Limb ischemia and reperfusion: relationship of functional recovery to nerve and muscle blood flow

The relative importance of nerve versus muscle injury in limb ischemia-reperfusion is poorly understood. We used 14C-butanol tissue distribution to measure regional blood flow simultaneously in the proximal and distal sciatic, the posterior tibial nerve trunk (NBF), and biceps femoris muscle (MBF) of rats during 3 hours of occlusion of the ipsilateral iliac and femoral arteries and subsequently for up to 9 days of reperfusion. Limb motor function was also serially assessed. The contralateral limbs served as controls. Experimental groups were untreated control (n = 16); methylprednisolone, 30 mg/kg (n = 13); the lazaroid U74389F, 3 mg/kg (n = 13); and lazaroid vehicle (n = 13), i.v. 15 minutes before occlusion and 15 minutes after reperfusion.

RESULTS

One hour after occlusion, NBF was -77% of the control value (p < 0.02) but MBF was unchanged (control NBF 15.2 +/- 3.3, control MBF 6.3 +/- 0.9, units mL.min-1 x 100 g-1). At both 2 and 21 hours of reperfusion, NBF was double that of control in all groups (p < 0.01); but MBF, which had been modestly elevated to 10.5 +/- 0.5 at 2 hours (p < 0.01), was already normal at 21 hours in all groups. During days 5 to 9 of reperfusion, NBF was still numerically elevated (NS); MBF remained at control. Functionally, test. limb scores were always grossly abnormal during occlusion (range: 7.1-8.5, normal = < 2). After 1 hour of reperfusion, all test limb scores were improved versus occlusion (p < 0.001, Wilcoxon rank-sum). Subsequently, there was gradual improvement in all groups, scores at 6 days ranging from 1.9 to 2.5.

CONCLUSION

NBF is rapidly and severely reduced during ischemia. During reperfusion, the hyperemic flow response in nerve is more prolonged than in muscle. Limb dysfunction during ischemia and reperfusion may be largely the result of axonal or neuromuscular junction injury or both. Neither of the two treatments had effects on blood flow or limb function.

The indirect participation of growth hormone in the thymocyte proliferation system

The specific binding sites for growth hormone was recognized on both thymic lymphocytes (thymocytes) and thymus epithelial cells. The somatotropic action of GH is considered to be mediated mainly by insulin-like growth factor-1 (IGF-1) and partially by GH itself. In this study, effect of GH and IGF-1 on DNA synthetic activity of thymocytes was examined. By 48-hrs. culture with IGF-1 and 24-hrs. 3H-TdR pulse labeling, significant enhancement of DNA synthetic activity of thymocytes was detected, while the enhancement in the culture with GH was very weak. It is considered that IGF-1 acts on the cells in G0/G1 phase in cell cycle. The effect of IGF-1 on thymocyte proliferation was examined by using the thymocytes incubated 12 hrs. before IGF-1 stimulation and 3-hrs. 3H-TdR pulse labeling. The optimal condition to induce thymocyte proliferation was 15-hrs. culture with 380 ng/ml of IGF-1. Furthermore, 10 ng/ml or higher concentration of GH significantly increases IGF-1 release from TECs in confluent state. These results suggest that GH indirectly participates in thymus growth by increasing IGF-1 release from TECs, which enhances thymocyte proliferation.

Positive and negative effects of neurotrophins on the isthmo-optic nucleus in chick embryos

The survival of neurons in the developing isthmo-optic nucleus (ION) is believed to depend on the retrograde transport of trophic molecules from the target, the contralateral retina. We now show that ION neurons transport nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) retrogradely and that BDNF and NT-3 support the survival of ION neurons in vivo and promote neurite outgrowth in vitro. Surprisingly, NGF enhanced normal developmental cell death in vivo in a dose-dependent way. These findings show that increased levels of NGF can have adverse effects on differentiated neurons. The negative effect of NGF could be mimicked by intraocular injection of antibodies that block binding of neurotrophins to the 75 kd neurotrophin receptor (p75). These data implicate a role for the p75 receptor in NGF's neurotoxicity and indicate that this receptor is involved in the mechanism by which ION neurons respond to BDNF and NT-3 in the target.

Cubital tunnel syndrome caused by abnormal insertion of triceps brachii muscle

Some cases of cubital tunnel syndrome are caused by anatomical abnormalities such as the epitrochleo-anconeus muscle or snapping and bulkiness of the medial head of the triceps brachii muscle. We report a rare cause of cubital tunnel syndrome that has not been reported previously. It was caused by an abnormal insertion of the medial head of the triceps muscle into the medial epicondyle. The clinical course and operative findings are described.

Effect of surgical trauma on regional blood flow in rat sciatic nerve

The factors affecting peripheral nerve blood flow (NBF) are not well defined. We used [14C]butanol distribution to quantitate NBF in rat sciatic nerve following either (1) simple surgical exposure (EXP) or (2) EXP plus nerve mobilization and isolation (ISOL). Undisturbed contralateral nerves were controls. The epineurial contribution to NBF after EXP was also assessed. Results (units: ml.min-1 x 100 g-1): Within 1 to 6 h after EXP (N = 7), NBF was 22.1 +/- 2.7 vs 11.9 +/- 1.5 control (P < 0.01). Seven to 24 h after EXP (N = 6), NBF was unchanged from control. Two hours following EXP, both endoneurial NBF and total (epineurial plus endoneurial) NBF were elevated (P < 0.05, P < 0.02, respectively). Within 48 h after ISOL (N = 6) NBF was 30.3 +/- 3.9 vs 13.2 +/- 2.1 control (P < 0.005). Three to seven days after ISOL (N = 8), NBF was unchanged from control.

CONCLUSION

Surgical trauma induces a brisk flow response in peripheral nerve that is proportionate in duration to the trauma severity. Measurements of NBF after EXP or ISOL are therefore potentially misleading if the changes in NBF due to the trauma are not accounted for.

Spontaneous rupture of adrenal pheochromocytoma: a case report

We report a case of retroperitoneal hemorrhage due to spontaneous rupture of a right adrenal pheochromocytoma, presenting as an acute abdominal emergency with symptoms of peripheral vasoconstriction. An elective operation was successfully performed on day 7 after sufficient volume replacement with continuous administration of an alpha and beta-adrenergic blocking agent.

The effect of blood volume replacement on the mortality of head-injured patient

In 77 head-injured and transfused patients, the amount of blood volume replacement (BVR) and patient outcome were retrospectively analyzed. They were divided into four groups of intracranial lesion by initial CT; acute subdural hematoma (SDH) with or without other lesions, traumatic subarachnoid hemorrhage only, epidural hematoma only and all other lesions. Result shows SDH is the most vulnerable to massive transfusion and BVR more than 5000 ml was fatal. Patients with other lesions have high possibility of survival even if BVR amounts to 7000ml. It is concluded, for patients resuscitated with excessive amount of transfusion (> 5000 ml), follow up CT and some vigorous treatment such as administration of hypertonic solutions should be scheduled.

[Malignant lymphoma of the prostate--a case report]

We report a case of prostatic malignant lymphoma causing bilateral hydronephrosis. A 73-year-old man was referred to our department, suffering from urinary frequency and gross hematuria. The mild elevation of serum prostatic tumor markers made us suspect prostatic carcinoma. He was admitted to our hospital and needle biopsy of the prostate was performed. Unexpectedly histological findings revealed "malignant lymphoma, diffuse large cell type". CT scan showed bilateral hydronephrosis, and renal function was decreased. As the patient suddenly vomited blood, gastric fiberscopy and biopsy was performed. Histological diagnosis of stomach was the same as for the prostate. After systemic chemotherapy of cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) regimen, renal function improved and the tumor of stomach reduced, but his respiratory condition rapidly worsened, and he died about 1 month after chemotherapy. Malignant lymphoma involving the prostate is very rare. Especially in Japan only 19 cases have been reported including our case. Four of the 19 men were in their twenties and so we remind the urologists of the possibility of "malignant lymphoma of the prostate" in young patients with dysuria or frequency.

Basic fibroblast growth factor promotes adhesive interactions of neuroepithelial cells from chick neural tube with extracellular matrix proteins in culture

Fibroblast growth factors have been increasingly assigned mitogenic and trophic roles in embryonic and postnatal development of the nervous system. Little is known, however, of their functional roles in early embryonic neural development at the neural tube stage. We have examined the effect of basic fibroblast growth factor (bFGF) on the adhesive behavior in culture of dissociated brachio-thoracic neural tube cells from 26- to 30-somite stage chick embryos. Cells plated on collagen-coated substratum at a low density attach to the substratum but show poor cell spreading. Addition of bFGF markedly promotes cell spreading, yielding an epithelial morphology. This effect becomes discernible 6–8 hours after cell plating with bFGF and is completed by 24 hours, with half-maximal and maximal effects attained at around 0.4 and 10 ng/ml, respectively. The number of cells remain largely constant up to 24 hours, and then cell survival and/or mitogenic effects of bFGF become apparent. The cell spreading effect is abolished by cycloheximide treatment, inhibited by the anti-beta 1-integrin antibody CSAT, and accompanied by about twofold increases in the expression of beta 1-integrin and vinculin, components of focal adhesion complexes. Cells cultured with bFGF for 24 hours exhibit enhanced cell attachment and cell spreading with little time lag following cell plating. In earlier embryonic stages, developmentally less mature cells depend much more on bFGF for their cell spreading and survival, while in later stages the cell spreading response to bFGF becomes undetectable as neural tube develops to spinal cord. The cell spreading effect of bFGF is realized on specific extracellular matrix proteins including laminin, fibronectin and collagen, but not on vitronectin, arg-gly-asp peptide (PepTite-2000), poly-L-ornithine or others. These results suggest that, in an early stage of neural tube development, bFGF is involved in the developmental regulation of adhesive interactions between neuroepithelial cells and the extracellular matrix, thereby controlling their proliferation, migration and differentiation.

Homologous desensitization of histamine H2 receptors in the human gastric carcinoma cell line MKN-45

The poorly differentiated human gastric carcinoma cell line MKN-45 possesses histamine H2 receptors, which are linked to stimulation of adenosine 3',5'-cyclic monophosphate (cAMP) production. Pretreatment of MKN-45 cells with histamine elicited a rapid and dose-dependent inhibition of cAMP production in response to subsequent administration of histamine, whereas pretreatment with prostaglandin E2 (PGE2) or forskolin, both of which stimulate cAMP formation in these cells, had no effect on the histamine-induced cAMP production. Neither NaF- nor forskolin-induced cAMP production was affected by histamine pretreatment. Scatchard analysis of data obtained for [3H]-tiotidine binding showed that histamine pretreatment affected neither the number of histamine H2 receptors nor the binding affinity of the ligand for the receptors. Finally, histamine pretreatment had no effect on cAMP response to subsequent addition of PGE2, which was reduced by PGE2 pretreatment. These results suggest that histamine induces homologous desensitization of H2 receptors on MKN-45 cells by a mechanism that does not involve stimulation of cAMP production.

[The states of recovery of blood counts and serum ferritin levels after blood donation]

Complete blood counts and levels of ferritin in serum (S-Fer) in 62 college students were analyzed continuously to clarify the effects of blood donation. In 14 (45%) of 31 females, hemoglobin (Hb) and S-Fer levels showed decrease of more than 5% and 30%, respectively, four weeks after donation of 200ml or 400ml of blood. In 11 (35%) of the males and 6% of the females, Hb levels increased over 5% during the same period. In 61% of the males and 45% of the females, S-Fer levels decreased. In only 19% of the males, the Hb and S-Fer levels were unchanged. Red blood cell (RBC) counts and Hb levels showed almost the same pattern. In 39% of the males and 48% of the females, the white blood cell (WBC) counts decreased more than 10%. In 10% of the males and 23% of the females, WBC counts increased more than 10% after blood donation. The WBC and RBC counts did not always show the same pattern of variation. After blood donation, the incidence of iron deficiency anemia among females increased from 13% to 23% and the incidence of latent iron deficiency among females increased from 10% to 42%.

Guanethidine chemical sympathectomy: spinal cord and sciatic nerve blood flow

The spinal cord vasculature is innervated by noradrenergic nerve fibers, the role of which in the regulation of regional spinal cord blood flow (RSCBF) is presently unclear. We used the distribution of [14C]butanol to simultaneously measure RSCBF at seven cord levels and the regional blood flow in sciatic nerve (NBF), truncal skin, and biceps femoris muscle. The subjects were control rats and rats that had been given parenteral guanethidine sulfate for 5 wk to induce selective postganglionic "chemical sympathectomy." Flows were measured under basal conditions (group I) and immediately after an arterial hemorrhage (group II). The results indicate that RSCBF was unchanged from control after guanethidine administration in both groups; however, NBF was elevated after guanethidine by 47% in group I and by 41% in group II. We conclude that in the spinal cord as in the brain, sympathetic inflow does not appear to have an important role in the regulation of regional blood flow. Sympathetic inflow appears to partly regulate NBF, however, probably by varying vascular tone.

Lanosterol and 27-norlanosterol oligosaccharides from the bulbs of Chionodoxa gigantea

New lanosterol and 27-norlanosterol oligosaccharides were found in the bulbs of Chionodoxa gigantea. Their structures were established mainly by extensive 2D NMR analysis as well as by comparison with spectral data of known compounds. The inhibition of cyclic AMP phosphodiesterase by the lanosterol derivatives was assayed as the primary screening test to find new medicinal materials.

Study on the efficacy of biodegradable poly(L-lactide) mesh for supporting transplanted particulate cancellous bone and marrow: experiment involving subcutaneous implantation in dogs

Poly(L-lactide) (PLLA) mesh sheets, monofilaments and mesh cylinders filled with fresh autogenic particulate cancellous bone and marrow (PCBM) were implanted subcutaneously into the back of 22 adult dogs for 1 yr. Polypropylene (PP) was used as a control. The inflammatory response to PLLA mesh sheets was slight, similar to PP mesh sheets. However, 3 months after implantation, histiocytes and multinucleate giant cells appeared on the surface of the monofilaments of PLLA mesh sheets and gradually increased in number as the monofilaments were degraded and absorbed. Almost no inflammatory cellular infiltration was seen in the tissue around PLLA mesh sheets or between the monofilaments. When a PLLA mesh cylinder filled with PCBM was implanted subcutaneously, the bone formation reached its peak 1 month after implantation, as in the case of a similar PP mesh cylinder, and bone formation was observed along the inner wall of the cylinder. In addition, a vascular net was abundant within the cylinder. The mechanical strength of the test material (PLLA monofilaments) did not change for almost 2 months after implantation, and 80% of its initial strength was retained for 3 months. These observations suggest that a PCBM graft supported by PLLA mesh would be very effective in the reconstruction of damaged maxillofacial bones, since histological tissue reactions associated with biodegradation of the PLLA mesh are mild and the PLLA mesh does not interfere with bone formation of PCBM. It was also found that the PLLA mesh retains its mechanical strength long enough to allow the PCBM transplant to develop sufficient strength to sustain the damaged region.

[Nutritional assessment of patients on continuous ambulatory peritoneal dialysis]

Nutritional status was assessed in 214 CAPD patients from eight centers in Japan. All patients were receiving adequate dialysis, as indicated by KT/Vurea and Karnofsky's activity scale. Subjective global assessment indicated that 25% of 83 female patients and 27% of 131 male patients were, at least, moderately malnourished. Mid-arm muscle circumference was lower in malnourished male patients than in well-nourished patients, however, in female patients none of the anthropometric variables reflected nutritional status. Lower serum albumin level was observed in malnourished male patients, but not in female patients. Daily protein intake, estimated from protein catabolic rate (PCR) was approximately 0.8 g/Kg BW in both males and females. This value is similar to those reported in literatures for CAPD patients. In our well-rehabilitated patients, PCR did not reflect the nutritional status as indicated by subjective global assessment. The data suggest that low protein intake was not always the major cause of malnutrition in these patients and that other factors, such as endocrine disorder, may also have contributed to malnutrition.

Reduction in tumour formation on porous polyethylene by collagen immobilization

After surface modification with collagen immobilization through covalent bonding, porous polyethylene pieces with an average pore size of 400 microns were implanted subcutaneously into the back of rats for 1 yr. It was found that connective tissues with abundant blood vessels were formed clearly, filling more than 90% of the pore volume and bound firmly to the pore walls. A tumour was found in only one of 24 implanted pieces (4.2%). On the other hand, the virgin porous polyethylene pieces without collagen immobilization exhibited inflammatory reactions within the pores and the connective tissues produced filled only 15% of the pore volume. Formation of a malignant histiocytoma was observed in 11 of the 24 pieces which had been implanted (45.8%). Thus, immobilization of collagen on the surface of an artificial material through covalent bonding proved to be very effective not only for firm bonding with soft connective tissues but also for a reduction of tumour formation.

Proton magnetic resonance spectroscopy of astrocytic tumors: an in vitro study

Water-soluble metabolites extracted from 20 astrocytic tumors (11 glioblastomas, 3 anaplastic astrocytomas, and 6 low-grade astrocytomas) and four normal brains were measured qualitatively and quantitatively using in vitro high-resolution proton magnetic resonance (1H-MR) spectroscopy. MR spectra from tumors exhibited characteristic patterns according to malignancy, presumably reflecting the metabolism of gliomas. Concentrations of choline-containing compounds, inositol, alanine, and glycine increased according to the malignancy, while that of total creatine decreased. In particular, glycine concentration was very high in glioblastoma, and an immunohistochemical study using anti-glycine antibody demonstrated that glycine was mainly distributed in glioma cells, not in proliferative endothelial cells. The ratios of choline-containing compounds and glycine to total creatine are useful parameters for grading gliomas, and the ratio of glycine to total creatine is useful for the differential diagnosis of glioblastoma from metastatic tumor. Such indications appearing in in vivo 1H-MR spectroscopy might provide clinically useful information on tumor metabolism and malignancy, and help assess the effects of radiation therapy and chemotherapy on gliomas.

Clinicopathology of kidneys from brain-dead patients treated with vasopressin and epinephrine

Studies were made on the biochemical and pathological conditions of kidneys of 20 brain-dead patients who were maintained for 0 to 48 days after brain death by administration of vasopressin and epinephrine. Twenty specimens were obtained by percutaneous biopsy or at autopsy. The biochemical and pathological degrees were compared with those on the day of brain death (day 0). Biochemical tests on day 0 indicated that they showed the diuretic phase of prerenal failure, and then glomerular hyperemia was extensive. Renal function recovered on day 1 and remained almost normal during the 14 day period. Their urine retained high levels of sodium and osmolarity for days 0 to 14, with mild hyponatremia and hypo-osmolarity of the plasma. Tubulointerstitial nephritis gradually became extensive. There was no significant change in the degrees of mesangial widening, mesangial cell proliferation or hyalinosis. Arterial intimal proliferation was gradually extensive after day 3 and glomerular endothelial proliferation was gradually extensive after a week. Brain-dead patients have been mostly reported to develop diabetes insipidus, but our brain-dead patients did not show any manifestation of this disease. We suggest that constant natriuresis and continuing high level of urine osmolarity might have been caused by prerenal renal failure, brain death followed by neurogenic impairment, high level of serum vasopressin, or interstitial nephritis.

Inhibition of tyrosine activity by cultured lichen tissues and bionts

Axenic, cultured thallus tissues from forty-six species of lichens were evaluated for their inhibitory effect on tyrosinase activity. Methanol extracts of tissues of three lichens, i.e. HYPOGYMNIA PHYSODES, LETHARIA VULPINA, and CETRARIA JUNIPERINA strongly inhibited tyrosinase activity, but extracts from the corresponding natural thalli showed only weak inhibition. The mycobiont of HYPOGYMNIA PHYSODES showed a higher inhibitory action than its photobiont.

Clinical significance of morphologic classification of coronary arterial segmental stenosis due to Kawasaki disease

Coronary arteriograms obtained in 1,392 patients from a cohort of 4,562 with Kawasaki disease showed 395 to have coronary arterial lesions. The specific lesions, known as segmental stenoses, were observed in 62 patients, involving 68 coronary arterial branches. The lesions involved the right coronary artery in 56 cases (14.2% of the group with arterial lesions) and the left coronary artery in the other 12 (3% of the overall group with arterial lesions). Three morphologic variations were observed. Braid-like lesions accounted for 15 lesions, involving the right coronary artery and occurring < 2 years after the onset of Kawasaki disease. Bridging vessels were observed in 40 of 68 arterial lesions, 30 of which involved the right coronary artery. Of these bridging vessels, 86% were present within 4 years of onset of the disease. Pericoronary communications were observed in the remaining 13 of 68 lesions, 11 involving the right coronary artery and appearing at variable intervals, but usually significantly later than the other lesions. Myocardial ischemia was found at the first study in 60% of braid-like lesions, but in only 29% of the lesions at follow-up studies. Of bridging vessels or pericoronary communications, 95 and 77%, respectively, were found to have produced ischemia in the initial study, which persisted in 78 and 77%, respectively. There are 3 different mechanisms involved in the formation of segmental stenosis, with different prognoses for the clinical course of myocardial ischemia.

An anatomic study of the innervation of the wrist joint and Wilhelm's technique for denervation

Innervation of the wrist joint has been clarified in this study by loupe dissection and histologic examination. The posterior interosseous nerve, the lateral antebrachial cutaneous nerve, the superficial branch of the radial nerve, and the dorsal branch and the perforating branches of the ulnar nerve innervate the wrist joint from the dorsal side. The anterior interosseous nerve, the palmar cutaneous branch of the median nerve, and the deep branch and the main trunk of the ulnar nerve innervate it from the palmar side. The findings indicate that surgical denervation of most of the articular nerves of the wrist joint is possible with the use of Wilhelm's procedure, but denervation of the palmar side of the intercarpal and carpometacarpal joints, which are innervated by the deep branch of the ulnar nerve, is not included in Wilhelm's technique.

Decreased CD4+CD29+ (memory T) cells in patients with chronic granulomatous disease

By the use of flow cytometry, 17 patients with chronic granulomatous disease (CGD) were examined for lymphocyte subsets. CD4+CD29+ cell (memory T cell) and CD8+CD11b+ cell (suppressor T cell) subsets in CGD were significantly decreased and remained practically unchanged throughout the period examined except in those < 6 months of age, although in controls both subsets gradually increased with age. These data indicate a certain abnormality in the maturation process of CGD T lymphocytes. Memory T cells are known to secrete a large amount of interferon-gamma (IFN-gamma). Recently, administration of IFN-gamma to CGD patients has become an effective treatment that reduces the frequency of serious bacterial infections. Decreased memory T cells may clarify the mechanism of therapeutic effectiveness, which remains unknown.

A case complicated with SLE during maintenance hemodialysis

A 40-year-old woman suffered from toxemia of pregnancy in 1977 and was admitted to hospital. Thereafter, she developed nephrotic syndrome, underwent a renal biopsy, and a diagnosis of membranoproliferative glomerulonephritis (MPGN) was made. She received steroid therapy, immunosuppressive drug and anticoagulant therapy, and recovered sufficiently to be discharged from hospital in April, 1979. During subsequent ambulatory treatment at our outpatient department, her renal function deteriorated gradually, and maintenance hemodialysis was started from June, 1990. In July, 1991, she was admitted to our hospital with pleurisy and pericarditis. There was no improvement despite antibiotic treatments. Laboratory data revealed leukopenia and lymphopenia. Under suspicion of systemic lupus erythematosus (SLE), relevant tests were carried out. Immunological abnormalities such as positive LE cells and the presence of various autoantibodies, together with clinical signs of hypersensitivity to sunlight, stomatitis and serositis, satisfied the diagnostic criteria of the ARA and a diagnosis of SLE was made. This case did not exhibit any clinical or serological abnormalities except for the renal disorder for a 10-year period after the histological diagnosis of MPGN, but was eventually diagnosed as SLE as a result of the manifestation of SLE symptoms for the first time after one year of maintenance hemodialysis. Immunological abnormalities and SLE during maintenance hemodialysis are discussed in relation to other reports.