Management of tracheal wall resection for thyroid carcinoma by tracheocutaneous fenestration and delayed closure using auricular cartilage

BACKGROUND

In the case of advanced thyroid carcinoma invading the trachea, surgical procedures for tracheal resection are selected in relation to the degree of invasion. We created a tracheocutaneous fenestration that was later closed with a free auricular cartilage autograft. We present a simple and effective method for permanent closure of tracheostoma.

METHODS

The surgical procedure for delayed closure consists of three steps: (1) preparing the hinge flap with additional undermining of the subcutaneous layer and the strap muscles; (2) removing a portion of the conchal cartilage from the auricle, which is easily performed with a semicircular skin incision along the anthelix of the ear; and (3) placing the conchal cartilage with its convex surface upward just over the sutured hinge flap layer.

RESULTS

Under local anesthesia, we successfully employed this reconstructive procedure for 5 patients. Unfortunately, however, in one patient, we had to reopen the closed tracheocutaneous fenestration on the second postoperative day because of an acute problem that was independent of the closure surgery. Four patients remain in satisfactory condition for more than 2 years since the closure of tracheostoma.

CONCLUSIONS

The auricular cartilage free graft is a relatively simple procedure which supplies tracheal wall skeletal support for the permanent closure of the tracheocutaneous fenestration.

Ordered Metal Nanohole Arrays Made by a Two-Step Replication of Honeycomb Structures of Anodic Alumina

A highly ordered metal nanohole array (platinum and gold) was fabricated by a two-step replication of the honeycomb structure of anodic porous alumina. Preparation of the negative porous structure of porous alumina followed by the formation of the positive structure with metal resulted in a honeycomb metallic structure. The metal hole array of the film has a uniform, closely packed honeycomb structure approximately 70 nanometers in diameter and from 1 to 3 micrometers thick. Because of its textured surface, the metal hole array of gold showed a notable color change compared with bulk gold.

Identification of the antithrombin III Kyoto mutation by restriction fragment length polymorphism analysis

Clarification of the molecular biologic abnormality underlying antithrombin III (AT III) deficiency is important to a complete understanding of the coagulation system. We have reported previously the deficiency of AT III Kyoto in which there has been a single substitution of thymine for guanine at codon 406 of exon VI. This results in the amino acid substitution of methionine for arginine. The nucleotide substitution at codon 406 in the mutant allele eliminates a Hae III restriction site. Accordingly, Hae III restriction analysis of the PCR fragments in this family could segregate the deficient members from the normal members, enabling the detection of the existence of Hae III restriction fragment length polymorphism of the PCR product (PCR-RFLP). Moreover, we confirmed by direct DNA sequencing with the polymerase chain reaction that the tested deficient members in an AT III Kyoto family inherit the same type of mutation in their genes. In conclusion, Hae III PCR-RFLP can be a useful method for screening of this mutant gene in the family.

[Complete remission of prostate cancer after LH-RH agonist neoadjuvant therapy: a case report]

We report a case of prostate cancer showing a complete remission after LH-RH agonist neoadjuvant therapy. A 69-year-old man was referred to our department complaining of pain on urination and urge incontinence. The serum prostate specific antigen (PSA) level was 41.6 ng/ml. Needle biopsy specimens from both lobes revealed moderately differentiated adenocarcinoma. Chest X-ray, computed tomographic (CT) scan, and bone scintigraphy demonstrated neither distant metastasis nor local invasion. LH-RH agonist was administered on a monthly basis as neoadjuvant therapy. After 4 injections, pelvic lymph node dissection and radical prostatectomy were performed on January 11, 1993. Thorough examination did not reveal any cancer cells in the removed specimen. The patient was discharged 30 days after the operation and has shown no evidence of distant metastasis or local recurrence as long as 19 months later.

Hemolytic anemia following high-dose intravenous immunoglobulin administration

We describe two cases of hemolytic anemia following high-dose intravenous human immunoglobulin administration in young females with idiopathic thrombocytopenic purpura. Inducement of hemolytic anemia by anti-A and anti-B antibodies in these cases necessitates the performance of a minor crossmatching procedure prior to immunoglobulin use to prevent the occurrence of this adverse reaction.

Studies on the preparation of bioactive lignans by oxidative coupling reaction. V. Oxidative coupling reaction of methyl (E)-3-(2-hydroxyphenyl)propenoate derivatives and lipid peroxidation inhibitory effects of the produced lignans

The oxidative coupling reactions of 2-hydroxycinnamates were investigated as a continuation of our previous studies on 4-hydroxy derivatives. The reaction of 2-hydroxycinnamate 1 and 2-hydroxy-4-methoxycinnamate 3 with silver oxide afforded polymerized lignin-like products, while that of 2-hydroxy-bis(methoxymethoxy)cinnamates 5 and 6, after acetylation, gave the enol acetates, 8 and 14, of oxotetrahydrobenzoxanthene derivatives, respectively. These two products were also obtained by the oxidation of 5 and 6 with potassium hexacyanoferrate(III). In the reactions of 5 and 6 with iron(III) chloride, the major products were the partially demethoxymethoxylated compounds 9 and 15, respectively. Thus, the course of the reactions in the oxidation of 2-hydroxycinnamates is quite different from that in the case of 4-hydroxy derivatives. The product 8 and the corresponding oxotetrahydrobenzoxanthene derivative were found to show moderate inhibitory effects upon lipid peroxidation.

Antioxidant role of Rhodnius prolixus heme-binding protein. Protection against heme-induced lipid peroxidation

Heme in aqueous solutions actively promotes free radical reactions leading to degradation of biological molecules. The blood-sucking insect Rhodnius prolixus has a heme-binding protein (RHBP) in its hemolymph (Oliveira, P.L., Kawooya, J.K., Ribeiro, J.M.C., Meyer, T., Poorman, R., Alves, E.W., Walker, F., Padovan, G.J., and Masuda, H. (1994) J. Biol. Chem. 270, 10897-10901. Here we show that this protein inhibits heme-dependent peroxidation of both linolenic acid liposomes and lipophorin, the main lipoprotein of insect hemolymph. The oxidized lipophorin is functionally impaired, being defective both in its capacity to be loaded with phospholipids from the fat body as well as in its ability to deliver phospholipids to the growing oocytes. RHBP prevents the heme-induced oxidative damage to lipophorin. It is proposed that in vivo RHBP binds the heme derived from digestion of blood hemoglobin, suppressing the generation of activated oxygen species and protecting the insect against oxidative stress throughout the feeding cycle.

[Protective effect of human macrophage colony-stimulating factor on fungal infection (2). In vitro effect of human macrophage colony-stimulating factor on systemic aspergillosis and in vitro effect on the activities of macrophage]

We studied the protective effect of human macrophage colony-stimulating factor (M-CSF) of fungal infection due to systemic aspergillosis in normal mice. We also examined the effect of M-CSF against the activities of mouse peritoneal macrophage which were relating to the phagocytosis, the killing, the production of superoxide after contacting with phorbol myristate acetate and the production of nitric oxide after contacting with interferon-gamma in vitro. M-CSF improved the median survival time and the survival rate of systemic aspergillosis. Combination therapy with M-CSF and amphotericin-B (AMPH-B) showed the therapy with either M-CSF or AMPH-B alone. M-CSF enhanced the activities of phagocytosis and the killing of ingested Candida albicans H and spores of Aspergillus fumigatus K by macrophage. Furthermore, M-CSF promoted the production of superoxide and nitric oxide in macrophage. These results indicate that M-CSF can enhance the fungicidal activity of macrophages by activation in vivo, thereby preventing the dissemination of fungal infection.

Long openings of calcium channels in fetal rat ventricular cardiomyocytes

Whole-cell and single-channel Ca2+ currents (ICa) of single fetal (12-18 days) and neonatal (1-10 d) rat ventricular myocytes were recorded using patch clamp techniques. Whole-cell ICa density increased markedly during the fetal period and remained almost constant during the neonatal period. In cell-attached patch recordings (with 110 mM Ba2+ in the pipette), the L-type Ca2+ channels, observed on both fetal d-12 and neonatal d 5, had the same conductance (23 pS). On fetal d-12, many relatively long openings were observed in addition to brief openings, whereas on neonatal d-5, long openings were less observed and brief openings dominated. Therefore, long openings of the Ca2+ channels occur in early development in rat heart cells, similar to that reported for chick hearts [7, 8]. The increase of the whole-cell current amplitude observed during development may be due to an increase in available channel number.

Thyroid abnormalities among children in the contaminated area related to the Chernobyl accident

Gradual increases of various radiation-related diseases including thyroid cancer following the Chernobyl accident have been recently reported. We have carried out systematic thyroid surveys in school children aged 10-15 years in the highly contaminated area and compared the results with a similar survey in a nonaffected neighboring area as a control. Systematic examinations of the thyroid gland were performed in 888 schoolchildren (408 males and 480 females) in the districts of Chechelsk city with 5 to over 40 Ci/km2 of radiation level for 137Cs. In the control area (Bobruisk city), 521 children with the same age range (229 males and 292 females) were examined. Thyroid surveys were carried out as follows: palpation, ultrasonography, blood examinations of thyroid function, and measurements of daily urinary excretion of iodine. Certain thyroid abnormalities were observed in the high radioactive fallout area more frequently than in the control region. In particular, the prevalence of multiple micronodular lesions in diffuse goiter in the contaminated area was significantly higher than in the control area. However, endemic goiter due to iodine deficiency was present in both districts. The environment factor of iodine deficiency might have resulted in the early occurrence of ultrasonographic thyroid abnormalities attributed to radioactive contamination.

[Protective effect of human macrophage colony-stimulating factor (hM-CSF) on fungal infection (1). In vivo effect of hM-CSF on systemic candidiasis and in vitro effect of hM-CSF on macrophages activities]

We studied the protective effect of human macrophage colony-stimulating factor (hM-CSF) on fungal infection due to systemic candidiasis in vivo and the activities of macrophages in vitro, in order to demonstrate the usefulness of M-CSF on fungal infection. The effect of hM-CSF on systemic candidiasis was examined by using normal and immunosuppressed mice. In addition, the effects of hM-CSF on the activity of reticuloendothelial system (RES) organ and on the phagocytic activity and NBT reduction activity of mouse macrophage were also examined in vitro. HM-CSF improved the survival rate of systemic candidiasis in both normal and immunosuppressed mice. Combination therapy with hM-CSF and fluconazole showed higher survival rate more than in the therapy with either hM-CSF or fluconazole alone. Furthermore, hM-CSF enhanced the activity of RES organ, phagocytosis by macrophages and NBT reduction by macrophages, significantly. These results indicate that hM-CSF enhances the phagocytic cactivity and candicidal activity by macrophages in vivo, thereby preventing dissemination of fungal infection.

[Valvular surgery for the patients 70 years old or older]

From January 1986 to June 1993, twenty one patients aged 70 years or older with valvular heart disease underwent open heart surgery. There were 12 males and 9 females with a mean age of 71.2 years (range 70 to 76). Eight patients were in NYHA class III, and 4 in class IV preoperatively. AVR was performed in 10 patients, MVR, MVR with TAP, OMC, AVR with MAP, DVR with TAP in 4, 4, 1, 1, and 1, respectively. Mechanical and bioprosthetic valves were replaced in 11, and 9 patients respectively. There were 6 early death (4 operative, 2 hospital). Longer duration of cardiopulmonary bypass (p < 0.05) and aortic crossclamp time (p < 0.05) were the risk factors independently for early mortality. Follow-up of 15 hospital survivors was 100% (8 months-7.7 years, mean: 3.2 years) and cumulative follow-up was 47.6 patients years (PY). There was one late death, and one prosthetic valve endocarditis (2.1%/PY). No other valve-related complications was occurred. Actuarial survival rate and freedom from valve-related morbidity at seven years were 83.3%, and 93.3%, respectively. These results show that operative mortality of valvular disease in elderly patients remains high, but the late results is acceptable one. Valve surgery for these elderly patients is reasonably acceptable.

Loading of lipophorin particles with phospholipids at the midgut of Rhodnius prolixus

32P-Labelled midguts (32P-midguts) of Rhodnius prolixus females were incubated in the presence of nonradioactive purified lipophorin and the release of radioactivity to the medium was analysed. The radioactivity found in the medium was associated with lipophorin phospholipids. When the 32P-midguts were incubated in the absence of lipophorin, no 32P-phospholipids were found in the medium. Comparative analysis by thin-layer chromatography of 32P-phospholipids derived from metabolically labelled 32P-midgut or lipophorin particles after incubation with 32P-midgut showed some differences, revealing a possible selectivity in the process of phospholipids transfer. The transfer of phospholipids to lipophorin was linear with time up to 45 min, was saturable with respect to the concentration of lipophorin, and was half-maximal at about 5 mg/ml. The binding of 32P-lipophorin to the midgut at 0 degrees C reached the equilibrium at about 1 h of incubation. The binding of 32P-lipophorin was inhibited by an excess of nonradioactive lipophorin, which suggests a specific receptor for lipophorin. The capacity of midguts and fat bodies to transfer phospholipids to lipophorin varied during the days following the meal. When lipophorin enzymatically depleted of phospholipids by treatment with phospholipase A2 was incubated with 32P-midguts, the same amount of phospholipids was transferred, indicating a net gain of phospholipids by the particle.

Studies on the preparation of bioactive lignans by oxidative coupling reaction. IV. Oxidative coupling reaction of methyl (E)-3-(3,4-dihydroxy-2-methoxyphenyl)propenoate and lipid peroxidation inhibitory effects of the produced lignans

The oxidative coupling reaction of the hydroxycinnamate 11 derived from daphnetin has been investigated. The reaction with silver oxide afforded, after acetylation, a dihydrobenzofuran derivative 17 and a benzodioxane derivative 16a as major products accompanied with a small amount of a bis(benzylidene)succinate 18 and a dihydronaphthalene 19, while the oxidation with iron(III) chloride gave the dihydronaphthalene derivative 20 corresponding to 19. The reaction with potassium hexacyanoferrate(III) and Na2CO3 produced, after acetylation, 16a and 19 in lower yields. The propensity for product formation in the reaction of 11 is discussed in relation to data for the reactions of hydroxycinnamate derivatives studied so far. The obtained compounds were tested for inhibitory effects on lipid peroxidation in rat brain homogenate and rat liver microsomes. In the rat brain homogenate the five compounds showed inhibitory activity more potent than that of idebenone. Compounds 17 and 20 were then tested in rat liver microsomes, and found to be more potent than schizotenuin A and much more potent than (+/-)-alpha-tocopherol.

The formation and functioning of yeast mitotic spindles

The mitotic spindle contains the machinery responsible for sister chromatid segregation. It is composed of a complex and dynamic array of microtubules, which are nucleated from the spindle poles. Studies of yeast spindle functions by molecular genetic analysis and by in vitro functional analysis have identified proteins that are mitosis-specific and present at very low concentrations in the cell, and have revealed the molecular bases of several processes required for the formation and functioning of the mitotic spindle. Here I review the current knowledge of the processes that are common to most eukaryotes: microtubule nucleation at the spindle poles, bipolar spindle assembly, maintenance of the spindle structure, chromosome attachment to the spindle and chromosome separation on the spindle.

Analysis of biological function of poly(ADP-ribosyl)ation in Drosophila melanogaster

To understand the biological function of poly(ADP-ribosyl)ation of proteins, we have isolated and characterized the gene for poly(ADP-ribose) polymerase from Drosophila melanogaster. Two approaches were taken to analyze the function of the poly(ADP-ribosyl)ation reaction. The first is analysis of the homology of the amino acid sequences of poly(ADP-ribose) polymerase from phylogenetically different eukaryotes, namely human, mouse, bovine, chicken, Xenopus laevis and Drosophila melanogaster and elucidation of the conserved amino acid sequences that appear to be important for the function of poly(ADP-ribose) polymerase. Analysis of the recombinant poly(ADP-ribose) polymerase which had truncated or mutated motifs expressed in E coli would confirm the importance of the conserved amino acid sequence. The interaction of poly(ADP-ribose) polymerase with other proteins involved in DNA repair, replication, recombination and transcription will clarify the function of poly(ADP-ribosyl)ation. The second approach is to get the mutants which have disruption in the poly(ADP-ribose) polymerase gene and to analyse the phenotypes of these mutants. The characterization of these mutants will be discussed.

Antimicrotubule effects of the novel antitumor benzoylphenylurea derivative HO-221

The antitumor action of HO-221, a novel benzoylphenylurea derivative, was studied. The in vitro cytotoxic strength of HO-221 was investigated, as measured by IC50 values, compared with those of other drugs with different action mechanisms, using Chinese hamster lung (CHL) cells, mouse leukemia L1210 cells and human promyelocytic leukemia HL-60 cells. Morphological alterations following treatment were observed under a phase contrast microscope, and the mitotic index was determined at regular intervals to check for accumulation of metaphase cells. HO-221 was found to have a very strong toxic effect on all cell types, equal to that of the spindle poisons used as controls. HO-221 also produced the same specific morphological changes as the spindle poisons, with a significant accumulation of metaphase cells. A chromosome analysis of treated cells showed that HO-221 frequently induced polyploid and aneuploid cells, but without accompanying chromosome-breaking activity. An in vivo mouse bone marrow micronucleus assay was also carried out. The assay allowed the in vivo identification of a chromosome breaker or a spindle poison through the measurement of the relative sizes of micronuclei produced and erythrocytes. HO-221 was found frequently to induce relatively large micronuclei, an action regarded as specific to spindle poisons. It was thus demonstrated that HO-221 acts as a spindle poison both in vitro and in vivo. In order to investigate the mechanism of this action, a study of tubulin assembly using purified calf brain tubulin was carried out, which demonstrated clearly that HO-221 inhibits microtubule assembly. A detailed investigation of the action mechanism of HO-221 as a spindle poison is now called for.

Studies on the preparation of bioactive lignans by oxidative coupling reaction. III. Synthesis of polyphenolic benzofuran and coumestan derivatives by oxidative coupling reaction of methyl (E)-3-(4-hydroxy-2-methoxyphenyl)propenoate and their inhibitory effect on lipid peroxidation

Three dihydrobenzofuran derivatives 11, 19, 22, a Pummerer's ketone 20 and a dimeric phenylpropanoid 24 were synthesized by oxidative coupling reaction of methyl (E)-3-(4-hydroxy-2-methoxyphenyl)propenoate 10, which was prepared from umbelliferone. The major product 11 was converted into its acetate 21 and schizotenuin D analogs 27, 28, 29. A new coumestan derivative 13 was synthesized from 29. Ten synthetic compounds thus obtained were tested for inhibitory effects on lipid peroxidation in rat brain homogenate.

Protein C deficiency found in a patient with acute myocardial infarction: a single base mutation 157 Arg (CGA) to stop codon (TGA)

Protein C has an important role in the regulatory mechanisms of coagulation and fibrinolysis. In patients with heterozygous protein C deficiency, there is an increased risk for thromboembolic disease, especially in the venous system. We describe a patient with protein C deficiency presenting with an acute myocardial infarction (AMI). Direct sequence analysis of the whole protein C gene detected a single base mutation at exon 7; 157 [Arg(CGA) to stop codon (TGA): 6182 C to T]. Thus, the patient was suspected to have a deficiency of the protein C heavy chain molecule, resulting in both a low protein C antigen and activity level. The mutation was also found in the propositus' son and was confirmed by differential termination of the primer extension (DTPE).

Coexpression of the collagen-binding stress protein HSP47 gene and the alpha 1(I) and alpha 1(III) collagen genes in carbon tetrachloride-induced rat liver fibrosis

HSP47 is a collagen-binding stress protein and is assumed to act as a collagen-specific molecular chaperone during the biosynthesis and secretion of procollagen in the living cell. The synthesis of HSP47 has been reported to correlate with that of collagen in several cell lines. We examined the expression of HSP47 mRNA during the progression of carbon tetrachloride (CCl4)-induced liver fibrosis in rats. Northern blot analysis revealed that the expression of HSP47 mRNA was markedly induced during the progression of fibrosis in parallel with alpha 1(I) and alpha 1(III) collagen mRNAs. By in situ hybridization, the distribution of HSP47 transcripts was similar to that of alpha 1(I) collagen and was observed only in cells lining collagen fibrils. These collagen-positive cells were confirmed to be Ito cells by immunohistochemistry for desmin. The absence of high levels of HSP47 mRNA in the liver of rats treated with only a single administration of CCl4 indicated that the induction of HSP47 mRNA was not due to the direct effect of CCl4 as a stressor, but was due to the progression of liver fibrosis. The function of HSP47 in liver fibrosis will also be discussed.

Studies on the preparation of bioactive lignans of oxidative coupling reaction. I. Preparation and lipid peroxidation inhibitory effect of benzofuran lignans related to schizotenuins

The parent benzofuran lignan 4 of schizotenuins 1-3 and related compounds were efficiently prepared by a judicious use of the oxidative coupling reaction, and were tested for their inhibitory effects on lipid peroxidation in rat brain homogenate and rat liver microsomes. Among twelve compounds tested in rat brain homogenate, compounds 13, 14 and 16 showed prominent inhibitory activity. Compounds 13 and 16 were then tested in rat liver microsomes, and their activity was found to be more potent than schizotenuin A (1) and much more potent than that of (+/-)-alpha-tocopherol.