Thermostable N-carbamoyl-D-amino acid amidohydrolase: screening, purification and characterization

A thermostable N-carbamoyl-D-amino acid amidohydrolase was found in the cells of newly isolated bacterium. Blastobacter sp. A17p-4. The bacterium also showed D-specific hydantoinase activity. The N-carbamoyl-D-amino acid amidohydrolase activity of the cells exhibited a temperature optimum at 50-55 degrees C, and was stable up to 50 degrees C. The N-carbamoyl-D-amino acid amidohydrolase of Blastobacter sp. A17p-4 was purified to homogeneity and characterized. It has a relative molecular weight of about 120,000 and consists of three identical subunits with a relative molecular weight of about 40,000. N-Carbamoyl-D-amino acids having hydrophobic groups served as good substrates for the enzyme. It has been suggested that D-amino acid production from DL-5-substituted hydantoin involves the action of a series of enzymes involved in pyrimidine degradation, namely amide-ring opening enzyme, dihydropyrimidinase, and N-carbamoylamide hydrolyzing enzyme, beta-ureidopropionase. However, the purified enzyme did not hydrolyze beta-ureidopropionate; suggesting that the N-carbamoyl-D-amino acid amidohydrolase coexisting with D-specific hydantoinase, probably dihydropyrimidinase, in Blastobacter sp. A17p-4 is different from beta-ureidopropionase.

Relation between recurrence and expression of proliferating cell nuclear antigen, sialyl LewisX, and sialyl Lewis(a) in lung cancer

Blood vessel invasion, recurrence rate, and time to recurrence were examined in relation to the immunohistochemical expression of proliferating cell nuclear antigen, sialyl LewisX, and sialyl Lewis(a) in 303 patients with lung cancer who had a curative resection from 1980 to 1991. Of these, 150 had adenocarcinoma, 117 had squamous, 21 had large-cell, and 15 had small-cell carcinoma. Significant differences were detected in the expression of proliferating cell nuclear antigen and sialyl LewisX between adenocarcinomas and the other histologic types; thus the subjects were divided into 150 with adenocarcinoma and 153 with non-adenocarcinoma. In those with adenocarcinoma, the frequency of blood vessel invasion was significantly higher in tumors with strong sialyl LewisX expression, and the disease-free survival of the patients with blood vessel invasion was significantly worse when their tumors strongly expressed both sialyl LewisX and proliferating cell nuclear antigen. In those with non-adenocarcinoma, on the other hand, tumors with strong expression of sialyl Lewis(a) and proliferating cell nuclear antigen showed significantly higher frequencies of blood vessel invasion and worse disease-free survival. In patients with recurrent tumors, those with strong proliferating cell nuclear antigen expression showed a significantly shorter time to recurrence. We conclude that sialyl LewisX and proliferating cell nuclear antigen expression in adenocarcinoma and sialyl Lewis(a) and proliferating cell nuclear antigen expression in non-adenocarcinoma may be an important determinant of recurrence.

Beta-ureidopropionase with N-carbamoyl-alpha-L-amino acid amidohydrolase activity from an aerobic bacterium, Pseudomonas putida IFO 12996

beta-Ureidopropionase of aerobic bacterial origin was purified to homogeneity from Pseudomonas putida IFO 12996. The enzyme shows a broad substrate specificity. In addition to beta-ureidopropionate (Km 3.74 mM, Vmax 4.12 U/mg), gamma-ureido-n-butyrate (Km 11.6 mM, Vmax 19.4 U/mg), and several N-carbamoyl-alpha-amino acids, such as N-carbamoylglycine (Km 0.68 mM, Vmax 9.14 x 10(-2) U/mg), N-carbamoyl-L-alanine (Km 1.56 mM, Vmax 1.00 U/mg), N-carbamoyl-L-serine (Km 75.1 mM, Vmax 3.78 U/mg), and N-carbamoyl-DL-alpha-amino-n-butyrate (Km 2.81 mM, Vmax 1.08 U/mg), are also hydrolyzed. The hydrolysis of N-carbamoyl-alpha-amino acids is strictly L enantiomer specific. N-Formyl-L-alanine and N-acetyl-L-alanine are also hydrolyzed by the enzyme, but the rate of hydrolysis is lower than the rate for N-carbamoyl-L-alanine. The enzyme requires a divalent metal ion, such as Co2+, Ni2+ or Mn2+, for activity, and is significantly affected by sulfhydryl reagents. The enzyme consists of two polypeptide chains with identical relative molecular mass M(r) 45000. The broad substrate specificity and metal ion dependence of the enzyme show that the beta-ureidopropionase of this aerobic bacterium is quite different from the beta-ureidopropionases of mammals and anaerobic bacteria.

Enzymatic asymmetric synthesis of alpha-methyl arylalkylamines and alpha-methyl arylalkylalcohols by arylalkyl acylamidases

With the novel microbial enzyme, 'arylalkyl acylamidase', optically active alpha-methyl arylalkylamines and alpha-methyl arylalkylalcohols have been obtained through enantioselective hydrolysis of their racemic amides and esters. (S)-Enantiomers of 1-methylbenzylamine, 1-methyl-3-phenylpropylamine and 1-methyl-3-phenylpropanol of high optical purity (> 94% e.e.) were synthesized with the cells of Nocardia erythropolis IAM 1440 or Cellulomonas fimi AKU 671. (R)-Enantiomer of 1-methyl-3-phenylpropylamine and (S)-enantiomer of 1-methyl-2-phenylpropanol of high optical purity (> 95% e.e.) were synthesized with the crude preparation of arylalkyl acylamidase of Pseudomonas putida Sc2 AKU 881.

Bronchoscopy findings and early treatment of patients with blunt tracheo-bronchial trauma

Five of 238 patients who suffered blunt chest trauna required surgery to repair a tracheobronchial injury. All patients were injured in a motor vehicle accident. The site of the injury was within 2.5 cm of the carina in four patients and 5.5 cm proximal to the carina in one. Pre-, intra-, and post-operative respiratory management was facilitated by the insertion of a Univent tube, an endotracheal tube with movable blocker capable of excluding one lung. The Univent tube prevented aspiration of blood by the healthy lung and the development of acute respiratory failure. Improved control over ventilation has the secondary benefit of allowing the surgeon to assess other injuries under less duress in patients with multiple trauma.

[A clinical study of so-called rare pulmonary tumors]

Six so-called rare pulmonary tumors, resected at the hospital are reported. Histologically there were pulmonary blastoma, pulmonary adenocarcinoma of fetal lung type, alveolar soft part sarcoma, oncocytic carcinoid tumor, hemangioendothelioma, and leiomyoma in each one case. The represented about 1.5% of all resected lung tumors. The age of these patients ranged from 28 to 67 years old, and all were females. Two patients experienced hemosuputum, but the others have no clinical symptoms. All the patients showed relatively well circumscribed mass shadows on chest X-ray films, but none could have accurate diagnosis by preoperative examinations. One patient with alveolar soft part sarcoma died of brain metastasis 18 months after the resection, however, the other 5 patients remained well from 2 year 7 months to 11 years after the surgery.

Blood vessel invasion and expression of sialyl Lewisx and proliferating cell nuclear antigen in stage I non-small cell lung cancer. Relation to postoperative recurrence

BACKGROUND

Recurrence in Stage I non-small cell lung cancer was examined with respect to vascular invasion and the immunohistochemical expression of sialyl-dimeric Lewisx (SLX) and proliferating cell nuclear antigen (PCNA).

METHODS

One hundred twenty-eight patients with Stage I non-small cell lung cancer who had a curative resection were the subjects of this study. Using tumor tissues fixed in formaldehyde solution, blood vessel invasion (BVI) and lymphatic invasion stained with Victoria blue-hematoxylin and eosin and the immunohistochemical expression of SLX and PCNA were retrospectively studied with respect to postoperative recurrence.

RESULTS

By univariate analysis, BVI and SLX and PCNA expression were significantly important factors of disease-free survival (P < 0.01). The disease-free survival of the patients with both BVI and SLX expression was significantly shorter than that of the patients with BVI but negative SLX expression (P < 0.02). In 35 patients with recurrence, tumors with PCNA expression showed a significantly shorter time to recurrence compared with tumors without PCNA expression (P < 0.01).

CONCLUSIONS

BVI and SLX expression may be important determinants of recurrence. PCNA may be a determinant of time to recurrence.

Surgical resection of a second primary lung carcinoma in a survivor of small cell carcinoma

Resection of a second primary lung carcinoma in a long-term survivor of small cell lung carcinoma is reported. The patient had adenocarcinoma as the second primary tumor and underwent lobectomy with mediastinal node dissection. He was alive 99 months after the initial diagnosis of small cell carcinoma and 54 months after curative pulmonary resection for his second primary carcinoma.

Fixation of biological specimens by high hydrostatic pressure

We investigated whether or not high hydrostatic pressure could be used as a new method of histological fixation. Various high hydrostatic pressures from 200 to 800 MPa (Mega Pascal) were applied to fresh organs including heart, liver, intestine and kidney of mice, and the gross and light microscopic findings were compared with those of organs fixed with formalin and those without fixation. The specimens processed with pressure were firm, elastic and pale, somewhat resembling the formalin fixed ones. Light microscopic examination revealed well preserved fine structures in the heart and intestine subjected to approximately 450 MPa for 15 min at room temperature, although the fine structures of the liver and kidney were not well preserved. The enzyme activity of alkaline phosphatase was rarely preserved in the formalin-fixed kidney, but could be easily detected in kidneys processed with a pressure of 450 MPa. We conclude that high hydrostatic pressure can be used as a fixative, both for preserving the basic tissue structure in certain organs and for retaining the biological activity of an enzyme. In addition, the fixation is uniform, the processing is fast, and the materials can be handled safely. At present, however, its application is limited to specific organs.

[Effect of Ca-antagonists on pulmonary blood flow during single-lung ventilation in the dog]

Experiments were conducted in 21 adult mongrel dogs to clarify the effects of Ca-antagonist (nifedipine sublingual administration 2.5 mg or 5 mg, or nicardipine intravenous administration 30 micrograms/kg or 60 micrograms/kg) on pulmonary blood flow under the condition of collapsed lung on the side of thoracotomy. Under anesthesia, an endotracheal tube with a movable blocker was used to intubate the trachea and the thoracotomized lung was collapsed. Subsequently, a Ca-antagonist was given and the ratio of the left main pulmonary artery/ascending thoracic aorta blood flow was used as an index of hypoxic pulmonary vasoconstriction (HPV). The following results were obtained. 1. Ca-antagonist administration under lung-collapse on the thoracotomy side resulted in inhibition of HPV of the collapsed lung, whereas, arterial blood oxygen tension (PaO2) remained in the acceptable range. 2. The maintenance of the lowered PaO2 within the acceptable range may have been due to the increase in cardiac output and the elevation of mixed venous blood oxygen tension resulting from Ca-antagonist administration, as well as the residual HPV even after administration of the Ca-antagonist.

Pure yolk-sac tumor of the lung

The first case of a pure primary yolk-sac tumor of the lung is presented. The tumor developed in the right upper lobe of a 31-year-old man; preoperatively, the serum alpha-fetoprotein concentration was elevated. Treatment consisted of pulmonary segmentectomy with postoperative combination chemotherapy. The patient is alive and well 13 months after surgery with a normal serum alpha-fetoprotein concentration.

Immunohistochemical study of glutathione-related enzymes and proliferative antigens in lung cancer. Relation to cisplatin sensitivity

BACKGROUND

With resected tumor tissue from 84 patients with lung cancer, the expression of glutathione peroxidase (GPX), glutathione reductase (GR), proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR) was examined in relation to cisdiamminedichloroplatinum (CDDP) sensitivity.

METHODS

The CDDP sensitivity was assessed from an increase of cells in the S-phase or G2M-phase by a DNA histogram after the tumor cells were incubated in a CDDP solution. The expression of GPX, GR, PCNA, and EGFR for each tumor was studied with an indirect immunoperoxidase technique on paraffin-embedded tissues.

RESULTS

The percentage of patients sensitive to CDDP according to the histologic type was 86% for small cell carcinomas, 40% for large cell carcinomas, 31% for squamous cell carcinomas, and 6% for adenocarcinomas. There was an inverse relationship between CDDP sensitivity and the frequency of GPX and GR expression, and both were significantly different among histologic types. The GPX and GR expression was significantly lower in the CDDP-sensitive group than in the resistant group (P < 0.01). However, the expression of PCNA and EGFR was significantly lower in the sensitive group in non-small cell carcinomas and squamous cell carcinomas (P < 0.05).

CONCLUSIONS

From the above findings, an immunohistochemical study of these antigens may be useful for predicting CDDP sensitivity in lung cancer.

N-carbamoyl-D-amino acid amidohydrolase from Comamonas sp. E222c purification and characterization

N-Carbamoyl-D-amino acid amidohydrolase was purified 119-fold, with 36% overall recovery from a cell-free extract of Comamonas sp. E222c. The purified enzyme was homogeneous as judged by SDS/PAGE. The relative molecular mass of the native enzyme was 120,000 and that of the subunit was 40,000. The purified enzyme hydrolyzed various N-carbamoyl-D-amino acids to D-amino acids, ammonia and carbon dioxide. N-Carbamoyl-D-amino acids having hydrophobic groups served as good substrates for the enzyme. The Km and Vmax values for N-carbamoyl-D-phenylalanine were 19.7 mM and 13.1 units/mg, respectively, and those for N-carbamoyl-D-p-hydroxyphenylglycine were 13.1 mM and 0.56 units/mg, respectively. The enzyme strictly recognized the configuration of the substrate and only the D-enantiomer of the N-carbamoyl amino acid was hydrolyzed. The enzyme activity was not significantly affected by N-carbamoyl-L-amino acids and ammonia. The enzyme was sensitive to thiol reagents and did not require metal ions for its activity. The enzyme did not hydrolyze N-carbamoyl-beta-alanine or N-carbamoyl-DL-aspartate suggesting that the enzyme is different from the N-carbamoylamide-hydrolyzing enzymes involved in the pyrimidine degradation pathway. The enzyme did not hydrolyze allantoin and allantoic acid, which are intermediates in purine degradation, N-carbamoylsarcosine and citrulline, suggesting that it is a novel N-carbamoylamide amidohydrolase.

[An experimental study on the relation between lung volume and pulmonary blood flow]

The purpose of this study was to elucidate whether or not the reduction of lung volume is related to the mechanism of blood flow reduction in the atelectatic lung. In adult mongrel dogs, whose main stem bronchus in the thoracotomized lung was obstructed, the change of blood flow in the lung containing N2 was compared with that in the collapsed lung. 1) Under a low partial pressure of O2 in the broncho-alveolar system by obstruction of the main stem bronchus, the blood flow did not change, even when the N2 volume in the lung was varied. Therefore, the change of blood flow in the collapsed lung is not attributable to the reduction of lung volume. 2) The lung blood flow increased when the partial pressure of O2 in the broncho-alveolar system was elevated by infusion of O2 into the collapsed lung, and it decreased with the subsequent O2 absorption leading to lung collapse. Therefore, the change of lung blood flow is due to the change of intraalveolar partial pressure of O2. 3) The reduction of blood flow in the atelectatic lung is caused by hypoxic pulmonary vasoconstriction, and is not influenced by the reduction of lung volume due to the lung collapse.

Total avulsion of the azygos vein and longitudinal laceration of the mediastinal pleura due to blunt chest trauma: a case report

Complete avulsion of the azygos venous arch associated with a subtotal longitudinal laceration of the posterior mediastinal pleura resulting from blunt motor vehicular trauma is reported. A sudden forceful anteromedial rotation of the decelerating cardiac mass may be the etiologic mechanism of the rare injury.

A comparison of Type A behaviour pattern, hostility and Typus Melancholicus in Japanese and American students: effects of defensiveness

A comparison of Type A behaviour pattern, hostility and Typus Melancholicus (TM) was examined in a sample of 228 Japanese and 121 American college students. It was found that: the Japanese students expressed Type A, especially hostility, less strongly than American ones; TM was seen to the same degree in both Japanese and American students; Type A was related to hostility and TM in both groups of students; and compared with American students, the Japanese students displayed the defensiveness more frequently, and there appeared to be a strong relationship between defensiveness and hostility. These results suggest the possibility that hostility, a component element of Type A, is manifested under the influence of defensiveness, which is partially related to a variety of different sociocultural contexts.

[Airway hyperreactivity test by measurement of specific airway conductance during quiet breathing]

In asthmatic patients, the threshold for specific airway conductance during quiet breathing (sGawqt) in the airway hypersensitivity test was determined using our newly developed pressure corrected flow type body plethysmograph and compared with that measured by means of respiratory resistance (Grs) Astograph in relation to the following parameters: 1) Dmin, an index of airway sensitivity (accumulated methacholine concentration at the time of onset of linear decrease in the dose-response curve), 2) SsGawqt and SGrs, indicators of airway sensitivity (slope when the value begins to decrease) and 3) PD35 (accumulated methacholine concentration when the valve has decreased to 35% of the initial value). Although no significantly difference was observed in SsGawqt and SGrs, significantly lower values of Dmin and PD35, indexes of airway sensitivity, were obtained with sGawqt method as compared to Astograph. These findings may indicate that the airway hypersensitivity test using our body plethysmography technique can be performed using a smaller amount of inhaled methacholine with less patient burden as compared to Astograph.

Purification and characterization of a novel enzyme, arylalkyl acylamidase, from Pseudomonas putida Sc2

A novel enzyme, arylalkyl acylamidase, which shows a strict specificity for N-acetyl arylalkylamines, but not acetanilide derivatives, was purified from the culture broth of Pseudomonas putida Sc2. The purified enzyme appeared to be homogeneous, as judged by native and SDS/PAGE. The enzyme has a molecular mass of approximately 150 kDa and consists of four identical subunits. The purified enzyme catalyzed the hydrolysis of N-acetyl-2-phenylethylamine to 2-phenylethylamine and acetic acid at the rate of 6.25 mumol.min-1.mg-1 at 30 degrees C. It also catalyzed the hydrolysis of various N-acetyl arylalkylamines containing a benzene or indole ring, and acetic acid arylalkyl esters. The enzyme did not hydrolyze acetanilide, N-acetyl aliphatic amines, N-acetyl amino acids, N-acetyl amino sugars or acylthiocholine. The apparent Km for N-acetylbenzylamine, N-acetyl-2-phenylethylamine and N-acetyl-3-phenylpropylamine are 41 mM, 0.31 mM and 1.6 mM, respectively. The purified enzyme was sensitive to thiol reagents such as Ag2SO4, HgCl2 and p-chloromercuribenzoic acid, and its activity was enhanced by divalent metal ions such as Zn2+, Mg2+ and Mn2+.

[Auto recording system for the Goldmann perimeter]

In order to develop a method for converting the Goldmann perimeter data directly for computer storage and evaluation, a recording instrument was designed as a modification of the Goldmann perimeter. By installing the two potentiometers on the pantographic arm and electrical switches, the position of the test target and the setting of the four levers which defines the size and the brightness of the test target were transferred directly to the computer. Accuracy of this recording system is better than 1.3 degree over the entire surface of the chart. This system will make it possible to easily follow changes in the visual fields of the same patient, i.e. shape change, numerical value.

[Clinical study of paragangliomas in the thorax]

Four cases of paraganglioma in the thorax, consisted of 3 cases originating from the mediastinum and a case of pulmonary metastasis from the posterior peritoneum, were clinically investigated. Three were malignant and one was benign with noradrenaline secretion. On surgical excision, preoperative arterial embolization was assumed to be useful for reducing hemorrhage during procedure. Pre and intra-operative circulatory management was also mandatory in case of functioning paraganglioma. Of the 3 malignant cases, 2 survived for more than 10 years with radiotherapy alone or surgical resection of multiple metastatic nodules in the bilateral lungs. The other one, though inoperable due to extensive invasion to right and left atria, showed highly sensitivity to intra-arterial infusion chemotherapy of CDDP. These results suggested that long term survival might be expected even in metastatic or inoperable cases. There were no reliable histologic features distinguishing malignant from benign tumors, however 2 malignant cases with local invasion showed aneuploid patterns in the DNA histograms, which might offer a adjunct possibility in the assessment of malignancy.

Relationship between tumor DNA ploidy and regional lymph node changes in lung cancer

Seventy-four patients with lung cancer, resected consecutively from April 1989 to August 1990, were divided into (1) 21 with diploid tumors having a single G0/G1 peak and a coefficient of variation (CV) of 4.9 or less, (2) 18 with peridiploid tumors having a single G0/G1 peak and a CV at 5.0 or more, and (3) 35 with aneuploid tumors having multiple G0/G1 peaks. Aneuploid tumors had higher frequencies of lymphatic invasion and metastasis to the mediastinal lymph nodes. To evaluate the relationship between ploidy tumor status and immunologic competence of the regional lymph nodes, histologic findings and the proportion of killer T-lymphocytes were examined in the dissected lymph nodes. Aneuploid tumors had significantly lower proportions of paracortical hyperplasia and killer T-lymphocytes than did diploid and peridiploid ones in the nonmetastatic lymph nodes of N0 and N1 disease. These findings suggest the possibility that a decline in the antitumor competence of these lymph nodes could cause metastasis to the nodes. The recurrence rates were 19% in diploid, 33% in peridiploid, and 54% in aneuploid tumors, and the 2-year survival rates were 87%, 78%, and 44%, respectively. Peridiploid tumors showed intermediate values between diploid and aneuploid in terms of immunologic competence, recurrence rate, and survival. They were assumed to have a different proportion of aneuploid cells than the other two.

[Operation of pleural dissemination of thymoma]

Nine patients underwent operation for pleural dissemination of thymoma and received radiotherapy postoperatively. In 5 patients dissemination was resected along with the invasive thymoma at the initial operation. In 6 patients resection of a part of the diaphragm was needed. In 4 patients recurrent dissemination of thymoma appeared in the phrenico-costal sinus, where not only the location of dissemination but also postoperative radiotherapy had not been performed properly at the time of the previous operation. Seven are alive 2 months to 7 years 10 months after the first operation for dissemination. Two died respectively 7 years and 3 years 5 months after the first operation for dissemination.

[A case of mediastinal teratoma--differentiation from lung abscess and bronchogenic carcinoma]

A 38-year-old man was admitted with persistent productive cough and right anterior chest pain. Chest X-ray showed two large masses connected with each other, one in the right lung field and the other in the anterior mediastinum. A tentative diagnosis of either lung abscess or bronchogenic carcinoma was initially made, because of elevated serum tumor markers (SLX and SCC) and persisting refractory inflammatory sings. However, open chest drainage revealed a few fine hairs and atheromatous materials within the masses, and the diagnosis of teratoma was made. We removed these masses, and investigated the reason for the elevation of tumor markers. Staining with SLX monoclonal antibody demonstrated that the pancreatic tissue in the masses contained SLX. Although this is the first reported case of teratoma producing tumor marker (SLX), it is highly possible that tumor markers may be elevated in the majority of patients with teratoma because of the genesis of this tumor.

Tracheal hamartoma--report of a case successfully treated with endoscopic surgery

This report presents the case of an 88 year old man with tracheal hamartoma discovered through a chest X-ray film showing obstructive pneumonia before the manifestation of any symptoms associated with tracheal obstruction. Since surgical treatment was unfeasible, the tumor was removed with success through electric cauterization using a gastrointestinal fiberscope.

Analysis of Rhizobium meliloti nodulation mutant WL131: novel insertion sequence ISRm3 in nodG and altered nodH protein product

Nodulation (nod) genes are required for invasion of legumes by Rhizobium bacteria. Mutant WL131 is a derivative of 102F51 that has a severe Nod- phenotype on alfalfa. Upon examination of the extended DNA region containing host-specific nodulation genes nodFEG and nodH, we found that the nodG gene of WL131 bears a novel insertion sequence, ISRm3. Complementation studies implied, however, that the phenotype on alfalfa correlated with the nodH locus. We found that nodH in WL131 encodes an altered gene product. Correlation of the WL131 defect with nodH was also supported by phenotypic behavior. Each mutation affected nodulation more severely on alfalfa (Medicago sativa) than on sweet clover (Melilotus albus). However, we found that the degree of requirement for nodH in nodulation varied with the conditions under which the plant was grown.

Prognostic implications of DNA histogram, DNA content, and histologic changes of regional lymph nodes in patients with lung cancer

Forty-six cases of resected lung cancer, including 20 cases at Stages I and II and 26 cases at Stage III (N2), were subdivided into two groups: a good prognosis group with a longer survival period and a poor prognosis group in which the patients died earlier of the cancer. From paraffin-embedded lymph node tissues of these patients, the authors examined DNA histogram pattern and DNA content, using flow cytometry, and histologic hyperplasia of germinal center and paracortical area; they also evaluated their correlation with the prognosis. In the good prognosis group at Stages I and II, paracortical hyperplasia (PH) of the lymph nodes was observed significantly more frequently. In the good prognosis group at Stage III, the incidence of PH, G2M phase in the DNA histograms, and DNA content were all significantly higher. DNA content was positively correlated with the grade of PH.

Resection of the superior vena cava for primary lung cancer: 5 years' survival

We describe a patient with squamous cell carcinoma of the right lung that required a resection of the superior vena cava combined with a tracheal sleeve pneumonectomy. The superior vena cava was totally replaced with a polytetrafluoroethylene graft with 115 minutes cross-clamping of the superior vena cava. The patient remains healthy and the polytetrafluoroethylene graft remains patent 5 years 4 months after operation.

[Surgical treatment of bullous emphysema using Gore-Tex sheet]

Surgical treatment for bullous emphysema using Gore-Tex sheet and mechanical stapler is reported. The techniques were followed in a Juetnner's report: Small cut is made at the center of a 10 cm square of a Gore-Tex sheet, through which the area of bullous lung planned for resection is tented out with a lung forceps. A stapling instrument charged with a 4.8 mm clips is placed over the sheet around the suture line, and closed over both sheet and lung parenchyma. The excess sheet is removed after resection of the bullous lung. Five cases of bullous emphysema with a history of pneumothorax were successfully treated by the above method. Air leakage disappeared on the first postoperative day at latest. We assume Gore-Tex sheet, although a non-absorbable material, is in use as well as polydioxanone ribbon for prevention of air leakage in surgical cases of bullous emphysema.

[Giant cell tumor of the bony thorax]

Two cases of giant cell tumor of the bony thorax are described. Case 1 presents a 21-year-old female with a recurrent giant cell tumor of the third and the fourth thoracic vertebrae that directly compressed the membranous portion of the trachea and brought about severe air way obstruction. The tumor was completely resected and the patient remains healthy without recurrence 30 months after surgery. Case 2 presents a 18-year-old female with a giant cell tumor invading transverse process of the seventh thoracic vertebra and the seventh rib and making a big mass in the thoracic cavity on the right side. This patient was first seen with hemothorax and treated just by tube drainage three months before undergoing total resection of the tumor. She remains well nine months after surgery.

[Torsion after left lower lobectomy and cerebral infarction following the re-exploratory thoracotomy: a case report]

A 38-year-old man had a left lower lobectomy for pulmonary carcinoid. Following the operation, torsion of the left residual upper lobe occurred. Re-explosive thoracotomy was performed on the second postoperative day. The left upper lobe showed a clockwise 180-degree rotation. Pneumonectomy was not done. After the re-thoracotomy, the patient developed right hemiplegia. Head CT showed a cerebral infarction due to the thrombus of pulmonary vein that was released after the repair of the torsion.

[Preferential action of eptazocine, a novel analgesic, with opioid receptors in isolated guinea pig ileum and mouse vas deferens preparations]

Actions of eptazocine, a novel analgesic, on isolated smooth muscle preparations were investigated. Eptazocine (10(-5) M) slightly inhibited electrically-driven twitch-tension in guinea pig ileum preparations sensitive to mu- and kappa-agonists, and this effect was antagonized by 10(-7) M naloxone. Eptazocine (10(-5)-10(-4) M) inhibited such an effect by the mu-agonist morphine. In mouse vas deferens preparations having delta-, mu- and kappa-receptors, eptazocine (10(-7) M-) inhibited the twitch-tension in a dose-dependent manner, being hardly inhibited by naloxone. On the other hand, MR-2266 (10(-6) M), a relatively selective kappa-receptor antagonist, inhibited the eptazocine effect. The Ke (equilibrium dissociation constant) value of naloxone against eptazocine was 325 nM and the Ke value of MR-2266 against eptazocine was 33.2 nM, showing that MR-2266 was 9.79-fold more effective than naloxone. These results suggest that eptazocine acted as a mu-receptor antagonist and as a kappa-receptor preferential agonist in isolated smooth muscle preparations.

A tuberculous pseudoaneurysm of the thoracic aorta presenting as massive hemoptysis--a case of successful surgical treatment

Tuberculous aneurysms of the aorta need early diagnosis and prompt surgical intervention because if untreated, they lead to severe consequences. We report herein, a case of a 63 year old woman who underwent successful resection of a tuberculous pseudoaneurysm which had ruptured into the left upper lobe of the lung after a punch biopsy, performed under bronchoscopy, had caused severe bleeding. Subsequent CT and MRI examinations suggested a fistula between the mass and the aorta and proved useful in establishing the diagnosis of a pseudoaneurysm. We wish to emphasize the need for bronchoscopy to be done carefully because of the risk of inducing massive hemoptysis.

Determination of inorganic phosphate by flow injection method with immobilized enzymes and chemiluminescence detection

A flow injection method with chemiluminescence detection has been developed for the enzymatic determination of inorganic phosphate. Purine nucleoside phosphorylase, xanthine oxidase, and urate oxidase were immobilized on controlled-pore glass beads. Hydrogen peroxide released by the enzymatic reactions of phosphate and inosine in carrier buffer was detected by the luminol-microperoxidase system in a flow cell. The calibration graph was linear over the range of 5 to 250 pmol, and reproducibility was 1.75% at 10 pmol. The detection limit was 500 fmol of phosphate in 50 microliters of sample injected. The phosphate content in deoxyribonucleic acid was measured by this method.

[Traumatic transection of the left main bronchus and laryngeal fracture resulting from blunt trauma--a successful case of emergency operation]

A 18-year-old female, who had incomplete transection of the left main bronchus and laryngeal fracture, due to blunt trauma, is reported. Chest X-ray on admission showed subcutaneous emphysema extending to the cervical soft tissues and marked pneumomediastinum. Bronchoscopic examination revealed disruption of the left main bronchus, leaving only the membranous portion. An emergency operation was performed 5 hours after the injury. A week later, bronchoscopic reexamination revealed tracheal stenosis just below the vocal cord, due to fracture of the cricoid and thyroid cartilages, which was enlarged to a certain extent by laryngoscopic intervention under cooperation of the laryngologist. The patient's postoperative course was uneventful, and two months later, was well with tracheostomy.

[A case of a 10-year survivor with squamous cell carcinoma of the lung, treated with radiation after an exploratory thoracotomy]

We have experienced a rare case of an unresectable lung cancer in a male patient who has survived 10 years after radiation therapy. The patient was aged 58 at the time of diagnosis. In May 1978, he was hospitalized because of an abnormal shadow in the upper left lung filed, and the diagnosis of squamous cell carcinoma was made by TBLB. Since subsequent surgery revealed an extensive tumor invasion to the large blood vessels, an exploratory thoracotomy was performed. Following postoperative 60 Gy radiation therapy, tumor regression was observed on examination of chest x-ray films. In July, 1988, 10 years and 3 months after this surgery, a back pain developed due to the recurrence of the tumor, and radiation therapy was given again. This relieved the pain. As of December 1988, he receives treatment on an outpatient basis and his performance status has been excellent.

[Influences of irradiation on the anastomotic sites of artificial grafts]

To examine the acute influences of irradiation on the anastomotic sites of EPTFE vascular grafts, an experimental study was performed using dogs. After replacement of superior vena cava and bilateral femoral arteries with EPTFE grafts, a total of 20 to 100 Gy doses were given at the anastomotic sites of superior vena cava and right femoral artery. There was no degradation of grafts themselves or rupture in the anastomoses at cumulative radiation doses of 20 to 100 Gy. However, in many dogs, receiving over 50 Gy doses at the anastomotic sites of superior vena cava, stenoses and/or overgrowth of granulation tissues were observed, although at those of right femoral artery, no remarkable differences were observed between dogs which received and those which did not receive irradiation.

Acute changes in the properties of baroreflexes in man after beta-blockade

1. To clarify whether acute changes in the properties of baroreflexes can occur in man, we evaluated the time course of baroreflex control of heart rate and cardiopulmonary baroreflex control of forearm vascular resistance (FVR) over 240 min after intravenous administration of propranolol (0.2 mg/kg) in 13 healthy young men. 2. Systolic and diastolic blood pressure remained unchanged after propranolol. Propranolol significantly decreased cardiac index and heart rate, and significantly increased total peripheral resistance. These effects remained unchanged for 240 min after propranolol. 3. Baroreflex control of heart rate was significantly augmented immediately after, and at 30, 60 min after propranolol, but partly reverted to the initial level afterwards. Cardiopulmonary baroreflex control of FVR was reduced immediately after, and at 30, 60 min after propranolol, but partly reverted to the initial level afterwards. Pressor responses to phenylephrine was reduced immediately after propranolol, but no significant differences were observed after 30 min. 4. These results suggest that acute changes in the properties of baroreflexes occur in man after propranolol.

The effects of sodium loading on cardiopulmonary baroreflexes

1. The effects of sodium loading on cardiopulmonary baroreflex control of forearm vasoconstriction were studied using lower body negative pressure (LBNP) in 12 healthy young subjects. 2. Before and during sodium loading, there was no significant change in mean blood pressure, heart rate, central venous pressure (CVP) or forearm vascular resistance (FVR). 3. The degree of reflex increase in FVR during LBNP at -10, -20, and -40 mmHg was significantly greater during sodium loading than regular diet. 4. During sodium loading, the slope of the regression line relating percent change in FVR and change in CVP was significantly increased. 5. These results suggest that sodium loading augments cardiopulmonary baroreflex sensitivity of FVR in normotensive subjects without a family history of hypertension.

Behavioral state distribution throughout 24-h video recordings in preterm infants at term with good prognosis

Behavioral state distribution in 19 preterm infants at term with good developmental prognosis was studied by 24-h video recordings. The preterm infants of shortest gestation had longer time awake and this was concentrated in the daytime. On classifying behavioral states by Prechtl's criteria, the preterm infants had a smaller amount of state 1 than healthy term infants; but a similar amount of state 5 in awake time. Preterm infants were thought to have accelerated development in terms of diurnal sleep-awake rhythm, and decelerated development in terms of the content of sleep manifested by the amount of state 1.

Recurrent lupus pneumonitis with pulmonary hemorrhage in systemic lupus erythematosus associated with chronic thyroiditis and antithyroid hormone autoantibodies

We describe a SLE patient with repeated lupus pneumonitis and pulmonary hemorrhage. The hemorrhagic episodes were considered to be related to thrombocytopenia and lupus pneumonitis, which have responded well to treatment with moderate doses of steroids and immunosuppressant. She was also found to be suffering from chronic thyroiditis (hypothyroidism) and was positive for anti-thyroid hormone antibodies, which have not been reported before in the SLE patients with thyroid diseases.

[A case of Legionnaires' disease associated with rhabdomyolysis]

Legionnaires' disease is primarily a respiratory disorder, but recently several cases with extrapulmonary manifestations are reported. We report a case of Legionnaires' disease associated with pneumonia, diarrhea, central nerve disorders and rhabdomyolysis. The pathogenesis of rhabdomyolysis in Legionnaires' disease remains speculative. Endotoxin isolated from Legionella pneumophila may play a role in the pathogenesis of the myonecrosis. An additional factor that might contribute to rhabdomyolysis in this case is severe dehydration induced by diarrhea. Pneumonia with elevated CPK levels and myoglobinuria may suggest Legionnaires' disease.

Effects of atropine on adrenergic responsiveness and reflex vasoconstriction in humans

To determine whether cholinergic mechanisms contribute to blood pressure regulation, we examined the effects of atropine on pressor responses to phenylephrine and vasoconstrictor responses to the cold pressor test (CPT) and lower body negative pressure (LBNP) in 16 healthy subjects. Heart rate, blood pressure and cardiac index were significantly increased, and central venous pressure (CVP) was significantly decreased after atropine (0.04mg/kg). After atropine, pressor responses to phenylephrine at doses of 20, 40 and 80 micrograms were significantly increased by 101, 112 and 93% (p less than 0.001); however, atropine attenuated pressor responses to CPT (p less than 0.001) and forearm vasoconstrictor responses to LBNP. In 6 propranolol-treated subjects, atropine also augmented pressor responses to phenylephrine but attenuated pressor responses to CPT. These results suggest that atropine augments the pressor response to an alpha-agonist, which may be partly explained by inhibition of compensatory vascular responses mediated by cholinergic mechanisms.

[Diffuse B-cell lymphoma of anterior mediastinum cured by short-term administration of CDDP-containing regimen]

The following report is of a case of diffuse B-cell lymphoma of the anterior mediastinum that was originally treated by resection and radiation in a patient who had pleural and subcutaneous metastases four months after operation. A total dose of 120 mg of CDDP, 60 mg of BLM, and 15 mg of VBL was administered in five weeks. The metastases completely disappeared by this dose alone, and the patient is alive and well seven and a half years after the chemotherapy.

[Clinical results of UFT plus anticoagulants as a postoperative adjuvant in lung cancer patients]

Warfarin, Ticlopidine and UFT as postoperative adjuvant have been administered patients with stage III and IV lung cancer who underwent surgical resection. In a controlled trial, 55 patients were divided into two groups, one with anticoagulants and UFT (27 cases), the other with UFT alone (28 cases). The prognoses of the two groups were followed for 6 years. The anticoagulant group demonstrated a statistically greater interval from operation to recurrence the control group, although the recurrence rates and the interval from recurrence to death were almost the same between the two groups. Survival rates of anticoagulant group were always superior to those of control group after 12 months postoperatively, and the median survival was about twice that of the control group. Although survival rates between the two groups revealed no statistical difference, in patients with adenocarcinoma, the difference between the two groups was statistically significant.

[Experimental and clinical study of interactions between fluorinated pyrimidine derivatives and anticoagulants]

Interactions between fluorinated Pyrimidine derivatives and anticoagulants were studied experimentally and clinically, using transplanted tumor tissues of Donryu rats and tissues from lung cancer patients. In rats, which were given 5-FU, uracil, tegafur and UFT respectively, the higher tumor concentrations of 5-FU and uracil were observed when given warfarin and ticlopidine beforehand, on the other hand, the concentrations of tegafur were almost the same between rats with and without anticoagulants. In patients with lung cancer, who were given UFT and anticoagulants, the higher concentrations of 5-FU and uracil in plasma, tumor and lymph nodes were observed than those who were given UFT alone. The 5-FU concentrations in normal lung tissues were about a half of those in tumor. These results suggest a existence of the synergistic effects between fluorinated pyrimidine derivatives and anticoagulants in plasma and tissue concentrations of 5-FU.

Interactions between UFT and anticoagulants in lung cancer patients

In order to study the interactions between UFT and anticoagulants, the plasma and tissue concentrations of 5-FU, uracil and FT-207 were examined in patients with lung cancer. Higher plasma concentrations of 5-FU and uracil were observed in the patients who were given warfarin and ticlopidine beforehand, whereas the concentrations of FT-207 were almost the same in the patients who were given anticoagulants as in those who were not. This may be interpreted as an inhibition of dihydrouracil dehydrogenase, the common metabolizing enzyme of 5-FU and uracil, by anticoagulants. With regard to the tissue concentrations, higher levels of 5-FU and uracil in the tumor and lymph nodes were obtained after anticoagulants were given beforehand. Concentrations of FT-207 in these tissues, however, were almost the same in the patients who were given anticoagulants as in those who were not. We thus concluded that an increase of 5-FU in tumor cells and lymph nodes can be achieved after elevating the plasma concentrations of ordinary oral doses of UFT by using anticoagulation therapy beforehand.

Growth and achievement of large- and small-headed children in a normal population

Growth and school achievement were examined at regular intervals in the 926 children enrolled in the Prospective Longitudinal Study on the Development and Growth in Nagoya City, conducted from 1964 to 1981. Among these children, 10 had head circumferences of more than 2 standard deviations (SD) above the mean and 6 ones of less than 2 SD below the mean at least once in each infancy and adolescence. The heights and weights of the large-headed children were greater than the means, and those of the small-headed children lower than the means. These physical characteristics were already observable at birth. Achievement in primary and secondary schools over 9 years was excellent in 5 (50%) and average in the other 5 of the large-headed children, and average in 5 (80%) and poor in the other one of the small-headed children. Therefore, head size is correlated to both physical growth and school achievement.