Clinical experience with PTFE graft replacement in the descending thoracic aorta

In 6 cases, we have performed polytetrafluoroethylene (PTFE) graft replacement in the descending thoracic aorta, with all patients alive and showing good results. Fifty months have passed since the first graft replacement, but no complications due to the PTFE graft have occurred.

[CP angle meningioma presenting as hemifacial spasm]

An interesting case of CP angle meningioma presenting with hemifacial spasm is reported. The patient was a 64-year-old woman with left hemifacial spasm of 18 years' duration which was the initial and the only symptom she had had for ten years until other signs and symptoms including tinnitus and hearing decrease on the left side, vertigo and left cerebellar disturbance occurred. Preoperative CT films showed an enhancing mass at the left CP angle. Operation was performed and the diagnosis of meningioma originating at the rostral edge of the jugular foramen was made. The tumor was extending from the lower cranial nerves up to the Vth nerve burring the VIIth, VIIIth, IXth, Xth, XIIth cranial nerves and vertebral artery within it and compressing the root exit zone of the VIIth nerve. It was totally removed by microsurgical techniques. Postoperative follow-up during eight months disclosed complete disappearance of hemifacial spasm. Residual neurological deficits were left hearing loss, mild facial weakness due to previous nerve blocks on the left side and slight hoarseness. But she was doing well as a housewife. So far, the authors have experienced with 1310 cases of microvascular decompression for hemifacial spasm and 730 cases for tic douloureux. There were only 4 cases (0.3%) in which a CP angle tumor was found in hemifacial spasm series, while in tic douloureux series as many as 79 tumor cases (10.8%) were found. A review of the literature revealed that hemifacial spasm due to CP angle meningioma was very rare, particularly as an initial symptom as in our case.(ABSTRACT TRUNCATED AT 250 WORDS)

The National Institutes of Health Intermittent Positive Pressure Breathing trial--pathology studies. III. The diagnosis of emphysema

In an attempt to predict the severity of emphysema in patients with moderately severe and severe chronic air-flow obstruction, antemortem pulmonary function data, including spirometry, subdivisions of lung volumes, diffusing capacity (transfer factor) for carbon monoxide, and elastic recoil were assessed in 46 patients who were autopsied during the National Institutes of Health Intermittent Positive Pressure Breathing Clinical Trial and we compared these to the morphologic severity of emphysema. The severity of emphysema was graded by the panel grading method using whole lung, paper-mounted (Gough-Wentworth) sections and the mean linear intercept (Lm). The FEV1 and FEF25-75 of the FVC, the DLCO, the diffusing capacity for carbon monoxide, and subdivisions of lung volumes showed significant but low order correlations with the emphysema score and Lm. Total lung capacity, determined by plethysmography, was better related to emphysema in this study than in others in which TLC was measured by helium dilution. Volume-pressure data fitted to the exponential equation (V = A - Be-KP) yielded a low order, but a significant relationship between Lm and the exponential constant (K), but not between K and the panel emphysema score. We conclude that the recognition of the presence and severity of emphysema continues to require a multivariate approach including clinical history, assessment of air-flow obstruction via routine spirometry, radiologic assessment of the lung with emphasis on total lung capacity, and evaluation of the diffusing capacity for carbon monoxide.

The effect of maternal CO2 breathing on lung development of fetuses in the rabbit. Morphologic and morphometric studies

We have examined male fetuses from rabbits exposed from Day 21 to Day 28 of gestation to 8% CO2 for 8 h each day. Fetuses of CO2-exposed mothers weighed less and had lungs that weighed less but when expressed per unit body weight were unchanged. Distended lung volumes were greatly increased in the CO2 group. Light microscope morphometry showed more mature lungs with increased volume proportion of air spaces, decreased air-space wall, and decreased nonparenchyma in CO2-exposed animals. Individual air-spaces were larger, gas exchanging surface area was increased, air-space walls were thinner, and higher ratios of mature to immature crests were found. Electron microscope morphometry showed decreased glycogen in alveolar Type II cells and increased volume proportion of lamellar bodies in the CO2 group. Type II cells were more cuboidal. We interpret these changes to represent increased tissue and cellular maturation in fetuses whose mothers breathed CO2. We speculate that the changes were brought about by increased fetal respiration, which may cause increased stretch and distention of the lung. Alternative mechanisms are discussed.

Genetic markers in the blood of three species of tamarins (Saguinus mystax, S. labiatus and S. oedipus)

Alkaline phosphatase (Alp), esterase-I (Es-I), esterase-II (Es-II), carbonic anhydrase (CA), cell esterase (cEs), esterase-D (Es-D), isocitrate dehydrogenase (ICD), malate dehydrogenase (MDH), 6-phosphogluconate dehydrogenase (PGD), tetrazolium oxidase (To), ceruloplasmin (Cp), Haptoglobin (Hp) and hemoglobin (Hb) in 58-75 samples of three species of tamarins (Saguinus mystax, S. labiatus and S. oedipus) were detected by means of horizontal starch gel electrophoresis. Two types (Es-I 1 and Es-I 2) for Es-I, four types (Es-II 1, Es-II 2, Es-II 3 and Es-II 2-3) for Es-II, three types (cEs 1, cEs 2 and cEs 1-2) for cEs, three types (PGD 1, PGD 2 and PGD 1-2) for PGD, two types (To 1 and To 2) for To, and three types (Hp 3, Hp 1-3 and Hp 2-3) for Hp were observed. However, Alp, CA, Es-D, ICD, MDH, Cp and Hb were monomorphic. In the S. mystax, no Es-II or PGD variants were observed. No Es-II variant was seen in the S. oedipus. Gene frequencies of cEs, PGD and Hb were biased in the three species. It is concluded that six polymorphic loci are useful as genetic markers for a species or individual.

[Ototoxicity tests for T-2588 in rats]

Ototoxic effects of T-2588 on the spiral and the vestibular organs of the inner ear were investigated in 50 rats of Sprague-Dawley strain. Fifty female rats were divided into 5 groups consisting of 2 T-2588-test groups at dose levels of 500 and 1,000 mg/kg/day, respectively, and 2 kanamycin (KM) groups at dose levels of 200 and 400 mg/kg/day, respectively, and the control group. The administration of T-2588 was done orally through gastric tube daily for 5 weeks. The ototoxic effect was evaluated by the differential frequency pinna reflex test with frequency ranging from 200 Hz to 20,000 Hz before, during and after the administration of a test substance, then investigated histopathologically on serial celloidin sections of the bilateral temporal bones. The results were summarized below. In any rat receiving either level of T-2588, pinna reflex impairment was not detected at any frequencies. And there was no noticeable change either in the cochlea or in the vestibulum. In 10 rats which received KM at a dose level of 200 mg/kg/day, there was no impairment in pinna reflex, but, histopathologically, the loss of outer hair cells was observed, though inner hair cells were present. In the vestibular organ, a scattered loss of hair cells was observed in 8 rats. One of 9 rats which received KM at a dose level of 400 mg/kg/day showed the loss of pinna reflex in the frequency range tested. This rat showed histopathologically extensive loss of both outer and inner hair cells. In other rats showing no impaired pinna reflex, the loss of outer hair cells was rather extensive, but inner hair cell loss was unilaterally confined in the basal end of the first turn. In the vestibular organs of all rats, a scattered loss of hair cells was observed.

[Effect of single or consecutive administration of T-2588 on hepatic-injured male rats]

The present study was carried out to examine the effect of single or consecutive administration of T-2588 on liver of male rat injured by the administration of D-galactosamine X HCl. The T-2588 was orally given to hepatic-injured rats at doses of 125 mg/kg and 1,000 mg/kg singly or for consecutive 5 days. A 10 ml/kg dose of the vehicle was orally given to control rats. The results obtained were summarized below. Single administration of T-2588. Twenty-four hours after a single administration of T-2588, the liver taken from control rats apparently indicated galactosamine-induced hepatitis. No drug-related alterations were observed in hepatic functional test, liver weight and histological examinations at either dose of T-2588. Galactosamine-induced hepatitis was not affected by a single administration of T-2588. Consecutive administration of T-2588. Twenty-four hours after a 5-consecutive-day administration of T-2588, galactosamine-induced hepatitis in control rats was restored to the normal state. The cure of galactosamine-induced hepatitis was not affected by a 5-consecutive-day administration of T-2588. The hepatic aldehyde dehydrogenase activity in hepatic-injured rats was not affected by a 5-consecutive-day administration of T-2588.

The National Institutes of Health Intermittent Positive-Pressure Breathing trial: pathology studies. II. Correlation between morphologic findings, clinical findings, and evidence of expiratory air-flow obstruction

We examined the lungs of 48 patients who died in the National Institutes of Health clinical trial of Intermittent Positive-Pressure Breathing. Bronchial lesions were not related either to clinical features or to tests of expiratory flow. In particular, bronchial muscle was not related to the response to bronchodilators or to the variability of flow rates. The degree of emphysema was well related to loss of body weight and was also positively related to right ventricular hypertrophy. It was also the major morphologic correlate of abnormal tests of expiratory flow, the slope of phase III of the single-breath nitrogen test, and increased residual volume. Emphysema was negatively related to bronchodilator response and variability of expiratory flow. The proportion of bronchioles less than 400 microns in diameter and a measurement of irregular bronchiolar shape were related to dyspnea and increased PaCO2 and were also related to abnormal tests of expiratory flow, phase III of the single-breath nitrogen test, and residual volume. The presence of increased muscle and fibrosis in the bronchioles appeared beneficial, being associated with a higher PaO2, a lower PaCO2, less edema, less right ventricular hypertrophy, better flow rates, and lower residual volumes. This may reflect the fact that airways with increased muscle and fibrosis are less markedly narrowed and less distorted. Goblet cell metaplasia appeared to be an important variable, independent of others, and was related to airway resistance. We divided patients into 3 groups according to severity of emphysema, and then into 2 subgroups of lower and higher flow rates in each category.(ABSTRACT TRUNCATED AT 250 WORDS)

The National Institutes of Health Intermittent Positive-Pressure Breathing trial: pathology studies. I. Interrelationship between morphologic lesions

We examined the lungs from 48 autopsied patients in the National Institutes of Health Intermittent Positive-Pressure Breathing trial who had moderately severe and severe chronic airflow obstruction. Compared with control patients without heart or lung disease, IPPB patients had mucous gland enlargement and increased muscle and decreased cartilage in bronchi. Most patients had severe emphysema. The bronchioles were narrower and more irregular in shape than in the control subjects. Bronchiolar inflammation, increased muscle and goblet cell metaplasia were moderately severe. Bronchioles had a higher proportion of muscle in younger control subjects than they did in older control subjects. A wide variation in severity of lesions in bronchi and bronchioles was observed. Correlations between lesions were of relatively low order. Mucous gland enlargement was negatively related to one measurement of emphysema and negatively related to bronchial eosinophilia. Mucous gland enlargement was not related to bronchial or bronchiolar inflammation or to bronchiolar narrowing. Emphysema was associated with decreased central airway muscle, decreased bronchial eosinophilia, increased bronchiolar narrowing, and distortion in the shape of bronchiolar lumens. Interrelationships between bronchiolar lesions were primarily between measurements of dimensions, and there was no relationship between bronchiolar narrowing and bronchiolar inflammation or fibrosis. Bronchiolar muscle was positively related to regularity of bronchiolar shape. We conclude that although lesions in the bronchi and bronchioles and parenchyma (emphysema) are easily demonstrable in patients with moderate and severe chronic air-flow obstruction, they vary widely in severity. The interrelationships are not strong, suggesting that relationships are due to a common etiologic agent, tobacco smoke.(ABSTRACT TRUNCATED AT 250 WORDS)

Binding of heparin fractions and other polysulfated polysaccharides to plasma fibronectin: effects of molecular size and degree of sulfation of polysaccharides

Heparin was divided into four fractions on fibronectin-Sepharose. The higher affinity fraction for fibronectin was larger in molecular size, higher in sulfate content and higher in affinity for anti-thrombin III. Together with these heparin fractions, the following three series of heparin samples were examined to compare the affinity for fibronectin-Sepharose: four fractions separated on Sephadex G-100; five fractions separated on antithrombin III-Sepharose, and six partially and completely N-desulfated heparins. The result showed that the affinity of heparin for fibronectin was dependent exclusively on its molecular size, and that an appropriate level of sulfate content in heparin (1.9-2.4 mol/disaccharide) was essential for the affinity. The sulfated preparations of glycosaminoglycans (heparan sulfate, dermatan sulfate and chondroitin 4-sulfate) and neutral polysaccharides (amylose and dextran) having higher sulfate content than heparin were found to display higher affinity for fibronectin than heparin. This suggested that highly sulfated polysaccharides showed potent affinity irrespective of their polysaccharide structure. The sulfated chondroitin 4-sulfate having a sulfate content and molecular size comparable to those of heparin was inferior to heparin with respect to affinity. A competitive dissociation experiment indicated that heparin and other polysulfated polysaccharides share a common binding site on the fibronectin molecule.