Laparoscopic intervention for intrathoracic stomach in infants

BACKGROUND

Intrathoracic stomach is an uncommon condition in infants. We report our experience managing such a condition successfully by laparoscopy in four patients.

METHODS

Patients' ages at the time of operation ranged from 30 days to 14 months. In all cases, the intrathoracic stomach was easily pulled down into the abdominal cavity. The phrenoesophageal ligament was completely resected, and the enlarged hiatus was narrowed by intraabdominal suturing technique. The esophagus was wrapped with the mobilized fundus in a floppy fundoplication. Anchoring sutures were placed between the wrapping cuff and crura.

RESULT

One patient had paraesophageal hernia (type 2), whereas the other had combined hiatal hernia (type 3). No adverse complications were observed in any of the cases. Symptomatic gastroesophageal reflux and radiographic recurrence of hernia were not seen in any case. The cosmesis was excellent in all cases.

CONCLUSIONS

We conclude that laparoscopic repair for intrathoracic stomach is a safe and feasible method when preoperative evaluation is conducted adequately.

Association between TNFA polymorphism and the development of asthma in the Japanese population

Tumor necrosis factor (TNF) is a proinflammatory cytokine that participates in the inflammatory reaction in patients with asthma. The TNFA and TNFB genes, which encode TNF-alpha and TNF-beta, respectively, are located within the region encoding the human major histocompatibility complex on chromosome 6p21.3, which showed linkage to atopic asthma in our genome-wide search. To determine whether polymorphisms in the 5' flanking region of the TNFA gene (-1031C/T, -863C/A, and -857C/T) and an NcoI polymorphism in the TNFB gene (LTA NcoI) are associated with the development of asthma, we performed transmission disequilibrium tests of families identified through children with atopic asthma. Genotypes of families were determined by polymerase chain reaction-based restriction fragment length polymorphism or SNaPshot analysis. Transmission disequilibrium tests of 144 asthmatic families revealed that transmission of the -857C allele and the -1031T-863C-857C haplotype in the TNFA gene to asthma-affected offspring occurred more frequently than expected (-857C allele, p = 0.0055; -1031T-863C-857C haplotype, p = 0.0002). Our results suggest that TNFA or nearby genes, including those in the major histocompatibility complex region, may contribute to the development of asthma in the Japanese population.

Benign transient non-organic ileus of neonates

There are a substantial number of neonates who present with Hirschsprung's disease-like symptoms, but respond very well to conservative therapy. However, once Hirschsprung's disease is ruled out, little attention is paid to these infants, because of the lack of necessity for surgical treatment and their excellent prognosis. The purpose of this study was to elucidate the clinical features of functional ileus of neonates, which we named benign transient non-organic ileus of neonates (BTNIN). Out of 61 neonates referred to our institution with suspected neonatal Hirschsprung's disease (NH), 10 were diagnosed as having NH and 51 as having BTNIN. All the cases of BTNIN showed marked abdominal distension, and 12 showed explosive defecation on digital examination at the first visit. Plain X-ray demonstrated marked whole intestinal dilatation in 12 cases including cases with niveau formation and segmental dilatation. These findings were indistinguishable from those of NH. However, all had a normal anorectal reflex, and rectal suction biopsy revealed normal acetylcholinesterase activity and submucosal ganglion cells. All the cases of BTNIN were treated with periodic glycerin enemas until daily spontaneous defecation was established, which took 2 to 14 months, with an average of 5.0 +/- 2.9 months. None of them showed residual symptoms during the follow-up period.

Ferromagnetic exchange coupling of vanadium(IV) dpi spins across pyrimidine rings: dinuclear complexes of oxovanadium(IV) bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionate) bridged by pyrimidine derivatives

Dinuclear oxovanadium(IV) complexes bridged by pyrimidine derivatives, L[VO(hfac)(2)](2) [L = pyrimidine (PM), 4-methylpyrimidine (MPM), 4,6-dimethylpyrimidine, 4-aminopyrimidine, and quinazoline; hfac = 1,1,1,5,5,5-hexafluoropentane-2,4-dionate], were synthesized and characterized. All of them showed intramolecular ferromagnetic interaction, and the magnetic susceptibilities were analyzed on the basis of the singlet-triplet model, giving 2J/k(B) = 2.2-5.5 K. PM[VO(hfac)(2)](2) crystallized in a monoclinic space group C2/c with a = 34.092(2), b = 6.9783(4), and c = 16.4940(9) A, beta = 109.104(1) degrees, V = 3707.8(4) A(3), and Z = 4 for C(24)H(8)F(24)N(2)O(10)V(2), and MPM[VO(hfac)(2)](2) gave isomorphous crystals. A semiempirical calculation study based on the determined structure suggests the presence of dpi-ppi interaction between vanadium and pyrimidine nitrogen atoms. Ferromagnetic coupling is explained in terms of a spin-polarization mechanism across the pyrimidine bridge. The intermolecular ferromagnetic interaction of PM[VO(hfac)(2)](2) can be interpreted by the contact between the spin-polarized pyrimidine moiety and the oxovanadium oxygen atom in an adjacent molecule.

Bis(hfac)-copper(II) complexes bridged by pyrimidines showing magnetic interactions

Crystals of bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)bispyrimidinecopper(II) (1), bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)bis(4-methylpyrimidine)copper(II) (2), bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)bis(quinazoline)copper(II) (3) showed ferromagnetic interactions at extremely low temperature. Crystal structure analyses revealed that these complexes were catena-bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)[mu-pyrimidine-N(1):N(3)]copper(II), [Cu(hfac)(2)(pm)(2)](n), catena-bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)[mu-4-methylpyrimidine-N(1):N(3)]copper(II), [Cu(hfac)(2)(4-Me-pm)](n), and catena-bis(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)[mu-pyrimidine-N(1):N(3)]copper(II), [Cu(hfac)(2)(qz)](n), for (1), (2) and (3), respectively. In (1) and (2) the pyrimidines bridge the Cu atoms with an axial-equatorial mode to form one-dimensional spiral chains. Complex (3) also forms a one-dimensional chain structure. The coordination mode of (3) is axial-axial at room temperature, while axial-equatorial at 120 K. On the other hand, the structure of the other modification of the 4-methylpyrimidine complex (4), showing paramagnetic properties, was revealed to be a trinuclei complex bridged by two 4-methylpyrimidines, tris[bis-(1,1,1,5,5,5-hexafluoropentane-2,4-dionato)copper(II)][bis-mu-4-methyl-pyrimidine-N(1):N(3)]. The chain structures with an axial-equatorial coordination mode of the bridging organic moieties should play an important role in the appearance of the ferromagnetic interactions.

Radical-copper wheels: structure and magnetism of hexanuclear hybrid arrays

Complexation of copper(II) bromide and chloride with 4-pyrimidinyl nitronyl nitroxide (4PMNN) as a bridging ligand gave discrete hexanuclear complexes carrying 12 spins, [CuX(2).(4PMNN)](6) [X = Br (1), Cl (2)], which crystallize in a trigonal space group. The crystallographic parameters are C(11)H(15)Br(2)CuN(4)O(2).0.3H(2)O, a = 28.172(2), c = 12.590(2) A, V = 8653(2) A(3), and Z = 18 for 1, and C(11)H(15)Cl(2)CuN(4)O(2).0.3H(2)O, a = 28.261(2), c = 12.378(1) A, and Z = 18 for 2. The hexanuclear arrays construct a perfect column perpendicular to the molecular plane. The diameter of the resultant honeycomblike channel is ca. 11.5 A defined by the interatomic distance of two opposing copper ions. Their magnetic behavior is interpreted as the simultaneous presence of ferro and antiferromagnetic couplings. The ferromagnetic couplings are attributed to the interactions between a copper spin and the axially coordinated nitronyl nitroxide spin and between nitronyl nitroxide groups through van der Waals contacts. The antiferromagnetic coupling is due to the interaction between copper ions across the pyrimidine bridges.

Sleep-wake rhythm during stay in an intensive care unit: a week's long-term recording of skin potentials

To monitor the sleep-wake cycle of patients during their stay in the intensive care unit (ICU), we tried continuous and long-term recording of skin potential (SP) levels in patients after surgery. A graph of the week-long SP showed the sleep-wake pattern to be evident until the fourth day. It disappeared beginning on the fifth day, resulting finally in delirium with a relatively high mean SP level. In another record, the administration of sedative agents to calm the excitement lowered the mean SP level and suppressed SP responses evoked by frequent day and night treatment or nursing care. Continuous monitoring of arousal level by SP will be of help in prevention of ICU syndrome.

Dipyrimidine–copper(II) dinitrate complexes showing magnetic interactions

Crystals of CuII(NO3)2(pm)3 (1), and two crystalline forms of CuII(NO3)2(H2O)2(pm)2, (2) and (3), showed ferromagnetic, antiferromagnetic and paramagnetic interactions at extremely low temperatures, respectively. Crystal structure analyses revealed that the complexes were catena-dinitrato[μ-pyrimidine-κN 1:κN 3]-(pyrimidine-N 1)copper(II), [Cu(NO3)2(pm)2] n , catena-diaquadinitrato[μ-pyrimidine-κN 1:κN 3]copper(II), [Cu(NO3)2(H2O)2(pm)] n , and diaquadinitratodipyrimidinecopper(II), Cu(NO3)2(H2O)2(pm)2 for (1), (2) and (3), respectively. In (1) the Cu atom is coordinated by the two nitrates and N atoms of the non-bridging pyrimidine and bridging pyrimidine to form a one-dimensional coordination polymer. The complex is a five-coordinated square pyramid and can be regarded as a pseudo-seven-coordinated complex, since other short non-bonding Cu...O contacts are observed. In the crystals of (2) the pyrimidine bridges the Cu atoms to form a one-dimensional coordination chain. On the other hand, complex (3) is not a coordination polymer. It is important to form a coordination polymer for the appearance of the magnetic interactions. Types of coordination of the bridging organic moieties should also play an important role in magnetic properties. Magnetic measurements of (1) and (2) show that they are good examples of uniform S = 1/2 ferro- and antiferromagnetic Heisenberg chains with exchange parameters 2J/kB = +1.8 and −36 K, respectively.

Application of a drug delivery system in a novel rat model of chronic hyperendotoxemia

There has not been an ideal reproducible small-animal model of chronic hyperendotoxemia to date. Our drug delivery system (DDS) is a new technology that can deliver a drug conveniently to a target organ at an optional rate. 2-Hydroxyethyl methacrylate (HEMA) was used as a carrier of lipopolysaccharide (LPS), and diethylene glycol and polyethylene glycol dimethacrylates (2G, 4G, 9G) were used as cross-linking agents. A mixed solution of HEMA and di(poly)ethylene glycol dimethacrylate was charged into a glass tube with or without LPS and polymerized by ultraviolet irradiation. This polymer was cut into DDS tablets of the same size with or without LPS. A mixture with HEMA:4G = 1:3 was the most suitable composition to release a constant concentration of LPS. We also developed a novel rat model of chronic hyperendotoxemia. Four DDS tablets, each containing 15 mg LPS, were implanted into the abdominal cavity of rats in the LPS group. The control group was implanted with four DDS tablets without LPS. Plasma levels of LPS in the study group were maintained at more than 2,000 pg/ml for 72 h after implantation. Weight gain was lower and body temperature was higher in the LPS group than in the control group. Plasma levels of inter leukin (IL)-6 in the LPS group were higher than in the control group only during the initial 12 h after implantation of DDS tablets. The white blood cell count at 24 h and platelet counts at 24, 48, and 72 h in the LPS group were lower than those in the control group. These results indicate that chronic hyperendotoxemia was maintained for 72 h by continuous release of LPS from the DDS. Moreover, the intensity of endotoxemia could be varied by varying the number of DDS tablets. It is concluded that our new rat model using LPS-DDS will be applicable and useful as a model of chronic hyperendotoxemia.

Single-component organic semiconductors based on novel radicals that exhibit electrochemical amphotericity: preparation, crystal structures, and solid-state properties of N,N'-dicyanopyrazinonaphthoquinodiiminides substituted with an N-alkylpyridinium unit

N,N'-Dicyanonaphthoquinodiimines fused with a pyrazine ring 1 were prepared from the corresponding quinones 4. The new acceptors 1 have a planar pi-system and undergo reversible two-stage 1e-reduction. Quaternization of the pyridyl substituent in 1d-f gave pyridinium derivatives 2d+, 2e+, and R-3+, respectively, which are stronger acceptors that undergo three-stage 1e-reduction. Upon electrochemical reduction of these cations, novel radicals 2d., 2e., and R-3. were generated and isolated as stable solids. The molecular geometries determined by X-ray analysis indicated that these radicals adopt a zwitterionic structure, in which the unpaired electron is located on the quinodiimine unit but not on the pyridyl group. These novel radicals undergo facile and reversible 1e-oxidation as well as two-stage 1e-reduction. The observed amphotericity endows the radicals with electrical conductivities (10(-5) to 10(-9) S cm-1), and these thus represent a new motif for single-component organic semiconductors.

Phase I trial of oral 2'-deoxy-2'-methylidenecytidine: on a daily x 14-day schedule

2'-deoxy-2'-methylidenecytidine (DMDC) is a potent deoxycytidine analogue. Preclinical studies of DMDC demonstrated activity against a variety of murine and human tumors in cell cultures and murine models and indicate enhanced antitumor activity of DMDC when it was administered in a manner that provided prolonged systemic exposure. In view of this observation, this study was designed to determine the toxicities, maximum-tolerated dose, and pharmacokinetic profile of DMDC. DMDC was given p.o. under fasting conditions for 14 consecutive days every 4 weeks in patients with advanced solid tumors. The starting dose was 12 mg/m2/day. Pharmacokinetic studies were carried out on days 1 and 14 of the first cycle. Fourteen patients received 22 courses of DMDC. The dose-limiting toxicities were anorexia, leukopenia, thrombocytopenia, and anemia. General fatigue was the common nonhematological toxicity. The maximum-tolerated dose was 18 mg/m2/day, at which two of six patients developed grade 3 toxicities. This dose level could also be considered for Phase II testing with this schedule. At the 18-mg/m2/day dose level, the mean terminal half-life, maximum plasma concentration (Cmax), the area under the plasma drug concentration-time curve (AUC(0-infinity)) on day 1 were 1.7496 h, 112.9 ng/ml, and 399.8 ng x h/ml, respectively. Forty to 50% of the administered dose was recovered in the urine, indicating a good bioavailability and resulting significant systemic exposure to the drug, which may enable chronic oral treatment.

Estimation of bacterial contamination in ultrapure water: application of the anti-DNA antibody

We constructed and established a hybridoma cell line that produces immunoglobulin G-type anti-DNA antibody. By using this antibody, we could successfully detect a single bacterial cell in ultrapure water (UPW). The detection system is composed of a membrane-supported western blotting-type immunoassay and a two-dimensional photon analyzer with high resolution. It can detect and count every bacterial cell in a wide field of view on a trapping filter i.e., a circle with an 18-mm diameter. This means 10 fg (10(-14) g) of bacterial DNA can be detected in the field. This system could be a useful tool for evaluating the number of bacteria contained by UPW and water used for medical purposes.

Reconstruction for the brilliance-upgrading project of the Photon Factory storage ring

Reconstruction of the Photon Factory storage ring (PF ring; 2.5 GeV) is now in progress to provide very brilliant synchrotron radiation to users, i.e. the emittance is being reduced by a factor of five. Components, such as the quadrupole and sextupole magnets, vacuum chambers, beamlines and beam-position monitors, are being replaced by new ones in 16 normal-cell sections of the PF ring. The accelerating cavities, injection systems and control systems are also being replaced. Operation will commence when the improvements are completed on 1 October 1997.

[A case of complete remission of gastric endocrine cell carcinoma with multiple bone metastasis by combination chemotherapy and high-dose chemotherapy with autologous peripheral blood stem cell transplantation]

A 31-year-old man was admitted to our hospital complaining of epigastric discomfort and severe lumbago. An upper gastrointestinal endoscopy revealed several submucosallike tumors. Histologic examination of biopsy specimens confirmed the presence of endocrine cell carcinoma. Gallium scintigraphy and CT revealed multiple bone metastasis. He was treated with 6 cycles of combination chemotherapy consisting of CDDP, etoposide, CPA, EPI and VCR. Both gastric tumors and bone metastasis completely disappeared. After 7 cycles of the chemotherapy, he was treated with HDCT with PBSCT. There was no severe complication. This result suggested that the combination of conventional chemotherapy and HDCT with PBSCT was useful in cancer patients with poor prognoses, such as advanced gastric endocrine cell carcinoma.

Expression of Bcl-2 in human breast cancer: correlation between hormone receptor status, p53 protein accumulation and DNA strand breaks associated with apoptosis

The expression of Bcl-2, a suppressor of apoptotic cell death, was investigated in 52 invasive carcinomas of the breast using reverse transcription-polymerase chain reaction and immunohistochemical methods. After consideration of both sets of results, 42 tumors (80.8%) were confirmed to be positive (Bcl-2(+)) and 10 (19.2%) were judged negative (Bcl-2(-)) for Bcl-2 expression. Related factors (p53 protein accumulation, hormone receptor status and apoptotic cell index) were also examined using immunohistochemical and in situ end-labeling methods to elucidate their correlations with Bcl-2 expression. Bcl-2 expression correlated significantly with the hormone receptor status, whereas it showed significant inverse correlations with p53 accumulation and the apoptotic index. It was concluded that estrogen and mutant p53 are related to the regulation of Bcl-2 expression and that the ability to prevent tumor cell death due to Bcl-2 can be developed by breast cancers.

[Scimitar syndrome with diagnostic MRI findings]

A fifty-year-old woman was admitted to our hospital because of an abnormal shadow on a chest X-ray film. She was asymptomatic. Chest X-ray film showed a scimitar-like vessel in the right lung, dextroposition of the heart, and hypoplasia of the right pulmonary artery. MRI revealed that the scimitar vein was anomalous pulmonary venous return from the right lung. Normal venous return from the right lower lobe to the left atrium was confirmed by pulmonary artery angiography. MRI findings have been useful in the diagnosis of scimitar syndrome.