Assessment of salivary gland dysfunction following chemoradiotherapy using quantitative salivary gland scintigraphy

PURPOSE

To assess chemoradiotherapy-induced salivary gland dysfunction using quantitative salivary gland scintigraphy (QSGS), and whether QSGS is capable of predicting the grade of persistent salivary dysfunction after chemoradiotherapy.

METHODS

From a time-activity curve using a stimulation test, the washout rate (WR) calculated was assessed. All glands (n = 155) were classified into four groups: a no-therapy group (n = 18), a chemotherapy alone group (n = 31), a radiotherapy alone group (n = 50), and a chemoradiotherapy group (n = 56). Subjective descriptions of xerostomia were recorded 1 year after the completion of the treatment period, and the 32 glands subjected to irradiation with or without chemotherapy were assessed.

RESULTS

The WR values were significantly lower in glands that received chemoradiotherapy than in glands treated with radiotherapy alone (mean: 0.75 x 10(-3), n = 40 vs. 0.22, n = 36, p < 0.015), but there was no significant difference in the WR values between the no-therapy group and the chemotherapy alone group. The mean values of WR were lower in the chemoradiotherapy glands than in the radiotherapy alone glands in each of cumulative dose ranges of 1-20, 21-30, and 31-60 Gy. With regard to recovery from xerostomia, the WR values at a cumulative dose range of 20 to 40 Gy were significantly lower in the not improved group (-0.418, n = 16) than in the improved group (0.245, n = 16) (p < 0.0001).

CONCLUSION

Chemotherapy per se has no or little adverse effect on salivary function, but combination chemotherapy can deteriorate radiation-induced injury of the salivary glands. QSGS appears useful in predicting the grade of persistent xerostomia following chemoradiotherapy.

[Maze procedure for a lone atrial fibrillation]

Between 1992. 2 and 1997. 12, the maze procedure for lone fibrillation or flutter (lone af) was performed in 8 patients including 2 patients with a sustained atrial fibrillation, 5 patients with a paroxysmal atrial fibrillation and 1 patient with a sustained atrial flutter. All patients had suffered from a drug resistance lone af which induced sever symptom that is the dyspnea, palpitation and fatigue. Therefore patients requested to receive the maze procedure, and they agreed with the informed concent. After the maze operation, the normal sinus rhythm was recovered in 7 of 8 patients (87.5%). In only 1 patient, a paroxysmal atrial fibrillation remained but his symptoms improved after surgery. So this operation is a good choice of a treatment for a drug resistance lone af.

Inhibitory effect of methylene blue-induced photooxidation on intimal thickening of vein graft

BACKGROUND

We have previously speculated that methylene blue-induced photooxidation of adventitial surface for 5 minutes can completely inhibit the intimal and medial growth of surgically prepared saphenous vein in vitro. In this study, inhibitory effect of methylene blue-induced photooxidation on intimal thickening of vein graft in vivo was investigated.

METHODS

Jugular vein grafts were photooxidized in 0.01% methylene blue solution for 5 minutes, and interposed into arterial circulation for 4 weeks in rabbits. Vein grafts were studied by morphometry and immunohistochemistry.

RESULTS

The intimal thickening of photooxidized vein grafts were suppressed significantly compared with those in the nonphotooxidized group. Proliferated cell nuclear antigen (PCNA) index (total PCNA-positive cells/total cell count x 100%) of vein graft was significantly higher in the nonphotooxidized group than those in the photooxidized group.

CONCLUSIONS

Methylene blue-induced photooxidation is effective in the inhibition of intimal thickening of vein graft interposed in the arterial circulation for 4 weeks in vivo.

Is the use of catecholamine before ischemic arrest safe? Effect of catecholamine on rat heart ischemia/reperfusion injury

Using an isolated working heart model, we studied the effects of dopamine, adrenaline, or noradrenaline pretreatment on ischemia/reperfusion injury. Hearts from Wistar rats were perfused in the first 20-minute working mode, 15 minutes in Langendorff mode, and in the second 20-minute working mode. Hearts were treated with dopamine (0.52 and 2.60 mmol/L), adrenaline (16 and 80 nmol/L), or noradrenaline (16 and 80 nmol/L) during the second working perfusion, then arrested with St. Thomas' Hospital cardioplegic solution and subjected to global ischemia (37 degrees C or 20 degrees C). During reperfusion, recoveries of cardiac function and creatine kinase leakage were measured. At 37 degrees C, dopamine and adrenaline had a harmful effect at both doses; noradrenaline was harmful at a high dose but beneficial at a low dose. At 20 degrees C, adrenaline, dopamine, and noradrenaline had a harmful effect at high doses but no harmful effect at low doses. To determine the role of beta adrenergic stimulation before ischemia, a dose-response study was undertaken with isoprotelenol and milrinone at 37 degrees C. Combined pretreatment with isoprotelenol and milrinone accelerated ischemia/reperfusion injury dose-dependently. Preischemic beta adrenergic stimulation thus plays a significant role in the deleterious effect of catecholamine pretreatment at high doses. At low doses, however, the effect of the inotropic agent could be changed depending on ischemic temperature. Our results suggest that catecholamine should not be given at high doses before ischemia, regardless of temperature during ischemia.

Synthesis and characterization of lipophilic 1-[18F]fluoroalkyl-2-nitroimidazoles for imaging hypoxia

In order to develop new imaging markers for brain hypoxia, two lipophilic nitroimidazoles, 1-(3-fluoropropyl)-2-nitroimidazole (FPN) and 1-(8-fluorooctyl)-2-nitroimidazole (FON) were synthesized and labeled with fluorine-18. The octanol/water partition coefficients were measured as an indication of lipophilicity, giving values of logP=0.28 for FPN and logP=2.72 for FON, respectively, which are in the range thought to be optimal for the diffusion of molecules across the blood-brain barrier. It was suggested from a comparative study of in vitro radiosensitization in V79 cells that these lipophilic analogs may have reduction potentials close to those of fluoromisonidazole (FMISO) and misonidazole (MISO), known hypoxic cell radiosensitizers. The preparation of 18F-labeled FON (18FON) and FPN (18FPN) was achieved via two-steps through [18F]fluoride ion displacement of tosylate precursors, in reasonable radiochemical yields. Tissue distribution of 18FPN and 18FON in normal rats and tumor-bearing mice after intravenous injection was investigated and compared to the behavior of 18F-labeled FMISO (18FMISO), a proven hypoxic imaging agent. The high lipophilicity of 18FON and 18FPN resulted in increased initial uptake into normal rat brain, relative to 18FMISO, followed by a rapid washout from brain. Both of these lipophilic analogs had significantly lower tumor uptake and lower tumor-to-blood ratios than 18FMISO, suggestive of a poor trapping mechanism within the tumor tissue. Neither 18FON or 18FPN offers improved biological properties over 18FMISO as a potential agent for use in brain hypoxic imaging.

As originally published in 1992: new surgical technique for total-defect aortopulmonary window. Updated in 1999

A new technique is described to repair aortopulmonary window with total defect in an 8-day-old baby. Because we expected the future growth of aorta, we used the anterior wall of the pulmonary artery as a large flap to reconstruct the posterolateral aortic wall. An equine pericardial patch was used to repair the defect in the pulmonary artery. This is a logically effective method for aortic reconstruction in a neonate with a large aortopulmonary septal defect.

Heat-resistant flexible-film optical waveguides from fluorinated polyimides

Heat-resistant flexible-film optical waveguides were fabricated from fluorinated polyimides. These waveguides operated in single mode and had low optical loss (0.3 dB/cm) at a wavelength of 1.3 microm for TE and TM polarizations. They also had good flexibility: The optical loss did not significantly change above a minimum radius of curvature of less than 20 mm. The birefringence of 9 x 10(-5) between the TE and TM polarizations is 2 orders of magnitude smaller than that for a waveguide upon a substrate. Moreover, these waveguides had high thermal stability and moisture resistance: The optical loss and single-mode behavior changed little after heating the waveguides at 420 degrees C for 1 h or after their exposure to 85% relative humidity at 85 degrees C for more than 350 h.

Phage display cDNA cloning of protein with carbohydrate affinity

Cell surface complex carbohydrate structures that are synthesized through the actions of glycosyltransferases play an important role in cell-to-cell and cell-to-extracellular matrix interactions. To examine the feasibility of phage display technique to clone cDNAs encoding glycosyltransferases, we performed biopanning experiments using human histo-blood group A transferase as a model enzyme and its substrate, blood group H-specific glycoproteins, as a bait ligand. Our attempts have been unsuccessful, possibly because of the enzyme's weak affinity with the target. However, we have selectively enriched several phage clones that expressed capsid proteins fused with galectin-3, a galactose/lactose-specific animal lectin of the galectin family. These results demonstrate that this novel approach of phage display is useful in cDNA cloning of proteins with carbohydrate-binding property.

[Surgical treatment for mitral regurgitation associated with secundum atrial septal defect]

We reviewed 25 patients who underwent a mitral valvuloplasty, from 1984 to 1996, for mitral regurgitation (MR) associated with atrial septal defect (ASD). Mean grade of MR was 2.3 +/- 0.7. The locations of mitral valve lesion were as follows; Postero-medial side of the anterior leaflet (AML) (11 patients: 44%), posteromedial side to center of the AML (7 patients: 28%), whole of the AML (5 patients: 20%), center of the AML (1 patient: 4%), posteromedial side of the posterior leaflet (PML) (1 patient: 4%). In summary, the mitral valve lesion was located in the AML in 96% patients and were seen in the postero-medial side of 96% patients. Mitral valve repair was performed as follows; chordae shortening only (3 patients: 12%), chordae shortening + Kay's annuloplasty (9 patients: 36%), Kay's anuloplasty (10 patients: 40%), using artificial chordae only (1 patient: 4%), using artificial chordae + Kay's annuloplasty (1 patient: 4%), using artificial chordae + ring annuloplasty (1 patient: 4%). In 24 patients, the grade of MR was less than 2/4 in the early postoperative period. In one patient, the grade of 3/4 MR was still remained. Reoperation were required in 2 patients, because of gradual increase of MR, 9 years and 10 years after the initial operation, respectively. In another patient, the grade 3/4 MR recurrently occurred at 6 months after the operation. He has been well maintained medically. In all 4 patients who had more than the grade 3/4 MR postoperatively, the annuloplasty was performed with Kay's method and the cause of MR was poor coaptation around the center of the AML. The mitral valve lesion associated with ASD seemed to be the dislocation of the AML which cause the discrepancy of the coaptation zone between both leaflets, without any prominent prolapse and chordae elongation. We put a particular emphasis on that the mitral valve repair should be performed with the recognition of the etiology of the mitral valve lesion. Especially, if the lesion extends around the center of the AML, sufficient coaptation area of both leaflets at the center of the AML should be obtained by anuloplasty.

Maze procedure for atrial fibrillation associated with atrial septal defect

BACKGROUND

Atrial fibrillation (AF) is a relatively common complication in elderly patients with an atrial septal defect (ASD). However, use of the simultaneous maze procedure for AF associated with ASD remains controversial. We examined the efficacy and risk of the use of the maze procedure in these patients.

METHODS AND RESULTS

Between March 1992 and April 1997, 26 patients underwent the maze procedure as a concomitant operation with ASD closure (maze group). Kosakai's modified maze procedure was performed in 17 patients, the modified Cox maze II or III procedure was performed in 6, and the restrictive right-sided maze procedure was performed in 3. The mean +/- SD age at surgery was 58.2 +/- 9.1 years. The mean +/- SD duration of AF was 7.8 +/- 8.5 years. The mean +/- SD left atrial dimension was 47 +/- 9 mm, and 24 patients (92%) had a larger-than-normal (> 35 mm) left atrium. The mean +/- SD follow-up period was 2.7 +/- 1.7 years. There were no hospital or late deaths. There was no thromboembolic episode in the late follow-up period. Sinus rhythm was regained in all patients who underwent conventional the right- and left-sided maze procedure except for 1 patient. However, 3 patients who underwent the restrictive right-sided maze procedure showed a return to AF rhythm. The atrial A wave was detected with the use of pulsed Doppler study in all patients who had a restored sinus rhythm. During the same period, 45 patients who were > 40 years old and without AF underwent only ASD closure (control group). The incidence of reopening the chest for bleeding was significantly (P = 0.046) higher in the maze group (12%) than in the control group (0%). Paroxysmal AF more frequently (P = 0.023) occurred in the control group (18%) than in the maze group (0%).

CONCLUSIONS

These results suggest that the standard maze procedure should be considered in patients with AF associated with ASD. The restrictive right-sided maze procedure was not reliable, probably due to preoperative enlargement of the left atrium.

Recovery of cardiac function by long-term left ventricular support in patients with end-stage cardiomyopathy

Effects of long-term left ventricular (LV) support on end-stage cardiomyopathy patients is unclear. We applied our LV assist system (LVAS) to six heart transplant candidates, aged 17 to 49, with dilated cardiomyopathy, including one dilated phase hypertrophied cardiomyopathy. LVAS was installed between the left atrium and the ascending aorta, and the pump was positioned parecorporeally. In all patients, their general condition improved, and their pump flows were kept at 4 to 5 L/min. Exercise was started after stabilization of their general condition under constant pump flow. Natural heart size and function were examined by echocardiography. In the beginning of assist, all patients showed impaired cardiac function and LV dilation. During LV assist, systolic function measured by ejection time improved in all patients. Left ventricular end-diastolic dimension (LVDd), showed a remarkable decrease in two patients, who were weaned from LVAS after 3 months of support. They are doing well more than 1 year and 3 years after removal; peak VO2 levels (ml/min/kg) were 30 at 1.2 years and 27 at 2.7 years after removal. In the other four patients, however, LVDd had no remarkable changes, and three could not be weaned from LVAS. The last was discontinued from LVAS after 5 months of support because of infection and died 2 months after removal. From this experience, long-term LVAS may provide the chance for recovery of the natural heart in patients with end-stage cardiomyopathy. The patients whose hearts showed remodeling were able to be weaned from LVAS, and their heart function maintained in good condition for several years.

[Surgical treatment for prosthetic valve endocarditis]

From April 1993 to May 1997, 21 patients underwent surgical treatment for prosthetic valve endocarditis (PVE). There were 13 males and eight females aged from 46 to 79 years old (mean 62 years). There were four cases of early PVE (onset of PVE within 60 days from previous valve replacement), and 17 cases of late PVE (after 60 days). The predominant organisms were Staphylococcus epidermidis (eight cases), Staphylococcus aureus (two cases), MRSA (one case), streptococcal species (three cases), Candida (two cases), Pseudomonas cepacia (one case) and Enterococcus (one case). The predominant organisms were identified in 16 of 20 cases by preoperative blood culture, and in 11 of 20 cases by intraoperative tissue culture, and in 19 cases in all. There were four cases of preoperative cerebral complications, and three cases resurged. The hospital mortality rate was 24% (five patients). Reoperation was required in four patients for recurrence of PVE. Autopsy was performed in four of five patients. Intramyocardial abscess was detected in three patients. Earlier diagnosis and earlier surgical treatment could prevent emboli due to vegetations, which might cause catastrophic results, and could achieve better outcomes. Identification of the predominant organisms, especially from operative tissue cultures, is required.

Effect of preischemic catecholamine treatment on ischemia-reperfusion injury of the myocardium: subtype, dose, and temperature dependency

Preischemic adrenergic stimulation may affect postischemic cardiac function. Using an isolated working heart model, we investigated the effects of preischemic catecholamine treatment on postischemic recovery. Hearts from Wistar rats were perfused in working mode for 20 min, in Langendorff mode for 15 min, and again in working mode for 20 min (W2). Hearts were treated with isoproterenol (8.0 and 40.0 nmol/L), phenylephrine (0.06, 0.30, and 1.50 micromol/L), or epinephrine (16 and 80 nmol/L) during the W2 period and then arrested with St Thomas' Hospital cardioplegic solution (STH) and subjected to global ischemia (37 degrees C or 20 degrees C), followed by reperfusion. At 37 degrees C, isoproterenol had a beneficial effect at the lower dose but a harmful effect at the higher dose; phenylephrine and epinephrine had a harmful effect at all doses. At 20 degrees C, isoproterenol and epinephrine had a harmful effect at a high dose; phenylephrine had no harmful effect at any dose. In a separate study, the influence of calcium modulators (diltiazem and ryanodine, added in the STH) on the catecholamine effect was investigated. The harmful effect of preischemic treatment with isoproterenol (24.0 nmol/L) or phenylephrine (0.9 micromol/L) was abolished by the calcium modulators. Thus, preischemic beta-adrenergic or alpha + beta-adrenergic stimulation has a deleterious effect on postischemic recovery of the myocardium. The effect could be altered depending on the subtype and dose of catecholamine and the ischemic temperature. Intracellular calcium movement could be involved in the mechanism responsible for the harmful effect of preischemic catecholamine treatment.

Artificial chordae for mitral valve reconstruction in children

BACKGROUND

Congenital mitral regurgitation continues to present a challenge for cardiac surgeons because of the diversity of the anatomy of the congenitally malformed mitral valve. We undertook aggressive repair of the mitral valve with artificial chordae for reconstruction of the prolapsed anterior leaflet in some children. The short-term results are reported herein.

METHODS

Three patients with isolated congenital mitral regurgitation underwent mitral valve repair with use of expanded polytetrafluoroethylene sutures as artificial chordae.

RESULTS

There have been no late deaths and no valve-related complications. Serial follow-up echocardiographic examinations have not revealed any increase in the severity of mitral regurgitation with continuing patient growth up to 39 months after the operation.

CONCLUSIONS

When combined with other conservative methods of mitral valve repair, chordal replacement with expanded polytetrafluoroethylene sutures in children undergoing mitral valve reconstruction produces good short-term results. We believe that it delays and possibly prevents the need for a mechanical prosthesis with its associated complications in this young patient population.

[Decreasing sarcoplasmic reticular calcium gives rise to myocardial protection--the effect of thapsigargin for myocardial protection under conditions of normothermia]

Deceasing sarcoplasmic reticular (SR) calcium may contribute to the myocardiac protection against ischemia and reperfusion-induced injury. Therefore, using the isolated working rat heart model, we investigated the effect of Thapsigargin (TH)-induced SR calcium diminution on the myocardial protection when added either before onset of ischemia or at time of reperfusion under conditions of normothermic ischemia. Hearts (n = 6/group) from male Wistar rats were aerobically (37 degrees C) perfused (20 min) with bicarbonate buffer. In the experimental protocol A, this was followed by a 3 min infusion of St. Thomas' Hospital cardioplegic solution No. 2 (STS) containing various concentrations of TH. Hearts were then subjected to 34 min of normothermic (37 degrees C) global ischemia and 35 min of reperfusion (15 min Langendorff, 20 min working). Reperfusion cardiac functions at 20 min of working perfusion was measured and compared with the preischemia values. STS added to 0.1 and 0.25 mumol/L TH improved recovery of aortic flow after 20 min reperfusion from 47 +/- 3% in the TH free controls to 62 +/- 3, 63 +/- 2% (n = 6) (p < 0.05). There was no difference in creatine kinase (CK) leakage during Langendorff reperfusion between the TH treated groups and the control group. In the experimental protocol B, 3 min of cardioplegia without TH and 34 min of ischemia (37 degrees C) were followed by a 10 min Langendorff reperfusion with various concentrations of TH, then 10 min Langendroff reperfusion for washing out, and 20 min working reperfusion. When TH was added to reperfusate the recovery of aortic flow did not change, 0.5 mumol/L TH group had the detelious effect. Thus, TH, when added to the cardioplegia, enhanced myocardial protection. We conclude that lessened uptake of Ca2+ into sarcoplasmic reticulum by inhibitors of the Ca(2+)-ATPase pump can decrease ischemia and reperfusion-induced injury.

Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience

BACKGROUND

Stereotactic radiation therapy is highly effective in the treatment of small brain metastases, regardless of the histology. This suggests that small extracranial malignancies may be curable with similar radiation therapy. The authors developed a novel treatment unit for administering such therapy.

METHODS

The unit consisted of a linear accelerator (linac), an X-ray simulator (X-S), computed tomography (CT), and a table. The gantry axes of the three machines were coaxial and could be matched by rotating the table. Patients were instructed to perform shallow respiration with oxygen. The motion of the tumor was monitored with the X-S. When the motion was slight enough, the table was rotated to the CT. To include all geometric movement on the CT images, each scan was made while the patient was performing shallow respiration. After the CT positioning, the table was rotated to the linac, and non-coplanar treatment was given. Beginning in October 1994, 45 patients with 23 primary or 43 metastatic lung carcinomas were treated. Radiation doses at the 80% isodose line were 30-75 gray in 5-15 fractions over 1-3 weeks with or without conventional radiation therapy.

RESULTS

The treatment was performed with no or minimal adverse acute symptoms. The daily treatment time was short. During a median follow-up of 11 months, local progression occurred in 2 of 66 lesions. Interstitial changes in the lung were limited.

CONCLUSIONS

With this unit and procedure, focal radiation therapy similar to stereotactic radiation therapy is possible for extracranial sites. The preliminary experience appeared safe and promising, and further exploration of this approach is warranted.

Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience

BACKGROUND

Stereotactic radiation therapy is highly effective in the treatment of small brain metastases, regardless of the histology. This suggests that small extracranial malignancies may be curable with similar radiation therapy. The authors developed a novel treatment unit for administering such therapy.

METHODS

The unit consisted of a linear accelerator (linac), an X-ray simulator (X-S), computed tomography (CT), and a table. The gantry axes of the three machines were coaxial and could be matched by rotating the table. Patients were instructed to perform shallow respiration with oxygen. The motion of the tumor was monitored with the X-S. When the motion was slight enough, the table was rotated to the CT. To include all geometric movement on the CT images, each scan was made while the patient was performing shallow respiration. After the CT positioning, the table was rotated to the linac, and non-coplanar treatment was given. Beginning in October 1994, 45 patients with 23 primary or 43 metastatic lung carcinomas were treated. Radiation doses at the 80% isodose line were 30-75 gray in 5-15 fractions over 1-3 weeks with or without conventional radiation therapy.

RESULTS

The treatment was performed with no or minimal adverse acute symptoms. The daily treatment time was short. During a median follow-up of 11 months, local progression occurred in 2 of 66 lesions. Interstitial changes in the lung were limited.

CONCLUSIONS

With this unit and procedure, focal radiation therapy similar to stereotactic radiation therapy is possible for extracranial sites. The preliminary experience appeared safe and promising, and further exploration of this approach is warranted.

Improved success rate of the maze procedure in mitral valve disease by new criteria for patients' selection

OBJECTIVE

We have carried out the maze procedure for atrial fibrillation (AF) as a combined operation with mitral valve surgery in a consecutive fashion until December 1994 (period 1). Therefore, the success rate in sinus rhythm conversion remained unsatisfactory. We have selected the patients according to arbitrarily decided new criteria since January 1995 (period 2), and examined the results prospectively.

METHODS

Between May 1992 and February 1997, we carried out the maze procedure in 220 patients as a combined operation with mitral valve surgery. During period 2, we carried out the maze procedure in 63 cases who satisfied all the new criteria (voltage of f-wave in V1 lead > 0.1 mV, cardiothoracic ratio (CTR) < 70%, LA dimension < 70 mm), and 37 patients out of these criteria. Success was defined as sinus rhythm restoration without sick sinus syndrome.

RESULTS

There were 4 hospital deaths (1.8%) and 4 late deaths (1.8%). Success rate was significantly (P = 0.0089) higher in period 2 (82%) than in period 1 (65%). Success rate was significantly higher in patients within criteria than out of criteria both in period 1, period 2, and total (77 versus 48%, P = 0.018; 90 versus 66%, P = 0.004, and 83 versus 55%, P = 0.0001).

CONCLUSION

The maze procedure is highly reliable when combined with mitral valve surgery if patients are selected properly.

Regulation by uniconazole-P and gibberellins of morphological and anatomical responses of Fraxinus mandshurica seedlings to gravity

The present study deals with roles of gibberellins (GAs) in gravitropic responses of woody stems of horizontally-positioned, 2-year-old seedling of Fraxinus mandshurica Rupr. var. japonica Maxim. The application of uniconazole-P, an inhibitor of GAs biosynthesis, to stem nodes at various concentrations significantly inhibited not only righting the stems but also wood formation. The application of GAs (GA3 and GA4) in combination with uniconazole-P negated the inhibitory effect of the treatment of uniconazole-P alone. The GAs alone did not affect wood formation, however, both GAs increased wood formation on both the upper and lower sides of horizontal stems with an increase in the concentration of combined uniconazole-P. In all of the seedlings, tension wood was formed on the upper side of stems. The application of uniconazole-P alone at various concentrations did not inhibit the formation of tension wood fibres.

[The temperature dependency of the protective properties of the St. Thomas' Hospital cardioplegic solution, the University of Wisconsin solution, and Bretschneider buffered solution]

We studied three preservation solutions such as St. Thomas' hospital cardioplegic solution No. 2 (ST), the University of Wisconsin solution (UW) and Bretschneider's solution (BR) for protective properties, especially in terms of temperature dependence during the preservation. Rat hearts were studied and divided into three groups; ST. UW and BR. In each group, six hearts were carried out perfusion, cardioplegic infusion, ischemia and reperfusion for four different conditions. Using an isolated working rat heart model, the hearts were subjected to 5 minutes Langendorff perfusion followed by 20 minutes working perfusion. During this working period, cardiac functions such as aortic and coronary flow, aortic pressure, and heart rates were measured every 5 minutes. After working perfusion, 3 minutes of cardioplegic infusion was carried out either with UW, ST, and BR at 37, 20, 4, 1 degree C. The hearts were subjected to either 35 min at 37 degrees C, 120 min at 20 degrees C, 300 min at 4 degrees C, or 450 min at 1 degree C. The hearts were immersed in the same solution during ischemia. The hearts were reperfused at 37 degrees C, initially in the Langendorff mode for 15 min. Coronary effluent was collected for the measurement of CK leakage during reperfusion. The heart were then converted to the working mode for 20 minutes. During working reperfusion period, the variables of cardiac function were again measured and expressed as a percentage of their individual preischemic control values. Under conditions of 37 degrees C ischemia, % recovery of cardiac output (%CO) in ST group is 62.8 +/- 2.8%, although the hearts preserved with UW and BR were not recovered. Under conditions of 20 degrees C ischemia, %CO in UW, ST and BR were 46.8 +/- 2.7, 82.0 +/- 3.1 and 41.4 +/- 2.6%, respectively. Under conditions of 4 degrees C ischemia, %CO in UW, ST and BR were 66.2 +/- 8.0, 68.6 +/- 2.3 and 47.2 +/- 2.9%, respectively. Under conditions of 1 degrees C ischemia, %CO in UW, ST and BR were 70.6 +/- 3.3, 56.5 +/- 1.6 and 43.0 +/- 2.5%, respectively. In conclusions, ST revealed the best protective properties for the heart preservation between 37 degrees C and 20 degrees C ischemia. The properties of ST was similar to that of UW under conditions of 4 degrees C, although UW showed most excellent protective properties under conditions of 1 degrees C ischemia. These results suggested that, protective ability of preservation solution might be changed by the temperature during preservation period.

Transcription of human ABO histo-blood group genes is dependent upon binding of transcription factor CBF/NF-Y to minisatellite sequence

We have studied the transcriptional regulatory mechanism of the human histo-blood group ABO genes, and identified DNA cis-elements and trans-activating protein that control the expression of these genes which are important in blood transfusion and organ transplantation. We introduced the 5'-upstream sequence of ABO genes into the promoterless reporter vector and characterized the promoter activity of deletion constructs using transient transfection assays with gastric cancer cell line KATO III cells. The sequence just upstream of the transcription start site (cap site), and an enhancer element, which is located further upstream (between -3899 and -3618 base pairs (bp) from the transcription initiation site) and contains 4 tandem copies of a 43-bp repeat unit, were shown in gastric cancer cells to be responsible for the transcriptional activity of the ABO genes. DNA binding studies have demonstrated that a transcription factor, CBF/NF-Y, bound to the 43-bp repeat unit in the minisatellite. Functional importance of these CBF/NF-Y-binding sites in enhancer activity was confirmed by transfection experiments using reporter plasmids with mutated binding sites. Thus, transcriptional regulation of the human ABO genes is dependent upon binding of CBF/NF-Y to the minisatellite.

Effects of protease inhibitors on postischemic recovery of the heart

It is well known that activation of proteases in the lysosomes and cytosol is one of the mechanisms of ischemic injury. It might thus be beneficial to determine whether the addition of several clinically available protease inhibitors to a cardioplegic solution can improve its protective ability. Using an isolated working rat heart preparation, the effects of several protease inhibitors (serine protease inhibitors; nafamostat mesilate and gabexate mesilate, a thiol-protease inhibitor; NCO-700; and a urinary trypsin inhibitor, urinastatin) on the postischemic recovery of function and enzyme leakage were investigated in this study. These protease inhibitors were added to either the cardioplegic solution or reperfusion solution. The addition of each of the protease inhibitors, except urinastatin, to the cardioplegic solution improved the postischemic recovery of function and reduced enzyme leakage. The dose-response characteristics of these three protease inhibitors were bell shaped, and the optimal concentrations of nafamostat mesilate, gabexate mesilate, and NCO-700 were 5 microM, 100 microM, and 20 microM, respectively. In contrast to the results of the preischemic treatment study, the addition of any of the protease inhibitors to the perfusion medium during Langendorff reperfusion failed to improve the postischemic recovery of function and to reduce enzyme leakage. Surprisingly, the addition of NCO-700 to the reperfusion solution at a concentration of 5 microM or higher had rather harmful effects on both functional recovery and enzyme leakage. These findings suggest that serine and thiol proteases may play an important role in myocardial injury during ischemia, but not necessarily during reperfusion.

Evolution of primate ABO blood group genes and their homologous genes

There are three common alleles (A, B, and O) at the human ABO blood group locus. We compared nucleotide sequences of these alleles, and relatively large numbers of nucleotide differences were found among them. These differences correspond to the divergence time of at least a few million years, which is unusually large for a human allelic divergence under neutral evolution. We constructed phylogenetic networks of human and nonhuman primate ABO alleles, and at least three independent appearances of B alleles from the ancestral A form were observed. These results suggest that some kind of balancing selection may have been operating at the ABO locus. We also constructed phylogenetic trees of ABO and their evolutionarily related alpha-1,3-galactosyltransferase genes, and the divergence time between these two families was estimated to be roughly 400 MYA.

[The effect of continuous perfusion with St. Thomas' Hospital cardioplegic solution containing glucose, insulin and L-aspartate on functional recovery after myocardial preservation in the rat]

The aim of this study was to determine the effect of the continuous perfusion with St. Thomas' Hospital cardioplegic solution (ST solution) containing glucose, insulin and L-aspartate upon post-preservation recovery of cardiac function in the isolated rat heart.

METHODS

Hearts from Wistar male rats were perfused with Krebs-Henseleit bicarbonate buffer (KHBB) solution and cardiac function was measured using an isolated working heart preparation. Hearts were then preserved by continuous perfusion, (1) with ST solution or ST solution containing L-aspartate (20 mmol/L9 at 20 degrees C and 4 degrees C for 12 hours, (2) with ST solution containing L-aspartate at 4 degrees C for 24 hours, (3) with ST solution containing glucose (9 mmol/L) and insulin (10 U/L solution) or ST solution containing glucose, insulin and L-aspartate at 20 degrees C for 24 hours. This was followed by 15 minutes of Langendorff perfusion and 20 minutes of working perfusion with KHBB solution. During the working perfusion in the post-preservation period, cardiac function was remeasured.

RESULTS

(1) At 20 degrees C, percent recovery of cardiac output (%CO) was 57.7 +/- 3.8% and 79.9 +/- 1.4*% in the L-aspartate-free group and the L-aspartate-containing group, respectively (*p < 0.05). At 4 degrees C, %CO was 74.4 +/- 2.2% and 80.5 +/- 1.7% in the L-aspartate-free group and the L-aspartate-containing group, respectively (NS). (2) %CO in L-aspartate-containing group at 4 degrees C decreased to 46.8 +/- 2.4% when preservation time was extended to 24-hours from 12 hours. (3) On the other hands, the addition of L-aspartate to the ST solution containing glucose and insulin resulted in an additive protection and %CO was 76.0 +/- 1.1% even after 24 hour preservation at 20 degrees C.

CONCLUSIONS

Our results indicate that L-aspartate as an additive to perfusion medium might be beneficial for myocardial preservation, and that at 20 degrees C, the addition of L-aspartate to the ST solution containing glucose and insulin could improve the post-preservation recovery after the 24-hour preservation.

Unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

To extend the indications for corrective operation in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries, surgical procedures were done to unify the blood sources for pulmonary perfusion. Since December 1985, 50 patients have undergone unifocalization at ages from 2 months to 26 years with a mean of 6 +/- 7 years. In total, 84 staged unifocalization procedures and 5 other palliative procedures were done in 49 patients. These included several operative procedures: simple ligation of major aortopulmonary collateral arteries in 8; pulmonary angioplasty in 29 including reconstruction of the pulmonary arterial tree by direct anastomosis or interposition between the central pulmonary arteries and the intrapulmonary arteries; construction of artificial central pulmonary arteries with use of a xenograft pericardial tube graft in 36 with no native central pulmonary arteries detected; and construction of supplemental central pulmonary arteries also with use of a pericardial tube graft in 10. The pericardial tube graft, if used, was anastomosed to the intrapulmonary arteries on one end and connected to a prosthetic tube on the other end so as to perfuse the reconstructed pulmonary arteries. The anastomosis was made inside the lung through the divided interlobar fissure. Five patients died after operation among those undergoing these 89 preparative operative procedures. Deaths were related either to bleeding caused by anticoagulation therapy administered to prevent thrombosis within the xenograft pericardial tube graft used or to progressive congestive heart failure as a result of an excessive amount of pulmonary blood flow. Twenty-six patients have undergone intracardiac repair after previous unifocalization. In 16 patients the artificial central pulmonary arteries surgically constructed were connected to each other and then an external conduit was placed. In another patient, intracardiac repair and unifocalization could be concomitantly achieved via a median sternotomy. The right ventricle to left ventricle systolic pressure ratio immediately after intracardiac repair in 27 patients ranged from 0.24 to 0.91 with a mean of 0.54 +/- 0.17. One patient (4%) died shortly after intracardiac repair because of thrombosis within the pulmonary arteries. Postoperative catheterization showed that pulmonary vascular resistance was correlated significantly with the number of pulmonary vascular segments functioning rather than with the condition of the central pulmonary arteries. We conclude that surgical unifocalization is a feasible procedure before subsequent intracardiac repair, even in patients with critically hypoplastic or absent central pulmonary arteries.

Amino acid residue at codon 268 determines both activity and nucleotide-sugar donor substrate specificity of human histo-blood group A and B transferases. In vitro mutagenesis study

Histo-blood group A transferase produces A antigens and transfers GalNAc to the acceptor substrate, H structures of glycolipids and glycoproteins. B transferase transfers galactose in place of GalNAc to the same acceptor substrate to synthesize B antigens. We have previously identified four amino acid substitutions between human A and B transferases. Out of these four, substitutions at the last two positions (codons 266 and 268) were found to be crucial for the different donor nucleotide-sugar specificities between A and B transferases as analyzed by gene transfer of chimeric A-B transferase genes. In the present study, we have in vitro mutagenized codon 268 of these two transferase cDNA expression constructs (glycine and alanine in A and B transferases, respectively) and produced substitution constructs with every possible amino acid residue at this position. We examined the activity and specificity of each construct by gene transfer followed by immunodetection of A and B antigens and in vitro enzymatic assay. Amino acid substitution constructs on the A transferase backbone with alanine, serine, and cysteine expressed enzymes with A and B transferase activities. Weak A activity was detected with histidine and phenylalanine constructs while weak B activity was detected with asparagine and threonine constructs. All the other amino acid substitutions at codon 268 on the A transferase backbone showed neither A nor B activity. The glycine construct on the B transferase backbone expressed both A and B transferase activities. Some substitution constructs on the B transferase backbone maintained B activity while some other substitutions abolished the activity. These results show that the side chain of the amino acid residue at 268 of the human A and B transferases is responsible for determining both activity and nucleotide-sugar donor substrate specificity and strongly suggest its direct involvement in the recognition of and binding to the sugar moiety of the nucleotide-sugars.

Temperature-dependent cardioprotection of exogenous substrates in long-term heart preservation with continuous perfusion: twenty-four-hour preservation of isolated rat heart with St. Thomas' Hospital solution containing glucose, insulin, and aspartate

BACKGROUND AND METHODS

Using an isolated working rat heart model, we determined the effects of glucose, insulin, and aspartate on recovery of cardiac function when used as components of preservation solution at different temperatures. After measurement of baseline cardiac function, hearts (n = 6 per group) were perfused with oxygenated St. Thomas' Hospital solution containing (1) vehicle, glucose (9 mmol/L) or aspartate (20 mmol/L) for 12 hours at either 20 degrees or 4 degrees C; (2) glucose or glucose + insulin (10 U/L) at 20 degrees C for 20 hours; and (3) glucose + insulin at 20 degrees C or glucose + insulin + aspartate at either 20 degrees or 4 degrees C for 24 hours. Cardiac function was measured after preservation and expressed as a percentage of baseline values.

RESULTS

At 20 degrees C, both glucose and aspartate increased recovery of cardiac output (vehicle, 57.7% +/- 3.8%; glucose, 76.5% +/- 2.4% [p < 0.05 versus vehicle]; aspartate, 79.9% +/- 1.4% [p < 0.05 versus vehicle]). At 4 degrees C, glucose decreased recovery of cardiac output, whereas aspartate did not change the value (vehicle, 74.4% +/- 2.2%; glucose, 61.4% +/- 2.8% [p < 0.05 versus vehicle]; aspartate, 80.5% +/- 1.7%). The addition of insulin to glucose increased recovery of cardiac output (glucose, 24.6% +/- 4.0%; insulin + glucose, 69.2% +/- 2.0%: p < 0.05). The combined use of these three agents showed an additive effect in improvement of recovery of cardiac output at 20 degrees C (glucose + insulin, 64.2% +/- 2.2%; glucose + insulin + aspartate, 76.0% +/- 1.1%; p < 0.05), but the recovery at 4 degrees C (63.1% +/- 1.8%) was significantly lower than at 20 degrees C.

CONCLUSIONS

These results suggest that glucose and aspartate afford differential cardioprotective effects depending on the temperature of the preservation solution and that combined use of glucose, insulin, and aspartate at the optimal temperature may extend graft preservation time.

[The effect of coenzyme Q10 and cold cristalloid cardioplegia on hypothermic global ischemia]

Coenzyme Q10 (CoQ10, ubiquinone) has been shown to be protective against myocardial ischemia/reperfusion induced injury. The purpose of this study was to investigate the effect of CoQ10 added to cold cristalloid cardioplegia on hypothermic ischemia and normothermic reperfusion using an isolated working rat heart. Hearts (n = 6-9/group) from male Wistar rats were aerobically (37 degrees C) perfused (20 min) with bicarbonate buffer. This was followed by a 3-min infusion of St. Thomas' Hospital cardioplegic solution containing various concentrations of CoQ10 (0, 1, 3, 6, 12, and 58 mumol/L). Hearts were then subjected to 180 min of hypothermic (20 degrees C) global ischemia and 35 min of normothermic (37 degrees C) reperfusion (15 min Langendorff, 20 min working). Ventricular fibrillation (Vf) upon reperfusion was irreversible in the 12 and 58 mumol/ L CoQ10 groups (4/6 and 3/6, respectively). In the hearts which Vf upon reperfusion was not irreversible, the percent recovery of aortic flow (%AF) was 43.3 +/- 5.4% (n = 9) in the control group versus 31.6 +/- 7.7% (n = 6), 38.0 +/- 12.0% (n = 6), 27.2 +/- 6.9% (n = 6), 31.3% (n = 2), and 30.4 +/- 14.2% (n = 3) in the 1, 3, 6, 12, and 58 mumol/L CoQ10 groups, respectively. Creatine kinase leakage during Langendorff reperfusion tended to be greater in the 12 and 58 mumol/L CoQ10 groups than in the control group. Thus, CoQ10 in the cold cristalloid cardioplegic solution induced irreversible Vf upon reperfusion and failed to improve functional recoveries following hypothermic global ischemia.

Positron-labeled antioxidant 6-deoxy-6-[18F]fluoro-L-ascorbic acid: increased uptake in transient global ischemic rat brain

The in vivo uptake and distribution of 6-deoxy-6-[18F]fluoro-L-ascorbic acid (18F-DFA) were investigated in rat brains following postischemic reperfusion. Global cerebral ischemia was induced in male Wistar rats for 20 min by occlusion of four major arteries. Two time points were chosen for 18F-DFA injection to rats subjected to cerebral ischemia, at the start of recirculation and 5 days following recirculation. The rats were then killed at 2 h after tail-vein administration of 18F-DFA and tissue radioactivity concentration was determined. Increased uptake of radioactivity in particular brain regions, including the cerebral cortex, hypothalamus, and amygdala following injection of 18F-DFA, compared to the sham-operated control, was observed 5 days after reperfusion. Similar results were also obtained in in vitro experiments using brain slices. Abnormal in vivo accumulation of 45Ca, a marker of regional postischemic injury, was observed in these brain regions in tissue dissection experiments. Furthermore, metabolite analysis of nonradioactive DFA using 19F-NMR showed that DFA remained intact in the postischemic reperfusion brain. The present results indicate that 18F-DFA increasingly accumulates in damaged regions of postischemic reperfusion brain.

Transient reperfusion with acidic solution affects postischemic functional recovery: studies in the isolated working rat heart

This isolated working rat heart study was designed to investigate the effect of duration of reperfusion and degree of acidity of the reperfusate on myocardial protection. The experimental time course was as follows: 20 minutes of perfusion with the heart working, 3 minutes of infusion with the St. Thomas' Hospital cardioplegic solution followed by global ischemia for 33 minutes at 37 degrees C, and 20 minutes of Langendorff reperfusion followed by 20 minutes of working perfusion. During the initial 3 minutes of Langendorff reperfusion, the pH of the reperfusate was changed to 5.6, 6.8, and 7.5 by addition of sodium hydroxide into Krebs-Henseleit nonbicarbonate HEPES buffer. A respiratory acidic reperfusate was used for the initial 0.5, 1, 2, 3, 5, and 15 minutes during reperfusion. The results were as follows: (1) Reperfusion with a mildly acidic solution (i.e., pH 6.8) yielded better recovery than reperfusion with solutions having pH levels of 5.8 or 7.5. (2) Reperfusion for less than 3 minutes with a reperfusate having a pH level of 6.8 provided better recovery, although reperfusion for longer than 3 minutes exacerbated reperfusion injury. In conclusion, the effects of reperfusion with acidic solution were influenced by degree and duration with biphasic response characteristics.

Results of unifocalization for pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries: patency of pulmonary vascular segments

Unifocalization, a surgical technique to unifocalize the pulmonary blood supply in patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries, is a useful preparative operation to extend the indication for corrective surgery. The preoperative and postoperative pulmonary angiograms of 51 patients (aged 3 months-26 years at first unifocalization, 29 males, 22 females), who underwent a total of 96 unifocalizations from December 1985 to July 1994, were studied to assess the effectiveness of each procedure of unifocalization. The procedures of unifocalization were ligation (9), angioplasty (6), direct anastomosis (25), bridging (6), additional central pulmonary artery creation (9), central pulmonary artery creation (36) and thrombectomy (5). Altogether 125 anastomoses were made, and the patency of 101 (80.2%) anastomoses was confirmed, 24 (19.2%) were shown to be occluded. The patency rate of the anastomoses between xenograft rolls and intrapulmonary arteries was 79.5% (70/88), while that between native central pulmonary arteries and intrapulmonary arteries was 83.8% (31/37; N. S.). The patency rate of the anastomoses involving intrahilar arteries was 88.0% (44/50), while that for the group involving extrahilar arteries only was 71.9% (46/64; P < 0.05). It is concluded that 1) unifocalization with the reconstruction of central pulmonary arteries using a pericardial roll is a useful method for patients with absent or hypoplastic central pulmonary arteries, 2) it is preferable to divide the fissures of lung in anastomosing pulmonary arteries of arborization abnormalities.

Physiological, morphological and anatomical responses of Fraxinus mandshurica seedlings to flooding

Two-year-old Fraxinus mandshurica Rupr. var. japonica Maxim. seedlings were flooded to 8 cm above soil level for 70 days. The flooding treatment altered the growth, morphology, stem anatomy and ethylene production of the seedlings. Although flooding did not affect height growth, it stimulated diameter growth of the submerged stems by increasing both the number and size of wood fibers produced; however, the thickness of the cell walls of the wood fibers was reduced by flooding. In response to the flooding treatment, the seedlings formed abundant hyperhydric tissues, originating from the vicinity of lenticels on the surface of the flooded stems, and adventitious roots, which grew through the hyperhydric tissues. Aerenchyma tissues were observed in the bark of the adventitious roots. The flooding treatment did not affect dry weight increment of leaves and stems, but it reduced the total dry weight increment of the root system even though it promoted adventitious root formation. Flooding also enhanced ethylene production in the submerged portions of stems. The potential roles of flood-induced ethylene in cambial growth and adventitious root formation in flooded plants are discussed.

What factors affect ventricular performance after a Fontan-type operation?

Postoperative conditions after a Fontan-type operation, particularly as they affect results in the early term, are thought to depend on factors such as the state of pulmonary circulation and ventricular function. In this study, we attempted to determine the factors that influence ventricular characteristics in the middle term after Fontan-type procedures. Catheterization was performed at a mean of 15 months after operation in 57 patients with univentricular atrioventricular connection who underwent the operation between 1.0 and 22.6 years of age. End-diastolic volume, end-systolic volume, ejection fraction, and end-diastolic pressure of the systemic ventricle were analyzed together with an estimation of the systemic flow index. These parameters were influenced significantly by the presence of atrioventricular valve insufficiency. The morphologically left ventricle showed a better ejection fraction than did the morphologically right ventricle, whereas the systemic flow index was greater in patients undergoing total cavopulmonary connection than in those receiving an atriopulmonary connection. Young age was significantly associated with a better postoperative contractility, whereas the potential for impaired ventricular compliance was suggested in several patients undergoing operation after 4 years of age. On the basis of our results, we conclude that total cavopulmonary connection performed at a young age should be the surgical procedure of choice and that atrioventricular insufficiency must be treated properly at, and even after, the initial definitive repair.

[Sarcoplasmic reticular calcium release and myocardial protection--effects of ryanodine and cold cristalloid cardioplegia on hypothermic global ischemia]

Myocardial rapid cooling is known to result in sarcoplasmic reticular (SR) calcium release. SR calcium release during an infusion of cold cardioplegic solution may contribute to myocardial protection against hypothermic global ischemia. We have, therefore, investigated using the isolated working rat heart preparation to determine the effect of cold cristalloid cardioplegic solution (K+ = 16 mmol/L) containing ryanodine on myocardial injury due to hypothermic global ischemia. Hearts (n = 6-12/group) from male Wistar rats were aerobically (37 degrees C) perfused (20 min) with bicarbonate buffer (Ca2+ = 2.4 mmol/L). This was followed by a 3 min infusion of St. Thomas' Hospital cardioplegic solution (20 degrees C) containing various concentrations of ryanodine. Hearts were then subjected to 180 min of hypothermic (20 degrees C) global ischemia and 35 min of normothermic (37 degrees C) reperfusion (15 min Langendorff, 20 min working). The recoveries of aortic flow were 46.4 +/- 3.7% in the ryanodine free controls versus 50.8 +/- 5.1, 50.6 +/- 4.8, 53.1 +/- 5.9, 59.4 +/- 1.9, 50.5 +/- 3.2 and 31.8 +/- 6.1% in the 0.18, 0.88, 1.31, 1.75, 10.00 and 100.00 nmol/L ryanodine groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular genetics of the ABO histo-blood group system

Molecular genetic study of the histo-blood group ABO system has elucidated the allelic basis of this genetic locus. Comparison of the nucleotide sequence has identified in the coding region differences which change amino acid sequences of the glycosyltransferases coded by these genes. Effects of the differences (mutations) on the specificity and activity of the glycosyltransferases have been examined.

Effects of ornithine on the electroretinogram in cat retina

PURPOSE

To study the acute effects of L-ornithine hydrochloride on the function of cat retina in vivo.

METHODS

A small amount of ornithine was administered intravitreously or intravenously. Changes in retinal function were monitored by vitreal electroretinogram (ERG) and intraretinal ERG with K(+)-selective microelectrodes.

RESULTS

Intravitreal injections (0.2 to 0.5 M; 15 microliters) of ornithine caused a decrease in the standing potential and the vitreal ERG c-wave amplitude. The ERG c-wave decreased continuously during a 5-hour period. Intravenous injection (0.2 M; 10 ml) of ornithine also diminished the c-wave. Intraretinal recording showed that the amplitudes of the retinal pigment epithelium (RPE) component and the Müller cell component of the ERG c-wave were reduced after intravitreal injection. The light-evoked [K+]o decrease in the subretinal space did not change. The change in transepithelial resistance contributed little to the decrease in the c-wave.

CONCLUSION

These results demonstrated that ornithine selectively affects the c-wave and suggested that it affects RPE and Müller cells directly without affecting photoreceptors.

[The effects of glucose and insulin upon functional recovery in the rat heart preserved by continuous perfusion with St. Thomas' Hospital cardioplegic solution]

The aim of this study was to determine the effect of the continuous perfusion with Krebs-Henseleit bicarbonate buffer (KHBB) solution or St. Thomas' Hospital cardioplegic solution (ST solution) containing glucose and insulin upon the post-preservation recovery in the isolated rat heart.

METHODS

Hearts from male Wistar rats (n = 6/group) were subjected to working perfusion with KHBB solution for measurement of cardiac function. They were continuously perfused (1) with KHBB solution or ST solution for 12 hours at 20 degrees C, (2) with ST solution for 12 hours at 37 degrees C, 20 degrees C or 4 degrees C, (3) with ST solution or ST solution containing glucose (9 mmol/L) for 12 hours at 20 degrees C or 4 degrees C, and (4) with ST solution containing glucose (9 mmol/L) or ST solution containing glucose (9 mmol/L) and insulin (10 U/L solution) for 20 hours at 20 degrees C. This was followed by 15 min of Langendorff perfusion and 20 min of working perfusion with KHBB solution. During the second working perfusion after preservation, cardiac function was measured again.

RESULTS

(1) Percent recoveries of cardiac output (%CO) preserved with KHBB and ST solution were 44.9 +/- 4.0 and 57.7 +/- 3.8%, respectively (p < 0.05). (2) %CO after preservation with ST solution at 37, 20, 4 degrees C were 0*, 57.7 +/- 3.8 and 74.4 +/- 2.2*%, respectively (*p < 0.05 vs the 20 degrees C group). (3) At 20 degrees C, glucose addition to ST solution increased %CO to 76.5 +/- 2.4% from 57.7 +/- 3.8% in glucose-free ST solution group (p < 0.05). However, at 4 degrees C, glucose addition to ST solution was rather harmful and decreased %CO to 61.4 +/- 2.8% from 74.4 +/- 2.2 in glucose-free ST solution group (p < 0.05). (4) The addition of insulin to the glucose-containing ST solution resulted in a significant increase in %CO from 24.6 +/- 4.0% in the insulin-free solution to 69.2 +/- 2.0%.

CONCLUSIONS

Our results indicate that 1) ST solution might be better than KHBB solution for a continuous perfusion medium of myocardial preservation, and 2) at 20 degrees C, the addition of glucose and insulin to the ST solution could be beneficial for the continuous infusion as a method of preservation, however, at 4 degrees C, these addition might be harmful, suggesting the temperature dependence in the utility of energy substrate.

Intraretinal analysis of electroretinogram with K+ microelectrodes during acute intraocular pressure elevation

We examined the effects of acute intraocular pressure elevation on the intraretinal electroretinogram in the cat dark-adapted eye. Perfusion pressure of the eye (mean arterial pressure minus intraocular pressure) was regulated within the range of 25-75 mm Hg by increasing the intraocular pressure, which was adjusted by changing the height of the reservoir of balanced salt solution perfused into the eye through a needle placed in the anterior chamber. The vitreal electroretinogram, transepithelial c-wave, slow PIII and light-evoked decrease in extracellular K+ concentration were recorded during intraocular pressure elevation in the dark-adapted retina. The c-wave increased in amplitude between 40 and 75 mm Hg of perfusion pressure and decreased below 40 mm Hg in some cases. These changes were unrelated to the standing potential. The transepithelial c-wave, slow PIII and light-evoked decrease in extracellular K+ concentration were larger in the range of perfusion pressure examined. These suggest that some factor induces electroretinographic changes that are not readily explained by hypoxia or pH changes alone.

MRI differential diagnosis of intrahepatic biloma from subacute hematoma

The magnetic resonance imaging (MRI) differential diagnosis of intrahepatic biloma from intrahepatic subacute hematoma has been reported in two cases. The biloma was heterogenously intense on T1-weighted images and homogenously hyperintense on T2-weighted images. The hematoma was hyperintense on the both T1- and T2-weighted MR images. The clinical significance of this MRI difference is that intrahepatic biloma needs drainage, whereas intrahepatic hematoma can heal spontaneously.

ABO blood group genotype and plasma von Willebrand factor in normal individuals

von Willebrand factor (vWF) is a multimeric plasma protein with ABO (H) blood group sugar chains. We investigated a total of 330 plasmas from normal individuals having various ABO genotypes, with special reference to vWF antigen and its platelet glycoprotein-Ib-related biological activities, termed ristocetin cofactor (RCof) and botrocetin cofactor (BCof). RCof reflects the biological activity of higher vWF multimers, while BCof reflects that of vWF of multimers of all sizes. Plasmas from normal individuals carrying one O gene (genotypes AO and BO) had slightly, but proportionally lower levels of vWF antigen, RCof, and BCof than those carrying no O gene (genotypes AA, AB, and BB). Normal plasmas from individuals carrying two O genes (genotype OO) showed much lower values for these parameters than the other plasmas, as previously reported. However, multimeric analysis of plasma vWF antigen revealed no differences among the different genotypes.

[Effect of CoQ10 on myocardial ischemia/reperfusion injury in the isolated rat heart]

It has been reported that CoQ10, ubiquionone, may have a protective effect on the mitochondrial injury induced by myocardial ischemia and reperfusion during open heart surgery. The purpose of this study was to investigate whether CoQ10 may enhance myocardial protection when given before ischemia, during ischemia or during reperfusion in the isolated working rat heart. Hearts (n = 6-9/group) from male Wistar rats were aerobically (37 degrees C) perfused (20 min) with bicarbonate buffer. In the first series of studies, this was followed by a 3 min infusion of St. Thomas' Hospital cardioplegic solution containing various concentrations of CoQ10. Hearts were then subjected to 39 min of normothermic (37 degrees C) global ischemia and 35 min of reperfusion (15 min Langendorff, 20 min working). The percent recovery of aortic flow (%AF) was 50.5 +/- 3.3% in the CoQ10 free controls versus 55.9 +/- 4.4, 62.1 +/- 3.1*% (*p < 0.05) in the 29, 44 and 58 mumol/L CoQ10 groups, respectively. Creatine kinase (CK) leakage during Langendorff reperfusion had a tendency to decrease in the 58 mumol/L group. In the second series of studies, 3 min of cardioplegia without CoQ10 and 38 min of ischemia (37 degrees C) were followed by a 15 min Langendorff reperfusion with 0 or 58 mumol/L of CoQ10 and 20 min working reperfusion. %AF was 53.2 +/- 2.7 and 39.2 +/- 7.1% in the 0 and 58 mumol/L CoQ10 groups, respectively. CK leakage had a tendency to increase in the 58 mumol/L group.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effects of Ebselen upon post-ischemic functional recovery in rat heart]

The effects of Ebselen (DR-3305) upon cardiac function and CK leakage with or without ischemia reperfusion insults were investigated in this isolated working rat heart study. In order to evaluate the effects of Ebselen upon cardiac function, it was administrated to the isolated rat heart with Langendorff perfusion for 15 min at 100 cmH2O. Cardiac functions such as aortic and coronary flow, heart rate and aortic pressure, before and after Ebselen treatment, were measured and expressed as percent of the control value. The coronary resistance was significantly reduced in 100 nM, 500 nM and 1000 nM of Ebselen pretreatment with dose dependent manner. However pretreatment with 1000 nM of Ebselen significantly decreased cardiac output with significant increase of CK leakage. The myocardial protective effects of Ebselen in the cardioplegia or reperfusate were investigated under conditions of normothermic ischemia. After measuring preischemic cardiac functions, the St. Thomas' Hospital cardioplegic solution was infused for 3 min followed by 35 min of global ischemia at 37 degrees C. Hearts were then aerobically reperfused for 15 min in the Langendorff mode. Subsequently, cardiac function was measured and expressed as percent of the preischemic control value. Ebselen addition to the St. Thomas' cardioplegic solution did not possess any myocardial protective effects, although addition to reperfusate possess the protective abilities at a concentration of 10 nM. From these data, Ebselen, which was one of the free radical scavenger, had the myocardial protective effects if it was added to reperfusate at a concentration of 10 nM.

Biventricular repair in cardiac isomerism. Report of seventeen cases

Ninety-three patients with cardiac isomerism were treated surgically from July 1985 to June 1991. Among them, three patients with right and 14 with left isomerism underwent biventricular repair. Ages ranged from 4 months to 41 years (mean 4.8 years). Anatomic repair was accomplished in 15 patients and functional repair with the right ventricle used as the systemic ventricle in two patients. Methods of atrial septation to separate pulmonary venous flow from systemic venous flow included atrial partition with a straight patch in seven patients, intraatrial rerouting with a tailored baffle in five, and a Mustard-type atrial switch in five. One hospital death (5.8%) and two late deaths (12%) occurred. Two patients required reoperation (12%), one reconstruction of a stenotic systemic venous connection and one mitral valve replacement because of incompetence. Surgically induced complete atrioventricular block was not observed in any of the patients. Optimal atrial septation offers the possibility of biventricular repair for patients with acceptable intraventricular structure.

Extent of aortopulmonary collateral blood flow as a risk factor for Fontan operations

Between November 1987 and January 1990, 33 patients (tricuspid atresia, 9 patients; mitral atresia, 3; single ventricle, 15; others, 6) underwent Fontan operations. The rate of blood flow returning to the heart during aortic cross-clamping was measured as an indication of the extent of development of aortopulmonary collateral arteries. Percent cardiac return (calculated by dividing the blood flow rate returning to the heart by the cardiopulmonary bypass blood flow rate and expressing the value as a percentage), were 1% to 9%, 7 patients; 10% to 19%, 11; 20% to 29%, 9; 30% to 39%, 4; 40% to 49%, 1; and 50% to 59%, 1 patient. Percent cardiac return showed a significant correlation with postoperative mean systemic venous pressure (r = 0.6, p < 0.01). In those patients in whom percent cardiac return was more than 33%, the mean systemic venous pressure after operation was high (more than 17 mm Hg), and none of these patients survived. To predict percent cardiac return preoperatively, the conventional indices of systemic ventricular volume, pulmonary artery area index, arterial blood oxygen saturation, pulmonary blood flow index, and pulmonary vascular resistance were analyzed. None of these showed significant correlation with percent cardiac return. However, all the patients who had a high percent cardiac return (more than 30%) also had both high arterial blood oxygen saturation (more than 75% in room air) and small pulmonary artery area index (less than 55%). In addition, the age at operation showed good correlation (r = 0.6, p < 0.01) to percent cardiac return.(ABSTRACT TRUNCATED AT 250 WORDS)