Late aneurysm after subclavian flap aortoplasty for coarctation of the aorta

Late aneurysms are common after repair of coarctation of the aorta by prosthetic patch aortoplasty but are rare after subclavian flap aortoplasty. We present the case of a 14-year-old boy who underwent a grafting procedure for a descending thoracic aortic aneurysm after subclavian flap aortoplasty for coarctation of the aorta when he was 2 years old. This is the fifth report of late aneurysm formation after subclavian flap aortoplasty.

Transplantation of the cadaver heart harvested one hour after hypoxic cardiac arrest using the core-cooling technique in dogs

A shortage of donor organs in clinical transplantation prompted us to study whether resuscitated dead hearts could be utilized for successful orthotopic heart transplantation. After 60 min of hypoxic cardiac arrest, one group of canine hearts was resuscitated (Res group, n = 6). The other group was harvested directly (Non-Res group, n = 6). In the Res group, cardiopulmonary bypass was utilized for resuscitation at 37 degrees C and the animals were then core-cooled to 15 degrees C. The hearts then were preserved in University of Wisconsin solution and orthotopically transplanted. Stable prostacyclin analogue (OP2507) and verapamil, a calcium antagonist, were added to the cardioplegia, and substrate-enriched warm blood cardioplegia and a hydroxy radical scavenger (EPC) were administered at the time of reperfusion of the transplanted heart. All animals in each group were successfully weaned from cardiopulmonary bypass with dopamine (5 micrograms/kg/min). Cardiac function without dopamine was better preserved in the Res group than the Non-Res group (Emax: 130.6 +/- 41.5% vs. 47.1 +/- 24.7%; mean +/- SD, as percent of postbrain death values, P < 0.01 by unpaired t-test). Cadaver hearts 60 min after anoxic arrest can be successfully re-animated and orthotopically engrafted. In addition, the core-cooling technique is useful. We believe this study serves as the key step in the clinical application of dead hearts to successful cardiac transplantation.

Buerger's disease in a middle-aged woman with diabetes mellitus. A case report

Buerger's disease or thromboangiitis obliterans with involvement of small arteries of the upper and lower extremities usually afflicts young male smokers, but this report presents a middle-age female nonsmoker with diabetes mellitus who satisfied clinical, angiographic and histologic criteria for the diagnosis of Buerger's disease.

[Comparison between the arthroscopic and open synovectomies for rheumatoid knee--a retrospective and random study on the results of the two methods]

Knee joints affected by rheumatoid arthritis (RA) were randomized to either arthroscopic or open synovectomy, and the postoperative results were compared retrospectively. The materials consisted of 58 patients with 75 surgically treated knees. Arthroscopic synovectomy was performed on 37 knees of 30 patients, who were followed for five years and four months on average. Open synovectomy was performed on 38 knees of 28 patients, who were followed for five years and five months on average. The results were evaluated for ; recurrence of synovitis ; duration of the symptom-free period ; progressive bone changes on radiography ; range of motion (ROM) ; duration of hospital stay ; duration of surgery. Due to the less invasive surgical procedure, arthroscopic synovectomy resulted in less post operative pain, and there was no restriction of ROM after surgery, no need for postoperative rehabilitation, shorter hospital stay, lower incidence of osteoarthritic changes, and earlier return to the daily life. However, as synovial membrane removal was unavoidably insufficient, the effect of surgery lasted for only 18 months on average and recurrence of synovitis was observed in 73 % of patients. Open synovectomy meant relatively greater invasion and postoperative pain. Due to the restricted ROM in some cases, postoperative treatment was required and the hospital stay tended to be prolonged. Nevertheless, the recurrence rate was only 37 % during follow-up and the effect of surgery persisted for an average of 75 months, much better than that of arthroscopic synovectomy. In the treatment of RA knees, the indications for arthroscopic and open synovectomies should be carefully studied in the light of the merits and for demerits of each procedure.

A direct demonstration of the catalytic action of monodehydroascorbate reductase by pulse radiolysis

To elucidate the catalytic mechanism of monodehydroascorbate (MDA) reductase from cucumber, its interaction with MDA radical was investigated by the use of pulse radiolysis. When approximately equimolar MDA radical to the fully reduced MDA reductase was generated, the fully reduced enzyme reacted first with MDA radical to form the red semiquinone, and the semiquinone further reacted with MDA radical to form the oxidized enzyme. At a low ratio (< 20) of MDA radical to enzyme concentration, the fully reduced enzyme reacted quantitatively with MDA radical to form the semiquinone with a second-order rate constant of 2.6 x 10(8) M-1 s-1 at pH 7.4. At excess MDA radical to enzyme concentration, a similar rate constant was obtained from the decay of MDA radical. These results suggest that the reaction of the semiquinone with MDA radical occurs at the same rate or rate-limiting step of the oxidation of the fully reduced enzyme by MDA radical. The rate constants decreased with an increase in NaCl concentration, suggesting that the localization of cationic groups of amino acid residue near the active site may provide electrostatic guidance to the anionic substrate of MDA radical.

[A surgical repair of partial anomalous pulmonary venous drainage to the high superior vena cava]

A 7-year-old boy with partial anomalous pulmonary venous drainage to the high superior vena cava (SVC) underwent surgical repair by Williams procedure. Right upper pulmonary vein was drained to the left atrium via the SVC and the surgically enlarged sinus venosus type ASD. SVC was ligated and divided. SVC was then anastomosed to RA appendage pedicle directly. Autologous pericardium was patched anteriorly to create a new SVC pathway. The postoperative course was uneventful without arrhythmia and cardiac catheterization 1 month postoperation revealed no stenosis of the SVC and right upper pulmonary venous return.

Molecular characterization of monodehydroascorbate radical reductase from cucumber highly expressed in Escherichia coli

Monodehydroascorbate radical (MDA) reductase, an FAD-enzyme, is the first enzyme to be identified whose substrate is an organic radical and catalyzes the reduction of MDA to ascorbate by NAD(P)H. Its cDNA has been cloned from cucumber seedlings (Sano, S., and Asada, K. (1994) Plant Cell Physiol. 35, 425-437), and a plasmid was constructed in the present study that allowed a high level expression in Escherichia coli of the cDNA-encoding MDA reductase using the T7 RNA polymerase expression system. The recombinant MDA reductase was purified to a crystalline state, with a yield of over 20 mg/liter of culture, and it exhibited spectroscopic properties of the FAD similar to those of the enzyme purified from cucumber fruits during redox reactions with NADH and MDA. The red semiquinone of the FAD of MDA reductase was generated by photoreduction. p-Chloromercuribenzoate inhibited the reduction of the enzyme-FAD by NADH, and dicumarol suppressed electron transfer from the reduced enzyme to MDA. The specificity of electron acceptors of the recombinant enzyme appeared to be similar to that of MDA reductase, even though the amino acid sequence encoded by the cDNA was somewhat different from that of the enzyme purified from cucumber fruits. The Km values for NADH and NADPH of the recombinant enzyme indicated a high affinity of the enzyme for NADH. The reaction catalyzed by the enzyme did not exhibit saturation kinetics with MDA up to 3 microM. A second order rate constant for the reduction of the enzyme-FAD with NADH was 1.25 x 10(8) M-1 s-1, as determined by a stopped-flow method, and its value decreased with increases in ionic strength, an indication of the enhanced electrostatic guidance of NADH to the enzyme-FAD.

Enhancement in gastric mucosal EGF and PDGF receptor expression with ulcer healing by sulglycotide

1. The effect of an antiulcer agent, sulglycotide, on mucosal expression of EGF and PDGF receptors with chronic ulcer healing was investigated. 2. Rats with experimentally-induced gastric ulcers were treated twice daily for 14 consecutive days, either with sulglycotide at 200 mg/kg or vehicle, and at different stages of treatment used for quantitation of gastric mucosal EGF and PDGF receptors. 3. The ulcer healing was accompanied by an increase in mucosal expression of both types of receptors. A 1.8-fold increase in EGF and 3.1-fold increase in PDGF receptors occurred by the 4th day following the development of ulcer and reached a maximum of 2.4-3.9-fold increase by the 10-14th day. 4. Treatment with sulglycotide caused accelerated ulcer healing accompanied by a significant enhancement in the receptors expression. A 2.3- and 3.6-fold increase in EGF and PDGF receptor expression occurred by the 4th day of sulglycotide treatment, reaching a 5.5- and 5.6-fold respective increase by the 10th day when the ulcer essentially healed. 5. The results attest to the ability of sulglycotide to stimulate the gastric mucosal proliferative activities associated with ulcer healing.

Trauma-instability-voluntarism classification for glenohumeral instability

Classification of glenohumeral instability is confusing. We think that the existence of trauma, directions of instability, voluntarism, and other factors make classification difficult. The purpose of this article is to create a new classification. One hundred eighty-nine patients with glenohumeral instability involving 207 joints (mean patient age 21.5 years) were subjects of this investigation. Our new classification, which is composed of three main factors (level of trauma, direction of instability, and voluntarism) and some subfactors, simplified it quite well. Abbreviations also make it easier to indicate each joint's condition. About half the subjects had no trauma or mild trauma. Two thirds of the joints with more than one dislocation or subluxation showed instability in other directions in addition to the direction of dislocation or subluxation. This classification is very useful to compare pathogenesis and results of treatment in patients with glenohumeral instability.

[Fontan-type procedure for an adult case of double-outlet right ventricle (S, D, L)]

The double-outlet right ventricle with L-malposition (DORV (S, D, L)) is one of the rare congenital heart diseases. Intracardiac rerouting with a internal conduit has been indicated in principle to it as the radical operation. DORV (S, D, L) is often combined with the pulmonic stenosis (PS), and Rastelli's operation is indicated to the case in which release of PS is difficult. We report a case of DORV (S, D, L) combined with PS and the hypoplastic right ventricle which is treated by the Fontan-type procedure. The patient was a 35-year-old female who had undergone Glenn's operation at 10 years of age under the diagnosis of transposition of the great arteries. Recently she complained of aggravation of the cyanosis and dyspnea on exertion. After thorough examinations, the disease was diagnosed as DORV (S, D, L) with doubly committed VSD which was combined with severe PS, hypoplastic right ventricle (29% of normal) and left-sided juxtaposition of atrial appendages. The development of her distal pulmonary arteries was estimated well enough (PA-index 448 mm2/m2). We judged that intracardiac rerouting with an internal conduit could not be applied due to her severe pulmonic stenosis, and that Rastelli's operation as the biventricular repair was also impossible because of her hypoplastic right ventricle. Thus we adopted the Fontan-type procedure with a new septation in the right atrium, namely oblique partition, and attained a good result. To our knowledge, this case is the fourth case report in Japan of DORV (S, D, L) treated with the Fontan-type procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of St. Jude Medical mitral valve function by exercise Doppler echocardiography

The aim of this study was to detect borderline mitral valve dysfunction in 100 asymptomatic patients with a St. Jude Medical valve. We studied rest and exercise hemodynamics by Doppler echocardiography. Study patients were divided into two groups according to the time since surgery: group A had valves implanted less than 5 years ago (44 patients), group B had valves implanted more than 5 years ago (56 patients). Although patients had no clinical signs of valve dysfunction, group B was found to have significant reduction of mitral valve area (p < 0.05). In the group A patients, mean gradients at rest increased from 4 +/- 2, 4 +/- 2, and 3 +/- 1 mmHg in valve sizes of 25, 27, and 29 mm, respectively, to 7 +/- 2, 7 +/- 3, and 5 +/- 2 mmHg with exercise. In the group B patients, mean gradients at rest increased from 7 +/- 1, 6 +/- 2, and 5 +/- 1 mmHg to 14 +/- 3, 13 +/- 3, and 10 +/- 4 mmHg, respectively, after exercise. The percent increase (mean) in peak pressure gradient with exercise was significantly higher in group B (more than 100%) than in group A (less than 80%) (p < 0.01). The percent increase in mean gradient with exercise was also significantly higher in group B (more than 100%) than in group A (less than 75%). In conclusion, patients with reduced valve area and more than a 100% increase of peak and mean gradients should be followed up carefully. If any signs or symptoms of heart failure develop, they must be considered as candidates for surgery.

[Complete resection of superior mediastinal seminoma, following reconstruction of superior vena cava--a case report]

The patient was a 37-year-old man with superior mediastinal seminoma, which invaded the bilateral brachiocephalic vein, superior vena cava, pericardium and left lung. These invaded organs were resected with the tumor and a vascular reconstruction was performed with EPTFE graft and pericardial patch. EPTFE graft was interposed between the left brachiocephalic vein and right atrium. Superior vena cava was reconstructed by means of pericardial patch. Histologically, the tumor was diagnosed as pure seminoma. He received the prophylactic irradiation (45 Gy). Although venography two years after operation demonstrated the obstruction of the EPTFE graft and marked stenosis of the pericardial patch, the patient remains free from the symptom and is doing well without recurrence 45 months after operation.

Quality of peptic ulcer healing induced by lansoprazole and roxatidine

This study reports preliminary results of a controlled, multicenter trial on the quality of ulcer healing induced by lansoprazole (LPZ) or roxatidine (R) in gastric ulcer (GU) or duodenal ulcer (DU) patients. Group A received LPZ 30 mg q.d. and group B received R 75 mg b.i.d. All drugs were given for 8 weeks in GU and for 6 weeks in DU. Endoscopy and gastric biopsy were performed to detect Helicobacter pylori before and on completion of treatment. The healing rates of groups A and B were 100 and 69.2%, respectively, in GU and 100 and 70.0%, respectively, in DU. This difference (p < 0.01) was significant between the two groups in GU. There was no significant difference between the two groups in the S2 stage shift rate in GU and DU. The H. pylori clearance rates of groups A and B were 33.3 and 20.0%, respectively, in GU and 62.5 and 33.3%, respectively, in DU. The differences in treatment response (healing rates and S2 shift rates) between the LPZ group and the R group may be related to the differences in suppression of acid secretion and in bactericidal effects on H. pylori.

Detection of "pathologic" prosthetic valve stenosis via exercise Doppler echocardiography

To detect borderline mitral valve dysfunction in asymptomatic patients, with Björk-Shiley valves, we studied the patients' hemodynamics at rest and during exercise by Doppler echocardiography. Supine bicycle exercise was performed by 65 patients. The patients were divided into two groups according to the measurements of the exercise Doppler echocardiography: a normally functioning group (n = 45) and a borderline group (n = 20). The valve area at rest was 2.0 +/- 0.6, 2.1 +/- 0.7, and 2.3 +/- 0.5 cm2 with valve sizes of 25, 27, and 29 mm, respectively, in the normal group and 1.9 +/- 0.5, 1.9 +/- 0.4, and 2.1 +/- 0.3 cm2 in the borderline group. The mitral valve area did not significantly change with exercise in either group. In the normal group, peak gradients increased from 9.9 +/- 3.5, 9.7 +/- 1.1, and 9.5 +/- 1.6 mmHg with valve sizes of 25, 27, and 29 mm, respectively, at rest to 15.1 +/- 3.1, 14.0 +/- 3.3, and 14.8 +/- 2.6 mmHg with exercise. Mean gradients increased from 5.2 +/- 1.2, 5.9 +/- 1.3, and 5.8 +/- 1.8 mmHg with valve sizes of 25, 27, and 29 mm, respectively, at rest to 8.0 +/- 2.5, 9.1 +/- 2.0, and 8.8 +/- 1.6 mmHg with exercise. In the borderline group, peak gradients increased from 10.5 +/- 3.1, 10.1 +/- 2.1, and 10.8 +/- 1.7 mmHg with valve sizes of 25, 27, and 29 mm, respectively, at rest to 24.5 +/- 4.2, 23.6 +/- 4.4, and 22.4 +/- 3.2 mmHg with exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of bidisomide (SC-40230), a new class I antiarrhythmic agent, on ventricular arrhythmias induced by coronary artery occlusion and reperfusion in anesthetized rats; comparison with mexiletine and disopyramide

We investigated the antiarrhythmic effects of bidisomide (SC-40230), a new class I antiarrhythmic drug, in early-phase ventricular arrhythmias induced by coronary artery occlusion and reperfusion in anesthetized rats. The effects of bidisomide were compared with those of mexiletine (MXT) and disopyramide (DSP), established class I antiarrhythmic drugs. Drugs were administered intravenously, 5 min before induction of coronary occlusion. Bidisomide (5 mg/kg) reduced the number of premature ventricular complexes and the incidence of ventricular tachycardia and ventricular fibrillation similarly to MXT and DSP in rats with ventricular arrhythmias induced by coronary artery occlusion. In rats with ventricular arrhythmias induced by coronary artery reperfusion following a 5-min coronary occlusion, the antiarrhythmic effects of 5 mg/kg of bidisomide were similar to those of the same doses of MXT and DSP. All three drugs significantly slowed the heart rate. Our results suggest that bidisomide may effectively reduce the severity of life-threatening ventricular arrhythmias that occur during acute coronary syndrome.

Surgical indications and treatment of mitral valve disease associated with secundum atrial septal defect with special reference to left ventricular geometry and function

There are few reports that discussed surgical indications and selection of surgical procedures for secundum atrial septal defect (ASD) associated with mitral valve disease from the viewpoint of left ventricular geometry and function. Our study on 20 patients (6 patients with ASD and MS, 14 patients with ASD and MR) indicated that adult patients with ASD and MS can be treated surgically even when left ventricular end-diastolic volume index (LVEDVI) is as low as 35 ml/m2 (one third of the normal level). Left ventricular wall movement returned to normal one year following surgery. Therefore, rather than myocardial impairment, right ventricular volume load disturbing left ventricular dilatation would be the more likely cause of diminished left ventricular function before surgery in the ASD and MS group. In both groups, two patients who initially had undergone mitral valve replacement died from low output syndrome because of the mismatch between the left ventricular volume and the prosthesis used, whereas there were no deaths in the patients who had mitral valve repair. For this reason, mitral valve repair is the treatment of choice for patients with both secundum ASD and mitral valve disease. When valve replacement is the only alternative, selection of prosthetic valves and maintenance of cardiac output by temporary cardiac pacing are important considerations. A low profile valve with a larger orifice area should be selected to avoid the mismatch between a left ventricular volume and a prosthesis.

Biosynthesis of mucin derived from a 60-kDa precursor protein in the human stomach

We studied the biosynthesis of mucin in the human stomach using an anti-mucin core peptide monoclonal antibody, 3G12. Human stomach mucosa was labeled with [35S]methionine, and chased for 3 h. An approximately 60-kDa subunit of human gastric mucin precursor protein was detected in the intracellular product. Under nonreducing conditions, dimer, trimer, and tetramer mucin precursor protein (120, 180, 240 kDa) were detected. Treatment with tunicamycin or endo-beta-N-acetylglucosaminidase H had no effect on the 60-kDa subunit and its oligomers. Extracellular products contained only the high molecular weight mucin, and the secretion was not affected by tunicamycin. By treatment with monensin or brefeldin A, the mature mucin was not secreted extracellularly. These findings suggested that a 60-kDa subunit of the mucin precursor protein was biosynthesized into mature mucin after oligomerization to tetramers, and that neither the oligomerization nor the intracellular transport of the mucin in the human stomach was associated with N-glycosylation.

Biosynthesis and secretion of mucin-related products in Hs746T gastric cancer cells

We have previously studied the biosynthesis and secretion of mucin in the normal human stomach and reported that the tetramer of the 60-kDa subunit of mucin core protein was synthesized and highly glycosylated, and that only high molecular weight mucin was secreted. In this study, we investigated the mucin-related products of a gastric cancer cell line (Hs746T). Analysis of intracellular and extracellular products immunoprecipitated with an anti-apomucin monoclonal antibody revealed that a 110-kDa protein, the dimer of the 55-kDa subunit, was synthesized and secreted. Tunicamycin treatment inhibited the secretion of the 110-kDa protein. These findings suggest that N-glycosylation may be involved in the secretory mechanism of the mucin-related product.

Enhancement in gastric mucosal laminin receptor expression with ulcer healing by sucralfate

The expression of gastric mucosal laminin receptor during chronic ulcer healing in the presence of sucralfate treatment was investigated. Rats with induced gastric ulcers were treated twice daily for 20 consecutive days either with sucralfate at 100mg/kg or vehicle, and at different stages of treatment used for gastric mucosal laminin receptor quantitation. The assays revealed that accelerated ulcer healing (8 days) in the presence of sucralfate was accompanied by a significant enhancement in the laminin receptor expression. A 2.8-fold increase in the receptor expression over that of controls occurred by the 3rd day of sucralfate treatment, reached a maximum of 3.1-fold increase by the 7th day and remained elevated even after 20 days of treatment. The results attest to the ability of sucralfate to stimulate and promote the events associated with gastric mucosal integrity restoration.

Nonpeptide ligands for human gamma delta T cells

gamma delta T cells respond to a variety of microbial pathogens and transformed cells. Their limited receptor repertoire and activation by mycobacterial antigens resistant to proteases suggest that they may recognize nonpeptide antigens. We have tested a variety of nonpeptide molecules for stimulation of human gamma delta T cells. Synthetic alkyl phosphates, particularly monoethyl phosphate (MEP), selectively activated gamma delta T cells and stimulated their proliferation in vitro. All gamma delta T cells stimulated by MEP expressed V gamma 2/V delta 2 receptors. The purified natural ligand of mycobacteria is chemically similar to, though distinct from, MEP and contains a phosphate residue that is critical for biological activity. Recognition and expansion of a specific T-cell receptor-bearing population to non-peptide ligands is unprecedented among T cells. We suggest that MEP mimics small natural ligands capable of expanding one subset of gamma delta T cells and that this recognition of nonpeptide antigens may play an important role in human immunity to pathogens.

Micropathologic changes of pars tensa in children with otitis media with effusion

Clinical studies have supported a relationship between otitis media with effusion in children and chronic otitis media in adults. Although clinical studies are numerous, relatively little is known about the histopathologic changes of the tympanic membrane in otitis media with effusion. Tympanic membranes were taken from the intermediate zone of the anteroinferior quadrant of the tympanic membrane during surgery for placement of tympanostomy tubes in 30 children (age range, 4 to 10 years) who did not show any improvement after 3 months of conservative treatment for otitis media with effusion. Control specimens were taken from normal temporal bones at autopsy. All specimens were observed with light and electron microscopy. Histologic degeneration of the tympanic membrane of patients with otitis media with effusion occurred most often in the lamina propria and the submucosal layer. There was an increase in the thickness of the tympanic membrane as a result of edema and fibrosis of the submucosal layer. A decrease in the thickness of the outer and inner fibrous layers occurred in the lamina propria. The histopathologic changes observed in the lamina propria may result in a change in the elastic properties of the tympanic membrane.

Criteria to detect mitral prosthetic valve dysfunction via continuous wave Doppler echocardiography

To detect the diagnostic criteria for mitral prosthetic valve dysfunction, Doppler echocardiography was used to assess valve function following mitral valve replacement in 100 patients [50 with St. Jude Medical (SJM) valves, 50 with Björk-Shiley (B-S) valves]. Mitral valve area (MVA) was calculated by dividing a constant of 220 by pressure half time (PHT) measured via Doppler technique [220/PHT]. The relationship of MVA to left ventricular function, geometric valve area (GVA) of the prosthetic valve, body surface area (BSA), and maximum disc-opening angle (maxOA) were assessed. In the SJM valves, MVA significantly correlated with valve area index (GVA/BSA). The % area index [(MVA/valve area index) x 100] was 100.2 +/- 12.8% on the average and no patients with the SJM valve showed the %area index of less than 73%. There was no incidence of valve dysfunction in the SJM valves. We concluded from these results that if the % area index is less than 73% (mean -2SD), the SJM valve dysfunction should be diagnosed. When the B-S valves were examined, there were 19 patients in whom the maximum opening angle had decreased to under 58 degrees. These patients also had decreased MVA and % area index. Evaluation of the relationship between the maximum opening angle and the % area index revealed that the patients in whom the maximum opening angle had diminished to under 50 degrees had low % area index (of less than 70%).(ABSTRACT TRUNCATED AT 250 WORDS)