Platelet aggregability and the occurrence of anastomotic leakage after esophageal reconstruction

In 21 patients who had undergone resection and reconstruction for esophageal carcinoma, the postoperative platelet aggregability was measured and the correlation between the occurrence of anastomotic leakage and platelet aggregability was investigated. There was no statistical difference in the clinical features of the patients between those with (n = 5) and without (n = 16) anastomotic leakage. Platelet aggregability was measured by the turbidimetric method from blood samples taken preoperatively, and at 1, 3, and 7 postoperative days (POD). The average values of platelet aggregability in patients without anastomotic leakage were 81.2, 70.4, 80.1, and 81.8%, while those with leakage were 81.3, 47.6, 52.3, 70.6% preoperatively, and 1, 3, and 7 POD, respectively. Thus, platelet aggregability significantly decreased in patients with anastomotic leakage on the first postoperative day (p < .05), and then gradually recovered postoperatively as time passed. Therefore, the measurement of platelet aggregability is considered to be one of the parameters predicting the occurrence of anastomotic leakage, and a prevention in the decrease of platelet aggregability as well as its activation could become a treatment for preventing anastomotic leakage.

[Ileovesical fistula caused by long-term indwelling of urethral catheter: a case report]

A case of an ileovesical fistula is reported. The patient was a 32-year-old female who suffered from spina bifida. She had had a urethral catheter indwelt at 13 years old for continuous incontinence caused by atrophic bladder. The patient noted lower abdominal discomfort and fecal urine at age 31 in January, 1989 and urination from anal appeared in March, 1990. In November, 1990, the patient was introduced to our hospital and diagnosed with ileovesical fistula. We performed partial cystectomy, ileal wedge resection and cystostomy on this patient. The pathological findings showed chronic inflammatory change. The ileovesical fistula may have been caused by a long-term indwelling of urethral catheter. We discussed the ileovesical fistula and the treatment of neurogenic bladder in a patient of spina bifida.

Effect of adrenomedullin on aldosterone secretion by dispersed rat adrenal zona glomerulosa cells

Adrenomedullin, a novel hypotensive peptide, was discovered in human pheochromocytoma. Although adrenomedullin exists also in normal adrenal medulla and several other organs, its effect on steroidogenesis in adrenal cortex has not been studied. We examined the effect of adrenomedullin on aldosterone secretion by the dispersed rat adrenal zona glomerulosa cells. Adrenomedullin (10(-12)-10(-7) M) did not affect basal aldosterone secretion. Adrenomedullin dose dependently inhibited aldosterone secretion stimulated by 10(-9) M angiotensin II and 10 mM potassium, whereas 10(-9) M ACTH-stimulated aldosterone was not significantly inhibited by adrenomedullin. N6,O2'-dibutyryladenosine 3':5'-cyclic monophosphate (db-cAMP, 10(-5)-10(-3) M) and Ca+ ionophore A23187 (10(-8)-10(-6) M) stimulated aldosterone secretion dose dependently, and A23187-stimulated secretion was significantly inhibited by adrenomedullin (10(-8) M), but db-cAMP-stimulated secretion was not inhibited by adrenomedullin. Our data suggest the possibility that adrenomedullin is a novel inhibitory peptide of aldosterone secretion induced by increasing concentration of intracellular free calcium.

Localized aerosol hyperthermia in patients with nasal allergy

A double-blind study was performed to evaluate the efficacy, the safety and the usefulness of localized aerosol hyperthermia (LAH) in 57 patients with nasal allergy. We used two localized aerosol hyperthermia devices, the equipment (AH) with an insufflated aerosol of 43 degrees C and a placebo device (PH) with aerosol of 32 degrees C. In the evaluation of clinical efficacy, efficacy rates were 46.4% in AH and 3.7% in PH during 2 weeks, respectively, and 53.3% in AH and 7.7% in PH during 4 weeks, respectively. There was a significant difference (p < 0.01) between the two treatment groups. The usefulness rates were 63.3% in AH and 7.4% in PH for patients with nasal allergy, showing a statistically significant difference (p < 0.01). No patients dropped out of the study due to adverse effects. These results suggest that the LAH is a very useful instrument for the treatment of nasal allergy.

Panaxynol, a polyacetylene compound isolated from oriental medicines, inhibits mammalian lipoxygenases

Panaxynol is a polyacetylene compound isolated from commonly used oriental medicines, and its effects on various cyclooxygenases and lipoxygenases were investigated. The compound had only a marginal effect on cyclooxygenase activities (IC50 values >> 100 microM), but inhibited lipoxygenases; 5-lipoxygenase (IC50, 2 microM), two isoforms of 12-lipoxygenase (leukocyte-type, 1 microM; platelet-type, 67 microM) and 15-lipoxygenase (4 microM). Thus, panaxynol inhibited leukocyte-type 12-lipoxygenase much more effectively than platelet-type 12-lipoxygenase. Falcarindiol, an analogue of panaxynol, inhibited these lipoxygenases with higher IC50 values than panaxynol. These compounds could provide a clue to develop a selective inhibitor of one isoform of 12-lipoxygenase.

Inhibition of human immunodeficiency virus type 1 (HIV-1) replication by daphnodorins

Three flavans, daphnodorins A, B and C isolated from Dahpne odora THUNB. were tested for their abilities to inhibit human immunodeficiency virus type 1 (HIV-1(IIIB)) replication in MT-4 cells. The effective concentrations (EC50) of daphnodorins A, B and C against HIV-1-induced cytolysis were 0.26 +/- 0.08, 1.8 +/- 0.6 and 3.6 +/- 0.5 micrograms/ml, respectively. Also these three compounds showed inhibitory effects of p24 antigen in human peripheral blood lymphocytes. As compared with 2',3'-dideoxycytidine 5'-triphosphate (DDC-TP), daphnodorin A and daphnodorin C had relatively weak inhibitory effects on the reverse transcriptase of HIV-1, while daphnodorin B did not show any inhibitory effect at concentrations up to 1000 micrograms/ml. These three compounds showed marked inhibitory effects on syncytium formation between HIV-1(IIIB)-infected and uninfected MOLT-4 (clone 8) cells at 3-30 micrograms/ml without inducing cytotoxicity. The concentrations of the compounds blocking syncytium formation were consistent with the effective concentrations (EC50) against HIV-induced cytolysis of MT-4 cells. These results, differing from reverse transcriptase inhibitors, suggest that the daphnodorins exert their anti-HIV-1 activity through inhibition of early events of viral replication including adsorption of the virions to the cells or the subsequent entry.

Cloning of a lectin cDNA and seasonal changes in levels of the lectin and its mRNA in the inner bark of Robinia pseudoacacia

A cDNA clone encoding a lectin was isolated by immunological screening of an expression library prepared from poly(A)+ RNA from the inner bark of Robinia pseudoacacia. The cDNA clone (RBL104) had an open reading frame of 858 bp that encoded a polypeptide with a predicted molecular weight of 31210. This molecular weight corresponded closely to that of a polypeptide immunoprecipitated from products of translation in vitro of the poly(A)+ RNA. Thus, RBL104 appeared to be a full-length cDNA. The N-terminal amino acid sequence of the purified lectin protein matched a portion of the predicted amino acid sequence. It appeared that the lectin was synthesized as a precursor that consisted of a putative signal peptide of 31 amino acids and a mature polypeptide of 255 amino acids. Southern blot analysis of the genomic DNA revealed that the lectin was encoded by a small multigene family. The lectin was mostly localized in the axial and ray parenchymal cells of the inner bark. A small amount of lectin was also found in the axial and ray parenchymal cells of the xylem. The lectin accumulated in the inner bark in September, remained at high levels during the winter and disappeared in May. The mRNA for the lectin was detected from August to the following March. The appearance and disappearance of the mRNA were observed prior to those of the lectin protein.

A multicenter, randomized, controlled trial of intravenous gamma globulin therapy in children with acute Kawasaki disease

We studied the effect of intravenous, polyethyleneglycol-treated, human immunoglobulin, administered at 200 mg/kg per day (group A: n = 147; male 86, female 61; age < 1 year, 50) or 400 mg/kg per day (group B: n = 152; male 87, female 65; age < 1 year, 52) for five consecutive days and compared it with freeze-dried, sulfonated human immunoglobulin [group C: n = 152; male 87, female 65; age < 1 year, 51), administered at 200 mg/kg per day for five consecutive days, on the prevention of coronary artery abnormalities in Kawasaki disease. Echocardiograms were interpreted blindly and independently. Proportions of 87.1%, 95.4%, and 82.3% in groups A, B, and C, respectively, had no coronary artery abnormalities. The confidence limits of difference between the proportions of groups A and C, groups B and C, and groups B and A were -4.4% and 10.4%, 7.8% and 15.9%, and 4.0% and 10.8%, respectively. Duration of fever and serum immunoglobulin G (IgG) levels were correlated with the prevalence of coronary artery abnormalities. We concluded that intravenous, polyethyleneglycol-treated, human immunoglobulin and freeze-dried, sulfonated human immunoglobulin had clinically equivalent effects on coronary artery abnormalities, and that five daily doses of 400 mg/kg of intravenous, polyethyleneglycol-treated, human immunoglobulin is more effective than that of 200 mg/kg gamma globulin.

A new apparatus for chronic observation of the microcirculation in situ to evaluate artificial organ performance

Chronic study of the peripheral circulation and metabolism is very important in evaluation of artificial organ performance. However, there has been no way to observe the microcirculation in situ, chronically and continuously, without restriction. In this study, the authors developed a new apparatus that could be implanted and connected to an artificial organ that would allow continuous observation of the microcirculation while the subject is awake. The apparatus uses a charge coupled device (CCD) under a new principle: thin living tissue, such as mesentery, is put directly on a highly integrated CCD and transilluminated with a light emitting diode (LED). The vascular nets in the tissue are projected onto the CCD like a contact photograph, which is sent to a television screen and can be analyzed for motion and function. A 0.5 inch CCD with 25K pixels was used in this study. The cover glass of the CCD was removed so the tissue would be able to directly contact the CCD surface. The CCD, as well as LED, were molded with hard polyurethane as electrical insulation. The apparatus is 35 mm in diameter and 10 mm high with a micro stand for lighting with the LED, which is easy to implant in a goat or calf. The resolution of this apparatus was tested by putting a micro scale on the CCD surface. Several tenths of micrometers could be seen. In an animal experiment with a rabbit, configurations of arterioles and venules and their motions could be observed continuously for a night until the electrical insulation was broken. This method might be a strong weapon in artificial organs research.

[Experience with multidrug chemotherapy for patients with head and neck malignant tumors--comparison between CP therapy and PTP therapy]

A combined chemotherapy regimen (CP chemotherapy) consisting of cisplatin (CDDP) and peplomycin (PEP) was employed to treat patients with head and neck malignant tumors. More recently, PTP chemotherapy added to CP chemotherapy with THP-adriamycin (THP-ADM) was employed. We proceeded to investigate the efficacy of these two chemotherapeutic regimens. The subjects of this study included 22 patients in the CP chemotherapy group (18 males and four females). The PTP chemotherapeutic regimen was administered to 23 patients (18 males and five females). The results showed response rates of 54.5% for the CP chemotherapeutic regimen and 60.9% for the PTP chemotherapeutic regimen. In both treatment groups, the response rate decreased as the disease stage increased. As adverse reactions to the chemotherapeutic regimens, nausea and vomiting occurred in 63.6% of the CP group and 69.6% of the PTP group. Leukopenia was detected in 18.2% of the CP group and 69.6% of the PTP group, while alopecia was seen only in the PTP group, at an incidence of 39.1%. Cardiotoxicity was not detected in either group.

Immunohistochemical detection of CEA, CA19-9, and DF3 in esophageal carcinoma limited to the submucosal layer

The immunohistochemical expression of CEA, CA19-9, and DF3 was studied in 20 normal epithelia, 11 cases of dysplasia, 32 squamous cell carcinomas restricted within the submucosal layer (SM carcinoma), and 42 advanced squamous cell carcinomas of the esophagus. The modes of expression were grouped into three patterns, i.e., negative, focal, and diffuse patterns. No diffuse expression of CEA, CA19-9, or DF3 was found in the normal squamous epithelium and dysplasia. In the carcinomas (32 SM carcinomas and 42 advanced carcinomas) the diffuse expression of CEA and CA19-9 was found in four lesions, and only one of the four lesions was an SM carcinoma, while the diffuse expression of DF3 was found in 16 of the 32 SM carcinomas and 25 of the 42 advanced carcinomas. These results indicated that the diffuse expression of these tumor-associated antigens were characteristic of tumor tissue in the esophagus, and particularly DF3 was diffusely expressed earlier than CEA or CA19-9. The expression of DF3 in the esophagus may, therefore, be a marker of the early stage of tumor growth.

[Effects of E. coli LPS on human platelet aggregation]

The effects of E. coli lipopolysaccharide (LPS) on washed platelets of the healthy volunteers were studied by measuring ADP induced aggregation and intracellular ionized calcium concentration ([Ca2+]i) by fluorescent calcium indicator, quin 2. Addition of LPS in platelets suspension in saline, caused an increased platelet aggregation. Adding LPS, however, in platelet suspension in Na(+)-citrated platelet poor plasma inhibited ADP aggregation. These trends were not affected by cyclooxygenase inhibitor, but partially antagonized by dibutyryl cyclic AMP, and verapamil. The intracellular calcium ion concentration ([Ca2+]i) was significantly increased (334 +/- 141 nM to 150 +/- 45 nM in control) on addition of LPS in platelet suspension containing ionized calcium. On the other hand, there was no significant difference observed with those suspended in calcium free solution (50 +/- 16 to 45 +/- 15 in control). These results indicate that changes of platelet aggregation by LPS were mediated by cyclic AMP and Ca2+, but not by arachidate derivatives. The author concludes that LPS changed the mechanism of Ca2+ influx of platelet membrane and elevated [Ca2+]i of platelets. These findings, however, probably are not the cause of aggregation of platelets during DIC.

Potentiation of antitumor effect of bleomycin by local electric pulses in mouse bladder tumor

C3H mice bearing subcutaneously transplanted mouse bladder carcinoma (MBT-2) were treated with intramuscular injection of bleomycin followed by local delivery of electric pulses at the tumor site. The tumors markedly reduced and even disappeared for several days after this treatment. Neither electric pulses nor bleomycin administration alone showed a significant inhibitory effect on the tumor growth. Thus, it is demonstrated that in mouse bladder tumor the antitumor effect of bleomycin can be considerably potentiated by local electric pulses.

A subpopulation of olivocerebellar projection neurons express neuropeptide Y

By neuropeptide Y (NPY) immunohistochemistry and in situ hybridization histochemistry with digoxigenin-labeled oligonucleotide probes for this peptide, a subpopulation of neurons in the caudal portions of the rat dorsal and medial accessory olives were found to express NPY immunoreactivity and mRNA. In the cerebellum, NPY-immunolabeled climbing fibers were distributed to the flocculus and parts of vermal cortex. The results suggest particular association of NPY with the climbing fiber system presumably mediating spinal, visual and vestibular inputs.

Identification of the cerebral motor cortex by focal magnetic stimulation: clinical application to neurosurgical patients

A figure-8 coil was designed that was capable of generating currents over a relatively limited area. In this study, we used the figure-8 coil to localize human cerebral motor cortex by transcranial magnetic stimulation and assessed its value as a diagnostic tool for neurosurgical disease. The subjects were 10 normal volunteers and 12 neurosurgical patients. The points obtaining a response were plotted and the response area was delineated for each stimulus output. Rectangular coordinates were subsequently determined for the C3-Cz-C4 line with the stimulation sites set 1.0 cm apart. Then amplitude and latency maps were displayed by a computer wave map program. In normal volunteers, the posterior margin of the site where a threshold +5% stimulus obtained a response from the THE or ADM muscles almost coincided with the central sulcus. The optimal areas were relatively narrow on the amplitude and latency maps. In the patient with a left frontal convexity meningioma, the left threshold +5% area for the THE and ADM muscles showed marked anterolateral shift. No threshold map could be obtained on the affected side in patients with metastatic tumor and astrocytoma. Low perfusion areas caused by moyamoya disease and arteriovenous malformations produced narrowing of the optimal zone on the threshold map of the affected side. Hyperexcitability of the motor cortex was recognized in the arteriovenous malformation patients. Transcranial focal magnetic stimulation is a useful noninvasive diagnostic method for identification of the human cerebral motor cortex. It provides important information about changes in the localization and excitability of the motor cortex in neurosurgical patients and should be helpful for treatment planning.

Automated monitoring of cell concentration and viability using an image analysis system

In order to automate measurements of cell concentration and viability in a suspended animal cell culture, we have developed an in situ microscopic image analysis system with an effective cell recognition algorithm. With a small amount of sample, this system can measure the cell density rapidly and aseptically. In addition, it can measure a cell size histogram including cell debris small particle distribution. These small particles have been found to be related to the viability of the mouse-mouse hybridoma STK1 cell line. By using cell debris small particle density as an indicator of cell viability, the developed system provides non-destructive viability monitoring without trypan blue staining.

Calcium control of actin-myosin-based contraction in Triton-treated murine bladder tumor cells

Using mouse bladder tumor cells (MBT-2 cells) and epithelial cells, the present study evaluated the functional characteristics of the actomyosin system in bladder cancer cells. An immunofluorescence study demonstrated the presence of contractile proteins (actin and myosin) in MBT-2 cells as well as bladder epithelial cells. Triton-treated MBT-2 cells and epithelial cells showed a Ca(2+)-dependent contraction. This was inhibited by N-ethylmaleimide-modified myosin subfragment 1 (NEM-S1), demonstrating that the interaction between actin and myosin is responsible for the contraction of Triton-treated cells. The extent of Ca(2+)-dependent contraction was much greater in MBT-2 cells than in epithelial cells. These results suggest that MBT-2 cells possess a locomotive apparatus consisting of actin and myosin, and that Ca2+ can activate this actomyosin system, leading to the contraction or active locomotory movement of tumor cells.

Operative procedures of reconstruction after resection of esophageal cancer and the postoperative quality of life

To investigate the influence of the operative procedures of reconstruction after resection of esophageal cancer on the postoperative quality of life, an interview was conducted and subjective and objective factors related to the quality of life were evaluated in 50 patients without a recurrence of esophageal cancer. Among the 50 cases, reconstruction by the antethoracal route was performed in 9 (group I) and by the retrosternal route in 24 (group II). Intrathoracic anastomosis was done in 17 (group III). A postoperative disturbance of the food passage was seen 22.0, 41.6, and 5.9% in groups I, II, and III, respectively. Dumping symptom was evident 11.1, 12.5, and 11.8%, respectively. Heartburn was seen only in two cases, in group III. A body weight loss of more than 1.0 kg from preoperative weight was seen in 33.3, 41.7, and 41.2% of groups I, II, and III, respectively. There was no difference in the postoperative performance status or laboratory data among the groups. Thus, although intrathoracic anastomosis was favorable for postoperative food passage, there was no significant difference in any other factors in the quality of life among the routes of reconstruction, and the quality of life gradually improved in patients of all groups as postoperative time passed in the cases without postoperative recurrence of esophageal cancer.

[Effects of testosterone on smooth muscle in the isolated rabbit corpus cavernosum penis]

It has been reported that there is no relationship between serum testosterone level and erectile function and that testosterone mainly acts on the brain and not on the penis. However, we have found that erectile dysfunction in some patients with low serum testosterone improved after androgen replacement therapy. We therefore studied the effects of testosterone on the contraction and relaxation of the corpus cavernosum penis. Four groups of rabbits were studied over a similar time span. The testosterone group were non-operated and received testosterone propionate 10 mg/day for 14 days before sacrifice. Two groups (castration+testosterone group and castration group) were castrated 28 days before sacrifice. The castration group received sesame oil for 14 days, and the castration+testosterone group received testosterone 10 mg/day for 14 days. Entire penis were removed immediately after death by desanguination and dissected to obtain corpus cavernosum strips. These strips were suspended under 1 g tension in a 20 ml organ bath containing Tyrode's solution. After equilibration for 2 hours, the addition of drugs was started. Changes in tension were monitored with an isometric transducer and recorded. The vasoactive drugs used were norepinephrine bitartrate, 1-phenylephrine hydrochloride, clonidine hydrochloride, acetylcholine chloride and vasoactive intestinal polypeptide. The contractility of the corpus cavernosum strips increased significantly in the testosterone group and the castration + testosterone group, but decreased significantly in the castration group as compared with the control after adding norepinephrine, phenylephrine and clonidine.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of chondrosarcoma of the thoracic vertebra]

A case of chondrosarcoma of the thoracic vertebra in a 47-year-old female is described. Chest X-ray, CT and MRI disclosed an abnormal mass lesion in the posterior mediastinum. The lesion was surgically removed through right thoracotomy. The operative findings revealed that the lesion, hard and measuring 6.5 x 4.5 x 4.5 cm in diameter, was originated from the 7th and 8th thoracic vertebra. The lesion was histopathologically diagnosed chondrosarcoma. The chondrosarcoma arising from the thoracic vertebra is very rare, and only 10 cases have hitherto been reported in the Japanese literature.

Mediastinal drainage prevents fatal pyothorax from anastomotic leakage after intrathoracic anastomosis in reconstruction for carcinoma of the esophagus

In our experience, anastomotic leakage occurred in five of 69 patients with intrathoracic anastomosis after resection of carcinoma of the esophagus. In the early period, only an ordinary right thoracic drain was put in place, and when leakage occurred, two patients died because of pyothorax, while one patient was saved by surgical drainage. However, in the recent period, in addition to the ordinary right thoracic drain, another drain has also been placed just distal to the anastomosis through the esophageal hiatus through the abdominal cavity, exiting the abdominal wall. After such procedure, drainage has been adequate without any occurrence of pyothorax, even when anastomotic leakage occurred, as in the two most recent instances. Therefore, unless drainage is inadequate and surgical drainage is indicated, as in instances of necrosis of substitutes, mediastinoabdominal drainage seems to be effective in the treatment of intrathoracic anastomotic leakage.