Suppressive effects of salts on droplet coalescence in a commercially available fat emulsion during freezing for storage

To assess possible improvements in the practical use of long-term freezing storage for commercially available fat emulsions, the effects of salts on coalescence (fusion) of emulsions during freeze-thawing cycles were studied. For this purpose, apparent size changes were measured by dynamic light scattering, and the dispersed droplets were directly observed by freeze-fracture electron microscopy before and after the freeze-thawing processes. Intravenous high-calorie nutrient fluid, based on soybean oil in water (2.2 wt% glycerin) and emulsified by egg phosphatides, was selected as a representative commercially available fat emulsion. Possible mechanisms of the suppressive effects of various salts (Li, Na, K, Rb, and Cs chlorides) on coalescence during repeated freezing with liquid nitrogen and subsequent thawing were examined in terms of the zeta-potential of the emulsion droplets and differential scanning calorimetry heating curves of the water-salt-glycerin ternary solution. The suppressive effects of salts on the coalescence of the emulsion droplets during freeze-thaw cycles could be ascribed to the suppression of ice crystal formation and the condensation of the droplets in unfrozen aqueous channels between the ice crystals during the freezing cycle.

Balloon pulmonary valvuloplasty for pulmonary valve stenosis with atrial septal defect

We performed successful balloon pulmonary valvuloplasty (BPV) in 6 patients with pulmonary valve stenosis and atrial septal defect (ASD) accompanied by atrial left-to-right shunt without an increase of shunting immediately after BPV. It suggests that such patients should be treated by BPV initially and the need for ASD repair can be assessed during long-term follow-up.

Exercise-induced urticaria and angioedema: reports of two cases

Two Japanese patients presented with histories of exercise-induced urticaria and facial angioedema, respectively. Each patient exercised by climbing steep stairs for 5 to 10 min at 22 degrees C. A 19-year-old female student with atopic dermatitis initially developed lesions of cholinergic urticaria, which became confluent on her face, trunk and extremities and were followed by discomfort of her throat. In a 34-year-old female patient, the exercise induced angioedema on the right eyelids preceded by sneezing and rhinorrhea. Plasma histamine levels were elevated in the first patient. No changes in serum levels of complement systems were observed after the exercise challenge in either patient.

[Urinary excretion of ulinastatin and NAG after cardiopulmonary bypass]

Although urinary trypsin inhibitor (ulinastatin, UTI) is excreted into urine, its physiological function has not been clarified well. Administration of UTI during surgical procedure was reported to protect renal function from surgical stress. This result suggests participation of UTI excretion in renal tubular function. In this study, the amount of urinary excretion of UTI and that of N-acetyl-beta-D-glucosaminidase (NAG) after cardiopulmonary bypass (CPB) were measured. The urinary UTI excretion increased after surgery and reached the maximum on the third postoperative day. NAG also increased gradually and was three times greater than control on the seventh postoperative day. There was a good correlation between NAG and UTI on the first postoperative day. It is suggested that UTI might correlate with the renal tubular function after CPB.

External biliary jejunal drainage through a percutaneous endoscopic gastrostomy for tube-fed patients with obstructive jaundice

We describe a new procedure, which can help patients with obstructive jaundice improve their quality of life (QOL). Although percutaneous transhepatic biliary drainage (PTBD) can relieve jaundice, the procedure has some disadvantages. Percutaneous endoscopic gastrostomy (PEG) is a useful method for providing nutritional support to patients unable to swallow. We have combined these two techniques. We used the combination ofa 20-F catheter and a 9-F jejunal catheter for PEG. The PTBD catheter and the 9-F jejunal catheter are connected outside the patient's body. Externally drained bile from the PTBD catheter can flow back into the jejunum, and the opening between the 20-F catheter and the 9-F jejunal catheter is used for tube feeding. This procedure was adopted in a patient. Since the procedure, the patient's nutritional status and daily living activities have improved. We conclude that the procedure is useful for tube-fed patients with obstructive jaundice.

Aluminum ions in analysis of released fluoride from glass ionomers

OBJECTIVES

Aluminum ions interfere with fluoride determination when an ion-selective electrode (ISE) method is used. This study examined the effect of the presence of aluminum ions on the determination of fluoride ions released from glass ionomers.

METHODS

Disk-shaped specimens of five different commercial glass ionomers were immersed in deionized distilled water at 37 degrees C for one day or up to seven weeks. The amounts of released aluminum were determined by atomic absorption spectrophotometry, whereas the released fluoride was quantitated using a fluoride ISE with TISAB plus two different decomplexing agents for aluminum (CDTA or sodium citrate-potassium nitrate) or TISAB only.

RESULTS

Released amounts of aluminum and fluoride ions were found to be significantly different among the five different glass ionomers tested. Based on preliminary examination of the effect of the amount of aluminum ions on the measured value of fluoride, it was found at the end of one day for some of the glass ionomers that the fluoride concentrations measured without decomplexing agents were significantly lower than those measured with decomplexing agents, depending on the amounts of aluminum in the solution. However, since all the glass ionomers tested leached out most the aluminum ions by seven days, the measured fluoride concentrations were not affected by a small amount of released aluminum from the glass ionomers immersed longer than seven days.

CONCLUSIONS

When fluoride release from the glass ionomer is determined using ISE, care must be taken with the experimental design and analytical procedures to eliminate the interference by aluminum ions.

Modulation of S-nitroso-N-acetyl-D,L-penicillamine (SNAP) induced HL-60 cell death by tetrahydrobiopterin

The effect of 5,6,7,8-tetrahydrobiopterin (BPH4) on HL-60 cell damage induced by a nitric oxide (NO) donor, S-nitroso-N-acetyl-penicillamine (SNAP), was investigated. The activity of lactate dehydrogenase (LDH), a marker of cell damage, was elevated dose- and time-dependently after treatment with SNAP. The cells underwent apoptosis, as judged from the characteristic morphological findings and the electrophoretic ladder pattern of DNA fragments. Apoptosis observed at an early time, 5 hours post-treatment with SNAP, was inhibited by BPH4. However, BPH4 significantly increased cell death observed at a later time, 20 hours after the treatment. These results suggest that BPH4 may be involved in modulating the cytotoxicity, including cell death, mediated by NO.

Appleby operation for carcinoma of the body and tail of the pancreas

Long-term survival of carcinomas in the body and tail of the pancreas after surgery is still rare. One of the major reasons for unresectability is cancerous invasion to major vessels, such as the common hepatic and splenic arteries. Resection of the involved arteries can increase resectability and thus might increase post-operative survival. The aim of this study was to clarify the importance of the Appleby operation for carcinoma of the body and tail of the pancreas. A Case Report was carried out with a 54 year-old man, had suffered back pain and loss of body weight for six months. Imaging procedures such as US, CT or angiography showed a carcinoma in the body of the pancreas, about 3 cm in size, and both the common hepatic and splenic arteries were invaded by the tumor. The Appleby operation was used for this patient, since firstly there was no invasion to the head of the pancreas, secondly neither the proper hepatic artery nor the SMA was involved, thirdly the root of the CA was free of carcinoma, and finally because clear pulsation of the proper hepatic artery could be felt one or two minutes after occlusion of the CHA, which indicated that resection of the CHA would not lead to hepatic ischemia. The postoperative course was uneventful. His appetite recovered well and his body weight increased to the level before the disease. The patient was relieved from back pain and has returned to work 18 months after the operation, although he had a local recurrence eight months after the operation. In addition, eleven cases with carcinoma of the body and tail of the pancreas were used for a literature review. The average survival time after the Appleby operation is 6.6 months, and four patients are still alive. One patient has survived 13 years after the operation. It was concluded that although the prognosis after Appleby procedure is still not satisfactory that this operation can at least offer patients a better quality of life.

[Significance of postoperative elevation of urinary ulinastatin after open heart surgery under cardiopulmonary bypass]

To investigate the role of ulinastatin in perioperative stress, we measured the urinary levels of ulinastatin (UTI) in patients subjected to open heart surgery under cardiopulmonary bypass. The UTI levels began to increase on the first postoperative day and reached its maximum level on the third postoperative day. There is a good correlation between the maximum level of urinary UTI and cardiopulmonary bypass time. These results indicate that urinary UTI level can be an indicator of surgical stress.

[Effects of ulinastatin on postoperative renal function in hepatectomized patients with liver cirrhosis]

Posthepatectomy patients with liver cirrhosis have a high incidence of multiple organ failure including renal failure. The depression of urinary ulinastatin (UTI) might be involved in renal derangements in the posthepatectomy patients with liver cirrhosis. We evaluated the relationship between the renal functions and the level of urinary UTI in perioperative period in the posthepatectomy patients with liver cirrhosis, and evaluated whether or not the renal function in the posthepatectomy patients with liver cirrhosis was protected by receiving synthetic UTI, Miraclid. In posthepatectomy patients with liver cirrhosis, the urinary UTI level was 26.3 +/- 13.0 IU. mg x Cr-1 on the first day and renal tubular dysfunction was noticed. On the other hand, in posthepatectomy patients with liver cirrhosis receiving Miràclid administered intravenously during the operation and postoperative three days, the urinary UTI level was 121.2 +/- 85.0 IU. mg x Cr-1 on the first day and renal function was maintained. These results indicate that in posthepatectomy patients with liver cirrhosis, an increase in urinary UTI level observed in response to surgical stress may not occur and this low level of urinary UTI may cause renal dysfunction in the postoperative period. The synthetic UTI, Miraclid, may have beneficial effects reversing the renal derangements resulting from the stress in posthepatectomy patients with liver cirrhosis.

[Pathology of bronchopulmonary aspergillosis]

This paper concerns the morphology of 3 types of bronchopulmonary aspergillosis: saprophytic aspergillosis (SPA), invasive aspergillosis (IVA) and allergic bronchopulmonary aspergillosis (ABPA)/allergic bronchopulmonary mycosis (ABPM). To know whether Aspergillus (ASP) in SPA only colonizes in preexisting cavities or presents significant pathogenecity, we examined 38 surgical specimens of SPA and 10 post-tuberculous open cavities (PT-OC). Macroscopically, SPA cavities had macroscopic ulcers (81.6%) and bronchi originating from the cavities (68.4%), in contrary to PT-OC that had neither of them. Microscopically, SPA cavities showed shallow ulcers (100%), coagulation necrosis (42.1%) and granulomatous reaction (52.6%), although ASP invasion to the viable lung tissue couldn't be discovered. The lung tissue around the SPA cavities showed various inflammation caused by transbronchial ASP dissemination from the cavities. We concluded that (1) SPA should be considered chronic destructive infection by ASP, but not colonization, (2) SPA couldn't be differentiated in quality from semi-invasive/chronic necrotizing pulmonary aspergillosis, and both should be categorized into secondary bronchopulmonary aspergillosis. Respecting IVA, we investigated 10 autopsy cases. In those cases, the disease was brought about in the lungs having no preexisting lesions. Three forms were distinguished; (1) 5 cases in that coagulation necrosis was a main feature (CN-IVA). (2) 2 cases having lung balls in cavitary lesions (LB-IVA), and (3) 3 cases showing suppurative lesions (SP-IVA). In CN-IVA and LB-IVA cases, ASP invaded to the viable lung tissue. But in 2 cases of SP-IVA, fungal hyphae were identified only in necrotic lesions but not in the viable tissue. Because the "invasive" was vague in definition, we should categorized these cases into primary bronchopulmonary aspergillosis. To determine the primary lesion of ABPA/ABPM, 5 lobectomy specimen were examined. All cases had hard or firm mucous plugs in the proximal bronchi, peripheral to which we found inflammation with tissue eosinophilia (bronchocentric granulomatosis with tissue eosinophilia : 5 cases, xanthogranuloma-like lesions : 2 cases, eosinophilic pneumonia : 2 cases and organizing pneumonia : 4 cases). Conglomerates of degenerated eosinophils, sometimes showing fir-structure, and fungal hyphae were recognized in both of mucous plugs and the peripheral lesions. We concluded that the mucous plug was the primary lesion of ABPA/ABPM.

[Lung volume reduction surgery for pulmonary emphysema--report of two cases]

Lung volume reduction surgery (LVR) was practiced in 2 male patients with pulmonary emphysema to improve pulmonary function. On admission, they complained of exertional dyspnea (Grade III of the Hugh-Jones dyspnea scale). Computed tomographic scan (band display) revealed emphysematous changes throughout both lung fields, especially in bilateral upper lobes. Nuclear lung perfusion scintigraphy showed markedly diminished blood flow in both upper lobes. The bilateral upper lobes of each patient were excised through median sternotomy using the linear stapling device. The staple lines were buttressed with bioabsorbable polyglycolic acid fabric. At 1 month after LVR, the forced expiratory volume in 1 second improved, respectively, from 0.51 L to 1.27 L (Case 1) and from 0.68 L to 0.85 L (case 2). In conclusion, LVR was useful to improve pulmonary function of the patients with pulmonary emphysema.

[Riboflavin Reference Standard (Control 951) of National Institute of Health Sciences]

The raw material for riboflavin was tested for preparation of the "Riboflavin Reference Standard (Control 951)" of National Institute of Health Sciences. Analytical data obtained were as follows: melting point, 284.6 degrees C (decomposition): specific absorbance, E1cm1% = 857 (267 nm), 277 (373 nm), 326 (445 nm); IR spectrum, the same as that of JP Riboflavin Reference Standard (Control 921); optical rotation, [alpha]20D = -135.6 degrees; thin-layer chromatography, three impurities were detected; high-performance liquid chromatography, a small amount of 10 impurities were detected: loss on drying, 0.10%; assay, 100.4% by spectrophotometry. Based on the above results, the raw material was authorized as the Riboflavin Reference Standard (Control 951) of National Institute of Health Sciences (Japanese Pharmacopoeia).

[Surgical treatment for patients with atypical mycobacteriosis]

We have been conducting surgical therapy for patients with atypical pulmonary mycobacteriosis (AM) since 1965 and have reported on the outcome of this approach to treatment. We have found that chemotherapy is not adequately efficacious against type III Mycobacterium avium complex (MAC), which suggests that surgical intervention may be the optimum approach for MAC. Among MAC patients who were treated surgically at our hospital in the period between 1966 and 1994, 74 cases on whom postoperative follow-up observation was possible served as the subjects of the present investigation. We report here on the outcome of treatment and related problems in these patients. Thirty-nine patients gave positive results for bacterial discharge on smear tests and all were positive on culture. Operation was performed on the right lung in 46 patients and on the left lung in 16. Pneumonectomy was conducted in 10 patients and lobectomy in 20. Other operative modes used included segmental resection in 9, pyothorax in 7, and thoracoplasty in 5 patients. Postoperative bacterial excretion was observed in 15 patients and was persistent bacterial discharge were advanced cases with lesions in another lobe, cases with a past history of tuberculosis, cases of cavitation with lesions on the contralateral side or cases with massive bacterial discharge prior to surgery. Postoperative death occurred in 5 patients: the cause of death was lung cancer in 1 case, serum hepatitis in 1 case, and respiratory failure evidenced by enlarged shadows in 3 cases. These findings pointed to a marked significance of surgical therapy for MAC patients. However, recurrent bacterial discharge has been observed occasionally in some patients even 5 years after surgery. This suggests the need for careful ongoing assessment of the efficacy of surgical therapy and long-term postoperative follow-up.

Effects of caloric intake on anticancer therapy in rats with valine-depleted amino acid imbalance

Valine-depleted amino acid imbalance solution markedly inhibits tumor growth but causes fatty liver as a side effect. However, much remains unknown about the mechanism of the development of fatty liver. Valine-depleted amino acid imbalance solution containing various concentrations of calories was administered to tumor-bearing rats for four days by means of total parenteral nutritional methods to investigate the interaction of caloric intake and the development of fatty liver. Compared with the total parenteral nutrition control group the triglyceride content of the liver rose significantly in the group given valine-depleted amino acid imbalance solution with an increase in caloric intake. Plasma total protein and albumin significantly decreased. The very-low-density lipoprotein concentration in serum was also significantly lower than that in the control group. Valine-depleted amino acid imbalance caused hypoproteinemia, suggesting a fall in synthesis of apolipoproteins in the liver indispensable for lipid release. Along with the increase in the total caloric intake, triglyceride synthesis in the liver increased, resulting in augmentation of fatty content of the liver, probably because of the decreased lipid release.

Spontaneous breathing with the use of a laryngeal mask airway in children: comparison of sevoflurane and isoflurane

We compared respiratory parameters during anaesthesia with sevoflurane and isoflurane through a laryngeal mask airway (LMA). Children were anaesthetized with O2 and air with 2.3% (1MAC) sevoflurane (n = 20) or 1.5% (1MAC) isoflurane (n = 20). After insertion of LMA, patients were allowed to breathe spontaneously and respiratory rate (RR) and PECO2 were measured (presurgery state). After the measurement, anaesthetic concentration was increased to 1.3 MAC (3.0% sevoflurane or 2.0% isoflurane) and surgical stimulation was added. Fifteen min after incision, the measurements were again performed (during surgery). In the sevoflurane group, mean RR and PECO2 were 32 breaths.min-1, and 6.0 kPa (45 mmHg) respectively, before surgery, and 35 breaths.min-1 and 7.0 kPa (52 mmHg) during surgery. In the isoflurane group, mean RR and PECO2 were 32 breaths.min-1 and 6.1 kPa (46 mmHg) respectively, before surgery, and 37 breaths.min-1 and 6.7 kPa (52 mmHg) during surgery. There were no statistical differences between the two anaesthetic groups. Clinical respiratory and cardiovascular parameters during spontaneous breathing with LMA in children are similar during sevoflurane and isoflurane anaesthesia.

Perceptual filling-in at the scotoma following a monocular retinal lesion in the monkey

Although no visual inputs arise from the blind spot, the same visual attribute there as in the visual field surrounding the blind spot is perceived. Because of this remarkable "perceptual filling-in," a hole corresponding to the blind spot is not perceived, even when one eye is closed. Does the same phenomenon occur in the case of a scotoma in which visual inputs are lost postnatally due to a retinal lesion? We report that it did: in the macaque monkey, behavioral evidence for filling-in at a scotoma produced by a laser-induced monocular retinal lesion was obtained. The visual receptive fields of neurons in the primary visual cortex (V1) in and around the representation of the visual field corresponding to the scotoma were also mapped, and no clear difference between the retinotopic organization of this part in V1 and that found in the normal visual field was found. Also, perceptual filling-in was found to occur only two days after the lesion. These findings suggest that the normal visual system possesses a mechanism that yields filling-in when some part of the retina is damaged, and that such a mechanism requires no topographical reorganization in V1.

Medicinal foodstuffs. IV. Fenugreek seed. (1): structures of trigoneosides Ia, Ib, IIa, IIb, IIIa, and IIIb, new furostanol saponins from the seeds of Indian Trigonella foenum-graecum L

Six new furostanol saponins called trigoneosides Ia, Ib, IIa, IIb, IIIa, and IIIb were isolated from a medicinal foodstuff, fenugreek seed, the seed of Trigonella foenum-graecum L. (Leguminosae) originating from India, together with two known saponins, glycoside D and trigofoenoside A. The structures of trigoneosides Ia, Ib, IIa, IIb, IIIa, and IIIb were determined on the basis of chemical and physicochemical evidence as 26-O-beta-D-glucopyranosyl-(25S)-5 alpha-furostane-2 alpha,3 beta,22 zeta,26-tetraol 3-O-[beta-D-xylopyranosyl (1 --> 6)]-beta-D-glucopyranoside, 26-O-beta-D-glucopyranosyl-(25R)- 5 alpha-furostane-2 alpha,3 beta,22 zeta,26-tetraol 3-O-[beta-D-xylopyranosyl (1-->6)]-beta-D-glucopyranoside, 26-O-beta-D-glucopyranosyl-(25R)-5 beta-furostane-3 beta,22 zeta,26-triol 3-O-[beta-D-xylopyranosyl (1 --> 6)]-beta-D-glucopyranoside, 26-O-beta-D-glucopyranosyl-(25R)-5 beta-furostane-3 beta,22 zeta,26-triol 3-O-[beta-D-xylopyranosyl (1-->6)]-beta-D-glucopyranoside, 26-O-beta-D-glucopyranosyl-(25S)-5 alpha-furostane-3 beta,22 zeta,26-triol 3-O-[alpha-L-rhamnopyranosyl(1 --> 2)]-beta-D-glucopyranoside, and 26-O-beta-D-glucopyranosyl-(25R)-5 alpha-furostane-3 beta,22 zeta,26-triol 3-O-[alpha-L-rhamnopyranosyl (1 --> 2)]-beta-D-glucopyranoside, respectively.

(+/-)-3-[4-(2-dimethylamino-1-methylethoxy)-phenyl]-1H-pyrazolo[3,4- B]pyridine-1-acetic acid (Y-25510) stimulates production of IL-1 beta and IL-6 at the level of messenger RNA expression in cultured human monocytes

(+/-)-3-[4-(2-Dimethylamino-1-methylethoxy)phenyl]-1H-pyrazolo[3, 4-b]pyridine-1-acetic acid (Y-25510) stimulated the mRNA expression for interleukin-1 beta (IL-1 beta), and enhanced the expression induced by lipopolysaccharide (LPS) in cultured human peripheral blood mononuclear cells (PBMC) and THP-1 cells, a cell-line derived from human monocytic leukemia. Y-25510 also stimulated the mRNA expression for IL-6 in both types of the cells, however, the stimulation required the presence of LPS. In THP-1 cells, the stimulation of IL-1 beta mRNA expression by Y-25510 was suppressed by cycloheximide, an inhibitor of protein synthesis. This phenomenon indicates that the stimulation requires de norv protein synthesis. In contrast, the stimulation of mRNA expression for IL-6 by Y-25510 was not suppressed by cycloheximide but suppressed by N alpha-p-tosyl-L-phenylalanine chloromethyl ketone (TPCK), an inhibitor of nuclear transcription factor-kappa B (NF-kappa B) activation, in the presence of LPS, suggesting that the stimulation requires NF-kappa activation. These results demonstrate that Y-25510 stimulates the mRNA expression for IL-1 beta and IL-6 by different mechanisms. Dexamethasone suppressed the LPS-induced expression of mRNA for IL-1 beta and IL-6 in THP-1 cells, whereas the drug never suppressed the mRNA expression for these cytokines in the presence of Y-25510. The result indicates that Y-25510 stimulates the mRNA expression for IL-1 beta and IL-6 by different mechanisms from those of LPS.