Split transplantation of the trachea: a new operative procedure for extended tracheal resection

Before tracheal transplantation can be applied clinically, several problems must be solved: immunosuppression, blood supply to grafts, and reliable long-term preservation of grafts. We have conducted experiments on tracheal transplantation to solve these problems. In the present study, we tried a new operative procedure to accomplish reliable revascularization of transplanted tracheal grafts. It has been reported that transplantation of a 10-ring length of trachea is difficult even with omentopexy. Long tracheal allografts can be transplanted with use of direct revascularization, but this technique is extremely troublesome. Thus we developed a new operative procedure, "split tracheal transplantation," in which grafts are divided at the midportion and covered with omentum, after demonstrating that the blood supply to tracheal grafts can be reestablished around the suture lines. Two groups of dogs were used. In group A (control, n = 4), a 10-ring length of trachea was autotransplanted. The anastomotic sites and grafts were covered with omental pedicles. In group B (split tracheal transplantation, n = 10), tracheal grafts 10 rings long were autotransplanted. These grafts were divided at the midportion, a piece of omentum was inserted between the two halves, and the midportion was sutured. Grafts were observed regularly by bronchoscopy and examined histopathologically after the animals died or were killed. In some animals, microangiography of the bronchial circulation was done. In the control group, necrosis, stenosis, or malacia of the grafts was observed in three of the four animals. In the split transplantation group, all animals survived for at least 2 months, all grafts were incorporated, and none showed ischemia, stenosis, or malacia. Microscopic examination and microangiography revealed that neovascularization of the graft was promoted by omentum inserted at the midportion of the graft. Split transplantation of the trachea is an easy and reliable way to extend tracheal resection.

Vascular involvement in benign infantile mitochondrial myopathy caused by reversible cytochrome c oxidase deficiency

A 1-month-old Japanese girl had profound generalized weakness, hypotonia, and severe lactic acidosis. The infant improved gradually: she held her head at 9 months, learned to walk by 15 months. At the first muscle biopsy at 11 weeks of age, the specimen was characterized by numerous ragged-red fibers and decreased enzyme activity on cytochrome c oxidase (COX) staining. Electron microscopic findings were characterized by the presence of excessive abnormal mitochondria not only in skeletal muscle fibers but also in blood vessels. Vascular abnormalities consisted of an increased number of enlarged mitochondria in endothelial and smooth muscle cells of small arteries. Biochemical analysis showed an isolated defect of COX activity, which was only 16% of the mean control level. At the second biopsy at 44 months of age, the COX activity had increased to normal in the entire specimen. On electron microscopy, the abnormal mitochondria present on the first biopsy specimen had disappeared both in muscle fibers and blood vessels; nearly all mitochondria were morphologically normal at the second biopsy. Now at 5 years of age she can run and does not show muscle weakness. We report reversibility of abnormal mitochondria with age not only in skeletal muscle fibers but also in blood vessels in a patient, who had reversible COX deficiency with a benign clinical course.

[CT and MR imaging findings in a case of cerebral alveolar echinococcosis masquerading as brain tumor]

We report a rare case of cerebral alveolar echinococcosis that was verified by pathological examination. The lesion presented as an intracranial mass which was slightly hyperdense on CT scans and very hypointense with central hyperintensity on T2-weighted MR images. The lesion exhibited marked contrast enhancement on both CT and MR images and was accompanied by extensive white matter edema. Although radiological differentiation from brain tumor was difficult, hypointensity on T2-weighted MR images appeared to be characteristic of lesions of cerebral alveolar echinococcosis.

Promotion and control of selective adhesion and proliferation of endothelial cells on polymer surface by carbon deposition

The adhesion and proliferation of endothelial cells can be drastically improved when cultivated on a carbon-deposited polymer surface. When the surface of segmented polyurethane, in which endothelial cells are not capable of proliferating, is modified by carbon deposition, cell adhesion and proliferation occurred selectively on the carbon-deposited region. Carbon deposition to a tissue culture-treated polystyrene surface on which cells are capable of proliferating further promoted cell spreading and proliferation. Cell patterning on carbon-deposited segmented polyurethane was also attempted by controlling the direction or region of cell proliferation. Carbon deposition onto the polymer surface brought about a decrease in the water contact angle of the surface. Precoating fibronectin or laminin on the carbon-deposited polymer surface brought about cell adhesion and proliferation in the carbon-deposited region, but not in the non-carbon-deposited region. Our data suggest that promotion of cell proliferation on a carbon-deposited surface is probably due to selective adhesion of adhesive proteins to the surface.

[Effect of aging on distortion product otoacoustic emissions]

The effect of aging on distortion product otoacoustic emissions (DPOAE) was investigated in 58 ears of 32 volunteers with normal hearing DPOAE levels to tones with a fixed frequency ratio (f2/f1 = 1.2) were measured with the CUBDIS system (MIMOSA Acoustics, USA). Age dependency of DPOAE level was clearly observed both in frequency plots (DP-gram) and input-output functions. In elderly persons, DPOAE levels for higher frequency primaries were significantly lower than in younger persons, when no remarkable change of audiometry threshold was noted. These results imply that the DPOAE level can be a sensitive indicator for age-related cochlear dysfunction.

Ultrastructural changes in canine lung preserved in newly developed solutions

The present study was undertaken to clarify the effect of differences in the ionic composition of a preservation solution by investigating ultrastructures of pulmonary endothelial cells and oxygenation ability of preserved lungs after reperfusion. The relation between the ultrastructural changes and the oxygenation ability was also examined. Canine lungs flushed with an extracellular-type (ET)-Kyoto solution (group A, n = 6), with an intracellular-type-Kyoto solution and prostaglandin El (group B, n=6), or with Euro-Collins solution and prostaglandin E1 (group C, n=6) were stored at 4 degrees C for 20 hr. In transmission electron microscopic findings, the frequency of ultrastructural changes (protrusion of endothelial cells and cellular vacuolization) was significantly less in group A (23.3 +/- 9.1 and 13.3 +/- 5.2%, respectively) than in group B (64.4 +/- 6.1 and 42.2 +/- 8.8%, respectively). In group A, PaO2 after 40, 70, and 130 min of reperfusion was uniformly excellent (289.4 +/- 5.7, 303.3 +/- 7.0, and 303.0 +/- 19.6 mm Hg, respectively) and significantly higher than in groups B and C (202.6 +/- 32.0 and 185.9 +/- 23.0 mm Hg, respectively) after 70 min and higher than in group C (155.7 +/- 36.3 mm Hg) after 130 min of reperfusion. A negative correlation was noted between the frequency of cellular vacuolization and the PaO2 after reperfusion. These results indicated that extracellular ion composition has significantly better effect on pulmonary vascular ultrastructures than intracellular ion composition. This may be a factor making ET-Kyoto solution superior to the other two solutions in oxygenation ability after reperfusion. When attempting to develop better lung preservation solution, the ability to preserve the ultrastructures of preserved lung may be an important consideration in the evaluation.

Comparative effects of contraction and angiotensin II on growth of adult feline cardiocytes in primary culture

The purposes of this study were 1) to determine whether angiotensin II causes growth of adult feline cardiocytes in long-term culture, 2) to compare the growth effects of angiotensin II with those resulting from electrically stimulated contraction, and 3) to determine whether the anabolic effects of contraction are exerted via the angiotensin type 1 receptor. Adult feline cardiocytes were cultured on laminin-coated trays in a serum-free medium. Cardiocytes were either electrically stimulated to contract (1 Hz, 5-ms pulse duration, alternating polarity) or were nonstimulated and quiescent. Quiescent cells were studied as controls and after treatment with angiotensin II (10(-8) M), losartan (10(-6) M; an angiotensin type 1-receptor antagonist), or angiotensin II plus losartan. Contracting cells were studied in the presence and absence of angiotensin II or losartan. In quiescent cardiocytes, angiotensin II treatment on day 7 significantly increased protein synthesis rates by 22% and protein content per cell by 17%. The effects of angiotensin II were completely blocked by losartan. Electrically stimulated contraction on days 4 and 7 in culture significantly increased protein synthesis rate by 18 and 38% and protein content per cell by 19 and 46%, respectively. Angiotensin II treatment did not further increase protein synthesis rate or protein content in contracting cardiocytes. Furthermore, losartan did not block the anabolic effects of contraction on protein synthesis rates or protein content. In conclusion, angiotensin II can exert a modest anabolic effect on adult feline cardiocytes in culture. In contracting feline cardiocytes, angiotensin II has no effect on growth. Growth caused by electrically stimulated contraction occurs more rapidly and is greater in magnitude than that caused by angiotensin II. Growth of contracting adult feline cardiocytes is not dependent on activation of the angiotensin receptor.

Plasma tissue factor and tissue factor pathway inhibitor levels in patients with disseminated intravascular coagulation

We measured the plasma levels of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in patients with disseminated intravascular coagulation (DIC) to examine the relationship between TFPI and vascular endothelial cell injury. Plasma TF (273 +/- 90 pg/ml) and TFPI (252 +/- 125 ng/ml) levels were significantly increased in patients with DIC compared with non-DIC patients. Plasma TF antigen level was significantly increased in pre-DIC patients (285 +/- 85 pg/ml), while the plasma TFPI level (152 +/- 54 ng/ml) was not markedly increased in such a state. The plasma TF/TFPI ratio was high in the pre-DIC patients (2.10 +/- 0.90), and low in the DIC patients (1.40 +/- 0.87) and healthy volunteers (0.84 +/- 0.26). There was no significant difference between the DIC patients with a good outcome and those with a poor outcome in terms of plasma TF levels, although the plasma TFPI level in the DIC patients with a good outcome (289 +/- 133 ng/ml) was significantly higher than that in those with a poor outcome (187 +/- 75 ng/ml). During the clinical course of DIC, plasma TF antigen was increased first, and an increase of the plasma TFPI level followed the increase in plasma TF level. These findings suggest that plasma TFPI is released from vascular endothelial cells and it may reflect vascular endothelial cell injury. It is conceivable that TF and TFPI may play an important role in the onset of DIC.

Second transplantation with CD34+ bone marrow cells selected from a two-loci HLA-mismatched sibling for a patient with chronic myeloid leukaemia

A 43-year-old man with chronic myeloid leukaemia underwent a second transplant with CD34+ bone marrow cells selected from his two-loci HLA-mismatched sibling after rejection of the first graft from an HLA-matched unrelated donor. By immunomagnetic positive selection, CD34+ marrow cells at 0.95 x 10(6)/kg with 97% purity and CD3+ T lymphocytes at 1.3 x 10(4)/kg were collected and transplanted. Engraftment was confirmed to be of CD34+ cell-donor origin. The patient developed only grade I acute graft-versus-host disease (GVHD) and no chronic GVHD to date. These observations suggest that allogeneic CD34+ bone marrow cells are capable of reconstituting haemopoiesis and that CD34+ selection could be applicable to T-cell depletion.

Lymphoblastic transformation of chronic myelomonocytic leukemia in an infant

A 10-month-old infant with chronic myelomonocytic leukemia (CMML) of 5 months' duration, who had been treated only with transfusion, displayed leukemic transformation characterized by lymphoid morphology, PAS positivity, and myeloperoxidase negativity. Surface marker analysis of blast cells revealed expression of lymphoid-associated antigens (CD10 and CD19) but not myeloid-associated antigens (CD13, CD14, and CD33). These findings suggest that some cases of infantile CMML are clonal disorders arising in a pluripotent stem cell that can also differentiate along the lymphoid cell lineage.

Effect of inorganic phosphate and ADP on the myofilament sliding induced by laser flash photolysis of caged ATP

Using the technique of laser flash photolysis of caged ATP, we have suggested that, under nearly isometric conditions, the unitary distance of myofilament sliding per ATP molecule (myosin head powerstroke) is about 10 nm. To give further information about the mechanism of myofilament sliding, we studied the effect of inorganic phosphate (Pi) and ADP on the photoreleased ATP-induced shortening of single glycerinated muscle fibers under very small external loads. Both the velocity and the distance of the myofilament sliding induced by 150 microM ATP increased by Pi (20 mM), and decreased by ADP (0.4 mM). On the other hand, Pi and ADP showed no significant effect on the myofilament sliding induced by 100 and 75 microM ATP. The potentiating effect of Pi on the myofilament sliding with 150 microM ATP can be explained as being due to the increase in population of AM.ADP.Pi with corresponding decrease in population of AM.ADP, and also the increase in population of M.ADP.Pi and M.ATP. Meanwhile, the inhibitory effect of ADP can be simply accounted for to be due to an accumulation of AM.ADP that already finished their force generating process. The ineffectiveness of Pi and ADP on the myofilament sliding with 100 and 75 microM ATP is consistent with the view that it is caused by almost synchronized single myosin head powerstrokes.

Inhibition by CsA and FK506 of the in vitro proliferative response of gamma delta T cells on stimulation with anti-TCR delta monoclonal antibody

Tg.Tla'-3-1 mice are transgenic C3H/He mice with a Tlaa-3 gene derived from A mice. We demonstrated that spleen cells from Tg.Tlaa-3-1 mice, but not C3H/He mice, showed a proliferative response on stimulation with immobilized anti-TCR delta monoclonal antibody (mAb 3A10). Thus, Tg.Tlaa-3-1 mice can be useful for analysis of the function of gamma delta T cells. Using spleen cells from Tg.Tlaa-3-1 mice, we showed that cyclosporin A (CsA) and FK506 inhibited the in vitro proliferative response of gamma delta T cells on stimulation with anti-TCR delta mAb. The dose-dependent inhibitory effect of CsA and FK506 on proliferation of gamma delta T cells on stimulation with anti-TCR delta mAb was similar to that on proliferation of alpha beta T cells on stimulation with anti-TCF beta mAb. Inhibition by CsA and FK506 of proliferation of gamma delta T cells was not reversed by addition of rIL 2 (recombinant interleukin 2) during culture. The proliferative response of gamma delta T cells among spleen cells from TCR alpha beta-depleted Tg.Tlaa-3-1 mice was also inhibited by CsA and FK506, suggesting that the inhibition directly affected gamma delta T cells without mediation by alpha beta T cells.

Infectivity of Salmonella typhimurium isolated from the bengalee to chickens

Due to its importance in public health, the infectivity of Salmonella Typhimurium (S. Typhimurium) originating from the bengalee, a variety of Lonchura striata, was examined in 3-day-old chickens. When chickens were inoculated orally with 10(4) CFU or 10(8) CFU of S. Typhimurium isolated from the bengalee and observed for 7 days, Salmonella was found in cloacal swabs from both groups. S. Typhimurium was also recovered from the liver, spleen and cecal of all the birds, and the counts in the cecal content were approximately 10(8) CFU per gram in each bird. Focal necrosis in the liver was observed in both groups. When chickens were inoculated with 10(4) CFU of S. Typhimurium originating from the bengalee or the chicken and observed for 21 days, more birds were positive for Salmonella in the former group than the latter group during the first week. S. Typhimurium was isolated from the liver, spleen and cecal content of both groups, and the counts of the cecal content were approximately 10(8) CFU per gram. Focal necrosis in the liver was noted in both groups. The results indicate that S. Typhimurium originating from the bengalee is infective and pathogenic to chickens, and the pathogenicity is almost similar to that of Salmonella derived from the chicken.

The infeasibility of using ten-ring irradiated grafts for tracheal allotransplantation even with omentopexy

In our previous study, we demonstrated that high-dose 60Co irradiation was able to prevent rejection of canine tracheal allografts. To determine the maximum possible length of these grafts, in the present study we attempted to transplant five-ring and ten-ring tracheal allografts in two groups of five dogs each. Either five or ten rings were excised from donor tracheas and irradiated with 100,000 cGy of 60Co. The irradiated tracheal grafts were transplanted to replace either five- or ten-ring sections of the mediastinal tracheas removed from the recipient dogs. The grafts were covered with omental pedicles and no immunosuppressants were used. Graft incorporation was achieved in four of the five dogs in the five-ring groups, and three of these dogs survived for more than 700 days. However, four of the five animals in the ten-ring group died from tracheostenosis accompanied by ischemia within 3 weeks. These findings demonstrate the impossibility of performing ten-ring tracheal allotransplantation using irradiated grafts, even with omentopexy.

Ectopic ureterocele with a horseshoe kidney in an adult

A rare adult case of a left ectopic ureterocele associated with a duplex horseshoe kidney is reported. To the best of our knowledge, only one pediatric case of horseshoe kidney with an ectopic ureterocele has been reported. The present case was successfully treated by ureteropyelostomy, upper ureterectomy and unroofing of the ureterocele. The patient is currently followed with excretory urograms and renograms.

Oral sustained-release cisplatin capsule

An oral sustained-release cisplatin preparation was prepared by combining microporous water-insoluble pharmaceutical polymer, ethylcellulose, a membrane and a gel-forming polymer, poly(acrylic) acid (Carbopol). As cisplatin is an extremely hydrophilic and small compound, it was difficult to control the release rate solely by the micropores on the ethylcellulose capsule. To retain cisplatin within the capsule, gel-forming polymer was formulated inside the capsule. The release rate of cisplatin was dependent both on the number of micropores of the capsule and the formulated amount of Carbopol. The number of micropores ranged from 20 and 30 to 60, and the formulated amount of Carbopol varied from 15 to 100 mg. In-vitro release experiments suggested that the release rate decreased as the formulated amount of Carbopol increased when the pore number was 60 and 30. However, when pore number was decreased to 20, the effect of the amount of Carbopol was not clearly observed. In the in-vivo study using rabbits, the sustained-release cisplatin capsule was evaluated in comparison with solution after oral administration of 20 mg drug. With the pore number of 60, Cmax was 0.46 +/- 0.02 microgram mL-1 at 4 h and thereafter serum concentrations declined rapidly. When the pore number was 30, serum cisplatin level-time profiles showed long-acting patterns and AUC was reversely correlated with the formulated amount of Carbopol. Cmax and tmax were 0.41 +/- 0.02 microgram mL-1 and 3.33 +/- 0.88 h, respectively and 0.23 +/- 0.01 microgram mL-1 was obtained at 24 h after oral administration of capsule having 30 pores and 15 mg of Carbopol. We conclude that the possibility of developing an oral sustained-release cisplatin preparation is feasible.