateral optokinetic pattern (OKP) than on the side with the visual cortex lesion. Analysis of this asymmetry revealed lower amplitude, remarkably impaired slow-phase velocity, and mildly impaired fast-phase velocity, with a slight difference in number of OKN. The findings suggested that asymmetry of OKP in patients with localized lesions of the unilateral visual cortices is primarily caused by the impaired slow-phase velocity of the contralateral OKN because of a slight change in number of OKN.