[A surgical case of achalasia with empyema]

A 57-year-old man who had been complicated with achalasia for thirty years was admitted because of back pain and low grade fever. Chest X-p and Chest CT showed consolidation in the left lower lung field. His respiratory condition was diagnosed as lung abscess preoperatively. After systemic chemotherapy, surgical management was done for both achalasia and this inflammatory respiratory disease. In the operation by left thoracotomy, it was revealed that this case had empyema, not lung abscess. Thus decortication of left lung and esophagomyotomy were performed simultaneously. In the treatment of achalasia, respiratory complications due to aspiration may appear. In addition, it is sometimes difficult to distinguish empyema from lung abscess preoperatively. Therefore much care should be taken during operation in order to treat these respiratory diseases.

[Clinical application of the thoracic balloon for postpneumonectomy patients]

Pneumonectomy may result in complications such as continuous intrathoracic bleeding and mediastinal shift. We used a thoracic balloon made of silicone rubber in 15 postpneumonectomy patients in an attempt to prevent such complications. Two types of thoracic balloons were used in our series. Type 1 thoracic balloon is a simple balloon requiring cooperation with a drainage tube, and Type 2 is a combination balloon and drainage tube. During surgery, air was injected into the thoracic balloon through an air filter. After removal of the thoracic balloon, infusion of sulfur hexafluoride, SF 6, into the thoracic cavity was performed on the 7th to 10th postoperative days. Placement of thoracic balloons in the pleural space after pneumonectomy is a simple, safe and useful method of preventing both intrathoracic bleeding and mediastinal shift.

[Postoperative lung function in patients with funnel chest]

We evaluated the postoperative lung function determined by spirometry in 54 patients with funnel chest (48 males and 6 females: age range, 4-18 years). Thirty-one patients had sternal turnover as corrective surgery, while 23 had sternal elevation with absorbable PLA (polylactic acid) strut. The mean value of vital capacity as a percentage of predicted (%VC) was 97.3% before operation. %VC was decreased at 3 months (80.5%), 6 months (87.4%), 12 months (82.8%), 24 months (85.9%), and 36 months (77.7%) after the operation (p < 0.01). In patients who had sternal elevation, %VC was decreased at 3 months but not at 6 months, 12 months, 24 months, or 36 months after the operation, while %VC was decreased at any point after the operation in patients who had sternal turnover. No significant changes were seen in forced expiratory volume in one second as a percentage of predicted (FEV1.0%), nor in the ratio of residual volume to total lung capacity (RV/TLC). In conclusion, sternal elevation with PLA strut is a better corrective surgery for funnel chest than sternal turnover, because of its less lung function loss after the operation.

[Anesthetic management of a patient with hyperkalemic tubular acidosis]

We experienced the anesthetic management of a 72-year-old female with hyperkalemia, metabolic acidosis and renal insufficiency, undergoing right total hip replacement for rheumatic arthritis. She had been treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for last several years. Anesthesia was maintained with isoflurane 0.2-1.0% and nitrous oxide in oxygen supplemented with vecuronium. Continuous infusion of prostaglandin E1 0.05-0.10 microgram.kg-1 x min-1 and bolus infusion of 7.0% NaHCO3 during the operation were useful in controlling blood pressure, improving hyperkalemia and maintaining renal function. Postoperatively, she was diagnosed to have hyperkalemic tubular acidosis due to interstitial nephritis induced by NSAIDs.

Inhibition of leukocyte adhesion to endothelial cells of human umbilical vein by Y-24180, an antagonist of platelet-activating factor

Effect of Y-24180 (4-(2-chlorophenyl)-2-[2-(4-isobutylphenyl)ethyl]-6,9-dimethyl-6H- thieno [3,2-f][1, 2, 4]triazolo[4,3-a][1,4]diazepine), an antagonist of platelet-activating factor (PAF), on adhesion of leukocytes to endothelial cells of human umbilical vein was examined. Y-24180 inhibited the adhesion of guinea-pig peritoneal exudate cells activated by leukotriene B4 to endothelial cells in a concentration-dependent manner. WEB2086, another PAF antagonist, did not show the inhibitory effect. Inhibition by Y-24180 was not influenced by addition of PAF. Y-24180 had no effect on the expression of intercellular adhesion molecule-1 or endothelial-leukocyte adhesion molecule-1 on endothelial cells activated with interleukin-1 beta, while it suppressed the expression of CD18 antigen on human peripheral blood polymorphonuclear cells activated with leukotrien B4, inhibiting their adhesion to endothelial cells activated with interleukin-1 beta. In oxazolone-induced ear edema in mice, which involves delayed-type hypersensitivity with infiltration by inflammatory cells, Y-24180 dose-dependently inhibited the increase in ear weights, but WEB2086 did not. These results indicate that Y-24180 inhibits not only the actions of PAF but also the adhesion of leukocytes by suppressing the expression of CD18 antigen, inducing the inhibition of infiltration by inflammatory cells.

[Surgical treatment of metastatic lung tumors]

From January 1970 to March 1991, 72 operations in 55 patients (31 males and 24 females) with metastatic lung tumors were performed in our department. Their cumulative survival rates was 25.5% at five years. With analysis of the various prognostic factors, patients both with solitary metastases and without lymph node metastases had a good prognoses. However, even in patients with recurrent lung metastatic tumors, long time survival was achieved with reoperation in two patients. We concluded that reoperation with or without effective chemotherapies was effective in selected patients.

[Changes of plombage-operations in respiratory surgery]

The first plombage-operation for pulmonary tuberculosis was by Dr. Nagaishi (1947) and Dr. Wilson, who developed the plombage method employing hollow polymethylmethacrylate spheres. Although the method presented a relatively effective option at a time when no effective drugs were available, its use was discontinued because of such complications as lung injury, cavity-perforation, and empyema. Therefore, soft elastic resin materials, such as those used in sponge-plombage and air-plombage, replaced the hard resin materials. Each plombage method is associated with a certain medical historical period, in Japan. Still the "Kinchyu" method was used. However, the complication of chronic empyema with bronchopleural fistula was difficult to treat. A notable recent method is the pedicled omentum plombage method, which is effective in the treatment of patients who have not responded to standard operations. Finally there was surely a clinical significance in each medical historical period.

Cloning and expression of the epsilon 4 subunit of the NMDA receptor channel

The primary structure of a novel subunit of the mouse NMDA (N-methyl-D-aspartate) receptor channel, designated epsilon 4, has been revealed by cloning and sequencing the cDNA. The epsilon 4 subunit shares high amino acid sequence identity with the epsilon 1, epsilon 2 and epsilon 3 subunits of the mouse NMDA receptor channel, thus constituting the epsilon subfamily of the glutamate receptor channel. Expression from cloned cDNAs of the epsilon 4 subunit together with the zeta 1 subunit in Xenopus oocytes yields functional NMDA receptor channels. The epsilon 4/zeta 1 heteromeric channel exhibits high apparent affinities for agonists and low sensitivities to competitive antagonists. The epsilon 4 subunit is thus distinct in functional properties from the epsilon 1, epsilon 2 and epsilon 3 subunits, and contributes further diversity of the NMDA receptor channel.

[A case of so-called carcinosarcoma of the lung]

A 65-year-old male was admitted to our institute because of bloody sputum. A tumor in right S6 was detected by X-ray, CT and MRI. Bronchoscopic study showed that the right lower bronchus was occluded by the tumor, in which non-epithelial malignant cells were detected. Therefore right bilobectomy was performed. This tumor was a pedunculated endobronchial type measuring 6 x 4 x 3cm. Histologically, the tumor presented carcinomatous (squamous cell carcinoma and adenocarcinoma) and sarcomatous elements. Immunohistologically, many malignant cells were positively stained by vimentin and muscle-actin, which suggested differentiation from muscle components.

[A case of mediastinal liposarcoma]

Primary liposarcomas of the mediastinum are rare neoplasms comprising only 0.13-0.75% of mediastinal tumors. We report a case of liposarcoma arising in the right posterior mediastinum. A 74-year-old man without symptoms was admitted to our hospital for evaluation of an abnormal shadow on chest roentgenogram. Computed tomogram (CT) and magnetic resonance (MR) imaging revealed a mediastinal tumor. The tumor was surgically removed, and the diagnosis of well-differentiated liposarcoma was established. MR imaging was superior to CT in evaluation of tumor extent, but not in differential diagnosis as liposarcoma or lipoma.

Hepatitis virus infection (HBV and HCV) in eleven Japanese hemodialysis units

To evaluate hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in hemodialysis (HD) units, serum samples from 607 HD patients and 150 staff members at 11 HD units in Japan were collected, and were compared with those from 704 ordinary blood donors as a control. Serum samples subjected to a first generation ELISA for antibody to HCV (anti-C100-3) and were tested by ELISA for HB surface antigen (HBs-Ag), antibody to HBs-Ag, and antibody to HB core antigen (anti-HBc) as HBV markers. We also tested for HCV infection with a second generation ELISA (for antibodies to C22-3, C33c, and C100-3) in 120 HD patients and 30 staff members at 2 selected HD units. Of 607 HD patients, 104 (17%) were positive for anti-C100-3 and 221 (36%) for HBV markers, indicating a much higher prevalence of HCV and HBV infection among HD patients than among ordinary blood donors (0.9% and 18%, respectively). Of 159 patients without a history of blood transfusion, 17 (11%) were positive for anti-C100-3, showing that HCV infection can be acquired without transfusion. The incidence of anti-C100-3 varied from 0% to 53% at different HD units, and HBV markers varied from 17% to 50%. Our study detected a high prevalence of co-infection with HBV and HCV, suggesting that HCV infection may contribute to chronic liver dysfunction in HD patients. Out of 150 staff members, 3 (2%) were positive for anti-C100-3, whereas 25 (17%) were positive for anti-HBc (indicating prior HBV infection).(ABSTRACT TRUNCATED AT 250 WORDS)

Use of a carrier for quantitation of a new dihydropyridine calcium antagonist (OPC-13340) in human plasma by highly sensitive gas chromatography with negative-ion chemical ionization mass spectrometry

A sensitive gas chromatographic-mass spectrometric method for the quantitation of (+/-)-methyl 3-phenyl-2(E)-propenyl 1,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-pyridinedicarboxylate (OPC-13340, I), a new dihydropyridine calcium antagonist with a potent and long-acting antihypertensive and antianginal effect, was developed in order to elucidate its pharmacokinetics. Dihydropyridine calcium antagonist have been usually quantifed by this technique in the negative-ion chemical ionization mode. However, direct application of this method to quantify trace amounts of I in biological fluids completely failed, owing to its adsorption on the column and oxidation of its dihydropyridine ring. Human plasma containing I and (+/-)-[2H3]methyl 3-phenyl-2(E)-propenyl 1,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-pyridinedicarboxylate (II), the internal standard, was extracted with n-hexane-diethyl ether under weakly basic conditions (pH 8). In order to prevent adsorption of the compounds on the column, (+/-)-[2H5]ethyl 3-phenyl-2(E)-propenyl 1,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-pyridinedicarboxylate (III), an analogue of I, was added to the extracts as a carrier. In addition, this carrier was also effective in preventing the oxidation of I. The quantitation limit of I in human plasma by this method was found to be less than 30 pg/ml. Thus, the method is sufficiently sensitive to study the pharmacokinetics of I in humans.

[Endoscopic endobronchial metastasis]

Although the incidence of endobronchial metastasis in cases of extrathoracic tumors is 2 to 5 percent in autopsy reports, it is about 30 percent according to endoscopic examination (so-called endoscopic endobronchial metastasis). To confirm the nature of endoscopic endobronchial metastasis, we reviewed the records from 1980 to 1990, presuming the primary foci of metastasis. Of the 36 patients with metastatic pulmonary tumor, 6 (16.7%) were diagnosed as having endobronchial metastasis endoscopically. The primary tumors were colonic cancer (2), prostatic cancer (2), cancer of the tongue (1), and renal cell carcinoma (1). The chest X-ray findings were nodular shadow (3), atelectasis (2), and hilar lymphadenopathy with atelectasis (1). Three patients were treated by lobectomy and the others by systemic therapy alone. The presumed primary foci of metastasis were peripheral lung (3), mediastinal lymph node (1), and undetermined (2). The results of the present study suggest that so-called endoscopic endobronchial metastasis does not necessarily imply metastasis to the bronchial wall.

Peroxidase-negative and myelomonocytic antigen-positive acute leukemia

Between 1983-1988 bone marrow samples obtained from 195 peroxidase-negative leukemia patients were analyzed for their surface antigens. Thirteen of these patients (6.7%) had myelomonocytic-positive and lymphoid-negative antigens. These leukemic cells reacted with CD13 in eight patients, CD33 in seven, CD11 in six and CDw41 in two. In none of these patients did the leukemic cells react with CD1, CD2, CD3, CD4, CD5, CD8, CD10, CD19 or CD20. Leukemic cells from two patients were reactive with CD7. These leukemic cells demonstrated L2 morphology in 11 patients and L1 morphology in one patient. The leukemic cells from the final patient were diagnosed as those of leukemic transformation of myelodysplastic syndrome. Chromosomal abnormality was observed in approximately half of the patients examined (6/10). Cytochemical analysis revealed that the leukemic cells were negative for periodic acid Schiff stain but positive for acid phosphatase. The prognosis of these patients was markedly poor as compared to acute lymphocytic leukemia or typical peroxidase-positive nonlymphocytic leukemia. Complete remission was induced in only 30% of patients and duration of survival was short (4.7 months). This suggests that myelomonocytic antigen-positive peroxidase-negative acute leukemia is a distinct type of leukemia and may require more aggressive therapy to improve survival.

Paraganglioma of the posterior mediastinum: value of magnetic resonance imaging

A case of paraganglioma arising in the posterior mediastinum in a 29-year-old man diagnosed by magnetic resonance imaging is reported. Excision of mediastinal paraganglioma is often hazardous because of its rich vascular supply and tendency to involve surrounding structures. Magnetic resonance imaging is valuable for the preoperative diagnosis of this vascular tumor as well as for determination of its resectability and appropriate surgical procedure.

Purification of brush border membrane vesicles from rat renal cortex by size-exclusion chromatography

Size-exclusion chromatography with controlled pore glass (CPG) was used in the further purification of renal brush border membrane vesicles (BBMV) isolated by the Ca precipitation method. The BBMV obtained had an almost spherical shape and their average diameter was about 95 nm in isotonic solution. The specific activities of alkaline phosphate and leucine aminopeptidase in the BBMV preparation were increased 18- and 17-fold, respectively, over those in the crude homogenate. The uptake of D-glucose by the purified BBMV in the presence of a sodium gradient reached 8.53 nmol/mg protein at 20 s. These results indicate that CPG chromatography is suitable procedure by which to obtain purified renal BBMV of homogenous size and with high specific marker enzyme activity for use in the study of membrane transport.

A new tetracycline antibiotic with antitumor activity. I. Taxonomy and fermentation of the producing strain, isolation and characterization of SF2575

A new antitumor antibiotic SF2575 has been isolated from a culture filtrate of Streptomyces sp. SF2575. The molecular formula was determined to be C40H43NO15 by elemental analysis, mass and 13C NMR spectral analyses. The spectral data revealed SF2575 to be a new tetracycline antibiotic. It was active against Gram-positive bacteria and exhibited antitumor activity against P388 leukemia in mice.