Intraventricular repair for Taussig-Bing anomaly

Among 41 patients with Taussig-Bing anomaly who underwent intracardiac repair, 10 patients were treated by intraventricular rerouting repair. The ages at operation ranged form 1 month to 8 years (average 2 years 3 months). Primary repair was done in four (average age 2 years 7 months), and repair was done after pulmonary artery banding in six patients (average age 2 years 2 months). The relationship of the great arteries was side by side in nine patients and oblique in one. After extensive resection of the infundibular septum, a distance of 8 to 18 mm from the tricuspid ring or chordae to the pulmonary valve was obtained (24% to 71% of total circumference for the subaortic route). The subaortic route was created to obtain an internal diameter at least equal to that of the aortic route. Tricuspid chordal or papillary muscle reattachment was performed in two patients. There were no early or late deaths. Follow-up ranged from 1 year 4 months to 22 years 3 months (average 5 years 8 months), and reoperation was required in one patient for residual pulmonary stenosis. The intraoperative pressure gradient between the left ventricle and aorta was 0 to 24 mm Hg (average 10.3 mm Hg), and postoperative study showed the gradients to be less than 19 mm Hg (n = 8). The age at operation, left ventricular-aortic pressure gradient, and postoperative tricuspid regurgitation were not significantly affected by the presence of severe hypertrophy of the infundibular septum (n = 4). These results indicate that intraventricular rerouting may be feasible in most patients who have the Taussig-Bing anomaly with side-by-side or similar relationships of the great arteries, and the age and conal anatomic variations do not appear to be significant limiting factors.

Scaphoid non-union: factors affecting the functional outcome of open reduction and wedge grafting with Herbert screw fixation

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensifier control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.

Hypofibrinogenemia in a girl with Langerhans cell histiocytosis during etoposide and prednisolone therapy

A case of a girl with Langerhans cell histiocytosis who had hypofibrinogenemia during etoposide (VP-16) and prednisolone therapy is described. A patient on a three times per week schedule of 100 mg/m2 etoposide in combination with 40 mg/m2 of prednisolone every day had hypofibrinogenemia of 90 mg/dL after 12 doses of etoposide. Hypofibrinogenemia improved after discontinuing the course of etoposide. The clinical course suggested that the combination of etoposide with prednisolone caused this side-effect. Although the exact mechanism of toxicity of etoposide with prednisolone remains unknown, it is possible that the side-effect might be due to reduced production of fibrinogen in the liver. Careful monitoring of fibrinogen is mandatory in patients receiving etoposide and prednisolone.

Vitamin A is involved in maintenance of epithelial cells on the bronchioles and cells in the alveoli of rats

We examined the effects of mild vitamin A deficiency and ozone (O3) exposure on the labeling index, a marker of cell proliferation, of epithelial cells on the bronchiole and cells in the alveoli of rat lungs, to assess the role of vitamin A in maintenance of epithelial cells on the distal airway and alveolus. Three-week-old rats were fed a vitamin A-depleted diet for 4 wk to induce mild vitamin A deficiency. After 2 wk rats were exposed to 16.4 mumol O3/m3 for 1 to 14 d. In vitamin A-sufficient rats, labeling indices of epithelial cells on the bronchiole and cells in the alveolus increased significantly in comparison with those of controls exposed to clean air on d 2 and 3 of O3 exposure. In vitamin A-deficient rats as well, labeling indices were increased by O3 exposure, but the magnitude of increase was significantly smaller than for vitamin A-sufficient rats. These results indicate that vitamin A deficiency resulted in decrease of proliferation of epithelial cells on the distal airway and cells in the alveolus of rats when the proliferation of these cells was stimulated by O3 exposure, suggesting an involvement of vitamin A in maintenance of lung epithelial cells.

Radial osteotomy for Kienböck's disease evaluated by magnetic resonance imaging. 24 cases followed for 1-3 years

24 patients with Kienböck's disease were followed with magnetic resonance imaging (MRI) for 1-3 years. 9 patients were treated with radial shortening, 10 with radial wedge osteotomy and 5 patients were treated non-operatively. Signal intensity of the lunate on T1-weighted or T2-weighted images increased postoperatively in all operated on patients, and normal or near-normal signal intensity was observed in 9 patients on T1-weighted images and in 15 patients on T2-weighted images postoperatively. Signal intensity did not increase in any patient treated non-operatively. The postoperative increase in signal intensity on MRI following radial shortening and radial wedge osteotomy presumably is due to revascularization of the lunate.

Effects of ozone and nitrogen dioxide on drinking and eating behaviors in mice

Male ICR mice were exposed continuously to ozone (O3) and nitrogen dioxide (NO2) for 7 days to examine the effects on drinking and eating behaviors. Ozone at 0.1 ppm did not affect drinking and eating activities, whereas drinking activity decreased in a concentration-dependent manner to 47.7, 12.8, and 3.0% of the control value with 2-day exposures to 0.2, 0.4, and 0.8 ppm O3, respectively, and eating activity decreased to 35.2 and 8.7% of the control value at 0.4 and 0.8 ppm O3, respectively. Body weight also decreased markedly by 2.0, 4.6, and 7.5 g at 0.2, 0.4, and 0.8 ppm O3, respectively. These decrements reached a maximum on the second day of exposure. However, alterations in drinking and eating activities and body weight were transient, leading to recovery during the continuous O3 exposures. The recovery processes were dependent on the concentrations of O3. Nitrogen dioxide at 4 ppm did not affect drinking and eating activities, whereas drinking activity decreased in a concentration-dependent manner to 56.8, 8.3, and 18.7% of the control value with 2-day exposures to 6, 8, and 12 ppm NO2, respectively, and eating activity decreased markedly to 21.8 and 16.4% at 8 and 12 ppm NO2, respectively. Body weight also decreased by 2.5, 5.5, and 6.1 g at 6, 8, and 12 ppm NO2, respectively. These decrements reached a maximum on the second day of exposure. As in the O3 exposures, the decrements in drinking and eating activities and body weight were transient and recovered during the continuous exposures to NO2 depending on the concentrations of NO2. Drinking and eating activities and body weights of mice that had been previously exposed to 12 ppm NO2 for 7 days did not show changes when the mice were exposed to 0.4 ppm O3 9 days after NO2 exposure. The present study demonstrates that photochemical oxidants suppress drinking and eating behaviors in mice and that they recover thereafter under the continuous exposure conditions.

[Ureteral stump metastasis from renal cell carcinoma: a case report]

A case of ureteral metastasis from renal cell carcinoma is reported. A 71-year-old man who had received radical nephrectomy for left renal cell carcinoma, G1 and about two years earlier presented with asymptomatic macrohematuria. He had received interferon therapy and surgical treatments for bone metastasis two times after the operation. Cystoscopic examination revealed bleeding from the left residual ureter but CT scan showed no abnormal findings. Left ureterectomy and partial cystectomy was performed and a small finger tip-sized tumor was found at 13.5 cm above the ureteral orifice. Pathological examination showed metastatic renal cell carcinoma, G1 > G2. Histologically and clinically, this tumor seemed to have metastasized by a hematological pathway. Seventeen cases of ureteral metastasis of renal cell carcinoma have been reported previously in the Japanese literature.

The prognostic significance of exercise-induced silent ST-segment depression in patients after myocardial infarction

To evaluate the prognostic value of exercise-induced silent ST-segment depression, 157 patients who had suffered myocardial infarction underwent symptom-limited exercise testing and coronary angiography. Patients were divided into 3 groups according to the presence or absence of ischemic ST-segment depression and angina during exercise testing. Group A patients had ST-segment depression without angina. Group B patients had both ST-segment depression and angina. Group C patients had neither ST-segment depression nor angina. All patients were followed without coronary artery bypass graft or percutaneous transluminal coronary angioplasty for an average of 36 months and the frequency of coronary events (cardiac death, recurrent myocardial infarction and unstable angina pectoris) was compared. Group A patients had less severe coronary artery disease, greater coronary reserve during exercise and exercised longer than group B. However, the prognosis of group A was similar to group B, and was worse than group C. Using the Cox proportional hazards model, ischemic ST-segment depression was the most useful index for predicting future coronary events among the baseline values, coronary angiographic and exercise testing variables. However, angina during exercise testing was not an independent predictor. Thus, post-infarction patients showing exercise-induced ST-segment depression should be treated carefully regardless of the presence or absence of angina.

Repair of bone defect with cultured chondrocytes bound to hydroxyapatite

Cultured chondrocytes were bound to hydroxyapatite (HA) and implanted in surgically created bone defects in the ulna of the rabbit. Chondrocytes were obtained from the iliac crest cartilage of the rabbit and were cultured on the HA block for two weeks before implantation. Scanning electron micrographs showed that pores of the HA surface and the inside of the block were filled with cultured cells. After cultivation for two weeks, the expression of chondrocyte-specific characteristics was confirmed in these cells by an implanted diffusion of chondrocyte-specific characteristics was confirmed in these cells by an implanted diffusion chamber experiment. The HA without chondrocytes served as a control. At two weeks postimplantation, proliferating chondrocytes were observed on the surface and in the inside pores of the HA-chondrocyte blocks but not the HA controls. At four and six weeks postimplantation, in the central region of the implants, there was a significant increase in the amount of bone formation in the HA with cultured chondrocytes. At 13 weeks post-implantation, the implants were partially resorbed and completely enveloped in lamellar bone, including bone marrow.

Comparison of tissue reaction with chondroitinase ABC and chymopapain in rabbits as the basis of clinical application in chemonucleolysis

Although chemonucleolysis with chymopapain is an approved treatment for lumbar intervertebral disk herniation, recent serious complications have raised doubt concerning its safety. It is therefore necessary to search for a safer and more selective agent than chymopapain for chemonucleolysis. Experimental chemonucleolysis with chondroitinase ABC was thus tested and compared with chymopapain. Acute tissue reactions to chondroitinase ABC were investigated and compared with chymopapain. The epidural space, yellow ligament, sciatic nerve, knee joint, and Achilles tendon were examined. Chymopapain damaged nervous and ligamentous tissues as well as cartilaginous tissue. Chondroitinase ABC did not damage nervous and ligamentous tissue. Chondroitinase ABC affected only cartilaginous tissue, and its action was chiefly limited to digestion of the matrix. Chondroitinase ABC has high enzymatic specificity for matrix in vivo. In addition, chondroitinase ABC is less toxic to noncartilaginous tissues than chymopapain. Chondroitinase ABC might be a more suitable and safer enzyme than chymopapain for chemonucleolysis.

Isolation and characterization of simian immunodeficiency virus from African white-crowned mangabey monkeys (Cercocebus torquatus lunulatus)

Forty-eight of 236 sera from seven species of African non-human primates in Kenya, including those of white-crowned mangabey monkeys (Cercocebus torquatus lunulatus) had antibodies to simian immunodeficiency viruses (SIVs). Isolates of simian lentivirus were obtained from seropositive white-crowned mangabey monkeys which are indigenous in West Africa. This virus, designated as SIVWCM, appeared morphologically similar to HIV by electron microscopy, showed Mg(2+)-dependent reverse transcriptase activity, and induced cytopathic effects in human CD4-positive cells. Western blotting analysis revealed that env products of SIVWCM cross-reacted with those of SIVAGM more strongly than with those of HIV-1 and SIVMAC, and clear hybridization bands were detected with an SIVAGM probe. For comparison of the virus sequence with those of other primate lentiviruses, part of the pol gene and the long terminal repeats (LTRs) were amplified and cloned. Sequencing showed that SIVWCM isolates were closely related to SIVAGM isolates. This study suggested that SIVAGM from the Cercopithecus genus and SIVWCM from the Cercocebus genus may be members of an SIV group that is genetically distinct from the SIV from a sooty mangabey monkey (SIVSMM) of the genus Cercocebus, to which the white-crowned mangabey monkey also belongs.

[Effect of recombinant human granulocyte colony stimulating factor in patients with transitional cell carcinoma of the urothelium receiving methotrexate, etoposide and cisplatinum combination chemotherapy]

We determined the effective method of administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in patients with transitional cell carcinoma of the urothelium receiving methotrexate, etoposide and cisplatinum (MEC) therapy. Recombinant human G-CSF was administered at 2 micrograms/kg subcutaneously starting after the white blood cell count was less than 3,000/mm3 (short administration) or starting immediately after finishing MEC therapy (prophylactic administration). The median white blood cell nadir for the control group, short administration group and prophylactic administration group, was 275 +/- 77, 250 +/- 317 and 2,066 +/- 47/mm3, respectively. The number of days with a white blood count of less than 1,000/mm3 for the control group, short administration group and prophylactic administration group was 6.6 +/- 0.6, 4 +/- 2 and 0.9 +/- 0.5 days, respectively. The difference between the control group and prophylactic administration group was statistically significant (p < 0.01). These findings indicated that the prophylactic administration of rhG-CSF following MEC therapy was effective for preventing leukopenia. Other side effects of stomatitis, diarrhea and pneumonia were also decreased using rhG-CSF after MEC therapy.

[Partial anomalous pulmonary venous connection to inferior vena cava (incomplete type of scimitar syndrome) in an elderly patient]

A 71-year-old woman presented with recent onset of dyspnea and fatigue on moderate exertion. She had been well during her entire life and had had three pregnancies and deliveries. Cardiomegaly was noted at the age of 30. On physical examination, systolic murmur was detected at the lower left sternal border. The chest X-ray showed cardiomegaly, increased pulmonary vascular markings and elevated right diaphragm. The electrocardiogram showed left ventricular hypertrophy. The echocardiography showed enlargement of right ventricle and atrium, massive tricuspid regurgitation and anomalous venous flow connected to the inferior vena cava from its right-posterior side. Cardiac catheterization demonstrated mild pulmonary hypertension and O2 step-up at the level of the anomalous venous connection to the inferior vena cava. On pulmonary arteriography, left pulmonary venous flow return to the left atrium and atrial septal defect was not found. Veins from the right lung met to form one vessel, went downward, and connected to the inferior vena cava at the level of Th12. L-R shunt was 45% and Qp/Qs was 1.83. Isolated partial anomalous pulmonary venous connection is a rare finding, and it is thought that the natural prognosis is good. The existence of our case, diagnosed at the age of 71, supported this concept.

The effect of hyperbaric oxygenation on bone in spontaneously hypertensive rats

We investigated whether hyperbaric oxygenation treatment can enhance osteogenesis in spontaneously hypertensive rats (SHRs). 8-week-old SHRs were exposed to hyperbaric oxygen for 6 weeks and were killed at 17 weeks of age. Wistar-Kyoto normal rats and untreated SHRs of the same age were used as controls. Radiographic measurements of cortical thickness and length of femora showed that these parameters increased in oxygen-treated SHRs; they became almost normal. Ash weight and ash, Ca and P content of L5 vertebras showed similar results. We conclude that high partial pressure oxygen has an effect on osteogenesis in SHRs.

Premature closure of the distal radial physis

Two cases of fracture of the radius treated by pinning resulted in severe wrist joint deformity due to premature closure of the epiphysial growth plate. Inappropriate pinning through the physis damaged the growth plate in both cases. They were treated by bone bridge resection with free fat interposition. The bone bar resection was effective in correcting the wrist joint deformity, and bone growth was expected without bone grafting.

Osteogenesis in sintered bone combined with bovine bone morphogenetic protein

Bone morphogenetic protein (BMP) was combined with true bone ceramic (TBC) in an attempt to produce a bone grafting material possessing the cancellous structure, osteoconductivity, and osteoinductivity of biologic bone. To determine the osteogenetic ability of this material (BMP-TBC) within bone marrow, BMP-TBC and TBC alone were implanted in the femoral condyles of Japanese White rabbits, and histographs of these implants, taken serially, were compared. Woven bone formation was observed both at the periphery and within surface pores of the BMP-TBC implants one week after implantation; these implants thus became secured to the host bone bed at an earlier stage than did TBC alone. The amount of new bone formation increased at a significantly higher rate with BMP-TBC than with TBC alone during the first four weeks. Therefore the BMP in BMP-TBC implants acts at an early stage on BMP-responding cells entering the pores of the TBC. These data also suggest that TBC, as a carrier for BMP, provides a favorable environment for the promotion of new bone formation.

Changes in regional myocardial function and external work in exercising dogs with ischemia

Changes in regional myocardial work of the nonischemic wall and left ventricular (LV) asynchrony of the nonischemic wall during exercise-induced ischemia were examined in seven conscious dogs instrumented with a micromanometer for LV pressure measurement and sonomicrometers for control and ischemic wall thickness and LV external short and long axes. Ischemia was produced during steady-state exercise by a pneumatic constrictor on the left circumflex coronary artery. Time difference between peak thickening of control (anterior) and ischemic (posterior) walls was measured as an index of LV asynchrony. LV pressure-wall thickness loop area of both the control wall (LVP-CW loop) and ischemic wall was calculated as an index of regional myocardial external work. With ischemia during exercise, peak LV pressure decreased by 11%, and time difference of peak thickening in the two walls increased, accompanied by marked deformation of the LVP-CW loop during early relaxation, which was related to protodiastolic thickening of the ischemic wall. Thus, despite a significant increase in percent systolic thickening during exercise, loop area of control wall was not enhanced. These changes of the LVP-CW loop were confirmed by calculation of stress-strain loop areas as an additional index of regional myocardial external work but having true dimensions of work. Stress-strain loop area in the control wall during ischemic exercise showed a similar value to that during control exercise, thereby confirming lack of compensatory increase. Thus, during exercise-induced ischemia, regional myocardial external work in the normal region does not increase despite an increase in systolic wall thickening.(ABSTRACT TRUNCATED AT 250 WORDS)

Southernmost carriers of HTLV-I/II in the world

To clarify the real distribution of HTLV-I and -II carriers among indigenous people in central and South America, blood samples collected from indigenous people in isolated regions of Southern Chile were examined. Among 199 inhabitants from Chiloe Island and Pitrufquen town, three cases (1.5%) showed positive anti-HTLV-I antibodies. Two out of the three (82-year-old male and 58-year-old female) reacted to HTLV-II-specific Gag and/or Env proteins but not to HTLV-I-specific ones. The latter case was confirmed as an HTLV-II carrier by polymerase chain reaction test.

DNA ploidy, c-myc oncoprotein p62 and v-H-ras oncoprotein p21 in colorectal carcinoma

DNA ploidy and expression of the c-myc oncoprotein p62 and the v-H-ras oncoprotein p21 were examined in 54 colorectal carcinomas. DNA ploidy, determined by DNA flow cytometry, was diploid in 19 samples and aneuploid in 35. Expression of the p62 oncoprotein, determined by immunohistochemical staining, was intensely positive in 18 samples while that of the p21 oncoprotein, also determined by immunohistochemical staining, was positive in 29. There was no correlation between DNA ploidy and expression of the p62 oncoprotein, and DNA ploidy did not correlate with expression of the p21 oncoprotein. There was, however, a close correlation between expression of the p62 oncoprotein and that of the p21 oncoprotein being P < 0.01 according to Peason's chi-square test.

Inhibitory effect of urate on oxidative damage induced by adriamycin-Fe3+ in the presence of H2O2

Urate strongly inhibited DNA damage induced by adriamycin (AD)-Fe3+ in the presence of H2O2. Deoxyribose (DOR) was degraded during the interaction of Ad-Fe3+ with H2O2, and urate strongly inhibited the DOR degradation. However, hydroxyl radical (HO.) scavengers did not always prevent the DOR degradation. ESR signal of 5,5-dimethyl-1-pyroline N-oxide-hydroxyl radical adduct was detected during the interaction of Ad-Fe3+ with H2O2. Mannitol and DNA strongly diminished the ESR signal but urate only poorly did. These results suggested that inhibitory effect of urate on the H2O2-dependent AD-Fe(3+)-induced DNA damage was not always due to trap only HO.. Lipid peroxidation of erythrocyte membrane was induced by AD-Fe3+ alone and H2O2 slightly inhibited the peroxidation reaction. Urate could not inhibit the Ad-Fe(3+)-induced lipid peroxidation. These results indicate that oxygen radical species which causes the lipid peroxidation does not involve in the H2O2-dependent Ad-Fe(3+)-induced DNA damage.