Simultaneous genotyping of alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 by single‐strand conformation polymorphism analysis

Alcohol dehydrogenase (ADH; EC 1.1.1.1) and aldehyde dehydrogenase (ALDH; EC 1.2.1.3) have important roles in the elimination of ingested ethanol. These enzymes have polymorphisms resulting from single-point mutations that cause kinetic differences in their respective enzyme activities. Simultaneous observation of these enzymes would be useful in investigating the association between these enzyme polymorphisms and alcohol-related problems. In this study amplified genomic DNA was amplified from nail clippings with two sets of primers for ADH2 and ALDH2 genes, respectively, in a micro test tube and the accuracy of the amplification was verified by direct sequencing. The PCR products were separated into four distinct bands by single-strand conformation polymorphism analysis. This genotyping method is fast, accurate. reliable and inexpensive, and requires the same amount of template DNA as non-simultaneous methods. In other words, the required amount of template DNA for this method is only half that required for the separate genotyping of ADH2 and ALDH2.

[New technology of intraaortic balloon pumping device]

Intraaortic balloon pumping (IABP) is the most popular circulatory assist device in cardiac surgery. In the development of IABP several modifications have been made. First, reduction in the caliber to 6 Fr is the most important modification of the IABP catheter to relatively small Japanese patients. Second, direct pressure measurement through the tip of the catheter enabled more accurate and real-time assist. Third, a novel balloon pump automatically selects the trigger source, arranges the timing of the IABP inflation/deflation, and detects the arrhythmias. Further development of IABP will bring safer and more reliable hemodynamic management in cardiac surgery.

Sensorless control for a sophisticated artificial myocardial contraction by using shape memory alloy fibre

The authors have been developing an artificial myocardium, which is capable of supporting natural contractile function from the outside of the ventricle. The system was originally designed by using sophisticated covalent shape memory alloy fibres, and the surface did not implicate blood compatibility. The purpose of our study on the development of artificial myocardium was to achieve the assistance of myocardial functional reproduction by the integrative small mechanical elements without sensors, so that the effective circulatory support could be accomplished. In this study, the authors fabricated the prototype artificial myocardial assist unit composed of the sophisticated shape memory alloy fibre (Biometal), the diameter of which was 100 microns, and examined the mechanical response by using pulse width modulation (PWM) control method in each unit. Prior to the evaluation of dynamic characteristics, the relationship between strain and electric resistance and also the initial response of each unit were obtained. The component for the PWM control was designed in order to regulate the myocardial contractile function, which consisted of an originally-designed RISC microcomputer with the input of displacement, and its output signal was controlled by pulse wave modulation method. As a result, the optimal PWM parameters were confirmed and the fibrous displacement was successfully regulated under the different heat transfer conditions simulating internal body temperature as well as bias tensile loading. Then it was indicated that this control theory might be applied for more sophisticated ventricular passive or active restraint by the artificial myocardium on physiological demand.

Acquired left ventricular-right atrial communication and severe aortic valve regurgitation caused by infective endocarditis

We report here on a surgical case of acquired left ventricular right atrial communication (LV-RA communication) and aortic regurgitation (AR) caused by infective endocarditis (IE). We successfully treated the patient with composite patches made from polytetrafluoroethylene (PTFE) and autologous pericardium. In general, LV-RA communication is a rare congenital cardiac anomaly (Gerbode-type shunt). However, acquired LV-RA communications secondary to IE are occasionally reported.When repairing an acquired condition due to IE, particular care should be taken to avoid recurrence, persistent infection and iatrogenic atrioventricular block.

[The use of 19 Fr silicone drains in chest surgery]

We evaluated a single 19 Fr Blake drain after chest surgery retrospectively. 50 patients underwent drainage of their pleural cavity using Blake drains. Blake drain was found to be effective in drainage of both air and fluid. In addition, this soft silicone drain seemed to improve the comfort of the patients. One single Blake drain is considered to be an option for chest drainage in most of general thoracic surgery.

[Cardiac surgery in patients with liver dysfunction; preoperative assessment, determinants, and consequences]

The population of patients with liver cirrhosis and congestive liver who are referred for cardiac operation is not large and definitive indications for surgical interventions remain unknown. We reviewed the literature on its clinical features and outcomes after cardiac surgery that would help cardiac surgeons to decide cardiac modality. According to our experiences, in cirrhotic patients, cardiac surgery can be performed safely in Child-Pugh class A and selected patients with class B. In addition, liver cirrhosis causes postoperative deterioration of liver function, especially when the indocyanine green (ICG)-R15 value exceeds 40%. Technetium-99m galactosyl human serum albumin liver scintigraphy is also useful for preoperative assessment. In patients with congestive liver, preoperative serum total bilirubin and technetium-99m galactosyl human serum albumin liver scintigraphy may become the determinant of indications. Careful patient selection and intensive perioperative care are required to improve the clinical outcome in patients with liver dysfunction undergoing cardiac surgery.

Acceleration of primary liver tumor growth rate in embolized hepatic lobe after portal vein embolization

BACKGROUND

Portal vein embolization (PVE) is now widely accepted as a useful preoperative procedure in selected patients undergoing extended hepatectomy. However, the effect of PVE on the growth of liver tumors has not been fully elucidated.

PURPOSE

To retrospectively evaluate the effects of PVE on the growth of liver tumors in the embolized lobes.

MATERIAL AND METHODS

Eight patients with a primary liver tumor, six hepatocellular carcinomas (HCC) and two cholangiocellular carcinomas (CCC), were studied. The growth rates of the tumors in the embolized lobes and non-embolized liver parenchyma were calculated using the computed tomography (CT) volume values at the time of tumor identification, and before and after PVE.

RESULT

The median tumor growth rate was 0.59 cm(3)/day (range 0.22-6.01 cm(3)/day) before PVE and 2.37 cm(3)/day (range 0.29-13.97 cm(3)/day) after PVE (P = 0.018). The tumor growth acceleration ratios ranged from 1.50 to 7.46 (median 2.65) in the six HCCs, and were 1.00 and 1.32 in the two CCCs. There was no apparent correlation between the tumor growth rate after PVE and the growth rate of non-embolized liver parenchyma (median 6.00 cm(3)/day, range 1.24-11.0 cm(3)/day).

CONCLUSION

Liver tumor growth in an embolized lobe accelerates after PVE, in patients with HCC.

Expression of immature and mature retinal cell markers in retinoblastoma

AIM

To clarify the expression of immature and mature retinal cell makers in retinoblastoma cells and to give insights into the cell origin of the retinoblastoma.

MATERIALS AND METHODS

Five samples from five eyes diagnosed with retinoblastomas were analysed by a standard immunohistochemistry using antibodies against Nestin and the hairy and enhancer of split mammalian homologue-1 (HES-1), both as markers for undifferentiated cells, and against Chx10, as a marker for both undifferentiated retinal cells and mature bipolar cells. Photoreceptor-specific nuclear receptor (PNR) was used as a postmitotic rod photoreceptor cell-specific marker, glial fibrillary acidic protein (GFAP) as a mature glia cell marker, and microtubule-associated protein (MAP) 2 as a mature neuronal cell marker.

RESULTS

Nestin was detected in what were possibly Müller cells, but not in the tumour stroma. HES-1 was not detected in the retinoblastoma tissue. Chx10 was detected in one of the five samples. In this one sample, Chx10 expression was confined in a minor portion of the retinoblastoma cells. PNR was not detected in the retinoblastoma tissue. Expression of GFAP was detected only in the stromal cells of the tumour, which presumably represents reactive stromal astrocytes. In contrast, in all the samples, MAP2 was expressed in most of the retinoblastoma cells.

CONCLUSIONS

The results of the current study support that retinoblastomas are derived from mature neural cells but do not originate from tumour stem cell(s).

The effect of interaction between hepatitis C virus and cigarette smoking on the risk of hepatocellular carcinoma

We evaluated the interaction between hepatitis C virus (HCV) and cigarette smoking on death from hepatocellular cancer in The Japan Collaborative Cohort Study. The odds ratio of death from HCC for smoking was 9.60 (1.50–61.35) and 1.71(0.58–5.08) among anti-HCV positive and negative individuals, respectively.

Coffee and risk of death from hepatocellular carcinoma in a large cohort study in Japan

We examined the relation between coffee drinking and hepatocellular carcinoma (HCC) mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). In total, 110 688 cohort members (46 399 male and 64 289 female subjects) aged 40–79 years were grouped by coffee intake into three categories: one or more cups per day, less than one cup per day and non-coffee drinkers. Cox proportional hazards model by SAS was used to obtain hazard ratio of HCC mortality for each coffee consumption categories. The hazard ratios were adjusted for age, gender, educational status, history of diabetes and liver diseases, smoking habits and alcohol. The hazard ratio of death due to HCC for drinkers of one and more cups of coffee per day, compared with non-coffee drinkers, was 0.50 (95% confidence interval 0.31–0.79), and the ratio for drinkers of less than one cup per day was 0.83 (95% confidence interval 0.54–1.25). Our data confirmed an inverse association between coffee consumption and HCC mortality.

Improvement of portal hypertension and hepatic blood flow in cirrhotic rats by oestrogen

BACKGROUND

In this study, we investigated the effects of oestrogen on nitric oxide synthase activity and nitric oxide production using the cirrhotic rat liver.

MATERIAL AND METHODS

Cirrhosis was induced by dimethylnitrosamine. Estradiol valerate was subcutaneously injected twice at week 4 after dimethylnitrosamine treatment. Furthermore, subcutaneous injection of an oestrogen receptor antagonist, ICI-182.780, was performed 2 days before administration of estradiol valerate. Portal pressure and hepatic blood flow were measured. Nitric oxide synthase activity was assessed by l-citrulline generation. Sinusoidal endothelial cells were isolated from the cirrhotic rat liver and cultured. The cells were incubated with estradiol and/or ICI-182.780 for 24 h. Images for nitric oxide in sinusoidal endothelial cells were obtained using diaminofluorescein-2 diacetate.

RESULTS

Cirrhotic rats treated with estradiol valerate showed a significant decrease in portal pressure and a significant increase in hepatic blood flow compared with those of control cirrhosis rats. However, in cirrhotic rats treated with ICI-182.780, the reduction of portal pressure and elevation of hepatic blood flow were completely inhibited. In cirrhotic rats treated with estradiol valerate, nitric oxide synthase activity was increased compared with that in control cirrhotic rats. The fluorescent level of intracellular nitric oxide in estradiol-stimulated, cultured, sinusoidal endothelial cells was higher than that in nontreated sinusoidal endothelial cells.

CONCLUSIONS

The present study indicated that oestrogen plays an important role in the enhancement of nitric oxide production in sinusoidal endothelial cells of cirrhotic liver and reduces the portal pressure in cirrhotic rats.

Sustained effects of plasma norepinephrine levels on femoral-radial pressure gradient after cardiopulmonary bypass

In order to determine the influence of the sympathetic nervous system upon the femoral-radial artery pressure gradient after cardiopulmonary bypass (CPB), we examined plasma norepinephrine levels in 34 adult male patients undergoing coronary artery bypass grafting. Cardiovascular parameters, including systolic arterial pressure, mean arterial pressure, cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), hemoglobin (Hb) and peak dP/dt of radial and femoral artery pressures were measured after sternotomy, and immediately after the discontinuation of CPB and 90 min after CPB. Plasma norepinephrine levels were measured after sternotomy, after aortic declamping and 90 min after CPB. The patients were divided into two groups. Group A consisted of 17 patients whose femoral minus radial systolic pressure difference was 15 mmHg or more at 90 min after CPB, while Group B consisted of 17 patients with the difference less than 15 mmHg. Group A patients had significantly longer time values in the duration of both CPB (Group A 175 +/- 10 min; Group B 115 +/- 12 min, P < 0.001) and aortic cross clamping (Group A 116 +/- 7 min, Group B 71 +/- 9 min, P < 0.001). Although there was no significant difference in Hb or PAP of 90 min after CPB in Groups A and B, the following values, listed in the order of A to B, were obtained; CI, 2.79 +/- 0.10 versus 3.46 +/- 0.16 l.min(-1).m(-2) (P < 0.01); mean radial artery pressure (MRP), 58.7 +/- 2.4 versus 65.1 +/- 1.8 mmHg (P < 0.05); peak dP/dt of radial artery pressure, 568 +/- 64 versus 1026 +/- 61 mmHg.sec(-1) (P < 0.001); and plasma norepinephrine concentration, 1.81 +/- 0.25 versus 0.98 +/- 0.10 ng.ml(-1) (P < 0.01), which were statistically significant. The higher femoral-radial artery pressure gradient after CPB was observed in patients with both a longer CPB time and a higher plasma norepinephrine concentration. These results suggest that a marked constriction of peripheral arteries might have produced a damped transmission of the pressure pulse to the radial artery.

Bilateral video-assisted thoracoscopic surgery in the supine position for primary spontaneous pneumothorax

On the basis of the bilateral nature of bullous lesions of the lung, the authors have performed single-stage bilateral video-assisted thoracoscopic surgery (VATS) in the supine position for primary spontaneous pneumothorax in five patients since October 1999. All five patients were males with a mean age of 23 years (range 19 to 29 years). The presenting pneumothorax was ipsilateral (right-sided) in four patients and simultaneous bilateral in the one remaining patient. Apart from the one case of simultaneous bilateral spontaneous pneumothorax (SBSP), all patients had a history of at least one pneumothorax episode requiring tube thoracotomy. Bilateral bullae were confirmed in all patients on preoperative chest computed tomography (CT). Bilateral bullectomy was performed by endo-stapler with no difficulties. Mean operating time was 111 minutes (range 85 to 140 minutes). All patients were returned to the surgical ward in good condition from the operating room immediately after extubation. No complications were observed, and duration of postoperative hospital stay was two to four days. All patients were alive without recurrence of pneumothorax after a mean follow-up period of 25 months (range, 9 to 43 months). Single-stage bilateral VATS in the supine position has shown itself to be an excellent approach for the treatment of bilateral bullous lesions, combining both efficacy and low morbidity.

Supraclavicular Approach Without Thoracotomy for Posterior Mediastinal Tumor

Using a right-sided supraclavicular approach, we operated on a 15-year-old girl with a posterior mediastinal neurogenic tumor and von Recklinghausen's disease. The encapsulated 95 x 65 x 40 mm neurofibroma was removed safely and completely without thoracotomy. No peripheral neurologic defect such as Horner's syndrome, paralysis of accessory nerve, or palsy of the right upper extremity was observed after operation. The postoperative course was uneventful and the patient was discharged on the third postoperative day with no symptoms. Today, various adaptations of video-assisted thoracic surgery are frequently utilized for many lesions. However, more direct, safer, and less invasive approaches should be selected based on local anatomy, such as the supraclavicular approach without thoracotomy that we utilized.

The Figure-L Unilateral Mini-Sternotomy for Anterior Mediastinal Tumor

We performed a figure-L unilateral mini-sternotomy for anterior mediastinal tumor resection in ten patients. Pathological diagnosis among the ten included six thymomas, three mature teratomas including one with a seminoma component, and one thymic cyst. Mean tumor length was 7 x 5 x 4 cm. The required skin incision was 8 cm in mean length. The third intercostal space was transected in six cases, the fourth intercostal space in four cases. Bilateral internal thoracic arteries were preserved in all cases. All tumors were completely resected without complications during the procedure. Mean operating time was 106 minutes (range 85 to 120 minutes). Postoperative hospital stay ranged from three to seven days without any complications. All patients were alive at the end of a mean follow-up period of 39 months (range 3 to 60 months). The figure-L unilateral mini-sternotomy is considered an effective and useful minimally invasive approach for anterior mediastinal tumors.

Mechanical stretch induces TGF-beta synthesis in hepatic stellate cells

BACKGROUND

It is known that mechanical stress induces extracellular matrix via transforming growth factor-beta (TGF-beta) synthesis in vascular smooth muscle cells. Activated hepatic stellate cells (HSCs) are an important source of TGF-beta in the liver. However, it remains unclear whether mechanical stress induces TGF-beta in HSCs. The Rho small GTP-binding protein (Rho) has recently emerged as an important regulator of actin and cytoskeleton. We examined whether TGF-beta is expressed in stretched HSCs and whether Rho is involved in stretch-induced TGF-beta synthesis.

MATERIALS AND METHODS

A cultured human HSC cell line, LI90, was used for this study. Hepatic stellate cells were cyclically stretched using the Flexercell(R) strain unit. Concentration of TGF-beta in the conditioned medium was estimated by a bioassay using mink lung epithelial cells transfected with a plasminogen activator inhibitor-1 promoter-luciferase construct. Transforming growth factor-beta mRNA expression of HSCs was estimated by a reverse-transcription polymerase chain reaction. Replication-defective adenoviral vectors expressing a dominant negative type of Rho was utilized to suppress its effect on HSCs.

RESULTS

Transforming growth factor-beta concentration of the conditioned media of stretched HSCs showed time-dependent increases as compared to nonstretched HSCs from 2 h to 24 h. Transforming growth factor-beta mRNA expression in stretched HSCs was increased compared with that in nonstretched HSCs. Transfection of dominant negative Rho inhibited the stretch-induced TGF-beta synthesis.

CONCLUSIONS

Mechanical stretch enhanced TGF-beta expression on mRNA and protein level in HSCs. Rho was closely related to stretch-induced TGF-beta synthesis in HSCs.

Placement of the Dumon Stent Using a Flexible Bronchofiberscope via Tracheostomy

In this paper, we report on a new technique of Dumon stent placement using a flexible bronchofiberscope. This procedure was used to insert Dumon stents in two bronchial obstruction and two bronchofistula cases. The stenting technique described here can be used through either a tracheostoma or the oral cavity; it presents a very straightforward and safe procedure that does not require the use of a rigid bronchoscope.

A single-stage video-assisted thoracoscopic surgery procedure for simultaneous bilateral spontaneous pneumothorax in a supine position

We report on the case of a 23-year-old man with simultaneous bilateral spontaneous pneumothorax (SBSP), treated with bilateral video-assisted thoracoscopic surgery (VATS) in a supine position. SBSP is a very rare condition that can be life-threatening when therapeutic techniques fail. We performed a unique operative procedure for SBSP using one-stage bilateral VATS in a supine position. This procedure is less invasive, more effective, and safer for the treatment of SBSP.

[Aortic root replacement using cryopreserved allograft for an infected aorta patient associated with mediastinitis]

We herein report a case of aortic root replacement using cryopreserved allograft. A 52-year-old man received aortic valve replacement using a mechanical prosthesis for aortic stenosis. He was complicated by postoperative methicillin-resistant staphylococcus aureus mediastinitis involving the ascending aorta. Surgical therapy including debridement, omental transposition, patch closure using pericardium had not achieved satisfied result. Aortic root replacement using cryopreserved allograft was mandatory for refractory aortic infection. He had an uneventful postoperative course. The cryopreserved allograft was effective for a patient with refractory aortic root infection due to postoperative mediastinitis.

Primary chylopericardium treated with video-assisted thoracoscopic surgery

Here, we report on a 30-year-old female with primary chylopericardium who successfully underwent thoracic duct clipping and partial pericardiectomy using video-assisted thoracoscopic surgery (VATS). Recently, a few cases of this disease have been treated utilizing VATS. This is a fully detailed description of the treatment of primary chylopericardium including a description of intraoperative findings and photographs obtained during the course of VATS.

A new combined surgical procedure for severe descending necrotizing mediastinitis with bilateral empyema

In this report, we will describe the treatment of a 38-year-old man with severe descending necrotizing mediastinitis (DNM) with bilateral empyema. DNM is a rare disease with a high mortality rate, and when accompanied by bilateral empyema, this is particularly serious and potentially fatal. To improve the prognosis of such patients, the establishment of an adequate surgical procedure for satisfactory debridement and drainage is essential. This is the first report on a new combined surgical procedure consisting of right standard posterolateral thoracotomy and left video-assisted thoracoscopic surgery (VATS) for severe DNM with bilateral empyema.