Relationship between maximal pulmonary ventilation and arterialized venous blood potassium and dopamine concentrations obtained at exhaustion in man

This study was performed to test the hypothesis that potassium concentration in arterialized blood may be closely related to maximal pulmonary ventilation (V.Emax) obtained at exhaustion during maximal exercise in man. Eleven healthy men performed bicycle exercise with incremental loading at 60 rpm until exhaustion. Pulmonary ventilation (V.E), oxygen uptake (V.O2), and heart rate (HR) were determined continuously throughout the experiment. Arterialized venous blood samples were collected to measure potassium ([K+]), lactate ([La]), hydrogen ion (pH), catecholamine ([CA]), and dopamine ([DA]) concentrations. A significant correlation (r = 0.98-0.88) between V.E and [K+], [La], and pH during exercise was observed in all subjects. Furthermore, a close relationship was found in this study between dopamine concentration measured at exhaustion ([DA]0) and maximal pulmonary ventilation per kilogram of body weight (V.Emax/W) (r = -0.668, p < 0.05) or maximum oxygen uptake per kilogram of body weight (VO2MAX/W) (r = 0.720, p < 0.05). However, no significant correlation was found between V. Emax/W and [K+]0 (r = 0.202, NS), [La]0 (r = -0.096, NS), and pH0 (r = 0.344, NS). These results suggest that dopamine may play a more important role in the determination of maximal pulmonary ventilation during exercise in man than K+ or pH.

Magnetic resonance imaging of the paranasal sinuses in divers

BACKGROUND

CT and magnetic resonance imaging (MRI) frequently reveal asymptomatic paranasal sinus mucosal hypertrophy in the general population.

HYPOTHESIS

Divers can suffer asymptomatic paranasal sinus mucosal injury secondary to barotrauma.

METHODS

We examined 20 professional divers by MRI and compared them to 20 normal controls. Paranasal sinus mucosal hypertrophy was defined as mucosal thickening of 3 mm or greater.

RESULTS

Nine divers had paranasal sinus mucosal hypertrophy vs. four controls (p = 0.09). There was no significant relationship between paranasal sinus hypertrophy and age, diving history, alcohol consumption, or smoking.

CONCLUSION

Divers had a tendency toward paranasal sinus mucosal hypertrophy.

Cochlear otosclerosis 30 years after stapedectomy confirmed by CT, MRI

A 64-year-old Japanese male patient, status post-stapedectomy, presented with progressive, bilateral SNHL of 30 years' duration. CT showed extensive demineralization of the otic capsule, suggestive of otospongiotic change in both ears. There were no hyperostotic lesions found, which would have been suggestive of otosclerotic change. MRI showed a morphologically intact membranous labyrinth in both ears, with no obstruction of the cochlear lumen. It was concluded that the patient has progressive otospongiotic change of the otic capsule, but no otosclerotic change.

[Study of optokinetic nystagmus and spino-motor functions with cyclo-rotatory optokinetic stimulus]

It has been shown that the neural channels from the otolith organs and the vertical semicircular canals connect to the cyclo-rotatory oculomotor system. However, only a few studies have been conducted to examine the relationship between the cyclo-rotatory optokinetic (COK) and the vestibular inputs. Accordingly, we have analyzed the cyclo-rotatory oculomotor output evoked by a COK stimulus, in 30 subjects; 21 normal adults, 4 elderly persons, and 5 persons with unilateral vestibular dysfunction. In addition, the spinal motor output was simultaneously recorded and comparatively analyzed. The increase in COK nystagmus (COKN) was less than that in horizontal and vertical OKN. There was a significant decline in the maximum slow phase eye velocity in the elderly subjects as well as in the subjects with unilateral vestibular dysfunction, compared to that in the normal adult subjects. Regarding the spinal motor output, in the subjects with unilateral vestibular dysfunction, a pronouned increase in the sway distance from the center of gravity was found with COK stimulus forward the lesioned side. However, with the COK stimulus, there was no significant correlation between the output functions of the cyclorotatory oculomotor system and those of the spinal motor system.

The origin of chlorarachniophyte plastids, as inferred from phylogenetic comparisons of amino acid sequences of EF-Tu

A molecular phylogenetic analysis of elongation factor Tu (EF-Tu) proteins from plastids was performed in an attempt to identify the origin of chlorarachniophyte plastids, which are considered to have evolved from the endosymbiont of a photosynthetic eukaryote. Partial sequences of the genes for plastid EF-Tu proteins (1,080-1,089 bp) were determined for three algae that contain chlorophyll b, namely, Gymnochlora stellata (Chlorarachniophyceae), Bryopsis maxima (Ulvophyceae), and Pyramimonas disomata (Prasinophyceae). The deduced amino acid sequences were used to construct phylogenetic trees of the plastid and bacterial EF-Tu proteins by the maximum likelihood, the maximum parsimony, and the neighbor joining methods. The trees obtained in the present analysis suggest that all plastids that contain chlorophyll b are monophyletic and that the chlorarachniophyte plastids are closely related to those of the Ulvophyceae. The phylogenetic trees also suggest that euglenophyte plastids are closely related to prasinophycean plastids. The results indicate that the chlorarachniophyte plastids evolved from a green algal endosymbiont that was closely related to the Ulvophyceae and that at least two secondary endosymbiotic events have occurred in the lineage of algae with plastids that contain chlorophyll b.

Enhanced nephrotoxicity of acetaminophen in fructose-induced hypertriglyceridemic rats: effect of partial hepatectomy

Fructose-induced hypertriglyceridemic rats become resistant to hepatotoxicity and susceptible to nephrotoxicity of acetaminophen (APAP). Enhanced susceptibility to APAP nephrotoxicity in fructose-pretreated rats is due, at least in part, to increased renal APAP concentration at the early phase (15 and 30 min after APAP administration). However, the mechanism of an increase in renal APAP concentration is still obscure. The present study was designed to test the hypothesis that a decrease in capacity of hepatic APAP metabolism is responsible for an increase in renal APAP concentration in fructose-pretreated rats. Non-pretreated rats and fructose-pretreated rats (25% fructose in drinking water for 3 weeks) received 70% or 90% partial hepatectomy (PH) or sham operation at 1 hr before APAP administration (600 or 750 mg/kg, i.p.). PH did not potentiate APAP nephrotoxicity and renal APAP concentration, and fructose-pretreated rats showed server renal lesions and greater renal APAP concentration than non-pretreated rats irrespective of PH. The result indicates that an increase in renal APAP concentration in the fructose-pretreated rats has no relation to an alteration in hepatic metabolic capacity of APAP.

Enhanced nephrotoxicity of acetaminophen in fructose-induced hypertriglyceridemic rats: contribution of oxidation and deacetylation of acetaminophen to an enhancement of nephrotoxicity

Fructose-induced hypertriglyceridemic Sprague-Dawley (SD) rats become resistant to hepatotoxicity and susceptible to nephrotoxicity of acetaminophen (APAP) as compared with normal SD rats. Fischer-344 rats, which are susceptible to APAP nephrotoxicity, have two toxic metabolic pathways involving cytochrome P450-dependent oxidation of APAP to N-acetyl-p-benzoquinone imine (NAPQI) and P450-independent deacetylation of APAP to p-aminophenol (PAP). SD rats, however, have only the former pathway. This study was undertaken to investigate whether alterations in the metabolic pathways of APAP and in the intrinsic susceptibility to toxic metabolites are responsible for an enhancement of APAP nephrotoxicity in the fructose-pretreated SD-rats. In the non-pretreated rats, the inhibition of APAP oxidation by the MFO inhibitor, piperonyl butoxide, and deacetylation by carboxyesterase inhibitor, bis(p-nitrophenyl)phosphate, did not alter APAP-induced renal lesions. In contrast, these inhibitors protected the fructose-pretreated rats from APAP-induced renal lesions. Since there were no differences in the severity of gentamicin-, chloroform, and 45 min-ischemia/reperfusion-induced renal lesions between the non-pretreated and the fructose-pretreated rats, it is unlikely that the increased intrinsic susceptibility to chemicals and their metabolites in the fructose-pretreated rats is a major factor in the enhancement of APAP nephrotoxicity. These results indicate that the enhancement of APAP nephrotoxicity in the fructose-pretreated rats is due, at least in part, to an alteration in metabolic pathways of APAP.

Identification and characterization of an anti-glial fibrillary acidic protein antibody with a unique specificity in a demented patient with an autoimmune disorder

We detected an antibody to a 48 kd antigen of the central nervous system in the serum from a demented patient with an autoimmune disorder. To identify and characterize the antigen, we screened a human cerebral cDNA library and performed immunoblot analysis following two-dimensional gel electrophoresis (2-D blotting). The sequences of the isolated cDNA fragments were homologous to human glial fibrillary acidic protein (GFAP). Two-D blotting using patient serum revealed that the antibody reacted with a restricted subset of GFAP molecules which exhibited relatively high isoelectric points. Furthermore, to elucidate the importance of the anti-GFAP antibody in dementia, we screened for the presence of an anti-GFAP antibody in the sera of 46 demented patients: 26 with Alzheimer's disease and 20 with vascular dementia (VD). We found an anti-GFAP antibody in the serum of only one patient with VD. Two-D blotting revealed that the anti-GFAP antibody in the serum from the VD patient reacted with a more acidic subset of GFAP molecules compared with the anti-GFAP antibody from our patient. In conjunction with the fact that the GFAP molecule with high isoelectric point was insoluble and less degraded, these results suggested that the anti-GFAP antibody in the serum of our patient was not generated due to a secondary response to soluble and degraded GFAP which leaked through the damaged blood-brain barrier as found in the VD patient, but was generated actively on the basis of dysregulation of the immune system. Possible effects of the autoantibody on astrocytic function and the pathogenesis in dementia are discussed.

Cochlear implant after reconstruction of the external bony canal wall and tympanic cavity in radically mastoidectomized patients with cholesteatoma

One of the postoperative complications of cochlear implants in patients, who previously received radical mastoidectomy, is an exposure of electrode by breakdown of thin epithelium in the open mastoid cavity. To avoid such complications, in the first stage, radical mastoidectomy with the reconstruction of the posterior bony canal wall and mastoid obliteration with bone chips and plates and the creation of the new tympanic cavity, were performed. One or 3 years later, implantation of a 22-channel cochlear implant, as the second stage procedure, was successfully performed in three patients with profound sensorineural hearing loss, due to cholesteatoma in the side of the ear in which cochlear implantation was indicated. The advantages of this technique are as follows: (1) Electrode is protected from the cavity problems, such as chronic infection or erosion of the epithelium in the open mastoid cavity; and (2) reconstruction of the new tympanic cavity and tympanic membrane is beneficial for avoidance of electrode exposure in the mastoid and tympanic cavity.

Isolation of cDNA clones for genes that are expressed in the tail region of the ascidian tailbud embryo

An ascidian tailbud embryo is comprised of the anterior trunk and posterior tail. We constructed cDNA libraries of the tail region and trunk region of the ascidian Halocynthia roretzi. The screening of the tail library by tail single-stranded cDNA minus the trunk library RNA as a probe, yielded cDNA clones for genes that are expressed in the tail epidermis, visceral ganglion, trunk lateral cells, muscle cells, and certain regions of the tail. Among them, a cDNA clone for a gene designated HrPost-1 is described in detail. HrPost-1 encodes a novel, possible secreted protein of 238 amino acids. The expression of the gene is zygotic. HrPost-1 transcript was first evident in the posterior B-line blastomeres including muscle cells and endodermal strand cells of the gastrula-stage embryo, and the expression in these regions disappeared by the early tailbud stage. Around neurulation, the HrPost-1 transcript appeared in epidermal cells of the posterior-most region of the embryo. As development proceeded, the gene expression spread anteriorly in the epidermal cells of the neurula and tailbud embryo, and thus at the early-to-mid tailbud stage, HrPost-1 expression appeared to define the boundary between the trunk and tail epidermis. These results suggest that, in addition to tissue-specific genes, the activities of a set of region-specific genes are associated with tail formation in the ascidian embryo.

[Advances in molecular biological investigation of blood group-active substances on the human red blood cell]

Blood group antigens on the human red blood cell are originally of serological significance. Recent advances in molecular biology and genetics have greatly increased our knowledge of the chemical structures, functions, and genetic backgrounds of these antigens. Carbohydrate antigens are widely expressed in various tissues, whereas protein(polypeptide) antigens are generally specific to the surface molecules of erythroid cells, suggesting their possible roles in membrane structure and function (transporters, receptors, adhesion molecules, and enzymes). This paper reviewed the recent topics with special regard to clinical significance including blood transfusion, and discussed.

Evaluation of the vertical semicircular canal function by the pendular rotation test: a study on patients with benign paroxysmal positional vertigo

The pendular rotation test (non-damped) in a head-tilted position, 60 degrees backward and then rotated 45 degrees either to the right or left, was performed in 6 patients with benign paroxysmal positional vertigo. The stimulus mode was amplitude = 360 degrees, frequency = 0.1 Hz, and the maximal speed = 114 degrees/s. By this test procedure, it was possible to evaluate the excitability of vertical semicircular canals. Using an infra-red CCD camera and a personal computer system, the evoked nystagmus was analysed. A statistically significant difference (p < 0.05) in the maximal slow-phase eye velocity of vertical nystagmus was found between those from the anterior semicircular canal and those from the posterior semicircular canal. The excitability of the posterior semicircular canal in the affected ear was found to be lower than that of the anterior semicircular canal.

Esophageal carcinosarcoma: a genetic analysis

Carcinosarcoma of the esophagus is a rare malignant neoplasm that consists of both carcinomatous and sarcomatous elements. The histogenesis of the sarcomatous component is generally considered to result from metaplasia of carcinomatous cells toward mesenchymal differentiation. True carcinosarcoma, characterized as a collision between a carcinoma and a sarcoma, is extremely rare. We describe a patient with primary achalasia who developed a true carcinosarcoma of the esophagus in which clonal differences between carcinomatous and sarcomatous elements were genetically and immunohistochemically demonstrated. A polypoid tumor located in the middle third of the esophagus developed in a 51-year-old man with longstanding achalasia. The tumor was predominantly composed of spindle-shaped sarcomatous cells. Squamous cell carcinoma in situ and islands of well-differentiated squamous cell carcinoma in the sarcomatous element were histologically observed. The sarcomatous element was immunoreactive for both mesenchymal and myoid markers. The carcinomatous component expressed type I and type II cytokeratins as well as epithelial membrane antigen. Analysis for chromosomal loss of heterozygosity performed in multiple microdissected samples of each sarcomatous and carcinomatous element revealed distinct genetic clonalities. These differences in immunohistochemical and genetic clonalities suggest that the tumor composed of squamous cell carcinoma and leiomyosarcoma originated separately from epithelial and mesenchymal precursors.

[Femoral to radial artery pressure gradient in the patients undergoing coronary artery bypass graft under normothermic cardiopulmonary bypass]

Femoral to radial artery pressure gradient was evaluated in 14 patients undergoing coronary artery bypass graft under normothermic cardiopulmonary bypass (CPB). CPB was instituted at a flow rate of 2.6 l.min-1.m-2, using non-pulsatile pump and blood temperature of pump arterial line was controlled to maintain bladder temperature between 36 and 37 degrees C. Pressure gradients occurred 30 min after commencement of CPB and the mean gradients of systolic, diastolic and mean artery pressure were maximum all at the end of CPB (38 +/- 7 mmHg, 4 +/- 1 mmHg and 10 +/- 2 mmHg). These pressure gradients remained until the end of the surgery. Throughout the operation, nasopharyngeal and blood temperature remained unchanged, while mean palm temperature increased from 31.8 degrees C (after induction) to 34.6 degrees C (30 min after commencement of CPB) and thereafter remained between 33.3 and 33.9 degrees C. This increase in peripheral temperature might indicate that normothermic CPB was accompanied by peripheral vasodilatation. These results indicate that the magnitude of femoral to radial pressure gradient during normothermic CPB is similar to that during mild hypothermic CPB.

A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study

OBJECTIVE

To determine whether postoperative adjuvant chemotherapy confers a survival benefit on patients with esophageal squamous cell carcinoma undergoing radical surgery, we undertook a cooperative, prospective randomized controlled trial.

METHODS

A total of 205 patients underwent transthoracic esophagectomy with lymphadenectomy at eleven institutions between December 1988 and July 1991. These patients were prospectively randomized into two groups (100 patients underwent surgery alone and 105 patients had additional two courses of combination chemotherapy with cisplatin (70 mg/m2) and vindesine (3 mg/m2). The two groups did not differ with respect to sex, age, location of tumor, and distributions of pT, pN, pM, or p stage.

RESULTS

The 5-year survival was 44.9% in the surgery alone group and 48.1% in the surgery plus chemotherapy group. The relative risk was estimated to be 0.89 (95% confidence interval, 0.61 to 1.31) in the surgery plus chemotherapy group compared with the surgery alone group. No significant differences in survival were detected between the two groups, even with lymph node stratification.

CONCLUSION

Postoperative adjuvant chemotherapy with cisplatin and vindesine has no additive effect on survival in patients with esophageal cancer compared with surgery alone.

Effects of fructose-induced hypertriglyceridemia on hepatorenal toxicity of acetaminophen in rats: role of pharmacokinetics and metabolism of acetaminophen

Fructose-induced hypertriglyceridemic rats become resistant to hepatotoxicity and susceptible to nephrotoxicity of acetaminophen (APAP), as compared with normal ones. The present study was designed to test the hypothesis that alterations in the distribution of APAP and in the intrinsic susceptibility to toxicants are responsible for the alteration in hepatorenal toxicity of APAP in fructose-induced hypertriglyceridemic rats. Following APAP-administration (750 mg/kg, i.p.), fructose-pretreated rats (25% fructose in drinking water for 5 weeks) showed nephrotoxicity of APAP more promptly and more severely than normal ones. Renal APAP-concentrations at the early phase (15 and 30 min. after APAP-administration) were significantly greater in fructose-pretreated rats than those in normal ones. Plasma and hepatic APAP concentrations in fructose-pretreated rats were greater than those in normal ones only at the later phase (plasma; 6 hr, liver; 6 and 12 hr after APAP-administration). There were no significant differences in the APAP-induced depletion of hepatic and renal glutathione and in the basal hepatic and renal cytochrome P-450 contents between these rats. Fructose-pretreated rats were also more susceptible to p-aminophenol (PAP), a nephrotoxic metabolite of APAP, than normal rats. Therefore, enhanced susceptibility to APAP-nephrotoxicity in fructose-pretreated rats may be due, at least in part, to increased renal APAP concentration and increased intrinsic susceptibility to the metabolic nephrotoxicant.

[Clinical experiences with the insertion of dynamic stent for the patients with esophago-tracheal fistula due to advanced esophageal carcinoma--two case reports]

We experienced two cases who were inserted dynamic stent (a tracheobronchial silicone stent) to treat esophago-tracheal fistula due to advanced esophageal carcinoma. This procedure permitted to perform esophageal bypass operation under intubated general anesthesia in the first case. After operation, severe coughing improved so much and he could start oral intake and resulted in better performance status. In the second case, by the insertion of dynamic stent general condition recovered well, so he could achieve full course of chemo-radiotherapy and enter in partial response. Esophago-tracheal fistula due to advanced esophageal carcinoma markedly worsens performance status and its treatment is usually very difficult. The insertion of dynamic stent may improved their quality of life, make it possible to achieve further therapy and improve their prognosis.

Extrapancreatic action of truncated glucagon-like peptide-I in Otsuka Long-Evans Tokushima Fatty rats, an animal model for non-insulin-dependent diabetes mellitus

To clarify the mechanism(s) of the antidiabetic effects of truncated glucagon-like peptide-1 (GLP-1) in diabetics, we examined its insulinotropic and extrapancreatic effects in a newly established strain of spontaneously non-insulin-dependent diabetic (NIDDM) rats, Otsuka Long-Evans Tokushima Fatty (OLETF) rats, that received a continuous infusion of truncated GLP-1 620 pmol/d/kg (G group, n = 12) or of vehicle (V group, n = 12) for 4 weeks by Alzet pump. Nonfasting plasma glucose levels were significantly lower (P < .05) in the G group than in the V group (7.0 +/- 0.67 v 9.1 +/- 1.7 mmol/L), and fasting plasma immunoreactive insulin (IRI) levels were lower in the former than in the latter (0.63 +/- 0.31 v 0.78 +/- 0.25 nmol/L). At day 15 of infusion, the G group showed an attenuated plasma glucose response to an oral glucose load, but had plasma IRI levels comparable to those in the V group. A long-term infusion of truncated GLP-1 increased the glucose infusion rate (GIR) significantly (P < .05) during a euglycemic-hyperinsulinemic clamp test (59.0 +/- 14.8 mumol/kg/min for group G v 38.9 +/- 12.2 for group V), but hepatic glucose output (HGO) did not differ significantly for either group. Uptake of 2-deoxy-D-glucose (2DG) by peripheral muscles in the G group was as much as 2.4-fold higher than in the V group (5.52 +/- 2.04 v 2.29 +/- 0.97 mumol/100 g muscle weight/min). We conclude from these data that truncated GLP-1, in addition to its well-known incretin effect, is capable of augmenting insulin action in peripheral tissues of diabetics, which can contribute, in part, to improve glucose intolerance in OLETF rats.

Cause and repair of flap necrosis over cochlear implant

OBJECTIVE

The aim of this report was to study the cause and treatment of flap-related complications over cochlear implant.

SETTING

The study was performed in an academic tertiary referral center.

PATIENT

A 53-year-old Japanese male patient had had two retro-auricular skin incisions for tympanomastoidectomy in the postauricular region before implantation of a cochlear implant. He also had worn a helmet daily during work in his factory.

INTERVENTIONS

Corrective surgery was performed for reformation of the local blood supply to the overlying skin flap and reinforcement of the tissue overlying the implant by use of a superiorly based temporal muscle and fascia flap that were sutured with an inferiorly based muscle and fascia flap.

RESULTS

We successfully transposed the flap covering the implant without explantation of the implant.

CONCLUSIONS

The delayed development of flap necrosis was thought to be due to pressure necrosis produced by the band in the patient's helmet lying on the skin over the implant and to poor local blood supply in the postauricular area stemming from the two previous skin incisions for mastoid surgery performed for cholesteatoma. In those patients who wear helmets, it is important to position the cochlear implant sufficiently behind the ear and to avoid the use of a helmet.

Kawaguchipeptin B, an antibacterial cyclic undecapeptide from the cyanobacterium Microcystis aeruginosa

Kawaguchipeptin B, an antibacterial cyclic undecapeptide, was isolated from the cultured cyanobacterium Microcystis aeruginosa (NIES-88). Its structure was elucidated as 1 on the basis of 2D NMR data and chemical degradation. Kawaguchipeptin B (1) inhibited the growth of the Gram-positive bacterium Staphylococcus aureus at a concentration of 1 microgram/mL (MIC).

Evaluation of post-mortem oxymetry with reference to the causes of death

We examined blood samples of 214 forensic autopsy cases, excluding fire victims, on a CO-oximeter system in order to evaluate post-mortem oxymetric profiles with reference to the causes of death. Oxyhemoglobin (O2-Hb) levels in the left and right heart blood, respectively, ranged from 0 to 97.7% and from 0 to 92.1%, showing no apparent correlation with the post-mortem intervals or rectal temperatures. In nearly 60% of the cases, O2-Hb was lower than 10%. A high O2-Hb level (over 50%) in the left heart blood was most frequently observed in death from cold exposure and occasionally in fatalities from blunt injuries and stab/incised wounds with or without medical care. O2-Hb in the heart blood was usually very low (under 10%) in fatalities from asphyxiation, drowning, poisoning and natural diseases. A greatest oxymetric variation was observed in death from injuries, probably due to varied causal mechanisms of death. In most cases, the differences between blood O2-Hb levels in the heart and iliac vessels were within 15%; whereas O2-Hb in the cerebral venous blood was usually evidently higher than that in the right heart blood. An inverse relation of O2-Hb levels to total hemoglobin contents was observed slightly for the blood in the heart and iliac vessels, and more obviously for the cerebral venous blood. The above post-mortem oxymetric profiles were considered to at least partially reflect the final balance of oxygen uptake and consumption in dying process, possibly also affected by the circulatory status, giving an objective index to the color of cadaveric blood (hypostasis), although it should be assessed in consideration of post-mortem interference and total hemoglobin contents. In any case, however, post-mortem oxymetry seemed to have a limited value owing to severe systemic hypoxia which would be a common final state before death from various fatal traumas and diseases, maybe except for those with extremely short agony.

Leptin suppresses basal insulin secretion from rat pancreatic islets

The effects of leptin on insulin secretion from pancreatic islets of Sprague-Dawley rats were examined in vitro. In a basal glucose medium (5.5 mM), insulin secretion from isolated islets was significantly decreased after addition of a recombinant leptin (80 nM) (3.20+/-0.14 nmol/10 islets/h) compared with that before the addition (4.41+/-0.30 nmol/10 islets/h). Although significant leptin suppression of insulin secretion was not observed under a glucose-stimulated (11.1 mM) condition, these results suggest that a negative feedback system may exist between leptin and insulin, which increases the production of leptin from adipose tissues.

Normothermic cardiopulmonary bypass: effect on the incidence of persistent postoperative neurological dysfunction following coronary artery bypass graft surgery

We retrospectively reviewed the records of 250 consecutive patients undergoing coronary artery bypass graft surgery (CABG) from January 1994 through January 1996 to determine the incidence of persistent postoperative neurological dysfunction after CABG and to compare normothermic and moderate hypothermic cardiopulmonary bypass (CPB). Normothermic CPB was used in 128 patients (36°-37°C) and hypothermic CPB (27°-28°C) in 122 patients. Postoperative neurological dysfunction included focal motor deficits, delayed recovery of consciousness (>24h) after surgery, and seizures within 1 week postoperatively. Persistent neurological dysfunction was diagnosed if complete resolution had not occurred within 10 days of surgery. The incidence of persistent postoperative neurological dysfunction was 4.1% in the hypothermic CPB group and 2.3% in the normothermic CPB group. There were no statistically significant differences between the two groups (P=NS). These results suggest that normothermic CPB did not increase the incidence of persistent postoperative neurological dysfunction compared to hypothermic CPB.

Long-term survival after surgery for advanced intrahepatic cholangiocarcinoma: a case report

Intrahepatic cholangiocarcinoma has a tendency to disperse intrahepatically and extrahepatically, therefore, resectability is limited and prognosis is generally poor. A 68-year-old female was diagnosed as intrahepatic cholangiocarcinoma in the right lobe based on systematic images including computed tomography, magnetic resonance imaging, ultra-sonography, endoscopic retrograde cholangiography, angiography, chest X-ray, as well as laboratory data. Tumor invasion to the right diaphragm, lung and chest wall was suspected pre-operatively. After pre-operative portal embolization, extended right hepatectomy with partial resection of the involved organs including diaphragm, lung, and chest wall was done en bloc. The patient made an uneventful postoperative recovery and there has not been any evidence of recurrence at present, over four and a half years after surgery. Experience in the present case indicates that radical surgery may be a potential approach to yield a hopeful outcome for patient with intrahepatic cholangiocarcinoma, even if the tumor invades adjacent organs directly.