[Surgical treatment of pulmonary aspergillosis]

We studied clinically upon 10 surgical cases of pulmonary aspergillosis. There were 7 male and 3 female cases, and the median age was 59 years. Seven cases had underlying bronchopulmonary diseases, and 9 cases had underlying diseases including systemic diseases, such as diabetes mellitus. There were 3 wedge resections, and 6 lobectomies, and 1 two-staged surgery (cavernostomy + muscle transposition). Eight cases whose lesion extended beyond neither chest wall nor mediastinal pleura were treated successfully by pulmonary resections almost within one lobectomy. One case, who had a cavitary lesion and multiple patchy infiltrates in the other lobes, cured by lobectomy including a main cavitary lesion and postoperative treatment with an antifungal agent. All cases returned home almost uneventfully, but 1 case of two-staged surgery died at home suddenly of massive hemoptysis. Surgical treatments of pulmonary aspergillosis are recommended when the lesions can be resected completely, that is, when patients are relatively well, lesions extend beyond neither chest wall nor hilar bronchus or vessels, and when the lungs other than the lesions are not extensively destroyed.

Chemical composition and antifungal properties of essential oils of three Pistacia species

The chemical composition of essential oils obtained from the leaves of Pistacia vera, Pistacia terebinthus, Pistacia lentiscus and the resin of Pistacia lentiscus were analyzed by GC and GC-MS. alpha-Pinene, beta-pinene, limonene, terpinen-4-ol and alpha-terpineol were found to be the major components. The antifungal activities of the above oils and P. lentiscus resin (total, acidic and neutral fractions) against the growth of three agricultural pathogens, Pythium ultimum, Rhizoctonia solani and Fusarium sambucinum were evaluated. Some doses of P. terebinthus, P. vera and P. lentiscus leaf oils and total and neutral fraction of P. lentiscus resin significantly inhibited the growth of R. solani. However, all samples did not show antifungal activity against P. ultimum and F. sambucinum, but increased the growth of F. sambucinum.

Epidermoid cyst of an accessory spleen at the pancreatic tail: diagnostic value of MRI

We report a rare case of an epidermoid cyst in an accessory spleen at the pancreatic tail. Only 12 cases have been reported. Among the different diagnostic modalities, magnetic resonance imaging was most useful for the differential diagnosis. Precise imaging of the cyst wall and its comparison with the surrounding organs are essential.

Assessment of risk of infection due to Cryptosporidium parvum in drinking water

The risk of infection of Cryptosporidium via drinking water was assessed using Monte Carlo simulation with the field survey data of the Sagami River watershed. The levels of Cryptosporidium in this river were found to follow the lognormal distribution. From the counted data, the median level of the Miyayama sampling point was estimated to be 5.7 oocysts per 100L. To calculate the annual risk of infection due to Cryptosporidium in drinking water, the Cryptosporidium level of Miyayama sampling point was used as the water source of the waterworks. The 95% percentile of the annual risk of infection was found to be 10(-2.60). If the daily risk was eliminated when the level of Cryptosporidium in treated water exceeded 1 oocyst per 20L, the 95% percentile of the annual risk was reduced by about 1 log. To reduce the 95% value of the annual risk lower than 10(-4), the risk of days with levels of Cryptosporidium in treated water exceeding 1 oocyst per 80L should be eliminated.

Transcription analysis of rpoH in Pseudomonas putida

We previously determined the complete DNA sequence of the rpoH gene encoding the heat-shock sigma factor (sigmaH) of Pseudomonas putida. In the present study, the transcriptional start sites of rpoH were determined to be 41 nucleotides (T1), 153 nucleotides (T2) and 157 nucleotides (T3) upstream from the translational start codon (AUG) of rpoH by rapid amplification of cDNA 5'-ends. Based on the locations of T2 and T3, a sigma70-type promoter (P2) was determined to be located in the open reading frame region of upstream ftsX in addition to the sigmaE-type promoter (P1; DNA Res. 6 (1999) 241). In the in vitro transcription assay with reconstituted RNA polymerases (Esigma70, EsigmaE, EsigmaH and EsigmaS) of Pseudomonas aeruginosa, EsigmaE transcribed rpoH from T1 and Esigma(70) transcribed it from T2 and T3. In both cases, the level of transcription was higher at 42 degrees C than at 30 degrees C. No transcript was detected when EsigmaH or EsigmaS was used. These results indicate that EsigmaE and Esigma70 recognize P1 promoter and P2 promoter, respectively, and also prove that the synthesis of rpoH mRNA is inducible upon heat shock.

Dynamic magnetic resonance imaging of femoral head perfusion in femoral neck fracture

A prospective followup study of 36 femoral neck fractures according to the assessment of femoral head perfusion using dynamic magnetic resonance imaging is reported. Patients were divided into three groups based on the dynamic magnetic resonance imaging findings (dynamic curve pattern and relative enhancement ratio) that were conducted within 48 hours of the injury. Traction was used to achieve anatomic reduction and to prevent additional damage to vascularity until minimally invasive internal fixation could be done. The fractures of all 17 patients whose femoral head perfusion was normal (Type A; n = 11) or was impaired but not totally absent (Type B; n = 6) healed without complications. Among the 19 patients whose femoral head perfusion was absent (Type C), 15 had complications (osteonecrosis, n = 10; nonunion, n = 5). Assuming that fractures with a Type A or Type B curve pattern would unite successfully and that those with a Type C curve pattern would not, the sensitivity, specificity, and accuracy of the predictions of successful osteosynthesis of the femoral neck fractures using this method were 81%, 100%, and 89%, respectively. The current classification of femoral neck fractures using dynamic magnetic resonance imaging may be useful in selecting an appropriate treatment method for the fractures.

Sesquiterpene coumarins from the roots of Ferula assa-foetida

From the chloroform extract of the roots of Ferula assa-foetida, two sesquiterpene coumarins designated assafoetidnol A and assafoetidnol B were isolated, in addition to six known compounds, gummosin, polyanthin, badrakemin, neveskone, samarcandin and galbanic acid. The structures of the sesquiterpenes new compounds were established by spectroscopic methods.

[Anterior chest wall reconstruction with myocutaneous flap after open drainage for infectious bulla and empyema following T4 lung cancer resection via anterior approach]

A 48-year-old man with T4 lung cancer underwent resection of the right upper lobe, chest wall, and superior vena cava, and reconstruction of the last 2 tissues via anterior approach after induction chemo-radiotherapy. However, a bulla in the apical segment of the lower lobe divided by stapling was infected after the operation, and open drainage through the anterior chest wall was mandatory due to massive air leak and spread of infection to the pleural space. As the incision were fortunately restricted in the anterior chest, he could undergo successful reconstruction of a full-thickness defect of the anterior chest wall using a serratus anterior muscle flap and a myocutaneous flap of lattissimus dorsi with minimum rib resection after 2 months. He has in regular work with a small limitation of raising the right upper extremitus these 7 years.

Eel urea transporter is localized to chloride cells and is salinity dependent

Urea transporters (UTs) in the ureotelic vertebrates have been well-characterized, but little is known about those of the ammonotelic teleost fishes. To clarify the physiological roles of UTs in the ammonotelic teleosts, we determined the structure, tissue and cellular localizations, and regulation of expression of eel UT (eUT) by cDNA cloning, Northern analysis, and immunohistochemistry. A full-length cDNA (approximately 1.9 kb) coding for a UT of 486 amino acid residues was isolated from a seawater eel gill cDNA library. Sequence comparison with those of other species indicated that the eUT is a short isoform with 10 transmembrane spans and has longer NH2- and COOH-terminal cytoplasmic tails compared with the mammalian counterparts. Northern blot analysis demonstrated high expression of eUT mRNA confined in the gill and a substantial increase of its levels when eels were transferred from freshwater to seawater. Immunohistochemistry showed that eUT is localized on the basolateral membranes of the chloride cells, establishing, at the cellular level, the site of urea excretion in the eel, an ammonotelic teleost.

Transgenic medaka overexpressing a melanin-concentrating hormone exhibit lightened body color but no remarkable abnormality

Melanin-concentrating hormone (MCH) is a cyclic heptadecapeptide that concentrates melanin granules in the melanophores and lightens the body color of a fish. To investigate the utility of MCH as a reporter gene, a transgenic medaka strain overexpressing the MCH gene was established and its phenotypic features were examined. The salmon MCH gene driven by cytomegalovirus promoter was injected into 100 fertilized eggs of the HNI-1 medaka strain, which exhibits black body color. One F(0) female transmitted the transgene and a lightened body color phenotype to the F(1) generation. A homozygous transgenic strain was established by crossing F(2) fish homozygous for the transgene. Expression of the transgene was detected in several organs by Northern blotting. The melanin granules of transgenics were highly shrunk. Bioassay using scales confirmed the secretion of MCH into blood, and the MCH concentration was estimated between 0.5 and 5 microM. Development, growth, feeding behavior, and reproduction of transgenics did not differ significantly among transgenic and nontransgenic siblings. The result whereby enhanced MCH expression induced a change in body color, but no remarkable abnormality, suggests the usefulness of MCH as a novel reporter gene with unique features.

Expression of E-Cadherin and Lymph Node Metastasis in Resected Non–Small-Cell Lung Cancer

This study was conducted to clarify the relationship between E-cadherin expression on tumor and lymph node metastasis as well as its prognostic roles in resected non-small-cell lung cancer. Two hundred forty-nine patients, who underwent surgical resection (stage I-IIIA), were examined. Paraffin-embedded sections of the primary tumors in all cases and of the metastatic lymph nodes in stage IIIA disease were stained with a monoclonal antibody against E-cadherin. Decreased expression of E-cadherin correlated with pathologic stage, tumor size, lymph node metastasis, and histological grade. The 5-year survival rate of E-cadherin-negative patients with stage IIIA disease was significantly lower than that of E-cadherin-positive patients. Multivariate analysis in stage IIIA disease indicated that E-cadherin was an independent prognostic factor. In the patients with clinical N0 tumors, the frequency of pathological N2 tumors was significantly higher in cases where the primary tumor was recognized as E-cadherin expression negative than in cases where the primary tumor was recognized as positive. Decreased E-cadherin expression showed correlation with presence of lymph node metastasis in resected non-small-cell lung cancer and with the prognosis of patients with stage IIIA disease.

Determination of pyrimidine dimers in Escherichia coli and Cryptosporidium parvum during UV light inactivation, photoreactivation, and dark repair

UV inactivation, photoreactivation, and dark repair of Escherichia coli and Cryptosporidium parvum were investigated with the endonuclease sensitive site (ESS) assay, which can determine UV-induced pyrimidine dimers in the genomic DNA of microorganisms. In a 99.9% inactivation of E. coli, high correlation was observed between the dose of UV irradiation and the number of pyrimidine dimers induced in the DNA of E. coli. The colony-forming ability of E. coli also correlated highly with the number of pyrimidine dimers in the DNA, indicating that the ESS assay is comparable to the method conventionally used to measure colony-forming ability. When E. coli were exposed to fluorescent light after a 99.9% inactivation by UV irradiation, UV-induced pyrimidine dimers in the DNA were continuously repaired and the colony-forming ability recovered gradually. When kept in darkness after the UV inactivation, however, E. coli showed neither repair of pyrimidine dimers nor recovery of colony-forming ability. When C. parvum were exposed to fluorescent light after UV inactivation, UV-induced pyrimidine dimers in the DNA were continuously repaired, while no recovery of animal infectivity was observed. When kept in darkness after UV inactivation, C. parvum also showed no recovery of infectivity in spite of the repair of pyrimidine dimers. It was suggested, therefore, that the infectivity of C. parvum would not recover either by photoreactivation or by dark repair even after the repair of pyrimidine dimers in the genomic DNA.

The prognostic significance of malignant pleural effusion at the time of thoracotomy in patients with non-small cell lung cancer

Surgery is usually not indicated for malignant pleural effusion (PE) due to its poor prognosis. However, PE is first detected at thoracotomy, and it is difficult to judge an appropriate mode of resection. Forty-nine patients with lung cancer were first diagnosed as PE and/or pleural dissemination (PD) at thoracotomy. The histological types were 36 adenocarcinoma, ten squamous cell carcinoma and three large cell carcinoma. Sixteen patients had only PE, 17 had only PD, and 16 had both PE and PD. Ten patients underwent only exploratory thoracotomy, seven partial resection, 27 lobectomy and five panpleuropneumonectomy. The overall survival rate was 26.7% at 3 years. The patients with PE and/or PD seemed to have a poorer survival compared to our previous study. The patients with only PE showed a significantly better prognosis than the patients with only PD (P=0.0001) or with PD+PE (P=0.019). The patients who underwent exploratory thoracotomy showed poor survival. There were significant differences in the survival in relation to the extent of the primary tumor. In conclusion, the patients with T1-2 of primary tumor and only a small amount of PE without PD can be expected to show long-term survival after tumor resection.

Comparison of changes in hemodynamics between unilateral and bilateral lung volume reduction for pulmonary emphysema

This study was aimed to compare changes in hemodynamics between unilateral (UL) or simultaneous bilateral (BL) lung volume reduction surgery (LVRS) for chronic obstructive lung disease. Sixteen patients underwent LVRS by stapler resection with neodymium: yttrium-alminum-garnet (Nd: YAG) laser ablation; five underwent BL-LVRS (four by median sternotomy and one by thoracoscopy) and 11 underwent UL-LVRS by thoracoscopy. Four patients had multiple bullae within pulmonary emphysema. At preoperation and 6, 12, 24, and 48 hours postoperatively, hemodynamics and right ventricular performance were evaluated. UL- and BL-LVRS reduced afterload of the right and left ventricle postoperatively. Although the pulmonary arterial resistance increased after surgery, the total pulmonary resistance decreased (p=0.001) in association with the reduced systemic vascular resistance (p=0.001). These reductions improved cardiopulmonary circulation, resulting in increased stroke volume and cardiac output (p=0.003). The right ventricular ejection fraction showed minimal change 48 hours postoperation. Two patients died of pneumonia caused by persistent air leakage. In conclusion, both the UL- and BL-LVRS showed similar effectiveness in terms of improvement in the systemic and cardiopulmonary circulation after LVRS, if there were no postoperative complications. We concluded that we had to reduce and repair the persistent air leakage after LVRS.

Addition of ATP and MgCl2 to the preservation solution attenuates lung reperfusion injury following cold ischemia

BACKGROUND

In lung transplantation, reperfusion injury following cold ischemia is one of the crucial problems for recipients.

OBJECTIVE

We evaluated the protective effect of adding a combination of ATP and MgCl2 to the preservation solution against lung reperfusion injury following cold ischemia.

METHODS

Using an isolated rat lung perfusion model with fresh rat blood as the perfusate, the rats were divided into five groups (n = 6). In the fresh group, the study lungs were flushed with phosphate-buffered saline (PBS), then immediately reperfused for 120 min. In the control group, the study lungs were flushed with PBS, then cold ischemia was induced for 9 h (4 degrees C), after which reperfusion was performed. In the other three groups, the protocols were the same as for the control group except that ATP and/or MgCl2 were added to the PBS: ATP group (100 microM ATP), MgCl2 group (100 microM MgCl2) and ATP + MgCl2 group (100 microM ATP + 100 microM MgCl2).

RESULTS

In the ATP + MgCl2 group, the intrapulmonary shunt fraction, peak airway pressure and wet to dry lung weight ratio were significantly lower than those in the control group. No improvement was observed in the ATP or MgCl2 groups. Histological examination supported these physiological results. In all groups, flush time and lipid peroxide levels in the lungs after cold ischemia did not show any significant differences.

CONCLUSION

The addition of ATP and MgCl2 to the preservation solution attenuated reperfusion injury following cold ischemia in rat lungs.

Monoterpene coumarins from Ferula ferulago

Two monoterpene coumarins, designated ferulagol A and B, as well as three known monoterpene coumarins and three sesquiterpene lactones were isolated from the chloroform extract of the roots of Ferula ferulago. The structures of ferulagol A and B were determined to be 7-[(E)-3'-hydroxy-3',7'-dimethyl-4',6'-octadienyloxy]coumarin and 7-[(3'Z,5'E)-7'-hydroxy-3',7'-dimethyl-3',5'-octadienyloxy]coumarin, respectively.

Studies on polishing of Ti and Ag-Pd-Cu-Au alloy with five dental abrasives

Titanium (Ti) and Ag-Pd-Cu-Au alloy were examined for their polishing behaviour by conducting manually controlled polishing tests using five dental abrasives [carborundum point (CR) and silicone points (R1 and R2)] driven by a high torque micromotor with rotational speeds ranging from 2000 to 15 000 r.p.m. Polishing of Ti resulted in less volume of removal upon polishing, a rougher surface and larger loss of abrasives, compared with polishing of Ag-Pd-Cu-Au alloy. Polishing of Ti with a rotational speed of 15 000 r.p.m. led to the largest volume of removal upon polishing, whilst that of 10 000 r.p.m. produced the optimal volume for Ag-Pd-Cu-Au alloy. It was concluded that Ti was much more difficult to polish, requiring special care (e.g. frequent exchange of abrasives). Development of new abrasives for polishing Ti is required.

A case of repetitive intrapleural cancer chemotherapy using INFUSE-A-PORT for malignant mesothelioma

A 57-year-old man was diagnosed as having malignant pleural mesothelioma. We placed an implantable reservoir (INFUSE-A-PORT) into his pleural cavity to administer repetitive intrapleural chemotherapy. We administered intrapleural chemotherapy 7 times over a period of 10 months. The progression of the disease was very gradual; he could continue working during this time. INFUSE-A-PORT may be useful for repetitive intrapleural chemotherapy in outpatient treatment of malignant mesothelioma.