Differential function of the costal and crural diaphragm during emesis in canines

In six mongrel dogs under thiopental anesthesia, piezoelectric transducers and bipolar electromyographic (EMG) wires were installed onto left costal, medial crural and lateral crural segments of the diaphragm. During CO2 rebreathing, shortening and EMG activity increased significantly in all three regions of the diaphragm compared to resting breathing. During emesis, (1) both shortening and EMG activity significantly increased compared to resting in costal segment; however, (2) lateral crural shortening was not increased in spite of significant increase in EMG activity; furthermore, (3) the medial crural segment lengthened without any increased EMG activity. These results demonstrate a differential recruitment of costal and crural diaphragm segments, and an additional differential activity within the crural segment between medial and lateral crural regions, during emesis. This activity of the canine diaphragm is consistent with a central influence of emesis upon individual regions of the diaphragm.

Lymphangioma of the jejunal mesentery in an adult: a case report and a review of the Japanese literature

A rare case of lymphangioma of the jejunal mesentery in a 34-year-old woman is presented. She was diagnosed as having an ovarian cyst preoperatively, but laparotomy revealed a cystic tumor of the mesentery that was histologically diagnosed as lymphangioma. Thus far, 44 cases of adult mesenteric lymphangioma have been reported in Japan. In nine cases, accurate diagnosis of mesenteric cysts was obtained preoperatively. In 31 cases, complete excision with or without bowel resection was done, whereas two cases were partially resected and one case was drained.

[A case of T-cell lymphoma showing multiple nodular shadows and an elevated titer of human T-lymphotropic virus type I (HTLV-I) antibody]

A 42-year-old man, born in Chiba prefecture, was admitted to our hospital because of multiple nodular shadows on chest X-ray film and an elevated titer of human T-lymphotropic virus type I (HTLV-I) antibody. The pulmonary lesion was diagnosed as T-cell lymphoma by open lung biopsy. There has been only one previous report of T-cell lymphoma showing multiple nodular shadows on chest X-ray. The elevated titer of HTLV-I antibody strongly suggested that the present case was one of adult T-cell lymphoma.

Assembly and channel-forming activity of a naturally-occurring nicked molecule of Staphylococcus aureus alpha-toxin

From the culture supernatant of Staphylococcus aureus Wood 46, we obtained a naturally-occurring nicked molecule of staphylococcal alpha-toxin. The nicked alpha-toxin consisted of non-covalently-linked 8-kDa and 25-kDa polypeptides, which were derived, respectively, from the N-terminal and the C-terminal part of the toxin nicked at the peptide bond between Glu-71 and Gly-72. The nicked toxin, as well as native alpha-toxin, bound to and oligomerized in the liposome membranes composed of choline-containing phospholipids (i.e., phosphatidylcholine and sphingomyelin) and cholesterol, and formed membrane channel in the liposome membranes. However, the channel-forming activity of the nicked toxin, assessed as a toxin-induced carboxyfluorescein leakage from the liposomes, was approx. 20-fold lower than that of native alpha-toxin. Channel-forming activity of the nicked toxin as well as native toxin was inhibited by divalent cations including Zn2+, Cd2+, Ca2+ and Mg2+, and degree of the inhibitory effect of the divalent cations was in the following order: Zn2+ > Cd2+ > Ca2+ > Mg2+. Thus, although the cleavage of alpha-toxin at the position between Glu-71 and Gly-72 drastically reduced channel-forming activity of the toxin, the nicked toxin retained the ability to oligomerize in phospholipid-cholesterol membranes and the characteristics of channel-forming activity in terms of the specificity for phospholipids and the susceptibility to divalent cations.

Correction of absorption spectra of a pH-sensitive dye for intracellular pH estimation in smooth muscle

Methods of correction for intracellular pH (pHi) estimation from the absorbance of the pH-sensitive dye, 4',5'-dimethyl-5-(and -6-) carboxy-fluorescein (Me2CF), were described. In the guinea-pig vena cava, a reasonable estimation of pHi changes was obtained when the distortion of the spectrum was corrected using the tissue absorbance at wavelengths longer than 570 nm.

Radical resections of childhood craniopharyngiomas

A series of 27 children with craniopharyngiomas is presented. All the craniopharyngiomas were detected by computed tomography, and radical total resection was attempted. Postoperative evaluations were done by a series of computed tomography and magnetic resonance imaging scans. Twenty patients who had total resection confirmed by surgical and radiographic observations showed no recurrence during the follow-up period of from 1 to 12 years. It is emphasized that total resection using modern diagnostic and surgical methods is the mainstay for childhood craniopharyngiomas.

Inhibitory effects of cyanide on mechanical and electrical activities in the circular muscle of gastric antrum of guinea-pig stomach

Effects of cyanide (CN) on spontaneous mechanical and electrical activities were studied in the circular muscle of the guinea-pig gastric antrum. CN (0.05-0.5 mM) inhibited both mechanical and electrical activities, but the inhibition was stronger in the former than the latter (slow wave). When glucose was removed for more than 30 min, slow wave was also blocked by CN. It is likely that ATP necessary for the generation of spontaneous activity can be supplied through either glycolysis or oxidative phosphorylation. CN slightly depolarized the membrane and the inhibition by CN was not affected by glibenclamide, a blocking agent of ATP-regulated K+ channel, suggesting that this channel is not activated by CN treatment. Basal level of intracellular Ca2+ measured with fura-2 tended to increase during the mechanical inhibition by CN. This was also clearly demonstrated in excess (60 mM) K+ solution. These results suggest that intracellular Ca2+ regulation is impaired and that there is uncoupling between intracellular Ca2+ and tension development in the presence of CN.

Intracellular alkalinization caused by chloride removal in the smooth muscle of guinea-pig vena cava

Intracellular pH (pHi) of smooth muscle of guinea-pig vena cava was measured with a pH-sensitive dye, 4',5'-dimethyl-5-(and -6-)carboxyfluorescein. Sustained intracellular alkalinization (pHi 7.46) was produced when Cl- was replaced with gluconate in the presence of HCO3-, but not produced in the absence of HCO3-. Alkalinization caused by Cl- removal was nearly completely blocked by 200 microM DIDS, a Cl- transport inhibitor. In the solution containing normal Cl- concentration, pHi (7.15) was not affected by DIDS, and pHi was also nearly the same in the presence and absence of HCO3-. When full alkalinization was developed in Cl(-)-deficient solution, HCO3- removal produced only a weak recovery. A carbonic anhydrase inhibitor, acetazolamide (100 microM) had no clear effect on pHi in both normal and Cl(-)-deficient solutions. Intracellular acidification caused by Na+ removal was much less when NaCl was replaced with sucrose than with N-methyl-D-glucamine chloride. It is concluded that when Cl- is removed, pHi can be strongly altered by a Cl(-)-HCO3- exchange mechanism in the guinea-pig vena cava. A contribution of this mechanism to pHi is, however, probably rather minor under physiological conditions.

[Prediction of nocturnal desaturation in elderly patients with chronic respiratory disease]

Previous reports suggest that nocturnal disorders of sleep and breathing have increased prevalence among the elderly, and episodic nocturnal oxygen desaturation (NOD) has an increased incidence in patients with chronic respiratory disease. Current Japanese criteria for home low flow oxygen therapy (LFOT), recommend LFOT for patients with daytime PaO2 < 55 torr or with daytime PaO2 < or = 60 torr who have significant NOD. Strict adherence to these LFOT criteria requries full overnight monitoring of arterial oxygen saturation (SaO2) in all patients with daytime PaO2 < or = 60 torr. Since widespread nocturnal oximetry involves significant expenditure of time and resources, it is important among patients with chronic respiratory diseases to predict those who will have significant NOD. The aim of the present study was to formulate criteria for identification of patients who are most likely to demonstrate significant NOD based upon daytime respiratory function data. Subjects included 34 elderly patients with daytime PaO2 > or = 55 torr, who had stable severe chronic respiratory disease (15 chronic emphysema, 6 chronic bronchitis, 12 post-tuberculosis, and 1 kyphoscoliosis). Study data included medical history, assessment of dyspnea by Hugh-Jones classification, and measurement of daytime, awake arterial blood gases and spirometry. Each subject underwent full overnight oximetry monitoring. The percentage of total sleep time recorded with SaO2 < or = 85% was noted (DST85), and NOD was defined as DST85 > or = 1%. Of the 34 patients, 11 were identified as NOD, and 23 as non-NOD patients. Duration and severity of dyspnea were not different between NOD and non-NOD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Protein binding of cephems in the elderly]

The serum protein-binding of 12 representative cephems (CET, CEZ, CZX, CPZ, CZON, CPM, CDZM, CFX, CMZ, CTT, LMOX, FMOX) was assessed, using sera from young healthy subjects (mean age, 28.6 years old) and elderly healthy subjects (mean age, 69.7 years old), applying equilibrium dialysis under the same conditions in vitro. The protein-binding capacity of 12 cephems in elderly subjects was significantly less than that in young subjects, and marked increase in free drug concentration was observed in elderly subjects. This decrease in the protein binding capacity of cephems in elderly subjects was possibly caused by decreased serum albumin and change in non-esterified fatty acid constitution related to aging. As free-drug concentration participates in the appearance of effects and adverse reactions, the possibility of an enhanced pharmacological effects and increased adverse reactions of cephems due to decrease of protein binding in elderly subjects should be considered.

C-cell hyperplasia in secondary hyperparathyroidism

Calcitonin is a hypocalcaemia producing hormone and is secreted by C-cells of the thyroid. The current study was undertaken on a hypothesis that C-cell hyperplasia may develop in the secondary hyperparathyroidism of chronic renal failure in response to sustained hypercalcaemia. With an immunoperoxidase staining method for calcitonin, C-cell hyperplasia was noted in four of six cases of autosomal dominant polycystic kidney disease and in three of six cases of acquired renal cystic disease, an overall incidence of 58% compared with an incidence of 36% (five of 14) in cases of primary hyperparathyroidism with parathyroid adenoma. Thus, both primary and secondary hyperparathyroidism may trigger C-cell hyperplasia in an attempt to produce a hypocalcaemic effect.

Long-term effects of treatment for childhood brain tumors

Recent studies have recognized brain tumor to be the most important solid malignancy in childhood. Improved diagnostic methods and advances in surgical technology and instrumentation have significantly lowered operative mortality, facilitating more precise and radical surgical resections.

[Adverse reactions to low osmolar iodine contrast media (second report)]

From January to December 1990, we performed a prospective survey of adverse reactions to contrast media at two different institutes of Juntendo University. We collected a total of 4555 case sheets during the period. The radiological procedures we investigated were computed tomography, intravenous urography, arteriography, venography and myelography. Low osmolar iodine contrast medium was used almost exclusively (except for five cases). The overall incidence of adverse reactions was 7.0%, and there were no severe or fatal reactions. The incidence of adverse reactions was higher in females (8.5%) than in males (6.1%). The incidence of adverse reactions increased according to the dose of contrast medium, especially when more than 101 ml was injected. Intra-arterial injection caused adverse reactions most often, followed by regular intravenous injections, followed by bolus intravenous injections. Adverse reactions occurred most often during injection. The next occurred in 5 minutes after injection, and then, 5-10 minutes after the injection of contrast medium. The incidence of adverse reactions was higher in patients with a history of allergy or previous reactions. Allergic adverse reactions were observed at a higher frequency. Pretesting was performed in 56.7% of the cases.

Reduced functions of intracellular Ca2+ in aggregation, secretion and protein phosphorylation of permeabilized platelets from stroke-prone spontaneously hypertensive rats

Aggregation, secretion and 47kDa protein (P47) phosphorylation by various agonists such as thrombin, ADP and ionophore A23187 were markedly reduced in platelets from stroke-prone spontaneously hypertensive rats (SHRSP) compared with those of age-matched Wistar Kyoto rat (WKY) platelets, suggesting defective functions of intracellular Ca2+ in SHRSP platelets (Tomita et al. Hypertension 1989; 14: 304-315). To clarify the mechanism of the platelet hypofunctions, saponin permeabilized platelets were prepared to compare the responses of platelets from both rats in varying concentrations of extracellular Ca2+. The leakage of lactate dehydrogenase from saponin (15 micrograms/ml)-treated platelets was approx. 5% of total activity; the degree of the leakage in both platelets did not differ. In saponin-treated platelets, extracellular Ca2+ alone did not induce either aggregation or secretion in both strains. However, in the presence of 1-oleoyl-2-acetylglycerol (10 micrograms/ml), Ca2+ dose dependently stimulated both aggregation and secretion. Under this condition, Ca2+ sensitivity of aggregation, secretion and P47 phosphorylation in SHRSP platelets were significantly reduced compared with those in WKY platelets. These results strongly suggest that intracellular Ca2+ functions are impaired in SHRSP platelets.

Effects of intracellular ATP on calcium current in freshly dispersed single cells of guinea-pig portal vein

In smooth muscle cells freshly dispersed from the guinea-pig portal vein, inward currents were recorded with the whole-cell clamp method in the presence of 2.4 mM Ca2+ under the condition in which outward K+ currents were suppressed and the effects of ATP in patch pipettes were studied. There was a large variation of the rate of current decay, the half-decay time ranging from 20 to 80 ms, but it was difficult to demonstrate clearly the presence of fast (T-type) and slow (L-type) Ca2+ channels based on threshold, the effects of changing holding potential, and of nicardipine, a dihydropyridine Ca2+ channel blocker. Intrapipette ATP had a weak potentiating effect on inward current, but did not seem to influence the correlation between peak current amplitude and current configuration. Cyanide (0.5 mM) reduced inward currents, particularly when ATP concentration was low and only limited recovery was observed. It was concluded that the amplitude and the rate of current decay of inward currents are not only determined by intracellular ATP, but also significantly influenced by some other factor, such as that involved in 'run-down' of Ca2+ currents.

Processing of structural polypeptides of infectious flacherie virus of the silkworm, Bombyx mori: VP1 and VP4 are derived from VP0

Infectious flacherie virus of the silkworm, Bombyx mori, contains five major polypeptides termed VP0, VP1, VP2, VP3, and VP4 in the order of descending molecular weight. Immunoblot analysis with specific antisera against each of these structural polypeptides showed that antisera against VP1 and VP4 unequivocally reacted with VP0 as well as their homologous structural polypeptides. Limited proteolysis of VP0 and VP1 by Staphylococcus aureus V8 protease gave several common polypeptide fragments. Amino acid sequence analysis showed that VP0 and VP4 shared a common NH2-terminal amino acid sequence. These results indicate that VP1 and VP4 are generated from VP0 and that VP4 occupies the NH2-terminal portion of VP0.

31P nuclear magnetic resonance study of phospholipid metabolites in ischemic liver

To assess the metabolic alterations induced by normothermic hepatic ischemia, 31P nuclear magnetic resonance analysis was performed on liver samples using perchloric acid extraction. In particular, phosphomonoesters and phosphodiesters, the intermediary metabolites of membrane phospholipid turnover, were characterized precisely and quantitated. Phosphocholine and phosphoethanolamine, the precursors of phospholipid anabolism, did not change, while the phosphodiesters decreased. In contrast, alpha-glycerophosphate, which is both a precursor of phospholipid synthesis and the intermediary product of phospholipid degradation, markedly increased following 30 min of normothermic ischemia. These findings suggest that cellular phospholipids are actively degraded during normothermic hepatic ischemia.

Influence of membrane fluidity on the assembly of Staphylococcus aureus alpha-toxin, a channel-forming protein, in liposome membrane

By use of multilamellar phosphatidylcholine (PC) liposomes of different acyl composition and cholesterol content as model membranes, we studied whether or not membrane fluidity affects the assembly process of Staphylococcus aureus alpha-toxin. Under conditions using fluid and solid membranes, we assayed accessibility (or hemolytic activity) of liposome-bound alpha-toxin to rabbit erythrocytes added, hexamerization of membrane-bound toxin using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) under nondenaturating conditions, and susceptibility of liposome-bound toxin to trypsin digestion. Our data indicated 1) that alpha-toxin bound to PC membrane as a hemolytically active monomer (or reversibly bound state); 2) that when the membrane was fluidized either by phase transition of PC or by inclusion of cholesterol over 20 mol %, the hemolytically active monomer of the toxin was irreversibly converted to nonhemolytic monomer (and/or unstable oligomer) in a first-order kinetics with a t1/2 of about 1 min, and thereafter hexamerization of the toxin gradually proceeded in the following 60-90 min; 3) that alpha-toxin might have different topology and/or conformation in PC membrane, depending on the presence or absence of cholesterol in the PC membrane; and 4) that coexistence of unsaturated acyl chain-carrying PC and cholesterol was a prerequisite for efficient hexamerization of alpha-toxin in membrane. Thus, increase in membrane fluidity promoted the assembly process of S. aureus alpha-toxin.

Induction of coronary artery spasm by intracoronary acetylcholine: comparison with intracoronary ergonovine

To investigate the mechanism of coronary spasm, we compared the action of acetylcholine with that of ergonovine in 11 patients with vasospastic angina (group 1) and in 15 patients with chest pain (group 2). Coronary arteriography was performed immediately after the patients received intracoronary injections of titrated increments of each agent. In the patients in group 1 occlusive or near-occlusive (99% luminal narrowing) coronary spasm associated with angina and ischemic electrocardiographic ST changes was noted in nine of 11 patients receiving acetylcholine and in all 11 patients receiving ergonovine. The region and the degree of the most severe coronary spasm on coronary arteriograms evoked by the two agents were the same in nine of the 11 patients in group 1. In the other two patients in group 1, spontaneous focal coronary spastic stenosis in the baseline coronary arteriogram was relieved by the intracoronary injection of acetylcholine, and a focal coronary occlusive spasm in the same region was induced repeatedly by the subsequent intracoronary injection of ergonovine (paradoxic phenomenon). In contrast, occlusive or near-occlusive coronary spasm was not induced by either agent in any patient in group 2. These results suggest that the two provocative tests for coronary spasm that involve acetylcholine and ergonovine are clinically useful in the diagnosis of vasospastic angina, but testing with intracoronary ergonovine is needed when a spontaneous focal coronary spasm is relieved by the intracoronary injection of acetylcholine. The results also indicate that in many patients with vasospastic angina, nonspecific hypersensitivity to acetylcholine or ergonovine in a definite region of the coronary arteries generally plays an important role in the induction of coronary spasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Direct injection method for quantitation of delta-aminolevulinic acid in urine by high-performance liquid chromatography

A highly sensitive and simple method for determining delta-aminolevulinic acid (ALA) in urine was established, using direct injection of urine into a high-performance liquid chromatographic column, with fluorometric detection after post-column derivatization with o-phthalaldehyde (OPA). The recovery of ALA was about 100% and ALA was completely separated on an ion exchange column (retention time, 38 min). The detection limit for ALA was 10 pmol (S/N = 2). The mean levels of urinary ALA of 10 healthy volunteers, 4 patients with acute intermittent porphyria, and 2 workers occupationally exposed to lead were 0.76, 5.25, and 23.54 mg/l, respectively. Because of its simplicity, the method is considered to be suitable for routine analysis of urinary ALA in the clinical laboratory.

Lung cancer accompanied by erythema

Skin manifestations associated with malignant diseases are designated syndroma dermatotumorale. A case of lung cancer combined with atypical erythema is reported. A 70-year-old man was admitted to hospital because of a 4-month history of atypical erythema of unknown origin. A nodule in the right lung was revealed on chest roentgenogram which was diagnosed as lung cancer. After right upper lobectomy, the erythema regressed gradually and disappeared completely in 7 days. It is suggested that the erythema was a manifestation associated with the lung cancer.

Slope of the end-systolic pressure-volume relation derived from single beat analysis is not always sensitive to positive inotropic stimuli in humans

Single beat estimation of the slope of the end-systolic pressure-volume relation assumes symmetric left ventricular pressure increase and decay and requires extrapolation of peak isovolumic developed pressure (Pmax) from the left ventricular pressure curve of an ejection contraction. To test the sensitivity of this slope to positive inotropic stimuli, biplane cineangiocardiography and simultaneous high-fidelity left ventricular pressure measurements were performed in 50 patients with heart disease. The end-systolic pressure-volume relations were assessed under baseline conditions and during norepinephrine infusion (n = 19) or after postextrasystolic potentiation (n = 24), or both (n = 7). Norepinephrine did not change left ventricular end-systolic volume despite significant elevations of end-systolic pressure. Postextrasystolic potentiation significantly decreased end-systolic volume in association with an unaltered left ventricular end-systolic pressure. The potentiation significantly decreased the pressure half-time of contraction, an index of the speed of the left ventricular pressure increase, while it increased the pressure half-time of relaxation, an index of the speed of the pressure decline, indicating asymmetric pressure increase and decay. The slope of the end-systolic pressure-volume relation increased from 3.3 to 4.4 mm Hg/ml/m2 (p less than 0.001) during norepinephrine infusion. In contrast, despite an augmented contractility, the slope decreased significantly from 3.2 to 2.4 mm Hg/ml/m2 (p less than 0.0001) after the potentiation. The slope showed a high correlation with Pmax (r = 0.86, p less than 0.0001, n = 107). Thus, the slope of the end-systolic pressure-volume relation derived from single beat analysis is not always sensitive to inotropic interventions.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatic islets of obese hyperglycemic mice (ob/ob)

The development of the obesity-associated hyperglycemic syndrome in ob/ob mice, genetically determined, was observed over time by a combined functional and structural study of pancreatic islets. Islet areas increased with advancing age in ob/ob mice from 2 times at 1 month to 30 times at 6 months of age the size of lean mouse islets. Islet areas apparently increased more than pancreatic insulin content in ob/ob mice. Glucose and insulin tolerance tests were performed to study in vivo responses to glucose and insulin, respectively, in 1-, 3-, and 6-month-old mice. With ob/ob mice, glucose tolerance tests revealed more elevation of plasma glucose than in lean mice, the lean mice revealing more elevated plasma insulin than the obese mice. In insulin tolerance tests, lean mice presented marked hypoglycemia, whereas ob/ob mice revealed slightly higher plasma glucose at 1 month of age but three to four times higher amounts than that of lean mice at 6 months of age. Thus, increasing insulin resistance in ob/ob mice older than 3 months is associated with progressively increasing islet area, which contains proportionally less insulin than that of lean mouse pancreas. The data suggest that insulin resistance in ob/ob mice progressively develops up to 6 months of age and that marked islet hyperplasia is likely in response to sustained hyperglycemia, leading to hyperinsulinemia and eventual marked obesity.