Inflammatory pseudotumor of the liver with primary sclerosing cholangitis

Inflammatory pseudotumor (IPT) of the liver is a rare benign variant of hepatic masses, and its exact etiology has not been elucidated. We report a case of IPT associated with primary sclerosing cholangitis (PSC). The patient was a 50-year-old man admitted to our hospital because of jaundice. Abdominal ultrasonography (US) and computed tomography showed multiple dilations of the intrahepatic bile ducts and multiple masses in the liver. On magnetic resonance imaging, the masses were slightly hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. On T1-weighted images after the bolus infusion of Gd chelate, the masses had no contrast enhancement, and they were hypointense in the arterial phase and portal venous phase. However, they were slightly enhanced and became almost isointense relative to the surrounding normal liver parenchyma in the delayed phase. Endoscopic retrograde cholangiography demonstrated multiple irregular strictures and dilations of the intrahepatic bile ducts. Angiography demonstrated no abnormal findings, but, interestingly, subsequent dynamic CO2-enhanced US showed a strongly hyperechoic string, indicating that an artery had penetrated through the hypoechoic mass. A US-guided percutaneous needle biopsy revealed that the lesions were morphologically comparable to IPT. After cholangiography and microscopic analysis of the tumor, the final diagnosis was determined to be IPT of the liver with PSC. A number of previous reports have suggested a possible relationship between IPT and PSC, based on pathological findings. This report confirmed, based on clinical findings, that PSC is one of the causes of hepatic IPT.

Involvement of a cis-acting element in the suppression of carbamoyl phosphate synthetase I gene expression in the liver of carnitine-deficient mice

The expression of carbamoyl phosphate synthetase I (CPS) gene is suppressed in the liver of carnitine-deficient juvenile visceral steatosis (JVS) mice at weaning and under starvation at adult age. To clarify the suppression mechanism, we produced CPSL transgenic JVS mice carrying a transgene composed of the chloramphenicol acetyltransferase (CAT) gene with the upstream region (-12 kb to +138) of the rat CPS gene and CPSE transgenic JVS mice carrying a transgene composed of the luciferase gene with minimal promoter (299 bp from -161 to +138) and enhancer (469 bp around -6.3 kb) fragments of the rat gene. The expression of the CAT gene as well as the endogenous CPS was suppressed in CPSL transgenic JVS mice, but luciferase gene expression was not suppressed in CPSE transgenic JVS mice. We isolated the 5'-upstream region of the mouse CPS gene and identified an activator protein-1 (AP-1) site downstream of the minimum enhancer region of both rat and mouse CPS genes. In conjunction with the 313-bp mouse promoter region, the 714-bp mouse enhancer fragment conferred a cell-type-dependent hormone responsiveness. In rat primary cultured hepatocytes, the addition of oleic acid suppressed reporter gene expression induced by dexamethasone in the construct containing the enhancer fragment of 714 bp with the AP-1 site, but not in its AP-1 site mutants or in 519 bp without the AP-1 site. These results strongly suggest that direct protein-protein interaction between AP-1 and glucocorticoid receptor is not involved in the suppression of the CPS gene in JVS mice and that the AP-1 element is the cis-element which is responsible for the suppression.

Endoscopic papillary balloon dilatation for common bile duct stones: efficacy of combination with extracorporeal shockwave lithotripsy for large stones

BACKGROUND

Endoscopic papillary balloon dilatation (EPBD) is generally considered a safe and effective technique for removal of common bile duct (CBD) stones. However, some reports have prompted concern about the risk of pancreatitis following the procedure, and it seems to be more difficult and to require adjunctive procedures more frequently in patients with large stones.

AIMS

To analyse the factors influencing pancreatitis after the procedure, and to examine which is the more suitable adjunct for treating large stones, mechanical lithotripsy (ML) or extracorporeal shockwave lithotripsy (ESWL).

PATIENTS AND METHODS

EPBD was performed in 92 patients, including 40 with large stones (> or = 12 mm). These 40 patients were randomly assigned to two groups receiving ML or ESWL to fragment stones (20 patients each).

RESULTS

Complete ductal clearance was obtained in all 92 patients. Significant elevation of the serum amylase level compared with the prior value (> 300 IU/l) was observed in 26 (28%), and eight (8.7%) developed clinical pancreatitis. To assess the influence of various factors on the amylase level, multivariate analysis was used. The number of stones and the time required for treatment had a significant influence on the incidence of increased amylase level (P < 0.05), and ML also significantly increased it (P < 0.05). On the other hand, the amylase level remained low in the ESWL group. ML caused elevation of amylase level in 11 patients (55%), while three (15%) had elevation after ESWL.

CONCLUSIONS

In patients with multiple stones, elevation of the amylase level is more frequent. This seems to be because repeated cannulation and much time is required for treatment. In patients with large stones, the rate was also high if ML was used, but was low when ESWL was used. ESWL may reduce the incidence of pancreatitis.

Anti-AIDS agents. 30. Anti-HIV activity of oleanolic acid, pomolic acid, and structurally related triterpenoids

Oleanolic acid (1) was identified as an anti-HIV principle from several plants, including Rosa woodsii (leaves), Prosopis glandulosa (leaves and twigs), Phoradendron juniperinum (whole plant), Syzygium claviflorum (leaves), Hyptis capitata (whole plant), and Ternstromia gymnanthera (aerial part). It inhibited HIV-1 replication in acutely infected H9 cells with an EC50 value of 1.7 microg/mL, and inhibited H9 cell growth with an IC50 value of 21.8 microg/mL [therapeutic index (T. I.) 12.8]. Pomolic acid, isolated from R. woodsii and H. capitata, was also identified as an anti-HIV agent (EC50 1.4 microg/mL, T. I. 16.6). Although ursolic acid did show anti-HIV activity (EC50 2.0 microg/mL), it was slightly toxic (IC50 6.5 microg/mL, T. I. 3.3). A new triterpene (11) was also isolated from the CHCl3-soluble fraction of R. woodsii, though it showed no anti-HIV activity. The structure of 11 was determined to be 1beta-hydroxy-2-oxopomolic acid by spectral examination. Based on these results, we examined the anti-HIV activity of oleanolic acid- or pomolic acid-related triterpenes isolated from several plants. In addition, we previously demonstrated that derivatives of betulinic acid, isolated from the leaves of S. claviflorum as an anti-HIV principle, exhibited extremely potent anti-HIV activity. Accordingly, we prepared derivatives of oleanolic acid and evaluated their anti-HIV activity. Among the oleanolic acid derivatives, 18 demonstrated most potent anti-HIV activity, with an EC50 value of 0. 0005 microg/mL and a T. I. value of 22 400.

[Aristolochic acids in herbal medicines]

Aristolochic acids are nitrophenanthrenes with a carboxylic acid fanction which have been found only among the Aristolochiaceae. In 1993, rapidly progressive interstitial renal fibrosis has been reported in women have been on a slimming regimen including Chinese herbal medicines in Belgium. In Japan, at the Kansai district, several cases of Chinese herbs nephropathy have been reported quite recently. In both cases, aristolochic acids was detected in the Chinese herbal medicines taken by the patients. We have Asiasarum Root, a species of Aristolochiaceae, in Japanese Pharmacopoeia. Therefore, we quantitatively analysed aristolochic acids in these herbal medicines and related plants.

Usefulness of novel imaging modalities in diagnosis of focal nodular hyperplasia of the liver

A 17-year-old woman was admitted because of a liver tumor found incidentally by ultrasonography. Liver function was normal and there were no markers of hepatitis viruses or malignancy. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging revealed a mass (2 cm in diameter) in the lateral segment of the left lobe of the liver. The lesion was not detected by hepatic arteriography. However, dynamic CT with fast scanning and dynamic CO2-enhanced ultrasonography demonstrated initial central enhancement of the mass followed by centrifugal spread of enhancement to the periphery. Color Doppler flow imaging detected a central color spot, shown to be an artery by a pulsed Doppler spectrum analysis. Fine-needle biopsy confirmed a diagnosis of focal nodular hyperplasia. Dynamic CT with fast scanning, dynamic CO2-enhanced ultrasonography, and color Doppler flow imaging were useful in detecting the vascular pattern specific to focal nodular hyperplasia. Investigation of further cases with these novel imaging modalities should help to establish a comprehensive diagnostic procedure and thus avoid unnecessary surgery for focal nodular hyperplasia, which is a completely benign lesion.

Inhibitory effects of shouseiryu-to on two-stage carcinogenesis. II. Anti-tumor-promoting activities of lignans from Asiasarum heterotropoides var. mandshuricum

Two lignans, asarinin (6) and xanthoxylol (7), were isolated from the radix of Asiasarum heterotropoides var. mandshuricum, which consist of a kampo prescription, Shouseiryu-to, as inhibitors of Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA). These lignans also exhibited remarkable inhibitory effects on a two-stage carcinogenesis test of mouse skin and pulmonary tumors. Furthermore, it was confirmed that these hydrophobic lignans dissolved in the water decoction of Shouseiryu-to, and these lignans might be among the active constituents of this kampo prescription in terms of its anti-tumor-promoting activity.

Deletion of serum lectin-reactive alpha-fetoprotein by acyclic retinoid: a potent biomarker in the chemoprevention of second primary hepatoma

A goal of cancer chemoprevention is the deletion of latent premalignant or malignant clones before they expand to a clinically detectable tumor. However, such clonal deletion has not been demonstrated in clinical studies. We have evaluated serum levels of lectin-reactive alpha-fetoprotein (AFP-L3), which suggests the presence of latent hepatoma cells, in a randomized controlled trial that used acyclic retinoid to prevent second primary hepatomas in patients who had received treatments that cured initial hepatomas. The trial involved 21 patients in each acyclic retinoid (600 mg daily) and placebo group and consisted of a 12-month period of drug administration and a subsequent follow-up period. Serum AFP-L3 was determined at entry and at the end of the 12-month treatment period using lectin-affinity electrophoresis and antibody-affinity blotting. Although neither treatment affected serum levels of total AFP, acyclic retinoid significantly reduced AFP-L3 levels after a 12-month administration (P < 0.01). Acyclic retinoid not only deleted AFP-L3 from patients who had been positive for AFP-L3 at entry but also prevented the appearance of AFP-L3 in patients who had been negative at entry (P < 0.01). In contrast, placebo significantly raised the incidence of AFP-L3-positive patients after a 12-month administration from that at entry (P < 0.05). Patients positive for AFP-L3 after a 12-month treatment had a significantly higher risk of second primary hepatomas in the subsequent follow-up period (P = 0.03). Acyclic retinoid may have deleted a clone of latent hepatoma cells producing AFP-L3 and thereby inhibited second primary hepatomas. Serum AFP-L3 may be a useful intermediate biomarker in the chemoprevention of second primary hepatomas by acyclic retinoid.

Inhibition of Na+,K(+)-ATPase by 1,2,3,4,6-penta-O-galloyl-beta-D-glucose, a major constituent of both moutan cortex and Paeoniae radix

The inhibition of Na+,K(+)-ATPase activity by various constituents of Moutan Cortex and Paeoniae Radix was studied. 1,2,3,4,6-Penta-O-galloyl-beta-D-glucose (PGG), a major component of both crude drugs, strongly inhibited Na+,K(+)-ATPase activity (IC50 = 2.5 x 10(-6) M), whereas galloylpaeoniflorin, benzoic acid, and catechin were weakly inhibitory, and albiflorin, oxypaeoniflorin, paeoniflorin, paconol, and phenol were ineffective. The inhibition of Na+,K(+)-ATPase activity by PGG was decreased in the presence of BSA or phospholipids. The inhibition mode of PGG was noncompetitive with respect to ATP. The K0.5 value for Na+ was increased by the addition of PGG from 9.1 to 12.3 mM, whereas that for K+ was not altered. PGG also inhibited K(+)-dependent p-nitrophenyl phosphatase activity with an IC50 value of 5.3 x 10(-6) M, and the extent of the inhibition increased at higher concentrations of K+. The K0.5 value for K+ was decreased by the addition of PGG from 3.3 to 2.0 mM. These results suggested that the inhibition of Na+,K(+)-ATPase activity is caused by interaction of PGG with the enzyme in the E2 state. The inhibitory effect of Moutan Cortex or Paeoniae Radix is considered to be mainly attributable to PGG.

Ester-type cephalotaxus alkaloids from Cephalotaxus harringtonia var. drupacea

Three alkaloids, neoharringtonine, homoneoharringtonine and 3'S-hydroxyneoharringtonine, were isolated from the leaves and stems of Cephalotaxus harringtonia var. drupacea. Their structures were established by spectroscopic methods, including two-dimensional NMR and CD spectra, and their antileukaemic activity was evaluated using P-388 leukaemia cells.

Extracorporeal shockwave lithotripsy of common bile duct stones without preliminary endoscopic sphincterotomy

BACKGROUND

Endoscopic sphincterotomy (EST) is now a standard procedure for common bile duct stones. It is less invasive than surgical treatment and is well established, but complications such as bleeding and perforation occasionally occur. We have been investigating the safest and most useful method of preserving the papilla of Vater. In the present study we evaluated the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL) for common bile duct stones without preliminary EST.

METHODS

From May 1992 to May 1995 ESWL was performed on 52 patients with common bile duct stones at our hospital. In all 52 patients a nasobiliary tube was inserted endoscopically, without preliminary EST, and ESWL was performed.

RESULTS

Fragmentation and subsequent complete clearance of stones was achieved in 35 patients (67.3%), and no additional treatment was necessary. In 17 patients (25.0%) fragmentation was not achieved, so EST and endoscopic extraction were performed, and the stones were cleared completely. None of the patients had major complications with clinical sequelae. We compared the completely cleared group and the failed group, to assess the influence of various factors. Our findings indicated that smaller, 'floating' stones responded more favorably to ESWL. When the largest stone was < 15 mm in diameter and the stone index (diameter of common bile duct/diameter of stone) was > 1.0, the success rate was very high 25 of 27 = 92.6%).

CONCLUSIONS

This treatment offers several advantages because it is less invasive, has few complications, and can preserve the papilla of Vater. This method is especially suitable for patients with smaller, floating stones.

3-Dehydroshikimate dehydratase in mung bean cultured cells

The activity of 3-dehydroshikimate dehydratase was detected in an extract prepared from cells of mung bean (Vigna mungo) that had been cultured in the presence of shikimate while such activity was not detectable in an extract prepared from cells cultured without shikimate. The enzyme was partially purified and characterized. The maximum activity of the enzyme was observed at pH 7.4. The activity was inhibited to a small extent by EDTA and sulfhydryl inhibitors. The partially purified enzyme was sensitive to thermal denaturation but was stabilized by Mg(2+) ions. These results suggest that 3-dehydroshikimate dehydratase might be induced in mung bean cultured cells in the presence of shikimic acid.

Antitumor agents, 162. Cell-based assays for identifying novel DNA topoisomerase inhibitors: studies on the constituents of Fatsia japonica

Two pleiotropic multi-drug resistant (PDR) KB cell lines were hypersusceptible to a cytotoxic extract from Fatsia japonica. Fractionation of an active extract using a cell-based assay for DNA topoisomerase inhibitors led to the isolation of three known triterpene glycosides, FJ-1-3 [1-3]. The structures of 1-3 were identified as 3-O-alpha-L-arabinopyranosyl-oleanolic acid [1], 3-O-alpha-L-arabinopyranosyl-hederagenin [2], and 3-O-[beta-D-glucopyranosyl(1-->4)-alpha-L-arabinopyranosyl]-hed eragenin [3], respectively. However, these isolates were not DNA topoisomerase II inhibitors in vitro and nor were they active when re-tested for differential cytotoxicity. Compounds 1-3 appear to function by interfering selectively with cellular drug accumulation. Other fractions probably contained compounds active against DNA topoisomerase I; however, the enriched preparations were not cytotoxic. The present findings indicate a simple modification to improve the cell-based bioassay procedure employed to guide fractionation.

Anti-AIDS agents, 21. Triterpenoid saponins as anti-HIV principles from fruits of Gleditsia japonica and Gymnocladus chinensis, and a structure-activity correlation

Gleditsia saponin C [1] and gymnocladus saponin G [2] were isolated from Gleditsia japonica and Gymnocladus chinensis, respectively, as anti-HIV principles. Compounds 1 and 2 demonstrated inhibitory effects against HIV replication in H-9 cells with EC50 values of 1.1 and 2.7 microM, respectively. Evaluation of the anti-HIV activities of the prosapogenins of 1 and 2 suggested that the unusual monoterpenyl moieties in 1 and 2 are essential for their anti-HIV activity. Derivatives of echinocystic acid [8], the aglycone of compound 1, were also prepared and evaluated for inhibitory activity against HIV replication. 3,16-Di-O-acetylechinocystic acid [12] was shown to be an anti-HIV agent with an EC50 value of 2.3 microM.

[Effect of 5-FU on the utilization of purine and pyrimidine by human gastric cancer cells (KATO III)]

Effect of utilization of purine and pyrimidine in the culture medium by human gastric cancer cells (KATO III) was evaluated. Nucleosides mixture solution (OG-VI), consisting of inosine, guanosine 5' monophosphate (5'GMP), cytidine, uridine and thymidine (4: 4: 4: 3: 1 in molar ratio) was used and their levels in the culture medium was measured by HPLC after 3 day culture. Purine, inosine and 5' GMP, in the medium almost decreased and purine base, xanthine and hypoxanthine levels increased, but changes in pyrimidine level were minimal. 5-FU decreased purine and increased pyrimidine consumption. Addition of nucleosides mixture did not enhance the cellular proliferation, but inhibited growth when given in higher concentrations. Nucleoside mixture solution enhanced growth inhibition by 5-FU and it is a potential biochemical modulator of 5-FU metabolism in human cancer cells.

Two new iridolactones and their glycosides from the roots of Patrinia scabra

Investigation of the roots of Patrinia scabra afforded two new iridolactones, patriscabrol and isopatriscabrol. Their structures have been established by extensive analysis of their NMR spectra and an X-ray crystallographic analysis of patriscabrol. Four monoglucosides of each iridolactone were also isolated together with an apioside of glucosidic patriscabrol.

Effect of nucleosides and a nucleotide mixture on proliferation of human gastric cancer cells (KATO III)

The effect of the nucleotides and a nucleotide mixture (OG-VI), consisting of inosine, guanosine 5'-monophosphate (5'-GMP), cytidine, uridine, thymidine (TdR) (4:4:4:3:1 in molar ratio), and TdR co-administration on proliferation of KATO III human gastric cancer cells in culture was evaluated. Consumption of purine and pyrimidine by cancer cells and changes in cell number with OG-VI or TdR were compared with the control culture medium (Williams E) after 72 hour-culture. Addition of OG-VI or TdR did not enhance the cellular proliferation, but inhibited growth when given in higher concentrations (0.3-3 mM inosine, 0.3-3 mM 5'-GMP, 0.22-2.2 mM uridine, 74-740 microM TdR). Consumption rate of TdR in the medium was less in the TdR group, 33.7%, than in the OG-VI group, 72.2% (p < 0.05). This suggests that TdR metabolism is modulated by other nucleosides and nucleotide included in OG-VI. Under the coadministration of 5-fluorouracil (FUra), addition of OG-VI or TdR suppressed cellular proliferation (p < 0.05). The inhibition rate of cellular proliferation in the OG-VI group was slightly higher than the TdR group, but there was no statistically significant difference between the two groups. The combination of FUra with OG-VI or TdR enhances the antitumor effect of FUra. It is concluded that the OG-VI does not enhance the tumor cell proliferation and it is a potential biochemical modulator of FUra metabolism in human cancer cells.

[Terpenoids and curcuminoids of the rhizoma of Curcuma xanthorrhiza Roxb]

The fresh rhizomes of Curcuma xanthorrhiza Roxb. were investigated for terpenoids and curcuminoids. Nine sesquiterpenoids, alpha-curcumene (1), arturmerone (2), xanthorrhizol (3), germacrone (4), beta-curcumene (6), beta-sesquiphellandrene (9), curzerenone (10), alpha-turmerone (11) and beta-turmerone (12), and three curcuminoids, curcumin (7), mono-demethoxycurcumin (8) and bis-demethoxycurcumin (13), were isolated and one monoterpenoid, camphor (5), was identified by capillary GC-MS. Four species of C. xanthorrhiza could be classified into two chemotypes by their bisabolane-type sesquiterpenoid compositions. The first type contained large amounts of 2, 11 and 12 (CX I type). The second type contained large amounts of 1, 3 and 6, and none of 2, 9, 11 and 12 (CX II type). These two chemotypes, CX I type and CX II type, were compared with the two chemotypes of C. longa L., CL I type and CL II type, on their contents by capillary GC and HPLC analysis. It was found that all of them contained curcuminoids, 7, 8 and 13 and large amounts of various bisabolane-type sesquiterpenoids.

Purgative activity and principals of the fruits of Rosa multiflora and R. wichuraiana

Pseudocarps or seeds of Rosa multiflora, crude drug "Eijitsu" have been used as purgative in Japanese traditional medicine. R. wichuraiana was generally thought to be able to substitute for the plant. The n-butanol fractions of both plant seeds were tested on purgative activities with mice, and the values of the 50% effective dose (ED50) were 5.6 g/kg as the seed weight for R. multiflora and 57 g/kg as the seed weight for R. wichuraiana. From pseudocarps of R. multiflora, a new purgative compound, multinoside A acetate, was isolated, and its ED50 value was tested to be 150 mg/kg (77-291 mg/kg, 95% confidence limit). The other isolated compounds were three known quercetin glycosides, quercetin 3-O-xyloside, isoquercitrin and hyperin. From pseudocarps of R. wichuraiana, three quercetin glycosides, isoquercitrin, hyperin and quercetin 3-O-beta-D-glucuronide were isolated similarly, but no purgative components of R. multiflora were detected.

Inhibition of Na+,K(+)-ATPase activity by beta-eudesmol, a major component of atractylodis lanceae rhizoma, due to the interaction with enzyme in the Na.E1 state

beta-Eudesmol, a major component of the crude drug "So-jutsu" (Atractylodis Lanceae Rhizoma), inhibited Na+, K(+)-ATPase activity most strongly among the various kinds of phosphatases examined. It also inhibited Ca(2+)-ATPase and H+, K(+)-ATPase, but to a lesser extent. Its effect on Mg(2+)-ATPase was minute. No effects on H(+)-ATPase or alkaline and acid phosphatase activities were observed. The effects of beta-eudesmol on horse kidney Na+, K(+)-ATPase were studied in detail, and the following results were obtained: (1) beta-eudesmol inhibited the Na+, K(+)-ATPase activity with an I50 value of 1.6 x 10(-4) M. The mode of its inhibition was uncompetitive with respect to ATP; (2) it prevented the stimulation of enzyme activity by Na+. The inhibition gradually increased in accord with the increase of Na+ concentration, and it was constant when Na+ was higher than 6.3 mM; (3) it did not alter the K+ concentration necessary for half-maximal activation (K0.5 for K+); and (4) it inhibited the enzyme activity with a mode of action different from ouabain. Phosphorylation of enzyme with [gamma-32P]ATP was inhibited by beta-eudesmol with an I50 of 1.4 x 10(-4) M. The inhibition was greater in 1 M NaCl than in 0.1 M NaCl. It had no effects on dephosphorylation steps, i.e. none of the non-specific, the ADP-sensitive (Na.E1-P----Na.E1) and the K(+)-dependent (E2-P----K.E2) dephosphorylation processes were affected. These results suggest that beta-eudesmol, a relatively specific inhibitor of Na+, K(+)-ATPase, interacts with the enzyme in the Na.E1 form and inhibits the reaction step Na.E1----Na.E1-P.

Protein kinase C in rat brain synaptosomes. Beta II-subspecies as a major isoform associated with membrane-skeleton elements

A small fraction (approximately 5%) of protein kinase C (PKC) in the adult rat brain synaptosomes is tightly associated with Triton X-100-insoluble components (most likely membrane-skeleton elements), and is solubilized only after denaturation with sodium dodecyl sulfate. The kinase domain of this PKC can be released as a soluble form after limited proteolysis with calpain, whereas the regulatory domain which binds phorbol ester remains insoluble. The PKC in this fraction was identified as the beta II-subspecies or its related molecule. Presumably, this enzyme subspecies is responsible for the phosphorylation of a major PKC substrate protein, growth-associated protein-43, which is located in nerve endings as well as in growth cones in association with the membrane-skeleton elements.

Pulmonary stenosis with intact ventricular septum: assessment and indication of reconstructive surgery for residual right-ventricular outflow tract obstruction

If not all of the right ventricular outflow tract obstruction (RVOTO) is removed in the operation for pulmonary stenosis, high right ventricular pressure can sometimes occur afterward. However, it is not easy to assess the amount of RVOTO that is to be removed, and there is no quantifiable method for selecting operative procedures. The aim of this report is to discuss the formulation of a numerical indicator, based on the parameters peak systolic right-ventricular pressure (RVP), systolic systemic arterial pressure (AP), pulmonary valvular orifice size (VS), and body surface area (BSA), from the results obtained in sixty-four open heart surgeries for pulmonary stenosis with intact ventricular septum. A group, in which an outflow tract patch was not used and which had a higher pre-operative RVP/AP ratio, had a tendency to have a correspondingly higher RVP/AP ratio one month after the operation. Most patients with a high RVP/AP ratio one month after the operation showed a significant decrease in this ratio a long time after the operation. But, there were exceptions to this rule where the ratio remained high. Reconstruction of the right ventricular outflow was considered for some patients whose RVP/AP ratios remained high. Reconstruction of the RVOT by using an outflow tract patch worked well for patients with an associated infundibular stenosis. A subannular patch was used for patients with infundibular stenosis, and a transannular patch was used for patients with annular stenosis. The optimal annulus size was such that VS/BSA was not less than 2 cm2/m2. A transannular monocusp patch was applied to an area which was more than 10 mm wide.(ABSTRACT TRUNCATED AT 250 WORDS)

Selective assay of protein kinase C with a specific peptide substrate

Protein kinase C is a family of multifunctional protein serine/threonine kinase and generally accepted to be involved in a wide variety of cellular signal transduction. Biochemical and immunochemical studies as well as sequence analysis of its cDNA clones have revealed the existence of multiple subspecies of this enzyme with obvious tissue-specific expression. Enzymatic properties of type I, II, and III protein kinase C subspecies, which are encoded by gamma-, beta I- and beta II, and alpha-cDNA, respectively, are well characterized. Many proteins and peptides are reported as phosphate acceptors of these protein kinase C subspecies. In this study, it is shown that a synthetic peptide, Gln-Lys-Arg-Pro-Ser-Gln-Arg-Ser-Lys-Tyr-Leu, which corresponds to amino acid residues 4-14 of bovine myelin basic protein, is the most specific and convenient substrate for selective assay of protein kinase C among various phosphate acceptor proteins and peptides. This peptide is phosphorylated at Ser-8, but not Ser-11 by protein kinase C subspecies in a manner dependent on Ca2+, phosphatidylserine, and diacylglycerol. This peptide is not phosphorylated by other protein serine/threonine kinases such as cyclic AMP-dependent protein kinase. Thus, it is possible to assay protein kinase C activity in the crude tissue extracts selectively using this peptide as a phosphate acceptor.

[The effects of crude drugs using diuretic on horse kidney (Na+ + K+)-adenosine triphosphatase]

In the folk-medicine, several kinds of crude drugs are used as diuretics. Twenty three kinds of diuretic drugs were chosen, and examined for their effects on the horse kidney (Na+ + K+)-adenosine triphosphatase (ATPase), which is an intrinsic enzyme of the plasma membrane and responsible for the active transport of Na+ and K+ across the membrane. Twenty one out of twenty three kinds of ethanol extracts of diuretic drugs inhibited the kidney (Na+ + K+)-ATPase activity. The intensity of the inhibition of these drugs was compared by estimating the amounts of their ethanol extracts which inhibited the (Na+ + K+)-ATPase activity by 50% (I50, micrograms/ml). Among these drugs, Atractylodis Lanceae Rhizoma (I50 = 12.8) Atractylodis Rhizoma (I50 = 15.2), Plantaginis Semen (I50 = 16.0), Plantaginis Herba (I50 = 16.0) and Alismatis Rhizoma (I50 = 22.0), have strong inhibitory effects on the kidney (Na+ + K+)-ATPase activity. The ethanol extracts of the rhizomes of Atractylodes lancea De Candolle and Atractylodis japonica Kitamura were examined with varying concentrations of ATP and ouabain. The mode of inhibition of these two extracts on the (Na+ + K+)-ATPase activity appeared to be uncompetitive with respect to ATP as judged from Lineweaver-Burk plot. The ethanol extract of Atractylodes japonica Kitamura decreased the I50 for ouabain from 1.6 x 10(-7) to 7.0 x 10(-9) M, while that of Atractylodes lancea De Candolle did not change the I50 for ouabain.

A case of systemic lupus erythematosus--its clinical and MRI resemblance to multiple sclerosis

We documented a case of systemic lupus erythematosus with clinical features of multiple sclerosis who developed transverse myelopathy. Magnetic resonance imaging showed the presence of an abnormal high signal intensity in the gray matter of a swollen spinal cord corresponding to the patient's neurological deficits. After two previous episodes of exacerbation and remission consistent with the clinical diagnosis of multiple sclerosis, right hemiparesis and hemisensory disturbances ensued, then lupus nephritis was confirmed by a renal biopsy.

Protein kinase C during differentiation of human promyelocytic leukemia cell line, HL-60

Protein kinase C (PKC) from human promyelocytic leukemia HL-60 cells can be resolved into three fractions (peak, a, b and c) by hydroxyapatite column chromatography. Peak a and c enzymes are indistinguishable from the brain type II PKC having beta (beta I and beta II)-sequence and type III having alpha-sequence, respectively. Peak b enzyme is a previously unidentified PKC subspecies that has enzymological properties subtly different from type I (having gamma-sequence), type II and type III PKC. Upon treatment of HL-60 cells with 1 microM retinoic acid, this peak b enzyme is decreased dramatically within 24 h, whilst peak a enzyme (beta-PKC) is increased, and peak c (alpha-PKC) enzyme is slightly decreased within 48 h. The result implies that the PKC subspecies in HL-60 cells have distinct functions during cell differentiation.

[Neuro-psychiatric symptom associated with primary Sjögren's syndrome]

Neuro-psychiatric complications of primary Sjögren's syndrome (SjS) were studied on their frequency and characteristics of clinical signs in 150 patients of our clinic. Clinical symptoms and laboratory examinations were compared in the patients group complicated with neuro-psychiatric symptoms and the non-complicated group. Neuro-psychiatric symptoms (neuro SjS) were complicated with 63 patients (42.0%). Central nervous system (CNS) involvement were occurred in 47 patients (31.3%). In this group (CNS SjS), psychiatric complications were observed in 43 patients (28.7%), consisted with 29 cases of neurosis, 7 cases of depression, 6 cases of presenile dementia, and others. Nine patients (6.0%) in this group had neurologic involvement that were 3 cases of aseptic meningitis, 3 cases of neurogenic bladder, and each case of multiple infarction, multiple sclerosis, and others. These 9 patients showed more frequently positive results for rheumatoid factor, anti-SSA antibody, leucopenia, and lymphopenia, so this subgroup might be consisted of a small group which was resemble to systemic lupus erythematosus. Cranial nerve involvement, mainly injured in trigeminal nerve, and peripheral nerve involvement were complicated with 5 patients (3.3%) and 24 patients (16.0%), respectively. In neuro-psychiatric complicated group, mean age was older and dry mouth were more frequent (p less than 0.05) than non-complicated group. In psychiatric complicated group, mean age was older (p less than 0.01) and dry mouth were more frequent (p less than 0.05). In any groups of neuro-psychiatric complications, the frequency of any autoantibodies was not statistically different from non-complicated group. But, in the group of cranial nerve involvement, anti-RNP antibody was 60.0% positive (in non-complicated group, 17.2%: p less than 0.05). In CNS SjS group, magnetic resonance imaging (MRI) abnormalities were occurred in 8 of 13 patients. High intensity lesions in white matter on the T2-weighted examinations was characteristic, which showed lacnar infarctions or demyelinated lesions in MRI abnormalities. In CNS SjS, corticosteroid or immunosuppressant was not always necessary, because this complication was self-limited or enough controlled by minor-tranquilizer or anti-depressant. The character of onset in neuro SjS was chronic and neuro SjS was insidiously developing disease. And more studies including treatment on neuro SjS were needed.

A synthetic peptide substrate for selective assay of protein kinase C

Among various phosphate acceptor proteins and peptides so far tested, a synthetic peptide having the sequence surrounding Ser(8) of myelin basic protein, Gln-Lys-Arg-Pro-Ser(8)-Gln-Arg-Ser-Lys-Tyr-Leu, (MBP4-14), is the most specific and convenient substrate which can be used for selective assay of protein kinase C. This peptide is not phosphorylated by cyclic AMP-dependent protein kinase, casein kinases I and II, Ca2+/calmodulin-dependent protein kinase II, or phosphorylase kinase, and can be routinely used for the assay of protein kinase C with low background in the crude tissue extracts. The Km value is considerably low (7 microM) with a Vmax value of twice as much as that for H1 histone.

[Clinical application of laryngeal mask airway]

The laryngeal mask is a unique alternative to the face mask and endotracheal tube offering significant benefits to both anesthesiologist and patient. We have applied laryngeal mask, 1) to create an adequate airway in cases of difficult or impossible intubation, 2) to establish a pathway for the fiberoptic bronchoscope, 3) to clear the airway for eye operation, and 4) to maintain the airway in patients in the lateral position. Further study, however, is necessary to establish definite indication for its application.

[Comparison of myocardial protective effects between GIK solution and St. Thomas solution by use of canine isolated heart-lung preparations]

The myocardial protection afforded by GIK solution, widely used as cardioplegic solution in this country, was compared with that provided by St. Thomas solution or oxygenated St. Thomas solution. Eighteen isolated heart-lung preparations of dogs were made and their hearts were subjected to 3 hours cold (4 degrees C) cardioplegic arrest. GIK group hearts (n = 6) received 20 ml/kg of GIK solution at the time of aortic cross-clamp perfused through the aortic root and were subsequently given 10 ml/kg of GIK solution every 30 minutes. St. Thomas group hearts (n = 6) and oxygenated St. Thomas group hearts (n = 6) were treated identically except that cardioplegic solution were St. Thomas solution or fully oxygenated one. Four hearts of GIK group showed ventricular fibrillation immediately after reperfusion that required DC countershock. Temporary A-V block was recognized in two hearts. In the other two groups, however, neither ventricular fibrillation nor A-V block was found. Heart rate, coronary flow, aortic flow and LVSW were measured before arrest and after 60 minutes of reperfusion (mean aortic pressure 70 mmHg, left atrial pressure 4 mmHg). Post reperfusion % recovery rates (post-reperfusion/before arrest) of heart rate, coronary flow, aortic flow and LVSW (mean value +/- standard deviation) were 93.4 +/- 10.32%, 104.6 +/- 24.91%, 18.8 +/- 8.54%, 32.6 +/- 6.12% respectively for GIK group, 81.4 +/- 6.50%, 125.9 +/- 15.23%, 35.4 +/- 9.91%, 56.3 +/- 12.90% for St. Thomas group and 83.1 +/- 8.40%, 121.6 +/- 16.92%, 47.0 +/- 7.89%, 69.1 +/- 9.71% for oxygenated St. Thomas group. St. Thomas and oxygenated St. Thomas groups revealed significantly (p less than 0.05, p less than 0.01 respectively) more excellent functional preservation than GIK group. Intramyocardial pH was also measured by use of glass needle pH electrode punctured into the anterior interventricular septum. Preischemic intramyocardial pH (at 37 degrees C) was 7.49 +/- 0.106 in GIK group, 7.48 +/- 0.113 in St. Thomas group and 7.43 +/- 0.114 in oxygenated St. Thomas group. During 3 hours of cardioplegic arrest, intramyocardial pH (at 4 degrees C) decreased to 6.84 +/- 0.101 in GIK group, 7.03 +/- 0.088 in St. Thomas group and 7.23 +/- 0.239 in oxygenated St. Thomas group, which was significantly higher than GIK group (p less than 0.01). Therefore oxygenated St. Thomas solution was found to maintain more favorable energy supply to ischemic myocardium. These results clearly evidenced that St. Thomas and oxygenated St. Thomas solutions would provide more effective myocardial protection during ischemic arrest than GIK solution.

[Laryngeal mask--a newly designed oral airway]

A newly developed oral airway, laryngeal mask (LM), was used in 40 patients by anesthesiologists of varied clinical experiences. Clear airway was obtained in 37 patients (92.5%). There were 3 patients in whom it was difficult to establish clear airway, probably because of inappropriate fitting of mask to larynx or of folding of epiglottis. Controlled or assisted ventilation was performed adequately in most of the patients, but there was recognizable gas leak in 13 patients when the airway pressure was above 15 cmH2O. The LM has many attractive features compared with a traditional face mask, and some of the promising clinical applications of LM are discussed.

Limited proteolysis of protein kinase C subspecies by calcium-dependent neutral protease (calpain)

Limited proteolysis of three distinct subspecies of protein kinase C (Ca2+/phospholipid-dependent enzyme, PKC), types I (gamma), II (beta I and beta II), and III (alpha), with Ca2+-dependent neutral proteases I and II (calpains I and II) was studied. All forms of PKC (82 kDa) were converted to two major fragments: a 45-49-kDa catalytic fragment and a 36-kDa regulatory fragment. The cleavage of these PKC subspecies by calpain I (active in the micromolar range Ca2+/ion concentration), and, to a lesser extent, by calpain II (active in the millimolar range), was enhanced by the simultaneous presence of phospholipid and diacylglycerol or phorbol ester, suggesting that the activated form of PKC is the preferred target for proteolysis. Analysis of the NH2-terminal sequence of the resulting catalytic fragments indicated that both calpains I and II cleave at one or two specific sites in the third variable region (V3) of each PKC molecule. Under comparable conditions with calpains I and II, the relative rates of cleavage of types I, II, and III PKC were approximately 100:16:2 and 100:48:23, respectively. The results imply that within the cell various PKC subspecies may be cleaved at different rates under different physiological conditions.

Generation of monoclonal anti-dermatan sulphate antibodies cross-reacting to calf thymus DNA

Monoclonal anti-dermatan sulphate antibodies were produced with hybridization after immunizing BALB/c mice with dermatan sulphate (DS). These antibodies were tested for cross-reactivity to double-stranded DNA (dsDNA) and heat-denatured DNA (ssDNA). Five clones had binding activity to DS, dsDNA and ssDNA in enzyme-linked immunosorbent assay, but no clones binding to DS alone were produced. Two (2H8 and 3C4) of the five clones were selected for analysis. Their binding activity to DS, ssDNA and dsDNA were inhibited by DS, dsDNA and ssDNA. DNase I treatment abolished the binding activity to dsDNA and ssDNA, completely, but had no effect on the binding activity to DS. On the other hand, chondroitinase ABC treatment of the solid-phased DS augmented the binding to DS. The inhibition assay using digested fractions suggested that the epitope recognized by 2H8 and 3C4 clones could not be in delta Di-4S or delta Di-diSB but in the linkage regions of DS.

Prevention by gamma interferon of fatal infection with Listeria monocytogenes in mice treated with cyclosporin A

The significance of interferons (IFNs) induced by Listeria monocytogenes in the antilisterial defense mechanism was studied in mice. Cyclosporin A (CsA) had no effect on IFN-alpha production that was induced in the bloodstream after intravenous infection of mice with L. monocytogenes, whereas IFN-gamma that was induced in the bloodstreams of control mice 6 h after stimulation with specific antigen in the late phase of infection was suppressed in CsA-treated mice, depending on the dose of the drug injected. The decrease in IFN-gamma production caused an increase in bacterial growth in the spleens and livers of CsA-treated mice. Furthermore, administration of a daily dose of CsA at 80 or 100 mg/kg of body weight resulted in fatal listeriosis, even though the dose was nonlethal for normal mice. The administration of recombinant murine IFN-gamma on day 0 of L. monocytogenes infection prevented CsA-treated mice from developing fatal listeriosis and restored their ability to produce IFN-gamma in the bloodstream, in response to specific antigen in the late phase of infection.

[Newly designed approach to an aneurysm eroding the sternum and protruding over the sternum]

A 54-year old man was admitted with a complaint of a pulsating tumor (7 x 6 x 2 cm) above the sternum accompanied by dysphagia. DSA showed the pulsating tumor was an aneurysm arising from the ascending aorta. CT gram of the sternum showed that the sternum was destroyed partially at the level of the 1st rib. We did the Y shaped skin incision. The clavicles, 1st and 2nd ribs were dissected out periosteally and perichondrially. We cut the clavicles and ribs, and dissected the mediastinum median to the internal mammary artery. Under the perfusion, F-F bypass and brain perfusion, the upper half of the sternum was dissected safely from the aneurysm. The aneurysm was false aneurysm and the perforating ostium was 3.5 cm in diameter. The margin of the perforating ostium had a deposit of calcium. Using an occlusion balloon catheter from the ostium, patch closure was done. The postoperative course was uneventful. We believe that this new approach is preferable to the severe erosion of the sternum by the aneurysm.

Tracheal dilatation by halothane and enflurane in man

The effect of halothane and enflurane on tracheal tone were studied in 21 patients during the induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia, maintained by nitrous oxide 70% in oxygen, was supplimented with succinylcholine drip infusion to immobilize the patient. Ventilation was controlled by a Volume-preset ventilator. In the halothane group, the initial cuff pressure was 14.8 +/- 1.3 (mean +/- SE) cmH(2)O but 10 min after 0.15 mg/kg of pancuronium injection, it increased to 21.7 +/- 2.3 cmH(2)O (control). Ten min after inhalation of 0.75% of halothane, cuff pressure decreased to 14.7 +/- 2.3 cmH(2)O (34 +/- 11% decrease from the control value). In the enflurane group, the initial cuff pressure was 17.6 +/- 1.8 cmH(2)O and it increased to 21.0 +/- 1.7 cmH(2)O (control) 10 min after pancuronium injection. Ten min after 1.7% of enflurane inhalation, cuff pressure decreased to 17.1 +/- 2.3 cmH(2)O (23.9 +/- 6% decrease from the control value). Halothane and enflurane produced similar tracheal dilatation in healthy individuals.

Induction of alpha/beta interferon and gamma interferon in mice infected with Listeria monocytogenes during pregnancy

Alpha/beta interferon (IFN-alpha/beta) was induced in the bloodstream of mice 48 h after intravenous infection with Listeria monocytogenes, whereas IFN-gamma was induced in the bloodstream 6 h after stimulation with specific antigen on day 5 of infection in virgin mice. In contrast, no IFN-alpha/beta or IFN-gamma was produced in the bloodstream of pregnant mice after L. monocytogenes infection. However, unusual acid-labile IFN-alpha/beta instead of IFN-gamma was produced in some of the pregnant mice in response to specific antigen. The bacterial growth in the organs of pregnant mice in the early stage of infection was normal, but resulted in the delay of T-cell-dependent elimination of bacteria from the organs of pregnant animals in the late stage, and numerous bacteria were detected in both the placenta and the fetus. The significance of the IFN system induced by L. monocytogenes infection in pregnant mice is discussed.