Comparison of the effects on bronchial hyperresponsiveness of antiallergic agents and beclomethasone dipropionate in long-term bronchial asthma. A retrospective study

The effect of antiallergic agents (DSCG) (disodium cromoglycate, ketotifen, and ibudilast) and beclomethasone dipropionate inhaler (BDI) on bronchial hyperresponsiveness to histamine inhalation was retrospectively assessed in 72 asthmatic patients with more than a year's duration of the disease. Decrease in bronchial hyperresponsiveness to histamine was observed in 10 out of the 33 (30%) antiallergic-agents-treated patients (group A, mean duration = 7.8 months), in 12 of 19 (63.2%) BDI-treated patients (group B, 6.2 months), but only 2 of the 20 (10%) control patients (group C, 7.8 months). Improvement of histamine PC20 was from 310 to 597 micrograms/ml (P < 0.01) in group A, from 308 to 1622 micrograms/ml (P < 0.0005) in group B, and from 575 to 525 micrograms/ml (NS) in group C. A significant decrease in the peripheral eosinophil count was observed only in group B. The improvement in bronchial hyperresponsiveness was parallel with that of asthmatic symptoms; the percentage of patients becoming symptom-free rose from 12 to 42%, 5 to 89%, and 5 to 20% in groups A, B, and C, respectively. Out of 11 unimproved patients in group A, 7 showed a significant improvement in their histamine PC20 by BDI treatment (mean PC20: 311-->1828 micrograms/ml). These results suggest that BDI might be more effective than antiallergic agents in the treatment of patients with long-standing bronchial asthma.

[A case of mitral regurgitation caused by total rupture of the posterior papillary muscle after acute myocardial infarction]

We observed a case of severe mitral regurgitation caused by total rupture of the posterior papillary muscle 13 days after acute myocardial infarction. The patient was a 76-year-old man who suddenly felt anterior chest pain. He was admitted to another hospital with the diagnosis of acute myocardial infarction. Electrocardiogram suggested a posterior infarction. He did well during the first 12 days of hospitalization, but at noon on the 13th day he developed anterior chest pain and dyspnea. Echocardiography demonstrated rupture of the posterior papillary muscle. He was subsequently transferred to our hospital with acute heart failure. He was initially treated with an intra-aortic balloon pump. Cardiac catheterization demonstrated 99% stenosis of segment 2 of the right coronary artery and mitral regurgitation, Sellers' stage IV. Intraoperative findings included total rupture of the posterior papillary muscle. Mitral valve replacement was performed using a Carbomedics prosthetic valve. The patient was discharged 53 days after surgery without heart failure or angina pectoris. This case represents the 6th successful operation of total papillary muscle rupture in Japan.

[Myocardial revascularization with bovine internal thoracic artery graft (BIOFLOW): a case report]

Bovine internal thoracic artery graft (BIOFLOW) was used for coronary artery bypass grafting (CABG). A 64-year-old woman who had undergone triple CABG with saphenous vein five years ago was referred to our hospital again with anginal attack. Coronary angiogram showed the obstruction of the graft for LAD and new stenosis at right coronary artery (RCA). Gastroepiploic artery was not available because the patient had a history of gastric ulcer several times, and saphenous vein had harvested initial operation. We planned re-CABG for LAD with left internal thoracic artery and RCA with BIOFLOW. But at the operation, LAD was not graftable because of severe calcification. So that we performed single CABG to RCA with BIOFLOW. The BIOFLOW was patent at the 28 th postoperative day. From our experience, BIOFLOW can be expected as a graft for CABG when saphenous vein, internal thoracic artery and gastroepiploic artery are not available.

Bronchial hypersensitivity in asthmatics in long-term symptom-free state

Improvement of asthmatic symptoms was shown to be closely associated with a decrease in bronchial hypersensitivity to histamine inhalation. Thus, the patients' clinical backgrounds were compared between 26 long-term cases whose symptom-free state lasted more than 1 year and 15 short-term cases whose symptom-free state ceased within 1 year. Among backgrounds, only the intrinsic type of asthma was significantly higher in number in the long-term group than in short-term group (65 percent vs 27 percent). The histamine threshold after the patients became symptom-free was significantly higher in the long-term group. In the short-term group, the values of PC20 just before the termination of the symptom-free state were all less than 5,000 mg/L of histamine. However, in the long-term group, the values of the PC20 for the final test were mostly over 5,000 mg/L. Decrease in bronchial hypersensitivity is considered to be a very important aim of therapy in bronchial asthma.

Multiple regulation of ornithine decarboxylase in enzyme-overproducing cells

We have isolated from mouse FM3A cells a variant cell line, termed EXOD-1, that overproduces ornithine decarboxylase (ODC). The cells were resistant to alpha-difluoromethylornithine, an irreversible inhibitor of the enzyme, and produced the enzyme protein to the extent of approx. 3-6% of total cytosolic protein. The rate of ODC synthesis in this cell line accounted for 25-50% of the rate of total protein synthesis. The amounts of the ODC gene and its mRNA in the variant cells were both about 60 times as much as those in wild-type FM3A cells. Upon removal of the inhibitor, the growth of the ODC-overproducing cells was stimulated approx. 2-fold. Under these conditions, the rate of ODC synthesis increased about 4-fold on day 1 and then decreased to near the original level by day 3. The amount of ODC mRNA increased about 1.7-fold on day 1 and 2.5-fold on day 3. No correlation was observed between changes in ODC synthesis rate and in ODC mRNA content, suggesting a translational repression of ODC mRNA due to accumulation of polyamines. In fact, the cellular contents of putrescine and spermidine markedly increased and that of spermine inversely decreased during the same period. Pulse-chase experiments showed that the accumulation of putrescine and spermidine also elicited a rapid degradation of ODC. Excess amounts of newly synthesized putrescine and cadaverine were excreted into the medium, whereas spermidine, spermine and acetylated polyamines were undetectable there. We conclude that ODC regulation upon removal of the inhibitor is dependent on at least three steps, namely the level of mRNA, the translational efficiency of mRNA and the stability of the enzyme, the last two of which are involved in cellular polyamines.

A new gel using super absorbent polymer for mapping the spatial dose distributions of electron beams by MR imager

A technique for mapping the spatial dose distribution with a magnetic resonance imager is presented. A ferrous sulphate solution with sulfuric acid was used as the detecting medium for radiation dose. To make a gel of the solution for filling up a cubic phantom, we developed a new gel component that is combined with a super absorbent polymer (Sumikagel N-100) and a cross-linked dextran gel (Sephadex G-200). In order to make the application for radiation treatment planning, mapping of the dose distribution was carried out using a Unix computer.

Energy loss of 70 MeV protons in organic polymers

Using Bragg ionization curves, measurements of the average stopping power of organic polymers relative to that of water have been made for 70 MeV protons losing about 30 MeV in the absorbers. By comparing calculated curves to experimental ones, I-values for the polymers were obtained, relative to the I-value for A1. For repeated measurements with A-150 tissue equivalent plastic, the standard deviation of the ratio of the average stopping powers q was +/- 0.06%. It was found that q depends on the year of production of A-150. For other absorbers, the uncertainty of q is estimated to be +/- 0.2%, with a corresponding uncertainty of the I-values of +/- 1.5%. Most measured I-values exceed values calculated with the additivity rule by about 10%. During the course of the measurements, fluctuations of the proton energy from the cyclotron of up to 0.8% were found.

Superior mesenteric varices and splenic renal shunt with portal hypertension: a case report of liver cirrhosis with complications

The case of a 58-year old woman with cirrhosis complicated by hepatocellular carcinoma, hepatic encephalopathy and superior mesenteric varices is described. Angiography revealed large superior mesenteric varices and it was demonstrated that the portal venous blood was shunted into the right internal iliac vein via the right ovarian vein. Clinically, this patient had hepatic encephalopathy and hyperammonaemia, but no oesophageal varices were discovered on endoscopy. The hepatic encephalopathy suggested that the portal blood containing ammonium from the superior mesenteric vein entered the brain through the systemic vein without the ammonia being metabolized by the liver.

Euthanasia: current problems in Japan

Approximately 30 years ago, a son prepared a cup of milk mixed with insecticide and arranged for his mother to unknowingly administer the poison to his father, who had been suffering severe pain after a cerebral apoplectic attack and demanding that his son assist him. in dying. After drinking the mixture, the father died, and the son was charged with homicide.

[A case of coronary artery-pulmonary artery fistula in tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (MAPCA)]

A case of four year old girl with tetralogy of Fallot, pulmonary atresia, major aortopulmonary collateral arteries and coronary artery to pulmonary artery fistula is reported. The patient was misdiagnosed as truncus arteriosus, pulmonary stenosis and major aortopulmonary collateral arteries (MAPCA) preoperatively. The ligation of MAPCAs was carried out through left thoracotomy as an initial procedure, because we believed that the area fed by MAPCAs had dual blood supply. However, the patient demonstrated pulmonary infarction post operatively. This complication forced us to postpone an intracardiac repair. At the time of intracardiac repair, after mentioned diagnosis was established and a Rastelli type operation and ligation of coronary-pulmonary artery fistula were carried out. A 18 mm Carpentier-Edwards valved conduit was used as an extracardiac conduit.

IN CONCLUSION

1) We experienced a rare association of coronary artery fistula in TOF with PA. 2) The MAPCAs functioning as a sole source of blood-supply to the lung should be precisely diagnosed preoperatively and uniforcalized before an intracardiac repair.

DNA index as a significant indicator of lymph node metastasis and local recurrence of rectal cancer

To confirm the prognostic significance of the DNA index (DI) in cases of rectal cancer, the nuclear DNA content of tumor cells was examined in 184 cases of rectal cancer treated with curative surgery, and the incidence of lymph node metastasis and recurrence of the cancer was analyzed. The incidence of lymph node metastasis was 43.9 percent in cases with aneuploidy (DI above 1.5), being statistically different from the 18.0 percent incidence in cases with diploidy (P < 0.001). Although the extent of lymph node metastasis was limited to adjacent lymph nodes in cases with diploidy, distant lymph node metastases were frequent in cases with aneuploidy, especially in those with a DI above 1.5. Furthermore, the incidence of recurrence of cancer, and especially of local recurrence, was significantly higher (P < 0.001) in cases with aneuploidy (DI above 1.5) than in cases with diploidy and aneuploidy (DI below 1.4). These findings indicate the significant value of the DNA index for the prediction of lymph node metastasis and local recurrence in patients with rectal cancer.

Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats

Termino-lateral neurorrhaphies have been used up to the beginning of this century. After this period, they have no longer been reported. We tested the efficacy of a new type of latero-terminal neurorrhaphy and evaluated the role of the epineural sheath. A group of 10 rats had the fibular nerve sectioned and the distal ending was sutured to the lateral face of the tibial nerve without removing the epineurium. All experiments were made on the right side, the left one remaining untouched in half of the animals of each group. The other half were denervated by sectioning and inverting the endings of the fibular nerves. In this way, tibial cranial muscles were either normal or denervated in the left side and reinnervated through latero-terminal neurorrhaphy in the right side. After 7.7 months, the animals were subjected to electrophysiological tests, sacrificed, and the nerves and muscles were taken for histological exams. A response of the tibial cranial muscle was obtained in 75% of the animals. The distal ending of the fibular nerve showed an average of 498 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (mu 2):841.30 for M2n and 1798.33 for M2d. We concluded that the termino-lateral neurorrhaphy was functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The presence of the epineurium was no impediment to axonal regeneration or to the passage of electrical stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypothalamic GnRH pulse generator activity during the estradiol-induced LH surge in ovariectomized goats

Electrophysiological manifestation of the hypothalamic GnRH pulse generator activity was examined during the LH surge induced by estradiol in ovariectomized goats. The characteristic increases in the frequency of multiple unit activity (MUA volley) associated with the pulsatile secretion of LH were recorded using electrodes implanted bilaterally in the medial basal hypothalamus. Estradiol was infused for 16 h at the rate of 3 micrograms/h, to induce an LH surge 10.0-11.5 h later. Regular recurrence of MUA volley was observed throughout the experimental period including the LH surge, but the interval between the MUA volleys became longer (p < 0.01) after the onset of the LH surge as compared with the pretreatment control period (32.9 +/- 2.1 vs. 60.0 +/- 5.1 min). These results suggest that an increased frequency of LH pulses is not a prerequisite for the LH surge in ovariectomized goats given estradiol, and imply that the positive feedback effects of estradiol on LH secretion appear to be exerted through a neuronal mechanism that is intrinsically different from the GnRH pulse generator.

Maturational stage specific immunoglobulin heavy chain gene rearrangements, determined by D and D upstream region gene structures

In 43 cases of various B-cell lineage tumors, precise gene structures of rearranged immunoglobulin heavy chain (IgH) were studied. By Southern-blot analysis of D upstream (5'D) gene of IgH, biallelic rearrangement structures, D-J or V-D-J, were determined and consequently maturational stage specific IgH rearrangement patterns were investigated. B-precursor ALL cases (especially stage IV of Nadler's criteria) have V-D-J rearranged IgH genes on both alleles. In contrast, most of the mature B-cell malignancies, excluding multiple myeloma, have IgH genotype of D-J/V-D-J. In addition, in case of D-J/V-D-J, the D gene used in D-J joining has been speculated by Southern-blot of D genes. So, these approaches for inquiring precise structures of rearranged IgH genes are supposed to provide new information of lymphocyte differentiation and leukemogenesis.

[Comparison of long-term outcome of closed mitral commissurotomy (CMC) versus open mitral commissurotomy (OMC) and mitral valve replacement (MVR)]

To predict the late result of percutaneous mitral balloon valvotomy (PMV), we studied long term outcome of CMC which is similar to PMV in terms of closed heart technic, comparing with those of OMC and MVR. 226 patients with mitral stenosis were studied. 117 patients had CMC, 72 had OMC and 37 had MVR. The cumulative follow up period in these groups were 1892 patient year, 632 patient year and 200 patient year respectively. Postoperative actual survival rate at 5, 10, 15 years in CMC patients were 95 +/- 2%, 91 +/- 3%, 86 +/- 3% respectively. No operative or late death was seen in OMC or MVR patients. Postoperative event free rate at 10 years in OMC or MVR patients (97 +/- 2%, 90 +/- 6%, respectively) were higher than that in CMC patients (79 +/- 4%). Thromboembolism developed in 7 (6%) CMC patients, and 4 of these patients died from cerebral embolism. No patient in OMC or MVR group had thromboembolism. Reoperation was done for mitral restenosis or regurgitation in 40 CMC patients. 15 (38%) of these patients were associated with pulmonary hypertension, and 22 (55%) patients had secondary tricuspid regurgitation. On the other hand, only 1 OMC patient and 1 MVR patient had reoperation due to restenosis or thrombosed artificial valve. These results suggest that PMV should be indicated for restricted cases of mitral stenosis.

[Clinical experience of continuous retrograde cerebral perfusion for assisted circulation during the surgical treatment of acute dissection of aorta: Stanford A type]

Surgical treatment of the dissection involving the ascending aorta or aortic arch represents one of the most complicated technical challenges. Recently continuous retrograde cerebral perfusion (CRCP) is sometimes applied in order to avoid cerebral complications. We compared two surgical groups, one of which was performed graft-replacement of ascending aorta using CRCP and another was utilized normograde cerebral circulation, about the technique of operation, total extracorporeal circulation (ECC) time, aortic clamp time, separate ECC time, total bleeding volume, and urination during operation. In the group using CRCP, separate ECC time was 53 min (mean), and intraoperative bleeding volume was only 1,170 ml. Good urination was obtained during operation. Postoperative courses were uneventful, and consciousness was smoothly and soon recovered. The new method of separate ECC has some advantages over the previously described methods, particularly for avoidance of cerebral complications. As it is not necessary to require dissecting, taping, and clamping of cephalic branches, operative procedure will be very simplified, easier and safer, leading to intraoperative bleeding is a fewer. It is our belief that this method should be widely applied in the operation of graft-replacement of ascending aorta or aortic arch in the near future.

[A case of bronchial asthma whose disease activity was associated with changes in serum alkaline phosphatase linked-immunoglobulins levels]

A 67-year-old female was admitted to our hospital with status asthmaticus. Serum alkaline phosphatase (ALP) level was elevated and ALP-linked immunoglobulins (ALP-Igs) were detected by ALP isozyme analysis. Treatment with prednisolone resulted in improvement of her asthmatic symptoms and serum ALP level. Thereafter, elevations of serum ALP and ALP-Igs levels were seen whenever she had an asthmatic attack. She had no manifestations of autoimmune diseases. Changes in ALP-Igs levels in association with asthmatic activity suggested that ALP-Igs were related to the pathogenesis of bronchial asthma in this case.