Clinical experience with PTFE graft replacement in the descending thoracic aorta

In 6 cases, we have performed polytetrafluoroethylene (PTFE) graft replacement in the descending thoracic aorta, with all patients alive and showing good results. Fifty months have passed since the first graft replacement, but no complications due to the PTFE graft have occurred.

[CP angle meningioma presenting as hemifacial spasm]

An interesting case of CP angle meningioma presenting with hemifacial spasm is reported. The patient was a 64-year-old woman with left hemifacial spasm of 18 years' duration which was the initial and the only symptom she had had for ten years until other signs and symptoms including tinnitus and hearing decrease on the left side, vertigo and left cerebellar disturbance occurred. Preoperative CT films showed an enhancing mass at the left CP angle. Operation was performed and the diagnosis of meningioma originating at the rostral edge of the jugular foramen was made. The tumor was extending from the lower cranial nerves up to the Vth nerve burring the VIIth, VIIIth, IXth, Xth, XIIth cranial nerves and vertebral artery within it and compressing the root exit zone of the VIIth nerve. It was totally removed by microsurgical techniques. Postoperative follow-up during eight months disclosed complete disappearance of hemifacial spasm. Residual neurological deficits were left hearing loss, mild facial weakness due to previous nerve blocks on the left side and slight hoarseness. But she was doing well as a housewife. So far, the authors have experienced with 1310 cases of microvascular decompression for hemifacial spasm and 730 cases for tic douloureux. There were only 4 cases (0.3%) in which a CP angle tumor was found in hemifacial spasm series, while in tic douloureux series as many as 79 tumor cases (10.8%) were found. A review of the literature revealed that hemifacial spasm due to CP angle meningioma was very rare, particularly as an initial symptom as in our case.(ABSTRACT TRUNCATED AT 250 WORDS)

The National Institutes of Health Intermittent Positive Pressure Breathing trial--pathology studies. III. The diagnosis of emphysema

In an attempt to predict the severity of emphysema in patients with moderately severe and severe chronic air-flow obstruction, antemortem pulmonary function data, including spirometry, subdivisions of lung volumes, diffusing capacity (transfer factor) for carbon monoxide, and elastic recoil were assessed in 46 patients who were autopsied during the National Institutes of Health Intermittent Positive Pressure Breathing Clinical Trial and we compared these to the morphologic severity of emphysema. The severity of emphysema was graded by the panel grading method using whole lung, paper-mounted (Gough-Wentworth) sections and the mean linear intercept (Lm). The FEV1 and FEF25-75 of the FVC, the DLCO, the diffusing capacity for carbon monoxide, and subdivisions of lung volumes showed significant but low order correlations with the emphysema score and Lm. Total lung capacity, determined by plethysmography, was better related to emphysema in this study than in others in which TLC was measured by helium dilution. Volume-pressure data fitted to the exponential equation (V = A - Be-KP) yielded a low order, but a significant relationship between Lm and the exponential constant (K), but not between K and the panel emphysema score. We conclude that the recognition of the presence and severity of emphysema continues to require a multivariate approach including clinical history, assessment of air-flow obstruction via routine spirometry, radiologic assessment of the lung with emphasis on total lung capacity, and evaluation of the diffusing capacity for carbon monoxide.

The effect of maternal CO2 breathing on lung development of fetuses in the rabbit. Morphologic and morphometric studies

We have examined male fetuses from rabbits exposed from Day 21 to Day 28 of gestation to 8% CO2 for 8 h each day. Fetuses of CO2-exposed mothers weighed less and had lungs that weighed less but when expressed per unit body weight were unchanged. Distended lung volumes were greatly increased in the CO2 group. Light microscope morphometry showed more mature lungs with increased volume proportion of air spaces, decreased air-space wall, and decreased nonparenchyma in CO2-exposed animals. Individual air-spaces were larger, gas exchanging surface area was increased, air-space walls were thinner, and higher ratios of mature to immature crests were found. Electron microscope morphometry showed decreased glycogen in alveolar Type II cells and increased volume proportion of lamellar bodies in the CO2 group. Type II cells were more cuboidal. We interpret these changes to represent increased tissue and cellular maturation in fetuses whose mothers breathed CO2. We speculate that the changes were brought about by increased fetal respiration, which may cause increased stretch and distention of the lung. Alternative mechanisms are discussed.

Genetic markers in the blood of three species of tamarins (Saguinus mystax, S. labiatus and S. oedipus)

Alkaline phosphatase (Alp), esterase-I (Es-I), esterase-II (Es-II), carbonic anhydrase (CA), cell esterase (cEs), esterase-D (Es-D), isocitrate dehydrogenase (ICD), malate dehydrogenase (MDH), 6-phosphogluconate dehydrogenase (PGD), tetrazolium oxidase (To), ceruloplasmin (Cp), Haptoglobin (Hp) and hemoglobin (Hb) in 58-75 samples of three species of tamarins (Saguinus mystax, S. labiatus and S. oedipus) were detected by means of horizontal starch gel electrophoresis. Two types (Es-I 1 and Es-I 2) for Es-I, four types (Es-II 1, Es-II 2, Es-II 3 and Es-II 2-3) for Es-II, three types (cEs 1, cEs 2 and cEs 1-2) for cEs, three types (PGD 1, PGD 2 and PGD 1-2) for PGD, two types (To 1 and To 2) for To, and three types (Hp 3, Hp 1-3 and Hp 2-3) for Hp were observed. However, Alp, CA, Es-D, ICD, MDH, Cp and Hb were monomorphic. In the S. mystax, no Es-II or PGD variants were observed. No Es-II variant was seen in the S. oedipus. Gene frequencies of cEs, PGD and Hb were biased in the three species. It is concluded that six polymorphic loci are useful as genetic markers for a species or individual.

[Ototoxicity tests for T-2588 in rats]

Ototoxic effects of T-2588 on the spiral and the vestibular organs of the inner ear were investigated in 50 rats of Sprague-Dawley strain. Fifty female rats were divided into 5 groups consisting of 2 T-2588-test groups at dose levels of 500 and 1,000 mg/kg/day, respectively, and 2 kanamycin (KM) groups at dose levels of 200 and 400 mg/kg/day, respectively, and the control group. The administration of T-2588 was done orally through gastric tube daily for 5 weeks. The ototoxic effect was evaluated by the differential frequency pinna reflex test with frequency ranging from 200 Hz to 20,000 Hz before, during and after the administration of a test substance, then investigated histopathologically on serial celloidin sections of the bilateral temporal bones. The results were summarized below. In any rat receiving either level of T-2588, pinna reflex impairment was not detected at any frequencies. And there was no noticeable change either in the cochlea or in the vestibulum. In 10 rats which received KM at a dose level of 200 mg/kg/day, there was no impairment in pinna reflex, but, histopathologically, the loss of outer hair cells was observed, though inner hair cells were present. In the vestibular organ, a scattered loss of hair cells was observed in 8 rats. One of 9 rats which received KM at a dose level of 400 mg/kg/day showed the loss of pinna reflex in the frequency range tested. This rat showed histopathologically extensive loss of both outer and inner hair cells. In other rats showing no impaired pinna reflex, the loss of outer hair cells was rather extensive, but inner hair cell loss was unilaterally confined in the basal end of the first turn. In the vestibular organs of all rats, a scattered loss of hair cells was observed.

[Effect of single or consecutive administration of T-2588 on hepatic-injured male rats]

The present study was carried out to examine the effect of single or consecutive administration of T-2588 on liver of male rat injured by the administration of D-galactosamine X HCl. The T-2588 was orally given to hepatic-injured rats at doses of 125 mg/kg and 1,000 mg/kg singly or for consecutive 5 days. A 10 ml/kg dose of the vehicle was orally given to control rats. The results obtained were summarized below. Single administration of T-2588. Twenty-four hours after a single administration of T-2588, the liver taken from control rats apparently indicated galactosamine-induced hepatitis. No drug-related alterations were observed in hepatic functional test, liver weight and histological examinations at either dose of T-2588. Galactosamine-induced hepatitis was not affected by a single administration of T-2588. Consecutive administration of T-2588. Twenty-four hours after a 5-consecutive-day administration of T-2588, galactosamine-induced hepatitis in control rats was restored to the normal state. The cure of galactosamine-induced hepatitis was not affected by a 5-consecutive-day administration of T-2588. The hepatic aldehyde dehydrogenase activity in hepatic-injured rats was not affected by a 5-consecutive-day administration of T-2588.

The National Institutes of Health Intermittent Positive-Pressure Breathing trial: pathology studies. II. Correlation between morphologic findings, clinical findings, and evidence of expiratory air-flow obstruction

We examined the lungs of 48 patients who died in the National Institutes of Health clinical trial of Intermittent Positive-Pressure Breathing. Bronchial lesions were not related either to clinical features or to tests of expiratory flow. In particular, bronchial muscle was not related to the response to bronchodilators or to the variability of flow rates. The degree of emphysema was well related to loss of body weight and was also positively related to right ventricular hypertrophy. It was also the major morphologic correlate of abnormal tests of expiratory flow, the slope of phase III of the single-breath nitrogen test, and increased residual volume. Emphysema was negatively related to bronchodilator response and variability of expiratory flow. The proportion of bronchioles less than 400 microns in diameter and a measurement of irregular bronchiolar shape were related to dyspnea and increased PaCO2 and were also related to abnormal tests of expiratory flow, phase III of the single-breath nitrogen test, and residual volume. The presence of increased muscle and fibrosis in the bronchioles appeared beneficial, being associated with a higher PaO2, a lower PaCO2, less edema, less right ventricular hypertrophy, better flow rates, and lower residual volumes. This may reflect the fact that airways with increased muscle and fibrosis are less markedly narrowed and less distorted. Goblet cell metaplasia appeared to be an important variable, independent of others, and was related to airway resistance. We divided patients into 3 groups according to severity of emphysema, and then into 2 subgroups of lower and higher flow rates in each category.(ABSTRACT TRUNCATED AT 250 WORDS)

The National Institutes of Health Intermittent Positive-Pressure Breathing trial: pathology studies. I. Interrelationship between morphologic lesions

We examined the lungs from 48 autopsied patients in the National Institutes of Health Intermittent Positive-Pressure Breathing trial who had moderately severe and severe chronic airflow obstruction. Compared with control patients without heart or lung disease, IPPB patients had mucous gland enlargement and increased muscle and decreased cartilage in bronchi. Most patients had severe emphysema. The bronchioles were narrower and more irregular in shape than in the control subjects. Bronchiolar inflammation, increased muscle and goblet cell metaplasia were moderately severe. Bronchioles had a higher proportion of muscle in younger control subjects than they did in older control subjects. A wide variation in severity of lesions in bronchi and bronchioles was observed. Correlations between lesions were of relatively low order. Mucous gland enlargement was negatively related to one measurement of emphysema and negatively related to bronchial eosinophilia. Mucous gland enlargement was not related to bronchial or bronchiolar inflammation or to bronchiolar narrowing. Emphysema was associated with decreased central airway muscle, decreased bronchial eosinophilia, increased bronchiolar narrowing, and distortion in the shape of bronchiolar lumens. Interrelationships between bronchiolar lesions were primarily between measurements of dimensions, and there was no relationship between bronchiolar narrowing and bronchiolar inflammation or fibrosis. Bronchiolar muscle was positively related to regularity of bronchiolar shape. We conclude that although lesions in the bronchi and bronchioles and parenchyma (emphysema) are easily demonstrable in patients with moderate and severe chronic air-flow obstruction, they vary widely in severity. The interrelationships are not strong, suggesting that relationships are due to a common etiologic agent, tobacco smoke.(ABSTRACT TRUNCATED AT 250 WORDS)

Binding of heparin fractions and other polysulfated polysaccharides to plasma fibronectin: effects of molecular size and degree of sulfation of polysaccharides

Heparin was divided into four fractions on fibronectin-Sepharose. The higher affinity fraction for fibronectin was larger in molecular size, higher in sulfate content and higher in affinity for anti-thrombin III. Together with these heparin fractions, the following three series of heparin samples were examined to compare the affinity for fibronectin-Sepharose: four fractions separated on Sephadex G-100; five fractions separated on antithrombin III-Sepharose, and six partially and completely N-desulfated heparins. The result showed that the affinity of heparin for fibronectin was dependent exclusively on its molecular size, and that an appropriate level of sulfate content in heparin (1.9-2.4 mol/disaccharide) was essential for the affinity. The sulfated preparations of glycosaminoglycans (heparan sulfate, dermatan sulfate and chondroitin 4-sulfate) and neutral polysaccharides (amylose and dextran) having higher sulfate content than heparin were found to display higher affinity for fibronectin than heparin. This suggested that highly sulfated polysaccharides showed potent affinity irrespective of their polysaccharide structure. The sulfated chondroitin 4-sulfate having a sulfate content and molecular size comparable to those of heparin was inferior to heparin with respect to affinity. A competitive dissociation experiment indicated that heparin and other polysulfated polysaccharides share a common binding site on the fibronectin molecule.

Selection and rejection of retrovirus-expressing tumor cells from a heterogeneous murine leukemia virus-infected cell population

We studied the basis of tumor recurrence at sites of rejection of retrovirus-infected guinea pig fibrosarcoma cells. Tumor recurrences, in contrast to the parent tumor, lacked retroviral antigens and did not release infectious virus. When reinjected into syngeneic animals, cell lines derived from tumor recurrences grew progressively. Tumor recurrences could be infected with the homologous retrovirus. Tumor rejection and recurrence were modulated by host immunity. In guinea pigs immunized to virus-infected cells, tumor recurrences occurred earlier and in a higher proportion of animals than in nonimmune guinea pigs. In some immunosuppressed guinea pigs, retrovirus-infected tumor cells grew progressively. Progressively growing tumors of immunosuppressed guinea pigs contained large amounts of infectious virus and expressed viral antigens. To identify the source of tumor recurrences, the parent virus-infected tumor was cloned. Clones were heterogeneous in virus expression; some clones released large quantities of infectious virus; others did not. Two clones formed tumors in syngeneic animals. Injection of a virus producer clone into virus-immune animals was not followed by tumor recurrence. The data suggest that the reappearance of tumors at sites of injection of retrovirus-infected fibrosarcoma cells represents immune selection and rejection of retrovirus-expressing cells. Cells with the potential to form tumor recurrences existed in the parent virus-infected tumor population.

Genetic variations in albumin and transferrin as species markers in plasma of Callithricidae

Albumin (Alb) and transferrin (Tf) polymorphism in plasma of Callithricidae was investigated by means of starch gel electrophoresis. In 52 blood samples of three species (Saguinus mystax, S. oedipus and S. labiatus), four Alb phenotypes (Alb 1, Alb 2, Alb 3 and Alb 2-3) and two Tf phenotypes (Tf 1 and Tf 2) were observed. No Alb variant was found in S. oedipus and S. mystax.

Rejection of retrovirus-infected tumor cells in guinea pigs: effect on bystander tumor cells

We studied the basis of rejection of retrovirus-infected tumor cells in guinea pigs by evaluating host response to injection of mixtures containing retrovirus-infected tumor cells and, antigenically and biologically distinct, uninfected tumor cells (line 10). After intradermal injection, line 10 grew progressively, metastasized to regional lymph nodes, and led to death of animals; line 107C3 4070A, a murine leukemia virus-infected fibrosarcoma cell line, grew for approximately 1 week and then regressed. Growth of the line 10 hepatoma was suppressed when the hepatoma cells were mixed with viable 107C3 4070A cells before injection into strain 2 guinea pigs. Viable virus-infected 107C3 cells were more effective than irradiated virus-infected cells in suppressing line 10 growth; mixture of line 10 with murine leukemia virus 4070A alone did not inhibit line 10 growth. Suppression of growth of line 10 cells by admixed murine leukemia virus 4070A-infected cells was less effective in animals with established viral immunity. Cyclophosphamide inhibited suppression of line 10 at sites of injection of virus-infected cells. Infection of line 10 with murine leukemia virus in vitro required cocultivation of line 10 cells with murine leukemia virus-infected fibrosarcoma cells; virus alone did not lead to acquisition of murine leukemia virus antigens by line 10 cells.

Tumor rejection mediated by an amphotropic murine leukemia virus

We studied the effects of murine leukemia virus infection on the growth of tumors in inbred strain 2 guinea pigs. Fibrosarcomas, induced by treatment of guinea pig fetal cells with chemical carcinogens, were exposed in vitro to the amphotropic murine leukemia virus, 4070A. Tumor cells exposed to murine leukemia virus 4070A in vitro expressed virus antigens, released both reverse transcriptase and infectious virus into supernatant fluids, and grew and regressed after injection into syngeneic animals. In contrast, uninfected tumor cells did not express virus antigens and grew progressively. Rejection of virus-infected tumor cells appeared to be a host-mediated event, since murine leukemia virus 4070A infection had no detectable cytopathic effect on fibrosarcoma cells. Rejection of virus-infected tumor cells occurred in guinea pigs unable to suppress the growth of the line 10 hepatoma at sites of injection of mycobacterial cell walls and unable to develop immunity to the line 10 hepatoma. Guinea pigs immunized with virus-infected tumor cells were unable to reject a challenge of uninfected tumor cells. The results are interpreted to mean that infection of guinea pig tumors in vitro by a murine leukemia virus led to synthesis of viral antigens by the tumor cells which in turn led to recognition of the tumor as foreign with consequent tumor destruction; tumor eradication occurred without development of immunity to cryptic, intrinsic tumor antigens.

A new simple method to detect an air-leaking lung field in pneumothorax by a flexible bronchofiberscope

A new simple method was designed to detect an air-leaking lung field in refractory pneumothorax. A constant volume of 100% helium gas was introduced into each lobe bronchus of two patients with pneumothorax via a flexible bronchofiberscope. In both patients, only when helium gas was introduced into the communicating bronchus with a ruptured emphysematous bullae, a high concentration of helium was detected in the intrathoracic gas. Thoracotomy has been used for patients with pneumothorax in which an air-leakage has persistently as well as recurrently continued, but this therapeutical approach has been frequently limited by a patient-age and an underlying disease. An exact detecting of the site of air leakage makes much expectant of an effectiveness of the outlet-closing treatment under a thoracoscope and finally leads to a new transbronchial treatment of pneumothorax.

Positioning of simultaneous intracardiac repair and/or ascending aorta and descending aorta surgery

A convenient positioning for simultaneous intracardiac repair and/or ascending and descending aorta surgery is presented. A Rastelli operation for pseudotruncus is described step by step as an example.

[Subacute toxicity test of cefoperazone in beagle dogs with the intramuscular administration for 3 months (author's transl)]

The subacute toxicity test of cefoperazone (CPZ), a new cephalosporin antibiotic, was carried out in both sexes of Beagle dogs. CPZ was injected in Beagle dogs intramuscularly at dose levels of 500, 250 and 125 mg/kg/day for 3 months. The same amount of physiological saline was injected to control dogs intramuscularly for 3 months. The following results were obtained: 1) Sign of severe pain was shown immediately after injection in groups of CPZ at 500 and 250 mg/kg/day. In the same groups, the focal necrosis, hemorrhage, cell infiltration and fibrosis of muscles of injected site were noted microscopically. 2) In only one out of 6 dogs given CPZ at 500 mg/kg/day for 3 months, decrease of red blood cells and in values of hemoglobin and hematocrit an increase of reticulocytes in the peripheral blood were observed. In the same dog, splenomegaly and extramedullary hematopoiesis in the liver was found histopathologically, and in addition, the body weight and the food intake decreased during the administration period, associated with the development of anemia. 3) In dogs receiving up to 250 mg/kg/day, atrophy of the thymus was recognized at autopsy and slight decrease of cortical lymphocytes was seen histopathologically. 4) Based on these results, the maximum safety dose of CPZ was thought to be 125 mg/kg/day from the present experiment.

[Multiple cerebral tuberculomata involving brainstem and cerebellum--report of a case (author's transl)]

A case of multiple cerebral tuberculomata involving the pons and cerebellum was presented. The lesions were demonstrated by CT as isodense to slightly dense foci. All four intra-axial lesions showed homogeneous enhancement following an intravenous injection of the contrast medium, and one of them was surrounded by a small area of low density, probably representing the perifocal edema. The patient responded well to chemotherapy with streptomycin, hydrazid and rifampicin : cranial nerve signs and long tract signs clearing rapidly and the enhancing lesions and mass effect on CT disappearing concomitantly. Although cerebral tuberculoma is nowadays very rare in Japan, still a high index of suspicion should always be entertained during the investigation of patients showing solitary or multiple enhancing lesions with no or slight degree of perifocal edema on CT, and a trial of antituberculous drugs should be given before the incurable malignancy is presumed or the lesion is explored surgically.