[Laparoscopic pelvic lymphadenectomy--experimental operation using young pigs and clinical experience in 21 cases with prostate and bladder cancer]

In order to gain the technical skills for performing laparoscopic pelvic lymphadenectomy, we selected the young pigs (12-15 kg) as the experimental model. Five pigs (male 2, female 3) underwent laparoscopic pelvic lymphadenectomy under intravenous anesthesia. Postoperatively, the pigs were euthanized, and laparatomy was performed to demonstrate the area of dissection. Operation time was from 50 to 80 minutes, and no complication occurred in all cases, mastery came rapidly. Following experimental operation, 21 cases with prostate and/or bladder cancer underwent laparoscopic pelvic lymphadenectomy for staging operation from Nov. 1991 to Oct. 1993. Operation time was from 60 to 310 minutes (mean 137). In one of 21 cases, lymph node metastasis was proved. Eighteen of 21 cases underwent radical prostatectomy or cystectomy between 6 to 24 days after laparoscopic pelvic lymphadenectomy. On radical operation, the adhesion of the post-lymphadenectomy was severe in the patients 8 days after laparoscopic pelvic lymphadenectomy, compared with those within 7 days. Radical operation was seemed to be recommended within 7 days after laparoscopic pelvic lymphadenectomy.

[Effective doctor-patient interaction and communication: psychiatric point of view]

Effective interaction and communication between doctor and patient is a central clinical function that cannot be delegated. Most of the essential diagnostic information arises from the interview, and the physician's interpersonal skills also largely determine the patient's satisfaction and compliance and positively influence health outcomes. Such skills, including active listening to patient's concerns, are among the qualities of a physician most desired by patients. Increasing public dissatisfaction with the medical profession is, in good part, related to deficiencies in clinical communication. Sufficient data have now accumulated to prove that problems in doctor-patient interaction and communication are extremely common and adversely affect patient management. It has been repeatedly shown that the clinical skills needed to improve these problems can be taught and that the subsequent benefits to medical practice are demonstrable, feasible on a routine basis, and enduring. There is therefore a clear and urgent need for teaching of these clinical skills to be incorporated into medical school curriculums and continued into postgraduate training and courses in continuing medical education. If current knowledge is now implemented in clinical practice, and if the priorities for research are addressed, there may be material improvement in the relationship between patient and doctor.

Platelet pertussis toxin-sensitive G proteins in affective disorders

Pertussis toxin (islet-activating protein, IAP) sensitive guanine nucleotide-binding regulatory (G) proteins were quantitatively determined using [32P]ADP-ribosylating response in the platelet membranes prepared from patients with affective disorders (3 bipolar, 10 major depression) and sex- and age-matched controls. IAP-catalyzed [32P]ADP-ribosylation was not significantly different between patients and controls, suggesting that the quantity of IAP-sensitive G proteins is unaltered in affective disorder patients. The implication of this result was discussed with special reference to the previous reports dealing with the role of G proteins in affective disorders.

[A case of argyrophilic grain dementia with emotional disorder]

Autopsy of a patient with mild dementia associated with an emotional disorder characterized by paroxysmal rage and excitement during the clinical course revealed massive argyrophilic grains in the subicular, entorhinal and amygdaloid regions, and to a lesser extent in other limbic areas as well. A few argyrophilic coiled bodies were also found in the subcortical white matter in the same area as the cortical argyrophilic grains. These pathological findings are consistent with a type of cytoskeletal abnormality referred to as 'argyrophilic grain dementia', which some authors describe as a new type of progressive dementia. Immunohistochemically, the grains reacted with anti-human-tau, and in part with anti-ubiquitin antibodies. Immunoelectron microscopic examination revealed the grains to consist of tubulo-vesicular structures within processes, but it was impossible to identify their origin. The neuropathologic substrate of this peculiar case of dementia was thought to be the grains in the limbic area. The detailed clinical picture and distribution of the grains are described to contribute to further discussion.

Competitive and noncompetitive NMDA antagonists block sensitization to methamphetamine

The present study examined the effects of both competitive (D-CPP-ene) and noncompetitive (MK-801) NMDA antagonists on behavioral sensitization to methamphetamine (MA). Behavioral effects of repeated administration of NMDA antagonists were also examined. Rats treated with MA according to an escalating dose schedule (2.5, 5, 7.5, and 10.0 mg/kg, SC, twice a day on days 1, 3, 5, and 7, respectively) indicated behavioral supersensitivity. Pretreatment with either MK-801 (0.5 mg/kg, IP) or D-CPP-ene (20 mg/kg, IP) prior to MA administration prevented the development of the supersensitivity. Rats treated with MK-801 showed a decrease in the motor activity when subsequently challenged with MK-801 compared with saline-treated rats. Likewise, rats administered with D-CPP-ene showed decreased motor activity when challenged with D-CPP-ene. There was no cross-sensitization nor tolerance between MA and MK-801 or D-CPP-ene. These results suggest that both competitive and noncompetitive NMDA antagonists block sensitization to MA and that repeated administration with NMDA antagonists results in behavioral tolerance.

Purification and primary structure of a new guanylic acid specific ribonuclease from Pleurotus ostreatus

A guanine nucleotide-specific RNase (RNase Po1) was isolated from caps of the fruit bodies of Pleurotus ostreatus. RNase Po1 is most active towards RNA at pH 8.0. The effect of heating on the molar ellipticity at 210 nm of RNase Po1 showed that RNase Po1 is more stable than RNase T1. The primary structure of RNase Po1 was determined to be < ETGVRSCNCAGRSFTGTDVTNAIRSARAGGSGNYPHVYNNFEGFSFSCTPTFFEFPVFRGSVYSGGSPG ADRVIYD- QSGRFCACLTHTGAPSTNGFVECRF. It consisted of 101 amino acid residues, with a molecular weight of 10,760. RNase Po1 has relatively higher sequence homology with RNase T1 family RNase. It contains 6 half cystine residues. The locations of four of them are superimposable on those of RNase U1 and RNase U2. The amino acid residues forming the active site of RNase T1 were well conserved in this RNase. Therefore, RNase Po1 is a unique member of the RNase T1 family in respect of the location of one disulfide bridge, and its stability.

A case of fulminant myocarditis rescued--by long-term percutaneous cardiopulmonary support

We report the case of a 41-year-old man with acute fulminant myocarditis. The patient went into cardiac standstill immediately after admission and was placed on a percutaneous cardiopulmonary support system. The system remained in place for 302 h, after which the patient recovered from cardiogenic shock without complications and has returned to normal life.

Hyperplastic polyps following treatment of acute gastric ulcers

Although hyperplastic polyps are the most common polyps of the stomach, the etiology of these polyps is not completely understood. We report a 61-year-old woman who developed gastric hyperplastic polyps following acute gastric lesions. She was admitted for endoscopic injection sclerotherapy of esophageal varices. After the end of sclerotherapy, acute gastric lesions developed. For treatment of the lesions, omeprazole was used for 8 weeks followed by famotidine for 8 weeks. At the end of the treatment, she developed multiple gastric hyperplastic polyps, suggesting that acute gastric lesions and/or treatment of the gastric lesions are related to the development of hyperplastic polyps in the stomach.

Determination of plasma tissue factor antigen and its clinical significance

To investigate the clinical significance of determination of plasma tissue factor (TF) antigen, we have developed a highly sensitive enzyme-linked immunosorbent assay (ELISA) for plasma TF, using two different monoclonal antibodies against TF apoprotein, 6B4 (catching antibody) and 5G9 (detecting antibody), and tetramethyl benzidine/H2O2 as substrates. Titration curves of recombinant human TF in buffer containing Triton X-100 were linear within the range from 50 to 2000 pg/ml. The total assay time was 3 h. Ultracentrifugation and immunoblot analysis indicated that human plasma and urine contained 50,000 g sedimentable and non-sedimentable forms of TF, both of which were detected by our ELISA method. Plasma and urine concentrations of TF in healthy subjects and patients with various diseases were measured by the ELISA method. In healthy subjects, plasma and urinary TF levels were found to be 149 +/- 72 pg/ml (n = 30) and 175 +/- 60 pg TF/urine creatinine mg (n = 95), respectively. TF was increased in plasma of patients with disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura, vasculitis associated with collagen diseases, diabetic microangiopathy and chronic renal failure receiving haemodialysis, but not in the plasma of endotoxaemic patients without DIC. The plasma TF/serum creatinine ratio did not show a positive correlation. Measurement of TF antigen in plasma may be useful for evaluating the endothelial damage and cell destruction in TF-containing tissues.

Effect of mood stabilizing agents on agonist-induced calcium mobilization in human platelets

The effect of mood stabilizing agents such as lithium, carbamazepine, valproic acid and clonazepam on serotonin(5-HT)- or thrombin-induced intracellular calcium (Ca) mobilization was studied in the platelets of healthy subjects using the fluorescent Ca indicator fura-2. After incubating platelet-rich plasma with these drugs for one or four hours, there was no significant difference in either basal Ca2+ concentration or 5-HT-stimulated Ca response between each agent treatment and control. 5-HT- or thrombin-induced Ca mobilization was not altered by four weeks of lithium carbonate administration in healthy volunteers. These results indicate that these mood stabilizers fail to affect the agonist-stimulated intracellular Ca mobilizing pathway either in vitro or ex vivo in the platelets of healthy subjects.

Time course of changes in phospholipid in cardiac mitochondria from rats recovering from prolonged swimming

The time course of the recovery of cardiac mitochondrial phospholipids was investigated in rats subjected to a 3 hour loaded swim. The 3 hour swim caused a 50% reduction in mitochondrial phospholipids compared with the level in sedentary controls. During the first 12 hours of the recovery period, phospholipids tended to increase but fell again before reaching control values by 120 hours after the swim ended. Phospholipid recovery in microsomes was completed in 12 hours. Total mRNA in cardiac tissue decreased by about 15% in rats subjected to a 3 hour loaded swim but recovered to control levels in the first 12 hours of the sedentary recovery period. Thus, fluctuations in cardiac mitochondrial phospholipids do not parallel the changes in total mRNA in cardiac tissue.

Phosphorylation of farnesol by a cell-free system from Botryococcus braunii

Farnesol was incorporated into squalene as well as botryococcenes when the alcohol was fed to the culture of Botryococcus braunii B race strain. In in vitro experiments with a 10,000 x g supernatant of cell homogenate, squalene was synthesized from farnesyl diphosphate in the presence of NADPH or NADH, but botryococcenes were not synthesized under the same conditions. A 100,000 x g pelet fraction was able to phosphorylate farnesol to give its mono- and diphosphate esters in a CTP dependent manner.

Effects of repeated administration of a high dose of methamphetamine on dopamine and glutamate release in rat striatum and nucleus accumbens

We examined effects of a high dose of methamphetamine (MA) (4.02 mg free base/kg, s.c., at 2-h intervals, 4 injections) on extracellular concentrations of monoamines such as dopamine (DA), dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA) and those of glutamate and other several amino acids in rat striatum (ST) and nucleus accumbens (NA) using in vivo microdialysis. Five days after the microdialysis, tissue concentrations of monoamines were measured. The toxic dose of MA markedly increased extracellular concentrations of DA, and decreased those of DOPAC, HVA and 5-HIAA in both ST and NA. Magnitude of the increase in DA release was not different between ST and NA. Extracellular concentrations of glutamate showed a gradual increase in ST, but not in NA, while other amino acids showed no changes in both ST and NA. Tissue concentrations of serotonin (5-HT) and 5-HIAA were decreased to 43-58% of control values in both ST and NA, whereas those of DA, DOPAC and HVA showed 43-54% decrease in ST but no changes in NA. These data suggest that the marked increase of DA release is not directly related to the MA-induced dopaminergic neurotoxicity. The increase in glutamate release found only in ST may be related to the dopaminergic damage in ST. It may be that enhanced release in DA and glutamate act synergistically to cause the dopaminergic neurotoxicity in ST. However, enhancement in glutamate release did not appear to be essential for the MA-induced serotonergic neurotoxicity.

Different NH2-terminal form with 12 additional residues of alpha 2-plasmin inhibitor from human plasma and culture media of Hep G2 cells

alpha 2-Plasmin inhibitor (alpha 2PI) was purified from plasma or from the culture media of Hep G2 cells by one-step immunoaffinity chromatography procedure. Majority of alpha 2PI purified from plasma was the previously recognized plasma alpha 2PI with NH2-terminal Asn (Asn-alpha 2PI), whereas majority of alpha 2PI purified from the culture media was retaining the "pro" peptide of 12 amino acids with NH2-terminal Met (Met-alpha 2PI). When Hep G2 cells were cultured in serum-free media, the alpha 2PI secreted to the media was totally in a form of Met-alpha 2PI. Incubation of Met-alpha 2PI with human plasma induced the complete conversion of Met-alpha 2PI to Asn-alpha 2PI. The results indicate that alpha 2PI is synthesized and secreted from liver cells as Met-alpha 2PI and Met-alpha 2PI is converted to Asn-alpha 2PI by proteolytic cleavage in plasma during the circulation.

Microdynamics of the phospholipid bilayer in cardiomyopathic hamster heart cell membrane

To investigate the microdynamics and the structural architecture of the membrane phospholipid bilayer during the course of cardiomyopathy, membrane fractions were prepared from hearts of cardiomyopathic Syrian hamsters (BIO 14.6) aged 4, 18 and 31 weeks and compared with age-matched control hamsters (F1b). Membrane cholesterol, phospholipids and phospholipid fatty acids were measured by thin-layer chromatography, gas-liquid chromatography and high performance liquid chromatography. Microdynamics of the phospholipid bilayer were determined by a nanosecond fluorometer using pulsed excitation of a fluorescent probe, diphenyl-hexatriene. At the age of 4 weeks, there was no difference in lipid compositions and microdynamics between the BIO 14.6 and F1b. At the age of 18 weeks, saturated fatty acids, 18:0 and 22:0 increased and 20:0, 20:2 and 32:4 decreased in the BIO 14.6. At the age of 31 weeks, adding to the above changes in phospholipid fatty acids, unsaturated fatty acids 20:4 and 22:6 decreased, moreover membrane phospholipids, especially phosphatidylinositol and phosphatidylethanolamine significantly decreased. The viscosity and the wobbling angle of phospholipid molecules were decreased significantly. We have previously demonstrated that intracellular Ca2+ accumulation might be responsible for the pathogenesis of cardiomyopathy. Thus, we conclude that cardiomyopathic membrane may alter its structure and function with age. These alterations in cell membranes might be involved in the cardiac hypertrophy and dysfunction through impaired Ca2+ handling in cardiomyopathic hamsters.

[The indications and limitations of open heart surgery without homologous blood transfusion in children and infants]

Open heart surgery without homologous blood transfusion in adults is a generalized method, but not in children and infants. We have attempted to perform open heart surgery without blood transfusion in small children and infants, and report here our experiences and ideas in this regard. The number of open heart surgeries we performed on patients less than 15 years old was 117 from April 1988 to April 1993. In 57 patients among them we attempted open heart surgery with bloodless priming in the cardiopulmonary bypass circuit. Eleven patients were given blood transfusion during the operation or the post-operative period. Another 46 discharged without blood transfusion. From April 1988 to December 1990 (the earlier period) we used the conventional style cardio-pulmonary bypass circuit with gravity venous drainage for 12 patients undergoing open heart surgery without blood transfusion. The lowest weight of these patients was 13 kg and the main diseases were ASD and mild VSD. From January 1991 to April 1993 (the later period), we used the new type cardio-pulmonary bypass circuit with lower priming volume for 34 patients undergoing open heart surgery without blood transfusion. The youngest age was 7 months and the lowest weight was 6.5 kg. The diseases were ASD (9), mild VSD and VSD/PH (15), TOF (6) and other (4). In the new cardiopulmonary bypass system, the venous reservoir and cardiotomy sucker are given negative pressure ((-10)-(-40) mmHg) with a vacuum not a pump, and only one roller pump is used for the arterial pump.(ABSTRACT TRUNCATED AT 250 WORDS)

Serotonin-induced platelet intracellular calcium mobilization in depressed patients

Serotonin(5-HT)-stimulated intracellular calcium(Ca) mobilization was measured in the platelets of depressed patients to assess 5-HT2 receptor function. The 5-HT-induced Ca response was significantly higher in unmedicated patients with bipolar depression and melancholic major depression than in those with non-melancholic major depression and normal controls. The enhanced Ca response to 5-HT failed to correlate with severity of depressive symptoms. In patients with bipolar disorder and melancholic major depression, there was no significant difference in 5-HT-stimulated Ca response between the unmedicated group and those in remission. These results suggest that 5-HT2 receptor function is increased in some types of depression, and raise the possibility that the enhanced Ca response to 5-HT may be trait dependent rather than state dependent.

Blood-borne macromolecule induces FGF receptor gene expression after focal ischemia

We have detected fibroblast growth factor receptor (FGFR) gene expression in the focal ischemia model. The FGFR gene expression in neurons can be explained by neuronal network disturbances, but the mechanism of astroglial gene expression remains uncertain. We speculated that blood-borne edema fluid may activate gene expression of astroglias. To prove this hypothesis, we compared the pattern's of gene expression of FGFR and distribution of edema fluid by using serial tissue sections of the middle cerebral artery (MCA) ischemia. The left MCA of twenty-four male Wistar rats were occluded, and sacrificed 1, 3, 4, 7 and 14 days later by transcardiac perfusion and fixation. The tissues were sliced thinly to 14 microns sections. Part of the tissue sections was used for in situ hybridization for rat FGFR with [35S]labeled RNA probes. The other part of the sections was used for immunostaining for albumin, immunoglobulin G (IgG) and IgM. The FGFR mRNA expression was evident in the lesion-side hemisphere. In the cortex, neurons mainly expressed FGFR gene in the cortex, whereas astroglias and capillary endothelium expressed FGFR in the corpus callosum and internal capsule. The albumin distributed cortex and white matter of the lesion-side and it extended to the contralateral side. The IgG distributed mainly in the lesion-side white matter, and in part extended to the contralateral side. The IgM only distribute to the infarcted area. When we compared topographical distribution of FGFR in the white matter and pattern of albumin, IgG and IgM distribution, pattern of IgG distribution correlated well to the area of FGFR expression.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacological characterization of epinephrine-stimulated GTPase activity in human platelet membranes

The alpha 2-adrenergic receptor-mediated stimulation of GTPase activity was investigated in human platelet membranes. The stimulatory effect of (-)-epinephrine was strictly dependent on Mg2+ and derived from a high-affinity GTPase activation. (-)-Epinephrine and (-)-norepinephrine stimulated GTPase activity in a concentration-dependent manner with EC50 values of 200 and 600 nM, respectively. These effects were stereospecific, since (+/-)-epinephrine, (+/-)-norepinephrine, and (+)-epinephrine were less potent in stimulating the enzyme activity with EC50 values of 4, 1 and 3 microM, respectively. Thrombin also stimulated GTPase activity concentration dependently with an EC50 value of 0.02 U/mL. The maximal effects of (-)-epinephrine, (-)-norepinephrine, and thrombin were not additive in any combination. Clonidine did not stimulate GTPase activity, whereas another synthetic alpha 2-adrenergic agonist, p-aminoclonidine, had the characteristics of a partial agonist. The rank order of potency for antagonists to inhibit the activation of GTPase by 1 microM (-)-epinephrine was yohimbine = rauwolscine > idazoxan = oxymetazoline = phentolamine = WB4101 = (+)-mianserin > (-)-mianserin > prazosin > (-)-propranolol. Negative logarithms of the IC50 values of these antagonists corresponded well with the negative logarithmic values of Ki(pKi) for the alpha 2A-adrenergic receptors determined by a receptor-binding technique in human platelets. These results indicate that epinephrine stimulates high-affinity GTPase activity of G proteins (putatively Gi2), which are also coupled with thrombin receptors, in a Mg(2+)-dependent and stereospecific manner, via alpha 2A-adrenergic receptor activation in human platelet membrane preparations.

An outbreak of Salmonella typhimurium infection in bengalees, a variety of Lonchura striata

Bengalees (a variety of Lonchura striata) in an aviary in Nagano Prefecture died of severe diarrhea in 1991. Pathological examination revealed slight enlargement of the liver and spleen. Histopathologically, necrotic granulomatous lesions were seen in the liver. Salmonella Typhimurium was isolated from the main organs and fecal samples. No evidence of Newcastle disease or chlamydiosis was detected. The disease was finally diagnosed as S. Typhimurium infection in bengalees. In spite of some countermeasures, 198 out of 268 birds died within 6 months, a mortality rate of 74%. Epizootiological survey revealed that the infection was transmitted by birds introduced from another prefecture. This is the first report of S. Typhimurium infection in bengalees.

Formation of farnesal and 3-hydroxy-2,3-dihydrofarnesal from farnesol by protoplasts of Botryococcus braunii

Farnesal and 3-hydroxy-2,3-dihydrofarnesal (3-hydroxy-3,7,11-trimethyl-6,10-dodecadiene-1-al) were formed from farnesol when the alcohol was incubated with the protoplast of Botryococcus braunii B race strain. This fact suggests the existence of farnesal hydratase in the alga. Feeding experiments showed that both farnesal and 3-hydroxy-2,3-dihydrofarnesal were efficiently incorporated into botryococcenes, triterpenoid hydrocarbons of the alga.

[Multiple myeloma associated with diffuse parenchymal amyloidosis of the lung]

A 58-year-old woman was hospitalized in March, 1991, with slight breathlessness on exertion. Laboratory investigations revealed M-protein (IgG lambda type, 7,575mg/dl) in serum, and Bence-Jones proteinuria. Osteolytic bone lesions were noted roentgeno-logically. Bone marrow aspiration showed the presence of 19% of atypical plasma cells, and the case was diagnosed as multiple myeloma. The chest X-ray film showed bilateral diffuse micronodules, which were found by a transbronchial lung biopsy to be diffuse parenchymal amyloid deposits. The patient was treated with melphalan, prednisolone and interferon-alpha for 6 courses. Clinical symptoms improved but no decrease of the level of M-protein was observed. The patient is still alive without changes of pulmonary shadows on X-ray films for the past 2 years.

[Clinical characteristics of impacted bile duct stone in the elderly]

Acute cholangitis due to impacted bile duct stone is sometimes fatal and require prompt bile duct decompression. Particularly, AOSC (acute obstructive suppurative cholangitis) is the most serious form of bacterial cholangitis and its prognosis is usually very poor when treated conservatively. We have been treated impacted bile duct stones by decompressing the duct endoscopically. Here, we report the characteristics of our elderly patients with impacted bile duct stones who received urgent decompression treatment mainly by endoscopic techniques. In the endoscopical treatment group, the number of patients with AOSC was 5 out of 46 AC (acute cholangitis) patients (11%) under 69 years old, 14 out of 52 (27%) from 70 to 79 years old, and 12 out of 28 (43%) over 80 years old. Obviously, the severity of acute cholangitis (ratio of AOSC to AC) was higher in the elderly. This tendency was similar to the patients who received urgent transhepatic decompression treatment, although they were small in number. In all the patients treated, 7 were classified into the most serious AOSC category with Reynolds' sign, and notably 6 out of 7 were over 70 years old. More strikingly, 5 of 7 patients were over 80, and their mortality rate was indeed high. Thus, in the elderly, bacterial cholangitis by impacted bile stones was a very serious condition. Especially, the outcome of AOSC over 80 years old with Reynolds' sign was very poor, in spite of emergency endoscopic treatment.