Aortic arch operation using selective cerebral perfusion for nondissecting thoracic aneurysm

BACKGROUND

Risks of increasing mortality and disability in aortic arch operations using the selective cerebral perfusion method for nondissecting aneurysm have not yet been determined. A multicenter, retrospective study was employed.

METHODS

The subjects were 143 patients who were admitted to one of the nine cardiovascular centers between January 1988 and December 1993, including 15 with ruptured aneurysm. A graft replacement of the transverse aortic arch or distal arch was performed in 80 patients, extensive aortic reconstruction comprising simultaneous replacement of the ascending or descending thoracic aorta (or both) in 46, and patch repair of involved arch in 17. The mean postoperative follow-up period was 19 months.

RESULTS

Hospital mortality was 36/143 patients (25.2%). Univariate analysis revealed that age of 70 years or more, ruptured aneurysm, and renal dysfunction affected hospital mortality. Neurologic deficits were noted in 15 patients (10.5%). Reoperation was performed in 13 patients for residual distal aneurysm or false aneurysm. Late death occurred in 10 patients and were due to vascular complications in 6. Multivariate analysis confirmed that aneurysmal rupture and renal dysfunction were independent predictors for vascular death including hospital mortality.

CONCLUSIONS

The present study confirmed that age, aneurysmal rupture, and renal dysfunction were significant predictors for mortality and disability in the aortic arch operation using selective cerebral perfusion for nondissecting thoracic aneurysm.

Surgical approach to tumor thrombus of renal cell carcinoma at the level between hepatic vein and diaphragm

BACKGROUND

The curative resection of tumor thrombus of renal cell carcinoma often provides a good prognosis, but the best surgical method for resection at the level between hepatic vein and diaphragm is still a matter of controversy.

METHODS

We performed transabdominal surgery without cardio-pulmonary bypass on 4 patients with tumor thrombus at the level between hepatic vein and diaphragm. The surgical procedures were as follows: The right lobe of the liver was separated and detached from the retroperitoneum, and then the vena cava was clamped just below the diaphragm simultaneous with clamping the porta hepatis. After complete circulatory isolation of the vena cava, the tumor thrombus was resected.

RESULTS

There were no severe complications postoperatively. Two patients died of cancer 18 and 38 months after surgery, and the other 2 are alive without evidence of disease after 62 and 66 months.

CONCLUSION

This anatomically rational approach is thought to be a good alternative to the pull-through method or cardio-pulmonary bypass for removing a tumor thrombus at this level.

Synergistic immunosuppression caused by high-dose methylprednisolone and cardiopulmonary bypass

BACKGROUND

Steroid use during cardiac operations may reduce the risk of postperfusion lung syndrome, but both cardiopulmonary bypass and steroids are immunosuppressive. The synergistic effects of the bypass and steroids on patients' immunologic activities, hemodynamics, and metabolisms during and after heart operations have not been clarified systematically.

METHODS

Twenty-four patients undergoing valve replacement were studied in a randomized, double-blind trial. Twelve of these patients (S group) received bolus methylprednisolone, 20 mg/kg body weight, and the remaining 12 patients (C group) received a placebo intravenously before and after bypass. Blood cell count, C-reactive protein, lymphocyte surface markers (CD3, CD4, CD8, CD16, and CD20), phytohemagglutinin response, interleukin-2 production, and natural killer cell activity were examined on admission through day 7. Cardiac output, blood gas, electrolyte, lactate, and serum glucose levels were examined perioperatively.

RESULTS

The peak white blood cell count in the S group was higher than that in the C group (analysis of variance: p [group] = 0.0436). The peak C-reactive protein level was higher in the C group than in the S group (p [group] < 0.0001). From the analysis of the surface markers, the steroid increased the natural killer cells before and soon after bypass (p [group] = 0.0117), and later tended to increase the CD4+ T and B cells during the postoperative recovery period. The phytohemagglutinin response in both groups decreased after bypass (p [time] < 0.0001), but the steroid caused exaggerated decreases before (p < 0.01 by Student's t test) and soon after (p < 0.001) bypass in the S group (analysis of variance: p [group] = 0.0127). The interleukin-2 production was suppressed by bypass alone after the bypass in the C group, but was further suppressed by the steroid before and after bypass in the S group (p [group] = 0.0446). The cardiac index, water balance, electrolytes, arterial oxygen tension, and timing of extubation were not different between the groups. In contrast, the glucose (p [group] = 0.0486) and lactate (p [group] = 0.0525) levels were higher in the S group than those in the C group.

CONCLUSIONS

T-cell functions are synergistically suppressed by cardiopulmonary bypass and high-dose methylprednisolone in heart operations. The hemodynamic benefits of the steroid are negligible, whereas glucose tolerance is worsened by the steroid during bypass.

Operation for nondissecting aneurysm in the descending thoracic aorta

BACKGROUND

Little is known about the risks of mortality and morbidity after descending thoracic aortic aneurysm repair using left heart bypass and temporary arterioarterial bypass.

METHODS

A multicenter, retrospective study was performed on 120 patients who were admitted to one of nine cardiovascular centers between January 1988 and December 1993 and underwent operation for nondissecting thoracic aortic aneurysm. The present series included 10 patients with ruptured aneurysm. Graft replacement was performed in 95 patients, patch repair in 22, and suture of the ruptured aorta in 3. Venoarterial bypass was used in 45 patients, left heart bypass in 56, and temporary arterioarterial bypass in 19 as circulatory support. The mean postoperative follow-up period was 30 +/- 21 months.

RESULTS

Hospital mortality occurred in 7 patients (5.8%). Univariate analysis revealed that only aneurysmal rupture was related to hospital mortality. Brain or cord injury was observed in 4. Of nine deaths that occurred after discharge, five were related to aneurysm and two were due to vascular event. No significant difference was noticed in probability of survival according to the circulatory supporting method. Only aneurysmal rupture affected probability of survival. Multivariate analysis revealed that aneurysmal rupture was the only independent predictor for vascular death including hospital mortality.

CONCLUSIONS

The present study confirms that aneurysmal rupture is a significant predictor for mortality and morbidity in aortic operations for nondissecting descending thoracic aneurysm, and that a similarly good outcome would be expected when using left heart bypass, temporary arterioarterial bypass, or venoarterial bypass.

Apoptosis, proliferative activity and Bcl-2 expression in Epstein-Barr-virus-positive non-Hodgkin's lymphomas

In order to clarify the effects of Epstein-Barr virus (EBV) infection on apoptosis and proliferative activity of non-Hodgkin's lymphoma, 135 Japanese lymphoma cases were investigated for the presence of viral RNA and its correlation with bcl-2 protein (Bcl-2) expression. In addition, the role of EBV in lymphoma-genesis was also studied in terms of EBV genotyping and specific deletion in the gene for the latent membrane protein 1 (LMP-1). EBER-1 RNA in situ hybridization revealed EBV in 18 cases (13.3%), comprising 12 of 44 T cell (27.3%) and 6 of 91 B cell (6.6%) lymphomas. Type A EBV was found in all 18 cases (100%), and 17 of the 17 (100%) evaluable cases showed a 30-bp deletion within the 3' end of LMP-1. Comparison of apoptotic indices (AI), assessed by DNA nick-end labelling, and proliferative activity, estimated in terms of Ki-67 labelling and mitotic indices (KI and MI), demonstrated an overall correlation among AI, KI and MI increases in association with Bcl-2 negativity, indicating a close relation between apoptosis and proliferation. EBV-positive cases showed significantly elevated AI values, independent of Bcl-2 positivity, with no change in KI and MI. These results indicate that EBV in Japanese non-Hodgkin's lymphomas is exclusively of type A with a specific deletion in LMP-1 and that it tends to be present in T cell lymphomas. Moreover, EBV up-regulates apoptosis without any relation to Bcl-2 expression and exerts only minor effects on proliferation.

p53 and bcl-2 expression and argyrophilic nucleolar organizer regions in patients with malignant maxillary sinus tumours

To investigate the relation between the clinicopathological findings, and the survival of patients with malignant tumours of the maxillary sinus, and the tumour's biological parameters, we examined the expression of p53 and bcl-2 and the number of silver-stainable nucleolar organizer regions (AgNORs) in 23 paraffin-embedded specimens from primary tumours. Fifteen of 23 (65 per cent) maxillary tumours expressed p53 and two of 23 (nine per cent) tumours expressed the bcl-2 gene product. The mean number of AgNORs per nucleus was 5.2 +/- 2.4. There was no relationship between the expression of p53 or bcl-2 and the patient's clinical course. In contrast, there was a statistically significant difference in the survival of patients with a high (> 6) number of AgNORs and patients with a low (< 6) number of AgNORs. These data suggest that the number of AgNORs may be useful in evaluating the prognosis of patients with malignant maxillary sinus tumours.

Regulation of cholecystokinin release and transcription in a rat without gene expression of cholecystokinin-A receptor

An Otsuka Long-Evans Tokushima Fatty (OLETF) rat does not possess cholecystokinin (CKK)-A receptor gene expression because of a genetic abnormality. We examined the CCK release and its transcription in OLETF rats in comparison with control (Long-Evans-Tokushima-LETO) rats. Animals at 5-6 and 24-25 weeks of age were used. The level of CCK mRNA and CCK concentration in the small intestinal mucosa, and the level of CCK-A receptor mRNA in the pancreas were examined. To examine CCK release, rats were prepared with external bile and pancreatic fistulae. The basal plasma levels of CCK and those at 2 h after bile-pancreatic juice diversion were measured by radioimmunoassay. The levels of CCK mRNA, and tissue CCK concentration increased significantly with age in both strains, but the values in OLETF rats were significantly lower than those in LETO rats. The CCK-A receptor mRNA level also increased with age in LETO rats. The plasma CCK concentration was significantly increased by bile-pancreatic juice diversion regardless of age and strain; however, the level of plasma CCK in OLETF rats at 24-25 weeks of age was significantly lower than that of LETO rats. It is suggested that the long-term defect of CCK-A receptor may decrease CCK release and transcription.

Predictive value of argyrophilic nucleolar-organizer-region-associated proteins in bladder cancer, using cell-imprint preparations

The predictive value of quantifying argyrophilic nucleolar-organizer-region-associated proteins (Ag-NOR) in routinely processed paraffin-embedded tissue sections of bladder cancer remains controversial. The purpose of this study was to determine whether cell-imprint preparations facilitate a more accurate determination of the mean number of Ag-NOR per cell (Ag-NOR score). The utility of using the Ag-NOR scores of cell-imprint preparations as a prognostic indicator in patients with bladder cancer was explored. We evaluated 90 patients with newly diagnosed bladder cancer using cell-imprint preparations to determine Ag-NOR score. The score significantly correlated with known prognostic factors associated with this tumor, including histological grade (P < 0.001), pathological stage (P < 0.01), and papillary structure (P < 0.001). Furthermore, the Ag-NOR score appeared to be an independent predictor of intravesical tumor recurrence of superficial bladder cancer (P < 0.05). These results suggest that the Ag-NOR score determined in a cell imprint preparation may serve as a useful prognostic indicator in bladder cancer.

Mechanism for mouse strain differences in the protective effect of Sudan III against the in vivo genotoxicity of 7,12-dimethylbenz[a]anthracene

The effect of Sudan III-pretreatment on the in vivo genotoxicity of 7,12-dimethylbenz[a]anthracene (DMBA) was investigated using C57BL/6 (B6) and DBA/2 (D2) mice. A significant increase in the frequency of micronucleated reticulocytes was observed in both strains of mice treated with DMBA. The increase was significantly reduced in B6 but not D2 mice by Sudan III-pretreatment. However, enhancement of metabolic activation was found in the Ames assay in the hepatic post-mitochondrial supernatant fraction (S9) from Sudan III-treated animals. It was greater with S9 from B6 than S9 from the D2 group. When the assay was performed in the presence of glutathione, this enhancement was significantly reduced. Sudan III induced some drug metabolizing enzymes, mainly CYP1A and glutathione S-transferase was also induced. The induction of CYP1A was more effective in B6 than D2 mice. These results support our hypothesis that the simultaneous induction of Phase I and II drug metabolizing enzymes is the mechanism for the chemoprevention by Sudan III and suggest that strong induction of CYP1A might be essential for a protective effect.

[Clinical study on a concomitant therapy with fluconazole and human recombinant granulocyte colony stimulating factor in the treatment of systemic fungal infections with hematological disorders]

The clinical efficacy and the safety of concomitant therapy with fluconazole and recombinant human granulocyte colony stimulating factor (rhG-CSF) was compared with fluconazole monotherapy in neutropenic patients with hematological disorders. The clinical efficacy rate was 73.5% (25/34) in the combination therapy and 48.1% (37/77) in monotherapy. The difference between the two is statistically significant. Side effects were not observed in the combination group, but laboratory abnormalities were found in 6 patients with an incident rate of 11%. The combination therapy with fluconazole and rhG-CSF may be selected as empiric therapy for systemic fungal infection associated with hematological disorders, since this combination therapy showed high efficacy and low incident of side effects. Some patients, however, did not show increased neutrophil counts in spite of rhG-CSF administration.

Effect of recombinant human granulocyte colony-stimulating factor on combination therapy with aztreonam and clindamycin for infections in neutropenic patients with hematologic diseases

The present multicenter study was performed to evaluate the effect of recombinant human granulocyte-colony stimulating factor (rhG-CSF) on combination therapy using aztreonam (AZT) and clindamycin (CLDM) to treat severe infection in neutropenic patients with hematologic diseases. Forty-three neutropenic patients with infections (rhG-CSF group) were treated with AZT (2 g) and CLDM (600 mg) 2-3 times daily as well as rhG-CSF (Lenograstim or Filgrastim: 2-5 mu/kg/day). The clinical efficacy of this regimen was compared to that obtained in 44 febrile neutropenic patients, with hematologic diseases, who received only AZT and CLDM in a previous study (historical control group). The overall efficacy rate was 69.8% (30/43) in the rhG-CSF group and 65.9% (29/44) in the historical control group. Although the neutrophil count was significantly increased and C-reactive protein tended to be lower in the rhG-CSF group, the daily maximum body temperature profiles of the 2 groups were nearly the same. These results suggest that rhG-CSF is of little benefit in the treatment of single infectious episodes in neutropenic patients, and that appropriate antibiotic therapy is more important.

[Questionnaire of cryopreserved allograft valves in Kyushu and Yamaguchi area]

Japanese Society of Cryopreserved Thoracic Tissue Implantation was recently set up. Cryopreserved allograft valves are about to pervade in Japan. To clarify the interest, demands and supply of cryopreserved allograft valve in the area of Kyushu and Yamaguchi, we performed questionnaire investigation regarding this issue. Collection rate of this questionnaire was 87.5% (35/40 hospitals). Ninety-seven percent of the hospitals answered that they were interested in cryopreserved allograft. Ninety-four percent of the hospitals answered that they did not ethically hesitate to use cryopreserved allograft. Ninety-one percent of the hospitals hoped to perform cardiac surgery using allograft aortic valve if allograft is available. With respect to securing donors of allograft, two-third of the hospitals did not decide whether they could be involved in obtaining donors of allograft. As the number of the cadaver kidney donors is about 20 per year in the area of Kyushu and Yamaguchi, shortage of donors of allograft valve is anticipated.

[Polycythemia vera progressing to acute lymphoblastic leukemia after 13 years]

A 54-year-old woman with leukocytosis, was referred to our clinic in February 1982. Based on findings of pancytosis, high NAP score, high serum vitamin B12, increase in total red cell volume and splenomegaly, she was diagnosed as having polycythemia vera (PV). Since then, she has been treated with pipobroman, hydroxycarbamide and phlebotomy. Leukocytosis with increase in blastic cells and thrombocytopenia was noted in August 1995, and she was admitted to our hospital. Since the blastic cells were CD10(+)19(+)20(+), she was diagnosed as having acute lymphoblastic leukemia and treated with vincristine and prednisolone, resulting in remission. This case suggests that PV is a disease of multipotent stem cells including those with a lymphoid lineage.

Analysis of the unique hamster cell tropism of ecotropic murine leukemia virus PVC-211

PVC-211 murine leukemia virus (MuLV) is a neuropathogenic variant of Friend MuLV (F-MuLV). Previous studies from our laboratory demonstrated that unlike the parental F-MuLV, PVC-211 MuLV can infect rat brain capillary endothelial cells efficiently and that it has acquired genetic changes responsible for its expanded cellular tropism. To determine if PVC-211 MuLV also has expanded its host range, we tested its infectivity on Chinese hamster ovary-derived CHO-K1 cells, which are generally resistant to ecotropic MuLV. The results indicated that PVC-211 MuLV, but not F-MuLV, was highly infectious for CHO-K1 cells. Studies using glycosylation inhibitors and glycosylation mutants of CHO-K1 cells, as well as interference studies, suggested that PVC-211 MuLV has acquired the ability to interact with the ecotropic MuLV receptor on CHO-K1 cells that has undergone glycosylation-dependent modification. Using chimeric viruses between PVC-211 MuLV and F-MuLV, we were able to localize the viral genetic element crucial for CHO-K1 cell tropism within the env gene of PVC-211 MuLV and show that glycine at position 116 and lysine at position 129 of the envelope glycoprotein SU were important. These viral determinants also appear to confer tropism for other hamster cells resistant to ordinary ecotropic MuLVs. Further studies on the interaction between PVC-211 MuLV and the receptor on hamster cells may provide novel insights into the molecular mechanisms for receptor recognition and binding by viral envelope glycoproteins.

[Acute myelogenous leukemia with ins(21;8) expressing AML-1-MTG8 fusion transcript]

Here we report a case of acute myelogenous leukemia (M2, FAB classification) presenting with cytogenetic abnormalities of ins(21;8), +del(8) without t(8;21). A 8;21 chromosome translocation is frequently found in acute myelogenous leukemia, especially in the M2 subtype. The translocation results in a fusion transcript between AML1 and MTG8 (ETO), assigned on chromosomes 21 and 8, respectively. Among patients with a t(8;21) abnormality, solid leukemic tumor deposits outside the marrow or good response to chemotherapy are observed frequently. Decrease in neutrophil alkaline phosphatase score and positive rate, and eosinophilia in bone marrow or the blast cells with Auer rods expressing CD19, CD56 antigens occur at a relatively high rate. Although our case lacked these clinical, cytological and cytochemical features, expression of chimeric AML1-MTG8 mRNA was detected. AML1-MTG8 fusion transcript may play a critical role in leukemogenesis of AML M2. Studies on this case may help to reveal the oncogenic function of the AML1-MTG8 fusion gene in AML M2.

Lazaroid (U74500A) prevents vascular and myocardial dysfunction after 24-hour heart preservation. A study based on cross-circulated blood-perfused rabbit hearts

BACKGROUND

The prevention of ventricular and vascular dysfunction has been recognized as an important factor in heart preservation. Because lipid peroxidation may cause cell membrane injury after ischemia and reperfusion, we hypothesized that the administration of a lipid peroxidation inhibitor lazaroid (U74500A) would result in an improvement of functional recovery after the 24-hour preservation period.

METHODS AND RESULTS

An isolated rabbit heart preparation perfused with support rabbit blood was used. Before preservation, 4 mg/kg of either lazaroid or solvent was given to donor rabbits. The hearts were preserved with University of Wisconsin solution for 24 hours at 0 degree C. The working model preparation (n = 7 in each group) showed a better cardiac output (74.6 +/- 25.7 versus 192.7 +/- 19.6 mL/min, P < .0001) and a lower lipid peroxide level (2.1 +/- 1.3 versus 0.6 +/- 0.3 nmol/mL. P < .05) of the coronary effluent in the heart treated with lazaroid. With a Langendorff preparation (n = 7 in each group), we evaluated the vascular dilatory function. The endothelial function assessed by the percentage increase of coronary flow in response to acetylcholine in the solvent group was significantly lower than that of the lazaroid group (69 +/- 24% versus 140 +/- 67%, P < .05), whereas no significant difference was observed between the groups regarding endothelium-independent vasodilatation as assessed by the responses to nitroglycerin and nitroprusside.

CONCLUSIONS

These results demonstrated an improved ventricular and endothelial function in the rabbit pretreated with lazaroid before preservation accompanied by a reduction of lipid peroxidation, indicating the potential benefits for long-term heart preservation.

Flow cytometric analysis of platelet activation markers CD62P and CD63 in patients with coronary artery disease

We investigated whether platelet activation could be quantitatively detected in patients with coronary artery disease using flow cytometric analysis of the expression of CD62P and CD63, which are activation-specific antigens on the platelet surface. Platelet samples were obtained from 16 healthy control subjects and 65 patients, of whom 25 had angiographically normal coronary arteries and 40 had at least one major coronary artery stenosis (> or = 50% narrowing). In both patient groups, CD62P expression was significantly higher than in the control group, but the difference between the two patient groups was not significant. In contrast, CD63 expression did not differ among the three groups. We also compared expression of these antigens after stratifying the patients according to the number of significant coronary artery stenoses. Patients with three-vessel disease had significantly increased CD62P and CD63 expression compared with the other subgroups. Our findings indicate that platelet activation occurs in patients with severe coronary artery stenosis.

AgNOR staining of cell imprint preparations of human bladder cancer

OBJECTIVE

To determine the clinical usefulness of argyrophilic nuclear organizer region (AgNOR) staining as applied to cell imprint preparations in bladder cancer.

STUDY DESIGN

The study group consisted of 59 bladder cancers (13 grade 1, 24 grade 2 and 22 grade 3). The staining time, quality of staining, relationship of AgNOR counts to tumor grade and interobserver variations in AgNOR counts were compared in cell imprint preparations and paraffin-embedded tissue sections. Interobserver variation was compared by calculating the coefficients of variation (CVs) and correlation coefficients between two independent observers.

RESULTS

Following an optimal staining time of 30 minutes, the AgNOR dots of cell imprint preparations were highly distinct. In contrast, the optimal staining time was variable, and the AgNOR dots often were observed to aggregate in paraffin-embedded tissue sections. The mean AgNOR count was significantly higher in imprint preparations. AgNOR counts from the imprint preparations showed a stronger relationship to tumor grade. The CVs of AgNOR scores in the cell imprints was significantly smaller, and the correlation coefficient was significantly greater.

CONCLUSION

AgNOR staining of cell imprint preparations is a more objective method than paraffin-embedded tissue sections in human bladder cancer.

Macromolecular composition of stress fiber-plasma membrane attachment sites in endothelial cells in situ

Stress fibers (SFs) are present along the apical (apical SF) and the basal (basal SF) portions of cultured cells. We have recently shown that apical SFs are anchored to the apical plasma membrane (PM) in a manner similar to how basal SFs are attached to focal adhesion sites. We propose calling such apical SF-membrane attachment sites "apical plaques." To study the macromolecular composition of the apical plaque and the focal adhesion in endothelial cells (ECs) in situ, we examined by confocal laser scanning and fluorescence microscopy guinea pig aortae stained with various antibodies against focal adhesion-associated proteins. Basal SFs oriented parallel to the blood flow direction were mainly located in the upstream half of the cell. Thin apical SFs were also observed. Spotty staining patterns were observed in the basal and the apical portions of cells stained with anti-vinculin, anti-talin, anti-paxillin, or anti-fibronectin receptor, indicating the presence of focal adhesions and apical plaques in ECs in situ. Although fibronectin receptors were present in the apical plaque, fibronectin was not detected on the apical cell surface. Our data suggest that the molecules responsible for the SF-PM association are the same between in vitro and in situ cells. Our results appear to support a hypothesis that the SF system is involved in sensing and/or signal transduction of fluid mechanical forces.

Association of tissue factor with a gamma chain homodimer of the IgE receptor type I in cultured human monocytes

Tissue factor (TF) is a high-affinity receptor for coagulation factors VII (F VII) and VIIa. The F VII/VIIa/TF complex is the major cellular initiator of the extrinsic coagulation cascade. We found that the occupancy of TF by its ligand, F VIIa, is involved with signal transduction and that TF is associated with the gamma chain homodimer identified as a component of IgE receptor type I (Fc epsilon RI). When 4-day cultured human monocytes were incubated with F VIIa, several polypeptides, especially a 70-kDa polypeptide, were transiently phosphorylated on tyrosine, residues. These phosphorylation events were inhibited by prior binding of anti-TF monoclonal antibody (mAb) HTF-K14, but not anti-TF mAb HTF-K180 to intact cultured monocytes. HTF-K14 blocked the binding of F VII/ VIIa to cell surface TF, whereas HTF-K180 did not. Anti-TF immunoprecipitates prepared from 1% digitonin lysates of cultured human monocytes incorporated phosphate in a gamma chain homodimer when incubated with [gamma-32P] ATP. The identity of the T-associated structures as gamma chains was established by immunoblot analysis of anti-TF mAb immunoprecipitates with anti-gamma chain mAb. In addition, anti-TF immunoblot analysis showed that TF co-precipitated with anti-gamma chain mAb. Our data suggest that gamma chains may play an important role in signaling via TF in human monocytes/macrophages.

[Unilateral and synchronous occurrence of renal cell carcinoma and ureteral tumor: a case report]

An 81-year-old woman was admitted to our hospital with left flank pain. Excretory urography revealed left hydronephrosis. Abdominal computed tomography (CT) revealed a large heterogenous tumor in the upper pole and marked hydronephrosis and hydroureter in the lower portion of the left kidney. Left total nephroureterectomy was performed under the diagnosis of renal pelvic and ureter tumor. The pathological diagnosis was of renal cell carcinoma (spindle type, grade 3) in the kidney and transitional cell carcinoma (grade 2) in the ureter. Postoperative chemotherapy was not given. Convalescence was uneventful and fifteen months after the operation she is alive with no recurrence or metastasis.

Association of HTLV-I with autoimmune thyroiditis in patients with adult T-cell leukaemia (ATL) and in HTLV-I carriers

OBJECTIVE

Human T-lymphotrophic virus type I (HTLV-I) is a retrovirus that causes adult T-cell leukaemia (ATL). This virus is associated with a variety of autoimmune disorders. The possible association between HTLV-I Infection and autoimmune thyroiditis has not been fully studied. We therefore evaluated anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TGAb) in the sera of patients with ATL, carriers of HTLV-I, and in healthy control subjects to investigate the possible association between such infection and auto-immune thyroiditis.

PATIENTS AND METHODS

Fifty-two ATL patients (21 males, 31 females; mean age 56.4 years) and 50 HTLV-I carriers (18 males, 32 females; mean age 56.7 years) were studied. The control subjects were 877 healthy adults (271 males, 606 females; mean age 54.8 years) who were negative for HTLV-I antibody. TPOAb, TGAb, thyroxine (T4) and thyrotrophin (TSH) were measured in serum using a radioimmunoassay kit.

RESULTS

Positivity for thyroid autoantibodies (TPOAb and/or TGAb) was found in 21 of 52 ATL patients (40.4%), 15 of 50 HTLV-I carriers (30.0%), and 120 of 877 control subjects (13.7%). The difference between the HTLV-I-Infected and the control subjects was statistically significant (P < 0.005). Female control subjects had a significantly higher prevalence of positivity for thyroid autoantibodies than the males (17.3 vs 5.5%, P < 0.001). Carriers of HTLV-I and patients with ATL of each sex showed an equally high prevalence of positivity for thyroid autoantibodies. Of the subjects who were positive for thyroid autoantibody, 7.5% of control subjects, 19.0% of ATL patients, and 40.0% of HTLV-I carriers had hypothyroidism. A significant difference in this respect was noted between the HTLV-I infected subjects and the control subjects (P < 0.005).

CONCLUSIONS

This study demonstrates a high prevalence of positivity for thyroid autoantibodies (TPOAb and/ or TGAb) in the adult T-cell leukaemia patients and the HTLV-I carriers. The adult T-cell leukaemia patients and the HTLV-I carriers each had a high prevalence of hypothyroidism. There was an association between HTLV-I infection and autoimmune thyroiditis.

Inhibition of lipid peroxidation with the lazaroid U74500A attenuates ischemia-reperfusion injury in a canine orthotopic heart transplantation model

BACKGROUND

The lazaroid U74500A is a 21-aminosteroid that inhibits lipid peroxidation and attenuates ischemia-reperfusion injury. We examined the effect of U74500A on heart preservation with the use of a clinically relevant canine orthotopic heart transplantation model.

METHODS AND RESULTS

Six donor dogs (group L) were pretreated intravenously with U74500A (10 mg/kg), and the dogs without pretreatment served as a control (group C, n = 6). The donor heart was preserved in cold University of Wisconsin solution for 24 hours. The heart was then transplanted orthotopically. Myocardial biopsy was performed to measure the adenosine triphosphate level at the end of ischemia. Before reperfusion, recipients in group L received another dose of U74500A (10 mg/kg) intravenously. After 3 hours of reperfusion, left ventricular function was evaluated by left ventricular pressure-volume relations with the use of a Millar catheter and conductance catheter, thereby deriving the slope of the end-systolic pressure-volume relation, the slope of the stroke work-- end-diastolic volume relation, and the slope of the maximum dP/dt--end-diastolic volume relation. At the same time, serum creatine kinase MB isoenzyme and lipid peroxide levels were measured. The slopes of the end-systolic pressure-volume relation, the stroke work--end-diastolic volume relation, and the maximum dP/dt--end-diastolic volume relation for group L were significantly higher than those for group C. The adenosine triphosphate levels for group L were significantly higher than those for group C. Serum creatine kinase MB isoenzyme and lipid peroxide levels for group L were significantly lower than those for group C.

CONCLUSIONS

Inhibition of lipid peroxidation by the administration of U74500A was effective for 24-hour canine cardiac preservation. These results indicate that U74500A is a promising agent for heart allograft preservation.

Postoperative cardiac rhythms with superior-septal approach and lateral approach to the mitral valve

BACKGROUND

The superior-septal approach provides an excellent view of the mitral valve and therefore has received considerable interest. However, the safety of this approach is controversial because it requires division of the sinus node artery in most cases.

METHODS

Postoperative cardiac rhythms were analyzed in 152 consecutive patients who underwent mitral valve procedures between January 1992 and February 1995 with a conventional right lateral left atriotomy (group 1, n = 69) or the superior-septal approach (group 2, n = 83). Follow-up ranged from 2 to 38 months, and the mean follow-up was 16.1 months in group 1 and 13.8 months in group 2.

RESULTS

The mortality rate was similar in the two groups (1.4% in group 1 and 1.2% in group 2), and the causes of death were not related to the left atriotomy. At discharge, 96% of the patients in group 1 who were in sinus rhythm preoperatively and 78% of those in group 2 remained in sinus rhythm. At the last follow-up, 88% of these patients in group 1 and 83% in group 2 remained in sinus rhythm. Among the patients in atrial fibrillation or junctional rhythm before operation, 12% in group 1 and 11% in group 2 had regained sinus rhythm at the last follow-up. There were no significant differences in these values.

CONCLUSIONS

Although the incidence of dysrhythmias was higher with the superior-septal approach in the early postoperative period, this approach provides an excellent operative view of the mitral valve and similar results in terms of late postoperative cardiac rhythms as the right lateral left atriotomy.