Surgical management of Mycobacterium avium complex disease

Between July 1991 and October 1996, eight patients with Mycobacterium avium complex (MAC) underwent pulmonary resection in our department. There was equal distribution of men women. The length of the preoperative period averaged 8.1 months (range: 1 to 30 months). Surgical resection was complete, consisting of lobectomy in 4 patients, lobectomy with partial resection in 2, segmentectomy in 1, and segmentectomy with partial resection in 1. There were no major complications postoperatively. No patients had positive sputum culture with MAC just after operation; however, one patient had positive sputum culture 6 months after operation. Our results show the good outcome of resectional surgery for MAC in properly selected patients, who should be operated as early as possible.

Effects of vitamin E deficiency and glutathione depletion on stress protein heme oxygenase 1 mRNA expression in rat liver and kidney

Heme oxygenase 1 (HO-1) is a stress protein and has been suggested to provide defense mechanisms against agents that may induce oxidative injury. Vitamin E (VE) is considered to function as an important cellular antioxidant. Rats were fed a VE-deficient (0E) or a VE-sufficient (10E) diet for 6 weeks and then were intraperitoneally administered buthionine sulfoximine (BSO), a glutathione (GSH)-depleting reagent. Whereas HO-1 mRNA levels were undetectable in untreated 0E and 10E rat livers, BSO administration induced HO-1 mRNA expression in both 0E and 10E rat livers. High levels of HO-1 mRNA expression were observed in particular in BSO-treated 0E rat livers. The time-course of changes in HO-1 mRNA expression in 0E rat liver after BSO administration showed that HO-1 mRNA expression was transiently induced at 2.5 hr after BSO treatment, the earliest time examined. In addition, to determine whether VE deficiency and GSH depletion affect the expression of HO-1 mRNA in other tissues, we also examined the time-course of HO-1 mRNA expression in BSO-treated 0E rat kidney. The expression pattern of HO-1 mRNA in the kidney was very similar to that in the liver, and the peak was also observed at about 2.5 hr after BSO administration. Interestingly, histologic assessment of liver and kidney showed that VE deficiency and GSH depletion induced injury in the kidney, but not in the liver.

Regulation and immunohistochemical analysis of stress protein heme oxygenase-1 in rat kidney with myoglobinuric acute renal failure

Intramuscular injection of hypertonic glycerol solution to rats results in acute renal injury. In this model, the proximal tubules are characteristically damaged. After glycerol injection renal glutathione (GSH) levels drastically decreased. On the other hand, stress protein heme oxygenase-1 (HO-1) was induced. When N-acetyl cysteine was administered to rats before 1 h glycerol injection, renal function was obviously improved. In this condition, the renal GSH content were sustained in the normal levels and HO-1 protein levels were decreased compared with those of glycerol-treated rats. Induction of HO-1 was accompanied by reduced renal GSH content. In addition, to investigate whether the location of HO-1 protein induced by glycerol injection is restricted to injured region or not in the kidney, we determined the localization of HO-1 protein using immunohistochemical staining. HO-1 protein was identified in the epithelia of the distal tubules, Henle's loop and collecting ducts, but not in the injured proximal tubules.

Immunohistochemical analysis of heme oxygenase-I in rat liver after ischemia

Total hepatic ischemia was induced by clamping the hepatic artery, portal vein, and bile duct. After 15 min hepatic ischemia, we examined a time course of the changes in the steady-state levels of heme oxygenase-1 (HO-1) mRNA and protein in the livers. The levels of HO-1 mRNA was transiently induced and peaked at 4 h after the start of reperfusion. In addition, a pattern of the time course of HO-1 protein levels was similar to that of HO-1 mRNA levels. Immunohistochemical analysis clearly showed that the localization of HO-1 protein induced by hepatic ischemia was restricted to the hepatocytes in the pericentral vein.

Bioactive constituents of Chinese natural medicines. IV. Rhodiolae radix. (2).: On the histamine release inhibitors from the underground part of Rhodiola sacra (Prain ex Hamet) S. H. Fu (Crassulaceae): chemical structures of rhodiocyanoside D and sacranosides A and B

The methanolic extract of the underground part of Rhodiola sacra (PRAIN ex HAMET) S. H. Fu was found to show inhibitory activity on the histamine release from rat peritoneal exudate cells induced by an antigen-antibody reaction. From the methanolic extract with the inhibitory activity on histamine release, a new cyanoglycoside called rhodiocyanoside D and two new monoterpene glycosides called sacranosides A and B were isolated, together with eight known compounds, rhodiocyanoside A, heterodendrin, lotaustralin, rhodioloside, 2-phenylethyl alpha-L-arabinopyranosyl(1-->6)-beta-D-glucopyranoside, 2-methyl-3-buten-2-yl beta-D-glucopyranoside, kenposide A, and rhodiooctanoside. The structures of new compounds were determined on the basis of chemical and physicochemical evidence, which included the synthesis of sacranoside A from (-)-myrtenol. All major chemical constituents from R. sacra inhibited the histamine release and, among them, lotaustralin and rhodiooctanoside were found to show potent inhibitory activity.

Molecular cloning of rat p38 mitogen-activated protein kinase and it's osmotic regulation in rat kidney

Rat p38 mitogen-activated protein (MAP) kinase cDNA was isolated from rat kidney cDNA library using a PCR cloning strategy. The deduced amino acid sequence consists of 360 amino acids and shares 95.3% similarity with human p38 MAP kinase. The message for rat p38 MAP kinase was about 3.4 kilobases and was highly expressed in the kidney. In water-deprived rat kidneys, the steady-state levels of p38 MAP kinase mRNA increased about 2.7-fold as compared with those of control rats. This result suggests that p38 MAP kinase may play an important role in the osmoregulation in the kidney.

Differential expression of S-adenosylmethionine synthetase isozymes in different cell types of rat liver

Mammalian S-adenosylmethionine (AdoMet) synthetase exists as two isozymes, liver-type and nonhepatic-type enzymes, which are the products of two different genes. It is known that the liver-type isozyme is only expressed in adult liver. Whereas, the nonhepatic-type isozyme is widely distributed in various tissues. In addition to the liver-type isozyme, a minor amount of the nonhepatic-type isozyme is also detected in adult liver. To investigate the distribution of these two isozymes in the liver in detail, the localization of these two isozymes was examined in each cell type of liver using a combination of cell fractionation technique and Western blot analysis. In the parenchymal cells, the liver-type isozyme protein was predominantly expressed, and a small amount of the nonhepatic-type isozyme protein was also detected. On the other hand, in the stellate cells the nonhepatic-type isozyme protein was exclusively or only expressed. Interestingly, a large amount of both isozymes were present in endothelial and Kupffer cell fraction. Using both antibodies to anti-rat nonhepatic-type and liver-type isozymes, respectively, immunohistochemical analysis clearly confirmed these results. In addition, in cultured hepatocellular carcinoma cells (FAA-HTC1), the nonhepatic-type isozyme protein only was detected, and the liver-type isozyme protein completely disappeared. This result indicates that the changes in the isozyme expression is regulated within the parenchymal cells. Administration of hepatotoxic drug carbon tetrachloride (CCl4) to rats resulted in about 40% to 50% reduction of enzyme activity in parenchymal cells and stellate cells compared with those of control rats. However, enzyme activity in endothelial and Kupffer cell fraction was not changed.

Expression of S-adenosylmethionine synthetase isozyme genes in regenerating rat liver after partial hepatectomy

Mammalian S-adenosylmethionine (AdoMet) synthetase exists as two isozymes, liver-type and non-hepatic-type enzymes. To investigate the possible role of AdoMet synthetase in proliferating cells, we have examined the expression of these two isozyme genes in regenerating rat liver after partial hepatectomy using Northern blot analysis. In normal adult rat liver the non-hepatic-type isozyme mRNA was not detectable, however, when partial hepatectomy was performed, there was an obvious appearance of the non-hepatic-type enzyme mRNA after operation. The levels of non-hepatic-type isozyme mRNA was peaked at 4h and maintained the level at least till 8 h after operation, then decreased. In addition, the liver-type AdoMet synthetase gene expression was also induced by partial hepatectomy with similar time course. These results indicate that these two AdoMet synthetase isozymes may play an important role during the prereplicative phase which precedes DNA synthesis.

Interleukin-2 induces gamma-S-adenosyl-L-methionine synthetase gene expression during T-lymphocyte activation

The regulation of expression of the gamma-S-adenosyl-L-methionine (AdoMet) synthetase gene was investigated in T-cells during G0/G1 transition, as well as throughout the G1 phase. Stimulation of G0 T-lymphocytes with concanavalin A induces AdoMet synthetase gene expression, starting 8 h after stimulation. Interleukin-2 (IL-2) stimulates the induction of this gene expression and AdoMet synthetase activity in G1 lymphoblasts, in part by an increase in the transcription rate of the gene. Phorbol esters, which also stimulate the proliferation of G1 lymphoblasts, show a similar kinetics of AdoMet synthetase mRNA induction. In contrast, the mRNA levels of the S-adenosyl-L-homocysteine hydrolase, another enzyme of the methionine cycle, remain unchanged upon IL-2 or phorbol 12,13-dibutyrate treatment. Dexamethasone and 8Br-cAMP, both inhibitors of lymphocyte proliferation, are able to block the expression of the AdoMet synthetase gene and, consequently, AdoMet synthetase activity. Together these findings indicate that the AdoMet synthetase gene is subject to cell-cycle regulation in T-lymphocytes.

Molecular cloning and characterization of a novel truncated from (ClC-2 beta) of ClC-2 alpha (ClC-2G) in rabbit heart

Two cDNAs encoding rabbit heart Cl- channels (rabClC-2 beta and rabClC-2 alpha) were isolated by a PCR cloning strategy. RabClC-2 beta is a novel cDNA consisting of 2998 bp and encoding the 822-amino acid protein, while rabClC-2 alpha is identical to previously reported ClC-2G. RabClC-2 beta is 68 amino acids truncated from NH2-terminus of rabClC-2 alpha, but all 13 putative hydrophobic domains are conserved in rabClC-2 beta. Although rabClC-2 alpha was suggested to be activated by extracellular hypotonicity, expression of rabClC-2 beta in Xenopus oocytes induced large Cl- currents even in the absence of extracellular hypotonicity. Induction of external hypotonicity did not further increase the amplitude of membrane currents. On the other hand, as similar to rabClC-2 alpha, rabClC-2 beta current was augmented by PKA activation. Thus, different RNA processing of the same gene appears to provide two highly homologous PKA-activated Cl- channels with or without responsiveness to cell swelling in rabbit heart.

Expression of deoxyuridine triphosphatase during liver regeneration in rat

Deoxyuridine triphosphatase (dUTPase) activity increases concomitantly with DNA replication in the course of liver regeneration in rat. We confirmed in this report using Western blot analysis and Northern blot hybridization that the increase of dUTPase activity was derived from expression of the gene. The content of dUTPase protein quantitatively coincided with the activity, they reached to the maximum at about 24 h after partial hepatectomy. We also detected a transcript (1.0 kb) presumed to be a rat spleen dUTPase mRNA by the human dUTPase cDNA probe. This transcript appeared in the liver after a lag of about 16 h, reached to the maximum at 24 h, and could be detected until 48 h after partial hepatectomy. The increase of this transcript nearly coincided with the changes of dUTPase activity and the quantity of enzyme protein. These results indicated that the expression of dUTPase gene is related to the DNA replication.

[Intrapleural bleomycin for management of malignant pleural effusions]

We studied the efficacy of intrapleural administration of bleomycin for the management of malignant pleural effusions of non-small cell lung cancer in 24 cases. Bleomycin 60 mg was administered into the pleural space after tube drainage. If the effusion continued, one additional dose was given. The efficacy was seen in 18 cases (75%). The main adverse drug reaction was transient fever among others. There was little toxicity and no cases of pulmonary fibrosis. Intrapleural administration of bleomycin is useful in management of malignant pleural effusions.

[Clinical and serological studies in six cases of chlamydial pneumonia]

Clinical and serological studies of chlamydial pneumonia were done in six patients (three men and three women). The other three patients had no avian contact and showed almost the same clinical symptom. Acute infection with Chlamydia psittaci and Chlamydia pneumoniae were diagnosed in two patients and in one patient, respectively, by MFA. Because in some cases Chlamydia psittaci pneumonia and Chlamydia pneumoniae pneumonia are difficult to differentiate, it is necessary to use a test that allows different chlamydia species to be distinguished.

[Phase II study of a continuous five-day intravenous infusion of cisplatin and etoposide with concurrent chest radiation therapy in limited stage small cell lung cancer]

The efficacy of continuous five-day intravenous infusion of cisplatin (CDDP) and etoposide with concurrent chest radiation therapy was evaluated in patients with limited stage small cell lung cancer. The first group of patients registered from February 1989 to September 1990 received three courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 40 mg/m2/day x 5 days) and concurrent chest radiation therapy on the third course with dose reduction of etoposide. The second group of patients registered after February 1991 received four courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 50 mg/m2/day x 5 days) and concurrent chest radiation therapy on the first and second courses with dose reduction of etoposide. The response rates were 91.7% and 93.3%, respectively. The median duration of survival was 32.0 months and 20.1 months, respectively. Major toxicity was leukocytopenia and 64% and 80% of patients encountered leukocytopenia of Grade 3 or 4. In conclusion, these regimens show remarkable efficacy with acceptable toxicity.

[Surgery of bilateral pulmonary aspergilloma]

A 60-year-old man with cough and fever was admitted to our hospital. Chest radiography revealed multiple bullae and fungus balls in both lungs. He was treated with MCZ and FCZ for about 2 months, but the chest radiograph shadows did not improve and the fever continued. A two-stage operation was performed. The bullae were incised and the fungus balls were removed, then a muscle flap plombage was made with a pectoralis major muscle, a latissimus dorsi muscle and an intercostal muscle. The postoperative course was uneventful and respiratory function was preserved.

Expression of non-hepatic-type S-adenosylmethionine synthetase isozyme in rat hepatomas induced by 3'-methyl-4-dimethylaminoazobenzene

It is known that a high incidence of hepatocellular carcinoma in rat liver can be induced by such azo dye carcinogens as 3'-methyl-4-dimethylaminoazobenzene (3'-MeDAB). Mammalian S-adenosylmethionine (AdoMet) synthetase exists as two isozymes, non-hepatic-type and liver-type enzymes, which are the products of two different genes. We have examined the expression of two AdoMet synthetase isozyme proteins and mRNAs in rat hepatomas induced by 3'-Me-DAB. The levels of non-hepatic-type enzyme protein and mRNA are clearly induced by 3'-Me-DAB feeding. On the other hand, the levels of liver-type enzyme protein and mRNA are nearly the same or slightly decreased during hepatocarcinogenesis. These results indicate that the expression of the non-hepatic-type isozyme gene is obviously influenced with the progression of carcinogenesis and that the non-hepatic-type isozyme is useful as a oncodevelopmental marker in the liver.

Immunohistochemical analysis of rat S-adenosylmethionine synthetase isozymes in developmental liver

Mammalian S-adenosylmethionine (AdoMet) synthetase exists as two isozymes, liver-type and kidney(non-hepatic)-type enzymes. The developmental expression of these two isozymes proteins has been investigated in rat liver using immunohistochemical techniques. The liver-type AdoMet synthetase is expressed only in adult liver, but not in fetal liver. On the other hand, the kidney-type AdoMet synthetase is predominantly expressed in fetal liver and faintly detected in adult liver. It was also found that both isozymes were localized to the hepatocytes of rat liver. These results clearly show that AdoMet synthetase isozymes are developmentally regulated within hepatocytes. In addition, in rat kidney we have shown that the kidney-type AdoMet synthetase is predominantly localized to the distal tubule.

External pH regulates the slowly activating potassium current IsK expressed in Xenopus oocytes

A slowly activating, delayed rectifier potassium current, IsK, was expressed in Xenopus laevis oocytes by injection of cRNA transcribed from a rat kidney cDNA clone. External acidification reversibly decreased the current amplitude. The effects were concentration dependent on protons with Kd at pH approximately 5.5 and a Hill coefficient of 1.0. External acidification reduced the maximal conductance (Gmax) without affecting the activation kinetics; this effect was not dependent on membrane voltages. These data suggest that H+ ions bind to the channel with a one-to-one stoichiometry, and this binding site may be located outside of the membrane electric field.

Molecular cloning and developmental expression of a human kidney S-adenosylmethionine synthetase

cDNA clones encoding the human kidney S-adenosylmethionine synthetase (kidney-type isozyme) were isolated. The amino acid sequence deduced from the cDNA indicates that this enzyme contains 395 amino acids and has a molecular mass of 43,660 Da. The predicted amino acid sequence of this protein shares 84% similarity with that of human liver S-adenosylmethionine synthetase (liver-type isozyme). In addition, the developmental expression of these two isozyme mRNAs has been studied in the human liver using the reverse transcription-polymerase chain reaction (RT-PCR).

Prospective study of laparoscopic cholecystectomy in two hundred and fifty patients

Two hundred and fifty consecutive patients (151 women, 99 men, age 49.3 years) with symptomatic gallstones as diagnosed on ultrasonography underwent elective laparoscopic cholecystectomy over a 12-month period. Preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) were also performed in 203 and 200 patients, respectively. Laparoscopic cholecystectomy was successfully performed on 248 of the 250 patients (99.2%). Two patients required conversion to open cholecystectomy because of a pin hole injury to the portal vein in one case, and because of technical difficulties with the dissection due to severe adhesions in the other patient. Procedure time in the initial 100 cases decreased from an average of 216 minutes for the first ten cases to 87 minutes for the last 30 cases, including the time required for intraoperative cholangiography (IOC). Bile duct stones were found in 4 cases on IOC which were diagnosed by preoperative ultrasonography, IVC and ERC in 0, 2 and 3 cases respectively. An intraabdominal drain was inserted for two days in all cases. The mean hospital stay was 8.6 days (range 4 to 19 days) with no readmissions. No complications were seen at short-term follow-up one month after discharge. Although there was a significant learning period, the procedure was safe and effective and could be performed with minimal risk. The results show that physicians with experience in both endoscopy and laparoscopy are well qualified to perform laparoscopic cholecystectomy after appropriate training.