Acutely severe myocarditis successfully treated by percutaneous cardiopulmonary support applied by a newly developed heparin-binding oxygenator and circuits

The feasibility of using the heparin-bound percutaneous cardiopulmonary support system (PCPS) for prolonged extracorporeal circulation in patients with acute severe myocarditis is demonstrated. The case histories of 2 patients with cardiogenic shock caused by acute myocarditis are presented; both were successfully treated with long-term PCPS using a newly developed heparin-binding oxygenator and circuits without changing the oxygenator. The courses of both patients remain uneventful more than 12 months after discharge. We also discuss the clinical aspects of using heparin-bound PCPS in patients with acute severe myocarditis.

A new high-molecular-weight glycophorin C variant with a duplication of exon 2 in the glycophorin C gene

Glycophorin C (GPC) and glycophorin D (GPD) are closely related sialoglycoproteins in the human red blood cell (RBC) membrane. Both are thought to be encoded by the GPC gene (GYPC). We report here the new GPC variant, MAT, with a high-molecular-weight form of GPC and GPD. The murine monoclonal antibody to GPC (CBC-96), which had specificity for the N-terminal region of GPC, gave a stronger reactivity with the MAT RBCs than did normal RBCs in direct agglutination tests. Immunoblotting of the MAT RBC membranes with anti-GPC antibodies showed the apparent molecular weight of GPC.MAT and GPD.MAT was 5000 greater than that of their normal counterparts. cDNA was synthesized from total RNA obtained from three unrelated, heterozygous MAT blood donors and analysed by the polymerase chain reaction with primers that spanned sequences encoded by GYPC. Two fragments were generated: one was 510 bp, the other was 453 bp and corresponded to the normal GPC. Sequencing of the mutant 510-bp fragment showed an insert of 57 nucleotides that corresponds to the entire sequence of exon 2 in GYPC. These results show that MAT is the result of a duplication of exon 2 in GYPC, which probably encodes the two high-molecular weight forms GPC.MAT and GPD.MAT. The MAT mutation is found with a frequency of 0.02% in the Japanese population.

Quantification and distribution of alpha 1-adrenoceptor subtype mRNAs in human vas deferens: comparison with those of epididymal and pelvic portions

1. This study was intended to quantify the amounts of the alpha 1-adrenoceptor subtype mRNAs in human vas deferens, and demonstrate the receptor subtype responsible for the vas contraction. 2. The RNase protection assay showed that the mean total amount of alpha 1a mRNA was 7.4 +/- 2.2 pg/5 micrograms of poly (A)+ RNA (97.0% of the total alpha 1 mRNA) in the epididymal portion (E-vas) and 4.9 +/- 0.8 pg/5 micrograms of poly (A)+ RNA (96.3% of the total) in the pelvic portion (P-vas). The E-vas showed a tendency to have a greater alpha 1a mRNA abundance than the P-vas (P = 0.11). The alpha 1b and alpha 1d mRNAs were absent or of extremely low abundance. 3. By an in situ hybridization, the alpha 1a and alpha 1d mRNAs were recognized in the smooth muscle cells of the E-vas and the P-vas, and the distribution pattern the same in both tissue. The alpha 1b mRNA positive site was scarcely detectable in both vas portions. 4. In a functional study, l-phenylephrine produced concentration-dependent contraction in the E-vas (Emax = 2.24 +/- 0.70 g; pD2 = 5.32 +/- 0.09) and the P-vas (Emax = 2.46 +/- 0.46 g; pD2 = 5.07 +/- 0.12). KMD-3213, a novel alpha 1A-adrenoceptor-selective antagonist, caused parallel rightward shifts of the concentration-response curves for l-phenylephrine. Apparent pKB values were 9.90 +/- 0.16 for the E-vas and 9.71 +/- 0.17 for the P-vas. There was no significant difference in Emax, pD2 or pKB estimates between the two portions. 5. We have found that alpha 1a mRNA is predominant in the human vas deferens, and confirmed that contraction of this organ is mediated by the alpha 1A-adrenoceptor.

Protective effect of T-686, an inhibitor of plasminogen activator inhibitor-1 production, against the lethal effect of lipopolysaccharide in mice

We have examined the effects of an inhibitor of plasminogen activator inhibitor-1 (PAI-1) production, (3E,4E)-3-benzylidene-4-(3,4,5-trimethoxy-benzylidene)pyrrol idine-2,5-dione (T-686), on lipopolysaccharide (LPS)-induced death in mice. Oral administration of T-686 (10 and 100 mg/kg/day) for 8 days prior to the LPS injection (35 mg/kg, i.v.) protected mice from the lethal effect of LPS in a dose-dependent fashion. Moreover, treatment with 100 mg/kg T-686 attenuated the increase in plasma PAI-1 activity and the decrease in AT-III activity induced by LPS. We conclude that T-686 can reduce the mortality of mice induced by LPS, which seems to be partially correlated with both hypercoagulation and hypofibrinolysis.

An estimation of craniofacial growth in the untreated Class III female with anterior crossbite

The literature has little to say regarding the normal growth and development of untreated individuals with Class III malocclusion or anterior crossbite. In part, this paucity of information is because of the relatively low prevalence of these characteristics in European-American populations and the need, recognized by the lay public and health professionals, for treatment of these conditions. Given the absence of true longitudinal data, this study attempts to estimate the growth of the untreated individual with Class III malocclusion and anterior crossbite by evaluating large samples of untreated subjects at distinct developmental stages. Initially the morphologic characteristics of 2074 Japanese female patients who had anterior crossbite were evaluated cephalometrically before treatment. On the basis of the cephalometric analysis, all subjects who did not have a Class III molar relationship were excluded from further analysis, leaving a sample of 1376. The subjects then were classified into seven groups (120-256 subjects per group) according to Hellman's stages of dental development. Descriptive statistics for 28 measurements were calculated. The results of this study imply that the maxilla in Japanese females maintains a retruded relationship to the cranial base and does not become less retrusive with time. In contrast, the mandible is protrusive even in the late deciduous dentition and becomes more protrusive with time, making the discrepancy between the upper and lower jaws progressively more severe. Dental compensations in both arches become increasingly evident as development progresses, and the underlying skeletal and dentoalveolar imbalances also are reflected in the soft tissue profile.

Second primary carcinoma in the residual cervical esophagus after thoracic esophagectomy: report of five cases

BACKGROUND AND OBJECTIVES

Development of second primary carcinomas after thoracic esophagectomy has become of much concern, because recently the prognosis of thoracic esophageal carcinoma after esophagectomy with extended lymph node dissection has been improving. We report our experience of diagnosing and treatment second primary carcinomas arising in the remaining esophagus after thoracic esophagectomy.

METHODS

Among 253 patients who underwent esophagectomy for thoracic esophageal carcinoma more than 2 years previously, second primary esophageal carcinomas developed in five (2.0%), and these five patients were examined.

RESULTS

All second primary carcinomas were found by endoscopy, and were diagnosed as superficial carcinoma (Tis or T1) of the residual cervical esophagus. One patient underwent laser irradiation, another endoscopic mucosal resection, two had surgical mucosectomy, and one segmental resection of the esophagus. After the second treatment, three patients were disease free for 37-38 months, one died of recurrent disease of the first carcinoma 36 months later, and one died of distant metastases of the second carcinoma 8 months later. There have been no local recurrences after treatments for the second primaries.

CONCLUSIONS

A variety of low-trauma treatments were employed for the second carcinomas because they were found at an early stage. Endoscopic follow-up is proposed to detect second lesions at an early stage.

Uprighting the mandibular molars stimulates mandibular growth during treatment of class II malocclusion

We hypothesized that uprighting of the mandibular molars creates a counter-clockwise rotation of the mandible and stimulates mandibular forward growth during the treatment of a Class II malocclusion. This investigation used 33 longitudinal lateral cephalometric radiographs of Class II, Division 1 female patients. All cases were treated with non-extraction. Treatment was started in early adolescence with .018 slot edgewise Alexander appliances. High-pull head-gear and Class II elastics were used. Seventeen cases that showed more than 5 degrees of uprighting of the mandibular first molars were selected as the uprighted group. Cases that showed less than 5 degrees of uprighting of the mandibular first molars were selected as the non-uprighted group. There was a significant correlation coefficient between the uprighted degree of the mandibular first molars and the degree of clockwise rotation of the mandibular plane to FH.

[An emergent surgical case of acute massive pulmonary embolism supported by antithrombotic percutaneous cardiopulmonary support system]

We present an emergent surgical case of massive pulmonary embolism. A 57-year-old male patient was refereed to our medical center for progressive dyspnea. He was intubated because of severe hypoxia. Pulmonary arteriography revealed massive pulmonary embolism. In the catheter laboratory he fell in shock and the heart was arrested, antithrombotic percutaneous cardiopulmonary support (PCPS) was introduced immediately. Emergent thrombectomy was carried out consequently under moderate hypothermic complete cardiopulmonary bypass. Up to 30 x 20 x 10 mm in size fresh clots were removed. Antithrombotic PCPS and IABP were maintained for 168 hours postoperatively. There were no hemorrhagic complication during the support because low dose heparin was administered continuously to keep ACT around 150 sec. He discharged from the hospital two months later and alive in good health. In conclusion, antithrombotic PCPS is very useful to care massive pulmonary embolism with thrombectomy.

KMD-3213, a novel alpha1A-adrenoceptor antagonist, potently inhibits the functional alpha1-adrenoceptor in human prostate

KMD-3213, (-)-(R)-1-(3-hydroxypropyl)-5-[2-[[2-[2-(2,2,2-trifluoroethoxy)phe noxy]ethyl]amino]propyl]indoline-7-carboxamide, is a novel and selective alpha1A-adrenoceptor antagonist. The potency of this drug to antagonize functional alpha1-adrenoceptor-mediated contraction in human prostatic smooth muscle was evaluated and compared with that of other alpha1-adrenoceptor antagonists. KMD-3213 inhibited noradrenaline-induced contractions with an apparent pK(B) value of 9.45 +/- 0.039, indicating a potency similar to that of tamsulosin. The affinity of prazosin for prostatic alpha1-adrenoceptors is given as potency for the alpha1L-adrenoceptor with an estimated pA2 value of 8.84 +/- 0.044. The data obtained in this study suggest that KMD-3213, an alpha1A-adrenoceptor-selective antagonist, has strong affinity for the alpha1L-adrenoceptor in the human prostate.

Synthesis biological evaluation of alkyl, alkoxy, alkylthio, or amino-substituted 2,3-dihydro-1,5-benzothiazepin-4(5H)-ones

2,3-Dihydro-1,5-benzothiazepin-4(5H)-ones substituted with an alkyl, alkoxy, alkylthio, hydroxy, or amino group on the fused benzene ring of the 1,5-benzothiazepine skeleton were synthesized and their vasodilating, antihypertensive, and platelet aggregation-inhibitory activities were investigated. (-)-cis-3-Acetoxy-5-[2-(di-methylamino) ethyl]-2,3-dihydro-8-methyl-2-(4-methylphenyl)-1,5-benzothiazepin- 4(5H)-one ((-)-13e) was selected for further studies as a potent inhibitor of platelet aggregation.

Sclerosing sweat duct carcinoma in the peri-anal skin: a case report

We report a case of sclerosing sweat duct carcinoma, a rare tumor, occurring in the peri-anal skin, a rare position. The patient, a 41-year-old Japanese woman, was admitted to our hospital with recurrence of sclerosing sweat duct carcinoma in the peri-anal skin, which had been initially resected at a local hospital. She underwent abdomino-perineal resection. No lymph node metastases or distant metastases were found. Although we allowed a 2-cm resection margin around the tumor, microscopy showed that the tumor had extended to within 2 mm of this margin at several sites, indicating that sclerosing sweat duct carcinoma is locally aggressive. An ample resection margin should therefore be taken at initial surgery for this type of tumor. Moreover, surgical excision that is wider and deeper than primary excision is required when this tumor recurs.

A new strategy for management of retroperitoneal tumors with supradiaphragmatic vena caval thrombi

A new surgical technique to treat retroperitoneal tumors with supradiaphragmatic vena caval invasion is described. In this technique, hepatic warm ischemia can be avoided with reversed hepatic outflow through the portal vein and neither hypothermic circulatory arrest nor cardiopulmonary bypass is necessary using centrifugal blood pump-driven bypass.

Characterization of dnaA gene expression in Mycoplasma capricolum

Expression of the dnaA gene in Mycoplasma capricolum was studied. The transcriptional start site was located 10 bp upstream from the putative translational initiation codon. Immunoblotting analysis revealed that DnaA protein was expressed at the levels significantly larger than those in Escherichia coli, and was localized mainly in the membrane. The transcriptional level of dnaA gene was reduced by inhibition of DNA synthesis with methyl methanesulfonate or mitomycin C, while the level of DnaA protein did not change. Reduction of protein synthesis did not significantly affect the total amount of DnaA protein, suggesting that the rates of synthesis and degradation of the protein are slow. These observations showed that the expression pattern of dnaA gene in M. capricolum is different from those of walled bacteria in some aspects.

A spontaneous testicular teratoma in an ICR mouse

A spontaneous teratoma was detected in the left testis of a 7-wk-old male ICR (Crj:CD-1) mouse. The tumor was composed of a variety of well-differentiated tissue elements from all 3 germ layers including neuronal tissue and stratified epithelium as ectoderm-derived tissues, bone, cartilage, striated muscle, and adipose tissue as mesodermal tissues, and respiratory columnar epithelium as endoderm-originated tissue. No tumor metastasis was detected. It may be of congenital origin as in strain 129 mice. To the best of our knowledge, this is the first report concerning spontaneous testicular teratoma in a strain ICR mouse.

Structural determination of monosialyl trisaccharides obtained from caprine colostrum

Acidic oligosaccharides were separated by dialysis, ion-exchange, preparative paper and gel chromatography from caprine colostrum. Four sialyl trisaccharides were characterized by 1H-NMR spectrometry as follows: alpha-N-acetylneuraminyl-(2,6)-beta-D-galactopyranosyl-(1,4)-2-N-acetami do-2 -deoxy-D-glucopyranose (Neu5Ac alpha 2-6Gal beta 1-4GlcNAc), alpha-N-acetylneuraminyl-(2,3)-beta-D-galactopyranosyl-(1,4)-D-glucopyra nose (Neu5Ac alpha 2-3Gal beta-1-4Glc), alpha-N-acetylneuraminyl-(2,6)-beta-D-galactopyranosyl-(1,4)-D-glucopyra nose (Neu5Ac alpha 2-6Gal beta 1-4Glc) and alpha-N-glycolylneuraminyl-(2,6)-beta-D-galactopyranosyl-(1,4)-D -glucopyranose (Neu5Gc alpha 2-6Gal beta 1-4Glc).

Changes in contrast enhancement of hepatocellular carcinoma and liver: effect of temporary occlusion of a hepatic vein evaluated with spiral CT

PURPOSE

To assess the hemodynamics of the liver and of hepatocellular carcinomas (HCCs) with hepatic vein occlusion.

MATERIALS AND METHODS

Selected hepatic veins were temporarily occluded with a balloon catheter in 21 patients with 28 nontreated nodular HCCs. Computed tomographic (CT) arteriography was performed without and with temporary occlusion of a hepatic vein that drained the blood from segmental liver parenchyma containing tumor by using a unified spiral CT and angiography system. The degree of enhancement and change in appearance of the HCC in each condition were compared.

RESULTS

All HCCs were well-enhanced, almost round masses at CT arteriography. At CT arteriography with hepatic vein occlusion, however, HCCs were changed as follows: (a) the absolute attenuation of the HCC was decreased in 27 (96%) of 28 tumors compared with that at CT arteriography without hepatic vein occlusion, while attenuation of the surrounding liver parenchyma was increased; (b) the size of the highly enhanced area in HCC became smaller in 17 (61%) tumors (of these, two disappeared); and (c) the shape was changed in 12 (43%) tumors.

CONCLUSION

Hepatic vein occlusion resulted in reciprocal hemodynamic changes in the liver parenchyma relative to HCCs: Enhancement of the liver increases and that of HCCs decreases.

Identification of 2'-fucosyllactose in milk of the crabeater seal (Lobodon carcinophagus)

1. An oligosaccharide was isolated from extracts of crabeater seal milk by preparative paper chromatography. 2. The saccharide was identified as Fuc alpha 1-2Ga1 beta 1-4G1c by 1H-NMR spectroscopy. 3. This work represents the first identification of an oligosaccharide, other than lactose, in the milk of a pinniped.

The pharmacologic profile of 606A, a novel angiotensin II receptor antagonist

The pharmacologic profile of a novel angiotensin I (AT1) receptor antagonist 606A was studied in various in vitro and in vivo preparations. The 606A showed a high affinity at AT1 receptors [inhibition constant (Ki), 12.8 +/- 0.4 nM] in rabbit adrenal cortical membrane and a low affinity to AT2 receptors (Ki, > 1 mM) in bovine cerebellar membrane, indicating potent and selective AT1 properties. In the guinea pig aorta, 606A reduced the maximal angiotensin II-induced contraction (pD'2, 9.06 +/- 0.04), whereas EXP3174 showed suppression of the maximum response and a shift to the right of the concentration-response curve at lower and higher concentrations, respectively (conventionally calculated pd'2, 8.61 +/- 0.23). The 606A had no effects on KC1-, norepinephrine-, serotonin-, and endothelin-1-induced contractions or any agonist activities. In anesthetized dogs, 606A inhibited the angiotensin II-induced pressor response 35 times more potently than losartan. In renal hypertensive rats and spontaneously hypertensive rats (SHRs), 606A decreased systolic blood pressure 10 and 3 times more potently than losartan, respectively, without any chronotropic effects. By repeated administration of 606A to SHRs for 2 weeks, an augmentation of the hypotensive effect was observed No rebound phenomena occurred after discontinuation. These results indicate the 606A is a potent AT1-selective insurmountable angiotensin II receptor antagonist having more potent angiotensin II receptor antagonistic and hypotensive effects than losartan in in vivo models. 606A is suggested to be a useful agent for the treatment of patients with hypertension.

Cloning, functional expression and tissue distribution of rabbit alpha1a-adrenoceptor

A cDNA clone, which has an open reading frame of 1398 nucleotides encoding a 466-amino-acid peptide, has been isolated from rabbit liver cDNA library. Compared with the peptide sequence, it shows high homology to alpha1a adrenoceptors of human, bovine and rat. We expressed this clone in COS-7 and investigated the pharmacological properties, revealing similarity to those of human alpha1a adrenoceptors. Competitive RT/PCR has detected the mRNA in variety of rabbit tissues, especially abundantly in liver, vas deferens, brain, and aorta, but not in heart.

Immunocytochemical characterization of malignant schwannoma-derived cells in culture

We recently demonstrated that cultured malignant schwannoma (MS)-derived cells can support human skin mast cell (HSMC) survival in vitro. Cultured HSMCs were spindleshaped in close contract with MS-derived cells, suggesting cell to cell interaction. To elucidate the mechanism of the enhanced HSMC survival in coculture with MS-derived cells and the cellular interactions between HSMC and MS-derived cells, we examined the immunocytochemical characteristics of MS-derived cells using immunofluorescence. Morphologically, cultured MS-derived cells were polygonal with abundant cytoplasm and resembled perineurial cells. The cultured cells immunoreacted positively with vimentin, fibronectin, laminin and collagen IV, but negatively with anti-S100 protein, anti-neuron specific enolase, and anti-neurofilament (68 kd, 145 kd, 200 kd) antibodies. MS-derived cells were distinct from Schwann cells in their lack of S100 protein and also distinguishable from endoneurial fibroblasts that produce fibronectin, but never expressed laminin or collagen IV. MS-derived cells thus possess the characteristics of perineurial cells in their general morphology and their immunocytochemical properties. Immunoreactivity for substance P (SP) and neurokinin A (NKA) was found in the cytoplasm of these cells, particularly around the nuclei. Vasoactive intestinal peptide, somatostatin, and calcitonin gene related peptide were negative. From these findings, we characterized the MS-derived cell's in vitro properties and concluded that it is similar to a perineurial cell. The extracellular matrix protein, laminin, and fibronectin expressed in the MS-derived cell might contribute to HSMC survival and morphology through cell to matrix adhesion. Neuropeptides such as SP and NKA, expressed in the MS-derived cell, might play some role in enhanced HSMC survival in vitro.

Protective effect of l-cis-diltiazem on hypercontracture of rat myocytes induced by veratridine

The protective effect of l-cis-diltiazem, the stereoisomer of d-cis-diltiazem, was studied against the veratridine-induced hypercontracture of rat myocytes. Veratridine increased both [Na+]i and [Ca2+]i, but did not cause hypercontracture in the absence of extracellular Ca2+. Both l-cis-diltiazem (0.1-10 microM) and d-cis-diltiazem (10-30 microM) inhibited the hypercontracture and the increase in [Ca2+]i in a concentration-dependent manner. However, l-cis-diltiazem did not exert a negative inotropic effect in K+ (20 mM)-depolarized rat papillary muscles even at a dose of 10 microM. As seen in the case of tetrodotoxin, l-cis-diltiazem and d-cis-diltiazem also suppressed the increase in [Na+]i. The results show that l-cis-diltiazem prevents the veratridine-induced hypercontracture of myocytes by suppression of the [Ca2+]i increase. The attenuation of the [Ca2+]i increase by l-cis-diltiazem was not dependent on inhibition of Ca2+ channels, but was partly due to inhibition of excessive Na+ entry via veratridine-modified Na+ channels.