In vivo properties of an intramedullary hydroxyapatite plug to improve femoral stem fixation

An intramedullary hydroxyapatite (HA) plug was inserted in each tibia of five rabbits. Histological observation showed the presence of newly formed bone tissue bridging between the inner cortex and the HA plug at 3 months postoperatively. This new bone was in direct contact with the HA plug, and there was no fibrous tissue intervention. Based on these results, the HA plug was used in a hip hemiarthroplasty with bone cement. The radiograph taken 4 years postoperatively showed that the plug-bone interface was indistinct, and some of the plug's edges became rounded by replacement with newly developed bone. The femoral component was stable without subsidence. The HA plug stabilized by bone ingrowth in the femoral canal would certainly be useful to prevent the femoral component from subsiding, in addition to increasing the cement-bone interface pressure at the time of surgery.

Tibial tubercle osteotomy in revision total knee arthroplasty

In revision total knee arthroplasty, osteotomy of the tibial tubercle provided satisfactory exposure to extract the broken tibial metal tray with rigidly fixed stem easily and safely. Three patients (three knees) underwent this osteotomy and were followed for a minimum of 2 years (range 2 years and 2 months to 2 years and 8 months). All of the osteotomies had healed within 6 months postoperatively. There were no complications related to the surgical technique.

Retrovirus-mediated gene expression in hematopoietic cells correlates inversely with growth factor stimulation

Cells of the hematopoetic system, especially hematopoietic progenitor and stem cells, are perceived as ideal targets for human gene therapy. In this report, the stability of retrovirus-mediated gene expression driven by three different potent promoters has been examined in purified human CD34+ cells. The promoters, murine stem cell virus (MSCV) long terminal repeat (LTR) and pgk, show gene expression in 10 times more hematopoietic colonies derived from CD34+ cells than the commonly used Moloney murine leukemia virus (Mo-MLV) LTR. Quantitative reverse transcriptase polymerase chain reaction (RT-PCR) analysis, however, demonstrates that the levels of gene expression in retrovirus-transduced cells decrease with time in long-term bone marrow cultures and in suspension cultures containing hematopoietic growth factors. Removal of hematopoietic growth factors from the suspension culture medium was associated with a decrease in cell proliferation and differentiation, but with stable gene expression. Retrovirus-mediated gene expression is, therefore, inversely related to proliferation and differentiation of the transduced CD34+ cells. These observations may have implications in future design and implementation of human gene therapy protocols.

In vitro properties of a chitosan-bonded self-hardening paste with hydroxyapatite granules

A new self-hardening paste was made by using a combination of chitosan, hydroxyapatite (HA) granules, ZnO, and CaO. The sol was made by dissolving 0.1 g of chitosan in a solution of 0.1 g malic acid and 2.0 mL physiological saline solution. Mixed with 0.03 g of CaO and 0.04 g of ZnO powders was 2.77 g (55 wt %) of HA granules which had a homogeneous pore distribution and a porosity of 35-48%. The size of the granules was set for 0.1-0.3 mm. Kneading and setting of the paste generated a little amount of heat (32.8 degrees C) as compared with the heat produced by polymethyl-methacrylate (PMMA) bone cement (114.5 degrees C). The pH value of chitosan-HA-hardened composite after setting was nearly equal to that of human plasma (pH 7.4), while that of PMMA bone cement maintained an acid pH of 4.7. Hydroxyapatite granules less than 0.1 mm, 0.1-0.3 mm, or 0.3-0.6 mm were set using chitosan sol. The size of the granules did not influence the compressive strength of the set chitosan-HA-hardened composite. The greatest compressive strength of chitosan-HA-hardened composite was obtained by using 55 wt % of HA granules. The strength of the chitosan-HA-hardened composite was comparable to that of the cancellous bone derived from tibial eminentia, but was considerably lower than that of the PMMA bone cement.

Development of Graves' disease from asymptomatic autoimmune thyroiditis: a case report

We report herein a case of hyperthyroid Graves' disease developed from asymptomatic autoimmune thyroiditis (AAT). A 25-year-old single female with AAT was followed up for over 3 years. Thereafter her condition progressed to hyperthyroidism with both positive TSH receptor antibodies (TRAb) and an increase in antithyroidal antibodies. It is possible that there was continuous destruction of thyroid epithelial cells without a hyperthyroid state, followed by production of TRAb, although Graves' disease very rarely develops from destructive thyroiditis including AAT.

Pluripotent and lineage-committed CD34+ subsets in leukapheresis products mobilized by G-CSF, GM-CSF vs. a combination of both

To define an optimal regimen for mobilizing blood-derived progenitor cells from healthy donors for allogeneic transplantation, we have studied the early and lineage-committed CD34+ subsets in the leukapheresis products after mobilization with G-CSF (10 micrograms/kg/d), GM-CSF (10 micrograms/kg/d), and the combination of G-CSF and GM-CSF (G/GM, 5 micrograms/kg/d of each). We used three color and five dimensional flow cytometry with a panel of monoclonal antibodies against CD3, CD7, CD10, CD11b, CD15, CD33, CD34, CD38, CD45, CD61, and CD71. As reference, we also analyzed CD34+ subsets in samples from umbilical cord blood (UCB) and from adult bone marrow (BM). The level of total CD34+ cells was 0.04 +/- 0.03% (mean +/- SD) in peripheral blood at baseline, and reached a maximum on day 5 or day 6 of administration of growth factors. The percentages of CD34+ cells in the leukapheresis products were 1.06 +/- 0.37% (mean +/- SD) with G-CSF mobilization, 0.35 +/- 0.24% with GM-CSF, and 0.92 +/- 0.61% with the combination of both. Among the CD34+ subsets, the percentage of cells that were CD34+/CD38- was highest in UCB (7.18 +/- 5.58%) and lowest in G-CSF mobilized peripheral blood (0.80 +/- 0.22%), whereas GM-CSF or G/GM mobilized products gave rise to intermediate levels (4.43 +/- 3.40%, 3.61 +/- 2.42%, respectively). The differences between G/GM and G-CSF, between UCB and G-CSF, or between UCB and BM are significant. The absolute numbers of CD34+/CD38- and CD34+/CD38-/HLA-DR+ subsets are also significantly higher in the G/GM mobilized products than in G-CSF products. The cloning efficiency of G/GM mobilized CD34+ cells was 2 times higher than that of G-CSF mobilized CD34+ cells, albeit the difference was statistically marginal. The profile of CD34+ subsets mobilized by the combination of G/GM approaches that found in UCB. Our data illustrate that different growth factors and regimens can preferentially mobilize different CD34+ subsets from normal donors, and that the combination of G-CSF and GM-CSF might be an optimal regimen.

[Effect of treatment with lansoprazole and amoxicillin in combination on healing process of duodenal ulcer]

The important role of Helicobacter pylori (H. pylori) in idiopathic duodenal ulcer disease is widely acknowledged. Treatment with amoxicillin and omeprazole has been highly successful in eradicating H. pylori in some pilot studies. We conducted a study in patients with active duodenal ulcer disease and H. pylori colonization of gastric mucosa using a combination of amoxicillin and lansoprazole. Lansoprazole has been shown to exhibit lower MIC than omeprazole. Sixty three patients who qualified for admission to the study were randomly assigned to receive either oral lansoprazole (30 mg, p.o., qam, daily for 6 weeks) (n = 30) or lansoprazole (6 weeks) plus amoxicillin (1500 mg, p.o, t.i.d., daily for 2 weeks) (n = 33). Six weeks after the initiation of treatment with lansoprazole, healing of the ulcers was assessed using electronic endoscope according to the classification of Sakita & Miwa. When lansoprazole alone was administered to the patients, H. pylori dormancy was attained in none of the patients, whereas dormancy was ascertained in 17 out of 33 patients when lansoprazole and amoxicillin were administered in combination. H. pylori dormancy was assessed by 13C urea breath test, histological examination of gastric mucosa and rapid urease test. Endoscopic evaluations revealed that S2/S1 ratio was significantly higher in patients with H. pylori dormancy than in those without. The results of our study confirmed that treatment to eradicate H. pylori with drugs such as lansoprazole and amoxicillin is effective in the healing of idiopathic duodenal ulcer disease.

Procedures of simultaneous radical resection indicated for primary synchronous esophageal and liver cancers--from the personal experience of three cases

Primary double cancers of the liver and esophagus are extremely rare. Only 7 cases, both cancers resected, were reported. A 2 stage surgical procedure has been recommended for such a case. We experienced 3 consecutive patients who underwent successful simultaneous radical resection with a good outcome. Case 1 with an advanced esophageal cancer (EC) and hepatocellular carcinoma (HCC) without liver dysfunction received subtotal esophagectomy and posterior segmentectomy of the liver under a thoraco-laparotomy. Case 2, with an early stage EC and HCC with Child A cirrhosis, received the same surgical procedures as case 1 to complete stanching under good visibility for esophagectomy, because of his bleeding tendency due to liver dysfunction. But post operative bleeding from the thoracic cavity continued for 5 consecutive postoperative days. Case 3, with an early stage EC and cholangiocellular carcinoma (CCC), underwent transhiatal esophagectomy and right hepatic lobectomy under laparotomy. All cases received active enteral nutritional (EN) support from the early postoperative day with good outcomes. In conclusion, simultaneous radical resection for synchronous cancers of the esophagus and liver might be a possible indication for patients who have little or slight liver dysfunction. In the case with liver dysfunction, esophagectomy should be performed under thoracotomy, but transhiatal resection, for complete stanching, even in the early stage EC. Post-operative EN support is essential for these patients to obtain a good outcome.

Alterations of fibrinolytic activity in human during and after hyperbaric oxygen exposure

To clarify the stage of fibrinolytic activation by hyperbaric oxygen (HBO) exposure, we examined its alterations in human during and after the HBO exposure. Eight healthy female volunteers breathed oxygen at 284 kPa (2.8 atmospheres absolute). Blood samples were collected before compression, shortly after compression to the pressure 284 kPa, shortly before the start of decompression, shortly after decompression, and then again 3 hours after decompression. We estimated the euglobulin fibrinolytic activity (EFA) and, the activities and antigens of both tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1). The PAI-1 activity and PAI-1 antigen showed significant decrease after compression to a pressure 284 kPa, before the start of decompression, and after decompression. The EFA level and t-PA activity rose significantly shortly after decompression, and 3 hours later returned on baseline. These findings suggest that fibrinolytic activity is elicited after HBO rather than during HBO.

Resection of the inferior head of the pancreas: report of a case

We developed a new technique for partial resection of the head of the pancreas with an end-to-side pancreaticoduodenostomy, while preserving the duodenum, the common bile duct, and the upper part of the head of the pancreas around the duct of Santorini. A resection of the inferior head of the pancreas was performed in a patient with an intraductal mucin-producing tumor of the pancreas. This procedure is considered to be appropriate for treating both benign disease and noninvasive malignant disease involving either the uncinate process or the duct of Wirsung, because it removes both the uncinate process and the pancreatic tissue around the duct of Wirsung. We thus believe that a resection of the inferior head of the pancreas with an end-to-side pancreaticoduodenostomy can help play a significant role in the management of patients with benign diseases and localized malignant tumors of the pancreas.

Improved method for preparation of samples for the polymerase chain reaction for detection of Coxiella burnetii in milk using immunomagnetic separation

Immunomagnetic separation (IMS) improved the detection of Coxiella burnetii in cow's milk by the polymerase chain reaction (PCR). IMS represents a novel approach to the isolation of microorganism from milk. The combination of IMS and PCR analysis has an adequate sensitivity for detection of C. burnetii.

Modulation of the receptor for urokinase-type plasminogen activator in macrophage-like U937 cells by inflammatory mediators

Macrophages in the tissues have been shown to express receptor for urokinase-type plasminogen activator (uPAR) on their cell surface which plays an important role in cell invasion and attachment. We examined the effects of inflammatory mediators on the expression of uPAR employing U937 cells which have monocyte/macrophage-like characteristics. U937 cells were incubated with various mediators such as interleukins (IL), tumor necrosis factors (TNF), dexamethasone, thrombin, fibrin fragment D, bradykinin, complement C5a, and components of the extracellular matrix. The uPAR expression on the cell surface was then analyzed by radio-ligand binding assay using 125I-scuPA. The strongest enhancement of uPAR was observed in the cells stimulated by TNF alpha and TNF beta. IL-1 beta, IL-6, and C5a also increased the uPA binding sites with various patterns of affinity change. Dexamethasone decreased the uPA binding sites without changing the affinity. Fibrin fragment D and IL-3 reduced the affinity without changing the number of receptors. These findings suggest that the expression of uPAR in inflammatory cells could be modulated by various inflammatory mediators.

Socioeconomic and behavioural risk factors for mortality of individuals with IDDM in Japan: population-based case-control study. Diabetes Epidemiology Research International (DERI) US-Japan Mortality Study Group

The aim of this population-based, one-to-one matched-pair case-control study was to evaluate the factors concerning the markedly increased risk for dying among Japanese subjects with insulin-dependent diabetes mellitus (IDDM) from a social and behavioural perspective. The study was based on the population-based cohort of IDDM subjects in the Diabetes Epidemiology Research International Mortality Study. We studied 90 cases who died and 90 living control subjects, selected from the rest of the cohort, who were matched for sex, birth year, year of diagnosis and duration of diabetes. Socioeconomic and behavioural status were surveyed through a questionnaire. Conditional logistic regression analyses based on 55 respondent pairs revealed that the better educated patients (year of completing education: odds ratio = 0.66) who kept the same physician (number of times a patient changed physician: odds ratio = 2.77) and who attended a clinic specializing in diabetes (attendance at university hospital clinic: odds ratio = 0.18) injecting insulin several times a day (number of injections, odds ratio = 0.31) and more frequently attending the clinic (> or = 12 times per year, odds ratio = 0.23) were at substantially lower risk of death. The results begin to profile the patients with the highest risk of dying who could be identified earlier and undergo intervention treatment.

Cell-cycle kinetics and VSV-G pseudotyped retrovirus-mediated gene transfer in blood-derived CD34+ cells

As hematopoietic stem and progenitor cells have a low mitotic index, we have quantitated the impact of cytokine combinations on cell cycling of CD34+ cells and, using VSV-G pseudotyped retroviral vectors, correlated our findings with ex vivo gene transfer. We tested nine different combinations of cytokines for induction of human peripheral blood CD34+ cells into cell cycle over 72 hours. Using the 5-bromodeoxyuridine-Hoechst 33258 (BrdU-Hoechst) assay, we measured the cell-cycle kinetics. The combinations of cytokines tested that were most efficient in inducing the CD34+ cells into cycle were stem cell factor (SCF) plus one of the following: interleukin-1 (IL-1), IL-3, granulocyte colony-stimulating factor (G-CSF). The maximum numbers of cells in S+G2M phase were observed after 48 hours of culture. At least 35 +/- 5% of the CD34+ cells remained quiescent in the first G0/G1 phase, however, no matter which cytokine combination was used. Cell-cycle analysis of the CD34+CD38- subset by 7-amino actinomycin D staining did not detect cycling cells during 72 hours of culture with any of the cytokines tested. To investigate whether the cells could be infected by the VSV-G pseudotyped virus containing the neomycin phospho-transferase gene (neo), we exposed CD34+ cells to the virus for 7-8 hours after 0, 36, and 48 hours of cytokine stimulation. Total CD34+ cells and the CD34+CD38- subset were analyzed by polymerase chain reaction (PCR) for reverse-transcribed viral DNA of the neomycin resistance gene (RT-neoDNA). Immediately after exposure to the virus, RT-neoDNA was detectable in CD34+ cells that have been cultured with or without cytokines for 36 to 48 hours. Forty-eight hours postinfection, however, RT-neoDNA could be detected only with cytokine combinations that induced mitosis of the CD34+ cells, consistent with the requirement for mitotic activity for retroviral integration. Similar experiments performed with the 34+CD38- subset showed that RT-reoDNA could not be detected at any time point. Thus, postinfection RT-neoDNA could be immediately detected in noncycling CD34+ cells but not in CD34+CD38- cells. These results suggest during short-term liquid culture, there may be blocks for reverse transcription of retroviral RNA in CD34+CD38-cells in addition to the lack of mitotic activity.

[Hard metal lung with diffuse small nodular shadows]

A 32-year-old woman was admitted to Niigata University Hospital with dyspnea and a non-productive cough. She had been exposed to hard metal dust for 4 years in a metal-polishing factory. Chest X-ray and CT films showed diffuse small nodular shadows in both lung fields and pulmonary-function tests revealed severe restrictive impairment. Specimens obtained by thoracoscopic lung biopsy showed fibrosis in the centers of lobules and in peribronchiolar regions. Giant-cell interstitial pneumonia-like findings were also noted. Tungsten carbide and cobalt were detected in these specimens, with an X-ray microanalyzer. Hard metal lung was diagnosed. By 1 year after she changed her place of work and began corticosteroid treatment her symptoms and pulmonary function had improved remarkably, although shadows on chest X-ray films remained to some extent.

The all-inside meniscal suture technique using new instruments

The all-inside meniscal suture was performed by using new arthroscopic instruments with a soft and fine (4-0 gauge) polyfilament thread that yielded relatively small knots so as to be innocuous to articular cartilage. No neurovascular injury, infection, or any other complication had occurred intraoperatively and postoperatively in this technique.

Comparison of the human genomic structure of the Runt domain-encoding PEBP2/CBFalpha gene family

We cloned the human cDNA corresponding to the cDNA (PEBP2alphaB-451) encoding the mouse polyomavirus enhancer-binding protein 2alphaB-451, representing a major splice variant from acute myeloid leukemia gene 1 (AML1). Genomic DNA clones of AML1 were also isolated and the exon/intron structure was determined. Furthermore, we determined and compared the genomic structures of three mammalian Runt domain-containing genes, PEBP2alphaA,AML/PEBE2alphaB and PEBP2alphaC.

The cDNA cloning of the hamster homologue of the human L6 gene

The cDNA cloning and sequencing of a Syrian hamster gene that produces a surface antigen on cells transformed by the SV40 or BK virus are described. Sequence analysis showed that this gene is a member of the transmembrane 4 superfamily (TM4SF) and encodes the Syrian hamster counterpart of the human and the murine L6 antigens. The amino-acid sequences are highly conserved, being 71% identical among three species.

Enhanced anticancer effect of vincristine with methionine infusion after methionine-depleting total parenteral nutrition in tumor-bearing rats

Methionine-depleting total parenteral nutrition (Met(-) TPN), in which an amino acid solution devoid of L-methionine and L-cysteine is infused, is thought to reduce tumor cell growth through acting as a partial late S-G2 (i.e., late-S and G2 phases) blocker. The antitumor effect of vincristine (VCR), which acts on mitotic phase cells, was examined with methionine infusion immediately after Met(-) TPN in Yoshida sarcoma (YS)-bearing rats. Rats were given Met(-) TPN for 8 days immediately after inoculation with YS cells (days 0 to 8), which was followed by methionine-containing (Met(+)) regular TPN for 3 days (days 9-11) along with intraperitoneal administration of 0.05 mg/kg/day VCR. All rats were then fed solid food and water ad libitum until they died, with 0.1 mg/kg VCR administration on days 12 and 13. As controls, a Met(-) TPN only group, Met(+) TPN groups with and without VCR, and freely fed groups with and without VCR were studied. The progression of YS was markedly suppressed by Met(-) TPN with VCR. The median survival time in days was 25 days, significantly longer (P<0.001) (generalized Wilcoxon's tests) by 11 to 14 days than that of any of the other groups. In conclusion, VCR appears to have greater efficacy as an anticancer agent when administered together with methionine after Met(-) TPN.

Esophageal carcinoma and coexisting hepatocellular carcinoma resected simultaneously

We have experience with two cases in which esophageal carcinoma and coexisting hepatocellular carcinoma were resected simultaneously. One patient had advanced esophageal carcinoma located in the thoracic esophagus and solitary hepatoma in the posterior segment of the liver with normal liver function. The other patient had superficial esophageal carcinoma in the thoracic esophagus and solitary hepatoma in the posterior segment of the liver with impaired liver function. Subtotal resection of the esophagus and posterior segmentectomy of the liver were performed simultaneously in both patients. In the patient with impaired liver function, postoperative management of respiration and bleeding was difficult, and intensive care was needed. Mediastinal lymph node resection was modified. Postoperative course was considered to have a close relationship to liver function. Thus, close evaluation of liver function is important to decide suitable treatment of patients with primary hepatocellular carcinoma and coexisting malignant neoplasms. With close evaluation of liver function and intensive postoperative care, simultaneous resection of esophageal carcinoma and hepatocellular carcinoma is not impossible or difficult.