Expression of high-affinity IgE receptor (Fc epsilon RI) on human alveolar macrophages from atopic and non-atopic patients

The expression of high-affinity IgE receptor (Fc epsilon RI) on alveolar macrophages was examined in order to determine the association of alveolar macrophages with IgE-dependent inflammation. Immunostaining showed that a 15-1 monoclonal antibody against Fc epsilon RI alpha chain reacted with alveolar macrophages from both atopic and non-atopic patients by immunostaining. In addition, preincubation of 15-1 monoclonal antibody specifically blocked monomeric IgE binding to alveolar macrophages. Reverse transcription polymerase chain reaction showed that CD14+ alveolar macrophages expressed Fc epsilon RI alpha, beta and gamma chain mRNA. These results show that alveolar macrophages express Fc epsilon RI and may participate in IgE-dependent inflammation mediated by Fc epsilon RI.

Positron emission tomographic study of central histamine H1-receptor occupancy in human subjects treated with epinastine, a second-generation antihistamine

Histamine H1-receptor occupancy in the human brain was measured in healthy young volunteers by positron emission tomography (PET) using [11C]doxepin. d-Chlorpheniramine, a selective and classical antihistamine, occupied 76.8 +/- 4.2% of the averaged values of available histamine H1 receptors in the frontal cortex after its administration in a single oral dose of 2 mg. Epinastine, a non-sedative antihistamine, occupied 13.2 +/- 18.5% of the available H1 receptors in the human frontal cortex after its administration in a single oral dose of 20 mg. There was significant correlation between H1 receptor occupancy by epinastine and its plasma concentration in each subject. PET data on the human brain were essentially compatible with those on H1-receptor occupancy in the guinea pig brain as determined by an in vivo binding technique, although for the same H1-receptor occupancy, the dose was less in humans than in guinea pigs. Our PET studies demonstrated that receptor occupancy by a second-generation H1 antagonist, epinastine, was less than 20% of the total H1 receptors, and that the low receptor occupancy was closely related to the low incidence of central side effects.

Limited TCR repertoire of infiltrating T cells in the kidneys of Sjögren's syndrome patients with interstitial nephritis

To analyze the mechanism of interstitial nephritis in patients with Sjörgren's syndrome (SS), we examined the TCR repertoire of infiltration T cells in kidney, labial salivary glands, and PBLs using a PCR. The repertoire of the TCR V beta gene on infiltrating T cells from the kidneys of SS patients was more restricted than those on infiltrating T cells in labial salivary glands and PBL. The TCR V beta 2 gene was expressed predominantly in six of seven (86%) SS patients. Junctional sequences of cDNAs encoding the V beta 2 gene on infiltrating T cells in the kidneys of five SS patients showed that some of the cells expanded clonally, indicating Ag-driven stimulation rather than superantigen-induced proliferation. The same V beta 2 clones in the kidney were not detected in labial salivary glands of the same SS patients; the conserved amino acid (arginine at position 96) in the CDR3 region of the V beta 2 gene was found at a frequency of 48.0% in the kidney, whereas it was detected in only 15.4% of the clones in lips. In conclusion, these findings suggest the possibility that T cells that infiltrate the kidneys of SS patients with interstitial nephritis might recognize different autoantigens than those that infiltrate labial salivary glands.

Limited TCR repertoire of infiltrating T cells in the kidneys of Sjögren's syndrome patients with interstitial nephritis

To analyze the mechanism of interstitial nephritis in patients with Sjörgren's syndrome (SS), we examined the TCR repertoire of infiltration T cells in kidney, labial salivary glands, and PBLs using a PCR. The repertoire of the TCR V beta gene on infiltrating T cells from the kidneys of SS patients was more restricted than those on infiltrating T cells in labial salivary glands and PBL. The TCR V beta 2 gene was expressed predominantly in six of seven (86%) SS patients. Junctional sequences of cDNAs encoding the V beta 2 gene on infiltrating T cells in the kidneys of five SS patients showed that some of the cells expanded clonally, indicating Ag-driven stimulation rather than superantigen-induced proliferation. The same V beta 2 clones in the kidney were not detected in labial salivary glands of the same SS patients; the conserved amino acid (arginine at position 96) in the CDR3 region of the V beta 2 gene was found at a frequency of 48.0% in the kidney, whereas it was detected in only 15.4% of the clones in lips. In conclusion, these findings suggest the possibility that T cells that infiltrate the kidneys of SS patients with interstitial nephritis might recognize different autoantigens than those that infiltrate labial salivary glands.

[Immunohistochemical identification of infiltrating mononuclear cells in tubulointerstitial nephritis associated with Sjögren's syndrome]

Using monoclonal antibodies, Immunoperoxidase analysis was performed on renal biopsy samples obtained from patients with Sjögren's syndrome associated with tubulo-interstitial nephritis. In all cases the interstitial infiltrates were predominantly CD5-positive T cells (mean 66%), whereas both B cell (CD19-positive) and monocyte (CD15-positive) populations participated to a lesser degree. CD16-positive NK/K cells were rarely encountered. The CD4/CD8 ratio was consistently higher than 1.0 (mean 2.08). The lymphocyte which invaded the tubular epithelial cells to present a feature of tubulitis were CD8 positive, suggesting that they were cytotoxic T cells. These results were in general accord with those obtained in the salivary glands of patients with Sjögren's syndrome. It was thus concluded that the same immunological process was probably operative in the renal tubulointerstitial tissue as in the salivary glands to induced the characteristic tissue changes of Sjögren's syndrome.

[Expression of ductal Fas antigen in sialoadenitis of Sjögren's syndrome]

The expression of Fas antigen on ductal epithelial cells of sialoadenitis was examined in patient with Sjögren's syndrome and normal subject. In two patients with severe sialoadenitis, Fas antigen was strongly expressed on the ductal epithelial cells. In contrast, Fas antigen was not seen in minor salivary gland of normal subjects and of mild sialoadenitis cases. This finding suggests that Fas antigen may play a role in the pathogenesis of sialoadenitis in Sjögren's syndrome by providing a specific target for cytotoxic T cells expressing Fas ligand.

Acute Budd-Chiari syndrome due to inferior vena cava occlusion following blunt trauma

Inferior vena cava (IVC) thrombosis or obstruction is a complication rarely associated with blunt trauma. We present a case of IVC thrombo-occlusive lesion with both hepatic and renal failure which developed after a thoracoabdominal blunt trauma. Direct thrombectomy and patch cavoplasty were successfully carried out under deep hypothermia using cardiopulmonary bypass.

[A successful case of transaortic coronary patch angioplasty for left coronary ostial stenosis in a middle-aged woman]

A 46-year-old woman was admitted to our hospital because of effort angina. Electrocardiogram on exercise showed a significant ST depression in I, II, III, aVF, and V3-6 201Thallium myocardial scintigram demonstrated a low uptake lesion on effort and redistribution in anterior wall of left ventricle. Coronary angiography showed a 50% stenosis only in the left coronary ostium. Operation was carried out by transaortic patch angioplasty using autologous pericardium fixed with 0.25% glutaraldehyde. Her postoperative course was uneventful. Anginal discomfort disappeared, and favorable results was obtained. Recent reports suggest that an isolated coronary ostial stenosis is a distinct clinical entity which is different from the usual atherosclerotic ischemic heart disease. The transaortic patch angioplasty might be useful operative method for the isolated coronary ostial stenosis.

[An experience of successful valve repair for acquired mitral and tricuspid regurgitation in dextrocardia, situs inversus, bilateral vena cava, and hemiazygos continuation]

A 56-year-old woman was admitted to our department because of congestive heart failure. Chest X-ray showed dextrocardia with situs inversus. The echocardiography revealed severe mitral regurgitation due to prolapse of posterior leaflet and secondary Venography demonstrated the bilateral superior vena cava, huge coronary sinus and hemiazygos continuation with hypoplastic inferior vena cava. Mitral valve regurgitation was repaired by Carpentier's and Burr's technique, and tricuspid valve regurgitation was repaired by Kay's technique. Her postoperative course was uneventful. Valve surgery for acquired valvular lesion in dextrocardia with situs inversus is rare. Although valve repair is easily performed even in mirror-image heart as well as in normal, levo-position heart, preoperative evaluation of systemic venous return is important in the case of dextrocardia with systemic venous anomalies.

Recent translocation of variable and diversity segments of the human immunoglobulin heavy chain from chromosome 14 to chromosomes 15 and 16

We studied the organization and origin of three orphon regions, VH-F, D5-a, and D5-b, of the human immunoglobulin heavy-chain gene using yeast artificial chromosomes. VH-F and two D5 regions were mapped to chromosome bands 16p11 and 15q11-q12, respectively, by using human/rodent somatic cell hybrids and fluorescence in situ hybridization. No D5 segments were found on chromosome 14, in contradiction to previous reports. The VH-F region consists of 7 VH segments and encompasses 160 kb of DNA. A cluster of VH segments homologous to the VH-F region orphons was found in the region 245-430 kb (V2-26 to V3-11) upstream of the JH cluster on chromosome 14. Comparison of VH sequences between the VH-F and the chromosome 14 loci indicates that the translocation of the VH-F region took place, at the earliest, 20 x 10(6) years ago. The D5-a and D5-b regions were obtained in two independent contigs. The former contains only D segments in 140 kb of DNA, while the latter carries 3 VH segments downstream of D segments in 110 kb of DNA. V54, one of these VH orphon segments, is about 95% homologous to V1-18, which is located within the putative ancestor of the VH-F region on chromosome 14. Furthermore, the region detected by two DNA probes flanking the V54 segment was found only in the proximity of V1-18 within the 0.8-Mb VH region on chromosome 14. These results suggest that the two orphon loci on chromosomes 15 and 16 may have been translocated simultaneously.

[A case of coronary artery bypass grafting for single coronary artery complicated by effort angina]

A case of coronary artery bypass grafting (CABG) for single coronary artery (SCA) complicated by effort angina pectoris was reported. A 52-year-old man was admitted complaining of effort angina. Coronary arteriography demonstrated a single coronary artery originated in left coronary sinus bifurcated to the left anterior descending artery (LAD) and the circumflex artery (CX) which extended around the atrio-ventricular fold to send a branch down the posterior small branches extend to posterior surface of the right ventricle. This type single coronary artery was classified to Smith's type I. Other findings included 75% stenosis in LAD #6 and #7, 90% stenosis in CX #11. CABG was carried out using left internal thoracic artery graft and saphenous vein graft. His postoperative course was uneventful. Anginal discomfort disappeared, and favorable results was obtained. SCA might be vulnerable to ischemic insult, so that coronary revascularization should be recommended in selected cases before the onset of serious complications.

[A successful case of left heart bypass with biocompatible bypass circuit and minimal heparin for severe heart failure after open mitral commissurotomy]

A successful case of left heart bypass (LHB) for severe heart failure after mitral commissurotomy is presented. A 44-year-old woman underwent surgery for mitral and tricuspid regurgitation, then could not be weaned from cardiopulmonary bypass because of low cardiac output and intractable ventricular arrhythmia. The LHB from right-sided left atrium to ascending aorta was instituted with anti-thrombogenic centrifugal pump system (Carmeda). During initial 6 hours of LHB, any anticoagulant drugs were not employed, thereafter the local administration of heparin into left ventricle was started with a dose of 200 unit per hour. The LHB was successfully weaned at 26 hours after institution. Her postoperative course was uneventful. The left heart bypass without systemic heparinization utilizing anti-thrombogenic material might be a safe and useful method for postcardiotomy cardiogenic shock.

Multichannel myocardial temperature probe

We present a new system to measure myocardial temperature at multiple points in myocardium. This system consists of a probe with multiple thermocouples, a data collector, and a personal computer. We have demonstrated a change in distribution of temperature in myocardium during hypothermic cardioplegic arrest.

[A left atrial appendage thrombus without mitral stenosis--a successful case of removal]

Successful thrombectomy for left atrial ball thrombus without mitral stenosis is presented. A 62-year-old man was admitted to our department because of intermittent claudication. Arteriography demonstrated complete occlusion in bilateral superficial femoral arteries, however, the arterial wall was much smooth, suggesting thrombo-embolism rather than arteriosclerosis obliterans. The transthoracic echocardiography revealed no abnormal lesion in mitral apparatus and in left atrial cavity. The bypass operation was carried out for arterial occlusion, when the intraoperative transesophageal echocardiography showed the ball thrombus in left atrial appendage. The urgent operation was successfully carried out on 14th postoperative day after bypass operation. The thrombus occupied almost all the left atrial appendage, and its size was 24 x 19 x 13 mm. The transesophageal echocardiography was useful in diagnosis for left atrial appendage thrombus. Once the diagnosis was made for large and movable left atrial thrombus, immediate surgical therapy should be recommended to avoid serious complications and sudden death.

Chronic salicylate intoxication and rhabdomyolysis in a patient with scleroderma and Sjögren's syndrome

A 44-year-old woman with scleroderma and Sjögren's syndrome developed altered consciousness, acute renal failure, and rhabdomyolysis. She had no history of trauma, seizures, alcohol abuse, hyperthermia, or other possible causative factors for rhabdomyolysis. A high serum salicylate level indicated a diagnosis of salicylate intoxication. Medical history after recovery revealed chronic salicylate ingestion for severe headaches. This is possibly the first reported case of rhabdomyolysis caused by chronic salicylate intoxication. Continuous hemodiafiltration early in hospitalization was an effective treatment.

Comparison and evolution of human immunoglobulin VH segments located in the 3' 0.8-megabase region. Evidence for unidirectional transfer of segmental gene sequences

Nucleotide sequences of 64 VH segments within the 3' 0.8-megabase region of the human immunoglobulin germ line VH locus were compared with trace evolution of human VH segments. Based on alignment of the deduced amino acid sequences of 37 functional germ line VH segments, a phylogenetic tree was generated using the neighbor-joining method. The phylogenetic tree clearly supports the previous classification of human VH segments into six families, which correlate roughly with mouse VH families with varying conservation. The human VH-III family is most homologous to mouse VH segments, suggesting that members of the VH-III family may be conserved by some functional constraint. The 5'-flanking region of each family has a family-specific structure. The sequenced 64 VH segments include 31 pseudogenes, of which 24 were highly conserved. Unidirectional transfer of segmental sequences was identified within the VH-III and VH-IV families, providing clear examples of germ line gene conversion. Such gene conversion may contribute to conserve structures of pseudo-VH segments. Comparison of the VH-IV family members indicates that recent repeated duplications and frequent gene conversions are responsible for strong conservation of this family, although functional selection is not completely excluded.

Structural analysis of the human VH locus using nonrepetitive intergenic probes and repetitive sequence probes. Evidence for recent reshuffling

The organization and evolution of the 0.8-Mb JH-proximal region in the human Ig VH locus were studied by mapping DNA fragments hybridized to non-repetitive intergenic probes and by determination of the content and distribution of repetitive sequences. Southern blot analysis of cloned DNA covering the 0.8-Mb region with intergenic probes allowed us to map two to seven cross-hybridizing fragments by each probe. Clusters of fragments detected by an identical set of probes appeared repeatedly within the 0.8-Mb JH-proximal region. Distantly located VH segments flanked by a cluster of DNA fragments hybridized by the same set of probes were highly homologous to each other, providing evidence for recent frequent duplication and translocation throughout the locus. DNA fragments detected by the same set of probes were orientated with the same 5' to 3' order within the cluster, suggesting little involvement of inversion upon recombination in the locus. The content of interspersed Alu and L1 sequences in the VH locus were not significantly greater than the average in the genome.

Structural analysis of the human VH locus using nonrepetitive intergenic probes and repetitive sequence probes. Evidence for recent reshuffling

The organization and evolution of the 0.8-Mb JH-proximal region in the human Ig VH locus were studied by mapping DNA fragments hybridized to non-repetitive intergenic probes and by determination of the content and distribution of repetitive sequences. Southern blot analysis of cloned DNA covering the 0.8-Mb region with intergenic probes allowed us to map two to seven cross-hybridizing fragments by each probe. Clusters of fragments detected by an identical set of probes appeared repeatedly within the 0.8-Mb JH-proximal region. Distantly located VH segments flanked by a cluster of DNA fragments hybridized by the same set of probes were highly homologous to each other, providing evidence for recent frequent duplication and translocation throughout the locus. DNA fragments detected by the same set of probes were orientated with the same 5' to 3' order within the cluster, suggesting little involvement of inversion upon recombination in the locus. The content of interspersed Alu and L1 sequences in the VH locus were not significantly greater than the average in the genome.

Successful surgical management for multiple cerebral mycotic aneurysms involving both carotid and vertebrobasilar systems in active infective endocarditis

Mycotic aneurysm is usually found in the middle cerebral artery associated with infective endocarditis. Previous reports we have identified include only 4 cases of vertebrobasilar aneurysm. We report on a 29-year-old female who had multiple mycotic aneurysms involving both the carotid and vertebrobasilar systems complicated by intracranial hemorrhage with infective endocarditis, in whom staged operations, mitral valve replacement and craniotomies, were successfully performed.

[A successful case of valve-sparing surgery for tricuspid valve endocarditis]

A successful repair for infective endocarditis of the tricuspid valve is presented. A 35-year-old man was referred to our hospital complaining of high fever despite antibiotic chemotherapy. Lung scan showed multiple thromboembolism. Blood cultures revealed staphylococcus aureus. Echocardiography showed vegetations attached to the tricuspid valve and severe tricuspid regurgitation. Conservative surgery such as vegetectomy and DeVega's annuloplasty was successfully carried out. The patient's postoperative course was uneventful. The conservative surgery might provide a satisfactory result in the selected cases with localized vegetation and minimum valve involvement.

[A case of impending rupture of acute aortic dissection with thrombosed false lumen in early phase]

A 73-year-old patient with acute aortic dissection in delayed shock state following sudden onset of chest-back pain and left sided hemothorax was successfully operated. Contrast enhanced CT demonstrated a crescent-shaped low density area in the descending aorta. Aortography showed ulcer-like projection (ULP) with minor leakage into left thorax, however, a flow in false lumen was not visualized. These findings suggested that the false lumen of type III aortic dissection was thrombosed in its early phase. The aneurysm was transected on left heart bypass through left thoracotomy. The entry of false lumen was found in proximal portion of descending aorta, in which fresh thrombus was filled. A graft was anastomosed and reinforced with felt strips in end-to-end. The postoperative course was uneventful. The ULP by aortography provides a possible sign of rupture in clinical course of aortic dissection.

Clinical effect of WEB 1881 (nebracetam fumarate) on patients with dementia of the Alzheimer type and study of its clinical pharmacology

We administrated WEB 1881, 800 mg/day (400 mg twice a day), nine patients with dementia of the Alzheimer type for 8 weeks, and undertook an open study to investigate the clinical effects of the distribution into the cerebrospinal fluid (CSF) as well as the influence on the neurotransmitter-related substances in the CSF. These were outpatients living at home with caregivers. Significant clinical improvement was shown by means of the Gottfries, Bråne, and Steen Scale and by Hasegawa's dementia scale. Unchanged WEB 1881 was identified in the CSF. The mean concentration of which was 198.7 ng/ml, this corresponded to 19.0% of the plasma concentration. Of several neurotransmitter-related substances measured in the CSF, a marked rise of AChE activity was observed. Adverse effects consisted of a slight skin eruption in one case and alterations in a clinical laboratory test in another case. These were, however, not significant from a clinical viewpoint. It is suggested that the mechanisms of action of WEB 1881 are based on its transit into the CSF as well as the activation of intracerebral acetylcholinergic systems.

Simultaneous determination of the enantiomers of pimobendan and its main metabolite in rat plasma by high-performance liquid chromatography

A high-performance liquid chromatographic method for the simultaneous analysis of the enantiomers of pimobendan and its main metabolite, with an n-hexane-ethanol-acetic acid solvent system, has been developed. After solid-phase extraction from plasma, the enantiomers were separated from each other using a Sumichiral OA-4400 column, which is commercially available and contains a chiral stationary phase composed of (S)-proline and (S)-1-(alpha-naphthyl)ethylamine coated on silica. The enantiomers were detected with a fluorescence detector (excitation at 330 nm, emission at 415 nm). The intra- and inter-day precision studies showed good reproducibilities: the coefficients of variation were less than 10.3% for pimobendan enantiomers and 13.0% for metabolite enantiomers. The calibration curves were linear (r2 > 0.996) in the concentration range 1.25-200 ng/ml. The minimum measurable level was 125 pg per 100 microliters of plasma. The method was used in a preliminary pharmacokinetic study in three male rats after intravenous administration of racemic pimobendan (2 mg/kg).

CD4+ T-lymphocytes and interleukin-5 mediate antigen-induced eosinophil infiltration into the mouse trachea

In order to determine the role of CD4+ and CD8+ T-cells and of interleukin-5 (IL-5) in causing antigen-induced eosinophil infiltration into the site of airway late-phase reaction, we examined the effect of the in vivo depletion of CD4+ and CD8+ T-cells on the eosinophil infiltration of the trachea induced by antigen inhalation in mice. We also studied the effect of anti-murine IL-5 monoclonal antibody (mAb) on the antigen-induced eosinophil infiltration in the trachea. The eosinophil infiltration into the trachea of ovalbumin (OVA)-sensitized BALB/c mice began to increase 9 h after OVA inhalation and persisted for more than 48 h. The in vivo depletion of CD4+ T-cells by pretreatment with anti-L3T4 mAb significantly decreased the eosinophil infiltration induced by OVA inhalation in the trachea of sensitized mice. However, the in vivo depletion of CD8+ T-cells by pretreatment with anti-Lyt-2 mAb had no significant effect on OVA-induced eosinophil infiltration in the trachea. Pretreatment with anti-murine IL-5 mAb also decreased OVA-induced eosinophil infiltration in the trachea. In contrast, neither disodium cromoglycate nor a selective antagonist for platelet-activating factor CV-6209 decreased OVA-induced airway eosinophilia in the mouse. Our results provide direct evidence that CD4+ but not CD8+ T-cells mediate antigen-induced eosinophil recruitment in the airways and that IL-5 mediates this eosinophil recruitment.

Structure and physical map of 64 variable segments in the 3'0.8-megabase region of the human immunoglobulin heavy-chain locus

We have constructed the physical map of the 0.8 megabase DNA fragment which contains the 3' 64 variable region (V) gene segments of the human immunoglobulin heavy chain (H) locus. The organization of the VH locus showed several features that indicate dynamic reshuffling of this locus. The sequenced 64 VH segments include 31 pseudogenes, of which 24 are highly conserved except for a few point mutations. Comparison of the 64 germline VH sequences shows that each VH family has conserved sequences, suggesting that there might be some genetic or selection mechanisms involved in maintenance of each family. The total number of the human VH segments was estimated to be about 120, including at least 7 orphons.

[A successful case of concomitant operation for coronary artery disease and rectal cancer in elderly patient]

We report a successful case of 75-year-old man who was simultaneously undertaken CABG for coronary artery disease and Miles' operation for rectal cancer. A concomitant cardiac and rectal operation involves serious problems, such as increasing operative risk, bleeding tendency after cardiopulmonary bypass, infection and radicality against malignancy, however, it should be a definitive method for the selective case.

[The long-term results of patients over 70 years old after coronary artery bypass surgery]

We have assessed the long-term results of heptagenerians after isolated coronary artery bypass surgery from 1979 to 1989 in 32 patients over 70 (mean 72) years old using actuarial techniques. In these patients, the long-term results could not be properly assessed because many other factors other than cardiac events influenced their survival. Accordingly, we compared our subjects with the general population matching the operative age and sex characteristics from life tables (= matched population). There was no operative mortality. The 5 year and 9 year survival rates were 93% and 31%. In the matched population, the 5 year and 9 year survival rates were 81% and 59%. The survival rate between the two groups was not significantly different. We concluded that the long-term results of coronary artery bypass surgery in patients over 70 years were similar to those of the matched population. Therefore, coronary artery bypass surgery should be offered to older patients for usual indications.

[A case of Japanese encephalitis demonstrating characteristic changes in MRI]

A 40-year-old woman developed high fever and headache. Five days later, she was admitted because of consciousness disturbance and tremulous movements in upper extremities. The paired sera showed more than fourfold elevation in complement fixation titer to Japanese encephalitis virus. She was diagnosed as Japanese encephalitis from the clinical features and serological tests. Magnetic resonance imaging (MRI), which was performed about seven months after the onset, revealed abnormal intensity areas bilaterally in the thalamus, hippocampus, substantia nigra, globus pallidus and white matter around the lateral ventricle. Eight months after the onset, she was left with bradykinesia, disturbance of rightening reflex, emotional lability and impairment of recent memory with a long period of amnesia, including not only her illness and subsequent events but also about several years before her illness. The characteristic memory dysfunction seems to be due to disorder of bilateral hippocampus, where MRI revealed abnormal intensity areas. And disorder of medial thalamic nucleus would be related to emotional liability. The relation between the clinical features and MRI findings is also discussed.

[Timing of operation based on evaluation of postoperative left ventricular contractility in patients with aortic regurgitation]

To evaluate the effect of aortic valve replacement on left ventricular function in aortic regurgitation, the ratio of end-systolic wall stress to end-systolic volume index (ESS/ESVI) and standard ejection phase indexes of left ventricular function were measured angiographically in 29 patients with isolated, chronic aortic regurgitation before and an average of 26 months after aortic valve replacement. The patients were divided into three groups based on preoperative left ventricular volume at end-systole (ESVI); 12 patients had an ESVI smaller than 100 ml/m2 (group I), 11 had an ESVI of 100 to 200 ml/m2 (group II) and 6 had an ESVI greater than 200 ml/m2 (group III). Postoperatively, end-diastolic volume index and ESVI decreased markedly in all 3 groups and end-systolic stress also decreased. Systolic pump performance assessed as ejection phase indexes improved in all groups with group I and group II showing normal or near-normal ejection fraction, while group III still had a depressed ejection fraction. Left ventricular contractile function as assessed by ESS/ESVI improved significantly in each group postoperatively. After operation, group I patients had normal values. However, both group II and group III still had a subnormal ratio, suggesting a depressed contractility despite normal or near normal systolic pump performance. Surgical correction for aortic regurgitation should be considered before a preoperative ESVI exceeds 100 ml/m2, to preserve postoperative left ventricular contractility.

Protein losing enteropathy associated with collagen diseases

Four patients with collagen diseases are described, who developed protein losing enteropathy in the course of their disease. Their protein losing enteropathies subsided after treatment with 60 mg/day oral prednisolone. Immunohistological studies of the small intestine showed deposits of C3 in the capillary walls of villi in two patients. Increased capillary permeability due to autoimmune phenomena may have a role in the pathogenesis of protein losing enteropathy associated with collagen diseases.

The immunosuppressant FK-506 prevents progression of diabetes in nonobese diabetic mice

A novel immunosuppressive compound, FK-506, isolated from Streptomyces has potent immunosuppressive activities. To investigate the effect of FK-506 on the course of diabetes in nonobese diabetic (NOD) mice, we gave this drug to these animals, from the age of 8 weeks, intraperitoneally, in doses of 0.1 mg (2.5 mg/kg/day) or 0.01 mg (0.25 mg/kg/day) three times a week. Overt diabetes were observed in 75.5% of control mice by the age of 20 weeks. In contrast, no diabetes occurred in mice given 0.1 mg of FK-506. Sixteen percent of mice treated with 0.01 mg of the drug became diabetic. Administration of this drug prevented the progression of insulitis in NOD mice. The mice given 0.1 mg of FK-506 lost weight, but this was reversible.

[Late results of CABG for postinfarction angina--relation to preoperative myocardial infarct size]

We evaluated the late results of coronary bypass grafting (CABG) in 85 patients. The patients were divided into two groups according to preoperative MI size estimated by the Selvester QRS score; 24 with MI size of larger than 20% of LV muscle (group A; average 28 +/- 11%), and 61 with MI size smaller than 20% (group B; average 10 +/- 9%). New York Heart Association classes of both groups following CABG improved significantly (from 2.8 +/- 0.7 to 1.3 +/- 0.4 in group A; p less than 0.01, from 2.5 +/- 0.6 to 1.2 +/- 0.5 in group B; p less than 0.01). There was higher incidence of serious ventricular arrhythmias in group A than in group B (83% vs. 21%, p less than 0.01). In Group A, LVEF and LVESVI did not improve following CABG (from 17 +/- 9 to 16 +/- 8 mmHg, from 39 +/- 15 to 40 +/- 15%, from 66 +/- 28 to 69 +/- 40 ml/M2), while in Group B, those improved significantly (from 13 +/- 6 to 11 +/- 5 mmHg; p less than 0.01, from 53 +/- 14 to 58 +/- 10%; p less than 0.01, from 39 +/- 23 to 32 +/- 14 ml/M2; p less than 0.05). The exercise-to-rest LVSWI ratios increased significantly following CABG in both groups (from 86 +/- 25 to 160 +/- 56% in group A; p less than 0.05, from 92 +/- 31 to 140 +/- 37% in group B; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Tubulointerstitial changes in systemic vasculitic disorders: a quantitative study of 18 biopsy cases

Tubulointerstitial alterations were studied in 18 biopsy cases of systemic vasculitis. To evaluate the changes more objectively, two indexes, the number of interstitial inflammatory cells and tubulitis percentage, were used. The group means of both of these indexes were statistically higher than those of the autopsy control group, while 14 of the cases (77.8%) showed a significant difference (P less than 0.01) between individual means and the control group means. On the other hand, tubulointerstitial changes in systemic vasculitis seemed to be less prominent than drug-induced tubulointerstitial nephritis (TIN) according to these indexes. However, comparing these indexes with those of drug-induced TIN, six cases (33.3%) of systemic angiitis could be regarded as having developed pathologic changes similar to TIN. Statistical difference was not shown in the indexes between those patients with histologic evidence of necrotizing angiitis and those without it. Clinically, urinary N-acetyl-beta-D-glucosaminidase (NAG) was abnormally high in all three examined cases, reflecting the damage of renal tubular epithelial cells. Not only the vascular and glomerular lesions, but also tubulointerstitial changes, should be evaluated in the renal biopsy specimen of systemic vasculitis.

[Effects of coronary revascularization on infarcted myocardial regions--evaluation on postoperative left ventricular regional wall motion during exercise]

In order to determine the effects of coronary revascularization for infarcted regions on postoperative left ventricular function and regional wall motion, we studied first-pass radionuclide angiography at rest and during exercise before and after operation in 18 patients with previous myocardial infarction. Preoperative mean value of left ventricular ejection fraction (LVEF) was significantly decreased during exercise from 56.8 +/- 14.1% to 46.1 +/- 15.5% (p less than 0.01). Postoperatively, there was no change of the values between at rest and during exercise: 53.6 +/- 14.1% versus 51.9 +/- 15.7%. Postoperative mean LVEF during exercise was significantly higher, compared with that of preoperative LVEF (p less than 0.05). Mean regional ejection fraction of infarcted regions was significantly decreased during exercise from 66.0 +/- 15.0% to 56.1 +/- 15.8% (p less than 0.01) before operation. However, there was no significant change in values between at rest and during exercise after operation: 65.4 +/- 13.9% versus 61.8 +/- 14.5%. Mean postoperative regional ejection fraction during exercise was significantly higher, compared with preoperative regional ejection fraction after operation (p less than 0.05). These results might be indicated that regional wall motion of the infarcted regions with ischemia enhanced by exercise preoperatively can be definitely improved by coronary revascularization.

[Evaluation of the effects of coronary artery bypass grafting on left ventricular function in patients with previous myocardial infarction]

The present study was designed to assess a left ventricular function following coronary artery bypass grafting (CABG) in patients with previous myocardial infarction (MI). The subject was consisted of 10 patients with MI (MI(+) group) and 6 without it (MI(-) group). Both groups underwent complete revascularization. Stroke index (SI), ejection fraction (EF), systolic pressure/end-systolic volume index (SP/ESVI) and end-diastolic volume index (EDVI) were evaluated utilizing radionuclide angiography at rest and during exercise (Ex) before and after CABG. The influence of size of myocardial infarction on left ventricular function were also analyzed. Preoperatively during Ex, EF showed decrease, SP/ESVI no change and EDVI increase in both MI(+) and MI(-) group compared with those at rest. Postoperatively during Ex, SI, EF and EDVI showed no change and SP/ESVI increase in both MI(+) and MI(-) group compared with those at rest. Ejection fraction and SP/ESVI during Ex in MI(+) group had significant differences compared with those in both MI(-) group and control group. Ejection fraction and SP/ESVI during Ex in MI(-) showed no difference compared with those in control group. The size of MI suggested by ECG scoring system (proposed by Wagner GS et al, Circulation '82) had negative correlations with both Ex-induced increment of postoperative EF and Ex-induced increase ratio of postoperative SP/ESVI. These data indicated that complete revascularization improved EF and SP/ESVI in patients with MI, and moreover normalized those in patients without MI. But in the case of extensive MI, even complete revascularization might not recover poor functional reserve during Ex.

Experimental complete right heart bypass. Proposal of a new model and acute hemodynamic assessment with vasoactive drugs in dogs

A new model of complete right heart bypass was devised in dogs. All systemic venous blood was directly led to the bilateral pulmonary arteries by end-to-side superior vena cava-right pulmonary anastomosis, diverting the inferior vena caval blood to the superior vena cava with a graft, ligating the inferior vena cava at its end and the pulmonary artery at its trunk, and shunting the coronary venous return from the right-ventricle to the left atrium. Nine consecutive dogs tolerated the procedures, and acute hemodynamic characteristics and responses to vasoactive drugs were observed for 5 hours throughout the following full studies. Cardiac output ranged from 66 to 102 ml/min/kg at a central venous pressure of 15 to 26 mm Hg. Norepinephrine, isoproterenol, and phentolamine were administered with the central venous pressure maintained constant at 18 mm Hg. Isoproterenol and phentolamine increased cardiac output while reducing pulmonary and/or systemic vascular resistance, with a possible concomitant inotropic effect in the former. Norepinephrine was detrimental, causing an increase in both pulmonary and systemic vascular resistance.

[Surgical treatments for coronary artery disease associated with cancer: a consideration of simultaneous procedure of coronary artery revascularization and surgery for cancer]

There were 14 patients with a mean age of 65 years (ranged from 47 to 77) who had severe coronary artery disease associated with cancer of other organs. Stomach cancer was in 8 patients, breast cancer in 2, lung cancer in 2, rectum cancer in 1, and esophagus cancer in 1. They were treated with sequence of coronary artery revascularization and surgery for cancer; 9 patients in a two-staged fashion and 5 recent patients in a simultaneous one. In the series of simultaneous procedure, A-C bypass was combined with left ventricular aneurysmectomy in one patient and closure of ASD in another. There was no cardiac complication in both series, but one death from the complication of surgery for cancer in the staged series. Three patients in the staged series could not help being postponed the surgery for cancer by slow recovery from A-C bypass. In conclusion, coronary artery revascularization should anticipate surgery for cancer and simultaneous combined procedures should be chosen when possible.

[A case of aorto-coronary bypass in Jehovah's Witness]

An aorto-coronary bypass grafting was performed in a 50 year-old man, a Jehovah's Witness, suffering from effort angina pectoris. Preoperatively, he was underwent PTCA for LAD occlusion, which failed. Single aorto-coronary bypass grafting using IMA was performed under the extracorporeal circulation primed with Ringer's Lactate and albumin. Moderate hypothermia with core temperature of 31.5 degrees C was used, and minimal level of the hematocrit was 18% during the perfusion. At the start of the operation, 800 ml of blood were withdrawn from the jugular vein to the blood bag which connected to a peripheral venous line uninterruptedly. During the operation, the autologous blood was continuously transfused very slowly and most of the autologous blood was transfused after the termination of extracorporeal circulation. The blood in the extracorporeal circuit was hemoconcentrated with ECUM (extracorporeal ultrafiltration method) from hematocrit level 22% to 35% and transfused. The postoperative course was uneventful. At the time of discharge from hospital on the 42nd postoperative day the hemoglobin level was 13.1 g/dl and hematocrit level was 42%.

Effect of FK-506, a novel immunosuppressive drug on murine systemic lupus erythematosus

A novel immunosuppressive compound extracted from the fermentation broth of Streptomyces tsukubaensis belongs to the macrolide family. We gave this drug (FK-506) to MRL/lpr and NZB X NZW F1 (B/W F1) mice, an animal model of human systemic lupus erythematosus (SLE), to investigate its effect on the course of the disease. This drug showed potential to prolong the lifespan, to reduce proteinuria, and to prevent the progression of nephropathy. Appreciable differences in the levels of anti-dsDNA antibodies between treated and control animals were nil.

Immunohistochemical identification of infiltrating mononuclear cells in tubulointerstitial nephritis associated with Sjögren's syndrome

Using monoclonal antibodies, immunoperoxidase analysis was performed on eight renal biopsy samples obtained from patients with Sjögren's syndrome-associated tubulointerstitial nephritis. In all cases the interstitial infiltrates were predominantly CD5-positive T-cells (mean 66%), whereas both B-cell (CD19-positive) and monocyte (CD15-positive) populations participated to a lesser degree. CD16-positive NK/K cells were rarely encountered. The CD4/CD8 ratio was consistently higher than 1.0 (mean 2.08). The lymphocytes which invaded the tubular epithelial cells to present a feature of tubulitis were CD8-positive, suggesting that they were cytotoxic T-cells. These results were in general accord with those obtained in the salivary glands of patients with Sjögren's syndrome. It was thus concluded that the same immunological process was probably operative in the renal tubulointerstitial tissue as in the salivary glands to induce the characteristic tissue changes of Sjögren's syndrome.