A new extraction bag to facilitate stone extraction in laparoscopic cholecystectomy: in vitro experiments

In order to avoid extension of the parietal wound when the stone load is too large to be simply extracted in laparoscopic cholecystectomy, we developed a new extraction bag. The new extraction bag has a characteristic shape to arrange the stones or fragments in a linear order. To evaluate the efficacy of the new bag we conducted in vitro stone extraction experiments and compared the new bag technique with conventional stone removal techniques. Mean experiment time to extract 60 small stones in a conventional technique group was 710 seconds, whereas it was 316 seconds with the new bag technique (p < 0.001). With this technique larger stones are also extracted without extending the parietal incision once they are fragmented in the bag. The results of our experiments suggest the new extraction bag as a simple and safe technique in minimally invasive stone extraction in laparoscopic cholecystectomy.

Iminodipeptides containing proline with C-terminal and N-terminal residues prime the stimulation of human neutrophil superoxide generation by fMLP

Preincubation of human peripheral blood polymophonuclear leukocytes with an iminodipeptide containing proline at the C-terminus and/or N-terminus, Pro-Pro, Gly-Pro, Pro-Gly, Ala-Pro and Pro-Ala, significantly enhanced N-formyl-methionyl-leucyl-phenylalanine-induced superoxide generation in a concentration-dependent manner. The iminodipeptide with C-terminal proline showed higher effect than that of the counterpart with N-terminal proline. These iminodipeptides also enhanced the superoxide generation induced by opsonized zymosan but not that induced by arachidonic acid or phorbol myristate acetate. Tyrosyl phosphorylation of the 45-kDa protein occurred in parallel with the iminodipeptide-dependent enhancement of superoxide generation in neutrophil.

5'-flanking region surrounding a human cytosolic phospholipase A2 gene

The 5'-flanking region and the first four exons of a gene encoding human cytosolic phospholipase A2 (cPLA2) were isolated from a human lambda EMBL3 genomic library and sequenced. The 5'-flanking region is characterized by CA repeats, one of microsatellites. The analysis of the 5'-flanking region with transcription factor database suggests the existence of the transcription factor binding sites such as NF-kappa B, NF-IL6, AP-1, AP-2, and PEA3. These factors are well known to be induced or activated by the reagents (tumor necrosis factor alpha, interleukin-1, epidermal growth factor, and phorbol myristate acetate) reported as the inducers of a cPLA2 gene.

Interleukin-1 beta induces cytosolic phospholipase A2 gene in rats C6 glioma cell line

Treatment of the rat C6 glioma cell line with interleukin-1 beta (IL-1 beta) resulted in an accumulation of cytosolic phospholipase A2 (cPLA2) in mRNA level. The increase of cPLA2 in mRNA level was observed at 6 hours after treatment of IL-1 beta and reached to the maximal level at 12 hours. The accumulation also remained sustained for up to 72 hours. Dose response curve of IL-1 beta showed that as little as 40 units/ml concentration induced the accumulation of mRNA and 100 units/ml concentration showed the maximal effect. In contrast, cyclooxygenase 2 gene was not affected with treatment of IL-1 beta.

Cloning and sequencing of phospholipase B gene from the yeast Torulaspora delbrueckii

The extracellular phospholipase B gene from baker's yeast Torulaspora delbrueckii was cloned and sequenced. Analysis of DNA sequence data revealed an open reading frame (ORF) encoding a 649-amino acid protein, that included amino acid sequences obtained from the purified enzyme. Comparison of these sequence data with the N-terminal amino acid sequence of the enzyme indicated that this secreted protein is synthesized as a large precursor with a 21-amino acid N-terminal extension to the mature enzyme of 628 amino acids. A homology search was carried out between phospholipase B from T. delbrueckii and Penicillium notatum. The deduced amino acid sequence of the cloned phospholipase B was homologous (about 50% identity) to phospholipase B from P. notatum, and contained six conserved regions. The transcriptional level of mRNA of the phospholipase B gene was higher in the cells from early exponential and stationary phases.

Ketamine increases the striatal N-[11C]methylspiperone binding in vivo: positron emission tomography study using conscious rhesus monkey

A system for positron emission tomography study of conscious monkeys was newly developed. By use of this system in combination with a microdialysis technique, the effect of ketamine on the binding and release of dopamine was investigated. The administration of ketamine (5 mg/kg) caused sedation accompanied by psychotic symptoms such as nystagmus and stereotyped movements of extremities. During this psychotomimetic period produced by ketamine, a significant increase in the accumulation of the dopamine D2 receptor ligand N-[11C]methylspiperone was observed in the striatum compared with the level in the conscious state, while no significant change was observed in the frontal cortex and cerebellum. In contrast to the use of ketamine as the anesthetic, pentobarbital (25 mg/kg), which produced deeper anesthesia but no psychotic symptoms, caused a decrease in the accumulation of N-[11C]methylspiperone in the striatum. Kinetic analysis, conducted by a graphical method, revealed that the value of the association constant (K3) for N-[11C]methylspiperone binding in the striatum was increased to approximately 130% by ketamine and decreased to approximately 70% by pentobarbital compared with the control values. Furthermore, the release of dopamine from the striatum measured by microdialysis was not affected by ketamine anesthesia. These results indicate that ketamine facilitates striatal dopaminergic neurotransmission through increasing the binding activity of dopamine D2 receptors in the striatum, and suggest that these changes may be related to the psychotomimetic behavioral symptoms of this drug.

Decrease in 6R-5,6,7,8-tetrahydrobiopterin content in cerebrospinal fluid of autistic patients

The levels of pterin compounds in the lumbar cerebrospinal fluid (CSF) of ten neurologically normal and twenty autistic children were measured by two different liquid chromatographic systems, a conventional and a newly developed direct method. Among pterin compounds 7,8-dihydroneopterin (NH2) and 6R-5,6,7,8-tetrahydrobiopterin (R-BH4) levels in autistic children were significantly reduced to 66.1 and 41.5%, respectively, of those found in the controls. The autistic children were divided into three subgroups according to their CSF homovanillic acid (HVA) level and age: the group with an elevated HVA level, the younger (< 7 year old) group with a normal HVA level, and the older (> 7 year old) group with a normal HVA level. In comparison, the further reduction was observed in NH2 and R-BH4 levels in the younger group and in the 7,8-dihydropterin (PH2) level in the group with an elevated HVA level. Thus, these results suggest that the endogenous biosynthesis of R-BH4 in the brain may be reduced in autistic children as compared with that in neurologically normal children.

A conserved epitope on H+,K(+)-adenosine triphosphatase of parietal cells discerned by a murine gastritogenic T-cell clone

BACKGROUND/AIMS

H+,K(+)-adenosine triphosphatase (H+,K(+)-ATPase) of parietal cells is an organ-specific enzyme recognized by autoantibodies found in human and murine autoimmune gastritis (AIG). Murine AIG can be induced in BALB/c mice by thymectomy 3 days after birth and is a T cell-mediated disease. This study examined the specificity of T cells that cause AIG and the role of H+,K(+)-ATPase in this disease.

METHODS

From an AIG mouse, a gastritogenic T-cell clone (II-6) was established, and its reactivity to synthetic peptides of H+,K(+)-ATPase was tested.

RESULTS

II-6 cells are CD4+, V beta 14+, and interferon gamma producers. Adoptive transfer of II-6 cells to syngeneic nude mice resulted in AIG without the production of autoantibodies to parietal cells. The II-6 cells were responsive not only to murine but also to human and porcine parietal cells. Their proliferation was also induced by amino acids 891-905 (alpha 891) and 892-906 (alpha 892) of the alpha subunit of porcine and human H+,K(+)-ATPase, respectively.

CONCLUSIONS

The T-cell response to a single epitope of H+,K(+)-ATPase, the amino acid sequence of which is conserved among at least three mammals tested, is sufficient to cause AIG. Autoantibodies to parietal cells are not detected in these AIG mice.

[Combined multimodality treatment for non-small cell lung cancer--with special reference to pre- and post-operative adjuvant therapy]

Surgical resection is the treatment of choice for patients with localized non-small cell lung cancer. However, the long-term survival rate of patients after such surgery is disappointing. Even in stage I patients who have undergone potentially curative operation, over 30% of them recur within five years. Most of the recurrences are caused by hematogenous metastases to the distant organs. However, all of the comparative study to evaluate postoperative adjuvant therapy, ie, chemotherapy, immunotherapy, radiotherapy, or their combination, showed negative results, except for a few positive outcomes. To date, there is no evidence that pre- and postoperative adjuvant therapy have shown a favorable impact on survival of postoperative patients with stage I disease. LCSG has had reportedly favorable results on survival of stage II and III adenocarcinoma and large cell carcinoma by postoperative CAP-chemotherapy. Postoperative chemotherapy and/or radiotherapy showed no impact on survival of stage III patients who underwent surgical intervention. However, preoperative induction therapy (IT) using combination chemotherapy (with or without radiotherapy) has improved the survival of patients with resected stage III disease, although most reports are of phase II trial or interim results. It seems to be true that the IT can render an advanced lung cancer resectable and also can control pre-existing micro-metastases in the distant organs. However, randomized prospective trials are required for evaluating an impact on the survival rate of the advanced non-small cell lung cancer.

Advanced primary non-Hodgkin's lymphoma of the small intestine in childhood: report of four cases

Primary non-Hodgkin's lymphoma of the small intestine (PLI) is an uncommon malignancy in childhood which carries a poor prognosis. Consideration of the possible diagnosis of PLI is important when children have vague abdominal symptoms, since thoughtful multidisciplinary treatment can result in a better prognosis. This paper reports the cases of four children who have presented to our hospital since 1985 with advanced stage III or IV PLI. All the children had a huge abdominal mass but none of them had complete intestinal obstruction. Regarding the diagnosis, ultrasonography frequently reveals a hypoechoic thickening of the intestinal wall with dilated intestinal loops. A delayed primary or second-look operation may be the treatment of choice following adequate chemotherapy, while total parenteral nutritional support may prevent gastrointestinal complications. Three of the four patients have been in complete remission for 2 to 4 1/2 years since their initial treatment.

Clinical profile and outcome of primary hyperparathyroidism accompanied by chronic renal failure

We encountered 5 cases of primary hyperparathyroidism (PHPT) accompanied by chronic renal failure over the past 4 years. Neither hypocalcemia nor hyperphosphatemia was found in the past records. The parathyroid hormone (PTH) levels in these cases were extraordinarily higher than those in usual patients suffering from renal failure. The manifestation of PHPT-developed insidiously together with the decline of renal function. Serum 1,25(OH)2D3 levels were lower than normal range in all cases, and which in turn might accelerate the progression of PHPT in a similar way as the development of secondary hyperparathyroidism. Parathyroidectomy (PTX) was done successfully in 4 cases, and the pathology of the biggest gland was adenoma but hyperplasia was found in other glands simultaneously. These results revealed the polymorphism of parathyroid glands in case of complication with renal failure. Furthermore, the interruption of postoperative 1 alpha(OH)D3 treatment induced the relapse of hyperparathyroidism (HPT). The case which refused PTX was treated by oral pulse therapy with 1,25(OH)2D3. The calcium/intact PTH sigmoidal curve examined 3 years later revealed that the set point shifted to right and upward despite therapy. It suggested that functional parathyroid mass became larger and the sensitivity to calcium became less under continuous stimuli on parathyroid glands. According to these results, PHPT accompanying with renal failure is resistant to medical therapy, and surgical treatment is a possibility. In this occasion, total PTX with autograft transplantation is better than simple adenectomy because even the glands not responsible to clinical manifestation of PHPT can have some pathological abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of arrhythmogenic right ventricular dysplasia: long-term outcome

Eight male patients ranging from 15 to 51 years old (mean age, 36.3 years) underwent surgical treatment of ventricular tachycardia (VT) associated with arrhythmogenic right ventricular dysplasia. One patient had an associated left ventricular aneurysm. The earliest activation site was detected for 15 lesions, and delayed potentials were recorded during sinus rhythm in all patients. On the basis of the epicardial mapping, the origins of the VT foci in the right ventricle were resected. Cryoablation on the surrounding myocardium was performed. There were no surgical deaths or postoperative fatal complications. During long-term follow-up, there has been no recurrence of VT and no congestive heart failure in the 6 patients without left ventricular involvement. The 2 patients with LV involvement died late of either congestive heart failure or development of VT originating from the left ventricle. In conclusion, a surgical approach consisting of myocardial excision and cryocoagulation offers a curative treatment of VT associated with arrhythmogenic right ventricular dysplasia and yields excellent long-term results when the VT origin is well identified in the right ventricle.

Why do I stand against the movement for cardiac transplantation in Japan?

In order to clarify the reason the author stands against the movement for cardiac transplantation in Japan, certain crucial differences between death judged by the classical criteria and so-called brain death are briefly discussed, followed by the presentation of three major arguments. First, various problems associated with postoperative care of organ recipients are delineated, particularly side effects of immunosuppressive drugs and long term prognosis with reference of life expectancy as well as quality of life. Second, it is emphasized that transplantation involves prejudice and inequality, since the number of potential organ recipients far exceeds that of donors and only a small portion of transplant candidates can actually receive the organs while others have to wait in vain. Third, once organ transplantation from brain dead patients is allowed, numerous ethical and social problems would arise including an arbitrary expansion of the criteria for brain death, selection of donors and recipients by taking non-medial factors into consideration, development of organ commerce leading to the involvement of organized crime, and the birth of a trend in transplant candidates to wish for an early death of histocompatible donors. Finally, it is pointed out that we must give serious thought to the danger of "from neck down" transplantation creating a new person from two bodies (which is a brain transplant in actuality) in the future, since the difference between such a procedure and the multiorgan transplantation presently practiced in many developed countries is only quantitative and one cannot find a logical reason to ban the former while retaining the latter.

[Pharmacokinetic and clinical evaluation of cefozopran in the pediatric field]

We conducted a pharmacokinetic and clinical studies on cefozopran (CZOP), a new cephem antibiotic for injection. 1. Changes in serum levels of the agent after intravenous bolus injection at a dose of 20 mg/kg to 4 pediatric patients (age: 5-10 years) were observed. The levels at 30 minutes after injection were 32.9-73.4 micrograms/ml average: 55.4 +/- 18.1 micrograms/ml), then the levels gradually decreased with half-lives of 1.67-2.24 hours (average: 1.85 +/- 0.27 hours) to 0.8-1.8 micrograms/ml (average: 1.2 +/- 0.4 micrograms/ml) at 8 hours after injections. Urinary levels reached at the maximum as, 1,773-3,450 micrograms/ml (average: 2,693 +/- 698 micrograms/ml) within 0-2 hours or 2-4 hours after injection, and recovery rates from urine in the first 8 hours after injection were 55.4-91.1% (average: 71.6 +/- 16.8%). 2. Transition to cerebrospinal fluid was examined in cases with purulent meningitis and aseptic meningoencephalitis. In the meningitis case, the level in cerebrospinal fluid 1 hour after administration was 8.8 micrograms/ml in the second day after the start of 4 times a day intravenous bolus injections with 42.5 mg/kg at each dose; The ratio of the drug level in cerebrospinal fluid to that in serum was 24.0%. In the meningoencephalitis, the levels in cerebrospinal fluid 1 hour after administrations were 1.1 micrograms/ml and 1.5 micrograms/ml in the second and the sixth days respectively, after the start of 4 times a day intravenous bolus injections with 50 mg/kg at each dose; the ratio of the levels in cerebrospinal fluid to those in sera were 0.93% and 2.41% respectively, at the second and the sixth day. 3. CZOP was clinically evaluated in 29 cases (ages: 2 months to 15 years) of pediatric infectious diseases. The agent was administered 3-4 times daily with 17-50 mg/kg at each dose, continued for 5-13 days. Total doses were 1.95-24.05 g. Clinical efficacy was evaluated in a total of 28 cases (1 case of purulent meningitis, 2 cases of acute purulent tonsillitis, 20 cases of acute pneumonia, 3 cases of urinary tract infections, 1 case of purulent lymphadenitis in cervical part and 1 case of cellulitis in face); The efficacies were "excellent" in 22 cases and "good" in 6 cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Molecular cloning and functional expression of a cDNA encoding the human V1b vasopressin receptor

Arginine vasopressin modulates the release of adrenocorticotropic hormone, beta-endorphin, and prolactin from the anterior pituitary. Release is mediated by the V1b receptor through the mobilization of intracellular Ca2+ by phosphatidylinositol hydrolysis. In contrast to its well characterized peripheral actions, such as antidiuresis, contraction of vascular smooth muscle, and stimulation of hepatic glycogenolysis, the exact site and mechanism of vasopressin action in the pituitary remain unclear. This is largely due to a lack of information on the molecular identity and exact localization of the V1b receptor. This lack prompted us to try to isolate this receptor subtype. Here we report the molecular cloning and functional expression of a complementary DNA encoding the human V1b receptor. The deduced 424-amino acid sequence of the receptor has highest overall homology with the V1a, V2, and oxytocin receptors, with homologies of 45, 39, and 45%, respectively. The receptor expressed in COS-1 cells has a single binding site for arginine vasopressin with a Kd of 0.17 +/- 0.04 nM. It binds various agonists and antagonists of vasopressin with affinities distinct from those of V1a and V2 receptors but consistent with those anticipated for the V1b receptor on the basis of the pharmacological studies. Furthermore, arginine vasopressin evoked calcium-dependent chloride current in Xenopus oocytes transfected with the receptor, which was not affected by a V1a/V2 antagonist. In contrast, the current evoked in oocytes transfected with V1a receptor was abolished by the antagonist. Northern blot analysis revealed that the receptor expression is restricted to the pituitary. These data clearly indicate that the cloned cDNA encodes the V1b receptor.

Galanin-containing neurons in the paraventricular nucleus: a neurochemical marker for fat ingestion and body weight gain

The physiological function of the peptide galanin (Gal) remains to be established. It is known to exist in high concentrations within the hypothalamus and to modulate the secretion of specific hormones, as well as to potentiate food consumption. Our study provides evidence for an essential function of neuronal Gal, within a specific hypothalamic area, in stimulating the behavioral process of fat ingestion and body weight gain. Through analyses of peptide levels via RIA and of gene expression via in situ hybridization, a close positive association is established between Gal in the paraventricular nucleus (PVN), particularly its midlateral region, and fat ingestion. No such relationship is detected for Gal in other brain areas or between PVN Gal and ingestion of carbohydrate or protein, supporting the behavioral and anatomical specificity of this relationship. Through PVN injection studies with antisense oligonucleotides to Gal mRNA, a dramatic decline in fat ingestion and body weight suggests that endogenous Gal contributes to the natural appetite for fat. Thus, Gal in the PVN is identified as a neurochemical marker for fat ingestion and, consequently, body weight gain.

GABAergic system inducing hyperthermia in the rat preoptic area: its independence of prostaglandin E2 system

Brain temperature of conscious freely moving rats was recorded during perfusion of the preoptic area (POA) with neuroactive compounds using the microdialysis technique. Unilateral perfusion of the POA with the sodium channel blocking agent, tetrodotoxin (1 microM), induced a pronounced hyperthermia. Of the neuroactive compounds examined, the greatest thermogenic response to local perfusion of the POA was elicited by the GABAergic agonist, muscimol. Muscimol (10, 20 and 100 microM) exhibited a dose-dependent and reversible hyperthermia. This hyperthermia was attenuated by co-perfusion with the GABAergic antagonist, bicuculline (10 microM). Muscimol-induced hyperthermia was independent of prostaglandin biosynthesis, and additive with prostaglandin E2 (10 microM)-induced hyperthermia. Prostaglandin E2-induced hyperthermia was not affected by co-perfusion with bicuculline. These data suggest the existence of two independent neurochemical systems for genesis of hyperthermia colocalized within the POA.

Antianxiety actions of Ca2+ channel antagonists with Vogel-type conflict test in rats

We examined the effects of various derivatives of Ca2+ channel antagonists in a modified rat Vogel-type conflict model. Flunarizine (10 and 20 mg/kg), nicardipine (20 mg/kg), and verapamil (20 mg/kg), given as single i.p. injections, significantly increased punished lickings by 50-110%. Chronic administration of diltiazem, at 20 mg/kg i.p. for 8 days, a dose ineffective with a single i.p. injection, produced a significant anticonflict action. The possibility that Ca2+ channel antagonists have anxiolytic action should be considered.

Early detection of successful coronary reperfusion based on serum myoglobin concentration: comparison with serum creatine kinase isoenzyme MB activity

The usefulness of serum myoglobin (Mb) concentration for early detection of successful reperfusion was compared with that of creatine kinase isoenzyme MB (CKMB) activity in 49 patients with acute myocardial infarction. To determine accurately the time of reperfusion, we performed coronary angiography every 5 minutes during reperfusion therapy. Reperfusion was obtained in 32 patients (reperfused group) but not in 17 patients (nonreperfused group) until 60 minutes after the initiation of reperfusion therapy. Blood samples were taken before and 15, 30, and 60 minutes after the angiographic confirmation of reperfusion in the reperfused group. In the nonreperfused group, samples were taken before and 15, 30, and 60 minutes after the initiation of treatment. We calculated the Mb ratio (value after reperfusion or treatment initiation to value before) and CKMB ratio (value after to value before). When values > 2.4 for the Mb ratio or > 2.0 for the CKMB ratio were used as the criteria for reperfusion within 60 minutes after initiation of treatment, the sensitivities were 91% and 56% at 15 minutes after reperfusion, 97% and 84% at 30 minutes, and 100% and 100% at 60 minutes, respectively. For each ratio the specificity of detection was 100% at all times evaluated. Thus the Mb ratio accurately detected the success of reperfusion as early as 15 minutes after reperfusion and may be more useful than the CKMB ratio for detecting the success of reperfusion within 30 minutes.

[A case of surgical treatment of Swyer-James syndrome]

Swyer-James syndrome was usually diagnosed on the past history and the radiologic features, and almost all the cases were followed by the conservative therapy. Therefore, the examination of the pathologic features was rare. We recently experienced a patient with Swyer-James syndrome, who had a history of respiratory infection from his childhood onward and whose chest radiograph revealed hyperlucency of the right lower lung field. A standard right middle and lower lobectomy was performed. Histological examination of the resected specimens revealed hypoplasia of alveoli and pulmonary artery.