The use of periodic acid-thiocarbohydrazide-silver protein-physical development (PA-TCH-SP-PD) procedure for the histochemical detection of neutral carbohydrates in the circumventricular organs of the rat

A periodic acid-thiocarbohydrazide-silver protein-physical development (PA-TCH-SP-PD) procedure was applied to the rat circumventricular organs (CVOs), which are known to be specialized structures in the brain. In the rat CVOs, vivid PA-TCH-SP-PD reactions were obtained in the apical surface and cytoplasm of the ependymal cells of the subcommissural organ (SCO) and the epithelial cells in the choroid plexuses (CPs) examined, and similar positive reactions were detected in the vascular walls and perivascular connective tissues in all the CVOs tested. Further, varying intensities of PA-TCH-SP-PD reactions were noted in the neuronal and glial networks of the organum vasculosum laminae terminalis (OVLT), subfornical organ (SFO) and area postrema (AP). The results obtained in the present study indicate that in the rat CVOs the histologic structures mentioned contain varying amounts of neutral carbohydrates and possible histophysiological significances of these carbohydrates in these organs have been discussed with references to their functions.

[Assessment of quality of life after transurethral resection of prostate for benign prostatic hyperplasia]

The quality of life (QOL) after transurethral resection of the prostate (TURP) was studied. A total of 113 patients were operated and released, and 86 (76%) cases responded to the TURP follow-up survey. The average age was 69 years and the average time elapsed after the operation was 220 days. Data regarding the patients undergoing TURP was gathered from a questionnaire consisting of 22 questions concerning the preoperative condition and 28 about the post-operative state. Performance status was not changed post-TURP. The patients showed improvements in nocturia, pollakisuria and dysuria. These urological symptoms were in accordance with the findings of uroflowmetry and American Urological Association Symptom Index. Ten questions addressing the patients mental and physical conditions revealed that good quality was generally retained. Sexual activity showed a tendency of gradual decrease in relation to increasing age. Ejaculatory function and actual satisfaction with the sexual act were obviously damaged by the operation. TURP showed no changes in regard to morning erection, sexual desire in an arousing atmosphere, penile hardness at sex and total satisfaction with the sexual life. Social life, family life and mental status were not influenced, but the physical status of 21 (26%) of the patients was decreased by the operation and hospital stay. Over all, 78% of the patients could maintain a good quality of life in post-TURP.

[A case of successful surgical treatment for coarctation of the aorta associated with ruptured cerebral aneurysm]

We present a case of a sixteen year old boy with coarctation of the aorta who suffered ruptured cerebral aneurysm. Both cerebral and aortic lesions were successfully corrected. He complained of sudden headache and nausea. Subarachnoid hemorrhage was diagnosed by computed tomography of the head. Cerebroangiography demonstrated coarctation of the aorta. Clipping of cerebral aneurysm was done at first, then three months later, complete resection of the aortic coarctation and artificial graft replacement was done by using femoral veno-arterial cardiopulmonary bypass.

Use of immobilized histidine in assay for endotoxin in patients with liver disease

The Limulus amebocyte lysate (LAL) test has the disadvantage of being influenced by various inhibitors and activators. We have developed a method for the LAL reaction that involves the specific adsorption and isolation of endotoxin using a membrane filter unit and immobilized histidine; in this present study we used the method to measure endotoxin in the plasma of patients with acute or chronic liver disease. The adsorbed endotoxins are separated from LAL-inhibitors or -activators by the membrane filter unit, and their activity is directly assayed with the LAL reagent in a filter cup without any inhibition or activation. The study population consisted of 23 subjects, 3 with fulminant hepatitis and 20 with cirrhosis (9 with esophageal varices and 11 without). All 3 (100%) of the samples of plasma from patients with fulminant hepatitis were positive for endotoxin, as were the samples of 7 (78%) of the 9 patients with cirrhosis and esophageal varices, and 2 (18%) of the 11 patients with cirrhosis but without such varices. The results suggested that this method appears to be useful for assaying the concentration of endotoxin in patients with fulminant hepatitis or cirrhosis of the liver.

[Redo operations for dissecting aortic aneurysm]

We reoperated twenty-four times upon twenty cases of dissecting aortic aneurysm since 1983. Nine of them (45%) were Marfan patients. Reoperations on the same part of the aorta as the prior procedure was done 15 times upon 13 cases with six hospital deaths (40%). Reoperations on the different part of the aorta from the prior operation was done 9 times on 9 cases with one hospital death (11%). Over all hospital mortality rate was 29%. The hospital mortality rate for Marfan patients (8%) was significantly better than that for non-Marfan patients (50%).

Effects of iodine pretreatment of sections upon immunogold-silver staining in light microscopic immunohistochemistry

Effects of Lugol's iodine pretreatment upon immunogold-silver staining were examined in terms of the intensification of the reaction products obtained by physical development. Iodine pretreatment has diminished the duration necessary for the development, whereas the staining reaction of an appropriate intensity, could hardly be obtained by the pretreatment. In addition, essential staining reactions tended to be accompanied by marked nonspecific silver precipitations. It is concluded that iodine pretreatment should either be omitted or used with cautions in immunogold-silver staining procedures for the precise detection of antigenic sites.

Mediastinal lymph node metastasis 38 months after surveillance for stage I seminoma: a case report

We present a case report of a relapse to the mediastinal lymph node alone, 38 months after orchiectomy on surveillance for stage I typical seminoma. The patient, a 63-year-old man, was treated with high inguinal orchiectomy for left testicular tumor and close follow-up. After 38 months from the initial treatment, the chest X-ray film and CT scan revealed mediastinal tumor. Fine needle aspiration cytology performed under the bronchoscopy showed seminoma cells. Complete remission was achieved after three courses chemotherapy of cisplatin, vincristine, methotrexate, peplomycin and etoposide (COMPE). He has continued to be clinically disease-free 8 months after completion of the treatment. According to the available data in the literature, 94% of the recurrences was detected within 3 years after orchiectomy, and 92% involved retroperitoneal lymph node metastases. This is a rare case who had a late relapse in the mediastinum alone.

[Management of voiding dysfunction in elderly patients: effectiveness of rehabilitation and familial care]

We examined whether the improvement of impaired mobility correlates with the success rate in achievement of catheter-free or diaper-free status of 260 hospitalized elderly patients whose activities in daily life (ADL) were impaired and urinary tract dysfunctions including urinary incontinence were managed by indwelling catheters or diapers. The contribution of physical rehabilitation and/or care given by family to the improvement of impaired mobility was also investigated. All 154 patients whose ADL improved during the course of the treatment acquired the catheter-free or diaper-free status. Of 106 patients whose ADL did not improve, 85 patients became free of catheters or diapers. All of the remaining 19 patients who continued to be dependent upon catheter or diapers had been bed-ridden during the course of the treatment. Among 201 patients who were bed-ridden before the treatment, the success rate in the improvement of impaired ADL in 84 patients who underwent physical rehabilitation and received care given by family, was 83%. The ADL improved in 71% of the 70 who received rehabilitation and 53% of 17 bed-ridden patients who received familial care. By contrast, only 2 out of 30 patients who received neither of them were free from the bed-ridden condition. The remaining 28 patients continued to be bed-ridden, and the 19 cases who were not free of indwelling catheters or diapers were a part of this population of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Management of voiding dysfunction in elderly patients: prognosis 1 year after discharge from hospital]

We investigated how 293 elderly patients who had been successfully treated to be free of catheters or diapers managed to urinate one year after their discharge from our hospital. Of 192 patients who returned to their own home 154 (80%) had good activities in daily life (ADL), and of 101 who moved to a nursing home or other hospital only 7 (7%) had good ADL. Among the 192 in their own home, 151 (79%) remained free of catheters or diapers thanks to the home care services provided by trained nurses belonging to our hospital. However, among the 101 at other facilities 21 (21%) could avoid these appliances. Furthermore, those who stayed in their own home with poor ADL had a significantly higher rate of being independent of catheters or diapers (34%) compared to those who lived in facilities other than their home with poor ADL (13%). These findings indicate that the elderly patients who reside in their own home or have good ADL possess a better chance of avoiding catheters or diapers compared to those who live in other than their residence or have poor ADL, and that continued urological care coupled with the home-visiting services is effective and important in attaining these aims.

Studies on chemical modification of monensin. V. Synthesis, sodium ion permeability, antibacterial activity, and crystal structure of 7-O-(4-substituted benzyl)monensins

7-O-(4-Substituted benzyl)monensins (3a-g) were synthesized from monensin (1), and their lipophilicity, antibacterial activity, and Na+ ion permeability were examined. 7-O-(4-Ethylbenzyl)monensin (3e) showed the largest Na+ ion permeability, but 3c,f,g showed smaller Na+ ion permeability than 7-O-benzylmonensin (2) in spite of higher lipophilicity. An X-ray study of the sodium salt of 3e revealed that the benzyl group was located over the position between the D and E rings, and that the ethyl substituent on the benzyl group was close to the C(28) methyl group on the E ring.

[13-week oral toxicity study of lactitol (NS-4) in dogs followed by 4-week recovery test]

13-week repeated dose toxicity studies were conducted on lactitol, a hepatic encephalopathy drug. In the experiment I, male and female dogs were orally treated with lactitol at doses of 0, 1.0, 2.5 and 6.25 g/kg/day for 13 weeks, followed by 4 weeks recovery period. In the experiment II, male and female dogs were orally treated with lactitol at doses of 0, 0.25, 0.50 and 1.0 g/kg/day for 13 weeks in order to require the no-toxic dose.

RESULTS

1. Soft stool and diarrhea were observed at the 0.50 g/kg group and above, and vomiting was observed at the 1.0 g/kg group and above. Increased water consumption was observed at the 6.25 g/kg group. No deaths occurred at all groups. 2. In urinalysis, increased urine volume was observed at the 6.25 g/kg group. 3. Blood chemistry showed decreased BUN at the 6.25 g/kg group. 4. There were no drug-related changes in body weight, food consumption, ophthalmological examination, electrocardiography, hematology and pathology. 5. At the end of the recovery period, all these changes observed at the end of the administration period were disappeared. Based on these results, it was considered that the no-toxic dose of lactitol is 0.25 g/kg/day.

Clinical significance of urinary enzymes and beta 2-microglobulin following ESWL

To examine the renal damage caused by shock waves, urinary excretion of enzymes and beta 2-microglobulin were determined before and after ESWL. Urine samples were obtained from 35 patients with renal stone and 26 patients with ureteric stone treated with ESWL. Urinary lactate dehydrogenase (LDH) levels significantly increased on day 0, just after ESWL, in both groups. In the ureteric stone group the kidneys received less shock waves than in the renal stone group. Increased urinary lactate dehydrogenase was considered to have derived from erythrocytes in urine. Elevated urinary N-acetyl-beta-D-glucosaminidase (NAG) levels were also observed on day 0 after ESWL in both groups, due to unknown reasons. Indirect effect of ESWL through the sympathetic nervous system or humoral factors may contribute to increases in the urinary excretion of NAG. No significant increase was found in urinary gamma-glutamyl-transpeptidase (GGTP) levels for 5 days after ESWL. Urinary beta 2-microglobulin (BMG) levels increased on day 0 in the renal stone group alone. In our present study, the clinical significance of urinary enzymes and BMG was not well evaluated, because urinary excretion of these indicators following ESWL were transient and mild.

Progression of bone disease without deterioration of hematological parameters in a child with Gaucher disease during low-dose glucocerebrosidase therapy

Gaucher disease is the most prevalent lysosomal storage disease. Although the efficacy of the macrophage-targeted human placental glucocerebrosidase is well known, it is still difficult to develop definitive guidelines regarding the appropriate therapy schedule. We describe an 8-year-old Japanese boy with Gaucher disease who had avascular necrosis of the right femoral head without deterioration of hematological variables during low-dose enzyme replacement therapy (12-13 IU/kg). This case demonstrates that continuous normal hematological findings may not preclude progression of other aspects of Gaucher disease in some patients during enzyme replacement therapy.

[52-week oral toxicity study of lactitol (NS-4) in dogs followed by 9-week recovery test]

Five male and 5 female beagle dogs were orally given lactitol, a hepatic encephalopathy drug, for 52 weeks at doses of 0, 0.25, 1.25 or 6.25 g/kg/day. A 9 week recovery test was conducted after the discontinuation of the drug treatment. Soft stool, diarrhea, and vomiting were seen in the 1.25 and 6.25 g/kg groups. In the 6.25 g/kg group, bloody stool and increased water consumption were also observed. Urinalysis showed larger amount of the urine volume in the 6.25 g/kg group. The cecum weight of this group was increased without any morphological changes. There were no drug related effects on survival, body weight gain and food consumption. Electrocardiographic, ophthalmoscopic, hematologic and biochemical examinations failed to show any abnormalities related to the drug treatment. The above mentioned changes were satisfactorily reversible. Based on the results obtained, the NOAEL of this study was suggested to be 0.25 g/kg/day.

Identification of the complement iC3b binding site in the beta 2 integrin CR3 (CD11b/CD18)

The divalent cation-dependent interaction of the beta 2 integrin CR3 (CD11b/CD18) with the major complement opsonic C3 fragment iC3b is an important component of the central role of CR3 in inflammation and immune clearance. In this investigation we have identified the iC3b binding site in CR3. A recombinant fragment representing the CR3 A-domain, a 200-amino acid region in the ectodomain of the CD11b subunit, bound to iC3b directly and in a divalent cation-dependent manner. The iC3b binding site was further localized to a short linear peptide that also bound iC3b directly and inhibited iC3b binding to the A-domain as well as to CR3 expressed by human neutrophils. These data establish a major recognition function for the integrin A-domain and have important implications for development of novel antiinflammatory therapeutics.

[Preliminary clinical results of surgery for type A acute aortic dissections using gelatin-resorcin-formaldehyde glue]

We used gelatin-resorcin-form-aldehyde (GRF) glue to fuse the false lumen of type A acute aortic dissection in four patients. All were operated on within 3-24 hours after onset, and gluing of the two cylinders of the dissecting aorta could be done safely in a short time. Initial intimal tears were located in the transverse aorta in three patients and in the proximal descending aorta in one. Simple transection and end-to-end anastomosis of the ascending aorta was done for the first two cases. But in the last two patients, we resected the intimal tear in the transverse aorta and applied GRF glue to the stump of the aortic arch and to that of the aortic root, followed by graft replacement of the ascending aorta. There were no hospital deaths. But we had to reoperate on one patient five months after the first operation due to potentially residual dissection in the aortic root. GRF glue is a very useful adhesive for acute aortic dissection operations, but further refinement of the operative technique using it is necessary.

In vivo function of surfactants containing phosphatidylcholine analogs

Increased phospholipase A2 activity demonstrated in some forms of lung injury may contribute to surfactant dysfunction. Phospholipase A2-resistant analogs of dipalmitoylphosphatidylcholine (DPPC) with surfactant properties might therefore be useful lipid components of treatment surfactants for certain lung injuries. The in vivo function of surfactants containing DPPC or the phospholipase-resistant analogs dihexadecylphosphatidylcholine (DEPC) or dihexadecylphosphonotidylcholine (DEPnC), with or without surfactant proteins B and C (SP-B+C), was thus evaluated in preterm rabbits (27 days' gestation). Rabbits randomly received one of seven surfactants (DPPC, DEPC, DEPnC, DPPC+SP-B+C, DEPC+SP-B+C, DEPnC+SP-B+C, or lipid extract surfactant [LES]) or 0.45% NaCl (control) and were ventilated for 30 min. Lipid-only surfactants decreased ventilatory pressures (peak inspiratory pressures minus positive end-expiratory pressure) relative to control (p < 0.05). Addition of SP-B+C further decreased ventilatory pressures to levels similar to LES (p < 0.01 versus control, lipid-only surfactants). Lung dynamic compliances and postventilation pressure-volume curves improved in the following order: LES, SP-B+C lipid surfactants > lipid-only surfactants > control (p < 0.05). All surfactant preparations decreased intravascular 125I-albumin recoveries in the lungs relative to control (p < 0.01 for all surfactants versus control). These results indicate that DEPC and DEPnC were as effective as DPPC as lipid components of synthetic surfactants. And like DPPC, the analogs interacted with isolated SP-B+C and improved in vivo function to levels comparable to LES.

[A case of thoracoscopic pulmonary lobectomy for lung cancer]

A case of thoracoscopic right lower pulmonary lobectomy is reported. A 79-year-old man was admitted to our hospital after the accidental finding of a right pulmonary growth. A computed tomography (CT) scan of the thorax confirmed the presence of a neoplasm, 2.5 cm in diameter, at the posterior-basal segment of the right lower lobe. Considering the general condition of the patient and the characteristics of the lesion, we decided to perform a assess the possibility of a thoracoscopic lobectomy instead of the traditional posterolateral approach. The pulmonary artery was dissected with the new endoscopic cherry dissector, and ligated with the polyester suture material and Endo Clip then dived with Endo scissors. The lower pulmonary vein was dissected with this endoscopic cherry dissector and divided with Endo GIA 30 clamping the new thoracoscopic De Bakey type vascular clamp. The specimen was extracted through the minimal thoracotomy (15 cm). The postoperative course was uneventful with minimal postoperative pain, and the patient was discharged after complete surgical recovery with excellent functional and cosmetic results.