[Autologous blood transfusion in cardiac surgery over 70-year-old patients]

We discussed the problems for autologous blood transfusion particularly in the preoperative blood donation about the patients over 70-year-old who underwent cardiac surgery in contrast with the younger patients. Following results were obtained: 1) Because aged patients have the tendency of anemia before predonation, full storage of blood donation could not be successed. 2 of 8 over 70-year-old patients were able to do the preoperative phlebotomy, and their mean volume were 355 gram as whole blood. On the other hand, 96% patients in younger group were phlebotomized preoperatively, and their mean value of storaged blood volume were 757 gram. 2) As the examinations about the iron-related parameters, not all aged patients were iron deficiency status. Their reticulocyte counts were nearly equal level to the younger group and plasma concentration of erythropoietin were higher in the aged patients than that in the younger group. These results indicate that erythropoiesis in the bone marrow was deteriorated in the aged patients. 3) In aged patients, all of them were required homologous blood transfusion at their perioperative terms. We thought that they have had the anemia before preoperation and our tolerable, allowable level to the postoperative anemia was not lower in the aged patients as against to the younger group. 4) We performed the autologous plasma donation with the membranous plasma separator added to the whole blood donation. It was easy and safe method, and circulatory indices were not changed before and after plasma-separation even in the aged patients. These autologous plasma were usefully administered as the volume expander postoperatively.

Importance of ornithine transcarbamylase (OTC) deficiency in small intestine for urinary orotic acid excretion: analysis of OTC-deficient spf-ash mice with OTC transgene

We report the effect of the ornithine transcarbamylase (OTC) transgene composed of 1.3 kb of the 5' flanking region of the rat OTC gene fused to rat OTC cDNA on urinary orotic acid excretion in OTC-deficient spf-ash (sparse-fur with abnormal skin and hair) mice during overnight-starvation and nitrogen loading. During starvation, spf-ash mice with about 6% and 2% of control levels of OTC activity in the liver and small intestine excreted a large amount of orotic acid in the urine. Transgenic spf-ash mice with about 10% and 30% of the control OTC activities in the liver and small intestine did not excrete more than the normal level of orotic acid. Accidental parasitization of transgenic spf-ash mice with ticks (Myocoptes musculinus) resulted in decrease of the OTC activities in the liver and small intestine to the levels in spf-ash mice, and increased excretion of orotic acid. During extermination of the ticks, the mice showed varied levels of OTC activity and orotic acid excretion. On nitrogen loading, transgenic spf-ash mice as well as spf-ash mice excreted larger amounts of orotic acid, while control mice showed no increase in its excretion. The levels of urinary orotic acid were inversely correlated to the logarithms of the OTC activities in the liver and small intestine, the correlation being significantly higher with intestinal OTC than with hepatic OTC activity. These results suggest that the level of OTC activity in the small intestine is important for production of orotic acid.

Existence of branched side chains in the cell wall mannan of pathogenic yeast, Candida albicans. Structure-antigenicity relationship between the cell wall mannans of Candida albicans and Candida parapsilosis

Isolation of side chain oligosaccharides from mannans of Candida albicans NIH B-792 (serotype B) and Candida parapsilosis IFO 1396 strains has been conducted by acetolysis under mild conditions. Structural study of these oligosaccharides by 1H and 13C NMR and methylation analyses indicated the presence of novel branched side chains with the following structures in C. albicans mannan. [sequence: see text] It was observed that the H-1 proton chemical shifts of the second and the third mannose units from the reducing terminus in each oligosaccharide are shifted upfield by substitution with an alpha-linked mannose unit at position 6 of the 3-O-substituted mannose unit. An agglutination inhibition assay between factor 4 serum and cells of Candida stellatoidea IFO 1397 lacking the beta-1,2-linked mannose unit, with oligosaccharides obtained from these mannans, indicated that only the branched oligosaccharides were active. This finding suggests that the branched oligosaccharides correspond to the epitope of antigenic factor 4. The presence of the branched structure in other mannans was detected by the characteristic H-1-H-2-correlated cross-peak of the alpha-1,2-linked mannose unit connected with the 3,6-di-O-substituted one by two-dimensional homonuclear Hartmann-Hahn spectroscopy.

Clinical evaluation of intramuscular administration of natural interferon-gamma in the treatment of chronic hepatitis B

Natural interferon-gamma at a dose of 0.5 x 10(6) or 1 x 10(6) IU daily was intramuscularly administered daily for 4 weeks to 15 patients with chronic hepatitis B. The efficacy and safety of the treatment were evaluated for 24 weeks following the completion of the 4-week treatment period. Persistent disappearance of HBeAg was observed in 5 of 15 patients. Serum hepatitis B virus (HBV)-related DNA polymerase disappeared in 5 of 13 patients at the end of interferon therapy. On the other hand, serum ALT and beta 2-microglobulin levels showed a significant increase during the interferon therapy period. The side effects were completely reversible. These findings suggest that interferon-gamma has an antiviral effect in patients with chronic hepatitis B and that the main mechanism of the therapeutic effect may be associated with the elimination of HBV-infected hepatocytes due to the immunopotentiating effect of the substance.

Regional medical information network using optical memory cards and integrated services for digital network

Since 1986, we have been developing a regional health and welfare system using optical memory cards. We have expanded the system and performed model experiments and evaluations this time. There are approximately 3000 card-holders and 23 card-reader terminals in use. They cover 50 percent of the medical facilities in the city of Isehara. Two medical clinics within neighboring cities have joined our project. Standard Deviation Index (SDI) has been introduced to standardize the numeric results of examinations. The terminals are connected with Integrated Services for Digital Network (ISDN) allowing remote access to the optical memory cards. This enhanced connectivity has allowed greater cooperation in delivering quality medical services.

Evaluation of aspiration biopsy cytology and combined preoperative tests in the diagnosis of breast cancer

This study was conducted to investigate the usefulness of aspiration biopsy cytology (ABC) and other combined tests for the preoperative diagnosis of breast cancer. In an analysis of 599 aspirates of breast tumors, "suspicious" cases were included among the positive, while "borderline" cases were considered to be negative. The sensitivity of ABC was 87.3%, the specificity was 92.3%, and the predictive value of a positive diagnosis was 92.8%. A total of 207 cases of breast cancer were evaluated to determine the diagnostic significance of breast cancer, particularly for tumors less than 2.0cm by means of quadruple test including physical examination, mammography (MMG), ultrasonography (US), and ABC. The combined tests of MMG or US, and ABC resulted in a sensitivity of 96.2% and 94.9%, respectively, and were considered to complement each other in the diagnosis of small breast cancer. Surgical biopsy is thus not always necessary in malignant cases that are conclusively diagnosed by the combined quadruple test.

A new mitochondrial DNA deletion associated with diabetic amyotrophy, diabetic myoatrophy and diabetic fatty liver

Mitochondrial dysfunctions of the muscle in diabetic amyotrophy and of the liver in diabetic fatty liver have been reported. We investigated mitochondrial gene mutations in three cases: (1) a patient with diabetic amyotrophy in the muscles of the lower extremities, and neuropathy; (2) 5 diabetics with myoatrophy, diabetic nephropathy, and chronic renal failure; and (3) an IDDM patient with a diabetic fatty liver. We identified a 5778-bp deletion (8214-13991) in mitochondrial DNA from the muscle and liver biopsy specimens by the primer shift PCR and PCR-direct sequence methods. It is speculated that 5778-bp deletion is due to homogeneous recombination in the 7-bp repeat sequence of TCCTAGA flanking the region deleted in the mitochondrial DNA. Determination of respiratory chain enzyme activities in fresh muscle mitochondria demonstrated the defect in complex I activity. The deletion covers areas coding ND3, ND4, ND4L, and ND5 in complex I. The 5778-bp deletion might cause a defect in mitochondrial oxidative phosphorylation and contribute to the pathogenesis of diabetic amyotrophy, myoatrophy with diabetic nephropathy, and chronic renal failure, as well as diabetic fatty liver in IDDM.

Relation between blood pressure and outcome in intracerebral hemorrhage

BACKGROUND AND PURPOSE

Controversy continues to exist regarding optimal blood pressure control in acute hypertensive intracerebral hemorrhage. Persistent marked elevation of the blood pressure can promote further bleeding, increase cerebral blood flow, and raise intracranial pressure. Relative hypotension, on the other hand, may promote hypoperfusion with secondary ischemia. This study was designed to assess outcome in patient groups defined by the degree of elevation in their pretreatment and posttreatment blood pressures.

METHODS

We retrospectively assessed 87 patients who were categorized according to an initial mean arterial pressure > 145 mm Hg (n = 34) compared with those with a pressure < or = 145 mm Hg (n = 53). We also studied blood pressure control within the first 2 to 6 hours of presentation with subjects categorized according to a mean arterial pressure > 125 mm Hg (n = 40) or < or = 125 mm Hg (n = 47).

RESULTS

An improved outcome in both mortality and severe morbidity was observed in the < or = 145 (chi 2 = 7.0, P < .005) and the < or = 125 mm Hg (chi 2 = 6.7, P < .005) groups.

CONCLUSIONS

Markedly elevated blood pressure on admission and persistent inadequate blood pressure control adversely affect the prognosis in hypertensive intracerebral hemorrhage.

Effects of danazol on proliferation and viability of 7,12-dimethylbenz(a)anthracene-induced mammary tumours in rats

The suppressive effects of danazol, an isoxazol derivative of a synthetic steroid 17 alpha-ethinyltestosterone, on cellular viability and DNA synthesis in 7,12-dimethylbenz(a)anthracene induced mammary tumours were investigated in adult female rats by enzyme assays and immunohistochemistry with bromodeoxyuridine (BrdU). Rats treated with danazol for 30 days showed a decrease of plasma levels of luteinizing hormone and estradiol associated with a dysfunction in hypothalamo-hypophysial-gonadal axis, resulting in lower activities in succinate dehydrogenase and thymidine kinase, and a reduction of BrdU-immunoreactive cells in mammary tumours compared with the control, i.e., decreases of viability and pyrimidine nucleotide synthesis in tumour cells in danazol-treated rats.

[Usefulness of intracardiac echocardiography for guidance of transseptal puncture procedure]

The clinical usefulness of intracardiac echocardiography (ICE) for the guidance of transseptal puncture procedure during percutaneous left heart bypass support (PLHBS) and percutaneous transvenous mitral commissurotomy (PTMC) was investigated to replace intraoperative transesophageal echocardiography monitoring which requires mild sedation and causes patient discomfort. The ICE procedure was assessed in 3 patients with PLHBS and 18 with PTMC using a 10 MHz rotating 8 French probe system especially developed for the purpose. Transseptal puncture procedure was observed by intraoperative ICE monitoring in the right atrium. The ICE images showed the transseptal puncture (Brokenbrough) needle as a point casting an acoustic shadow. By moving the ICE probe up and down, the excursion of the needle and its approach to the septal wall could be clearly observed. If the puncture needle is forced into the intra-atrial septum, the septal wall was clearly observed to protrude into the left atrium (tent-formation). In a tent-formation the puncture site could be determined by ICE alone. Intracardiac echocardiography guidance was useful and may improve the safety and reliability of the transseptal puncture procedure in PLHBS and PTMC.

[Multi-lead ambulatory electrocardiograph for recording body surface ST maps in daily life]

We attempted to construct ambulatory body surface isopotential maps of ST segment using our newly designed multi-lead ambulatory electrocardiograph. The multi-lead ambulatory electrocardiograph. The multi-lead ambulatory ECG system consisted of a commercially-available 4-channel recorder and a specially designed adapter, by which 30-lead ECGs were recorded together with body position signals for 24 hours. The electrode positions were selected from the 87 lead points for body surface mapping according to Yamada et al. Compensation for ST distortion and interpolation of ST level on time scale techniques were performed before the construction of ST maps. The extension and location of ST depression area thus obtained after compensation and interpolation were thought to be reasonable. In conclusion, the ambulatory recording of body surface ST maps is possible using our new device and may become useful for study of myocardial ischemia in daily life.

Mammalian expression of single chain variable region fragments dimerized by Fc regions

To promote application of a single chain variable region fragment (sFv) in immunoglobulins, a sFv gene was connected to an IgGi Fc gene, designated as a sFvc gene, and used for transfection of Sp2/0. As a result, the sFvc protein was found to be secreted in a dimeric form. It is thus felt that the sFvc protein, which mimicks the shape of a naturally occurring antibody, can be simple and useful to reproduce divalency and Fc-associated effecter functions as seen in a natural antibody.

Reconstruction of chest wall after full-thickness resection. Two case reports

Full-thickness reconstruction to repair defects in the chest wall was performed with a new method, using Marlex mesh, artificial bones and musculocutaneous flap. The artificial bones were constructed from ceramic iliac crest spacers connected by wires and methyl methacrylate. The advantage of the method is that the artificial bone can be created in various lengths and curves, tailored for the individual defect.

[Postoperative choreoathetosis in a case of tetralogy of Fallot]

We presented a case of severe postoperative choreoathetosis which occurred in a 3-year-old boy with tetralogy of Fallot early postoperatively but almost completely recovered within two years after the operation. Because of the large coronary arterial branch on the right ventricular outflow, a small outflow incision and deep hypothermia (lowest rectal temperature was 13 degrees C) and short duration of circulatory arrest (8 minutes) were adopted. Postoperative course was uneventful till the onset of choreoathetosis on the fifth postoperative day. His symptoms and signs of choreoathetosis, oral-facial dyskinesias, hypotonia, affective changes and also pseudobulbar signs were becoming serious during the first week from the onset, but afterwards his condition started getting better gradually every week, and every month. Now, 20 months after the operation, he is almost completely recovered except for small and slow involuntary movements. Though investiations including CT, MRI and EEG were all almost normal, regional nonspecific low area of the frontal lobe and cerebellum was detected by SPECT (single photon emission computed tomography) on the 32nd and 94th postoperative days, respectively.

Use of monoclonal antibody to detect bone morphogenetic protein-4 (BMP-4)

A monoclonal antibody that reacts with murine and human bone morphogenetic protein-4 (BMP-4) has been developed using recombinant BMP-4 as an immunogen. The antibody that bound most tightly to recombinant murine (rm)BMP-4 was selected, subcloned, and characterized. The specificity of the antibody was confirmed using Western blot analysis and enzyme-linked immunosorbent assay (ELISA). The antibody reacts with murine and human BMP-4 in both the reduced and nonreduced condition; however, this antibody shows cross-reactivity with neither human BMP-2 nor TGF-beta 1. Thus, the produced antibody could recognize the disulfide-linked dimeric structure of bioactive BMP-4, regardless of the species. Immunocytochemical study using this antibody successfully shows the cytosolic localization of BMP-4 in osteoinductive cells; i.e., BFO and Saos-2 in which the level of mRNA for BMP-4 was proved to be constitutively high by Northern blot analysis. In addition, the antibody could demonstrate the presence of BMP-4 in developmental bone formation in the alveolar bone of rat embryo by immunohistochemistry. The antibody could be used for a more sensitive approach for quantitative analysis of BMP-4.

c-fos expression in central cardiovascular pathways

Injection of muscimol in the caudal ventrolateral medulla increases blood pressure and stimulates neuronal c-fos expression in the rostral ventral medulla (RVM). The blockade of c-fos expression in the RVM by antisense oligonucleotides attenuates the blood pressure response to this muscimol-induced disinhibition of the RVM and also reduces resting blood pressure. The results suggest that cardiovascular neurons in the RVM express c-fos and that the basal and stimulated expression of the c-fos gene is important in the central regulation of blood pressure.

Effects of cadmium and lead exposure on urinary N-acetyl-beta-D-glucosaminidase, beta 2-microglobulin and metallothionein of workers

Cadmium (Cd), lead (Pb), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (BMG), metallothionein (MT) and creatinine (cre) in urine were measured in 36 male workers. Urinary Cd and Pb ranged from 0.2 to 9.7 and 0.1 to 4.8 micrograms/g cre with geometric means of 1.17 and 1.27 micrograms/g cre, respectively. Partial correlation coefficients between the logarithm of urinary Cd and that of NAG, BMG or MT controlling for pH and age were 0.460 (p < 0.01), 0.095 and 0.677 (p < 0.01), respectively. Partial correlation coefficients between the logarithm of Pb and that of NAG, BMG or MT controlling for pH and age were 0.040, 0.403 (p < 0.05) and -0.183, respectively. Multiple regression analysis was conducted on urinary NAG, BMG and MT using age, pH, log U-Cd and U-Pb. Log U-Cd was the only significant predictor variable of NAG (beta = 0.572; p < 0.01). Log U-Pb was the only predictor variable of BMG (beta = 0.386, p < 0.01). pH (beta = 0.286, p < 0.05) and Log U-Cd (beta = 0.839, p < 0.05) were significant predictor variables of MT.

[REN plot for a graphic expression method of clinical laboratory data statistics]

Laboratory data have been processed statistically on an assumption that they formed a normal distribution curve by themselves or after their transformation. The data of clinical medicine, however, frequently form distributions different from the normal one and thus they are not exactly represented by simple statistics such as mean and standard deviation. We used non-parametric percentiles(pct) as parameters for an improved expression of data distributions. The parameters used in this method are as follows: mean, 50 pct as median, 25 and 75pct as a concentration indicator, 5 and 95pct as a 90 percent central range, 2.5 and 97.5pct as a 95 percent central range, and minimum and maximum data as a distribution range. These indicators were presented on a new form of box-and-whisker plot. This expression was named as REN plot. Our method was compared to the other statistical expression methods using the data of control surveys of Factor IX activity of normal plasmas and prothrombin time of abnormal standard plasmas as well as APTT of abnormal plasma measured for intra-laboratory quality control. It was found that any form of data distribution, normal or abnormal, was precisely expressed in detail and the gradient of data densities were visually plotted by our method. Also neither the median, central range nor distribution range was influenced by extreme values. It was concluded that REN plot was useful expression for the statistical analysis of clinical laboratory data.

Characteristics of relaxation induced by calcitonin gene-related peptide in contracted rabbit basilar artery

Increasing evidence suggests that disturbances in the modulatory influence of the vasoactive peptide, calcitonin gene-related peptide (CGRP), contribute to the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH). However, only limited success has been achieved in trials attempting to ameliorate vasospasm by modifying CGRP function. To better understand the potential utility of targeting CGRP-mediated relaxation, it is important both to identify the interactions CGRP may have with other elements of the vasospastic response and to characterize the mechanisms through which CGRP elicits vasodilative effects. The present studies examined the effects of CGRP on vascular responsiveness using tension measurements of ring strips of rabbit basilar artery maintained in vitro. Pretreatment of vessels with CGRP (100 nM) inhibited vasoconstrictor responses to the potent protein kinase C (PKC) activator, phorbol 12,13-dibutyrate (PDB). This particular contractile response was selected because PKC-mediated vasoconstriction is a critical component of the vasospastic response after SAH. In a posttreatment paradigm, CGRP was also found to reverse established constriction responses to PDB (2 nM) and histamine (3 microM) in a dose-dependent manner. When tested against the maximum effective dose of PDB (30 nM) in the posttreatment paradigm, CGRP (100 nM) did not elicit significant relaxation. However, after washing both of these drugs out of the test chamber, a persistent effect of CGRP was revealed: the decay of PDB-induced contraction was accelerated in vessels that had previously been treated with CGRP. These findings indicate that CGRP elicits both immediate and sustained influences on contractile responses mediated by PKC. Finally, two potential mechanisms for the vascular response to CGRP were examined. Adenosine triphosphate (ATP)-sensitive K+ channels do not appear to participate in CGRP-mediated dilation; inhibitors of these channels, glibenclamide and tolbutamide, did not block CGRP-induced relaxation. In contrast, a possible role for the nucleotide cyclic adenosine monophosphate (cAMP) in the vascular response to CGRP was indicated by the dose-dependent elevation of cAMP levels by CGRP. Together these studies indicate that CGRP can modulate the contractile response to PKC activation. These effects are associated with increases in the levels of cAMP, but occur independently of fluxes through ATP-sensitive K+ channels.

The dominant negative effect of thyroid hormone receptor splicing variant alpha 2 does not require binding to a thyroid response element

The functionally inactive thyroid hormone receptor splicing variant-alpha 2 (TRv alpha 2) can inhibit transcriptional activation by TR alpha 1 or beta 1, demonstrating a dominant negative effect (DNE). We examine here the three commonly proposed mechanisms, namely, competition for binding to thyroid hormone response elements (TREs), formation of inactive heterodimers, and squelching. A mutation introduced into the DNA-binding domain (DBD) of the TRv alpha 2 was designed to prevent its binding to TREs. In transient cotransfection studies, the DBD mutant has nearly the same DNE as does TRv alpha 2 on three different TRE-containing reporter genes. The DNE of TRv alpha 2 is also not reversed by cotransfection with excess retinoid X receptor-alpha. Extracts of COS cells cotransfected with TR alpha 1 and either TRv alpha 2 or DBD mutant at different ratios were analyzed by gel shift assays. Neither TRv alpha 2 or the mutant altered binding of TR alpha 1 to four radiolabeled TREs. TRv alpha 2 itself can inhibit constitutive transactivation by a thymidine kinase promoter-driven reporter construct. Our results suggest that TRv alpha 2 can function in a dominant negative manner without binding to a TRE, at least for certain TREs. It is concluded that the DNE of TRv alpha 2 may occur through another unrecognized mechanism, perhaps by binding to basal transcription factors.