Classification criteria for polymyositis and dermatomyositis

OBJECTIVE

The establishment of classification criteria for polymyositis (PM) and dermatomyositis (DM).

METHODS

Questionnaires inquiring about patients with DM, PM, systemic lupus erythematosus, progressive systemic sclerosis and noninflammatory neuromuscular diseases were distributed to the main medical institutes in Japan. Data were collected and analyzed by computer.

RESULTS

Among skin lesions of DM, heliotrope rash, Gottron's sign and erythema or purpura on the extensor surfaces of the extremity joints were shown to be distinguishing criteria. In both DM and PM, proximal muscle weakness, muscle grasping and spontaneous pain, nondestructive arthritis or arthralgia, elevated CK or aldolase level, presence of systemic inflammatory signs, myogenic changes on EMG, positive and anti Jo-1 antibody and pathologic findings compatible with inflammatory myositis were distinguishing criteria items.

CONCLUSION

When a patient satisfies one of 3 skin lesion items and at least 4 other items, he or she shall be classified as having DM, sensitivity 94.1%. When a patient satisfies at least 4 items other than skin lesion items, he or she shall be classified as having PM, sensitivity 98.9%. Specificity of DM and PM is 95.2%.

Induction of hepatic drug-metabolizing enzymes by chlornitrofen (CNP) and CNP-amino in rats and mice

The induction of hepatic drug-metabolizing enzymes by chlornitrofen (CNP) and CNP-amino was studied in the liver of male rats and mice. CNP-amino increased the activities of 7-pentoxyresorufin O-depentylase (PROD) and 7-benzyloxyresorufin O-debenzylase (BROD) as CYP2B1-dependent monooxygenase 3.6- and 4.1-fold in rats. On the contrary, these enzyme activities in mice were induced by CNP rather than by CNP-amino. Furthermore, immunoblotting showed that the protein levels of CYP2B subfamily cytochrome P450 (P450) in liver microsomes of rats and mice were increased by CNP or CNP-amino. Phase II drug-metabolizing enzymes, UDP-glucuronyltransferase (UGT) and glutathione S-transferase (GST) levels in mice were also significantly increased from 1.4 to 2.5-fold by CNP or CNP-amino. However, neither CNP nor CNP-amino affected UGT and GST in rats. These results suggest that CNP and or CNP-amino induce the P450 isoforms of CYP2B subfamily in the rat and mouse liver, and that the inducibility of drug-metabolizing enzyme by the compounds is different between rats and mice.

Isolation and sequencing of two cDNA clones encoding Rho proteins from the fission yeast Schizosaccharomyces pombe

The rho genes encode a group of low-molecular-weight GTP-binding proteins that show about 30% identity in the amino-acid sequence to the ras gene product. Two cDNA clones, both of which are similar to the rho genes, were isolated from a cDNA library of the fission yeast Schizosaccharomyces pombe, using the human rhoA cDNA as a probe. These genes were called rho1+ and rho2+. The encoded Rho1 protein showed 72.7% identity to the budding yeast RHO1 and 66.8% to human RhoA, and the encoded Rho2 protein showed 53.2% identity to the budding yeast RHO2 and RhoA.

[Electronmicroscopic study on tongue squamous cell carcinoma--radiotherapy cases]

We examined the ultrastructures of the tongue squamous cell carcinomas which received radiotherapy and compared the metastatic cases with the non-metastatic cases. The results were as follows: 1. The non-metastatic cases were clinically T1N0 or T2N0 and histologically Grade I or II of the WHO classification. Electronmicroscopic observation of these cases revealed that numerous microvilli and a small number of desmosomes were found and the cell attachment seemed to be weak. These findings were different from those of the non-metastatic cases which received surgery. 2. In the metastatic cases of which the primary lesions were controlled, microvilli were not developed and a number of desmosomes were shown as compared with those in the non-metastatic cases. However, cell atypia and dispersion of the nuclear chromatin were clearly recognized.

Rare association of human papillomavirus DNA with esophageal cancer in Japan

To examine whether human papillomavirus (HPV) DNA is associated with esophageal cancer, frozen and paraffin-embedded neoplasms of the upper aerodigestive tract, including esophageal cancer, were investigated. DNA obtained from frozen specimens and cell lines were analyzed by both polymerase chain reaction (PCR) and Southern blot hybridization. DNA from paraffin-embedded samples were analyzed strictly by PCR. DNA of HPV types 6 and 11 was detected in papillomas of the upper respiratory tract at > 50%. However, HPV DNA was infrequently detected in specimens from the upper digestive tract (31 esophageal cancers and 2 esophageal carcinoma--derived cell lines), even by PCR at a sensitivity of 0.1 copy number per cell. These results suggest that the etiologic significance of HPV infection in esophageal cancer is negligible.

Carbidopa/levodopa and selegiline do not affect platelet mitochondrial function in early parkinsonism

Previous studies have demonstrated impaired complex I activity in platelets from Parkinson's disease (PD) patients who were receiving levodopa and other medications for their disease. Eleven patients with early PD underwent three sequential plateletphereses: while on no medication, after receiving carbidopa/levodopa for 1 month, and after receiving carbidopa/levodopa plus selegiline for 1 additional month. As expected, carbidopa/levodopa and selegiline significantly improved motor function in these patients. Treatment with carbidopa/levodopa alone and carbidopa/levodopa plus selegiline did not affect the activities of complexes I, II/III, and IV and citrate synthetase. These observations support the hypothesis that impaired complex I activity in PD patients is a characteristic of the disease and not due to medications.

[Saphenous vein to saphenous vein bypass grafting in four redo CABG patients]

In four redo CABG patients, new saphenous vein grafts were anastomosed to the angiographically normal part of the old, and partially narrowed or occluded saphenous vein grafts in an end-to-side fashion. Inner surface of the old saphenous vein was confirmed to be smooth and free of atherosclerotic change during anastomosis. Postoperative course was uneventful and angiography demonstrated the good patency of new saphenous vein grafts in all patients. Although this technique is not acceptable if the old saphenous vein graft shows extensive atherosclerotic change, this method may be a useful alternative in case of limited saphenous vein graft disease in terms of less difficulty and operation time.

[Changes in smooth muscle cell proliferation in pulmonary arteries of rats given monocrotaline]

To study the relationship between proliferation of smooth muscle cells and structural changes in arteries of rats given monocrotaline, light microscopy with immunohistochemistry for bromodeoxyuridine (BrdU) was done after a single subcutaneous injection of monocrotaline. In increase in DNA synthesis in smooth muscle cells was seen from 3 days until 14 days after administration. Since this increase was seen before pulmonary hypertension and medial thickness developed some mechanisms that induce proliferation of pulmonary atrial smooth muscle may have been triggered soon after monocrotaline injection.

Interaction of tetrachloroethylene with rat hepatic microsomal P450-dependent monooxygenases

1. We have studied the effects of tetrachloroethylene (PCE) on the kinetics of the P450-dependent monooxygenases in rat liver microsomes. 2. 7-Pentoxyresorufin O-depentylase (PROD) and 7-benzyloxyresorufin O-debenzylase (BROD) activities in phenobarbital (PB)-treated rat liver microsomes were substantially inhibited by PCE. The inhibition profiles were non-competitive for both enzyme activities; Ki's from Eadie-Hofsee plots were 0.16 and 0.29 mM for PROD and BROD respectively. In contrast, the enzyme activities in untreated, beta-naphthoflavone (BNF)-, isoniazid (ISN)- and pregnenolone-16 alpha-carbonitrile (PCN)-induced microsomes were not affected by PCE. 3. 7-Ethoxycoumarin O-deethylase (ECOD) activity in PB-induced microsomes was competitively inhibited by PCE, with a Ki that was lower than those of other microsomes. 4. PCE inhibited 7-ethoxyresorufin O-deethylase (EROD) activities in some microsomes slightly. The Ki for PCE was the lowest in untreated, followed by ISN-treated microsomes. 5. No effect of PCE upon aniline 4-hydroxylase (AN4H) and testosterone 6 beta-hydroxylase (TS6BH) activities was evident in any microsomal preparation. 6. These results indicate that PCE inhibits PB-inducible, P450-dependent monooxygenases in vitro non-competitively or competitively, and that the P450 enzymes of the P4502B subfamily may contribute to PCE toxicity.

Decrease in CRE binding activity by chronic morphine administration in mouse brain

Recent studies have suggested that opiate addiction is associated with transcriptional changes. We developed a novel method, in situ DNA-protein binding (ISDB), for investigating the distribution and changes of DNA binding activity of transcription factors in the brain. Using this method, we found that cAMP response element (CRE) binding activity was decreased by chronic morphine treatment in specific regions including the amygdala complex, thalamus, cerebral cortex and hypothalamus in mouse brain. This effect persisted for at least 14 days after the cessation of morphine. These data suggest that chronic morphine treatment elicits a long-term change in cAMP-mediated gene expression in the brain.

Analysis of a suppressor mutation ssb (kinC) of sur0B20 (spo0A) mutation in Bacillus subtilis reveals that kinC encodes a histidine protein kinase

sur0B20 is a mutation that suppresses the effects of spo0B delta B or spo0F221 mutations in Bacillus subtilis, sur0B20 is an allele of the spo0A gene (Glu-14 to Val-14 conversion) and restores the sporulation of spo0B or spo0F mutants to the wild-type level. Here, we report the isolation of suppressor mutations of sur0B20 (ssb). One of these mutations, ssb-12, severely impairs the suppressor activity of sur0B20. A 2.5-kbp MboI fragment which complements the ssb-12 mutation was cloned by the prophage transformation method using phi CM as a vector. Nucleotide sequencing of the fragment revealed two open reading frames (orf1 and orf2). Gene disruption and complementation experiments showed that orf2 is the ssb gene. ssb was shown to encode a protein with a molecular weight of 48,846 (428 amino acid residues) showing strong similarity to transmitter kinases, especially KinA, of two-component regulatory systems. Therefore, ssb was renamed kinC. Deletion of kinC had no observable effect on sporulation. kinC transcription was induced at the onset of sporulation, probably from a sigma A-dependent promoter, and its expression was shut off at T3. DNase I protection experiments showed that the Spo0A protein binds to two adjoining sites in the kinC promoter region with different affinities. These results suggest that kinC expression might be regulated by Spo0A.

Low doses of anticancer drugs increase susceptibility of tumor cells to lysis by autologous killer cells

Pretreatment of squamous cell carcinoma (SCC) cells from four patients with low doses of cisplatin, carboplatin or 5-fluorouracil increased the susceptibility to lysis by autologous killer cells in vitro. Exposure of two SCC cell lines to low doses of these drugs increased the cell surface expression of both HLA class I and intercellular adhesion molecule-1 (ICAM-1). HLA class II, neural cell adhesion molecule and B7 were not expressed on the cell surface before or after such treatment. The results suggest that these drugs increase the susceptibility of tumor cells to autologous cell-mediated cytotoxicity, at least in part, by enhancing the expression of HLA class I and ICAM-1.

Expression of genes MAGE-1, -2, and -3 by human maxillary carcinoma cells

We analysed the expression of melanoma antigen-encoding (MAGE) gene-1, -2, and -3 in 20 maxillary carcinomas consisting of two cell lines: freshly isolated cancer cells from specimens from 13 patients, and 5 biopsy specimens. The cells were subjected to reverse transcription by the polymerase chain reaction. Fourteen (70%) out of 20 maxillary carcinomas expressed at least one of the MAGE genes. In contrast, five control samples of inflammed mucosa from the maxillary sinus of patients with chronic sinusitis were all negative for the expression of these genes. Results indicated that patients with maxillary carcinoma may be good candidates for specific immunotherapy.

Hepatic cholesterol 7 alpha-hydroxylase activity and serum 7 alpha-hydroxy-cholesterol level during liver regeneration after partial hepatectomy in rats

Hepatic cholesterol 7 alpha-hydroxylase is a rate-limiting enzyme for bile acid synthesis, and we have previously shown that the serum 7 alpha-hydroxycholesterol level reflects the enzyme activity in patients with an intact liver. The purpose of this study was to evaluate the alterations in hepatic cholesterol 7 alpha-hydroxylase activity and the serum 7 alpha-hydroxycholesterol level after hepatectomy and the correlations between these parameters and liver mass. Hepatic cholesterol 7 alpha-hydroxylase activity, the serum 7 alpha-hydroxycholesterol level and the remaining liver weight were determined after 70% hepatectomy in rats. Cholesterol 7 alpha-hydroxylase activity was decreased on days 1 and 2 (from 28.3 +/- 3.7 to 8.5 +/- 2.8 and 13.3 +/- 3.6 pmol/min/mg protein, respectively), returned to the preoperative level on day 3 (24.7 +/- 2.6 pmol/min/mg protein) and further elevated thereafter (71.4 +/- 10.9 on day 7 and 51.3 +/- 6.6 pmol/min/mg protein on day 14). The serum level of 7 alpha-hydroxycholesterol changed simultaneously with the enzyme activity, and a significant correlation between the two parameters was observed (r = 0.915, p < 0.0001). The correlations between the liver weight and hepatic cholesterol 7 alpha-hydroxylase activity and serum 7 alpha-hydroxycholesterol level were significant (p < 0.01), but the significances disappeared for the period of days 3-14 (r = 0.424, p = 0.08; r = 0.299, p = 0.228, respectively). In conclusion, hepatic cholesterol 7 alpha-hydroxylase activity is suppressed by hepatectomy and then activated as the liver regenerates. The serum 7 alpha-hydroxycholesterol level is a good parameter of this enzyme activity after partial hepatectomy.

Deoxycholic acid in gall bladder bile does not account for the shortened nucleation time in patients with cholesterol gall stones

The relations between the concentration of deoxycholic acid (DCA), the cholesterol saturation index, and the nucleation time in gall bladder bile were measured to determine the role of DCA in bile in the pathogenesis of cholesterol gall stone disease. Bile was obtained from patients with cholesterol gall stones (n = 30), subjects without gall stones (n = 35), and patients with pigment gall stones (n = 9). Three of 30 cholesterol gall stone patients and 10 of 35 gall stone free subjects were treated with antibiotics by mouth to decrease the concentration of bile DCA and determine the effect of DCA on biliary lithogenecity. Both the percentage and concentration of DCA in bile were similar in patients with and without cholesterol gall stones despite significant differences in their cholesterol saturation indices and nucleation times. Neither the percentage nor the concentration of DCA in bile correlated with either the cholesterol saturation index or the nucleation time. Analysis of subgroups with matching cholesterol saturation indices showed no correlation between the proportion of DCA in the bile and the cholesterol nucleation time. The proportion of DCA in bile was decreased by antibiotic treatment, but this had no effect on the cholesterol saturation index or nucleation time. These results suggest that DCA in bile is not responsible for biliary cholesterol saturation or cholesterol nucleation time.

Hepatic resection for hepatolithiasis and long-term results

BACKGROUND

Hepatic resection is an established procedure for treating patients with hepatolithiasis. The long-term results after hepatic resection for hepatolithiasis were appraised.

STUDY DESIGN

Of 127 patients with hepatolithiasis seen between 1973 and 1993, 43 patients underwent hepatic resection, and constituted the basis of this study.

RESULTS

There was one operative death (operative mortality rate of 2.3 percent) and three deaths as a result of concomitantly associated cholangiocellular carcinoma. Of the remaining 39 patients, the complete stone clearance rate was 67 percent with operation alone, but reached 87 percent when cholangioscopy was used. Operative morbidity was recorded in five patients (12 percent), but they recovered with conservative therapy. Stones recurred in 15 percent of patients after a mean follow-up period of four years (range of three to six years). Eleven (28 percent) of 39 patients died after hepatectomy as a result of related diseases after a mean follow-up of 6.2 years. These 11 patients had associated biliary drainage procedures. They experienced a higher mortality rate (p < 0.05) than patients who did not have biliary drainage.

CONCLUSIONS

We conclude that hepatic resection is adequate treatment for hepatolithiasis. The patients having additional biliary drainage procedures had a higher mortality, but one cannot reach conclusions about the negative effect of the drainage procedures because the drainage procedures were done in a selected and not a randomized manner.

[Regional work of the left ventricle before and after CABG]

To evaluate the effects of CABG on regional function of the left ventricular wall, regional work of the left ventricular anterior wall was calculated before and after CABG in 8 patients with multivessel coronary artery disease. In all patients, including CABG for LAD branch, complete revascularization was performed. Regional work of the left ventricular wall was calculated as RW (mJ/cm3) = - integral of sigma d epsilon, where sigma = wall stress and epsilon = regional strain (1n (1/H): H = wall thickness). A major and a minor axis, and anterior wall thickness during cardiac cycle were obtained from the left ventriculogram. Preoperatively, the RW varied widely (from -0.9 to 13.3 mJ/cm3). In 4 cases, the RW decreased and in the other cases, it increased. The RW converged in the tight range (from 2.5 to 6.7 mJ/cm3), postoperatively. These results suggest a uniformalization of the RW in the different regions of the left ventricle was established after the complete revascularization. We conclude that the RW obtained from the analyses of sigma-epsilon relationship is a useful index for evaluating the effects of CABG on the treated region of the left ventricle.

[A case of aortitis operated twice Bentall's operation due to valve (graft) detachment]

A 40-year-old man had received emergency Bentall's operation due to acute aortic regurgitation (AR) of aortitis in October, 24, 1990. On out patient clinic, the CRP had been kept from 0.5 to 1.5 mg/dl in dose of 10 mg of prednisolone. In the midnight of November, 17, 1992, his condition deteriorated to circulatory shock and echocardiography revealed massive AR due to para-annular graft detachment with large pseudoaneurysm of 50 mm. He was transferred for emergency operation. The composite graft shifted 2-3 cm above the annulus and detached in three quarter of the annulus. Distal anastomosis was also detached in half of anastomosis and coronary anastomosis almost detached. He was operated on modified Bentall's operation employing Piehler's technique and he is now followed in dose of 10 mg of prednisolone. There are some cases of aortitis showing recurrent valve or graft detachment like this case, even if modified Bentall's operation have been done to decrease the mechanical stress to the annulus and the inflammation have been controlled under the dosage of steroid.

[Therapeutic effectiveness of 131I-MIBG on malignant pheochromocytoma--results of long-term follow-up]

The therapeutic response of 131I-MIBG was evaluated in 4 patients with malignant pheochromocytoma who had been treated with 131I-MIBG and followed-up over 5 years. The patients were 2 men and 2 women with ages ranging from 41 to 69 years old (mean 53 years). The primary tumors in 3 of 4 patients had been resected four to eight years before 131I-MIBG treatment. One patient was diagnosed as adrenal pheochromocytoma, and two were retroperitoneal paraganglioma. And in one patient, the resection of primary mediastinal tumor was not performed due to the adhesion to pericardium but the diagnosis of paraganglioma was obtained by biopsy of bone lesion. All patients showed the clear accumulation of 131I-MIBG in tumor on scintigraphy. The number of doses of 131I-MIBG ranged from one to three times with 3.7 GBq per administration and a cumulative activity from 3.7 to 11.1 GBq. Treatment effect was obvious in one patient with lung, bone, and lymph node metastases whose cumulated absorbed dose with 11.1 GBq of 131I-MIBG exceeded over 150 Gy. At the present time, the duration of survival since the beginning of initial 131I-MIBG therapy is over 5 yrs. The other three patients, however, showed little effects, and died with the disease in 2.6 to 4.1 years after the initial 131I-MIBG therapy. 131I-MIBG will become a promising agent for therapy in patients with malignant pheochromocytoma with high degree of accumulation.

Sialic acid contents in chicken eggs and tissues

Sialic acid contents were determined as potential commercial sources in egg fractions (yolk, white, chalaza, yolk membrane and shell membrane), oviduct, and rooster comb and wattle tissues by the periodate–thiobarbituric acid method with a partial modification. In egg fractions, the concentration of sialic acid was highest (P < 0.05) in yolk membrane (13.7 ± 0.5 μg mg−1), higher (P < 0.05) in chalaza (5.1 ± 0.2 μg mg−1) and yolk (5.2 ± 0.4 μg mg−1) than in white (2.2 ± 0.3 μg mg−1), and lowest (P < 0.05) in shell membrane (0.6 ± 0.1 μg mg−1). In oviduct, the concentration of sialic acid was lower (P < 0.05) in magnum (3.7 ± 0.6 μg mg−1) than in the remaining regions, among which the concentration was similar (5.6 ± 0.3 μg mg−1). The sialic acid concentration was similar in comb and wattle tissues (2.6 ± 0.4 μg mg−1). Sialic acid containing glycopeptide fractions were isolated from yolk, white, and comb and wattle tissues by papain proteolysis and gel chromatography. Key words: Sialic acid, egg, oviduct, comb, wattle

Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease

Between April 1992 and October 1993, we combined a modified maze procedure with mitral valve repair (n = 26) or replacement (n = 36) in 62 patients with atrial fibrillation, including 16 patients undergoing reoperation. Associated procedures included aortic valve operation (n = 22), tricuspid annuloplasty (n = 28), atrial plication (n = 10), and others (n = 3). Duration of atrial fibrillation varied from 0.1 to 23 years (average 8.3 +/- 6.4 years), the f-wave voltage ranged from 0 to 0.45 mV (0.16 +/- 0.09 mV), and cardiothoracic ratio varied from 46% to 85% (64% +/- 9%). We modified the maze atriotomies to preserve the sinus node artery and used cryoablation to simplify procedures. Aortic crossclamp time was 142 +/- 25 minutes and cardiopulmonary bypass time 226 +/- 34 minutes. No early or late deaths occurred in a total of 783 patient-months of follow-up. In 52 patients (84%) who regained atrial rhythm, an atrial A-wave was detected in 84% for transtricuspid flow and in 71% for transmitral flow. One patient with sinus rhythm had an episode of transient neurologic ischemia 4 months after mechanical valve implantation. The 10 patients who remained in atrial fibrillation had preoperative fibrillation for a significantly longer time than the rest of the patients with atrial rhythm (14.8 versus 7.2 years p < 0.001) and a larger left atrial dimension (70 versus 58 mm, p < 0.01). Nonetheless, no variable alone could have predicted postoperative rhythm for individual patients. The results suggest that the maze procedure is safe and effective and therefore should be considered for patients with chronic atrial fibrillation undergoing mitral valve operations.

Synthesis of neoglycolipids containing a mucin-type core unit

The unnatural glycolipids O-beta-D-galactopyranosyl-(1-->4)-O-(2-acetamido- 2-deoxy-beta-D-glucopyranosyl)-(1-->3)-O-(2-acetamido-2-deoxy-alpha-D- galactopyranosyl)-(1-->1)-ceramide (1), O-beta-D-galactopyranosyl-(1-->4)-O-(2-acetamido-2-deoxy-beta-D-glucopyr anosyl) - (1-->6)-O-(2-acetamido-2-deoxy-alpha-D-galactopyranosyl)-(1-->1)-ceramid e (2), and O-beta-D-galactopyranosyl-(1-->4)-O-(2-acetamido-2-deoxy-beta-D- glucopyranosyl)-(1-->3)-O-[O-beta-D-galactopyranosyl-(1-->4)-(2-acetamid o-2- deoxy-beta-D-glucopyranosyl)-(1-->6)]-O-(2-acetamido-2-deoxy-alpha-D- galactopyranosyl)-(1-->1)-ceramide (3), and their beta-(1-->1)-linked isomers, were synthesized. The precursor oligosaccharides for 1, 2, and 3 were made by coupling O-2,3,4,6- tetra-O-acetyl-beta-D-galactopyranosyl)-(1-->4)-3,6-di-O-acetyl-2- deoxy-2-phthalimido-alpha,beta-D-glucopyranosyl trichloroacetimidate with tert-butyldiphenylsilyl 2-azido-4,6-O-benzylidene-2-deoxy-beta-D-galactopyranoside, tert-butyldiphenylsilyl 2-azido-3-O-benzoyl-2-deoxy-beta-D-galactopyranoside, and tert-butyl-diphenylsilyl O-(2,3,4,6-tetra-O-acetyl-beta-D-galactopyranosyl)-(1-->4)-O-(3,6-di-O-a cetyl-2 - deoxy-2-phthalimido-beta-D-glucopyranosyl)-(1-->3)-2-azido-2-deoxy-beta- D- galactopyranoside, respectively. These oligosaccharides were converted into their trichloroacetimidates, which were coupled with 3,2'-di-O-benzoyl ceramide. Deprotection of the coupling products gave the title compounds 1, 2, and 3.

Tricuspid valve replacement with the bileaflet St. Jude Medical valve prosthesis

Case histories of 39 patients who underwent tricuspid valve replacement with the St. Jude Medical prosthesis between June 1979 and August 1992 were reviewed in March 1993. The average patient age at the time of the operation was 46 +/- 11 years (range from 17 to 68 years). Concomitant mitral and/or aortic valve replacements were performed in 30 patients. All patients were given warfarin to maintain thrombotest between 10% to 25%. This number was between 2.8 to 1.6 times the control value in the International Normalized Ratio of prothrombin time. Three operative deaths occurred (7.7%). Among six late deaths, two patients died suddenly of unknown causes, and the remaining patient deaths were not valve-related. The actuarial survival rate at 14 years was 54.7%. Valve thrombosis occurred in one patient and was successfully treated with intravenous urokinase. This was the only valve-related complication (0.67%/patient-year). No reoperations were necessary in the tricuspid position. In conclusion, the St. Jude Medical valve is our choice of prosthesis for tricuspid valve replacement in adult patients who can receive proper anticoagulation therapy.

Up-regulation of hepatic LDL receptor gene expression by monatepil, a novel calcium antagonist, in high cholesterol diet-fed Japanese monkeys

The action of the novel antihypertensive calcium antagonist monatepil on the hepatic LDL receptor was investigated at the gene expression level to clarify the mechanism of its hypolipidemic effect. In cholesterol-fed control monkeys, the LDL receptor mRNA level decreased to approximately 30% of that in the normal diet-fed monkeys. However, the administration of monatepil increased LDL receptor mRNA to normal levels (three- to fourfold stimulation). It is suggested that monatepil raises the number of LDL receptors in liver tissue and that this increase may accelerate the removal of plasma LDL. Treatment with prazosin, an alpha 1-adrenoceptor antagonist, also increased the LDL receptor mRNA level, but this restorative effect was much weaker than that of monatepil, suggesting that mechanisms additional to its alpha 1-adrenoceptor blocking activity are involved in the hypolipidemic effect of monatepil.

[Clinical analysis of methicillin-resistant Staphylococcus aureus (MRSA) infection]

In 14 patients from which methicillin-resistant Staphylococcus aureus (MRSA) was isolated at the Department of Urology, Tone Chuo Hospital June, 1992 and October, 1993, the site of infection, background of patients, and drug resistance were analyzed. The 14 patients consisted of 11 males and 3 females between 45 and 85 years old with a mean of 71.6 years. The site from which MRSA was isolated was urine in 11, wound in 2, nasal cavity in 1, pharynx in 1, and renal fistula in 1 (detected at 2 or more sites in 2). The underlying condition was prostate hyperplasia in 2, prostate cancer in 4 (after radical prostatectomy in 1, complicated by bladder stone in 1), bladder tumor in 3, (during bladder instillation of BCG in 1), perirenal abscess in 2, renal pelvic tumor in 1, neurogenic bladder in 1, and after Boari's operation in 1. Urethral catheterization had been performed in 3. A fewer of 38 degrees C or above was noted in 3. Mixed infection was observed in 10, and was caused by Escherichia coli in 2, Proteus mirabiris in 1, Candida in 1, Klebsiella in 2, Pseudomonas aeruginosa in 2, and Serratia in 2. Four patients has previously been administered antibiotics, which were third generation cephems in 3 and penicillin in 1. The drug sensitivity was 100% for vancomycin (VCM), 30% for imipenam (IMP), 31% for minomycin (MINO), 31% for amikacin (AMK), and 7% for fosfomycin (FOM). As for chemotherapy, VCM+FOM+sulbactam/cefoperazone were administered to 6, and ceftazidime+ MINO were administered to 1.(ABSTRACT TRUNCATED AT 250 WORDS)