[Three cases of coronary to pulmonary arterial fistulae combined with valvular disease]

Three cases of coronary to pulmonary arterial fistulae (CAF) combined with valvular disease are reported. The first case was 53-year-old male admitted with mitral stenosis (MS) and left atrium thrombus. CAF originating from both coronary artery and draining to pulmonary artery were found by coronary angiography. Open mitral comissurotomy (OMC), thrombectory and ligation of CAF were performed. Case 2 was 52-year-old female suffered from CHF due to MS. Abnormal communication from left coronary artery to pulmonary artery was demonstrated. OMC and ligation of CAF were performed. Case 3 was 65-year-old male with combined valvular disease. MS, aortic regurgitation and CAF from right coronary artery to pulmonary artery were revealed. Mitral and aortic valve replacement and ligation of CAF were done. Diffusion of coronary angiography increase chance to reveal coronary artery fistulas during examination of acquired cardiac disease. Coronary artery fistulas draining into pulmonary artery were completely ligated by double ligation at both the arising point from coronary artery and the draining point to pulmonary trunk.

[Indication and result of hypothermic fibrillatory arrest in coronary artery bypass grafting]

Currently, cardioplegic arrest is used for almost all coronary artery bypass grafting (CABG). However, there are some cases in which aortic occlusion or the cardioplegic infusion is not desirable. In this paper, we discussed the indications and the usefulness of hypothermic fibrillatory arrest for CABG. From April 1992 to March 1995, CABG with hypothermic fibrillatory arrest was performed in 6 patients (3.9% of total CABG cases). The reasons of employing hypothermic ventricular fibrillation were as follows; calcified ascending aorta in 2 patients, coronary aneurysm associated with Behçet's decrease in 1, revascularization to the totally obstructed branches with poor left ventricular function in 2, and collateral circulation from bronchial artery with total obstruction of left main trunk in 1. The age range was 48 to 68 years with a mean of 59.0 +/- 7.8 years. Five patients had a history of myocardial infarction and 2 of them had a left ventricular ejection function less than 0.25. Surgical procedures consisted of elective ventricular fibrillation without aortic cross-clamp, systemic hypothermia and local pericardial cooling, left atrial or pulmonary artery venting, and local vessel isolation during distal anastomosis. Average number of grafts was 2.0 +/- 0.6, and 5 left internal thoracic arteries, 2 gastroepiploic arteries and 5 saphenous vein were used. Mean duration of ventricular fibrillation was 74.0 +/- 17.5 min. Postoperative angiography confirmed all bypasses patent. Only 1 patient, whose preoperative left ventricular ejection function was 0.20, died of heart failure 5 months after the operation. All other patients survived asymptomatically. Hypothermic fibrillatory arrest is useful and reliable technique in coronary artery bypass grafting when aortic occlusion or cardioplegic arrest is not desirable.

Cysteine protease of Porphyromonas gingivalis 381 enhances binding of fimbriae to cultured human fibroblasts and matrix proteins

It has been shown that Porphyromonas gingivalis 381, a suspected periodontopathogen, possesses fimbriae on its cell surface. The organism is also known to produce proteases which can degrade the host cell surface matrix proteins. In this study, we investigated the effect of protease on the binding of the purified P. gingivalis fimbriae to cultured fibroblasts or matrix proteins. A protease that can hydrolyze benzoyl-L-arginine p-nitroanilide was obtained from P. gingivalis 381 cells by sonication in phosphate-buffered 0.2% Triton X-100 and was purified by column chromatography. The molecular size of the protease was estimated to be 55 kDa by gel filtration or 47 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. The enzyme activity was markedly inhibited by sulfhydryl reagents, antipain, and leupeptin. The protease degraded various host proteins, including collagen and fibronectin, and cleaved the COOH terminus of the arginine residue in peptides such as benzoyl-L-arginine p-nitroanilide. However, P. gingivalis fimbriae were not degraded by protease activity. The enzyme activity was enhanced in the presence of reducing agents or CaCl2. When cultured fibroblasts were partially treated with the protease, the binding of the purified P. gingivalis fimbriae to the fibroblast monolayer was increased significantly. However, this enhancing effect was suppressed upon the addition of antipain and leupeptin. Similarly, binding of the fimbriae to the collagen or fibronectin immobilized on the microtiter wells was also enhanced. Addition of these host matrix proteins efficiently inhibited the binding of fimbriae to the fibroblast monolayer. The binding assay of fimbriae using dipeptidyl ligand affinity column chromatography demonstrated a clear interaction between fimbriae and the arginine residue. Taken together, these results indicate that the P. gingivalis protease at least partially degrades the host matrix proteins, which, in turn, may lead to an increased exposure of the cryptic ligands that can result in enhanced fimbria-mediated binding of this organism to periodontal tissues.

Strategy for breast conserving treatment--analysis of recurrence and prognosis after breast cosnserving treatment

Two hundred and four patients with small breast cancer (T < or = 3.0 cm. N0 or N1a) were given breast conserving treatment (radiation group: 101, non-radiation group: 103) during the period from Feb. 1988 to Jan. 1995. Survival analysis of breast conserving treatment radiation group versus non-radiation group revealed the following: 1) Breast conserving treatment had a good prognosis, and a 5-year overall survival rate of 96.2%. 2) There was no significant difference of 5-year overall, disease-free and ipsilateral breast disease-free survival rate between the radiation group and non-radiation group. 3) Surgical margin involvement was the most significant risk factor in local recurrence after breast conserving treatment, and non-radiation was a possible risk factor. 4) Local recurrence was a significant risk factor for distant metastases after breast conserving treatment the same as node positive. These results suggested as follows: 1) Lumpectomy with a clear margin and radiation is the best choice for small breast cancer (T < or = 3.0 cm, N0 or N1a). 2) Adjuvant therapy after surgical treatment is necessary for local recurrence.

[A study on the maternal plasma C21 steroids concentration during pregnancy]

During pregnancy, C21 steroids such as progesterone (P4), and cortisol (F), have been reported to be closely involved in uterine contraction. To clarify the association between changes in steroid hormones and the onset of delivery, we measured the concentrations of six C21 steroids in maternal blood by high performance liquid chromatography. Changes in each steroid hormone were evaluated by analysis of variance during pregnancy. Pregnenolone, a source of C21 steroids, gradually increased during pregnancy. P4 and 17P4, its metabolite, reached a peak 3 weeks before delivery and noticeably decreased thereafter. Accompanying a decrease in P4 and 17P4, 20P4 and F, its metabolite, were noticeably increased. The association among these steroid hormones was also evaluated. The correlation between P4 and F was reversed after 3 weeks before delivery. These results suggest that steroid hormones in the maternal blood begin to change dynamically about 3 weeks before delivery. In particular, a decrease in P4 and an increase in F seem to be closely related to the onset of delivery.

Observation of enhanced backscattering from a plane mirror viewed through polymer-film-dispersed liquid crystals

We report experimental results on enhanced backscattering from a plane mirror that is viewed through polymer-film-dispersed nematic liquid crystals. The distribution of the averaged intensity of the light reflected from the mirror placed behind the polymer film is investigated with an image-processing system when a Gaussian beam wave is incident. The enhanced light peak is observed in an incident beam direction, the result of which is predicted by a theory based on the circular Gaussian statistic random-phase-screen model. We pay attention to the enhancement dependence on parameters such as the distance between the polymer film and the flat mirror. The observed result is similar to a previous study by Jakeman et al. in which a random diffusive glass plate was used as a random-phase screen [J. Phys. D 21, 32 (1988)].

[Coronary artery bypass grafting in a patient with a single coronary artery]

Coronary artery bypass grafting in a patient with a single coronary artery is reported. A 61-year-old male who had chest pain and palpitation was transferred to our hospital. His ECG showed ischemic change, and CPK rose to a high level. Emergency coronary angiography revealed a type L II A (Lipton's criteria) single coronary artery and atherosclerotic stenosis on three major branches. He underwent CABG of LAD using LITA, #3 and #14 using saphenous vein grafts. Post operative angiography confirmed patent grafts, and the patient was free from symptoms.

Serum-soluble interleukin-2 receptor levels before and after surgical treatment for Graves' disease

Serum-soluble interleukin-2 receptor (ssIL-2R) is released from its specific affinity membrane receptor on activated T lymphocytes and is detected as a form of the alpha-chain of IL-2R in the peripheral blood. We measured the ssIL-2R levels by enzyme-linked immunosorbent assay in 29 healthy subjects and 39 patients with Graves' disease who were given antithyroid drugs to prepare them for surgical treatment. The preoperative ssIL-2R levels in Graves' patients were significantly higher than those in the healthy controls (681 +/- 387 vs 369 +/- 149 U/ml); in particular, the preoperative levels in hyperthyroid patients were significantly higher than those in euthyroid patients. On the 5th day after thyroid resection, their ssIL-2R levels (560 +/- 296 U/ml) were significantly lower than the preoperative levels. There were no correlations between the preoperative ssIL-2R levels and the immunological parameters such as thyroglobulin antibody, microsomal antibody, and thyroid-stimulating hormone receptor antibody. Thus, we conclude that ssIL-2R levels can be decreased by surgical resection of goiter in Graves' patients whose hyperthyroid status does not respond to the administration of antithyroid drugs, and this may be a useful indicator of immunological status after surgical treatment of Graves' disease.

[The mechanism of beta-receptor desensitization in human myometrial culture cell]

Beta-adrenoceptor desensitization is considered to be primarily due to phosphorylation of receptors by protein kinase A (PKA) and beta-adrenaline receptor kinase (beta-ARK) and sequestration of receptors themselves. But in the human uterine muscle, the desensitization mechanism has been evaluated only as a phenomenon, and there are few studies on its mechanism. We evaluated cAMP production by beta-agonist and changes in the number of beta-receptors in cultured human myometrial cells. Uterine muscle cell were obtained from patients with benign disease before menopause and cultured. 1) At the confluent stage, dl-Isoproterenol Hydrochloride (ISP) was added under various conditions, and the intracellular cAMP concentration was determined by EIA. 2) After the addition of ISP (10(-6) M), plates were incubated at 37 degrees C, and beta-AR on the cell membrane surface (S beta-AR) and total beta-AR (T beta-AR) was measured in a binding assay with 125I-pindolol. The production of cAMP dose-dependently increased 30 minutes after the addition of ISP at 10(-6) M or higher, but rapidly decreased thereafter. T beta-AR was similar in the cells treated with ISP (10(-6) M) and the untreated cells. On the other hand, S beta-AR decreased by about 50% in the ISP treated cells. These result suggest the desensitization of beta-AR in human uterine muscle, and the involvement of the sequestration mechanism as its cause.

[A case report of surgical repair of a ruptured aneurysm of the sinus Valsalva in an aged person with cardiac cachexia]

A 71-year-old woman underwent surgical repair of a ruptured aneurysm of the sinus Valsalva. She had an aneurysm of the right coronary sinus ruptured into the right atrium. There was no VSD. The patient suffered from heart failure for 38 years and went into cardiac cachexia. Direct closure from the right atrium was performed and the patient has resumed full physical activities. As far as we know, this is one of the oldest patients who underwent successful surgery for this disease in this country.

[Coronary artery bypass grafting in a patient with right aortic arch associated with retroesophageal anomalous left subclavian artery]

A rare case of coronary artery bypass grafting in a patient with right aortic arch was presented. A 62-year-old man was admitted to our hospital with angina pectoris. Coronary angiography revealed total obstruction of left anterior descending artery and jeopardized collateral from right coronary artery. Aortography disclosed right aortic arch associated with retroesophageal anomalous left subclavian artery. As the symptom of neither the vascular ring nor the subclavian steal syndrome was recognized, left internal thoracic artery along with the saphenous vein was used for bypass conduit. The patient is doing well without any troubles 7 months after the operation. Attention should be made to use left internal thoracic artery in a patient with right aortic arch.

[Intraocular penetration of oral levofloxacin in rabbits]

The intraocular penetration of levofloxacin was studied in albino and pigmented rabbits after oral administration of 14C-levofloxacin at a dose of 20 mg/kg. The radioactivity of the eyeball of albino rabbits in the autoradiogram was much higher at 1 hr than at 2 or 6 hr after administration. On the other hand, the distribution of radioactivity in pigmented rabbits was similar at 1, 2, and 6 hr after administration. The radioactivity levels in melanin-containing tissues such as the iris-ciliary body and the choroid-retina were significantly higher in pigmented rabbits than in albino rabbits 2 hr after oral administration. The radioactivity levels in the ocular tissues without melanin except for the cornea were similar in albino and pigmented rabbits. These results indicate that the intraocular pharmacokinetics of levofloxacin are markedly affected by its affinity for melanin.

Neural expression of a sodium channel gene requires cell-specific interactions

In the protochordate Halocynthia roretzi, voltage-activated sodium current undergoes a change in kinetics within 48 hr of fertilization. Molecular cloning and microinjection of antisense DNA into single cells suggest that the kinetic changes are due to the increased expression of a putative neural-specific sodium channel gene, TuNa I. TuNa I gene transcription is first induced in late stage gastrulae, preceding the appearance of the rapidly inactivating sodium current unique to neural cells. In cleavage-arrested and intact embryos, cell interactions between specific animal and vegetal blastomeres are required for induction of TuNa I gene expression. Our results implicate cell contact, prior to neurulation, as a mechanism for selectively activating the TuNa I gene expressed in cells of the neural lineage.

[Intra-arterial infusion chemotherapy for recurrent breast cancer via an implantable system--the second report]

Intra-arterial infusion chemotherapy via an implantable port catheter has been applied in 16 patients with locally recurrent breast cancer. The regimen consisted of induction and subsequent maintenance: intra-arterial infusion of epirubicin (EPI). Non-responders were entered into the second-line regimen consisting of Methotrexate and 5-FU (MF). The results were as follows: 1) The response rate (CR+PR) of EPI to locoregional lesions was 50%, and the median duration of response was 5.7 months. 2) The response rate and the duration of response of MF were 25% and 3 months, respectively. 3) Patients with ER-rith, no previous therapy and a long disease-free interval tended to have a high rate of response to intra-arterial infusion therapy. 4) Improvements of QOL, such as intractable pain, infection and severe lymphedema were recognized in 68.6% of the cases. In more than half of the cases, these treatments were carried out in an outpatient clinic. 5) Leucopenia and catheter or portal problems were encountered in 68.6% and 25.0%, respectively. We conclude that intra-arterial infusion chemotherapy via implantable system is a promising modality with regard to therapeutic effect and improvement of quality of life.

[Combined coronary artery bypass grafting and choledocholithotomy--a report of two cases]

A 74-year-old man and a 66-year-old woman were diagnosed as angina pectoris with choledocholithiasis. Combined coronary artery bypass grafting and choledocholithotomy were performed successfully in the two cases. For the prevention of cardiac complications and mediastinal infection, coronary artery bypass grafting was performed prior to choledocholithotomy. However, skin incisions were different in both cases. In the case with the biliary tract infection, both two surgical procedure were performed through a single skin incision in order to prepare the gastroepiploic artery as a graft. The combined operation is considered to be useful in selected cases with ischemic heart disease and choledocholithiasis.

Serum soluble interleukin-2 receptor in colorectal cancer

Preoperative serum soluble interleukin-2 receptor (IL-2R) levels were measured in patients with colorectal cancer, and correlated with various factors as stage, lymph node metastasis, liver metastasis, grade, serum CEA and IAP (immunosuppressive acidic protein). The levels of serum soluble IL-2R in Dukes stage C were significantly higher than in normal control and in Dukes stage A. Serum levels were also significantly higher in patients with lymph node metastasis than in patients without such metastasis, and in IAP positive patients compared to IAP negative patients. Preoperative serum IL-2R levels thus seem to reflect the stage of the disease.

The ascidian embryo as a prototype of vertebrate neurogenesis

Ascidian tadpole larvae, composed of only about 2500 cells, have a primitive nervous system which is derived from the neural plate. The stereotyped cell cleavage pattern and well characterized cell lineage in these animals allow the isolation and culture of identified blastomeres in variable combinations. Ascidian embryos express cell-type-specific markers corresponding to their cell fates, even when cultured under cleavage-arrest by cytochalasin B. This system provides us with a unique opportunity to study the roles of cell lineage and cell contact in early neuronal differentiation in the absence of events associated with complex morphogenesis. In addition, the isolated, cleavage-arrested blastomeres are ideally suited to electrical recording, permitting the use of ionic channels as specific markers for differentiation. In the cleavage-arrested embryos, suppression of one type of K+ channel, and induction of two types of Na+ channels, occur following cell contact with the vegetal blastomere. The combination of molecular and electrophysiological analyses on this simple animal system may provide insights into the nature of the cell interactions important in early neurogenesis, both in ascidians and in vertebrates.

[Cardiac hemangioma of the interventricular septum and right ventricle: a case report]

A 52-year-old man who had been pointed out cardiac tumor on echocardiography, CT, MRI and coronary angiography was admitted to our hospital. He was asymptomatic. The surgical excision of the tumor was performed under extracorporal circulation and the postoperative period was free of event. It was not certain whether it originated from interventricular septum or right ventricle. The histology was mixed hemangioma composed of capillary and cavernous type.

[A case report of graft replacement of the ascending and transverse aorta without homologous red blood cell transfusion]

A 28-year-old man of DeBakey type I dissecting aneurysm was received graft replacement of the ascending and transverse aorta under the deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion for cerebral protection during circulatory arrest. From 3 weeks before operation, autologous blood was collected from the patient with the intravenous administration of a recombinant human erythropoietin (rHuEPO) and was subsequently used in the operation. As result, the graft replacement of the ascending and transverse aorta was performed without homologous red blood cell transfusion and postoperative neurological complications. We believe autologous blood transfusion with rHuEPO and circulatory arrest with CRCP contributes operations of aortic aneurysms without homologous blood transfusion.

Lymphoplasmacytic lymphoma in a stallion

Lymphoplasmacytic lymphoma found in a 6-year-old Anglo-Arabian stallion was investigated histologically, immunohistochemically and ultrastructurally. The animal showed a large mediastinal mass and generalized lymph node involvement. The neoplastic cells were in various differentiation stages of small lymphocyte, centrocyte, centroblast, immunoblast and plasma cell. Some neoplastic cells showed positive cytoplasmic reactivity for mu and lambda chains. There were well developed rough endoplasmic reticulum (RER) and Golgi complexes in plasmacytoid cells, and slightly developed RER or a few long strands of RER in medium-sized to large lymphoid cells. These findings suggest that this neoplasm is of B-cell origin.

[Recent advances in the molecular biology of voltage-sensitive Na+ channels]

Na+ channels play a crucial role in generating action potentials in neurones and other excitable cells. alpha-subunits, composed of four homologous repeats, are responsible for most of the Na+ channel properties. The combination of molecular biology with electro-physiological tools has proved useful for understanding the molecular mechanism of the channel function. Activation, inactivation and ion permeation occur, based on Segment 4, III-IV linker, the region intervened by Segment 5 and 6, respectively. Mutations in a human skeletal muscle Na+ channel gene cause heritable muscle disorders, hyperkalemic periodic paralysis and paramyotonica congenita. Future directions in Na+ channel studies may include gene regulation of the Na+ channel related to neural cell fate and subcellular localization of channel molecules concurrent with plasticity or development.

[A case of modified Fontan procedure for SLL single ventricular heart with bicaval total occlusion]

We successfully performed a modified Fontan procedure and bidirectional Glenn shunt for a 6-year-old boy with single ventricular heart (SLL). After the operation, the patient suffered from a severe pneumonia, so intravenous catheter had to be inserted for a long time. Post operative angiography revealed bicaval total occlusion. But, inspite of these several complications, this patient is doing well. We believe that if bilateral SVC without communication exist on such a candidate for the Fontan type procedure, LSVC should be anastomosed to PA. The bidirectional Glenn shunt will contribute to save a life of the patient when the systemic venous route was occluded. In addition, the anticoagulation therapy should be taken for the patients underwent the Fontan type procedure.

Neural induction suppresses early expression of the inward-rectifier K+ channel in the ascidian blastomere

1. Early expression of ion channels following neural induction was examined in isolated, cleavage-arrested blastomeres from the ascidian embryo using a two-electrode voltage clamp. Currents were recorded from the isolated, cleavage-arrested blastomere, a4-2, after treatment with serine protease, subtilisin, which induces neural differentiation as consistently as cell contact. 2. The inward-rectifier K+ current increased at the late gastrula stage shortly after the sensitive period for neural induction both in the induced (protease-treated) and uninduced cells. Ca2+ channels, characteristic of epidermal-type differentiation, and delayed-rectifier K+ channels and differentiated-type Na+ channels, characteristic of neural-type differentiation appeared much later than the inward-rectifier K+ channels, at a time corresponding to the tail bud stage of the intact embryo. 3. When cells were treated with subtilisin during the critical period for neural induction, the increase in the inward-rectifier K+ current from the late gastrula stage to the neurula stage was about three times smaller (3.67 +/- 1.74 nA, mean +/- S.D., n = 14) than in untreated cells (11.25 +/- 3.10 nA, n = 26). The same changes in the inward-rectifier K+ channel were also observed in a4 2 blastomeres which were induced by cell contact with an A4-1 blastomere. However, when cells were treated with subtilisin after the critical period for neural induction, the amplitude of the inward-rectifier K+ current was the same as in untreated cells. Thus the expressed level of the inward-rectifier K+ channel was linked to the determination of neural or epidermal cell types. 4. There was no significant difference in the input capacitance of induced and uninduced cells, indicating that the difference in the amplitude of the inward-rectifier K+ currents derived from a difference in the channel density rather than a difference in cell surface area. 5. The expression of the inward-rectifier K+ channel at the late gastrula stage was sensitive to alpha-amanitin, a highly specific transcription inhibitor. In both induced and uninduced cells, injection of alpha-amanitin at the 32-cell stage reduced the current density of the inward-rectifier K+ channel to about 2 nA/nF, corresponding to 13% of that recorded from uninjected cells. By contrast, the expression of the fast-inactivating-type Na+ current, which transiently increased along with the inward-rectifier K+ channel, was resistant to alpha-amanitin injection. 6. The dose of alpha-amanitin injected was controlled by monitoring co-injected fluorescent dye, fura-2.(ABSTRACT TRUNCATED AT 400 WORDS)

[Double valve replacement for secondary atrioventricular regurgitation due to dilated cardiomyopathy--a case report]

A successful surgical case of double valve replacement for a patient with dilated cardiomyopathy was performed. A 45-year-old man was admitted to our hospital with paroxysmal atrial fibrillation and congestive heart failure. Echo cardiogram and cineangiography showed dilatation and decreased contraction of the left ventricle. A diagnosis of dilated cardiomyopathy was established since neither coronary artery disease nor valvular disease were observed. He was treated with medication of diuretics and pacemaker implantation. However, mitral and tricuspid regurgitation occurred and progressed 7 years later. Since then, he repeated admission and discharge against the strong medication. He became medically uncontrollable at the age of 58. Because of this, surgical treatment had to be considered. Double valve replacement for mitral and tricuspid valve was performed on September, 1989. Avoidance of cardiopulmonary bypass was only possible with the aid of catecholamine. Poor left ventricular function and pleural effusion frequently shown on chest X-ray film complicated the postoperative course. And with hospital treatment, he discharged three months after the operation. He has been doing well without any significant complaint during the past two years and cardiomegaly has been decreasing as well.

[Study on the pharmacokinetics of cefepime (I)]

The pharmacokinetics of 14C-cefepime dihydrochloride (14C-CFPM), were studied in rats upon both single and repeated intravenous administration. 1. Blood level of radioactivity was 59.27 micrograms eq./ml at 5 minutes after single intravenous administration at a dose of 20 mg/kg, and declined biexponentially thereafter. The values of AUC and T 1/2 were 70.1 micrograms eq..hr/ml and 38.0 hours, respectively. 2. Blood level of radioactivity was 59.41 micrograms eq./ml at 5 minutes after administration on the 7th day of repeated intravenous administration at a daily dose of 20 mg/kg, and declined more slowly as compared to the case of single administration. The values of AUC and T 1/2 after repeated administration were 159.7 micrograms eq..hr/ml and 44.5 hours, respectively. 3. Urinary and fecal excretion rates after single administration were 93.3% and 3.3%, respectively. 4. Urinary and fecal excretion rates were almost constant throughout the repeated administration; 88.4-90.7% and 2.3-3.7%, respectively. 5. 14C-CFPM distributed rapidly to the whole body except to the central nervous system. Although the radioactivity was removed rapidly from tissues, high levels of radioactivity remained in the kidney and the spleen as compared to other tissues. 6. Tissue concentrations of radioactivity at 5 minutes after the final dose of repeated administration were about the same as those after single administration but they declined more slowly than those after single administration. High levels of radioactivity were found in the kidney and the spleen as were found upon single administration. The ratios of these levels between repeated and single dosing were 4.3 and 2.6 for kidney and spleen, respectively. 7. Data obtained with autoradiograms of the whole body were consistent with measured tissue distribution obtained in both cases of single and repeated administration.

[Intra-arterial infusion chemotherapy in locally recurrent breast cancer]

Intra-arterial infusion chemotherapy (IA) using implantable reservoir was performed in four locally recurrent breast cancers. The regimen consisted of several cycles of induction (1 cycle, 90-150mg: EPI) and the following maintenance infusion. The results were as follows. (1) D.F.I. of all cases were short and pre-treatment of 3 cases was not effective. (2) Clinical response was 2 CR and 1 MR. We confirmed that IA was an effective treatment for not only locally recurrence but also disseminated foci. (3) In 3 out of the four cases there was reduction of severe arm swelling. These findings suggested that IA using implantable reservoir was useful for the treatment of locally recurrent breast cancer in terms of anti-cancer effect and improved QOL.

[Study on the pharmacokinetics of cefepime (II)]

The pharmacokinetics of 14C-cefepime dihydrochloride (14C-CFPM), was studied in dogs after single intravenous administration at a dose of 20 mg/kg. Protein binding was also investigated both in vitro and in vivo. 1. Blood level of radioactivity was 83.53 microns eq./ml at 5 minutes after single intravenous administration and declined biexponentially thereafter. The values of AUC and T1/2 were 229 microns eq.(.)hr/ml and 90 hours, respectively. 2. Urinary and fecal excretion rates were 95.1% and 2.7%, respectively. 3. The in vitro protein binding at 1 to 100 microns/ml of drug concentration was 7.9 to 12.7% in rat, 12.4 to 18.6% in human, and 12.5 to 14.5% in dog. In vivo protein binding, which increased with time after administration, was 10.8 to 92.9% in rat and 17.5 to 64.9% in dog at 5 minutes to 6 hours.

[An emergency surgical case of double aortic arch with hemoptysis]

A 78-year-old man was admitted because of hemoptysis. CT and aortogram revealed double aortic arch. Bronchofiberscopy revealed intratracheal hemorrhage which was associated with right aortic arch. An emergency operation was performed to prevent massive intra-tracheal bleeding. The patient underwent ligation of the right aortic arch through median sternotomy. After operation, hemoptysis disappeared and the postoperative course was uneventful. Surgical cases of double aortic arch are rare, especially with critical hemoptysis in aged patients.

[Comparative studies of various conduits for myocardial revascularization with Kawasaki disease]

Between October 1976 and December 1991, 36 patients with Kawasaki disease underwent coronary bypass surgery. Comparisons were made from the postoperative morphologic condition of 4 conduits; saphenous vein graft (SVG n = 27), left internal thoracic artery (LITA n = 22), right internal thoracic artery (RITA n = 5) and gastroepiploic artery (GEA n = 8). The patency rate of arterial grafts was 100% at 1 month after surgery, and kept as high as 94.7% at 1-3 years after surgery. On the other hand, the patency rate of SVG was 90% at 1 month, but decreased to 52% at 1-3 years postoperatively. Arterial grafts sometimes showed string sign at 1 month after surgery, but the length and the diameter increased during 1 year after surgery. The internal thoracic artery showed superior flow potential compared with GEA. Thus, the internal thoracic artery is the first choice and GEA is the second as the graft material with Kawasaki disease. Long-term result of SVG was very poor, so coronary revascularization only by the arterial grafts is recommended.

[A case report of thrombosed Björk-Shiley valve in aortic position diagnosed using transtelephone PCG monitoring]

We report a successful elective re-AVR and MVR 10 years after AVR with aortic root enlargement and OMC. The patient was a 41-year-old woman. The diagnosis of thrombosed Björk-Shiley (B-S) valve was first suspected by transtelephone PCG monitoring and reconfirmed by the frequency analysis of prosthetic valve sounds and the aortography preoperatively. The thrombosis was 15 x 8 x 6.5 mm in size and located at the minor orifice of B-S valve, extending to the strut. The transtelephone PCG was useful in analyzing prosthetic valve sounds for patients especially living away from the hospital.

[Evaluation of chest wall resection in the patients with breast cancer involving chest wall]

Twenty-three patients with advanced or recurrent breast cancer involving bony chest wall were treated by extended full-thickness chest wall resection and immediate reconstruction. The results were as follows: 1) Distant metastases were found concurrently or subsequently in more than half of the patients. Therefore, we should regard chest wall lesions as a systemic disease. 2) Long term result was encouraging, with 73.9% local control rate. 3) Post-surgical prognosis of the patients with sternal metastasis and solitary chest wall lesions were favorable, in that order. 4) Both local control rate and survival of the patients with mediastinal invasion, however, were fairly poor. 5) Disease-free interval (D.F.I.) after mastectomy longer than 5 years correlated significantly with a long survival after chest wall resection. As a result, we confirmed that chest wall resection was the treatment of choice for the patients with long D.F.I. and solitary chest wall lesion without mediastinal invasion nor metastasis, but the postoperative systemic therapy was indispensable to improve the patient's survival.

[Disorder of serum electrolytes following CAP therapy]

Combination chemotherapy with Cyclophosphamide, Adriamycin and Cisplatin (CAP) is one of the most effective chemotherapies for ovarian cancer. Severe vomiting induced by this treatment may cause a disorder of the serum electrolytes. Severe hyponatremia was observed in one patient who complained of convulsions and unconsciousness. Accordingly we studied the disorder of serum electrolytes in 158 courses of CAP treatment (44 patients) during the five years from 1984 to 1988. The serum electrolytes were influenced by the amount of vomiting in this study. Consequently frequent examination of serum electrolytes is necessary during this treatment.

Spatial-temporal appearance of developing immunoreactive TRH neurons in the neuroepithelial wall of the diencephalon

Using an anti-pro-thyrotrophic hormone-releasing hormone (TRH) serum for immunohistochemical analysis, we examined the ontogenesis of TRH-producing neurons in the rat diencephalon, and distinguished three waves in the neurogenesis corresponding to the time and place of their origin. The first wave started on day 12.5 of embryonic age (E12.5); the neurons appeared within the neuroepithelium in both the anterior and posterior walls of the optic recess. These cells then migrated anteriorly into the marginal layer of the developing preoptic area (group 1 cells) and posteriorly into the hypothalamus (group 2 cells). The second and third waves occurred on E13.5-14.5 and E16.5-17.5, respectively. We named the cells that appeared in the neuroepithelium of the anterior portion of the hypothalamus as group 3 and 5 cells, and those in the posterior portion as group 4 and 6 cells. Group 1 and 3 cells generated the lateral and medial preoptic TRH neurons, and group 2 and 4 cells generated the cells in the lateral hypothalamic nucleus. Group 6 cells were involved in the development of the dorso-medial hypothalamic nucleus. Group 5 cells gave rise to the hypophysiotrophic secretory neurons in the parvocellular paraventricular nucleus. The cells derived from each cell group showed distinct morphological characteristics. These findings suggest that the ventricular wall of the hypothalamus is protomapped in a spatial-temporal manner to generate TRH neurons with distinct functional properties.

Developmental changes in delayed rectifier K+ currents in the muscular- and neural-type blastomere of ascidian embryos

1. Developmental changes in the amplitude, kinetic properties, tetraethyl-ammonium (TEA) sensitivity, and ion selectivity of the delayed rectifier K+ currents were investigated in differentiating muscular-type (M) and neural-type (N) blastomeres isolated from the early cleavage-arrested ascidian embryos, using conventional two-microelectrode voltage clamp techniques. 2. No voltage-sensitive outward K+ currents were found in either type of blastomere during the first 35 h of development at 9 degrees C. Thereafter the delayed rectifier K+ current became apparent. The peak amplitude of the K+ current in the M-blastomere increased abruptly from 50 to 60 h and tended to plateau after 60 h, while in the N-blastomere it continued to increase after initial emergence at around 35 h. 3. The threshold potential level of the K+ current in the M-blastomere was initially about -10 mV in a standard external solution (1 mM-K+ solution), but shifted towards the hyperpolarized direction until it reached a steady level at 45 h after fertilization. At the fully differentiated stages, the threshold was around -32 mV and -26 mV in the M- and N-blastomeres, respectively. 4. Throughout development, the reversal potential of the tail current changed with the external K+ concentration in both M- and N-blastomeres as expected for a K(+)-electrode. There was no significant difference in the selectivity ratios for the K+ channel between the two types of blastomeres. The relative selectivities were K+ (1.000): Rb+ (0.774): NH4+ (0.122): Na+ (0.074) and K+ (1.000): Rb+ (0.724): NH4+ (0.155): Na+ (0.074) in the M- and N-blastomeres, respectively. 5. Modified Scatchard plots of TEA-sensitivity data indicated a one-to-one reaction between TEA and the K+ channel. These plots revealed the presence of TEA-resistant K+ channels in addition to TEA-sensitive K+ channels in the M-blastomere, but revealed only TEA-sensitive K+ channels in the N-blastomere. The dissociation constant (Ki) values of these three types of K+ channel did not change during development. In the M-blastomere, the Ki of the TEA-sensitive K+ channel was 1.29 +/- 0.05 mM (mean +/- S.E.M., n = 31) and that of the TEA-resistant K+ channel was 1.4 +/- 0.1 M (mean +/- S.E.M., n = 31) at a test potential of 45 mV. The Ki value of the neural-type K+ current was 1.38 +/- 0.03 mM (mean +/- S.E.M., n = 20) at 45 mV.(ABSTRACT TRUNCATED AT 400 WORDS)

Further evidence of the presence of rat embryonic hypothalamic factors that induce the differentiation of gonadotrophic hormone-releasing hormone-containing secretory neurons

We examined the presence of factor(s) in the embryonic medial basal hypothalamus (MBH) that may influence nasal placode (NAP)-derived luteinizing hormone-releasing hormone (LHRH) neurons in determining their secretory phenotype. In this study, we performed organotypic culture and transplantation of the NAP from 12.5-day-old embryos of rats and vomeronasal organ (VNO) from 14.5-day-old embryos. Surgical operations, however, were performed on 16.5-day-old embryos. The NAP and VNO were cultured singly or with the MBH obtained from the embryos of the same age and, further, in a medium with a nerve growth factor or fibroblast growth factors. Although LHRH neurons were derived from the NAP and VNO in all the cultures, judging from numbers and cellular morphologies, the MBH was most effective. The VNO was transplanted into the third ventricle of adult female rats singly or with the cerebral cortex, the mesencephalon-myelencephalon complex, or the MBH from 14.5-day-old embryos. All the grafts gave rise to LHRH neurons, but the number of the neurons was far greater in the grafts cotransplanted with the MBH, in which the neurons projected long processes to blood capillaries and formed neurovascular complexes, the feature of which may suggest the occurrence of the secretory activity in the fibers. The animals were examined 5 days after the surgical operations. In rhinoectomized embryos, LHRH neurons were distributed throughout the brain in the same pattern as found in intact rats, showing normal cellular morphology. In the encephalectomized rats, immunoreactive LHRH cells were present only in the terminal ganglia. These findings indicate that the embryonal MBH has a factor (s) that is essential to the development of secretory LHRH neurons.

[A case of inflammatory breast cancer successfully treated with intra-arterial infusion of high-dose epirubicin]

A 56-year-old female with extensive inflammatory breast cancer was treated with intra-arterial infusion chemotherapy using a high dose of epirubicin. One cycle consisted of epirubicin; 150 mg (day 1, 4, 7) and daily administration of tamoxifen; 40 mg. After completion of 2 cycles of the regimen, both the main tumor and the extensive inflammatory skin lesion completely disappeared (CR). Hair loss, gastrointestinal disorders and leukopenia (nadir; 1,600) were the side effects encountered, but all of them were reversible. These findings suggested that dose-escalation of epirubicin was effective, and that cases with extensive skin involvement were also candidates for this modality.

[Clinical significance of a tumor marker NCC-ST-439 in breast cancer--a comparative study with CA 15-3, CEA and TPA]

We compared a new tumor marker NCC-ST-439 (ST-439) with CA 15-3, CEA and TPA for its clinical usefulness in 600 patients with breast cancer (81, primary; 49, recurrent; 470, non-recurrent), and confirmed the following results. The sensitivity of ST-439 (41.5%) was significantly higher (p less than 0.05) than that of CA 15-3 (26.2%), CEA (28.5%) and TPA (26.9%). The specificity of ST-439 (84.5%), however, was considerably lower (p less than 0.01) than these other three markers. In primary cases, the positive rate of ST 439 (34.6%) was significantly higher (p less than 0.05) than that of the other markers, and was remarkable in the early stage. As to the positive rate at the various metastatic sites, there were a few differences among these four markers. Because of no significant correlation among these markers, combination assay with ST-439, CA 15-3 and CEA showed an excellent sensitivity (57.7%). These results suggest that ST-439 is a useful tumor marker not only in monitoring the recurrence, but also in the diagnosis of primary cancer.

[A case of successful surgical repair for congenital corrected transposition of the great arteries associated with Ebstein's malformation and diverticulum of atrialized ventricle]

Congenital corrected transposition of the great arteries (C-TGA) is frequently associated with VSD and PS. Systemic atrioventricular valve regurgitation is also sometimes present in patients with C-TGA. It is though that left-sided A-V valve regurgitation is caused by the deformities of the tricuspid valve (TV) or intolerance of TV and the right ventricle (RV) against systemic pressure load. We had a patient with C-TGA associated with Ebstein's malformation. The patient suffered from congestive heart failure due to left-sided A-V valve regurgitation. In this case, the septal and posterior leaflets were displaced below the atrioventricular annulus. The edges of all valves were thickened and partially calcified. Focal agenesis was found in the septal leaflet. There was a distinct atrialized ventricle which had a thin wall and no trabeculae. It shaped like a diverticulum of 3 cm in depth toward the diaphragm. Preoperative cardiac catheterization showed that the functional RV had an adequate size (RVEDVI 162% of normal) and ejection fraction was 53%. Left-sided valve replacement was performed using SJM 31M with preservation of TV. Left-sided atrioventricular annulus was so deformed due to the diverticulum that the prosthetic valve was sutured at the ventricular wall below the atrioventricular annulus to which TV had attached. Good clinical result was obtained after surgical treatment.

Anti-bilirubin monoclonal antibody. III. Preparation and properties of monoclonal antibodies to unconjugated bilirubin-IX alpha

Anti-bilirubin-IX alpha monoclonal antibodies exclusively specific for unconjugated bilirubin-IX alpha are prepared and characterized. Using modified MBS (metamaleimidobenzoyl-N-hydroxysuccinimide ester) method, bilirubin-IX alpha was covalently coupled to bovine serum albumin (BSA) retaining its intramolecular hydrogen bonds as well as three-dimensional structure. Somatic cell fusion was performed between murine spleen cells immunized with the bilirubin-IX alpha-BSA and murine myeloma P3-X63-Ag8-U1 cells. After screening assay, 58 clones were identified which were producing antibodies not to albumin nor MBS, but to haptenic bilirubin-IX alpha. In inhibition analysis, the antibodies in the culture supernatant reacted only with bilirubin-IX alpha to a varying degree, but did not react with conjugated bilirubin-IX alpha, including bilirubin-IX alpha monoglucuronide, bilirubin-IX alpha diglucuronide, and ditauronic bilirubin-IX alpha.

Expression of blood group A and B antigens in nuclear heterochromatin in mucous cells of human cervical glands

Using a post-embedding immunogold labeling procedure, we found that monoclonal antibody against A (MAb-A) or B antigen (MAb-B) reacted with nuclear heterochromatin regions, as well as secretory granules, in mucous cells of human cervical glands. Systematic and critical observation of specimens from 24 individuals of different blood groups revealed that the labeling pattern with MAb with strictly dependent on the blood group (A,B, or O) of the donors, i.e., MAb-A reacted with the heterochromatin from blood group A and AB but not with B and O individuals. Labeling with MAb-B was also specific for the heterochromatin from blood group B donors. On the other hand, MAb against H antigen did not react with the heterochromatin from any individuals examined, despite the fact that H antigens were detected by the MAb in secretory granules. Such specific reactions provide evidence that certain types of blood group-related antigens exist in the nuclear heterochromatin in mucous cells of human cervical glands. In contrast to the secretory granules in which ABH antigens were recognized by blood group-specific lectin, heterochromatin regions had little or no affinity for these lectins. Furthermore, the secretory status of individuals affected the staining intensity with MAb in secretory granules but not in the heterochromatin. These results suggest that the blood group substances found in the heterochromatin may have different molecular properties from those in the secretory granules, although both have the same determinant structures of ABH antigens.

[A study on hyperprolactinemia in female patients with alcoholics]

The clinical signs and symptoms of sexual dysfunction with amenorrhoea, loss of libido and infertility, are frequently found in chronic alcoholic women. But few investigations have been made concerning hormonal changes in fertile aged women experiencing sexual dysfunction. In order to assess prolactin levels of fertile-aged women with alcoholism under 40 years of age-excluding those with liver cirrhosis were surveyed. We found that many of them (82.6%) had moderate elevations of plasma prolactin. Hyperprolactinemia is commonly associated with amenorrhoea and hypogonadism. An acute alcohol loading experiment was conducted on 6 healthy female volunteers in luteal phases of their menstrual cycles in order to evaluate the effects of alcohol on the hypothalamo-pituitary-ovarian axis. Evidence was obtained that alcohol intake caused transient hyperprolactinemia. The present results indicated that hyperprolactinemia can occur with high frequency among alcoholic women and this causes sexual dysfunction and ovarian dysfunction. The etiology of hyperprolactinemia could not be explained solely by the direct action of alcohol, rather, liver dysfunction must be implicated.

Changes in sodium channels during neural differentiation in the isolated blastomere of the ascidian embryo

1. The current density and the kinetics of voltage-sensitive sodium channels during neural differentiation were examined in the isolated, cleavage-arrested blastomere of ascidian embryos which contains presumptive neural regions. The macroscopic sodium current were measured with the two-microelectrode voltage-clamp technique and the single sodium channel currents were recorded with the patch-clamp technique under the cell-attached configuration. 2. The entire time course of sodium channel development could be divided into three phases from the current density and channel gating properties. 3. In the first phase, from fertilization to about 40 h, the density of the sodium channel current was from 8 to 50 microA cm-2. The channel gating properties were similar to those of the sodium channel in the egg cell except for a negative shift in the voltage dependence of the peak inward current, the steady-state inactivation, and the decay time constant. The sodium channels in this phase were classified as 'type-I' channels. 4. In the second phase (40-60 h after fertilization), the density of the sodium channel current increased from 20 to 800 microA cm-2. The curves of the I-V relationship and of the steady-state inactivation shifted in the positive direction by 5-10 mV. 5. At 45-55 h, when the rate of increase in the sodium current was greatest, as much as 40 microA cm-2 h-1, the decay time course of the sodium current became slowest. The time for the current to decline from the peak to the one-tenth of the peak (t 1/10) increased to about five times that in the first phase. After 55 h t 1/10 gradually decreased. 6. In this phase, steady-state inactivation curves showed two inflexion points at different levels of membrane potential and were fitted with a sum of two Boltzmann distribution curves with distinct parameters. The relative contribution of the component with its voltage dependence shifted in the positive direction tended to decrease with development. 7. On examining single-channel recordings, two types of sodium channel were identified in this phase. One type (type-II) showed frequent repetitions of open-to-shut states throughout a voltage step. The ensemble current of the type-II channel showed a slow decay, suggesting that this type of channel may underlie the markedly slow decay of the macroscopic current in this phase. The second type (type-III) had more late openings than the type-I channel but fewer than the type-II channel.(ABSTRACT TRUNCATED AT 400 WORDS)

Inactivation kinetics of the sodium channel in the egg and the isolated, neurally differentiated blastomere of the ascidian

1. Inactivation kinetics of the sodium channel was compared between the egg-type channel in the egg cell and the differentiated-type channel in the cleavage-arrested, neurally differentiated blastomere of the ascidian. The techniques of the two-microelectrode voltage clamp and the cell-attached patch clamp were used. 2. In both types of channel, the time course of inactivation development obtained with a two-pulse protocol at potentials from -40 to -60 mV could be fitted with two exponentials with distinctive parameters. 3. The time course of recovery from inactivation at potentials more negative than -70 mV was compared between the two types of channel. At -80 to -120 mV, a delay of recovery was evident in the egg-type channel, whereas no delay was observed in the differentiated type. 4. In both types of channel, the two time constants of the inactivation of the macroscopic current, derived from the measurements of inward current, inactivation development and recovery from inactivation, had a bell-shaped voltage dependency. The fast time constants had a peak at -55 mV in the differentiated type and -70 mV in the egg type. The slow time constants had a peak around -60 mV in both types. 5. At the single-channel level, the averaged current from the differentiated-type channel showed both fast and slow decays. The frequency of late openings was higher in the differentiated-type channel than in the egg type. 6. The voltage dependence of the decay time constant and the carried charge in the summed current of the single-channel events was found to be shifted in the negative direction by 10-30 mV, compared with that of the macroscopic current. 7. The possibility that the higher frequency of late openings in the differentiated-type channel might be derived from delayed activation was excluded, since first-latency histograms of the single channel were not significantly different between the two types of channel.

Experimental demonstration of optical field evolution in waveguide junctions by using a video camera observing system

We have experimentally proved the optical field evolution in waveguide junctions formed by potassium ion exchange in a glass substrate using a microcomputer assisted video camera observing system. The optical field profiles in various waveguide junctions such as Y- and X-junctions have been clearly observed. Most of the results support the predicted operation of the junctions.

Difference in the ability of blood group-specific lectins and monoclonal antibodies to recognize the ABH antigens in human tissues

Twelve different kinds of blood group-specific lectins have been used along with monoclonal anti-A, -B and -H antibodies for detecting the corresponding antigens in selected human tissues. Although most of the lectins recognized the antigens in the tissue sections examined, they displayed marked differences in their recognition patterns in certain tissues. Helix asparsa agglutinin (HAA), Helix pomatia agglutinin (HPA) and monoclonal anti-A antibody recognized A antigens in the mucous cells of salivary glands from blood group A or AB nonsecretor as well as secretor individuals, whereas Dolichos biflorus agglutinin (DBA), Griffonia simplicifolia agglutinin-I (GSA-I), Sophora japonica agglutinin (SJA) and Vicia villosa agglutinin (VVA) did not bind to them from nonsecretors. A antigens in endothelial cells, lateral membrane of pancreatic acinar cells and small mucouslike cells of submandibular glands from some individuals were likewise recognized by HAA and HPA but not by other blood group A-specific lections. In contrast, both HAA and HPA did not recognize the A antigens in mucous cells of Brunner's glands while other A-specific lectins and monoclonal anti-A antibody reacted specifically with the antigens. Such a difference was not observed with lectins specific for blood group B. However, the B antigens in Brunner's glands were recognized by these lectins but not with monoclonal anti-B antibody. The difference in labelling ability was also noted among the blood group H-specific lectins and monoclonal anti-H antibody in endothelial cells of blood vessels. Ulex europaeus agglutinin-I reacted with these cells irrespective of ABO and the secretor status of the individuals, while Anguilla anguilla agglutinin and monoclonal anti-H antibody reacted only with those cells from blood group O individuals. No reaction was observed with Lotus tetragonolobus agglutinin in these tissue sites. These results suggest a great diversity of blood group antigens in different human tissues.