Development of a dissecting aneurysm on the vertebral artery immediately after occlusion of the contralateral vertebral artery: a case report

A 49 year old female presented with subarachnoid hemorrhage due to a ruptured dissecting aneurysm on the left vertebral artery (VA). Following an occlusion test, we performed proximal occlusion of the left VA with detachable balloons. However, a dissecting aneurysm on the right VA developed three weeks later. After an occlusion test had showed no change in cerebral blood flow, auditory brain stem response, or neurological status, proximal occlusion of the right VA was performed. The patient has returned to normal life without neurological deficits. Bilateral dissecting aneurysms of the VA are quite common, but de novo VA dissecting aneurysms or enlargement of such aneurysms after occlusion of contralateral VA are rare. This case suggests that hemodynamics stress may be a causal factor in the development of VA dissecting aneurysms. Careful pre- and post-operative neuroradiological examination of the contralateral VA are required in patients undergoing VA occlusion for dissecting aneurysms.

[A new reconstruction procedure as antireflux surgery after proximal gastrectomy. Interposition of the jejunal pouch with valvuloplasty]

In order to reduce the incidence of reflux esophagitis following proximal gastrectomy, we have developed a new reconstruction procedure with an interposed jejunal pouch with antireflux valvuloplasty between the esophagus and the gastric remnant. After a standard proximal gastrectomy and lymph node dissection, the jejunum is divided at a point 25 cm from the Treitz ligament. The distal jejunum is pulled up through the transverse mesocolon with a mesenterium and anastomosed to the esophagus with a PCEEA stapling device. The pulled through jejunum is doubled up at a point 30 cm from the esophagojejunostomy, and the 5 cm tip of the jejunum is resected. A 5.5 cm autosuture GIA is inserted into the jejunum from both cut ends of the jejunum for side-to-side anastomosis on the antimesenteric side to make a 5 cm long jejunal pouch, and the jejunum is further divided 5 cm distal from the jejunal pouch. As a result, the interposed jejunal segment is omponed of a single-lumen 15 cm jejunum, a parallel lumen 5 cm jejunum, and a double-lumen jejunum. In the double-lumen jejunum, the jejunal pouch plays the role of a pressure absorber in the residual stomach, and the septum of the parallel lumen jejunum that of an anti-reflux valve. Peristalsis of the single lumen 15 cm jejunum prevents reflux to the esophagus. Postoperative examinations showed that this reconstruction method has satisfactory to excellent results.

Local hypercoagulative activity precedes hyperfibrinolytic activity in the subdural space during development of chronic subdural haematoma from subdural effusion

The involvement of coagulation and fibrinolysis in the development of chronic subdural haematoma (CSH) from subdural effusion was investigated. Subdural fluid and venous blood samples were obtained from 34 patients with CSH and 9 patients with subdural effusion, and analyzed using enzyme-linked immunosorbent assays for thrombin-antithrombin III complex (TAT), prothrombin fragment F1 + 2 (F1 + 2), tissue factor, tissue factor pathway inhibitor (TFPI) and D-dimer. CSH was classified into the layering type, believed to be active, and other types according to x-ray computed tomography. All markers in the blood of both patient groups were similar to the values of normal subjects. Levels of TAT and F1 + 2 were much higher in the subdural fluid than in the blood of patients with CSH (P < 0.001, P < 0.001) and with subdural effusion (P < 0.05, P < 0.05). The level of D-dimer in the subdural fluid was significantly higher than in the blood (P < 0.001) in patients with CSH, but not in patients with subdural effusion. All markers in the subdural fluid of layering type CSH, except TFPI, were significantly higher than in the other types (P < 0.05). Local hypercoagulative activity in the subdural space is present in subdural effusion and precedes hyperfibrinolytic activity in CSH. Thrombin generation as indicated by TAT and F1 + 2 might be involved in the development of CSH. Propagation of CSH may be modulated by the coagulation system including the extrinsic pathway and fibrinolysis.

Genes for the ribosomal S4 protein encoded in higher plant mitochondria are transcribed, edited, and translated

Here we describe the structure and expression of the mitochondrial gene that encodes the S4 subunit of the mitochondrial ribosome (rps4) in two higher plants, rapeseed and rice. The ORFs of rapeseed and rice rps4 genes are 362 and 352 codons long, respectively, and their corresponding transcripts are edited (C-to-U conversions) in 19 and 15 positions, respectively. The amino acid sequences deduced from the sequences of the two rps4 genes are 78.1% identical to each other and show about 50% identity to the liverwort (Marchantia polymorpha) mitochondrial RPS4 polypeptide. Both higher plant mitochondrial genes have an inserted sequence (of 137 and 141 codons for rapeseed and rice, respectively) relative to the liverwort rps4 gene. In rice rps4, the 3' portion of the inserted sequence can potentially form two stem-loop structures that resemble two domains characteristic of group II introns, i.e., domains V and VI. However, RT-PCR analysis showed that these sequences were not spliced out during maturation of the rps4 transcripts. Antibodies specific for the plant RPS4 proteins were prepared. Protein blot analysis revealed that RPS4 polypeptides are present in both rapeseed and rice mitochondria, whose sizes are in agreement with the molecular weights calculated from the non-spliced sequences. The rps4 genes and RPS4 polypeptides have been also identified in the mitochondria of wheat, maize, soybean, and turnip by Southern and Western analyses, respectively.

Acutely severe myocarditis successfully treated by percutaneous cardiopulmonary support applied by a newly developed heparin-binding oxygenator and circuits

The feasibility of using the heparin-bound percutaneous cardiopulmonary support system (PCPS) for prolonged extracorporeal circulation in patients with acute severe myocarditis is demonstrated. The case histories of 2 patients with cardiogenic shock caused by acute myocarditis are presented; both were successfully treated with long-term PCPS using a newly developed heparin-binding oxygenator and circuits without changing the oxygenator. The courses of both patients remain uneventful more than 12 months after discharge. We also discuss the clinical aspects of using heparin-bound PCPS in patients with acute severe myocarditis.

Histamine-induced calcium released from cultured human mucosal microvascular endothelial cells from nasal inferior turbinate

Changes in cytosolic Ca2+ concentration ([Ca2+]i) in cultured human mucosal microvascular endothelial cells (HMMECs) from nasal inferior turbinate were measured using a fluorescent Ca(2+)-sensitive dye, fura-2, and photometric fluorescence microscopy. Histamine caused a transient increase in intracellular free Ca2+ in cell populations and in individual cells, followed by a decrease to a sustained elevation. Histamine (100 microM) elevated [Ca2+]i in HMMECs up to 563 +/- 20 nM from a resting level of 60 +/- 45 nM (means +/- SD, n = 31). Promethazine (a histamine H1 receptor antagonist) inhibited [Ca2+]i increase during histamine stimulation, whereas cimetidine (a H2 receptor antagonist) and thioperamide (a H3 receptor antagonist) showed no inhibition. These results suggest that the histamine increase [Ca2+]i in HMMECs induces both a Ca2+ release from stores and a Ca2+ influx through activation of the H1 receptor.

Involvement of 5' flanking sequence for specifying RNA editing sites in plant mitochondria

Unsuccessful insertion of foreign DNA into plant mitochondrial genomes has hindered scientific evaluation of cis-elements needed for RNA editing. Both a normal atp6 gene and a chimeric atp6 sequence are present in rice mitochondria. The chimeric atp6 contains one-half of the normal atp6 sequence in its 5' portion and an unknown sequence in its downstream portion. The C-nucleotide at position 511, located just upstream of the unknown sequence recombined in the chimeric atp6 sequence, is edited, as are other possible editing sites upstream from position 511. We report here that the 5' sequence adjacent to the editing site of atp6 contains cis-information required for RNA editing and that the 3' sequence flanking the editing site provides little contribution to editing-site recognition.

Regulatory effects of aggregated LDL on apoptosis during foam cell formation of human peripheral blood monocytes

In order to investigate the mechanisms how modified lipoproteins enhance foam cell formation, we cultured peripheral blood monocytes with various stimulants and examined the effects of aggregated low-density lipoprotein (agLDL) on cell viability and lipid metabolism. AgLDL could completely inhibit phorbol ester-induced apoptosis, which was accompanied by intracellular cholesterol accumulation. Suppression of apoptosis-promoting proteases, ICE and CPP32, was observed in agLDL-treated cells. This indicates that agLDL accelerates foam cell formation through inhibition of apoptosis and enhancement of lipid accumulation in activated monocytes. By contrast, apoptosis was enhanced when monocytes were cultured with agLDL and M-CSF. Intracellular cholesterol accumulation was not significant in M-CSF treated cells. This suggests that M-CSF may act anti-atherogenic through apoptotic elimination of lipid-baring macrophages and enhanced lipid turnover. Our observation supports the novel hypothesis that regulation of apoptosis may play an important role in the development of atherosclerosis.

[A device in reconstruction method after distal subtotal gastrectomy: special reference to double tract method with jejunal pouch]

In the surgery of gastric cancer, it is necessary to consider not only the curability of gastric resection but also the quality of life of the patients in the choice of reconstruction method after distal gastrectomy. We have devised the jejunal pouch double tract method after gastrectomy. We reported in this study on the details of method and the satisfactory results. We employed 15 cases of gastric cancer which should be resected over three quarters of the stomach because the tumor occupation were in the middle third of the stomach and were expected long survival period. The operative procedure was as follows: (1) completion of gastric resection and lymph node dissection, (2) separation of jejunum at the site of 25 cm anal side from the Treitz's ligament, (3) pulling up the anal side of the jejunum preparing double jejunal pouch with approximately 10 cm in length using GIA, (4) anastomosis between residual stomach and jejunal pouch, (5) duodenojejunostomy at the site of 3-5 cm anal side from the pouch, (6) jejunojejunostomy at the site of 15 cm anal side from the duodenojejunostomy. Double tract reconstruction with jejunal pouch after distal gastrectomy is well-balanced method in the storage and discharging capacity, and useful in the view of better quality of life, especially in the cases which could be expected long survival period.

Sonic analysis for detection of cervical and intracranial vascular disease

A sonic analysis system was developed for the detection of cervical and intracranial vascular disease. The system analyzes recorded sound signals converted to digital data, and plots the frequency, time interval after the QRS wave of the electrocardiogram, and amplitude on the graph using contour lines. Sonic analysis of 22 patients with and 23 patients without cerebrovascular disease identified a characteristic pattern of disease called the "circular pattern." Five of 10 patients with internal carotid artery stenosis, four of seven with cerebral aneurysms, three with cerebral arteriovenous malformation, and two of two with dural arteriovenous malformation showed the circular pattern. Only one of 23 control patients showed the circular pattern. This system is a promising method for cost-effective mass screening for the early detection of cerebrovascular disease.

[The effect of prophylactic intravenous diltiazem drip infusion on myocardial ischemia during noncardiac surgery]

We evaluated the effect of intravenous diltiazem infusion in 105 noncardiac surgical patients. Subjects were elective surgical patients with coronary artery disease and coronary risk factors which were hypertension (WHO standards), diabetes mellitus, hyperlipemia (total cholesterol > or = 220 mg.dl-1), obesity (body mass index : male > or = 26 kg.m-2, female > or = 25) and old age (70 years old or above). The prophylactic intravenous diltiazem infusion (1.0 micrograms.kg-1.min-1) was started immediately after induction of general anesthesia or epidural analgesia and continued until the end of operation. All patients were monitored by ST trend graph during anesthesia, and ischemia pattern was defined as > or = 1 mm ST changes and lasting over 1 min. Ischemic ST-T changes were noted in 4 cases in the operating room. ST depression was noted in 2 cases before starting anesthesia and these 2 cases showed improvement with diltiazem infusion lasting until the end of operation. ST-T changes were noted in 2 cases during surgery and these 2 cases showed improvement with diltiazem isosorbide dinitrate. We conclude that prophylactic intravenous diltiazem infusion may prevent ischemia during noncardiac surgery.

[Seasonal changes of laboratory data in patients with Japanese cedar pollinosis]

Japanese cedar pollen (JCP) causes a significant seasonal allergic rhinitis in Japan during the early spring. Blood samples were collected monthly from October 1993 through October 1994 from 11 patients with Japanese cedar pollinosis. The patients were segregated into two categories based on specific IgE (RAST): single positive RAST to JCP only and multiple positive RAST to JCP, house dust (H1) and mite (D1). These two populations differed in levels of total serum IgE, numbers of eosinophils, basophils and neutrophils in peripheral blood and clinical symptoms. Seasonal increase of JCP-specific IgE was observed after pollen season in both groups. In the single positive group, but not in the multiple positive group, seasonal increase of the number of eosinophils in peripheral blood was observed with post seasonal fall and the level of total serum IgE was increased in the same manner as that of the JCP specific IgE. Although it was not significant, there was a broad seasonal increase of serum nitrate anion, a metabolite of nitric oxide.

Further ST elevation at reperfusion by direct percutaneous transluminal coronary angioplasty predicts poor recovery of left ventricular systolic function in anterior wall AMI

Some patients with acute myocardial infarction (AMI) develop further ST elevation at reperfusion by percutaneous transluminal coronary angioplasty (PTCA). This study reports the ST deviation at reperfusion by direct PTCA in relation to the clinical factors and the recovery of left ventricular (LV) systolic function. Fifty-two patients with anterior wall AMI were treated with direct PTCA. They were classified into the following 3 groups according to the change in ST elevation at reperfusion: increase of > or = 20% (ST reelevation); reduction of > or = 20% (ST resolution); and the other (ST no change). Angina pectoris preceding AMI occurred less often in the ST reelevation group (ST reelevation group, 38%; ST no change group, 81%; ST resolution group, 70%; p < 0.05). Recovery of LV ejection fraction during the first month after direct PTCA was significantly poor in the ST reelevation group in contrast to the ST resolution group (ST reelevation group, -6.3 +/- 13%; ST no change group, 18 +/- 20%; ST resolution group, 45 +/- 29%; p < 0.0001). The change in ST elevation at reperfusion was an index predicting the recovery of LV systolic function in the reperfusion by direct PTCA.

Feasibility of diagnosing chronic myocarditis by endomyocardial biopsy

In studies of all the layers of autopsied hearts from patients with chronic myocarditis, local clusters of lymphocytes are frequently noted, in contrast with hearts obtained from patients with acute myocarditis. Myocardial biopsy specimens, however are no larger than about 2mm x 3mm. With this in mind, the present study was undertaken to determine whether chronic myocarditis can be diagnosed by endomyocardial biopsy. Specimens were obtained from seven patients in whom chronic myocarditis was confirmed by the clinical course and by autopsy findings. In H&E stained specimens, sites corresponding to the biopsy sites in both ventricles (right ventricular free wall, right ventricular side of the ventricular septum, left ventricular lateral wall) were selected at random (five sites each from the right and left ventricles in each patient) and examined under a light microscope. A mean of 5 or more lymphocytes per visual field (by light microscopy at 400-fold magnification), a proposed quantitative diagnostic criterion of myocarditis, was noted in the right ventricle in three patients (5 lymphocytes in two patients and 6 in one patient) and in the left ventricle in one patient (5 lymphocytes). Also, when the presence of lymphocyte clusters, considered to be a characteristic feature of chronic myocarditis, was determined, clusters of 20 or more lymphocytes per visual field were found in the same patients as those mentioned above, namely, in three patients (42.8%) in the right ventricle, as mentioned above, and in one patient (14.3%) in the left ventricle. At the sites of these lymphocyte clusters. findings such as degenerative changes of the myocardial cells and interstitial fibrosis were also associated, making possible a diagnosis of myocarditis. Therefore, in chronic myocarditis, even if five specimens are obtained by right ventricular biopsy, in approximately one half of patients the diagnosis of chronic myocarditis will be missed because of sampling errors.

[A case of isolated ACTH deficiency with neuromuscular symptoms]

A female case of isolated ACTH deficiency associated with neuromuscular symptoms was reported. Although her initial development was delayed with perinatal troubles, developmental catch up was seen. The patient complained of general fatigue with weakness and poor school performance at the age of eleven. Muscle weakness predominant to the proximal portion and mental dullness were suspected from neurological examination. Her laboratory data were as follows; mild elevation of CK in serum, subclinical thyroidal dysfunction, abnormal electrocardiogram, slow wave activity on electroencephalogram, delayed nerve conduction velocity, and localized hypoperfusion of cerebral blood flow on single photon emission computed tomogram. Histological examination of muscle biopsy demonstrated only mild fiber size variation. During two years' follow-up, her intelligence quotient fell down, while muscle weakness did not progress significantly. At the age of fourteen, a low level of plasma ACTH was pointed out by chance and a definitive diagnosis was obtained by endocrinological examinations; no response of ACTH and cortisol on insulin stimulation, delayed response of cortisol on continuous ACTH stimulation, and no response of plasma ACTH on corticotropin releasing hormone stimulation. Other signs of adrenocortical insufficiency, such as hypoglycemia and abnormal serum electrolytes, were not observed during the clinical course. This case suggested that isolated ACTH deficiency should be considered for differential diagnosis of neuromuscular disorders.

Targeting presequence acquisition after mitochondrial gene transfer to the nucleus occurs by duplication of existing targeting signals

We have cloned a gene for mitochondrial ribosomal protein S11 (RPS11), which is encoded in lower plants by the mitochondrial genome, in higher plants by the nuclear genome, demonstrating genetic information transfer from the mitochondrial genome to the nucleus during flowering plant evolution. The sequence s11-1 encodes an N-terminal extension as well as an organelle-derived RPS11 region. Surprisingly, the N-terminal region has high amino acid sequence similarity with the presequence of the beta-subunit of ATP synthase from plant mitochondria, suggesting a common lineage of the presequences. The deduced N-terminal region of s11-2, a second nuclear-encoded homolog of rps11, shows high sequence similarity with the putative presequence of cytochrome oxidase subunit Vb. The sharing of the N-terminal region together with its 5' flanking untranslated nucleotide sequence in different proteins strongly suggests an involvement of duplication/recombination for targeting signal acquisition after gene migration. A remnant of ancestral rps11 sequence, transcribed and subjected to RNA editing, is found in the mitochondrial genome, indicating that inactivation of mitochondrial rps11 gene expression was initiated at the translational level prior to termination of transcription.

Intracellular Ca2+ mobilization in cultured human mucosal microvascular endothelial cells from the nasal inferior turbinate

Human mucosal microvascular endothelial cells (HMMECs) were isolated and cultured from the mucosa of nasal inferior turbinates. These cells were identified by human factor-VIII antigen and UEA-I. We also investigated alterations in intracellular calcium concentration [Ca2+]i, in HMMECs using the Ca(2+)-sensitive dye fura-2. Depolarization by high K+ (150 mM) induced no changes in [Ca2+]i in HMMECs, thereby indicating the lack of voltage-dependent Ca2+ channels in these cells. Extracellular ATP increased [Ca2+]i in HMMECs both in the presence and absence of extracellular Ca2+. These results suggest that ATP may induce a release of Ca2+ from intracellular stores in HMMECs. Adenosine induced no changes in [Ca2+]i in HMMECs. It is thus likely that HMMECs obtained from the nasal inferior turbinate may carry P2-purinoceptors but not P1-purinoceptors.

[Selective thermocoagulation of unresectable malignant tumors using radiofrequency]

Based on our experimental findings on porcine liver, we have been conducting a clinical trial of selective hyperthermia by radiofrequency (RF) capacitive heating with laparotomy for patients with unresectable malignant tumors. In 10 patients with malignant tumors (8 carcinoma of the pancreas, 2 carcinoma of the gallbladder), laparotomy and RF heating were performed after informed consent. The local heat coagulation was produced by heating equipment using 13.56 MHz radiofrequency produced by Omron Corporation, Japan. Four 2-cm electrode needles were placed in the tumor in a square array at intervals of 2.0 cm. Hyperthermia was given for 30 min with a controlled temperature of 50 degrees C in the RF field (2 x 2 x 2 cm3). That of the surrounding area was maintained at less than 40 degrees C. The calculated volume treated by RF ranged between (2 x 2 x 2 cm3) x 1 and (2 x 2 x 2 cm3) x 6. We followed all patients by computed tomographic (CT) scan 2 weeks after coagulation. Tumor markers in the blood were assayed before and 14 days after heating. Follow-up CT scans demonstrated that after the tumor mass had been heterogeneously enhanced, it changed to a homogeneous low-density area in 6 of 10 patients. The levels of tumor markers decreased to lower than the pre-treatment values in 9 of 10 patients. In all patients, the changes in CT scans and/or decrease in the markers were confirmed. Complications such as bleeding or abscess formation were not observed. It was suggested that the selective hyperthermia was safely produced by this equipment. The encouraging results in these patients justify further clinical trials.

A ribosomal protein L2 gene is transcribed, spliced, and edited at one site in rice mitochondria

The mitochondrial ribosomal protein L2 gene (rpl2) is coded by two exons of 840 and 669 bp separated by an intron sequence of 1481 bp in the rice mitochondrial genome. The rpl2 gene is located three nucleotides upstream of the ribosomal protein S19 gene (rps19) and both genes are co-transcribed. cDNA sequence analysis identified splicing of the intron sequence from the rpl2 mRNA as well as RNA editing events. The deduced secondary structure of the rpl2 intron sequence shows the characteristic features of a group-II intron. A single RNA editing site is identified in rpl2 and six editing sites in rps19 transcripts. In addition, one editing site is observed in the 3 nucleotide intergenic region. Analysis of individual cDNA clones showed a different extent of RNA editing. The rice rpl2 intron is located at a different site and shows no significant nucleotide sequence similarity with the rpl2 intron of liverwort. However, 60% nucleotide sequence identity is observed between the rice rpl2 intron and the Oenothera nad5 intron in a 234 nucleotide region. The mitochondrial rpl2 sequence is absent from the pea mitochondrial genome and we consequently propose that the mitochondrial RPL2 protein is encoded by a nuclear gene in pea.