Kimura's disease involving the median nerve: a case report

Kimura's disease is an uncommon chronic inflammatory process of obscure origin. It is more common among Orientals and affects particularly the young male. Sites of predilection include the head and neck region, primarily the subcutaneous tissue and dermis. Unusual sites of occurrence that have been reported include the kidney, the orbit, the ear and the spermatic cord. Kimura's disease involving a major nerve bundle has not been described, and we report here the findings of a case of histologically proven Kimura's disease of the median nerve occurring in a 21-year-old Chinese girl. Typical diagnostic histological features of Kimura's disease in contrast to angiolymphoid hyperplasia, and the treatment options for Kimura's disease are also described.

Carbohydrate-reactive, pore-forming outer membrane proteins of Aeromonas hydrophila

Two outer membrane proteins of Aeromonas hydrophila A6, isolated in a one-step affinity chromatography process based on carbohydrate reactivity, were found to be pore-forming molecules in artificial planar bilayer membranes. These carbohydrate-reactive outer membrane proteins (CROMPs; M(r)s, 40,000 and 43,000) were subjected to amino acid analysis. The amino acid profiles for these two outer membrane proteins were almost identical. A partial protein sequence of a 14-amino-acid fragment of the 40,000-Da protein revealed homology with outer membrane porins of Escherichia coli and A. hydrophila. CROMPs were compared with carbohydrate-reactive porins also extracted from outer membranes of A. hydrophila A6. These porins were isolated by using standard porin purification techniques (insolubility in 2% sodium dodecyl sulfate, solubility in 0.4 M NaCl, and Sephacryl S-200 gel filtration), and then Synsorb H type 2 affinity chromatography was done. The physical and functional properties of the carbohydrate-reactive porins and CROMPs were found to be identical. On the basis of pore-forming properties in planar lipid bilayers and channel inhibition with maltotriose solutions, a nonspecific, general diffusion porin and a LamB-like maltoporin were identified in both CROMP and carbohydrate-reactive porin preparations. To our knowledge, the use of carbohydrate reactivity to isolate channel-forming proteins from bacterial outer membranes has not been reported previously.

Surgery for old ankle fracture. 13 cases followed for 9 (5-15) years

Between 1978 and 1988, we treated 13 cases of neglected ankle fractures by open reduction and internal fixation or osteotomy 11 (2-36) months after the accident. Having been followed for 9 (5-15) years, the results were evaluated. All the patients were improved, even though restoration of the anatomy of the joint often was difficult. Those operated on after less than 6 months had better function than those with longer delays.

Delayed treatment of ankle fracture

BACKGROUND

Cases of old ankle fractures with different delayed treatments in different conditions were collected and evaluated to determine which treatments were optimal for individual type of fractures.

METHODS

Sixteen cases of old ankle fractures were managed by open reduction and internal fixation, osteotomy, or removal of loose fragment according to the condition of the fractures between 1977 and 1987. The follow-up period was from 5 to 15 years with mean 7.9 years. The final result was evaluated by a modified performance index.

RESULTS

All the 12 patients treated with open reduction and internal fixation for malposition got improved with the mean performance score rising from 37 before operation to 76 after operation. Improvement was also noted in all the 3 patients treated with osteotomy for malunion without significant arthritis, rising from 44 to 88. One patient had painful non-united fragment of medial malleolus, and removal of the loose fragment was done to improve the score from 58 to 96.

CONCLUSIONS

Management of old ankle fractures can be effective and beneficial when appropriate treatments are given according to the different conditions of the fracture and joint.

Preoperative localization of occult medullary carcinoma of the thyroid gland with single-photon emission tomography dimercaptosuccinic acid

BACKGROUND

Patients who undergo thyroidectomy for medullary carcinoma of the thyroid gland (MTC) often have elevations of postoperative serum calcitonin levels, which are indicative of metastatic or residual disease. It has been extremely difficult to localize tumor in these patients with standard diagnostic studies such as ultrasonography, computed tomography, or magnetic resonance imaging scans. Previous studies have suggested that planar technetium 99m (V) dimercaptosuccinic acid (DMSA) scintigraphic scans can localize MTC in these patients. We have recently increased the sensitivity of planar scintigraphic images by using single-photon emission tomography (SPECT). This study was performed to compare the sensitivity of planar DMSA scans with that of SPECT DMSA scans.

METHODS

Two normal volunteers and three patients with occult MTC after previous total thyroidectomy underwent planar and SPECT DMSA scans. Each patient subsequently underwent surgical exploration based on the DMSA scans.

RESULTS

Physiologic DMSA uptake was noted in the nasopharynx, axial skeleton, breast, liver, spleen, heart, kidneys, urinary bladder, great vessels, and skeletal muscles in both normal volunteers and patients with occult MTC. Planar DMSA scans and dynamic computed tomographic scans failed to localize MTC in any of these patients who had minimal disease. SPECT DMSA scans correctly localized cervical MTC in two of three patients, as proved by subsequent surgical resection. One patient who had a negative cervical exploration is presumed to have had a false-positive SPECT DMSA scan.

CONCLUSIONS

SPECT DMSA scans appear to be a sensitive, safe, and noninvasive localization technique for patients with occult MTC who have undergone previous thyroidectomy.

Isolation of carbohydrate-reactive outer membrane proteins of Aeromonas hydrophila

Outer membrane proteins of Aeromonas hydrophila A6 were isolated by affinity chromatography on the basis of their reactivity with trisaccharide structures analogous to the terminal trisaccharide of the H antigen of the human ABO(H) blood group system and were characterized by using antisera raised against the isolate. The outer membrane extract for affinity chromatography was prepared from pressure-disrupted outer membranes by differential centrifugation, followed by solubilization of outer membrane components in a nondenaturing, nonionic detergent. Carbohydrate-reactive outer membrane proteins (CROMPs) were then purified by affinity chromatography on two different affinity matrices composed of trisaccharides resembling the terminal trisaccharide of the H antigen, attached to inert silica beads. The relative efficiencies of H type 1 and 2 terminal trisaccharides as affinity adsorbents were established. Reactive proteins were eluted under alkaline conditions (pH 11.0) and in the presence of soluble H substance prepared from group O secretor saliva, but not by 60 mM alpha-L-fucose or under acid conditions (pH 3.0). The eluate contained at least three components (M(r)s, 43,000, 40,000, and < 14,000), as detected by immunoblot analysis with a polyvalent, polyspecific rabbit antiserum to A. hydrophila A6 (serum 3/83). A specific antiserum (serum 3/91) prepared in a rabbit by repeated immunizations with nitrocellulose containing the 43,000-Da band reacted with three bands (M(r)s, 43,000, 40,000, and < 14,000) in immunoblot analysis of solubilized outer membranes of A. hydrophila A6, suggesting that the 40,000- and < 14,000-Da elements are immunologically related to components of the 43,000-Da protein. Furthermore, pretreatment of A. hydrophila A6 with serum 3/91 reduced the strength of bacterial hemagglutination. The purified CROMPs did not agglutinate human group O erythrocytes. The reactivity of isolated CROMPs with a second CROMP-specific antibody (lipopolysaccharide-absorbed serum 3/83) was investigated. CROMPs, proteinase K-treated CROMPs, and bovine serum albumin were bound to latex beads and reacted with lipopolysaccharide-absorbed serum 3/83. Antibodies eluted from CROMP-latex inhibited hemagglutination of human erythrocytes by A. hydrophila A6 to a titer of 4. Antibody eluted from proteinase K-treated CROMP-latex beads showed hemagglutination inhibition activity only when undiluted. There was no hemagglutination inhibition antibody activity detectable in the eluate from bovine serum albumin-latex beads. These results show that antibodies which react with the isolated CROMPs also react with an H-antigen-reactive hemagglutinin of A. hydrophila A6. The possibility that CROMPs act as an adhesin, or adhesins, and contribute to the virulence of this organism is discussed.

1H, 15N, and 13C NMR signal assignments of IIIGlc, a signal-transducing protein of Escherichia coli, using three-dimensional triple-resonance techniques

IIIGlc is an 18.1-kDa signal-transducing phosphocarrier protein of the phosphoenolpyruvate:glycose phosphotransferase system (PTS) of Escherichia coli. Virtually complete (98%) backbone 1H, 15N, and 13C nuclear magnetic resonance (NMR) signal assignments were determined by using a battery of triple-resonance three-dimensional (3D) NMR pulse sequences. In addition, nearly complete (1H, 95%; 13C, 85%) side-chain 1H and 13C signal assignments were obtained from an analysis of 3D 13C HCCH-COSY and HCCH-TOCSY spectra. These experiments rely almost exclusively upon one- and two-bond J couplings to transfer magnetization and to correlate proton and heteronuclear NMR signals. Hence, essentially complete signal assignments of this 168-residue protein were made without any assumptions regarding secondary structure and without the aid of a crystal structure, which is not yet available. Moreover, only three samples, one uniformly 15N-enriched, one uniformly 15N/13C-enriched, and one containing a few types of amino acids labeled with 15N and/or 13C, were needed to make the assignments. The backbone assignments together with the 3D 15N NOESY-HMQC and 13C NOESY-HMQC data have provided extensive information about the secondary structure of this protein [Pelton, J.G., Torchia, D.A., Meadow, N.D., Wong, C.-Y., & Roseman, S (1991) Proc. Natl. Acad. Sci. U.S.A. 88, 3479-3488]. The nearly complete set of backbone and side-chain atom assignments reported herein provide a basis for studies of the three-dimensional structure and dynamics of IIIGlc as well as its interactions with a variety of membrane and cytoplasmic proteins.

Secondary structure of the phosphocarrier protein IIIGlc, a signal-transducing protein from Escherichia coli, determined by heteronuclear three-dimensional NMR spectroscopy

IIIGlc is a signal-transducing phosphocarrier protein of the phosphoenolpyruvate:glycose phosphotransferase system of Escherichia coli. The secondary structure of IIIGlc is determined by heteronuclear (15N, 13C) three-dimensional NMR spectroscopy. Sequential, medium-range, and long-range nuclear Overhauser effects seen in NMR spectra are used to elucidate 11 antiparallel beta-strands and four helical segments. The medium-range nuclear Overhauser effect patterns suggest that the helices are either distorted alpha-helices or are of the 3(10) class. The amino acids separating the active-site histidine residues (His75 and His90) form two strands (Ala76-Ser81 and Val85-Phe91) of a six-stranded antiparallel beta-sheet that brings His90 and His75 in close proximity. Sequence similarities in IIIGlc and several other sugar-transport proteins suggest that the histidine residues within these proteins may be arranged in a similar manner. The 18-residue N-terminal peptide that precedes beta-strand Thr19-Ile22 in native IIIGlc is disordered and does not interact with the rest of the protein. Furthermore, removal of the N-terminal heptapeptide by a specific endopeptidase does not affect the structure of the remaining protein, thus explaining the phospho-acceptor activity of modified IIIGlc with the phospho-histidine-containing phosphocarrier protein of this system.

Influence of glucocorticoids on skeletal muscle proteolysis in normal and diabetic-adrenalectomized eviscerated rats

The effect on skeletal muscle proteolysis of acute (20-hour) glucocorticoid treatment (dexamethasone 1.5 mg/kg, subcutaneously [SC]) was tested using the eviscerated rat preparation. According to this method, the peripheral tissues (primarily the skeletal muscles) are isolated by functional hepatectomy-nephrectomy. Total proteolysis is estimated from the rate of rise of plasma tyrosine concentration in the presence of cycloheximide to block protein synthesis. Myofibrillar proteolysis is measured from the rate of release into the plasma of the nonreutilized, nonmetabolized amino acid 3-methylhistidine (3MH), in the absence of cycloheximide. In normal rats, dexamethasone increased total proteolysis by 20% and myofibrillar proteolysis by 75% (both P less than .025 v saline controls). In diabetic-adrenalectomized rats prepared 2 weeks earlier (65 mg/kg streptozocin [STZ] followed by adrenalectomy), dexamethasone caused much greater increments in rates of total proteolysis (94%) and myofibrillar proteolysis (240%) (both P less than .001 v saline controls). Because diabetic animals are extremely sensitive to glucocorticoid-induced proteolysis, we also examined whether the acute proteolytic effect of diabetes itself might be mediated by adrenal cortical hormones. Previously adrenalectomized rats studied 20 hours after STZ showed a 40% augmentation of total proteolysis (P less than .01), an effect similar to that produced by acute diabetes in rats with intact adrenals. We conclude that glucocortical hormones cause a catabolic effect on total and myofibrillar skeletal muscle protein which is exaggerated when the counteracting action of insulin is reduced, but that the excess proteolysis of acute insulin deficiency is independent of the endogenous glucocorticoids secretion.

Skeletal muscle proteolysis in rats with acute streptozocin-induced diabetes

Skeletal muscle proteolysis was studied in rats 1 day after induction of diabetes with 65 mg/kg streptozocin. An evisceration procedure, including functional hepatectomy-nephrectomy, was performed, and the rate of proteolysis in the remaining tissues, primarily skeletal muscles, was evaluated over 2 h. With cycloheximide to block protein synthesis, total protein breakdown was measured from the rate of rise in plasma tyrosine concentration. The rate of degradation of contractile (myofibrillar) protein was estimated from the rate of rise in plasma concentration of 3-methylhistidine released from the breakdown of actomyosin. Compared with nondiabetic control preparations, the total protein degradation rate was increased 30% by diabetes (P less than .001), and myofibrillar catabolism was accelerated by 60% (P less than .005). In diabetes, the increase in proteolysis was accompanied by reductions in circulating insulin to 25-50% of normal level, whereas food intake did not differ from control. Treatment of diabetic rats with exogenous insulin, including acute infusions postoperatively, completely reversed the proteolytic effects of diabetes. The findings demonstrate that the hypoinsulinemia of acute diabetes increases the catabolism of skeletal muscle protein and that the inhibitory effect of normal levels of insulin includes a specific action to restrain myofibrillar proteolysis.

Site-directed mutagenesis of the phosphocarrier protein. IIIGlc, a major signal-transducing protein in Escherichia coli

The glucose-specific phosphocarrier protein (IIIGlc) of the bacterial phosphoenolpyruvate:glycose phosphotransferase system (PTS) is a major signal transducer that mediates the intricate interplay among extracellular signals (PTS and non-PTS sugars), cytoplasmic and membrane proteins (PTS and non-PTS transporters), and adenylate cyclase. To further define the central role of IIIGlc in these multiplex signaling mechanisms, we have used site-directed mutagenesis to construct three mutant IIIGlc proteins containing single amino acid changes; Phe-3 was replaced with tryptophan [( Trp3]IIIGlc), and His-75 and the active-site His-90 were replaced with glutamine [( Gln75]IIIGlc and [Gln90]IIIGlc, respectively). [Trp3]IIIGlc resembles the wild-type protein in most properties and should be valuable for spectrophotometric experiments. In contrast, clear differences between mutant and wild-type proteins were observed with both [Gln75]IIIGlc and [Gln90]IIIGlc in in vitro sugar phosphorylation assays. As predicted, [Gln90]IIIGlc with a modified active site cannot be phosphorylated. Unexpectedly, [Gln75]IIIGlc accepts but cannot transfer phosphoryl groups, suggesting His-75 may also be a critical amino acid for IIIGlc-mediated signaling mechanisms. The physiological effects of these mutations are briefly described.

Sensory transduction in bacterial chemotaxis involves phosphotransfer between Che proteins

The CheA protein of the Salmonella typhimurium chemotaxis system is phosphorylated by ATP. Phospho-CheA transfers its phosphoryl group to a second chemotaxis protein, CheY. Unlike phospho-CheA, phospho-CheY is relatively unstable, rapidly decaying to phosphate and CheY. We propose that phosphorylation of CheY may play a role in its function as a tumble regulator to control motor behavior in response to attractant and repellent stimuli.

Effect of cardiopulmonary bypass and global ischemia on human and canine left ventricular mass: evidence for interspecies differences

Previous studies in dogs suggest that global ischemia with cardiopulmonary bypass causes increased left ventricular (LV) mass and water content. To investigate effects in humans, we developed a simplified method for mass determination by intraoperative two-dimensional echocardiography. LV mass was measured as echocardiographic short-axis myocardial area. This was validated by linear regression versus postmortem LV mass in 10 dogs (r = 0.89) and versus single-plane angiography in 18 patients (r = 0.73). According to this method, there was no change in LV mass (209 gm versus 208 gm; NS) at constant preload in 20 patients during routine operations (eight coronary revascularizations, 10 aortic valve replacements, and two mitral valve replacements). The same method used in 10 dogs after 2 hours of bypass, 60 minutes of normothermic global ischemia, and reperfusion revealed an LV mass increase from 113 +/- 13 gm (SE) to 150 +/- 16 gm (p less than 0.01) at matched preload. In addition, in 14 dogs after 2 hours of bypass alone, LV mass was unchanged (98 +/- 5 gm versus 101 +/- 5 gm; NS) at matched preload. Data recently derived from a separate study in our laboratory revealed a statistically significant increase in canine LV mass when conditions of human cardiopulmonary bypass and cardioplegic arrest were reproduced. We conclude that uncomplicated cardiac operations in humans do not alter LV mass. This supports the safety of crystalloid cardioplegia in humans. While present evidence is not conclusive, it appears that the threshold for edema formation after ischemic injury may be higher in humans than it is in dogs. The clinical relevance of studies of cardioplegia in edematous dog hearts thus deserves careful scrutiny.

Verdoglobinuria phenomenon in severe electrical burns

Verdoglobinuria is considered to be an ominous sign of Pseudomonas aeruginosa septicaemia in burns. No report of the survival of a case with this phenomenon could be found in the literature. Stone et al. (1964) first reported verdoglobinuria as an important diagnostic basis for P. aeruginosa septicaemia in burns. A patient with high-tension electrical injury was admitted to our hospital burn department in 1977. Verdoglobinuria occurred. This patient is reported as follows. There was a large defect in the left chest wall with exposure of the heart and secondary P. aeruginosa pyothorax which happened during the early stage of injury. It led to septicopyraemic shock. The patient's urine was examined under ultraviolet rays, the fluorescence was ultrapositive. Verdoglobinuria was positive proof. After active measures were administered, the patient was out of danger from this septicopyraemic shock. The metabolism mechanism of verdoglobin, diagnostic effect of verdoglobinuria on P. aeruginosa septicaemia in severe burns and treatment are discussed.

Left ventricular ejection fraction during cardiac surgery: a two-dimensional echocardiographic study

Although long-term effects have been studied, the immediate effect of surgery for acquired heart disease on left ventricular function is not well defined. Accordingly, 44 adults with acquired heart disease underwent intraoperative two-dimensional echocardiography with a gas-sterilized transducer before and immediately after cardiopulmonary bypass. Ejection fraction was measured by short-axis area change at the maximum left ventricular cross section (SAAC-EF) and also by a method using multiple sections. Correction of both mitral and aortic regurgitation produced a significant intraoperative decrease in ejection fraction from 0.49 +/- 19 (SD) to 0.32 +/- 0.16 (p less than .02) and from 0.41 +/- 0.13 to 0.30 +/- 0.17 (p less than .0005), respectively. Relief of aortic stenosis and mitral stenosis resulted in an intraoperative increase in ejection fraction from 0.45 +/- 0.10 to 0.55 +/- 0.09 (p less than .02) and from 0.41 +/- 0.05 to 0.50 +/- 0.07 (p less than .05), respectively. Ejection fraction after coronary artery bypass grafting was unchanged. Preload (end-diastolic area) was significantly decreased after correction of aortic regurgitation (p less than .02) but unchanged in other lesions. We conclude that (1) correction of pure mitral and aortic valvular lesions produces characteristic alterations in ejection fraction in the immediate postoperative period; (2) with the possible exception of patients with aortic regurgitation, the observed change in ejection fraction does not appear to reflect changes in preload; (3) noninvasive assessment of left ventricular function by two-dimensional echocardiography during cardiac surgery appears feasible and could provide data important for clinical decision making in the early postoperative period.

Antagonism of pentobarbitone-induced respiratory depression by naloxone in rats

The effects of naloxone, pentobarbitone, or their combination, on arterial blood gases were studied in urethane-anaesthetised rats. Naloxone itself did not significantly alter the blood gases. Pentobarbitone significantly decreased PO2 and elevated PCO2, and these effects were prevented by pretreatment with naloxone. Arterial blood pH was unaffected by any of the drugs. The findings suggest that naloxone lacks a specific analeptic effect, but can antagonise respiratory depression induced by pentobarbitone.

Effect of nitroprusside on end-diastolic pressure-diameter relations of the human left ventricle after pericardiotomy

Although studies in human beings have suggested that sodium nitroprusside may increase the diastolic compliance of the left ventricle, animal models have provided contradictory evidence following pericardiotomy. The effect of nitroprusside on the human left ventricle after pericardiotomy has not been reported. Accordingly, we studied the effects of intravenous sodium nitroprusside in eight patients during cardiac operations. Curves relating left ventricular end-diastolic pressure (EDP) to echocardiographically determined end-diastolic diameter (EDD) were determined during the transfusion of volume from the reservoir of the heart-lung machine (EDP varied from 5 to 35 mm Hg) before and during nitroprusside administration (1 to 4 mcg/kg/min). An average relation (EDP = 0.41 +/- 0.40 [SD] e1.18 +/- 0.58 EDD was obtained for eight patients by exponential curve fitting (r = 0.80 +/-08). Nitroprusside decreased systolic left ventricular pressure (118 +/- 16 to 100 +/- 13 mm Hg, p less than 0.001, paired t test) but did not alter the control curve relating EDP to EDD. We conclude that EDD-EDP relations of the human left ventricle are not altered by nitroprusside administration in the absence of the restraining influence of the pericardium. This suggests that nitroprusside has no significant direct effect on diastolic properties of the human myocardium.

Systolic and diastolic properties of the human left ventricle during valve replacement for chronic mitral regurgitation

M mode and two dimensional echocardiography were combined with pressure-flow data to analyze systolic mechanics and diastolic compliance in nine patients during valve replacement for chronic mitral regurgitation. Both M mode (six patients) and two dimensional (four patients) echographic analyses revealed large decreases in early postoperative shortening fraction (-24 +/- 17 [standard deviation] percent M mode study, p < 0.01: -30 +/- 12 percent two dimensional study, p < 0.02), which were significantly different from small changes observed in control subjects (M mode study, +7 +/- 10 percent, 25 subjects and two dimensional study, -7 +/- 14 percent, 8 subjects). Additional data suggest that ventricular compliance is increased in chronic mitral regurgitation and that elimination of the low impedance left atrial pathway by valve replacement is associated with a significant increase in wall stress (five patients, p < 0.02) that appears to be responsible for the decreased ejection fraction postoperatively. Analysis of hemodynamic variables other than ejection fraction and rate of circumferential shortening revealed no difference between five postoperative patients with chronic mitral regurgitation and five with coronary artery disease. These results in human subjects confirm predictions from studies in animal models and suggest that unique properties of chronic mitral regurgitation and demand special attention when patients with this condition are being evaluated for surgery.