[Surgical management of peripheral vascular disease in patients with severe coronary artery disease: importance of operative concept to reconstruct catheter insertion route for PTCA or CABG]

We discussed the operative concept of revascularization of lower extremities in patients associated with severe, coronary artery disease (CAD). Those with symptomatic CAD may undergo coronary artery bypass (CABG) or percutaneous coronary angioplasty (PTCA) with or without intraaortic balloon pump (IABP). Special attention should be paid during operation in these patients in order to reconstruct the arterial catheter route, which gives us the best way to percutaneous transfemoral approach to the aorta or the coronary arteries. One should not choose arbitrarily extra-anatomical bypass, such as axillo-femoral or femorofemoral, in these cases. Also, artificial graft should not be applied in the common femoral arteries, which will make percutaneous approach difficult. Common femoral arteries, if needed, are best reconstructed by means of thromboendarterectomy. Attaining smooth, bilateral aorto-ilio-femoral continuity is the main goal of revascularization of lower extremities in patients with CAD.

Three-dimensional analysis of condylar hyperplasia with computed tomography

Three-dimensional surface reconstruction imaging from CT scans was used to study the deformity of the mandible in six patients with mandibular asymmetry. High-resolution axial CT scans of the mandible were obtained using Somatom-DR3 (Siemens). COSMOZONE-2SA (Nikon) with PC-9801VX21 (NEC) was used to reconstruct the three-dimensional images. The six patients were divided into two groups. One group was classified as unilateral hybrid forms and the other group was classified hemimandibular elongation on the diagnostic criteria of Obwegeser and Makek (1986). In the three-dimensional surface reconstruction, exact location and the degree of the deformity in the region from the ascending ramus to the condylar head and the lingual aspect from the ascending ramus to the mandibular body were accurately represented. In addition, the three-dimensional images could be easily rotated arbitrarily, precise evaluation could be done at every part of the mandible. On diagnosis, the mandibular morphology classified into the unilateral hybrid forms was presumed to vary from case to case even in the same classification.

Site-directed mutagenesis of phosphoenolpyruvate carboxylase from E. coli: the role of His579 in the catalytic and regulatory functions

Phosphoenolpyruvate carboxylases (PEPC) [EC 4.1.1.31] from a wide variety of organisms contain a unique and highly conserved sequence, 578FHGRGGSIGRGGAP591 (coordinates for the Escherichia coli enzyme), which has been presumed to participate in the binding of phosphoenolpyruvate (PEP). Since previous chemical modification studies had suggested the importance of His for the catalytic activity, the role of His579 was investigated by constructing variants of E. coli PEPC, in which this residue was substituted to Asn (H579N) or Pro (H579P). Kinetic studies with partially purified enzymes revealed the following: (1) The apparent maximal velocities in the presence of acetyl-CoA (CoASAc, one of the allosteric activators) were 29% and 5.4% of the wild-type enzyme, for H579N and H579P, respectively. (2) The half-saturation concentration for PEP was increased about 40-fold by the substitutions, while those for another substrate (HCO3-) and the metal cofactor (Mg2+) were increased only 2- to 4-fold. (3) The half-saturation concentrations of four kinds of allosteric activators and of dioxane, an artificial activator, were also changed to various extents. Among them the most remarkable increase was observed for CoASAc (28-fold). (4) The concentration of an allosteric inhibitor, aspartate, required for 50% inhibition remained substantially unchanged. It was concluded that the imidazole group of His579 is not obligatory for the enzyme catalysis, but plays important roles in catalytic and regulatory functions.

[A case report of coronary artery bypass grafting with the left internal mammary, the right gastroepiploic, and the inferior epigastric arteries]

We performed coronary artery bypass grafting with the left internal mammary artery, right gastroepiploic artery, and inferior epigastric artery on a 60-year-old male. The inferior epigastric artery used as a free graft was placed between the in situ left internal mammary graft proximally and the obtuse marginal branch distally. Both the left internal mammary graft to the left anterior descending artery and the right gastroepiploic artery to the right coronary artery were used as an in situ graft. All grafts were patent two weeks after the operation and the patient was free from angina at three months follow-up period.

[Study on the simulation in planning for orthognathic surgery by using a personal computer]

This study was made in order to develop and evaluate three-dimensional simulation programs in planning for orthognathic surgery by using microcomputer system. Microcomputer system is composed of CPU (NEC, PC-9801), high resolutional color display, color printer, image scanner, and MOUSE. This simulation is composed of four procedures. 1. Data input Three-dimensional coordinate data on tracing obtained from CT films is inputted. One data file is made from one outline of structures. 2. Three dimensional reconstruction A control file is made to arrange data files constructing structures. 3. Simulation This procedure is composed of cutting and movement. The horizontal projection of mandible is displayed. After cutting simulated orthognathic surgery is designed, new data files and new control file are made. A movement consists of parallel translation and rotation. A movement data is combined with movements designed on each of three projections. 4. Three-dimensional graphic display Three-dimensional graphics of the mandible before and after a simulation for orthognathic surgery are displayed by perspective views with treated hidden lines and accurate pictures (COSMOZONE 2SA, NIKON). These simulation programs were carried out with the asymmetrical patient. The simulation was supposed that the operation was combined with sagittal splitting osteotomy of the right mandibular ramus and body ostectomy of the left lower first premolar part. Three-dimensional graphics of the mandible before and after the simulation were presented. Its three-dimensional mandibular position and form after orthognathic surgery were predicted. These three-dimensional simulation programs may be important procedure, when a treatment planning in asymmetrical prognathic case is discussed.

[A case of cerebral cysticercosis: cyst growth is confirmed by CT scan during 6 years of follow-up]

A rare case of a 40-year-old woman with cerebral cysticercosis is reported. She has lived on the Island of Tokunoshima and has never travelled overseas. She was hospitalized in the hospital of Kagoshima University in 1980. A small cyst in the right temporal lobe, and a calcified area in the left parietal lobe was noticed on CT scan. When she was admitted to our hospital in December 1986, the cyst in the right temporal lobe was larger than it was 6 years before. An operation was performed for the cyst in the right temporal lobe. The cyst was pathologically confirmed as cysticercosis. Postoperatively, immunological reaction of cysticercosis was positive, but X-rays and CT scan of extremities showed no abnormal findings. Cerebral cysticercosis is a rare disease in Japan. CT scan is very useful in the diagnosis of this disease. Multiple cysts and calcified area in the parenchymal region are specific findings on CT scan.

C-reactive protein and 6-keto prostaglandin F 1-alpha in patients with gynecologic cancer

C-reactive protein (CRP) is an acute phase reactant that appears to have a variety of biologic effects, including stimulation of prostaglandin production by peripheral blood monocytes. Both CRP and 6-keto prostaglandin F 1-alpha (6-keto PGF1-alpha) have been noted to be elevated in the sera of patients with malignant disease, therefore the current study was undertaken to determine whether any correlation exists between serum levels of these two substances. Thirty-five samples of sera from 16 patients undergoing treatment for primary gynecologic malignancies were tested. CRP was elevated above normal in 97% of samples and 6-keto PGF1-alpha was elevated in 91% of samples. No correlation between levels of CRP and 6-keto PGF1-alpha was identified. Serial serum samples were available for 6 patients undergoing therapy; in 5 of 6 patients CRP levels reflected the clinical disease course. There was no apparent correlation between 6-keto PGF1-alpha levels and clinical progression or regression of disease.

Magnetic resonance studies in human brain oedema following administration of hyperosmotic agents. Special references to relaxation times and proton MRS

Changes of proton relaxation times (T1 and T2) and proton Magnetic Resonance Spectroscopy (MRS) were studied in patients with brain oedema following administration of hyperosmotic agents. Relaxation times of oedema tended to decrease following infusion of hyperosmotic agents. In most patients examined, changes of relaxation times tended to achieve their lowest value at 30-60 minutes after infusion. However, the changes of relaxation times were not uniform. In some patients, relaxation times continued to decrease for more than 2 hours, while in other patients relaxation times which had earlier decreased subsequently had increased at 2 hours. The peak of water components, obtained by SIDAC (Spectroscopic Imaging by Dephasing Amplitude Changing) method was observed to change as did relaxation times. Changes of relaxation times and the peak of water components, obtained by SIDAC (Spectroscopic Imaging by Dephasing Amplitude Changing) method was observed to change as did relaxation times. Changes of relaxation times and the peak of water component may vary depending upon factors including the kinds of lesions causing oedema, phase of oedema (acute or chronic), etc. Proton relaxation times and the peak of water component obtained by proton MRS were useful in evaluating the changes of oedematous area.

Magnetic resonance study of brain oedema induced by cold injury--changes in relaxation times before and after the administration of glycerol

Experiments were carried out to determine the ability of magnetic resonance systems to assess change in relaxation times following the induction of experimental brain oedema and subsequent administration of hypertonic glycerol. Nine small mongrel dogs were used for these experiments. Twenty-four hours after producing a cold lesion, magnetic resonance (MR) studies were performed and physiological data were measured. Thirty min after beginning the administration of glycerol, serum osmotic pressure was raised 88 mOsm/l. After administering glycerol a small reduction in long spin echo images was observed in the periventricular high intensity area. The T1 and T2 values appeared to be decreased from 30 min after glycerol administration. This decrease continued until the period of observation ended. Statistically significant changes in the T2 values, especially in the white matter of the opposite side, were seen. The changes in T1 were generally not statistically significant. We conclude that the changes in water content of the oedematous brain following the administration of glycerol can be detected by magnetic resonance systems, that these changes become appreciable 30 min after administration of glycerol and continue at least two more hours, and that the changes in T2 were larger than those in T1.

Potential clinical applications of C-reactive protein

This article reviews the clinical applications of C-reactive protein (CRP). This acute-phase protein is a distinct and sensitive marker for inflammation and tissue injury. It is a simple, fast, and relatively inexpensive latex agglutination test. The aspects of CRP reviewed include diagnostic support, serial measurements to evaluate disease course and therapeutic response, and screening studies.

First crystallization of a phosphoenolpyruvate carboxylase from Escherichia coli

Two different forms of crystal for a phosphoenolpyruvate carboxylase from Escherichia coli were obtained by the hanging-drop vapor diffusion technique, using polyethylene glycol 4000 as precipitant. The hexagonal crystal in space group P6(2)22 (or P6(4)22) has cell dimensions of a = 131 A and c = 325 A, whereas the orthorhombic crystal in space group I222 has a = 119 A, b = 252 A and c = 83 A. A tetrameric molecule (396,244 Mr), a subunit of which contains 883 amino residues, has a crystallographic 2 symmetry in the hexagonal crystal or 222 symmetry in the orthorhombic crystal, respectively.

Characteristics of psychomotor performance and time cognition in moderately obese patients

To clarify adherence of obese subjects to external food-relevant stimuli, we examined time cognition and psychomotor functioning of the obese under noneating conditions in the present study. Matched on the basis of age, sex, height, intelligence quotient and education, 13 moderately, but adult-onset obese (mean obesity index +/- SEM, 53.9 +/- 5.0% by Matsuki's method) and 13 normal weight subjects (-6.3 +/- 2.3%) were tested. Obese females were slower than normal weight control subjects in alternate tapping of two metal plates (p less than 0.01) and in transfer of a dowel (p less than 0.05). Normal subjects were slightly but significantly (p less than 0.05) more efficient in a self-cued traverse movement test, whereas the obese subjects were very much less efficient in the self-cued than in the externally-cued test. These findings suggest that evaluation of deficits of the obese must consider other factors in addition to simple physical slowness due to fattening. In time cognition tests, cognitive levels of the obese were more accurate when initiated by time cues than when they were self-cued (p less than 0.01). The results indicate that obese (even after adult-onset) may exhibit impairment in internal time cognition when deprived of external modulating time cues.

Stereospecific feeding modulation by endogenous organic acid gamma-lactone in rats

Stereospecificity of 3,4-dihydroxybutanoic acid gamma-lactone (3,4-DB) and 2,4,5-trihydroxypentanoic acid gamma-lactone (2,4,5-TP) in their effects on feeding behavior and humoral factors was assessed by infusion into the rat third cerebroventricle. Initial transient food intake was most potently affected by infusion of 2.50 mumol of the 2S,4S-stereoisomer of 2,4,5-TP (80%) at 1100 h. Among the others, 2.50 mumol of the 2R,4S-isomer was somewhat potent in feeding elicitation (20%). Feeding induced by these isomers was not accompanied by periprandial drinking. Ambulation increased with elicitation of feeding. During the first dark period after infusion at 1940 h, 2.50 mumol of the 3S-isomer of 3,4-DB decreased food intake, including reduced meal size, and prolonged postprandial intermeal interval, but the 3R-isomer did not. Potent hypoglycemia with hyperinsulinemia was caused by the 2S,4S-isomer of 2,4,5-TP, and the S-isomer of 3,4-DB caused responses that were reciprocal to those to 2,4,5-TP. The remaining isomers did not affect feeding or humoral factors. The results suggest that the S- or S,S-stereo-isomer of the endogenous organic acid gamma-lactones may be important in modulating food intake through the hypothalamus.

Effects of the kallikrein-kinin system on phasic coronary vasospasm in dogs

It is well known that kinins are liberated from kininogen in blood during angina attack to maintain blood flow in coronary artery. We examined the effects of bradykinin, one of kinins, on the coronary artery other than vasodilation. The isolated canine coronary artery ring was suspended in gassed (95% O2, 5% CO2) Krebs-Henseleit buffer at 37 degrees C in vitro. The experimental phasic contraction of coronary artery was induced by 6 x 10(-4)M of 3,4-diaminopyridine which decreases K conductance (Y. Uchida, Jpn. Circ. J: 49, 128, 1985). The effect of bradykinin and other substances on the cycle length of contraction (CL), the peak tension of contraction phase (PT) and the tension during relaxation phase (RT) were observed. The phasic contraction was eliminated by 10(-7)M nifedipine and 10(-6)M diltiazem which block voltage dependent Ca channels. These Ca blockers reduced PT, but slightly increased CL, and weakly reduced RT. The phasic contraction was also eliminated by 10(-6)M bradykinin. However, bradykinin, unlike Ca blockers, did not reduce PT, but markedly prolonged CL and decreased RT significantly. This inhibition mode was very similar to those of nicorandil which increases K conductance. These data suggest that bradykinin plays a protective role in coronary vasospasm, and this antivasospasm effect may be mediated through the increase in K conductance.

Ryanodine inhibits the Ca-dependent K current after depletion of Ca stored in smooth muscle cells of the rabbit ileal longitudinal muscle

1. Effects of ryanodine on the membrane currents were investigated on dispersed smooth muscle cells of rabbit ileal longitudinal layer using voltage and patch clamp procedures. 2. With voltage clamp, membrane depolarization to 0 mV from the holding potential of -60 mV produced an inward Ca current (ICa) which was followed by transient and sustained outward currents (ITO and ISO, respectively). Prolonged depolarization of the membrane produced spontaneous oscillations of the outward current (oscillatory outward current; IOO) on ISO. 3. Ryanodine (30 microM) modified neither the basal membrane current recorded at the holding potential (-60 mV) nor ISO. Ryanodine inhibited both ITO and IOO in a concentration-dependent manner (IC50 = 5.5 and 4.5 microM, respectively, measured 12 min after application of ryanodine). These values were much higher than that observed in skeletal muscle for Ca release. 4. The time course of the ryanodine-induced inhibition of IOO was slow and the inhibition was irreversible. Caffeine (3 mM) enhanced the amplitudes of ITO and IOO in the presence of Ca, and only transiently enhanced IOO in the absence of Ca. However, following application of 10 microM ryanodine, 3 mM caffeine did not increase IOO. 5. Ryanodine (3-30 microM) slightly enhanced the amplitude of ICa evoked by depolarization pulses at potentials more negative than O mV but not that induced by larger depolarizations (positive potentials). 6. With patch clamp procedure, single Ca-dependent K channel currents were recorded in cell free and cell attached configurations. Application of 30 microM ryanodine transiently enhanced the Ca-dependent K current without any detectable changes in the amplitude of the single channel current recorded in the cell attached condition. In the inside-out membrane patch, when the intracellular membrane side was superfused with 1 microM Ca buffered with 10 mM EGTA, bath application of 10 microM ryanodine had no effect on the Ca-dependent K current. 7. It was concluded that both ITO and IOO are generated by Ca released from intracellular stores, mainly sarcoplasmic reticulum. Ryanodine appears to open irreversibly the Ca channel in the store and to inhibit the Ca-dependent K channel due to depletion of the stored Ca.

Effects of inositol phosphates on the membrane activity of smooth muscle cells of the rabbit portal vein

The effects of intracellular perfusion of inositol 1,4,5-trisphosphate (InsP3) or inositol 1,3,4,5-tetrakisphosphate (InsP4) on electrical responses of smooth muscle cell membranes of the rabbit portal vein were studied using the whole cell voltage clamp technique. Depolarisation to 0 mV from a holding potential of -60 mV, evoked inward Ca (Ica), transient outward (ISO), oscillatory outward (IOO) and sustained outward (ISO) currents. Generation of IOO was dependent on the [Ca]o, but it was also generated in 0 mM Ca solution for over 10 min. From amplitude histograms, IOO was divided into two components. Reduction in [Ca]o inhibited the appearance of but not the amplitudes of both IOO components. However, the larger component of IOO was more resistant to a reduction in [Ca]o than the smaller one. InsP3 (10 microM) increased the frequency of both IOO components to a greater extent than their amplitude, but the larger component was more sensitive to InsP3 than the smaller one. The increase in the occurrence of IOO induced by InsP3 did not occur following pretreatment with 3 mM caffeine or 1 nM A23187. In normal PSS, InsP3 was evoked by a depolarising pulse positive to -40 mV, whereas following perfusion with InsP3 (10 microM), IOO was evoked at -60 mV. In normal PSS, intracellular perfusion with 10 microM InsP4 changed neither the frequency nor the amplitude of IOO, and the amplitudes of ICa, ITO and ISO were also unchanged. However, in 10 mM Ca solution, 10 microM InsP4 generated IOO at a membrane potential of -60 mV.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ginsenoside-Rb1 as a suppressor in central modulation of feeding in the rat]

Ginsenosides, the main component of Panax ginseng root, have been reported to show several pharmacological actions on the peripheral metabolism of glucose and lipid and on endocrine secretion. The present study aimed to clarify the effects of ginsenoside-Rb1 on feeding behavior and endogenous chemical substances. Rb1 infusion into the rat third cerebroventricle was started at 1930 hr, and ingestive behavior was recorded in a soundproof room illuminated daily from 0800 to 2000 hr. Rb1 at doses of 0.05, 0.10 and 0.20 mumol potently decreased food intake dose-dependently during the first dark period after infusion. Analysis of meal patterns revealed that the suppressive effect was due to decreasing meal size, but not to postprandial intermeal interval and eating speed. Drinking episodes decreased concomitantly with feeding suppression only at the highest dose of 0.20 mumol. Ambulatory activity was not affected in the doses tested. Infusion of Rb1 increased plasma glucose, leaving insulin unaffected. Microinjection of 0.01 mumol Rb1 into the hypothalamic ventromedial nucleus (VMH) decreased food intake, but injection into the lateral hypothalamic area did not. Taking these data together, Rb1 was found to have a suppressive effect on feeding partly through the VMH.