[A case report of bilateral multiple pulmonary arteriovenous fistulas treated surgically at one-stage procedure by median sternotomy]

A 40-year-old female was admitted because of abnormal chest shadows. Chest CT and pulmonary angiography revealed bilateral multiple arteriovenous fistulas in the right S5a, S5b and left S5, S9. Fistula excision and bilateral partial resection of lung were performed through median sternotomy in one stage. This surgical options allows entire removal of the fistulas as well as preservation of lung function.

1α,25-Dihydroxyvitamin D3 directly induces fusion of alveolar macrophages by a mechanism involving RNA and protein synthesis, but not DNA synthesis

The results of our present study indicate that 1 alpha, 25-dihydroxyvitamin D3[1 alpha, 25(OH)2D3] directly induces fusion of mouse alveolar macrophages without any participation of T-lymphocytes by a mechanism involving RNA and protein synthesis but not DNA synthesis. We have reported that 1 alpha, 25(OH)2D3 induces fusion of alveolar macrophages by a direct mechanism and by a spleen cell-mediated indirect mechanism [(1983) Proc. Natl. Acad. Sci. USA 80, 5583-5587]. Alveolar macrophages pretreated with or without anti-Thy 1.2 antibody and complement fused similarly when they were incubated with 1 alpha, 25(OH)2D3. The vitamin suppressed DNA synthesis, but it significantly enhanced RNA and protein synthesis. The 1 alpha, 25(OH)2D3-induced fusion was blocked by adding actinomycin D or cycloheximide, but not by hydroxyurea.

Cytological evaluation of angiogenesis in endometrial aspirates

We conducted a comparative study of angiogenesis observed in endometrial aspirates according to histological type. Cytological specimens from 14 cases of proliferative phase endometrium, 21 cases of endometrial hyperplasia and 18 cases of well-differentiated endometrial adenocarcinoma were used in the investigation. Immunohistochemical staining was performed according to standard methods using CD34 monoclonal antibody, and new vessels were examined. New vessels were identified in all of the histological types, but no morphological differences were seen. New vessels were observed in more cases of adenocarcinoma than in cases of normal tissue or hyperplasia, and the differences were significant. The difference between the maximum and minimum rates of occurrence of cell clusters possessing new vessels tended to be greater in adenocarcinoma than in the other tissue types (P < 0.05). Based on the above findings, examination of new vessels appearing in aspirated endometrial specimens appeared to be of help in differential diagnosis, but it also seemed necessary to take changes due to the menstrual cycle etc. into consideration.

[Percutaneous transluminal septal ablation with ethanol in hypertrophic obstructive cardiomyopathy: a case report]

A 48-year-old man with hypertrophic obstructive cardiomyopathy was treated by nonsurgical septal ablation. He had previously received medical treatment using atenolol and verapamil, but severe symptoms of chest discomfort, dyspnea, and shortness of breath had persisted for 2 years. Under coronary angiography control, the first major septal branch of the anterior descending coronary artery was catheterized with a 2.0 mm coaxial percutaneous transluminal coronary angioplasty balloon catheter. After inflation of the balloon, 1.5 ml of absolute alcohol was slowly injected into the septal artery to induce a small septal infarction. The left ventricular outflow pressure gradient was decreased from 108 before to 30 mmHg after the procedure as measured by Doppler echocardiography. His chest symptom improved from New York Heart Association class III to II and left ventricular outflow gradient was maintained at 0 mmHg (at rest) at 3 months after treatment. This is a new, less invasive treatment using catheterization instead of surgical myectomy. The indication, complication, and long-term effect of the treatment must be carefully evaluated, but this is expected to become a useful method.

Evaluation of effect and distribution of heparin administered in vascular reconstructive surgery

BACKGROUND

The aim of this study was to find out whether intravenously administered heparin is distributed equally not only proximal but also distal to the arterial occlusion level in vascular reconstructive surgery.

METHODS

Ten consecutive patients (7 men and 3 women) with an average age of 69.9 years (range, 51 to 76 years) who underwent graft replacement for aortic abdominal aneurysm from April to December 1994 were studied. Mean aortic clamp time was 76 minutes. Heparin sodium (100 U/kg) was administered intravenously to keep activated clotting time (ACT) over 250 secs and was neutralized by protamine sulfate (1 mg/kg) just after reperfusion. ACT, blood lactate and CPK-MM in the brachial and dorsal pedis artery were measured before heparin administration (control), just after arterial occlusion, just before reperfusion and 10 minutes after protamine administration.

RESULTS

ACT was significantly prolonged after arterial occlusion and recovered after protamine administration with no significant differences between proximal and distal values at each point. Lactate showed significant increase after arterial occlusion which was more remarkable distally. CPK-MM was all the way within the normal range.

CONCLUSIONS

In vascular reconstructive surgery which requires temporary arterial occlusion for as long as 80 minutes, the effect of heparin is excellent and equal throughout the body by collateral vessels, and the metabolic influence due to blockade of the blood flow is not so critical as to lead to cellular damage although anaerobic glycolysis is promoted distally due to hypoxia.

BE-31405, a new antifungal antibiotic produced by Penicillium minioluteum. I. Description of producing organism, fermentation, isolation, physico-chemical and biological properties

A new antifungal antibiotic, BE-31405, was isolated from the culture broth of a fungal strain, Penicillium minioluteum F31405. BE-31405 was isolated by adsorption on high porous polymer resin (Diaion HP-20), followed by solvent extraction, precipitation and crystallization. BE-31405 showed potent growth inhibitory activity against pathogenic fungal strains such as Candida albicans, Candida glabrata and Cryptococcus neoformans, but did not show cytotoxic activity against mammalian cells such as P388 mouse leukemia. The mechanism studies indicated that BE-31405 inhibited the protein synthesis of C. albicans but not of mammalian cells.

Expression of p53, MDM2 protein and Ki-67 antigen in recurrent meningiomas

Association of p53 gene abnormalities with tumor progression and prognosis of many neoplasms has been demonstrated, but little is known about the clinical significance of p53 abnormalities in meningiomas. The significance of p53 protein expression in recurrent meningiomas and its relationships with MDM2 protein and proliferation activity were investigated by analyzing 39 meningiomas immunohistochemically. p53 protein was expressed in 11 (35%) of 31 non-recurrent and 7 (88%) of 8 recurrent meningiomas. A high frequency of p53 expression was observed in recurrent meningiomas, which tended to have a high p53 positive index (p53 PI), indicating that p53 immunoreactivity may be a marker for predicting tumor recurrence. Four recurrent meningiomas with high p53 PIs were analyzed by the polymerase chain reaction-single strand conformation polymorphism method to detect p53 gene mutations, but none were found in exons 4-8 of this gene. Fifteen (71%) of 21 MDM2-positive and 3 (17%) of 18 MDM2-negative tumors expressed p53 protein, showing that MDM2 expression was more common in meningiomas with p53 expression. p53 immunoreactivity in the absence of mutation may indicate stabilization of the wild type through interaction with the MDM2 protein. The Ki-67/MIB-1 proliferation index (MIB-1 PI) correlated well with recurrence. The p53-positive tumors had a significantly higher mean MIB-1 PI than p53-negative tumors, suggesting that wild-type p53 inactivation by the MDM2 protein may be involved in controlling the proliferative activity in meningiomas. In conclusion, immunohistochemical examination for p53 protein as well as proliferative activity may help predict the malignant potential of tumor recurrence.

Multivarious clinical manifestations of multiple pseudoaneurysms in Behçet's disease

In Behçet's disease, an aneurysm is prone to progress rapidly to a pseudoaneurysm. Acute limb ischemia due to acute thrombosis of a femoral pseudoaneurysm and subsequent Horner's syndrome due to another subclavian pseudoaneurysm are very rare but acceptable complications in Behçet's disease. We present a case of Behçet's disease with multiple pseudoaneurysms, which also showed these other clinical manifestations. Over a short time span, the patient rapidly developed left femoral and right subclavian pseudoaneurysms, which were successfully resected with graft replacements.

Cysteine-scanning mutagenesis around transmembrane segment III of Tn10-encoded metal-tetracycline/H+ antiporter

Each amino acid in the putative transmembrane helix III and its flanking regions (from Gly-62 to Tyr-98) of the Tn10-encoded metal-tetracycline/H+ antiporter (Tet(B)) was individually replaced with Cys. Out of these 37 cysteine-scanning mutants, the mutants from G62C to R70C and from S92C to Y98C showed high or intermediate reactivity with [14C]N-ethylmaleimide (NEM) except for the M64C mutant. On the other hand, the mutants from R71C to S91C showed almost no reactivity with NEM except for the P72C mutant. These results confirm that the transmembrane helix III is composed of 21 residues from Arg-71 to Ser-91. The majority of Cys replacement mutants retained high or moderate tetracycline transport activity. Cys replacements for Gly-62, Asp-66, Ser-77, Gly-80, and Asp-84 resulted in almost inactive Tet(B) (less than 3% of the wild-type activity). The Arg-70 --> Cys mutant retained very low activity due to a mercaptide between Co2+ and a SH group (Someya, Y., and Yamaguchi, A. (1996) Biochemistry 35, 9385-9391). Three of these six important residues (Ser-77, Gly-80, and Asp-84) are located in the transmembrane helix III and one (Arg-70) is located in the flanking region. These four functionally important residues are located on one side of the helical wheel. Only two of the residual 31 Cys mutants were inactivated by NEM (S65C and L97C). Ser-65 and Leu-97 are located on the cytoplasmic and periplasmic loops, respectively, in the topology of Tet(B). The degree of inactivation of these Cys mutants with SH reagents was dependent on the volume of substituents. In the presence of tetracycline, the reactivity of the S65C mutant with NEM was significantly increased, in contrast, the reactivity of L97C was greatly reduced, indicating that the cytoplasmic and periplasmic loop regions undergo substrate-induced conformational change in the mutually opposite direction.

[Two-staged repair of coarctation of the aortic arch with severe subaortic stenosis and ventricular septal defect]

Aortic arch coarctation proximal to the left subclavian artery is a rare anomaly. It is about 1% of all coarctation of the aorta. This 16 days neonate with coarctation of aortic arch with severe subaortic stenosis and ventricular septal defect was underwent two staged repair. In the first-stage operation, coarctation of the aortic arch was reconstructed by extended end to end direct anastomosis through posterolateral thoracotomy. In the second stage, we performed intracardiac repair with use of a technique which included resection of superior margin of conus septum through VSD and patch closure of VSD. The postoperative pressure study showed no gradient between left ventricle and left radial artery. The postoperative course was satisfactory. This patient is doing well.

Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations

BACKGROUND

There have been sporadic cases of persistent atrial fibrillation and sick sinus syndrome after the maze procedure. The purpose of this study was to identify the predictors of sinus rhythm restoration after operation.

METHODS

Between March 1993 and June 1995, we evaluated retrospectively 96 consecutive patients who underwent the maze procedure (maze III) in combination with another type of cardiac operation. Four patients who died and 6 patients who required permanent pacemaker implantation because of sick sinus syndrome were excluded. Ambulatory electrocardiographic monitoring was evaluated 1 year after operation. Multiple logistic regression analysis was applied to identify the predictors of sinus rhythm restoration.

RESULTS

The final population comprised 86 patients (mean age, 59.8 years; 67 patients with mitral valve disease). Overall, sinus rhythm was restored in 68 of 86 patients (79.1%). The magnitude of the atrial fibrillatory wave positively predicted postoperative sinus rhythm restoration. Conversely, left atrial diameter was inversely related to postoperative sinus rhythm restoration. The odds ratio of having both a fine atrial fibrillatory wave (< 1.0 mm) and enlarged left atrial diameter (> or = 65 mm) for patients with sinus rhythm restoration was 0.04 (95% confidence interval, 0.01 to 0.28).

CONCLUSIONS

Atrial fibrillatory wave and left atrial diameter were independent predictors of sinus rhythm restoration after the maze procedure in patients with chronic atrial fibrillation and organic heart disease.

Thrombotic obstruction of a reinforced ringed expanded polytetrafluoroethylene graft caused by formation of a pseudoaneurysm at a nonanastomotic site: report of a case

We report herein the case of a 72-year-old man in whom a nonanastomotic pseudoaneurysm arose from a reinforced ringed expanded polytetrafluoroethylene (EPTFE) graft (Gore-Tex, Flagstaff, AZ, USA) following an axillobifemoral bypass. The pseudoaneurysm developed 2 years after graft insertion and induced graft thrombosis. The development of the pseudoaneurysm can be attributed to the fact that his axillobifemoral bypass graft was so short it deformed the proximal anastomosis, and the graft was subcutaneously tunneled onto the major pectoral muscle. These technical errors placed the graft under too much tension in the longitudinal direction, which resulted in graft disruption and pseudoaneurysmal formation, followed by thrombosis of the axillary artery. Moreover, the possibility of direct trauma at the time of insertion cannot be substantiated. Although the very poor compliance and design of the externally supported ring could not tolerate stretch deformity in the Gore-Tex graft, only one other case of a nonanastomotic pseudoaneurysm has ever been reported.

Transmembrane glutamic acid residues play essential roles in the metal-tetracycline/H+ antiporter of Staphylococcus aureus

Three transmembrane aspartyl residues play essential roles in the transposon Tn10-encoded metal-tetracycline/H+ antiporter (Tet(B)) [Yamaguchi, A. et al. (1992) J. Biol. Chem. 267, 7490-7498]. The tetK gene-encoding tetracycline resistance protein (Tet(K)) of Staphylococcus aureus mediates metal-tetracycline/H+ antiport similarly to Tet(B); however, it has no transmembrane aspartyl residue. On the other hand, Tet(K) has three glutamyl residues, Glu-30, Glu-152 and Glu-397, in the putative transmembrane regions. In the present work, tet(K) gene was expressed in Escherichia coli and the transport activity was measured in everted membrane vesicles. When these glutamyl residues were replaced with Gln, the tetracycline transport activity was almost completely lost, indicating the important roles of these residues in Tet(K). In the case of Glu-397, even the charge-conserved mutation to Asp caused complete loss of the activity. On the other hand, the mutation of Glu-30 and Glu-152 to Asp resulted in significant retention of transport activity. These results are similar to those on the mutation of the three transmembrane aspartyl residues in Tet(B), indicating that the transmembrane glutamyl residues in Tet(K) play roles similar to those of the transmembrane aspartyl residues in Tet(B).

[A case of ruptured sinus of Valsalva aneurysm with bicuspid aortic valve]

A 40-year-old male underwent operation with a suspected diagnosis of a ruptured of Valsalva aneurysm and a bicuspid aortic valve. The aneurysm with an apical rupture protruded into the membranous septum, between the leaflets of the tricuspid valve. The aortic valve was bicuspid, with the aneurysm originating from the right sinus of Valsalva. We presume that the bicuspid aortic valve tends to cause the sinus of Valsalva aneurysm in point that each coronary sinus is given excessive pressure compared with that in the normal aortic valve. Rarity of the combined cases is possibly because the bicuspid aortic valve is frequent while the sinus of Valsalva aneurysm is rare in Western countries and vice versa in Japan.

Morphometrical analysis of nucleolin immunohistochemistry in meningiomas

Nucleolin (110 kDa) is a major nucleolar protein in eukaryotic cells and one of the nucleolar organizer region (NOR)-associated proteins. We studied immunohistochemically 32 cases of meningioma, using specific antisera against nucleolin, and analyzed various nucleolin parameters, such as the number of regions and the total area of nucleolin staining per nucleus. The mean number and area of nucleolin stainings per nucleus were compared with the histological malignancy and Ki-67/MIB-1 proliferation index; the correlation with parameters of silver-stained NOR (AgNOR) was also studied. The results showed that there were statistically significant differences in the mean number and area of nucleolin stainings per nucleus between meningiomas and other two groups, atypical and anaplastic meningiomas (P < 0.05), although there was no difference between atypical and anaplastic meningiomas. The mean number and area of nucleolin stainings per nucleus were correlated with the incidence of Ki-67 positivity and AgNOR area. In view of the technical problems inherent in AgNOR staining, immunohistochemistry for nucleolin may represent a more specific and reproducible means for NOR visualization and be a promising technique for assessing cell proliferation.

[A case report of total cavopulmonary connection following total cavopulmonary shunt]

A 20-year-old man underwent total cavopulmonary shunt for univentricular heart type A (A.L.L.) with hemiazygos connection six years ago. Four years later, his condition deteriorated with easy fatigue and cyanosis. Cardiac catheterization showed recanalization of ligated SVC. Chest CT showed tight adhesion between the chest wall and the ascending aorta. We approached the heart through left anterolateral thoracotomy in order to avoid injury of the aorta and the ventricle during redo median sternotomy. Total cavopulmonary connection with intraatrial conduit was performed under circulatory arrest and retrograde cardioplegia without aortic cross clamp. His postoperative course was satisfactory. Left thoracotomy was useful for total cavopulmonary connection following total cavopulmonary shunt associated with postoperative adhesion.

Insertion of the 70-kDa peroxisomal membrane protein into peroxisomal membranes in vivo and in vitro

Biosynthesis and intracellular transport of 70-kda peroxisomal membrane protein (pmp70) has been studied in rat hepatoma, h-4-ii-e cells. Pulse-chase analysis showed that a newly synthesized 35S-PMP70 first appeared in the cytosolic fraction and was then transported into the peroxisomal fraction. The half-life of 35S-PMP70 in the cytosolic fraction was approximately 3 min. Integration of 35S-PMP70 into membranes occurred in the peroxisomal fraction and was completed within 30 min. No proteolytic processing of 35S-PMP70 was observed. An in vitro import system was reconstituted to characterize the insertion mechanism of PMP70 into peroxisomes. Peroxisomes isolated from rat liver were incubated at 26 degrees C with [35S]methionine-labeled in vitro translation products of PMP70 mRNA in the presence of the cytosolic fraction. The peroxisomes were reisolated and insertion of 35S-PMP70 into the membrane was analyzed using a Na2CO3 procedure. The binding and insertion of 35S-PMP70 were dependent on temperature and incubation time and was specific for peroxisomes. Pretreatment of peroxisomes with trypsin and chymotrypsin almost abolished the binding and insertion of 35S-PMP70. The translation products contained several truncated 35S-PMP70s. The NH2 terminally truncated 35S-PMP70s, with a molecular mass greater than 50 kDa, bound to and inserted into peroxisomal membranes, whereas truncated 35S-PMP70s smaller than 45 kDa did not. These results suggest that PMP70 is post-translationally transported to peroxisomes without processing and inserted into peroxisomal membranes by a specific mechanism in which a proteinaceous receptor and a certain internal sequence of PMP70 are involved.

[A case of failure of mitroflow pericardial valve with severe hemolytic anemia]

A 49-year-old woman who underwent mitral valve replacement with 29 mm Mitroflow pericardial valve in 1985 started to have severe hematuria, anemia and icterus around May 1994. She was diagnosed to have mitral regurgitation with hemolytic anemia due to structural deterioration of the prosthetic valve. She underwent replacement of the prosthetic valve with 29 mm St. Jude medical mechanical valve, which alleviated the symptoms remarkably. The explanted valve showed an extensive cuspal tear and prolapse close to the commissure and poor endothelialization of the inflow surface of the frame. In our experience the rate of structural deterioration of the Mitroflow valve is so high that we discontinued using this bioprosthesis.

[Quality of life, subjective health status and health and life satisfaction in rheumatoid arthritis]

A Japanese version of Arthritis Impact Measurement Scales (AIMS) was developed after the original AIMS Version 2 and utilized for Quality of Life (QOL) measurement in 691 patients with Rheumatoid Arthritis (RA). Various medical (physical and laboratory) examinations, which are widely used in the clinical settings for the assessment of RA activity and severity, were also performed by physicians. Interrelationships between QOL, patient subjective health status, and health and life satisfaction were analyzed with the following results: 1: The effect of QOL impairment by RA upon patients' subjective health rating and health satisfaction were not constant over the range of severity of disease status. Pain was found to lower overall subjective health and health satisfaction regardless of RA class. On the other hand, while the deterioration of mobility aspects of QOL had negative effects upon patients' subjective health status and satisfaction among less-disabled RA patients, any of physical aspects of QOL, including the degree of mobility impairment, showed no significant association with patients' subjective health status and satisfaction in the more disabled. 2: Psychological aspects of QOL (mood and tension) had significant associations with patients' subjective health status and satisfaction. In the less severe group, mood impairment had a significant effect on subjective health and satisfaction, while in the more severe group tension showed a significant association. It was indicated that management of psychological aspects of QOL is important in RA patients to improve and advance their subjective health status and satisfaction. 3: Although social aspects of QOL, i.e. social support, social life and job status, showed no significant relationship to subjective health rating and health satisfaction, those with less disease severity who lacked social support and who had a jobless state were likely to have lower disease acceptance and life satisfaction, while those with more severe disease who had less social interaction manifested lower life satisfaction. These results suggested that social aspects of QOL, while not directly associated with subjective health rating, could be important factors affecting disease acceptance and life satisfaction.

[The validity and reliability of a Japanese version of Arthritis Impact Measurement Scales in patients with rheumatoid arthritis]

A Japanese version of Arthritis Impact Measurement Scales (Japanese-AIMS) was developed after the original AIMS Version 2 (AIMS 2). We then conducted a Quality of Life measurement of 691 patients with Rheumatoid Arthritis (RA) with this newly developed questionnaire. Based on the data collected, the validity and reliability of the Japanese-AIMS was examined. The validity of the Japanese-AIMS, which was assessed by the examination of internal consistency among items and through factor analysis, was almost comparable with that of the original AIMS 2. QOL scales were also validated using internal standards based on the subject's responses to other items in the questionnaire. The test-retest reliability, which was the correlation of scale scores between two tests administered 4-5 weeks apart, was slightly lower than the original one. We conclude that the validity and reliability of the Japanese AIMS were comparable with those of the original one, though there could be possibly improved by the minor revision of phrasing. The large scale QOL measurement study with RA patients is under way, using the Japanese-AIMS with minor revision.

Alterations of sympathovagal balance in patients with hypertrophic and dilated cardiomyopathies assessed by spectral analysis of RR interval variability

Spectral analysis of RR interval variability was performed in 35 ambulatory patients with early hypertrophic cardiomyopathy (HCMa, NYHA class I), 21 hospitalized patients with advanced hypertrophic cardiomyopathy (HCMh, NYHA class II or III), and 18 hospitalized patients with dilated cardiomyopathy (DCMh, NYHA class I, II or III). Twenty-nine ambulatory subjects (COTa) and 20 hospitalized volunteers (COTh) served as normal controls. The RR interval standard deviation (SD), the high-frequency power (HF: 0.15-0.40 Hz) corrected by the mean RR interval (CCVHF) and the normalized unit of the HF power (NUHF) served as markers of vagal modulation. Low-frequency power (LF: 0.04-0.15 Hz) corrected by the mean RR interval (CCVLF) and the normalized unit of LF power (NULF) were markers of sympathetic modulation. The LF/HF ratio was an index of sympathovagal balance. There was no significant difference in the SD, CCVHF, NUHF, CCVLF, NULF or the LF/HF ratio between the HCMa and COTa groups. At night, the SD was lower in the HCMh group relative to the COTh group (P < 0.01). The HCMh group demonstrated lower CCVHF and NUHF values (P < 0.01), higher NULF values (P < 0.01) and higher LF/HF ratios (P < 0.05) at night relative to the COTh group. Two patients who later died suddenly in the HCMh group had markedly reduced CCVHF values (0.2-0.8%) relative to the survivors in the group (mean +/- SD in the morning, afternoon and night, 1.07 +/- 0.43%).(ABSTRACT TRUNCATED AT 250 WORDS)