[Quantitative hemodynamic assessment of internal thoracic artery grafts using transthoracic duplex imaging]

The hemodynamics of blood flow in internal thoracic artery (ITA) grafts were studied using transthoracic duplex imaging prior to and following coronary artery bypass grafting (CABG) in 37 patients. Transthoracic images of the ITA were obtained through the first intercostal space using a 7.5 MHz probe, and their diameter and area were measured by B-mode imaging. Systolic, diastolic, mean and end-diastolic blood flow velocity (Vs, Vd, Vm, and Ved) were determined based on Doppler signals and systolic, diastolic, and total blood flow (Fs, Fd, and Ftotal) were calculated by the following formula: Flow = Vm x area x 60/10(3). The diameter of the ITA increased following CABG. Prior to CABG, Vs, and Fs, were dominant, while following CABG, the hemodynamic pattern was diastolic dominant, although individual variation existed. The ITA blood flow was measured in 4 groups, in patients who had had a previous anterior myocardial infarction and no redistribution on myocardial scintigraphy (group I), in patients with 99-100% coronary artery stenosis who had not had an anterior myocardial infarction or who had an anterior myocardial infarction and had redistribution (group IIa), in patients with the same criteria as group IIa but who had 90% coronary stenosis (group IIb), and in patients with 75% coronary stenosis who had not had anterior myocardial infarction (group IIc). Blood flow was 57, 73, 44mL and 34 mL/min, and the percentage of diastolic flow was 72, 69, 61, 59% respectively. These results show that ITA blood flow competes with native coronary artery flow in patients with moderate coronary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Efficacy of oral midazolam as premedication in adult]

Midazolam was administered as a premedicant to 90 patients aged from 20 to 55 years with ASA status 1 or 2. The patients were divided into 3 groups: group I 10 mg orally, group II 20 mg orally, group III 5 mg intramuscularly. All premedications were given 30 minutes before entering the operating room. The perioperative effects of midazolam on blood pressure, pulse rate, respiratory rate and SpO2 as well as sedative, hypnotic and amnemonic effects were evaluated in these patients. There were no remarkable changes in the blood pressure, pulse rate or respiratory rate. There was no problem on the upper airway tract, but a slight decrease in SpO2 was observed in a few patients. In this study, sedative and hypnotic effects were almost satisfactory. Midazolam produced significant anterograde amnesia, and the amnemonic rate was 66.7% in group I and 86.7% in group II and III. In conclusion, oral midazolam is an effective preanesthetic medication in adult.

Effect of "Megafiller" insertion on the wear of composite resins

We have previously reported that insertion of coarse particles of beta-Quartz Glass Ceramic Insert (Megafiller) into a composite resin markedly reduced the polymerization shrinkage of resin restorative materials. In this study, we examined the effects of Megafiller insertion on wear resistance evaluated by the glass beads abrasion test, and the conventional toothbrushing abrasion test. The depth of wear was determined by measuring the thickness of the specimen before and after the wear tests using a profile projector accurate to 1 micron. In general, the depth of wear of the composites was reduced by Megafiller insertion, but the differences in the depth of wear between composites with and without the Megafiller were not significant except for a few materials. There were slight differences in the wetness of Megafiller in some composite resins.

The effects on blood flows of coronary artery by-pass grafts during intra-aortic balloon pumping

The internal thoracic artery (ITA), as well as aorto-coronary by-pass grafts, has been used for widely coronary artery by-pass grafting. Intra-aortic balloon pumping (IABP) is the first choice for left ventricular support when low output syndrome occurs during coronary artery by-pass surgery. However, the effect of diastolic augmentation by IABP may vary to the type of grafts. Graft flow with and without IABP support were measured in six patients undergoing elective coronary artery bypass surgery requiring IABP at Kanazawa National Hospital. The patients ranged in age from 59 to 67 years, with a mean age of 63 years, and included one woman and five men. In all cases, the left ITA was dissected from the thoracic wall as pedicle, and anastomosed in situ to the left anterior descending artery. Saphenous vein grafts (SVGs) were used for aortocoronary by-pass to the obtuse marginal branches, the first diagonal branches, the left circumflex branches, and/or the right coronary artery. Blood flow in 6 ITAs, 11 SVGs to the left coronary artery systems, and three SVGs to the right coronary artery was measured by ultrasound transit-time flowmeter simultaneously with the electrocardiogram. Blood flows in ITA grafts and SVGs were measured during IABP assist and unassisting under hemodynamically stable conditions after discontinuing cardiopulmonary by-pass. The systolic and diastolic flows of each graft were measured using the peak of the R wave and the end of T wave on the electrocardiogram as the references for systole. Systolic flow during IABP were similar to unassisted flow in both ITA and SVGs.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro and in vivo anti-herpes viral activities and biological properties of CV-araU

We compared the in vitro and in vivo antiviral effects against herpes simplex virus type 1 (HSV-1) and other biological properties of 1-beta-D-arabinofuranosyl-5-[(E)-2-chlorovinyl]uracil (CV-araU) and 1-beta-D-arabinofuranosyl-5-[(E)-2-bromovinyl]uracil (BV-araU, sorivudine). Both CV-araU and BV-araU exhibited antiviral activities against HSV-1 in the cell culture derived from mouse, though the activities were lower than those seen in human cells. For intraperitoneal and intracerebral infections in mice with HSV-1 strain WT-51, both compounds, administered twice daily, were effective in increase in the survival rate at doses of 15 mg/kg and 30 mg/kg, respectively. In pharmacokinetic analysis, both drugs were absorbed well in the rat gastrointestinal tract following oral administration. There was no difference between the metabolism of orally administered CV-araU and BV-araU in rats. High levels of the corresponding base were found in plasma after oral administration of CV-araU and BV-araU, but much lower base levels were seen after intravenous doses. Both drugs were resistant to degradation by rat liver enzymes.

Highly efficient transfection into primary cultured mouse hepatocytes by use of cation-liposomes: an application for immunization

Transfection methods for primary cultured mouse hepatocytes were examined. Of four conventional transfection methods examined, involving use of DEAE-dextran, calcium phosphate, cation-liposomes (lipofection), and cation-multilamellar liposomes, only cation-liposomes induced highly efficient transfection into primary cultured mouse hepatocytes. The highest transfection rate reached more than 60% of the total cells. Three other commonly used cell types (CHO-K1, COS-1, 3T3-L1) were also tested as target cells, but highly efficient transfection was observed specifically in primary cultured mouse hepatocytes. The transfection remained at a high level from 6 to 48 h after the start of incubation with the cation-liposome-DNA complex in the absence of serum, and the transfection rate decreased in inverse relation to the increase in cell density. The transfection was inhibited by free low density lipoprotein (LDL), EDTA, and an endocytosis inhibitor, cytochalasin B. These data suggest that the transfection is mediated not only by membrane fusion, as is generally accepted, but also by endocytosis. This information should be useful for research in hepatocyte biology and the development of gene therapy. As one of the applications, simple and successful immunization was achieved by administration of hepatocytes transfected with murine adhesion molecule, integrin VLA beta 1 subunit, genes into a Syrian hamster.

Assessment of frequency shifts in R-R interval variability and respiration with complex demodulation

A complex demodulation (CDM) method for continuous assessment of frequency shifts and time-dependent changes in amplitude in the rhythmic components existing in predefined frequency bands was proposed and applied to the analysis of high-frequency (HF) and low-frequency (LF) components of the R-R interval and to the analysis of respiration via impedance spirogram. Simulation studies revealed that this CDM technique furnishes mathematical features well suited to the investigation of non-stationary R-R interval signals and can delineate time-dependent fluctuations in both amplitude and frequency, accurately differentiating between HF and LF components. Analysis of data during paced breathing at different respiratory frequencies revealed that the estimated frequency of the HF component and respiration faithfully reflected the frequency of paced breathing. Analysis of data during dynamic exercise with increasing workload (20 W/min) showed that the frequency of the HF component was elevated with exercise and that both HF and LF amplitudes were reduced progressively with advancing load. CDM-derived frequency and amplitude of respiration were highly correlated to direct breath-by-breath respiratory frequency and tidal volume measurements. We conclude that this method could provide a powerful means for continuously assessing time-dependent changes in both cardiovascular and respiratory variations.

Assessment of the brain areas perfused by superselective intra-arterial chemotherapy using single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime--technical note

The brain areas perfused by superselective intra-arterial (i.a.) chemotherapy were assessed using single photon emission computed tomography (SPECT) with technetium-99m-hexamethyl-propyleneamine oxime (99mTc-HMPAO). A superselective catheter was introduced into the anterior, middle, or posterior cerebral artery of patients with malignant glioma for i.a. chemotherapy. 99mTc-HMPAO was subsequently injected via the same catheter used for chemotherapy, and a higher dose of 99mTc-HMPAO was injected intravenously to obtain adequate background brain images. Comparison of the SPECT images with magnetic resonance images could confirm complete perfusion of the tumor tissue. In two patients with malignant glioma, regions of interest were selected in the peritumoral brain area and a reference brain area, and the radioactivity was measured. The concentration of 99mTc-HMPAO was about 50 times higher in tissue perfused by superselective injection into anterior or middle cerebral artery compared to intravenous injection. 99mTc-HMPAO SPECT is readily available in many institutions and the information provided is useful for planning more effective and safe i.a. chemotherapy.

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)