[A case of emergent surgical salvage for the mitral prosthetic perivalvular leakage diagnosed only by the transesophageal Doppler echocardiography]

A case of the successful emergency surgery for the mitral prosthetic perivalvular leakage (PVL) which was diagnosed only by the transesophageal Doppler echocardiography (TEE) is reported. A 59-year-old male who had been diagnosed MS + TR + severe PH underwent mitral valve replacement with St. Jude medical valve 27 M. On the eighteenth postoperative day hemoglobinuria was noticed suddenly. Subsequently hemolysis and nonoriguric renal failure was aggravated, then we suspected PVL, but heart murmur was not audible or PVL could not been detected by the transthoracic echocardiography (TTE). PVL was detected for the first time by the TEE, then open heart resuture was emergently performed. The site of the PVL was the portion where the anterior mitral annulus adjoined the aortic annulus, that is, adjacent to the right fibrous trigone. This site is the portion which a surgeon should treat very carefully and where the PVL is very difficult to detect by the TTE. In regard to the detection of the PVL in mitral position, the TEE, which has ultrasonically no flow masking by the mitral prosthesis, is the very useful diagnostic means.

HLA-DR4 antigen and lymph node metastases in poorly differentiated adenocarcinoma of the stomach

BACKGROUND

The authors investigated whether HLA antigens could act as a predictor of the risk of lymph node metastasis in patients with gastric cancer.

METHODS

The microcytotoxicity assay was used to examine 51 HLA antigens of the A, B, C, DR, and DQ loci in 573 patients who underwent resection of gastric cancer. The incidence of HLA antigens in patients with or without lymph node metastasis was analyzed using the chi-square method.

RESULTS

The incidence of patients with HLA-DR4 antigen with or without lymph node metastasis was 45.9% and 34.8%, respectively (P = 0.0098, corrected P = 0.49). The relative risk of lymph node metastasis in patients with HLA-DR4 was 1.6. In poorly differentiated adenocarcinoma, the incidence of HLA-DR4 antigen in patients with lymph node metastasis was significantly higher (47.5%) than in patients without lymph node metastasis (18.5%), if corrected P values were tested (P = 0.0007, corrected P = 0.0387). The relative risk of lymph node metastasis in patients with poorly differentiated adenocarcinoma with DR4 was 4.0.

CONCLUSIONS

The data suggest an association between the presence of HLA-DR4 and an increased risk of lymph node metastasis, especially in poorly differentiated adenocarcinoma.

Adenosine enhances intracellular Ca2+ mobilization in conjunction with metabotropic glutamate receptor activation by t-ACPD in cultured hippocampal astrocytes

2Cl-Adenosine, a non-metabolized adenosine agonist, enhanced the increase in intracellular Ca2+ concentration ([Ca2+]i) in cultured hippocampal astrocytes induced by (+-)-1-aminocyclopentane-trans-1,3-dicarboxylic acid (t-ACPD), a metabotropic glutamate agonist. In the absence of 2Cl-adenosine, the half effective concentration (EC50) of t-ACPD was about 80 microM. On the other hand, in the presence of 1 microM 2Cl-adenosine, the EC50 of t-ACPD shifted to about 5 microM, although the maximum [Ca2+]i did not change. The synergistic effect of 2Cl-adenosine with t-ACPD on [Ca2+]i elevation was not inhibited by the elimination of extracellular Ca2+, but was inhibited by A1-specific adenosine antagonists. These results indicate that adenosine can act via the A1 receptor as an endogenous co-activator of the metabolic processes induced by metabotropic glutamate receptor activation.

Recovery from ultraviolet-induced growth arrest of primary rat hepatocytes by p53 antisense oligonucleotide treatment

Recent evidence suggests that wild-type p53 prevents cell-cycle progression after DNA damage, which may provide a sufficient period for the cells to repair the genetic lesions that may otherwise lead to cell death or cellular transformation. We tested whether this hypothesis is generally applicable to parenchymal cells of internal organs. When primary neonatal rat hepatocytes were exposed to a nonlethal dose of ultraviolet light, actinomycin D, or mitomycin C, most cells expressed abundant p53 with an abnormally extended half life in their nuclei, and their growth was arrested despite treatment with growth factors (epidermal growth factor and insulin). When DNA-damaged cells were treated with p53-antisense oligonucleotides, p53 expression was significantly suppressed, and an appreciable fraction of the cells entered S phase. However, when damaged cells were administered p53-sense or retinoblastoma susceptibility gene-antisense oligonucleotides, there was no recovery from growth arrest. The data strongly suggest that p53 is a component of at least one signal transduction pathway leading to growth arrest in DNA-damaged cells.

Studies on active substances in herbs used for hair treatment. I. Effects of herb extracts on hair growth and isolation of an active substance from Polyporus umbellatus F

The effects of methanol extracts of 80 herbs on hair growth were investigated, using normal C3H/He mice from which telogen hair on the back had been removed. Eighteen of the extracts apparently promoted hair regrowth on the mice. As one of active principles in Polyporus umbellatus F., 3,4-dihydroxybenzaldehyde was isolated by column chromatography on Amberlite XAD-2, Sephadex LH-20 and silica gel.

Quadruple cancers in a human T-cell leukemia virus type 1 carrier

Human T-cell leukemia virus type 1 (HTLV-1) infection is considered to contribute to the risk of malignancies other than adult T-cell leukemia. We report a 64-year-old male HTLV-1 carrier who developed quadruple malignancies such as cancer of the urinary bladder, skin, larynx and liver.

The study of tumor necrosis factor beta gene polymorphism in lung cancer patients

BACKGROUND

In recent years numerous reports have discussed the relationship between the human leukocyte antigen and lung cancer. However, the genetic background of lung cancer has not yet been precisely clarified.

METHODS

To investigate the genetic background of lung cancer, the human leukocyte antigens in 159 normal healthy control subjects and 102 lung cancer patients were studied, and restriction fragment length polymorphism analysis of the tumor necrosis factor (TNF) beta gene in 165 normal healthy control subjects and 135 lung cancer patients was performed.

RESULTS

Lung cancer patients showed a high frequency of human leukocyte antigen B61; however, no statistical difference was found. In the lung cancer patients, the TNF beta 10.5/10.5-kb allele was found at a low frequency, 38.5%, compared to 53.3% in normal controls (chi 2 = 7.51, P = 0.011, corrected P = 0.033, relative risk = 0.77). In the relationship between the histologic types and the TNF beta gene, the TNF beta 10.5/10.5-kb allele showed low frequencies: 38.5% in adenocarcinoma, 38.2% in squamous cell carcinoma, and 27.8% in small cell carcinoma, although no statistical difference was shown. In relation to the postoperative survival period, the TNF beta 10.5/10.5-kb allele was associated with prolonged survival.

CONCLUSIONS

The TNF beta 10.5/10.5-kb allele may be associated with resistance to lung cancer and with a better prognosis.

Necessity to improve common understanding about the security issues among hospitals in Japan and some feasible approaches

To improve common understanding about security issues, the importance of classifying the information is stressed, after describing briefly the social background concerning privacy-related problems in Japan. We discuss here the classification only from the following two points of view: (a) the ownership; and (b) how to use. We will derive a two-dimensional fuzzy membership function to describe the ownership and a 'how to use' three-dimensional one as models for describing the framework concerning access right and informed consent.

Developmental change in activity of red cell porphobilinogen deaminase and its electrophoretic variant in the Japanese population

The activity of porphobilinogen deaminase (PBGD), an enzyme whose partial deficiency is associated with acute intermittent porphyria (AIP), changes during development. Little is known about the postnatal change of PBGD activity and the prevalence of its electrophoretic variant in the Japanese population. The activity of PBGD was measured fluorometrically in 194 infants aged 0-12 months, while isoelectric focusing of PBGD was performed in 400 healthy Japanese adults aged 20-45 years and 30 children with various hematological disorders aged 1-15 years. The PBGD level was 1.9 times higher in the neonates than in the adults, decreased abruptly during the first month of life, and reached the adult level at the age of 9 months. None of the 400 healthy Japanese adults and the 30 children with hematological disorders showed any electrophoretic variant. These results suggest that there is no need to consider any polymorphism in the gene dose study of PBGD and that the biochemical screening of AIP is applicable to since the late infancy.

Craniosynostosis and hemizygosity for D7S135 caused by a de novo and apparently balanced t(6;7) translocation

Craniosynostosis (CRS) is frequently seen in the del(7p) syndrome, and the gene for this cranial anomaly (CRS1) has been assigned to 7p21. We present a 3-year-old boy with CRS involving the sagittal and coronal sutures, who had a de novo and apparently balanced translocation, t(6;7)(q16.2;p15.3). Southern blot analysis of several loci on 7p14-->pter showed that the patient was heterozygous for HOX1I and IL6, possibly homozygous for D7S149, but hemizygous for D7S135 with a loss of the paternal allele. These findings suggest the localization of a candidate gene for CRS1 to be on 7p15.3 in the close proximity to the D7S135 locus.

Endotoxin protects the gastric mucosa against ulcerogenic stimuli

It is well-documented that large amounts of endotoxin produce hemorrhagic mucosal lesions in the stomach. To determine whether endotoxin, when injected at small doses, similarly exerts ulcerogenic actions, endotoxin (0.4-40 micrograms/kg) was injected into 24 hr-fasted rats. These small doses of endotoxin did not affect the integrity of the gastric mucosa. Unexpectedly, however, pretreatment with these minute amounts of endotoxin protected the gastric mucosa against various ulcerogenic stimuli such as stress, nonsteroidal anti-inflammatory drugs and ethanol. The anti-ulcer actions of endotoxin were not observed in endotoxin-insensitive animals (C3H/HeJ mice), thereby suggesting that endogenous cytokines such as interleukin-1 may mediate these protective actions. These findings stand in contrast to the toxic effect of endotoxin as an ulcerogen and indicate that endotoxin, albeit its term "toxin," may have a beneficial effect for the host.

CD7, CD4 and myeloid antigen-positive acute lymphoblastic leukemia

We report a case of acute lymphoblastic leukemia (ALL, FAB-L2) with unique cellular characteristics. Leukemic cells were negative for various cytochemical stainings except acid phosphatase. Immunophenotypic studies revealed CD7+, CD4+, CD8-, CD2+, CD3-, CD13+, CD25+, CD33+ and CD34+. The immunoglobulin heavy chain and T-cell receptor beta, gamma and delta chain genes were germline configurations. This patient had a karyotype of complex abnormalities involving Nos. 5 and 7. Leukemic cells showed a prominent response to interleukin-3, granulocyte macrophage colony stimulating factor (GM-CSF) and G-CSF with partial granulocytic differentiation in a colony assay. A binding assay confirmed the presence of both high and low affinity receptors for GM-CSF. These findings suggest that CD7+CD4+CD8-CD3- putative T-cell precursors may retain the capacity to differentiate to myeloid lineage.

[Unrelated match bone marrow transplantation for severe aplastic anemia]

The results of unrelated bone marrow transplantation (BMT) is poor because of the rejection of bone marrow graft and graft versus host disease (GVHD). However, the rate of rejection has been reported to be decreased by intensive immuno-suppressive preconditioning regimens combined with total body irradiation (TBI). We report a case of an 18-year-old male with severe aplastic anemia who received a matched BMT from an unrelated donor. The pre-conditioning regimen included cyclophosphamide (50mg/kg) for 4 days, total lymphoid irradiation (TLI: 6Gy) and TBI (5Gy). GVHD (grade 1), hemorrhage cystitis and varicella occurred after BMT but were cured. His performance status is now 100% on the Karnofsky score at 10 months after BMT.

Evaluation of prognoses of patients with gastric cancer by the responsiveness of peripheral blood lymphocyte to OK432 in vitro

The response of peripheral blood lymphocytes to the streptococcal preparation OK432 was examined in vitro in 193 gastric cancer patients. When the patients were divided by stimulation index (SI) into two groups, SI > or = 20 and SI < 20, the response rate of SI > or = 20 group of stage IV was 37.5%, and higher than those of the other stages (p < 0.05). In the relationship between SI and the survival period in stage III, the SI > or = 20 group showed longer survival than the SI < 20 group (p < 0.05). There was no statistically significant difference in survival between SI > or = 20 and SI < 20 in stage IV, but no member of the SI < 20 group survived more than 2 years, whereas the five-year survival of the SI > or = 20 group was 38.9%. In the overall survival of stage III and IV, the SI > or = 20 group showed longer survival than the SI < 20 group (p = 0.001). The lymphoproliferative responses to OK432 decreased in very advanced gastric cancer patients and this might lead to poor prognosis.

Selective impairment of the cytoplasmic Ca2+ response to glucose in pancreatic beta cells of streptozocin-induced non-insulin-dependent diabetic rats

Pancreatic islets from the streptozocin-induced non-insulin-dependent diabetes mellitus (NIDDM) rat model showed a diminished insulin response to 16.7 mmol/L glucose, but the insulin response to arginine remained intact. To evaluate the importance of intracellular calcium concentration ([Ca2+]i) in the diminished insulin response to glucose, the [Ca2+]i of pancreatic beta cells was investigated using fura-2. Glucose produced heterogeneous responses of [Ca2+]i, which were in beta-cell clusters of both the control and NIDDM groups. Many cells showed initial slight decreases of [Ca2+]i, which were followed by gradual and large increments of [Ca2+]i after glucose stimulation of beta cells in the control group. On the other hand, the increase of [Ca2+]i in response to glucose was markedly diminished in beta cells of the NIDDM group compared with controls. The average lag time to [Ca2+]i elevation of beta cells in the NIDDM group was significantly longer than that of the control group. Arginine produced marked increases of [Ca2+]i, in contrast to the effect of glucose stimulation in the NIDDM group. These results suggest that the diminished and delayed [Ca2+]i increases in beta cells of NIDDM rats in response to glucose stimulation are responsible for the selectively impaired insulin response to glucose in the rat model of NIDDM.

Studies on antiinflammatory agents. III. Synthesis and pharmacological properties of metabolites of 4'-acetyl-2'-(2,4-difluorophenoxy)methanesulfonanilide (FK3311)

We synthesized putative metabolites of 4'-acetyl-2'-(2,4-difluorophenoxy)methanesulfonanilide (FK3311, 1), a novel antiinflammatory agent, in order to confirm their structures and also to investigate their pharmacological properties. The structures of the metabolites 2-5 were confirmed by direct comparison with the synthesized authentic compounds. We employed the following tests to assess pharmacological activities: zymosan-induced prostaglandin E2 production for in vitro activity, adjuvant-induced arthritis for antiinflammatory activity, and acetic acid-induced writhing for analgesic activity. Metabolite 2 is nearly equipotent to 1 in the in vivo tests and metabolite 3 is an active metabolite with in vitro activity comparable to that of 1.

Evaluation of sodium dodecyl sulfate non-acrylamide, polymer gel-filled capillary electrophoresis for molecular size separation of recombinant bovine somatotropin

Sodium dodecyl sulfate (SDS) non-acrylamide, polymer gel-filled capillary electrophoresis was examined as an alternative to the high-performance size-exclusion chromatographic (HPSEC) method for the analysis of recombinant bovine somatotropin (bovine growth hormone, rbSt). A calibration curve for the molecular mass of protein standards (M(r) 14,000 to 97,000) was linear (r2 = 0.998) when the molecular mass of the proteins and their peak migration time were plotted on a logarithmic (log-log) scale. Relative standard deviation (R.S.D.) of the molecular mass determination was approximately 2-3%. A pre-production as well as a production lot of the SDS gel-filled capillary columns were examined. Performance of both of these columns were equivalent. Peak migration time remained relatively constant beyond 140 sample injections. Gradual loss of theoretical plates was noted over the course of the assay; however, the peak resolution remained adequate for the analysis of rbSt. Peaks corresponding to monomer, dimer, trimer, and tetramer of rbSt were base-line resolved by the SDS gel-filled capillary electrophoresis. Theoretical plate of the monomer peak was approximately 28,000-30,000 per 40 cm column. Both the monomer and the dimer recovery studies indicated that the calibration curves are linear (r2 > 0.993) and the slopes are not different from one. Amounts of the components in rbSt determined by the SDS gel-filled capillary electrophoresis compared well with those of the HPSEC method. The results of this study indicated that the SDS non-acrylamide gel-filled capillary electrophoresis may be a viable alternative to the HPSEC method for the molecular size separation and analysis of recombinant proteins.

[Immunogenetic studies of spina bifida--sibling cases in three families]

We reported sibling cases of spina bifida in three families. In the first family, three boys were the products of one mother and different two fathers. They all suffered from spina bifida cystica with various degrees of hydrocephalus. Cyst closure and ventriculo-peritoneal shunt were performed. Elder boys had more severe neurological deficits. In the second family, two boys and one girl were affected. The elder boy had minimum neurological deficit but the younger boy had a severe neurological deficit and hydrocephalus. Cyst closure was performed on both of them but the shunting procedure was not. The girl was normal. In the third family, three girls were affected. The second girl suffered from spina bifida cystica with hydrocephalus and cyst closure was performed. After that ventriculo-peritoneal shunt was done. Other two girls were spina bifida occulta without any neurological deficit. HLA typing, red blood cell antigen typing and chromosome test were studied in three families. There was no evidence of linkage between spina bifida and HLA antigens. Also no relationship between spina bifida and red blood cell antigens. They all had normal chromosomes. We could not make as one material for genetic counseling from above studied three methods.