[A case of ventricular septal perforation treated surgically with an infarction exclusion technique]

We report an 85-year-old woman with postinfarction interventricular septal perforation. She underwent successful emergent surgical treatment by a slightly modified method based on David-Komeda's procedure. Perforation in this case occurred four days after acute myocardial infarction. Preoperative Qp/Qs was 2.58, and pulmonary artery pressure was 34/25 mmHg. The area of infarction was large, and the perforation was the linear type 2.5 cm long near the apex. A probe was not able to pass through the perforation due to its complicated configuration. A double Xenomedica patch was sutured on the left side of the interventricular septum without excising the infarcted area. The suture line was placed on healthy myocardium apart from the infarcted area. The Xenomedica patch was sandwiched between the closure line of the ventriculotomy. Four days after surgery, residual shunt was observed by echocardiogram, but this subsequently disappeared on the 17th postoperative day. The patient was discharged from our hospital on the 57th postoperative day, and is now doing quite well.

Changes in photosystem stoichiometry in response to environmental conditions for cell growth observed with the cyanophyte Synechocystis PCC 6714

Changes in photosystem stoichiometry in response to shift of environments for cell growth other than light regime were studied with the cyanophyte Synechocystis PCC 6714 in relation to the change induced by light-quality shift. Following two environment-shifts were examined: the shift of molecular form of inorganic carbon source for photosynthesis from CO2 to HCO3- (CO2 stress) and the increase in salinity of the medium with NaCl (0.5 M) (Na+ stress). Both CO2 and Na+ stresses induced the increase in PSI abundance resulting in a higher PSI/PSII stoichiometry. CO2 stress was found to elevate simultaneously Cyt c oxidase activity (Vmax). The feature was the same as that caused by light-quality shift from preferential excitation of PSI to PSII (light stress) though the enhancement by either stress was smaller than that by light stress. Under our experimental conditions, PSI/PSII stoichiometry appeared to increase at a fairly constant rate to the basal level even when the basal level had been differently determined by the light-quality. Enhancing rates for PSI/PSII stoichiometry and for Cyt c oxidase activity were also similar to each other. Since the two stresses affect the thylakoid electron transport similarly to the shift of light-quality, we interpreted our results as follows: three environmental stresses, CO2, Na+, and light stresses, cause changes in electron turnover capacity of PSI and Cyt c oxidase under a similar, probably a common, mechanism for monitoring redox state of thylakoid electron transport system.

The inhibitory effect of vitamin E on pulmonary polyamine biosynthesis, cell proliferation and carcinogenesis in mice

We investigated the modulating effect of vitamin E on pulmonary polyamine biosynthesis, cell proliferation and carcinogenesis in mice treated with urethane. Pulmonary ornithine decarboxylase induction and subsequent polyamine accumulation were observed during the initiation and promotion phases of the urethane-induced lung carcinogenesis in mice. The increases of ODC activity and polyamine level during both phases were almost inhibited when a high vitamin E diet was provided. The urethane-increased level of pulmonary proliferating cell nuclear antigen as a marker of cell proliferation during the carcinogenesis was inhibited by vitamin E treatment. Also, vitamin E suppressed the urethane-induced elevation of pulmonary cyclooxygenase activity as a marker of tumor promotion. In conjugation with these events, vitamin E reduced the development of lung tumors in mice treated with urethane. These results indicated that vitamin E could act as a useful chemopreventive agent against lung carcinogenesis in mice due to the regulation of cell proliferation.

The inhibitory effect of vitamin E on K-ras mutation at an early stage of lung carcinogenesis in mice

In this study, we investigated the effect of vitamin E on the activation of the K-ras oncogene with a 61st codon A-->T mutation at an early stage of urethane-induced lung carcinogenesis in mice. Thirty days after urethane injection, the K-ras mutation was detected in 64% of lung samples tested by mutant-allele-specific amplification. The consumption of a supplemented diet with about 20-times more vitamin E than the control diet, only during the promotion phase or during both the initiation and promotion phases of lung carcinogenesis, reduced the frequency of the mutation to 36 and 18%, respectively. Also, vitamin E suppressed the level of proliferating cell nuclear antigen as a marker of cell proliferation in the lungs of mice treated with urethane. These results support the notion that vitamin E is a useful chemopreventive agent against lung cancer.

Evaluation of the human gene encoding recoverin in patients with retinitis pigmentosa or an allied disease

PURPOSE

To determine whether defects in the human recoverin gene cause retinitis pigmentosa (RP) or an allied disease such as Usher syndrome, Leber congenital amaurosis, or the Bardet-Biedl syndrome.

METHODS

Single-strand conformation polymorphism analysis and direct genomic sequencing techniques were used to screen 596 unrelated patients, comprising 167 patients with dominant RP, 168 with recessive RP, and 261 with an allied disease.

RESULTS

Four sequence variants were discovered. The first was a missense change (Ala200Thr) found in one family with autosomal dominant RP and in one family with autosomal recessive RP; it did not segregate with disease. The second was a silent, single-base variation affecting codon Ser24 with a minor allele frequency of approximately 0.5%. The third was a silent, single-base variation affecting codon Va1122. The fourth was a single-nucleotide substitution in intron 2, 11 bp upstream of exon 3.

CONCLUSIONS

The authors found no evidence that mutations in the recoverin gene are a cause of RP or another of the hereditary retinal diseases studied. The human phenotype associated with mutations of the recoverin gene remains unknown.

Apoptosis in retinal ganglion cell decrease in human glaucomatous eyes

Hematoxylin-eosin staining, the TUNEL method for in situ detection of the intranuclear DNA fragmentation, which indicates apoptosis, and electron microscopy were used to study the morphologic changes in specimens from the eyes of 8 patients with secondary glaucoma and 2 normal control eyes to evaluate our hypothesis that apoptosis causes a decrease in retinal ganglion cells in human glaucomatous eyes. The TUNEL method permits identification of intranuclear DNA fragmentation. Apoptosis was found in the ganglion cells of 2 glaucomatous eyes with recent sight loss, and in the ganglion cells of a control eye from a 95-year-old subject, taken at autopsy. Results of our study indicate that a decrease in retinal ganglion cells in glaucomatous eyes is caused by apoptosis. In addition, apoptosis resulting from aging must be considered in order to understand the reduction of retinal ganglion cells in the glaucomatous eyes of elderly patients.

[A case of primary orbital chondrosarcoma]

The case of a twenty-year-old male with orbital chondrosarcoma is reported. He visited National Defense Medical College Hospital because of reduced vision in the right eye since two months previously. His corrected visual acuity was 8/20 in the right eye and 20/20 in the left eye. Fifteen degrees lateral displacement of the right globe and limitation of right ocular movement were recognized. Right fundus examination revealed optic disc edema and protuberant nasal fundus. Orbital computed tomography (CT) demonstrated a high density area between the inner part of the right orbit and the ethmoid sinus. Magnetic resonance imaging (MRI) showed a smoothly outlined and low intensity (T1) space occupying lesion. This lesion was irregularly enhanced by gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA). This orbital tumor was removed by an anterior approach. Histopathological examination revealed well-differentiated chondrosarcoma (grade 1) as determined by small prominent chondromatous cell projection into the collagen fibrous stroma, and existence of binucleate cells in the hypercellular region. After the operation the disc edema disappeared and his corrected right visual acuity improved to 20/20.

Inhaled nitric oxide after lung ischemia reperfusion; effect on hemodynamics and oxygen free radical scavenger system

OBJECTIVE

Pulmonary hypertension and transient graft dysfunction may complicate the postoperative course of patients undergoing lung transplantation. Recent studies have suggested that ischemia followed by reperfusion impairs release of endothelium-derived nitric oxide (NO). We investigated the acute effect of inhaled NO on hemodynamics and the oxygen free radical scavenger system after reperfusion following lung ischemia.

METHODS

Fourteen anesthetized mongrel dogs were ventilated mechanically. After median sternotomy the left lung was rendered ischemic by totally clamping the left pulmonary hilum. After 90 min, the left lung was reperfused for 150 min by unclamping of the left hilum and clamping the right pulmonary hilum so that all pulmonary blood flow was directed to the left lung. Seven dogs inhaled 30 parts per million (ppm) NO during reperfusion (NO group); the other seven dogs were ventilated without NO inhalation (control group). Hemodynamics, gas exchange, superoxide dismutase activity and lipid peroxide of pulmonary venous blood, and wet/dry ratio of reperfused lung were measured.

RESULTS

Neither of the two groups showed any change in systemic blood pressure prior to or following reperfusion. Immediately after reperfusion, mean pulmonary arterial pressure was significantly less (23.2 +/- 4.2 mmHg) in the NO group than in the control group (32.7 +/- 5.8 mmHg), as had been throughout reperfusion. Pulmonary vascular resistance and right ventricular end diastolic pressure were lower after reperfusion in the NO group. Superoxide dismutase activity after reperfusion in the control group significantly decreased to 41% of preischemic value. In the NO group, however, no decrease was seen and a significantly higher value was observed. The wet/dry ratio of reperfused lung was 5.47 +/- 0.52 in the control group and 4.72 +/- 0.36 in the NO group, with decreased pulmonary moisture noted in the NO group. There was no difference in lipid peroxide between the two groups.

CONCLUSION

NO inhalation suppressed pulmonary hypertension after reperfusion following lung ischemia without affecting systemic arterial pressure. As superoxide dismutase activity was not depressed in the NO group, NO inhalation might enhance suppression of oxygen free radicals. These findings suggest that NO inhalation may be therapeutically useful after lung transplantation.

Prevention of heartburn relapse by low-dose famotidine: a test meal model for duration of symptom control

AIM

To establish whether patients taking famotidine 10 mg to treat an episode of heartburn were protected from a recurrence of symptoms after a subsequent test meal.

METHODS

Frequent heartburn sufferers (n = 366) were randomized to receive double blind treatment with famotidine 10 mg or 2 x 250 mg chewable alginate tablets within 30 min of a spontaneous episode of heartburn. After 4 h, patients with no or slight residual symptoms consumed a meal likely to induce heartburn. Over the next 4 h patients recorded the severity of heartburn and any consumption of 'rescue' antacids. At the end of this time they rated the global efficacy of their treatment in controlling meal-induced symptoms.

RESULTS

Study groups were well matched for all baseline characteristics. Of the 366 randomized patients, 276 took study medication and data from 269 patients (132 famotidine, 137 alginate) were analysed for efficacy. Compared to the alginate control group famotidine treated patients reported better global efficacy following the test meal (P < 0.001; relative odds for a more favourable response: 2.26 [95% CI: 1.45-3.53]). Fewer patients receiving famotidine resorted to antacid rescue (P = 0.038; relative odds for a more favourable response: 2.24 [95% CI: 1.04-4.79]) and peak heartburn was significantly less severe with famotidine treatment (P < 0.001: relative odds for a more favourable response: 2.90 [95% CI: 1.85-4.53]). Eleven famotidine-treated patients (8%) and 13 alginate patients (9%) reported adverse events.

CONCLUSION

Compared to patients receiving an alginate preparation, patients self medicating with famotidine 10 mg for heartburn are better protected against a recurrence of their symptoms when they next eat. This suggests that the duration of acid control (9 h) previously demonstrated with this dose translates into a similar duration of measurable symptom control during the day.

Identification of Eucalyptus citriodora clones micropropagated in tissue culture

The extent of genetic identity observed in the young individuals which were micropropagated from a single Eucalyptus individual was analyzed by using DNA-fingerprinting. Among 40,000 tissue-cultured-seedings of E.citriodora, 200 plants were randomly chosen so that each total DNA might be extracted from their leaves. Using these DNAs as template, PCR was performed with some primers we found in advance that leads polymorphism for DNA of E. citriodora. In this study, all over the 200 cases, the band pattern formed cDNA fragment on a gel after electrophoresis was the identical one mutually.

Treatment of node-positive endometrial cancer with complete node dissection, chemotherapy and radiation therapy

We assessed the therapeutic significance of systematic aortic and pelvic lymphadenectomy followed by adjuvant therapy in node-positive endometrial carcinoma. Among 173 stage I-III patients, 30 (17%) had positive nodes: ten in the pelvic region alone (group P) and 20 in the aortic region alone or in both regions (group A). The adjuvant therapy was administered as follows: subjects in group P received 50 Gy pelvic radiation, including three post-surgical T3 (pT3) patients who received either one or three cycles of cisplatin-based chemotherapy before radiation. Subjects in group A were given three cycles of chemotherapy followed by 50 Gy pelvic and 50 Gy extended field periaortic radiation using a four-field or conformational technique. Five-year survival was 95% for 143 patients with negative nodes and 84% for 30 patients with positive nodes (100% for group P and 75% for group A). In group A, 5-year survival was 38% for eight patients with both pT3 and histology other than endometrioid type G1, and 91% for the remaining 12 patients. Either way, both group P and group A patients had a better prognosis than previously reported. In summary, aortic and pelvic lymphadenectomy and subsequent chemotherapy and radiation therapy based on node status seem to improve the survival of endometrial cancer patients with positive nodes.

Inhibitory effect of pheophorbide a, a chlorophyll-related compound, on skin tumor promotion in ICR mouse

Anti-tumor-promoting activity of pheophorbide a (PPBa) a chlorophyll-related compound, was examined in a two-stage carcinogenesis experiment in ICR mouse skin by 7,12-dimethylbenz[a] anthracene (DMBA, 0.19 mumol) and 12-O-tetradecanoylphorbol-13-acetate (TPA, 1.6 nmol). Topical application of PPBa (160 nmol) markedly reduced the average number of tumors per mouse and the ratio of tumor-bearing mice (inhibitory ratio: IR = 56%, P < 0.01 and 31%, P < 0.005, respectively). PPBa exhibited potent anti-inflammatory activity in ICR mouse ears and moderate inhibitory activity toward TPA-induced superoxide (O2-) generation in differentiated HL-60 cells. While CuPPBa, a synthetic copper complex of PPBa, exhibited higher anti-inflammatory activity than that of indomethacin, it showed little antioxidative effect against formation of lipid hydroperoxides (LOOHs) and malondialdehyde (MDA), suggesting that the antioxidative effect of PPBa might not be important for anti-inflammatory activity. These results imply that the active mechanism of PPBa for anti-tumor promotion might be partly involved in inhibition of TPA-induced inflammatory responses by suppressing leukocyte activation.

[An operative case of suture-granuloma which resulted from an intra-pulmonary treatment 10 years ago and manifested hemoptysis]

We experienced a 27-year-old male patient with recurrent hemoptysis manifested by granuloma which resulted from surgical repair that was performed for right pneumothorax using unabsorbable sutures (braided silk) before 10 years. The patient had been suffering from fever and cough for three months before hemoptysis. Chest X-ray and CT scan films showed a mass shadow in the lateral side of the right lung field. Furthermore, bronchoscopy revealed bleeding in B3 of the right lung. The patient underwent right upper lobectomy, which disclosed that hemoptysis was due to a granuloma (2.3 x 3.2 cm in size) formed around sutures. The granuloma was caused not only by foreign body reaction but also by transbronchial infection.

1'-Acetoxychavicol acetate, a superoxide anion generation inhibitor, potently inhibits tumor promotion by 12-O-tetradecanoylphorbol-13-acetate in ICR mouse skin

The anti-tumor-promoting activity of 1'-acetoxychavicol acetate (ACA) was examined in a two-stage carcinogenesis experiment in ICR mouse skin using 7,12-dimethylbenz[a]anthracene (0.19 mumol) and 12-O-tetradecanoylphorbol-13-acetate (TPA; 1.6 nmol). Topical application of ACA (160 nmol) markedly reduced the average number of tumors per mouse and the ratio of tumor-bearing mice: inhibition ratios 90% (p < 0.001) and 42% (p < 0.005), respectively. ACA even at a dose equimolar to TPA (1.6 nmol) significantly reduced the average number of tumors per mouse: inhibitory ratio 44% (p < 0.05). ACA potently inhibited TPA-induced superoxide (O2-) generation in differentiated HL-60 cells (IC50 = 4.3 microM) and suppressed the lipid hydroperoxide formation by 42% (p < 0.001) in the ethyl linoleate autoxidation test.

Interrogative suggestibility in opiate users

The present study investigated interrogative suggestibility in opiate users. A group of patients undergoing a methadone detoxification programme in an in-patient drug treatment unit (Detox group, n = 21), and a group of residents who had come off drugs and were no longer suffering from withdrawal syndrome (Rehab group, n = 19) were compared on interrogative suggestibility and various other psychological factors. Significant differences were found between the two groups, with the Detox group having more physical and psychological problems, and a higher total suggestibility score in comparison with the Rehab group. These findings are discussed in relation to the context of police interrogations and the reliability of confessions made by suspects and witnesses dependent on opiates.

Identification of pheophorbide a and its related compounds as possible anti-tumor promoters in the leaves of Neptunia oleracea

Six chlorophyll-related compounds isolated from leaves of Neptunia oleracea (Leguminosae) inhibited the activation of tumor promoter-induced Epstein-Barr virus (EBV). Photo-irradiation of pheophorbide a, the major active constituent, did not enhance this inhibitory activity, and thus ruled out any photosensitizing effect playing the major role.

[Coronary artery bypass grafting for acute myocardial infarction]

Five hundred and fourteen cases with acute myocardial infarction were admitted to our hospital during the past 5 years, since April 1990. Among 343 cases who had emergency coronary angiography, 53 cases had coronary artery bypass grafting surgery within 2 weeks after the onset of acute myocardial infarction. Mean number of bypass grafts was 2.9 +/- 0.9/patient, and operative mortality was 25% (13/53). Clinical condition immediately before the surgery and surgical mortality was, shock state in 20 cases (mortality 50%), IABP dependent state in 23 cases (mortality 13%), post-infarction angina in 8 cases (mortality 0%). Mortality in 8 cases whose infarct-related artery was left main trunk was as high as 63%. Eight of 9 cases whose cardiac indices were below 2.01/min/m2 immediately after the surgery died of pump failure. On the contrary, only 2 of 37 cases whose post-operative cardiac indices were above 2.01/min/m2 died of non-cardiac reason. To improve the surgical results, we concluded that powerful mechanical support such as ventricular assist system should be applied to post-operative pump failure cases whose cardiac indices were below this limit despite the aid of IABP.

Absence of down-regulation and translocation of the eta isoform of protein kinase C in normal human keratinocytes

Among 11 isoforms of protein kinase C (PKC), we previously reported that the eta isoform of PKC plays a crucial role in mediating differentiation of keratinocytes. Activation of PKC is associated with its intracellular translocation from the cytoplasm to the plasma membrane, followed by down-regulation through proteolytic cleavage of the PKC molecules. In the present study, we demonstrated that the eta isoform of PKC is unique in that it is not translocated nor down-regulated upon stimulation. The level of the eta isoform, assayed by immunoblotting, remained unchanged during the first 12 h and then increased slightly up to 24 h when treated with tumor promoters or activators of PKC in constitutively expressing normal human keratinocytes. The activity of the eta isoform also remained unchanged after the 12-O-tetradecanoyl-phorbol-13-acetate treatment, as judged by binding ATP analog, autophosphorylation, and phosphorylation of an exogenous substrate. The alpha isoform of PKC, however, was rapidly down-regulated and was undetectable by 6 h after the treatment. These observations were further confirmed by immunohistochemical staining of normal human keratinocytes and transiently expressing COS1 cells. In addition, although the alpha isoform rapidly translocated to the plasma membrane, the eta isoform remained in the cytoplasm.

Chemopreventive effect of a xanthine oxidase inhibitor, 1'-acetoxychavicol acetate, on rat oral carcinogenesis

The effect of a xanthine oxidase inhibitor, 1'-acetoxychavicol acetate (ACA), on 4-nitroquinoline 1-oxide (4-NQO)-induced oral carcinogenesis was investigated in male F344 rats. All rats except those in the ACA-alone and untreated groups were given 4-NQO (20 ppm) In the drinking water for 8 weeks to induce oral cancer. Starting 1 week before the 4-NQO exposure, animals were fed diet containing 100 ppm or 500 ppm ACA for 10 weeks, followed by the basal diet without ACA for 22 weeks. Other groups were fed the diet containing ACA at 100 ppm or 500 ppm for 22 weeks, starting 1 week after the cessation of 4-NQO exposure. The remaining groups consisted of rats given 500 ppm ACA alone or untreated rats. At the termination of the experiment (32 weeks), the incidences of tongue neoplasms and preneoplastic lesions, polyamine levels in the tongue tissue, and cell proliferation activity estimated in terms of 5-bromodeoxyuridine (BrdU)-labeling index and by morphometric analysis of silver-stained nucleolar organizer regions' protein (AgNORs) were compared among the groups. Feeding of ACA at the two doses during initiation or postinitiation significantly decreased the development of tongue carcinoma (93-100% reduction, P < 0.001) and preneoplasia (43-50% reduction for hyperplasia and 34-48% reduction for dysplasia, P < 0.05). There were no such lesions in rats fed ACA alone or those in the untreated control group. The number of AgNORs per cell nucleus was significantly decreased by feeding of ACA at a high dose (500 ppm) (29% inhibition, P < 0.05). The BrdU-labeling index was also reduced by dietary administration of ACA (23-32% inhibition, P < 0.01). In addition, ACA feeding reduced tongue polyamine levels (35-40% inhibition, P < 0.05). These results indicate that ACA inhibited rat oral carcinogenesis, and such inhibition might be related to suppression of cell proliferation in the oral mucosa by the xanthine oxidase inhibitor.

Growth inhibition of human leukemic cells by WT1 (Wilms tumor gene) antisense oligodeoxynucleotides: implications for the involvement of WT1 in leukemogenesis

We have previously reported expression of WT1 in acute leukemia. To elucidate its biological significance, we examined the effect of the suppression of the WT1 expression by WT1 antisense oligomers on the growth of the leukemic cells expressing WT1. When 20 different WT1 antisense (AS) oligomers covering from the 5' cap sites of the WT1 gene to the 3' end were examined for the inhibitory effect on the growth of K562 cells expressing WT1, four WT1 AS oligomers inhibited the cell growth, whereas WT1 sense and random sequence oligomers had no effect on the cell growth of K562. Moreover, WT1 AS oligomers significantly inhibited the growth of the clonogenic cells of fresh leukemic cells in six of 14 patients with acute myeloid leukemia, in one of two patients with chronic myelogenous leukemia (CML) chronic phase, and in one of one patient with CML blastic crisis. However, these oligomers did not inhibit normal colony-forming unit-granulocyte-macrophage. Western blot analysis clearly demonstrated the significant reduction in the WT1 protein levels in the K562 and fresh leukemic cells that were treated with the WT1 AS oligomers, confirming that the inhibitory effect of the WT1 AS oligomers on the cell growth operates via the reduction in the WT1 protein levels. These results show that WT1 plays an important role in leukemogenesis.

[Isolated rupture of the ventricular septum caused by nonpenetrating trauma--a case report of operation in acute stage]

We experienced a case of the isolated ventricular septal defect due to nonpenetrating chest trauma. The patient was 22-year-old male who hit his chest with a steering wheel on car accident. The echocardiogram examined on the next day revealed a ventricular septal defect. Four days after the injury, intracardiac repair was performed. On cardiopulmonary bypass the ventricular perforation (35 x 35 mm size) located in the muscular portion near the apex was closed with a PTFE and equestrian pericardial patch. Postoperative cardiopulmonary function could improve enough to wean from IABP and respiratory support. However, the patient died on the fifth postoperative day of severe hepatic failure due to profound shock persisted after the accident.