Hypocarbia and cystic periventricular leukomalacia in premature infants

One hundred sixty seven survivors among very low birthweight infants with a gestational age of less than 35 weeks have been studied prospectively. The purpose of this study was to clarify the relationship of severe prenatal and perinatal complications and hypocarbic alkalosis, defined as a carbon dioxide tension (PaCO2) of less than or equal to 2.67 kPa and a pH of 7.50 or greater during the first 24 hours of life, to cystic periventricular leukomalacia (PVL) depicted by serial cranial ultrasonographic examinations. Complications occurred in 16 infants, five of whom presented with PVL, while eight of 151 infants without complications had PVL. Twenty six of the infants had hypocarbic alkalosis, six with evidence of PVL, and seven of the 136 infants without hypocarbic alkalosis had PVL. These results suggest a significant relationship of complications and hypocarbic alkalosis to PVL. Mechanical ventilation should be managed carefully in premature infants to avoid PaCO2 of lower than 2.67 kPa.

Transient and all-night effects of passing truck noise on the number of sleep spindle

Changes in the number of transient and all-night sleep spindles by traffic noise of 55 to 65 dB(A) were studied. The sleep parameters were the number of spindles per minute in stages 2, 3, and 4 (S2, S3, S4) and the total number of spindles divided by the total sleep time. A transient decrease in the number of spindles was recognized and after noise exposure, the number of spindles increased to near the pre-exposure level. Spindles were counted from S2, S3 and S4 for all-night sleep. The number of spindles in all-night sleep by noise exposure increased. The authors explain discrepancies in the results by a compensatory brain mechanism of sleep disturbance due to passing truck noise.

[A simple method for differentiation of hydrogen sulfide-producing bacteria by the pH-dependent EDTA-sensitivity test]

The pH-dependent EDTA-sensitivity test was performed to differentiate several strains of bacteria forming black colonies by the production of hydrogen sulfide on TCBS (thiosulfate-citrate-bile salt-sucrose agar) medium (tentatively designated as hydrogen-sulfide production bacteria). Two halotorelant strains of 16 hydrogen sulfide-producing strains showed the same bacteriological properties and isoprenoid quinone type as did a reference strain of Proteus mirabilis and were classified into the EDTA-insensitive group as were P. mirabilis and P. vulgaris. On the other hand, the other 14 halophilic strains, showing similar but not identical bacteriological properties or the isoprenoid quinone type to those of Shewanella putrefaciens IFO 3908, were classified into the "EDTA-sensitive (at pH 5)" group as were some species of the genus Vibrio. By the same sensitivity test, S. putrefaciens IFO 3908 was classified into the "EDTA-sensitive (at any pH)" group. These results indicate that the pH-dependent EDTA-sensitivity test is useful for differentiation of bacterial isolates producing hydrogen sulfide and having similar bacteriological properties.

Correlation of quantitative CT with selective alveolobronchogram and pulmonary function tests in emphysema

BACKGROUND

Emphysema diagnosed by computed tomography (CT) has been reported to be correlated with morphologic data from autopsied lungs or resected lobes. However, autopsied lungs or resected lobes are quite different from lungs in vivo. We examined the correlation between a quantitative analysis of CT and the in vivo morphologic degree of emphysema (selective alveolobronchography [SAB]) in patients with COPD.

METHODS

We measured the mean attenuation value (MAV) of the lung fields between -700 HU and -1,024 HU to exclude the effect of high-density structures in 21 patients with COPD. Low attenuation, greater than 2 SD below the mean value of five normal healthy subjects, was used as an index of emphysema. To quantitate the amount of emphysema, the relative area of low attenuation to the area of the entire lung field (2SD percent) was measured. The morphologic degree of emphysema was determined from the diameter of ring shadow (DR) of SAB. We also examined the relationship between CT data and pulmonary function tests.

RESULTS

The DR was highly correlated with the CT indexes of MAV and 2SD percent; (r = -0.894, p < 0.001, and r = 0.890, p < 0.001). Both MAV and 2SD percent were correlated with pulmonary function tests such as Dco, FEV1, and residual volume (r > 0.60).

CONCLUSIONS

The MAV and relative area of emphysema obtained from CT density measurements accurately assess the severity of emphysema in patients with COPD as well as SAB.

Efficacy of steroid hormone in solution for intracranial irrigation during aneurysmal surgery for prevention of the vasospasm syndrome

A series of 55 patients with ruptured cerebral aneurysms were treated with moderate removal of subarachnoid clot followed by intracranial irrigation with pH 8.0 Hartmann solution containing 1 mg/ml of methylpredonisolone sodium succinate after the aneurysmal clipping during early (before day 3) operation. Six (11%) of the 55 patients suffered vasospasm syndrome postoperatively. The clinical results are significantly better than a series of 68 patients operated on and treated before day 3 by intracranial irrigation with Hartmann solution (pH 8.0) only. The possible preventive effect of direct intracranial administration of steroid hormone is discussed.

Natural autoantibody against apolipoprotein A-I. Detection and characterization of the monoclonal antibody established from normal unimmunized BALB/c mice

During the course of studying the immunogenicity of soybean lipids, we observed frequent production of the mAbs that bind to apolipoprotein A-I (apoA-I) when spleen cells from unimmunized normal BALB/c mice were employed for fusion. Of the 986 colonies from six fusions, 38 (3.9% of the total) were directed against apoA-I and 13 mAbs (IgM) were established for further analysis. The following lines of evidence indicate that this family of mAb may form a novel family of natural autoantibodies against apoA-I: 1) The mAbs were shown to bind effectively to high density lipoprotein from various species, including BALB/c mouse, and immunoblotting analyses revealed that the mAbs bound specifically to the 28-kDa protein of high density lipoprotein. 2) The 28-kDa protein was purified to homogeneity and identified as apoA-I by amino acid sequence analyses and by its cross-reactivity with a xenogenic anti-apoA-I mAb (clone A/11). 3) Differing from the xenogenic anti-apoA-I mAb, the present mAb did not bind to native apoA-I, whereas an effective binding was observed only when the apoA-I had formed a complex with neutral lipids containing polyunsaturated fatty acids such as trilinoleoylglycerol and 5-cholesten-3 beta-ol 3-linoleate. 4) Sera from unimmunized BALB/c mice had readily detectable Abs against apoA-I and the majority of the serum autoantibodies were of the IgA and IgM isotype. 5) The anti-apoA-I mAbs displayed a functional heterogeneity in their reactivity with polyanionic substances and some of the mAbs established showed an extensive cross-reaction with polyanionic substances such as ssDNA and cardiolipin.

[An autopsy case of AIDS with hemophilia A who died of DIC and gastrointestinal bleeding associated with gastric carcinoma (signet ring cell carcinoma)]

We describe a 39 years-old male hemophilia A patient with acquired immunodeficiency syndrome (AIDS) developing to disseminated intravascular coagulation (DIC) due to gastric carcinoma. He had been diagnosed as human immunodeficiency virus (HIV) sero-positive in 1990. Since then, he has been treated by the oral administration of zidovudine (AZT), dideoxyinosine (ddI) and intravenous administration of glycyrrhizin. In September 1990, he suddenly complained abdominal pain with bloody stool. His condition deteriorated in spite of our intensive treatment for DIC. He died of multiple organ failure (MOF) due to DIC. The autopsy findings showed gastric carcinoma, defined of signet ring cell carcinoma histopathologically. But neither opportunistic infection nor other cause of DIC were observed.

Effects of deep saturation diving on the lymphocyte subsets of healthy divers

We examined the effect of deep saturation diving on the host defense mechanisms of five healthy volunteers using fluorescein-dye-conjugated monoclonal antibodies. Six divers engaged in a 440-m saturation diving simulation with total hyperbaric exposure of 30 days; five served as subjects. Change in the expression of surface molecules on the lymphocytes was analyzed during that period. Blood samples were serially taken on Days 4, 6, 8, 15, 22, 29, and after surfacing. The total number of lymphocytes showed no remarkable change. However, the fraction of T (CD3+) cells decreased from 68.0 +/- 3.3% to 55.8 +/- 5.8% (Day 8), and B cells increased reciprocally. In these T cells, the CD4:CD8 ratio (normally > 1.0) became less than 1.0 during compression and thereafter. In spite of the prophylactic use of anti-external otitis agents, one of the divers revealed a remarkable growth of Pseudomonas in the external auditory meatus, showing a high level of blood endotoxin (10.2 pg/ml). These results suggest that decrease in CD4+ fraction of T lymphocytes might explain in part the decreased resistance of divers to infective microorganisms in deep saturation diving.

Pulsatile flow and simple flow control method during weaning period in centrifugal pump: toward more expanded usage in open heart surgery

To expand the usage of the centrifugal pump (CP) in open heart surgery, we performed two studies. In the first, we evaluated pulsatile flow in the CP. In vitro pump performance of the Terumo Capiox pump (TCP) and the Sarns Delphin pump (SDP) and increase of free hemoglobin (mg/dl) after driving 6 h were investigated using bovine blood. A roller pump (RP) was used as a comparison. Equally effective pulsatile flow was obtained in both CPs. Hemolysis was less severe in TCP (120 mg/dl) than SDP (210 mg/dl) and RP (320 mg/dl). In the second study, we evaluated a simple flow control method. Flow rate was easily controlled with step-wise clamping of 3-pronged tubing (Triple-flow) without changing rotational speed, regardless of afterload. Fluctuation of flow was much less with this method than with the rotational speed change method. The use of pulsatile flow of TCP, with its minimum increase of hemolysis and the easier flow control method during the weaning process, may expand the usage of CP in open heart surgery.

Natural autoantibody against apolipoprotein A-I. Detection and characterization of the monoclonal antibody established from normal unimmunized BALB/c mice

During the course of studying the immunogenicity of soybean lipids, we observed frequent production of the mAbs that bind to apolipoprotein A-I (apoA-I) when spleen cells from unimmunized normal BALB/c mice were employed for fusion. Of the 986 colonies from six fusions, 38 (3.9% of the total) were directed against apoA-I and 13 mAbs (IgM) were established for further analysis. The following lines of evidence indicate that this family of mAb may form a novel family of natural autoantibodies against apoA-I: 1) The mAbs were shown to bind effectively to high density lipoprotein from various species, including BALB/c mouse, and immunoblotting analyses revealed that the mAbs bound specifically to the 28-kDa protein of high density lipoprotein. 2) The 28-kDa protein was purified to homogeneity and identified as apoA-I by amino acid sequence analyses and by its cross-reactivity with a xenogenic anti-apoA-I mAb (clone A/11). 3) Differing from the xenogenic anti-apoA-I mAb, the present mAb did not bind to native apoA-I, whereas an effective binding was observed only when the apoA-I had formed a complex with neutral lipids containing polyunsaturated fatty acids such as trilinoleoylglycerol and 5-cholesten-3 beta-ol 3-linoleate. 4) Sera from unimmunized BALB/c mice had readily detectable Abs against apoA-I and the majority of the serum autoantibodies were of the IgA and IgM isotype. 5) The anti-apoA-I mAbs displayed a functional heterogeneity in their reactivity with polyanionic substances and some of the mAbs established showed an extensive cross-reaction with polyanionic substances such as ssDNA and cardiolipin.

Toxicity of neomycin on enzyme activities of kidney and duodenal mucosa in vivo: organ specificity and species difference between rats and mice

Inhibitory effects of neomycin administration (10-80 mg/kg body weight/day, s.c. for 7 days) on several enzyme activities of kidney and duodenal mucosa were compared between male rats and mice. In Wistar rat kidney, tubular brush border Mg(2+)-dependent, HCO3(-)-stimulated ATPase activity was inhibited by neomycin in a dose-dependent manner, while microsomal Mg(2+)-Na(+)-K(+)-ATPase activity and cytosol carbonic anhydrase (CA) activity were inhibited only by larger doses. In rat duodenal mucosa, Mg(2+)-HCO3(-)-ATPase and CA activities were also inhibited only by larger doses. Serum urea nitrogen (UN) concentration and urinary N-acetyl-beta-D-glucosaminidase (NAG) activity were increased in a dose-dependent manner. In ddY and C57black mice, however, all enzyme activities in kidney and duodenal mucosa were almost unaffected by any dose of neomycin and showed no changes in serum UN concentration and urinary NAG activity except for ddY mice in which NAG activity was only increased by the largest dose of neomycin. In light microscopic analysis, 80 mg neomycin/kg produced necrosis in the greater part of rat proximal tubuli with no changes in duodenal brush border. On the other hand, no histological changes were produced in the renal cortex or duodenal mucosa of mice by any dosage. In conclusion, there are organ-specific and species differences in the effects of neomycin between rats and mice.

A light microscopic study of glomerulosclerosis in Japanese patients with noninsulin-dependent diabetes mellitus: the relationship between clinical and histological features

We studied the relationships of renal lesions with clinical features and renal prognosis in 128 Japanese patients with noninsulin-dependent diabetes mellitus (NIDDM). Diabetic glomerulosclerosis (DMGS) was found in 108 cases (84.4%), and DM-associated glomerulonephritis (GN), IgA nephropathy and membranous nephropathy, was in 20 cases (15.6%). There was no significant difference in age at renal biopsy, age at DM onset, DM duration, glomerular filtration rate (GFR), urine protein and serum IgA level between patients with DMGS and DM-associated GN. With respect to histological parameters, the increase in mesangial matrix was more closely related to DM duration, GFR and urine protein than to the degree of glomerular sclerosis. The index of glomerular lesion (IGL), which was calculated by combining these two lesions, had a more significant correlation with the clinical features than the tubulo-interstitial lesions. We suggested that the mesangial change was an initiating reaction, and the interstitial one was secondary in NIDDM patients. The prognosis of renal function after renal biopsy of the patients whose serum creatinine level was less than 1.2 mg/dl, was poorer in cases with nodular lesion than in those with diffuse lesion. The grade of tubulo-interstitial lesion was also more severe in these patients with nodular lesion. However, the controls of blood glucose, blood pressure, serum total cholesterol were not different among the two groups. On the other hand, serum creatinine level of most patients with associated GN did not change for a long period, up to 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-four-hour total small bowel hypothermic storage preservation and transplantation in the rat: a study of various preservation solutions

Three hundred forty-eight Sprague Dawley rats were used as donors and recipients of fresh and preserved small bowel transplants in order to evaluate both the most important determinants of failure after preservation and transplantation, and the effect of various preservation solutions used for 24 h. Four different solutions were tested: saline for the control group, and Euro-Collins (EC), University of Wisconsin (UW), and albumin-dextran-adenosine-allopurinol-verapamil (ADAAV) for the experimental groups. The survival at 3 days was 80% for the control group, 66.6% for the ADAAV group, and 53.5 and 46.6% for the UW and EC groups, respectively (p < .05 saline vs EC, UW; p > .05 saline vs ADAAV). Another two groups received small bowels on which the effect of nonflushing was studied for 6 and 24 h. In general, laboratory and histologic studies did not show a significant difference among the various groups of preserved small bowels. The worst groups were the nonflushed preserved small bowels, in which no survival was obtained. Although some improvement was noted in early survival with the ADAAV solution, no true-long term survivors were seen in any of the preservation groups studied. Factors of preservation injury were related to hemorrhagic necrosis and sepsis in the majority of the experimental groups. Thus, there were no available preservation solutions that could give consistent results after 24 h of small bowel preservation in the rat.

c-Jun expression in single cells and preneoplastic foci induced by diethylnitrosamine in B6C3F1 mice: comparison with the expression of pi-class glutathione S-transferase

Expression of the oncogene product c-Jun was examined and compared with that of class pi glutathione S-transferase (GST-II) during chemical hepatocarcinogenesis in female and male mice. A single i.p. injection of diethylnitrosamine (DEN) (10 mg/kg) was administered to B6C3F1 mice and livers were immunohistochemically investigated with anti-c-Jun and anti-GST-II antibodies at various time points thereafter. In females, almost all foci detected by hematoxylin and eosin staining were positive for c-Jun 3, 6, 9 and 11 months after the DEN administration. Seventy-one and 82% of c-Jun-positive foci at 9 and 11 months respectively, were also positive for GST-II, while this was the case for only 15% at 6 months. In males almost all foci were also positive for c-Jun at 3 and 6 months, but 23% of foci were negative at 9 months. Unlike the foci in females, 96 and 79% of those in males expressing c-Jun were negative for GST-II at 6 and 9 months respectively. Both GST-II expression in foci of females and its lack in those of males were highly correlated with c-Jun expression. Furthermore, single cells expressing c-Jun were also observed in both sexes at 3 months and thereafter, but not at 2 or 4 weeks. Alterations in the numbers of c-Jun-positive single cells, minifoci and foci followed sequentially revealed the number of such single cells to decrease, while foci increased, the sum being relatively constant. On the other hand, while a large number of GST-II-positive single cells were detected in female livers 2 and 4 weeks after the DEN administration, they markedly decreased thereafter, suggesting that the majority were unlikely to give rise to foci. Thus, c-Jun may be a better positive marker not only for preneoplastic foci, but also putative precursor single cells in both female and male mice and therefore be useful for analysis of hepatocarcinogenic processes.

[A case of small cell carcinoma of the stomach with multiple liver metastases]

We report a very rare case of small cell carcinoma of the stomach. A 69-year-old man, complaining of epigastric discomfort, was admitted to our hospital. Gastric endoscopy showed a Borrmann type 3 tumor at the lesser curvature of the cardia. Multiple liver metastases were observed in CT-scan, and total gastrectomy and cannulation to the hepatic artery were carried out. Macroscopically it was gastric cancer with P0H3N1T3M0, Stage IV b, histologically small cell carcinoma, intermed, INF gamma, ss, ly1, v3, n1(+), ow(-), aw(-). Immunochemotherapy was carried out, but liver metastases developed. The prognosis of this disease is very poor, resulting from rapidly developing metastases and invasion, in spite of treatments such as gastrectomy, chemotherapy and radiotherapy. More effective treatments are needed.

A novel modified tissue-type plasminogen activator (t-PA), E6010, gradually increases coronary blood flow after thrombolysis compared with native t-PA, urokinase and balloon catheter occlusion-reperfusion

In a canine copper coil-induced coronary thrombosis model, the differences in frequency of reperfusion arrhythmias (premature ventricular complexes: PVC) and mortality rate after thrombolysis by intravenous bolus injection of a novel modified tissue-type plasminogen activator (t-PA), E6010, and by continuous intravenous infusion of native t-PA or urokinase were evaluated. Rapid coronary occlusion and reperfusion were produced with a balloon catheter in another group of dogs, and the findings were compared with those in the thrombolysis groups. Reperfusion occurred gradually after the administration of E6010, but was significantly more rapid after administration of native t-PA and urokinase (P < 0.05). PVC were observed more frequently in native t-PA, urokinase and balloon occlusion-reperfusion groups than in the E6010 group. The mortality rate due to ventricular fibrillation was 0.0% in the E6010 group, 50.0% in the native t-PA and balloon occlusion-reperfusion groups, and 33.3% in the urokinase group. These results suggest that the more gradual reperfusion of the coronary artery at an earlier period after drug administration led to the lower frequency of reperfusion arrhythmias and low mortality rate in the E6010 group than in the native t-PA, urokinase and balloon occlusion-reperfusion groups.

Production and characterization of a novel tissue-type plasminogen activator derivative in Escherichia coli

We have created a novel thrombolytic agent by the combination of mutation with partial deletion of tissue-type plasminogen activator (t-PA). We constructed Escherichia coli expression vectors for (i) native t-PA (nt-PA) and its derivatives; (ii) K1K2P, consisting of kringle 1 (K1), kringle 2 (K2), and protease (P) domains; (iii) K2P, consisting of K2 and P domains; (iv) D-nt-PA; (v) D-K1K2P; and (vi) D-K2P. The latter three are point mutants of nt-PA, K1K2P, and K2P, respectively, in which Arg275 (number corresponds to that of nt-PA) has been mutated to Asp. The production of nt-PA and its derivatives was remarkably improved by (i) removal of the 3' noncoding region of nt-PA cDNA from expression vectors and (ii) expression in mutant E. coli derived from E. coli HB101, which is insensitive to heat-shock inductions. The proteins produced were precipitated as insoluble aggregates in the cells and were renatured to active forms by extraction with 8 M urea followed by dialysis against a redox buffer containing GSH and GSSG. The renaturation yield depended on the pH of the buffer and the number of disulfide bonds of the proteins (nt-PA << K1K2P < K2P). The mutation of Arg275 (the plasmin cleavage site) caused an increase in the catalytic enhancement by fibrin and a decrease of the interaction with plasminogen activator inhibitors.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive symptoms among Japanese and American adolescents

An epidemiologic study of depressive symptoms was conducted with self-administered questionnaires among 8th grade students (12-15 years of age) in Japan (n = 570) and the United States (n = 115 Anglos, n = 180 Hispanics). The Todai Health Index-Depression Scale (THI-D), which had been developed in Japan, was used in the study after translation from Japanese to English for the U.S. subjects. The THI-D mean score for Japanese boys was significantly higher than that for Hispanic boys. Also, a gender difference was found across the ethnic groups, in which girls expressed depressive feelings more than boys.

Probable lung injury by long-term exposure to oxygen close to 50 kilopascals

To investigate the possibility of lung injury after long-term saturation dives where oxygen partial pressure was kept between 42 and 50 kPa, we measured lung volumes, diffusing capacity (DLCO/VA), and ethane production in the alveolar expirate on six divers who participated in a 1.1-MPa saturation dive (9 days of total dive time) and on another six divers in a 4.5-MPa saturation dive (29 days of total dive time). Vital capacity after surfacing did not significantly decrease in divers after either dive profile, in comparison with predive values. DLCO/VA was significantly decreased only in the 4.5-MPa saturation divers after surfacing. Ethane production, used as an index of in vivo lipid peroxidation, was significantly increased immediately after the 4.5-MPa saturation dive. The decompression procedure seemed to have little effect on the decrease in diffusing capacity and increase in ethane production. These observations indicated that the decrease of DLCO/VA was assumed to be caused by oxygen-derived free radicals.

Norepinephrine excitation of cutaneous nociceptors in adjuvant-induced inflamed rats does not depend on sympathetic neurons

To test the contribution of sympathetic postganglionic neurons (SPGNs) to adrenergic excitation of cutaneous nociceptor activities in adjuvant-inflamed rats (AI rats), we studied the effects of norepinephrine (NE) in a group of sympathectomized AI rats. Sympathectomy was complete in 4-6 weeks by guanethidine (30-50 mg/kg). NE excited polymodal receptor units in the saphenous nerve at an incidence (25-30%) similar to that in AI rats, while CH-38083 blocked such excitation. These results show that alpha 2-adrenoceptors in SPGNs are not involved in the norepinephrine excitation of cutaneous nociceptors in AI rats.

[Pineal cyst: its diagnosis and treatment]

Four cases of pineal cyst were presented and their features on magnetic resonance (MR) imaging were discussed while reviewing the literature relevant to this clinical entity. Pineal cyst is a normal developmental variant and in most of the cases its diagnosis is not difficult, but in a limited number of cases, pineal cyst needs to be differentiated from cystic tumors which have developed in the region of the pineal gland, such as pineocytoma or astrocytoma. Most pineal cysts are found incidentally during MR screening studies and no surgical interventions are needed. Pineal cysts should be considered for surgery only when the diameter of the cyst is more than 1.0cm, or when obstructive hydrocephalus is verified on MRI or CT, and/or when definitive neurological signs such as Parinaud's syndrome are present. It was also stressed that embryological considerations are indispensable for evaluating pineal cysts on MR images.