A successful surgical repair of the hepatic hydrothorax using pneumoperitoneum: report of a case

A successful surgical repair of a right hepatic hydrothorax in the absence of ascites is reported. A technetium-99m scintigram that was injected intraperitoneally provided evidence of a one-way flow of fluid from the peritoneal to pleural cavity. To identify any possible minute defects in the diaphragm, carbon dioxide was insufflated into the peritoneal cavity during the operation. We performed a direct suture of the defect observed on the diaphragm. The pleural effusion subsequently vanished after the operation.

Identification of a cis-regulatory element involved in phytochrome down-regulated expression of the pea small GTPase gene pra2

The pra2 gene encodes a pea (Pisum sativum) small GTPase belonging to the YPT/rab family, and its expression is down-regulated by light, mediated by phytochrome. We have isolated and characterized a genomic clone of this gene and constructed a fusion DNA of its 5'-upstream region in front of the gene for firefly luciferase. Using this construct in a transient assay, we determined a pra2 cis-regulatory region sufficient to direct the light down-regulation of the luciferase reporter gene. Both 5'- and internal deletion analyses revealed that the 93-bp sequence between -734 and -642 from the transcriptional start site was important for phytochrome down-regulation. Gain-of-function analysis showed that this 93-bp region could confer light down-regulation when fused to the cauliflower mosaic virus 35S promoter. Furthermore, linker-scanning analysis showed that a 12-bp sequence within the 93-bp region mediated phytochrome down-regulation. Gel-retardation analysis showed the presence of a nuclear factor that was specifically bound to the 12-bp sequence in vitro. These results indicate that this element is a cis-regulatory element involved in phytochrome down-regulated expression.

An enzymatic cycling method using pyruvate orthophosphate dikinase and firefly luciferase for the simultaneous determination of ATP and AMP (RNA)

A novel bioluminescent enzymatic cycling assay for ATP and AMP with concomitant use of firefly luciferase and pyruvate orthophosphate dikinase (PPDK) was developed. In this system, AMP and pyrophosphate produced from ATP by firefly luciferase were converted back into ATP by PPDK. This resulted in constant luminescence once the stable phase had been reached. Background luminescence of the reagent was reduced with adenosine phosphate deaminase by degrading ATP and AMP in the reagent. The maximum recycling ratio calculated from the integrated luminescence value was 2.64 cycles/min. The measurable ranges for ATP and AMP were equal and were between 4 x 10(-13) and 4 x 10(-17) mol/assay. The amount of yeast RNA could be estimated in the range of 1 x 10(-8) to 1 x 10(-12) g/assay by estimating the amount of AMP resulting from the degradation of RNA with nuclease P1. Various food samples were subjected to measurement of the amount of ATP + AMP + RNA to provide an index for hygiene monitoring. For beef extract, sensitivity was improved by more than 20 million compared to the previous methods relying only on the amount of ATP as an index.

Erinacine E as a kappa opioid receptor agonist and its new analogs from a basidiomycete, Hericium ramosum

A kappa opioid receptor binding inhibitor was isolated from the fermentation broth of a basidiomycete, Hericium ramosum CL24240 and identified as erinacine E (1). Three analogs of 1 were produced by fermentation in other media and by microbial biotransformation. Of these compounds, 1 was shown to be the most potent binding inhibitor. Preliminary SAR studies of these compounds indicated that all functional groups and side chains were required for the activity. Compound 1 was a highly-selective binding inhibitor for the kappa opioid receptor: 0.8 microM (IC50) for kappa, >200 microM for mu, and >200 microM for delta opioid receptor. Compound 1 suppressed electrically-stimulated twitch responses of rabbit vas deferens with an ED50 of 14 microM. The suppression was recovered by adding a selective kappa opioid receptor antagonist nor-binaltorphimine, indicating that 1 is a kappa opioid receptor agonist.

Initial experience with cool head, warm body perfusion in aortic arch surgery

BACKGROUND

Hypothermia has been an essential technique in aortic arch surgery for protecting the brain. To reduce the adverse effect caused by hypothermia, we modified the perfusion technique in aortic arch surgery. Initial results using this modified technique are reviewed.

METHODS

Nineteen patients were operated on for aortic aneurysm involving the aortic arch. Fifteen patients had nondissecting aneurysm and four patients had type A dissecting aneurysm including three with acute dissection. While on the hypothermic (25 degrees C to 28 degrees C of nasopharyngeal temperature) antegrade selective cerebral perfusion (SCP) was performed by direct cannulation to the brachiocephalic and left common carotid arteries, visceral perfusion via the femoral artery or graft was performed with tepid or normothermia (34 degrees C to 36 degrees C).

RESULTS

Hospital mortality rate was 5.3% (1/19 patients). None of the 19 patients suffered from stroke postoperatively. Duration of total cardiopulmonary bypass and SCP was 144 +/- 36 minutes and 90 +/- 34 minutes, respectively. Eighteen surviving patients were extubated at 9.4 +/- 13.2 hours and stayed in the intensive care unit (ICU) for 3.0 +/- 1.8 days after the surgery.

CONCLUSIONS

Our initial experience revealed that the modified technique using simultaneous hypothermic cerebral perfusion and tepid or normothermic visceral perfusion can be a useful adjunct during aortic arch surgery providing quick recovery.

Experimental brain injury induces expression of amyloid precursor protein, which may be related to neuronal loss in the hippocampus

Previous reports have demonstrated that some focal brain injuries increase amyloid precursor protein (APP) immunoreactivity in the region surrounding the injury where it was localized, in damaged axons and in pre-alpha 2 cells of the entorhinal cortex. However, to date, APP expression in the hippocampus remote from the impact site has not been comprehensively studied. Therefore, we have evaluated APP expression not only in the locally injured cerebral cortex but also in the hippocampus remote from the impact site. In the present paper, diffuse axonal injury was induced in rats in midline fluid percussion injury. APP expression was examined post injury using Western blot analysis and immunohistochemistry. Western blot analysis demonstrated that the expression of 100-kd APP was increased in both the cerebral cortex and hippocampus 24 h after injury. It then decreased in the hippocampus, but did not change in the cerebral cortex, 7 days after injury. Immunohistochemical studies showed increased immunoreactivity of APP in the neuronal perikarya and reactive astrocytes near the region of injury in the cerebral cortex 24 h to 7 days after injury. In the hippocampus, APP accumulated in the CA3 neurons 24 h and 3 days after injury, although no hemorrhagic lesions were seen at that site. The APP positive neurons in CA3 showed shrunken cell bodies and pyknotic nuclei 3 days after injury, and some of the neurons in CA3 had disappeared by 7 days postinjury. The results of present study suggest that traumatic brain injury induces overexpression and accumulation of APP in neuronal perikarya and that these events are followed by degeneration of CA3 neurons. Further, the decline in APP expression in the hippocampus is thought to be due to neuronal loss in CA3 subsector.

Cognitive dysfunction and histological findings in rats with chronic-stage contusion and diffuse axonal injury

The Morris water maze (MWM) technique is well known as a prominent method of evaluating learning acquisition and memory retention impairments in rats. We previously reported on a modified fluid percussion device that is able to consistently produce experimental cortical contusion (CC) and diffuse axonal injury (DAI) in separate groups of rats. The purpose of the present protocol is to evaluate the differences in learning acquisition and memory retention impairments between these two types of injured rats in the chronic stage using the MWM technique. CC and DAI rats are respectively induced by lateral and midline fluid percussion. We also compare the histological differences between these two different types of traumatic brain injury. The results show statistically significant differences in learning acquisition impairment between the sham and CC rats and between the sham and DAI rats. However, a difference in memory retention impairment was expected to be seen only between the sham and DAI rats. Histologically, the loss of CA3 pyramidal cells in the hippocampus was observed ipsilaterally in the CC and bilaterally in DAI. Neuronal cell loss was observed in bilaterally in layer II of the entorhinal cortex in DAI, but not in CC.

The incidence and characteristics of silent cerebral infarction in elderly diabetic patients: association with serum-soluble adhesion molecules

The purpose of this study was to investigate the relationship between complications arising from silent cerebral infarction (SCI) and changes in the levels of serum-soluble adhesion molecules in 82 elderly diabetic patients aged 60 years and older. SCI was found in 43 % of the 82 patients, with incidence increasing in relation to age. The prevalence of SCI was higher in subjects with hypertension, poor metabolic control and increased fibrinolysis. The levels of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1) and E-selectin (sE-selectin) were higher in diabetic patients than in non-diabetic subjects (p < 0.05, p < 0.001, and p < 0.05, respectively). Also, sICAM-1 and sVCAM-1 were found at increased levels in diabetic patients with SCI compared to those without SCI (p < 0.01 and p < 0.05, respectively). In particular, the level of sICAM-1 was increased in patients with SCI due to perforating arterial occlusion, while the level of sVCAM-1 was increased in patients with SCI due to cortical arterial occlusion. However, no significant difference was found in sE-selectin levels. Overall average of the intima and media thickness (IMT) of the common carotid arteries increased with age. IMT proved to be greater in patients with SCI than in patients without SCI (p < 0.05), and showed a weak but significant positive correlation with sVCAM-1, while no correlation was found with either sICAM-1 or sE-selectin levels. In conclusion, measurement of serum adhesion molecules may be useful for diagnosing the early stages of brain damage and for prophylactic treatment which may prevent the onset or progression of SCI.

Clinical application of power Doppler imaging to visualize coronary arteries in human beings

Supplementation of angiographic information during bypass procedures is an attractive goal for the echocardiographic researcher. Compared with color flow mapping, power Doppler imaging is superior in terms of identifying small vessels and noise suppression because of the use of Doppler signal strength for imaging. Although power Doppler imaging does not provide information about flow velocity or its direction, it does show detailed vessel flow in a static organ. Our study was designed to obtain angiographic images of the coronary artery by the use of power Doppler imaging in 31 patients during open heart surgery. During cold cardioplegic infusion, the epicardial coronary artery and the coronary artery within myocardium, such as the septal perforator, could be well visualized by power Doppler imaging. There was good correlation between the diameters of coronary arteries measured from power Doppler imaging and those from quantitative coronary angiography (r = 0.964, p < 0.0001). We obtained clear and accurate images of the coronary artery by using power Doppler imaging during cardiac standstill. These images might provide meaningful supplemental information to the operator, such as confirming the target coronary artery during the cardioplegia and choosing the appropriate arterial portion for a bypass operation.

Effect of prostaglandin E1 on pulmonary hypertension after protamine injection during cardiac surgery

BACKGROUND

The effects of prostaglandin E1 on pulmonary hypertension were assessed after protamine injection at the end of cardiopulmonary bypass during cardiac surgery.

METHODS

Ten patients scheduled for cardiac surgery presented with pulmonary hypertension (mean pulmonary artery pressure greater than 30 mmHg) after protamine injection and were treated by infusion of 0.02 microg x kg(-1) x min(-1) prostaglandin E1. Hemodynamic measurements were made on occasions after cardiopulmonary bypass. Prostaglandin E1 decreased pulmonary artery pressure, pulmonary vascular resistance, right ventricular stroke work index and pulmonary vascular resistance/systemic vascular resistance ratio, but did not change blood pressure, systemic vascular resistance, left ventricular stroke work index or cardiac output.

CONCLUSION

Prostaglandin E1 normalized pulmonary hypertension after protamine injection, but did not change arterial blood pressure and cardiac output.

Microsatellite instability in Japanese hereditary non-polyposis colorectal cancer does not induce mutation of a simple repeat sequence of the bax gene

The identification of frameshift mutations in the coding region of the bax gene in Western cases of hereditary non-polyposis colorectal cancer provided evidence that the disease could be caused by the disruption of a tumor suppressor gene associated with microsatellite instability. In order to determine whether this observation could be extended to Japanese colorectal cancers, we analyzed the simple repeat sequence of (G)8 in the bax gene of tumor genomes from 15 cases of Japanese hereditary non-polyposis colorectal cancer that showed microsatellite instability in at least one of four examined microsatellite loci. None of 15 tumor DNA samples had a frameshift mutation in this region of the bax gene. Our results suggest that direct disruption of the bax gene is not a major factor responsible for carcinogenesis in Japanese hereditary non-polyposis colorectal cancers even though microsatellite instability is present.

CJ-12,373, a novel topoisomerase II inhibitor: fermentation, isolation, structure elucidation and biological activities

A novel isochroman carboxylic acid CJ-12,373 was isolated from Penicillium sp. CL22557. CJ-12,373 inhibits both DNA gyrase-mediated supercoiling and relaxation without the formation of a cleavage intermediate, suggesting that CJ-12,373 inhibits DNA gyrase at a stage distinct from the religation step. CJ-12,373 is not selective for procaryotic DNA gyrase as it also inhibits relaxation mediated by eukaryotic topoisomerase II. The antimicrobial potency of CJ-12,373, however, is largely attributed to its inhibition of DNA gyrase.

New quinolone compounds from Pseudonocardia sp. with selective and potent anti-Helicobacter pylori activity: taxonomy of producing strain, fermentation, isolation, structural elucidation and biological activities

Eight novel quinolones with anti-Helicobacter pylori activity were isolated from the actinomycete Pseudonocardia sp. CL38489. The quinolones were very potent against H. pylori with MICs up to 0.1 ng/ml. The quinolones appear to be specific for H. pylori, since they did not show antimicrobial activity when tested against a panel of other microorganisms.

Determinants of kinin release in isolated rat hindquarters

We studied the determinants of kinin release into the venous effluent of rat hindquarters perfused with Krebs bicarbonate buffer. Kinin release in preparations perfused with control media (14.6 +/- 2.5-20.7 +/- 6.7 pg/15 min) was surpassed by that in preparations perfused with media containing kininase inhibitors (243 +/- 53 to 276 +/- 78 pg/15 min). Kinin release increased when purified kininogen (from 242 +/- 43 to 3,365 +/- 725 pg/15 min) or kallikrein (from 270 +/- 49 to 30,649 +/- 8,040 pg/15 min) was added to the perfusate. Conversely, kinin release fell when the kallikrein inhibitor aprotinin (from 272 +/- 58 to 122 +/- 27 pg/15 min) or soybean trypsin inhibitor (from 273 +/- 52 to 195 +/- 25 pg/15 min) was added. Both basal and kininogen-induced kinin release were attenuated in preparations perfused with media containing cycloheximide, a protein synthesis inhibitor, but kallikrein-induced kinin release was not. These data suggest that kinin release from perfused rat hindquarters reflects the activity of both the kinin-degrading and kinin-generating pathways and that the latter is sustained by a kallikrein manufactured de novo and by preexistent kininogen(s).

Novel lactone compounds from Mortierella verticillata that induce the human low density lipoprotein receptor gene: fermentation, isolation, structural elucidation and biological activities

Among methods of controlling hypercholesterolemia and hyperlipidemia is the direct stimulation of hepatic low density lipoprotein (LDL) receptors. Two novel lactone compounds, CJ-12,950 and CJ-13,357, containing and unusual oxime moiety, were isolated from a zygomycete Mortierella verticillata. These lactones are potent inducers of the LDL receptor gene in vitro, that enhanced LDL receptor expression in human hepatocytes 2-fold at 100 nM.

Chemoenzymatic synthesis of the branched oligosaccharides which correspond to the core structures of N-linked sugar chains

Synthetic routes are described to a partial structure common to all high mannose-type sugar chains and complex-type sugar chains based on a chemoenzymatic strategy which incorporates, (a) enzymatic synthesis of oligosaccharide blocks using glycosidases, and (b) chemical synthesis of the branching oligosaccharides via regioselective coupling. All reaction products correspond to key intermediates necessary for the construction of N-linked oligosaccharides and we have synthesized the branched tetra-manno-oligosaccharide high mannose-type sugar chain and the branched hexa-oligosaccharide complex-type sugar chain using this simple and direct method.

CJ-12,954 and its congeners, new anti-Helicobacter pylori compounds produced by Phanerochaete velutina: fermentation, isolation, structural elucidation and biological activities

Seven new phthalide compounds with anti-Helicobacter pylori activities were isolated from the basidiomycete Phanerochaete velutina CL6387. The two most potent phthalide compounds, CJ-12,954 and CJ-13,014, have MICs of 5 ng/ml. The structure-activity relationship shows that the presence of a spiroketal part in addition to the phthalide part, greatly enhances the activity. The phthalide compounds appear to be specific for H. pylori, since they did not show antibacterial activities when tested against a panel of other microorganisms.

Long-term efficacy of a self-retaining intraurethral catheter for the treatment of prostatic obstruction

BACKGROUND

Transurethral prostatectomy is a standard treatment modality for infravesical obstruction with benign prostatic hyperplasia. However, some patients cannot undergo this procedure, so alternative devices or surgical procedures have recently been developed.

METHODS

We treated 26 patients with prostatic outflow obstruction by placement of a self-retaining intraurethral catheter (IUC). All patients had coexisting medical complications which contraindicated transurethral prostatectomy.

RESULTS

In the short-term, the treatment was successful in 96.2% of the patients, however, longer follow-up demonstrated a significant failure rate, and the 3-year success rate declined to 12.5%. The majority of late failures were associated with urinary tract infections.

CONCLUSION

These results showed that although placement of an IUC to treat prostatic obstruction was effective in the short-term, its long-term efficacy was highly limited.

Enzymatic treatment to eliminate the extracellular ATP for improving the detectability of bacterial intracellular ATP

A novel and effective treatment of biological samples with a combination of adenosine phosphate deaminase and apyrase was developed for reducing extracellular ATP, which has been a major problem encountered in improving the sensitivity of assays for intracellular ATP by the firefly luciferin-luciferase (L-L) method. Under the enzymatic reaction conditions, ATP and the related adenosine derivatives were converted to IMP, which are not active to the L-L system. In the model system (3.2 x 10(-8) M ATP in 1% yeast extract solution) the treatment with adenosine phosphate deaminase resulted in the reduction of ATP to 1.3 x 10(-11) M, and the concomitant use of apyrase lowered the concentration to 3.3 x 10(-13) M. The treatment (0.05 U/ml of adenosine phosphate deaminase and apyrase) was applied to the detection of bacteria in broth by the L-L method, affording the detection of 42 colony-forming unit (CFU)/ml of Escherichia coli and 10 CFU/ml of Staphylococcus aureus in the broth.

Evaluation of learning and memory dysfunction and histological findings in rats with chronic stage contusion and diffuse axonal injury

We previously reported a modified fluid percussion device capable of consistently producing experimental cortical contusion (CC) and diffuse axonal injury (DAI) in separate groups of rats by lateral and midline fluid percussion, respectively. The purpose of the present study was to compare the differences in learning acquisition and memory retention impairments between these two types of injured rats in the chronic stage using the Morris water maze technique. We also compared the histological differences between these two different types of traumatic brain injury. The results showed a statistically significant difference in learning acquisition impairment between the sham and CC rats and also between the sham and DAI rats. However, a significant difference in memory retention impairment was observed only between the sham and DAI rats. Histologically, the neuronal cell loss of CA3 pyramidal cells in the hippocampus was observed on the ipsilateral side in the CC and bilaterally in DAI. The neuronal cell loss was seen in bilateral entorhinal cortex layer II in DAI, but it was not seen in CC. From these results, we speculate that the marked cell loss in the hippocampus CA3 region in both CC and DAI rats was related to the impairment of spatial learning acquisition. The marked cell loss in entorhinal cortex layer II in DAI rats may be one of the important factors in the impairment of spatial memory retention.

Enzymatic syntheses of GlcNAc beta 1-2Man and Gal beta 1-4GlcNAc beta 1-2Man as components of complex type sugar chains

GlcNAc beta 1-2Man and GlcNAc beta 1-6Man were synthesized using the reverse hydrolysis activity of beta-N-acetylglucosaminidase from both jack beans and Bacillus circulans. In turn, Gal beta 1-4GlcNAc beta 1-2Man and Gal beta 1-4GlcNAc beta 1-6Man were synthesized regioselectively using the transglycosylation activity of beta-galactosidase from Diplococcus pneumoniae and B. circulans, respectively. These di- and trisaccharides are important components of complex type sugar chains and will be used as intermediates in our synthetic studies.

Congenital midline sinus of the upper lip: case report and review of literature

A case report of a congenital midline sinus of the upper lip in a 5-year-old girl is presented. The patient complained of intermittent swelling around the frenulum of the upper lip. The sinus was located on the midline of the philtrum just below the base of the columella. Excision of the sinus tract via an intraoral approach gave a satisfactory result. Microscopic examination of the resected sinus revealed it to be lined by stratified squamous epithelium with sebaceous glands and hair follicles. Fifteen other cases have been reported in the English literature and are reviewed. There are two postulates that can account for the formation of the upper lip sinus based on two major theories of the development of the face: the fusion theory and the merging theory. However, the etiology of this rare congenital sinus remains obscure.

[Diagnostic values and limitations of conventional urodynamic studies (uroflowmetry.residual urine measurement.cystometry) in benign prostatic hypertrophy]

PURPOSE AND METHODS

Diagnostic values and limitation of conventional urodynamic study (UDS) were assessed in 380 patients with benign prostatic hypertrophy (BPH), in terms of uroflowmetry, measurement of postvoid residual urine and cystometry.

RESULTS

Maximum and average flow rate on uroflowmetry improved with increasing voided volume. Neither maximum nor average flow rate correlated with size of the prostate, subjective symptom (International Prostate Symptom Score) and bothersomeness for prostatism. Pre-TUR maximum flow rate did not predict outcomes on postoperative flow rate and surgical treatment failures. Uroflowmetry did not differentiate between obstruction and weakness of detrusor contraction. The intraindividual variation of postvoid residual urine was great and the volume of residual urine correlated poorly with subjective symptom, size of the prostate, maximum and average flow rate. On filling cystometry, although uninhibited detrusor contraction was much more frequently observed in patients with urge incontinence as compared with continent patients, there was no significant difference in other parameters between the two groups. Every parameter on cystometry did not correlate with nocturnal frequency. Postoperative persistence of urge incontinence did not correlate with the bladder volume at the first desire to void or at the maximum desire to void, an amplitude of uninhibited detrusor contractions, or bladder compliance. In some cases, evaluation of the intravesical pressure on voiding phase and uroflowmetry was diagnostic of apparent obstruction.

CONCLUSIONS

In diagnosis of BPH, conventional UDS has limitation for certain and some caution showed be taken in interpretation of the data. However, since conventional UDS provides important and objective information on obstruction and detrusor function, which are independent of subjective symptom and prostate size, these should be necessary in diagnosis, determination of treatment options and evaluation of treatment outcomes in BPH.

[Emergency percutaneous cardiopulmonary support for patients with cardiac arrest or severe cardiogenic shock]

A total of 20 patients who developed cardiac arrest or severe cardiogenic shock were resuscitated with percutaneous cardiopulmonary support system (PCPS). The etiology of shock was acute myocardial infarction (n = 8), post-infarction left ventricular (LV) free wall rupture (n = 9) and others (n = 3). After successful resuscitation with PCPS, 17 patients underwent therapeutic interventions: either closure of an LV rupture (n = 9), coronary artery bypass grafting (n = 4), percutaneous transluminal angioplasty (n = 1) and percutaneous transluminal coronary recanalization (n = 1). Of the 20 patients, 17 were weaned from PCPS or standard cardiopulmonary bypass. Nine patients survived longer than 30 days and 6 patients were discharged from the hospital. In nine patients with LV free wall rupture, one could be discharged from the hospital. Even though our experience is still small in number, it can be concluded that cardiopulmonary resuscitation using PCPS improves survival in fatally ill patients.

Familial presumed cerebral cavernous angiomas diagnosed by MRI: three generations

Familial cerebral cavernous angiomas are rare, with an autosomal dominant pattern of inheritance. To our knowledge, 25 families with this disorder have been described. We report three family members in a direct line of descent, who all brain had lesions typical of cavernous angiomas on MRI.

Improved management of selective cerebral perfusion in aortic arch surgery

To establish a safe and reliable method for cerebral protection in aortic arch surgery, the authors attempted antegrade selective cerebral perfusion (SCP) based on the characteristics of jugular venous oxygen saturation (SjO2). Twenty patients were divided into two groups: a control group and SCP group. In the control group, in 13 adult patients undergoing cardiac surgery using standard hypothermic cardiopulmonary bypass, the relationship between SjO2 and nasopharyngeal temperature (NPT) during rewarming showed an inverse linear correlation:SjO2 = -2.3 NPT + 133 (r = 0.616). In the SCP group, seven patients with aortic arch aneurysm underwent surgery using SCP performed through direct cannulation of the innominate and left carotid arteries. While on SCP (83 +/- 24 min), the blood was warmed from 28 to 36 degrees C. Cerebral perfusion pressure of 40-60 mm Hg was necessary to maintain the SjO2 equal to the value in the control group at each NPT during SCP in all seven patients. None of the patients had any post operative complications. Our experience suggests that SCP can be safely performed at both mild hypothermia and normothermia under monitoring of perfusion pressure and SjO2 in aortic arch surgery.

Growth and metastasis of surgical specimens of human breast carcinomas in SCID mice

PURPOSE

We have studied the growth and metastatic potential of surgical specimens of breast carcinomas engrafted into the large abdominal (gonadal) fat pad of severe combined immunodeficient (SCID) mice. We present results of this study, details of the implantation protocol and histologic characterization of several of the tumor xenografts.

MATERIALS AND METHODS

We evaluated the growth within SCID mice of 48 breast carcinoma specimens derived from 46 patients (45 primary breast cancers or local recurrences and 3 regional metastatic lymph nodes) obtained from resected tissues at this Institute over a 3-year period. The growth of each transplant was assessed by histologic examination of the xenografts at various times after implantation or upon passage into additional mice.

RESULTS

We observed that placement of human breast tumors within the gonadal fat pad could result in tumors that grew either rapidly, slowly, or not at all. Of 48 tumors studied, 12 (25%), including one of the three lymph node-derived tumors, grew rapidly enough within some or all of the implanted mice (i.e., the tumors reached a diameter of 2-3 cm within 2-6 months) to allow repeated passage. Metastatic spread to the SCID mouse lung, liver, and/or diaphragm and other sites was observed with the xenografts derived from 8 of these 12 rapidly growing tumors. Tumors in a second category often took from 6 months to over 1 year to only double or triple in size. This slow-growth group consisted of 25 patients' tumors (53%), including the remaining two metastatic lymph node-derived tumors. These xenografts would usually maintain a slow growth rate even upon later passage into new animals. A third category consisted ofpatients' tumors (23%) that failed to grow at all (i.e., no evidence of tumor growth in any of the mice implanted), as discerned by histologic evaluation at various times after implantation. Histologic examination of tumor xenografts and metastatic tumors revealed considerable variation in histopathology among the different patients' tumors.

DISCUSSION

Further examination of the heterogeneous properties of primary human breast carcinomas within SCID mice may provide a simple yet valuable new approach for the long-term study of human breast cancer biology. Importantly, use of the protocol described here can often permit the isolation of substantial quantities of human breast cancer cells for biochemical and molecular analyses. The ability to passage patients' breast tumors into large numbers of mice will permit the preclinical testing of new therapies for the treatment and prevention of this disease.

Doxorubicin encapsulated in sterically stabilized liposomes is superior to free drug or drug-containing conventional liposomes at suppressing growth and metastases of human lung tumor xenografts

Liposomes containing polyethylene glycol-derivatized phospholipids are able to evade the reticuloendothelial system and thereby remain in circulation for prolonged periods. We report here that doxorubicin encapsulated in these sterically stabilized liposomes (S-DOX) suppresses the growth of established human lung tumor xenografts in severe combined immunodeficient (SCID) mice and inhibits the spontaneous metastases of these tumors. The enhanced therapeutic efficacy of S-DOX compared to free doxorubicin was demonstrated in two independent human/mouse models. In the first model, S-DOX inhibited the growth of a human non-small cell lung tumor xenograft established orthotopically in the lungs of SCID mice. Treatment of these mice with S-DOX, but not with free drug, suppressed the growth of the tumor in the lung, prevented metastasis from the lung, and enhanced survival percentage. In another model, the human lung tumor is engrafted into gonadal fat pad of SCID mice. Human tumor xenografts grow floridly in this site of engraftment, and the tumor spreads from this primary site into the peritoneal cavity and subsequently reaches the liver and lung. In this model, free drug suppressed the growth of the primary tumor but had no effect upon the subsequent spread of the tumor into the peritoneal cavity, liver, and lung. In contrast, treatment of the tumor-bearing mice with S-DOX (but not with doxorubicin in conventional liposomes) suppressed the tumor spread to the peritoneal cavity, completely arrested metastasis to the liver and lung, and suppressed the growth of the primary tumor xenograft. This report provides the first evidence that antitumor drugs delivered by sterically stabilized liposomes can arrest the metastasis of human tumor xenografts.

Endoscopic trigonoplasty in pediatric patients with primary vesicoureteral reflux: preliminary report

PURPOSE

We investigated the preliminary surgical results of endoscopic trigonoplasty in pediatric patients with primary vesicoureteral reflux.

MATERIALS AND METHODS

We performed endoscopic trigonoplasty in 6 pediatric patients (11 refluxing ureters). Reflux was grade II in 4 reno-ureteral units, grade III in 5, grade IV in 1 and grade V in 1 (international classification). Surgery was done using laparoscopic and endoscopic instruments.

RESULTS

Vesicoureteral reflux disappeared 3 to 12 months postoperatively. Analgesics were administered postoperatively to 4 patients for 24 hours and to 2 for 48 hours. No bladder irritability or postoperative upper urinary tract dilatation was observed in the early postoperative period.

CONCLUSIONS

Minimally invasive endoscopic trigonoplasty can be an effective surgical procedure for pediatric patients with vesicoureteral reflux.

Rationale of lymph node dissection for breast cancer--from the viewpoint of analysis of axillary lymphatic flow using activated carbon particle CH40

In order to rationalize lymph node dissection for breast cancer, we reviewed regional lymphatic flow from the mesial and outer half of the breast using intra-tumoral injection of activated carbon particles (CH40). Seventy patients with breast cancer were included in this study. Cancers were located in the mesial half of the breast in 25 cases and in its outer half in 41 cases. Since regional lymph nodes were blackened by CH40, lymph node dissection was performed easily and small lymph nodes could be readily examined. The average number of resected nodes in each case was 29.4. When CH40 was injected into the mesial half of the breast, the rates of blackened nodes (number of macroscopically blackened lymph nodes/number of total removed lymph nodes) in the stations were 46.6% (No. 1a), 41.4% (No. 1b), 62.1% (No. 1c), 61.8% (No. 2), 69.2.% (No. 2h), and 65.6% (No. 3). When CH40 was injected into outer half of the breast, those were 62.0% (No. 1a), 64.3% (No. 1b), 68.7% (No. 1c), 75.3% (No. 2), and 67.8% (No. 2h). Regardless of tumor location, the rates of blackened nodes were high in each station. In conclusion, regardless of tumor location it is impossible to determine the level of axillary dissection for breast cancer. It should be all or nothing.

Emergency cardiopulmonary bypass support in patients with severe cardiogenic shock after acute myocardial infarction

A total of 16 patients who developed severe cardiogenic shock were resuscitated with a percutaneous cardiopulmonary support system (PCPS). The etiology of shock was acute myocardial infarction (n = 7), or post-infarction left-ventricular (LV) free wall rupture (n = 9). After successful resuscitation with the PCPS, 15 patients underwent therapeutic interventions: closure of an LV rupture (n = 9), coronary artery bypass grafting (n = 4), percutaneous transluminal angioplasty (n = 1), and percutaneous transluminal coronary recanalization (n = 1). Of the 16 patients, 14 were weaned from PCPS or standard cardiopulmonary bypass. Six patients survived longer than 30 days, 3 (19 percent) of whom were discharged from the hospital. The long-term survival rate in the 6 patients who underwent coronary revascularization was 33 percent (2/6). Of the 9 patients with LV free wall rupture, 1 was discharged from the hospital. Even though it cannot be concluded, from this small number of patients, that cardiopulmonary resuscitation using PCPS improves survival, it appears that PCPS is a powerful resuscitative modality for seriously ill patients with acute myocardial infarction or LV rupture.

Two cases of recurrent pulmonary metastasis resected after operation for gastric cancer

It is said that the prognosis is poor in cases with recurrent pulmonary metastasis after operation for gastric cancer. In this article, 2 cases with nodular type of pulmonary metastasis resected after operation for gastric cancer and surviving well are reported by the authors. Case 1: 57-year-old female. The patient underwent a total gastrectomy for the 3'type of cardiac cancer. As the serum levels of tumor markers increased and the chest X-ray examination revealed a mass lesion in the right lung (S10), the operation for the lesion under the diagnosis of metastatic lung cancer was performed 1 year and 2 months after gastrectomy. The patient died of pulmonal and pleural metastasis 4 years and 7 months after the first operation. Case 2: 65-year-old male. The patient underwent a subtotal gastrectomy for the 5' type of gastric cancer. Chest X-ray examination for follow-up study revealed a mass lesion in the left lung (S5). The patient underwent a left pulmonary superior lobe resection 2 years and 9 months after gastrectomy. The patient is still alive 6 years after the first operation. Surgical treatment must be actively considered for nodular type of metastatic lung cancer after operation for gastric cancer.

Effect of specific binding of high density lipoprotein to eel hepatocytes on their secretion of lipoprotein

Specific binding of eel serum high-density lipoprotein (HDL) to eel hepatocytes was demonstrated by using a synthesized fluorescent lipophilic dye. HDL binding was inhibited by the addition of unlabeled HDL. The binding of HDL to the hepatocytes was saturated at concentrations over 100 micrograms HDL protein/ml and Kd value was 20 micrograms HDL protein/ml. A fluorescent photomicrograph of the cultured eel hepatocytes which were incubated with the dye showed the bright, circumferential plasma membranes stained with the dye. 125I-HDL was incorporated into the acid insoluble- and soluble-fractions of the cultured hepatocytes during incubation at 28 degrees C for 1 h. There are three remarkable characteristics of the effect of HDL on the cultured hepatocytes. One is that the addition of HDL to the hepatocytes induced the efflux of cholesterol, triacylglycerol, and phospholipid from the hepatocytes. The second characteristic is that the efflux of the intracellular lipids was carried out with very-low-density-like or chylomicron-like lipoprotein secreted by the hepatocytes. The third characteristic is that HDL specifically stimulated the synthesis of the lipoprotein and had no effect on the synthesis of intracellular proteins and the secreted proteins except for the lipoprotein.

[Therapy of carcinomatous peritonitis by the angiogenesis inhibitor TNP-470 in mice: analysis of timing and doses for intraperitoneal administration]

In order to perform therapy for carcinomatous peritonitis by a new angiogenesis inhibitor, TNP-470, we investigated the effective timing and the optimal doses for intraperitoneal administration using two mice models. In both carcinomatous peritonitis models caused by M 5076 tumor and B 16 melanoma, the early administration of TNP-470 within one week after tumor inoculation extended the survival times of the mice receiving the drugs, whereas the administration of TNP-470 one week or later after inoculation did not affect the survival time. However, there were significant differences in the effective therapeutic doses of TNP-470 between the two models. It is important to select the best timing and doses for intraperitoneal administration of TNP-470 based on the state of angiogenesis and the sensitivity of the tumor tissues to TNP-470.

[Trial of a treatment for lymph node metastases in patients with breast cancer using aclarubicin bound to activated carbon particles]

A new dosage formulation (ACR-CH), composed of aclarubicin (ACR) bound to fine activated carbon particles, was developed for the treatment of lymph node metastases in patients with breast cancer. In a mice experimental model, ACR-CH had superior therapeutic effects on lymph node metastases compared to the same dose of ACR aqueous solution. In clinical trials, patients with breast cancer received a local injection of 10 mg/person of ACR in the form of ACR-CH or ACR aqueous solution just before mastectomy. In the regional lymph nodes removed by the operation, the ACR concentration of 40.7 micrograms/g in patients given ACR-CH was higher than the 25.1 micrograms/g in patients given ACR aqueous solution, whereas in blood plasma the concentration was higher in patients given ACR aqueous solution than in those given ACR-CH.

Inhibition of colon cancer cell proliferation by antisense oligonucleotides targeting the messenger RNA of the Ki-ras gene

Point mutations that activate the Ki-ras proto-oncogene are present in approximately 50% of human colorectal tumors and the activated Ki-ras gene is considered to play an important role in colorectal cancer cell proliferation. Five different colon cancer cell lines and two kinds of control cell lines were treated with antisense oligonucleotides complementary to the messenger RNA of Ki-ras. Treatment with antisense oligonucleotides at concentrations between 10 and 40 microM significantly and dose-dependently inhibited cell growth, colony formation and Ki-ras protein production of the colon cancer cells with activated Ki-ras, but did not affect the normal cells and colon cancer cells without Ki-ras mutation. These results show that use of synthetic oligonucleotides is an effective way of producing antisense-mediated changes in the behavior of human colon cancer cells with an activated Ki-ras gene.

Generation of novel rapamycin structures by microbial manipulations

A new rapamycin producing culture was isolated and designated as Actinoplanes sp. N902-109. The addition of a cytochrome P-450 inhibitor and precursor feeding using this culture, and biotransformation approaches generated new rapamycin analogs with modifications at C-4, C-9, C-16, C-27, C-28 and/or C-39. The immunosuppressive activity of the resulting analogs was established in the mixed lymphocyte reaction assay.

Therapeutic effects of the angiogenesis inhibitor TNP-470 against carcinomatous peritonitis in mice

The therapeutic effects of the new anti-angiogenesis factor TNP-470 were examined against carcinomatous peritonitis in mice. In the first experiment using carcinomatous peritonitis caused by i.p. inoculation of 10(6) M5076 tumor cells, TNP-470 solution was injected i.p. in a bolus of 50 mg/kg body weight into two groups of 10 mice either 1 or 8 days after the i.p. inoculation. The administration of TNP-470 on day 1 extended the survival time of the mice compared with 10 control mice receiving no treatment, whereas TNP-470 given on day 8 did not affect the survival time. In the next experiment on the M5076 tumor, TNP-470 solutions at 100 or 300 mg/kg were injected i.p. in a bolus into two groups of 20 mice 1 day after the inoculation 10(6) tumor cells, respectively. The administration of TNP-470 at 100 mg/kg also had an inhibitory effect. However, TNP-470 at 300 mg/kg caused toxic death in half of the mice. Next, we examined the effects of TNP-470 on another type of carcinomatous peritonitis model, which was caused by i.p. inoculation of 10(6) B16 melanoma cells. In this experiment, TNP-470 solutions in a bolus of 150 mg/kg were injected i.p. into six groups of 10 mice each on day 1 only (group 1), on days 1 and 4 (group 2), on days 1, 4 and 7 (group 3), on day 8 only (group 4), on days 8 and 11 (group 5), or on days 8, 11 and 14 (group 6), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Kissing aneurysms of distal anterior cerebral arteries demonstrated by magnetic resonance angiography

BACKGROUND Multiple aneurysms, associated with distal anterior cerebral artery (ACA) aneurysm, are not rare; therefore, it is important to examine multiplicity of the aneurysms preoperatively. CASE REPORT A case of ruptured distal ACA aneurysm, associated with another one in a mirror position, is reported. A 43-year-old woman suffered subarachnoid hemorrhage. Conventional angiography demonstrated a saccular aneurysm on the bifurcation of the right or left distal ACA; however, magnetic resonance angiography (MRA) revealed two mirror-image aneurysms on both bifurcations. CONCLUSION MRA was useful for preoperative diagnosis of kissing aneurysms on distal ACAs.

Disappearance of arachnoid cysts after head injury

The mechanism of the disappearance of arachnoid cysts is not fully understood. This article discusses the spontaneous disappearance of these cysts after head injury. Five patients underwent computed tomography and were diagnosed as having a subdural hematoma or effusion associated with arachnoid cysts. In four of the five patients, the cyst decreased in size or disappeared. These cases suggest a possible mechanism by which this type of cyst associated with subdural hematoma or effusion might disappear. For the arachnoid cyst to disappear, the rupture of the cyst wall appears to be essential, and after rupture, subdural effusion must develop around the cyst. As this effusion is absorbed, the fluid in the cyst drains away, after which the cyst becomes smaller and gradually disappears. This hypothesis supports the possibility of a "natural cure" for arachnoid cysts without surgical intervention.

[Familial amyloidotic polyneuropathy (FAP type I) with late-onset; siblings showing heterogeneity in age of onset]

A 66-year-old man with late-onset FAP type I with Val30-->Met mutation in transthyretin was described. The age of clinical onset was 62 years old. The somatic motor and sensory involvement predominantly distributing in the distal part of the extremities preceded the manifestation of autonomic symptoms. He was diagnosed as having somatic motor and sensory neuropathy. However, 4 years after the onset, autonomic symptoms such as orthostatic hypotension, alternating constipation and diarrhea developed. Sural nerve biopsy and DNA study established the diagnosis of FAP type I. A 77-year-old brother of this patient, also had the type I mutation of transthyretin, but did not show any neurological symptoms or electrophysiological abnormalities, indicating significant discordance to the onset age of clinical phenotypes in this family. As suggested in an experiment on transgenic mice with FAP gene, factors other than FAP gene, possibly an environmental factor, may have been related with the clinical onset of FAP. Both siblings in this family, had FAP type I gene mutations, yet showed a significant discordance to the phenotypic manifestations of FAP. This supports the view that multifactorial background may well influence the clinical onset and progression of this disease.