Autoerythrocyte sensitization syndrome with thrombocytosis

A case of autoerythrocyte sensitization syndrome in a 59-year-old female is reported. She had several episodes of circular ecchymoses on her left thigh. Intradermal injection of autoerythrocytes reproduced a similar ecchymosis. Thrombocytosis was detected and treated with busulfan which induced a delayed improvement of the ecchymosis outbreaks over 2 years of follow-up.

Effects of verapamil on myocardial stunning in xanthine-oxidase deficient hearts: pre-treatment vs. post-ischemic treatment

The role of free radicals and the protective action of calcium antagonists have been established in myocardial stunning in canine hearts, which contain a considerable level of xanthine oxidase, a free radical producing enzyme. However, myocardial stunning in hearts which lack xanthine oxidase and its modification by calcium antagonists in vivo remain uncharacterized. The present study examined this issue using open-chest anesthetized rabbits. Myocardial stunning was induced by a 10-min coronary occlusion and reperfusion. Regional systolic thickening fraction (TF) was determined using an epicardial Doppler sensor, together with other hemodynamic parameters. In untreated control rabbits, recovery of TF from the 10 min transient ischemia was 43 +/- 3% of the baseline at 30 min after reperfusion. Administration of verapamil (200 micrograms/kg bolus plus 40 micrograms/kg/min), which was started before the onset of ischemia and continued until 20 min after reperfusion, significantly improved the recovery of TF to 74 +/- 6% (p < 0.05). A similar improvement in post-ischemic contractile function (TF = 77 +/- 10%) was observed when verapamil was injected at the same rate, but the infusion was discontinued 1 min after the coronary occlusion. Myocardial ATP depletion after the 10 min ischemia was significantly less in the verapamil-pretreated rabbits compared with untreated controls (10.1 +/- 1.0 vs. 6.2 +/- 0.7 mumol/g dry wt., p < 0.05). The difference in TF between the rabbit with and without verapamil treatment could not be explained by afterload reduction. When verapamil (100 micrograms/kg bolus plus 20 micrograms/kg/min) was given during the reperfusion period alone, TF recovery was poorer (TF = 22 +/- 8%) than the control value. Thus, it was concluded that verapamil attenuates myocardial stunning in the hearts with trace levels of xanthine oxidase, and that the beneficial effect is achieved only by pretreatment, not by post-ischemic treatment with verapamil.

Effects of thromboxane A2 synthetase inhibitor (CV-4151) on reperfused skeletal muscle in rats

To clarify the role of thromboxane A2 synthetase inhibitor (CV-4151) in the ischemia-reperfusion injury, the effect of CV-4151 was investigated in the gastrocnemius muscles of female Lewis rats. All tissues except femoral vessels were transected at the midthigh level and 4 h of ischemia was induced by vascular clamping of the femoral artery and vein, followed by 1 h of reperfusion. The sham group (n = 8) underwent the operation without ischemia-reperfusion; the control group (n = 8) with ischemia-reperfusion, and the CV-4151 group (n = 8) was pretreated with CV-4151 20 mg/kg. Skeletal muscle blood flow was measured by a hydrogen gas clearance method; the blood flow restored fully in the CV-4151 group, while it remained significantly low in the control group after 1 h of reperfusion (p < 0.05). Tissue levels of adenosine triphosphate (ATP) and creatine phosphate (PCR) were measured after 1 h of reperfusion; ATP decreased to 25% of nonischemic values in the control group. In contrast, premedication with CV-4151 significantly improved the recovery of ATP (p < 0.01). PCR showed the same tendency as ATP; CV-4151 also improved the recovery of PCR significantly (p < 0.05), but CV-4151 did not prevent the production of lipid peroxides. Serum thromboxane B2 was determined by radioimmunoassay; in the sham and the CV-4151 group the level was significantly lower than in the control group (p < 0.05). was significantly lower than in the control group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in soft tissue interposition after reduction of developmental dislocation of the hip

Changes occurring in soft tissue interposition in 111 cases of developmental dislocation of the hip (DDH) reduced by overhead traction (OHT) were assessed by arthrogram. Soft tissue interposition was classified into five types based on the shape of the limbus, and changes in tissue thickness in the acetabular floor were examined. Thickness of soft tissue interposition was in the normal range in 92 hips of 111 hips (82.9%), but in hips in which a thick pad of the soft tissue was apparent at the acetabular floor both in the dislocated and reduced positions, soft tissue did not recede in 61.5% of hips.

Adenylate cyclase activation promotes the recruitment of coronary vasodilator reserve and improves subendocardial contractility during coronary hypoperfusion

This study was designed to examine the effects of an adenylate cyclase activator, NKH477, on epicardial and endocardial contraction and coronary blood flow (CoF) in the presence or absence of ischemia and to compare it to those of adenosine. We measured coronary pressures (CoP), coronary blood flow, epicardial and endocardial wall thickening (i.e., %EPWT and %ENWT, respectively, by sonomicrometry) in 18 anesthetized dogs. The left circumflex coronary artery was perfused with arterial blood using a pressure controlled servo pump. Propranolol (0.5 mg/kg) and atropine (0.25 mg) were used to minimize the neurogenic effects. CoP decreased from 100 mm Hg to 40 mm Hg with and without drugs. At CoP of 100 mm Hg, intracoronary infusion of NKH477 (10(-8) M/kg/min) produced a two-fold increase in CoF, but there were no changes in either the %EPWT or the %ENWT. During coronary hypofusion at coronary pressures equal to 40 mm Hg, NKH477 increased CoF from 16 +/- 2 to 28 +/- 4 mL/min (p < 0.05) and improved %ENWT significantly from 6 +/- 7 to 23 +/- 7% (p < 0.05). However %EPWT was not improved by NKH477. On the other hand, the intracoronary infusion of adenosine (10 micrograms/kg/min) increased CoF from 16 +/- 5 to 21 +/- 6 mL/min (p < 0.05) at CoP of 40 mm Hg. However, this dose of adenosine failed to improve %ENWT (16 +/- 10% vs. 14 +/- 10%, n.s.). Thus, the improvement of subendocardial function by NKH477 might be related to the improvement of subendocardial perfusion which could be induced by the potentiation of endogenously released adenosine as well as the direct vasodilator effect. This contrasts with the effects of exogenously administered adenosine, which failed to improve subendocardial contractility.

[A comparison between wheel-running and ambulatory activities in young, adult and old rats based on long-term observation]

It has been considered that spontaneous motor activity (SMA) represented by wheel-running activity (WRA) or ambulatory activity (AA) is one of the most basic indicators in the behavioral-pharmacological test in small rodents. Since various differences are noticeable between WRA and AA in their characteristics or drug responses, both activities may be not considered as the same category of SMA. The main purpose of this study was to elucidate the background difference between WRA and AA in three different aged groups, based on their long-term observation. AA data obtained by Gundai type Ambulo-drinkometer were applied for comparison with WRA data obtained by Wheel-drinkometer. WRA, AA and drinking behavior all showed clear diurnal rhythms characterized by nocturnal animals under light-dark condition (LD = 12:12 h). WRA and AA, in particular the former, tended to decrease according to the aging. More than 30 days habituation was required in order to obtain stable daily WRA level in adult rats. AA of young rats was higher than the other aged rats. The present results suggest that indicators, conditions, measurement apparatus, age etc have to be considered in behavioral-pharmacological observations using WRA or AA.

Identical blood pressure levels and slower heart rates among nurses during night work and day work

To investigate the effects of shift work on circadian BP variation, ambulatory 24h BP monitoring was performed during the day shift and night shift on 17 normotensive nurses. On both shifts, BP and heart rate increased in the working phase and decreased during sleep. The mean 24h BP and heart rate were identical in the two shifts. During sleep, BP was lower and the heart rate was slower in the day shift (night sleep) perhaps because of deeper sleep than during daytime sleep associated with the night shift. During work, BP was identical but the heart rate was significantly slower during the night shift. These data suggest that the circadian BP variation is determined largely by the sleep-wakefulness cycle and that the heart rate is also influenced by the internal body clock.

Identification of human T cell leukemia virus type IIb infection in the Wayu, an aboriginal population of Colombia

Human T cell leukemia virus type II (HTLV-II) is endemic in a number of native American populations and high rates of infection have also been demonstrated in intravenous drug abusers (IVDAs). Studies of virus isolates in the latter population have shown the existence of two closely related subtypes of the virus, HTLV-IIa and HTLV-IIb. To characterize the viruses present in native Americans, we analyzed by nucleotide sequence analysis the proviruses from the Wayu, an aboriginal population residing in Colombia, South America. The results showed HTLV-IIb infection in this population, and also demonstrated remarkable conservation of sequence when compared to the proviruses in IVDAs.

Mixed type of total anomalous pulmonary venous connection with hemi-pulmonary vein atresia

This reports a successfully corrected case of an 8-day-old baby who had a rare mixed type of total anomalous pulmonary venous connection in which the left pulmonary vein connected to the portal vein and the right one was atretic as demonstrated by pulmonary artery wedge angiography. The left common pulmonary vein and right pulmonary veins were anastomosed to the left atrium, separately. The patient tolerated the operation and has been well. Early total repair after accurate diagnosis was successful for this rare combination of anomalous pulmonary venous connection.

[Cerebrospinal fluid fistula following an operation of mediastinal schwannoma: a case report]

A 33-year-old man was operated for the mediastinal schwannoma. During the operation, the 9 th intercostal nerve was avulsed and revealed liquorrhea. Lyodura and fibrin glue was applied for sealing the site of dural defect. But post-operative course was not successful. So, we used the external cerebrospinal fluid drainage system. After this procedure, thoracic fluid from the chest tube was reduced and we could remove the chest tube in the 20th post operative day. This case indicates that in case of thoracotomy, it is difficult to expect easy closure of cerebrospinal fluid fistula under conservative therapy. Therefore it was considered that specific repair during the operation and spinal drainage in the post-operative early phase should be performed.

[Response to exercise in patients after repair of tetralogy of Fallot]

Cardiac catheterization and submaximal exercise testing was performed in 38 patients after repair of tetralogy of Fallot (TF), and compared to 6 control patients who had functional murmurs. Cardiac index, heart rate, and stroke volume index were significantly lower in the TF group than in the control group. Right and left ventricular end-diastolic pressure increased significantly during exercise, which was not found in the control group. Total pulmonary vascular resistance (TPVR), which decreased significantly with exercise in the control group, did not change remarkably during exercise. TPVR was significantly higher in the TF group than in the control group both at rest and during exercise. Several factors were compared between patients with good cardiac index (> 5.0 l/min/m2; Group 1) and poor cardiac index (< 5.0 l/min/m2; Group 2) during exercise. Stroke volume index, right ventricular ejection fraction at rest were significantly higher in Group 1 than Group 2. TPVR, right and left ventricular end-diastolic and end-systolic volume index were significantly lower in Group 1 than in Group 2. There was no significant difference in heart rate, left ventricular ejection fraction, residual pulmonary stenosis, right to left ventricular systolic pressure ratio, and severity of pulmonary regurgitation between two groups. These findings indicate that abnormalities of exercise tolerance in patients after repair of TF were related to poor response of heart rate, pulmonary vascular resistance, and systolic and diastolic ventricular function.

[Clinical observations on bladder cancer--difference in clinical features with age]

Three hundred and ninety-four patients with transitional cell carcinoma of the bladder who initially visited Yokohama City University Hospital were reviewed according to age group. The patients were divided into four groups, group A (less than 49 years old), group B (from 50 to 64 years old), group C (from 65 to 79 years old) and group D (more than 80 years old). The clinical characteristics as follows were obtained by statistical analysis compared with these four groups. No statistical significance was obtained about frequency of macroscopic hematuria as chief complaint. However, the younger age groups (A and B) tended to visit hospital later after the first symptom of hematuria. The older age groups (C and D) had multiple and large tumor at the first cystoscopic examination. The older age groups (C and D) had high stage and high grade tumor at the first roentgenological examination and transurethral biopsy or resection. The 5-year recurrence free rate after transurethral resection of bladder tumor (TUR-BT) of the older age group (D group) was lower than that of the other groups. The 5-year survival rate of older age group was lower than that of the younger age group. However, no statistical significance between the age groups existed concerning high grade or high stage tumor and survival after total cystectomy. We clarified here that the clinical features of elderly patients who have bladder cancer were significantly different from those of younger patients. Otherwise the prognosis of patients who have high grade and/or high stage bladder cancer were demonstrated to be poor regardless of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of human mast cells from their progenitors

Two types of human mast cells, which are morphologically similar to skin mast cells and lung mast cells, respectively, can be developed from pluripotent stem cells under different culture conditions. The major growth factor for mast-cell development is c-kit ligand, which induces mastocytosis in vivo. However, this cytokine is not sufficient for full maturation of the cells.

Results of pulmonary resection of metastatic colorectal cancer and its application

A resection of pulmonary metastases from colorectal cancer was performed in 27 patients. The cumulative 5-year survival after thoracotomy was 41.1%. Patients with either one or two metastases had a significantly better survival, with a 5-year survival of 54.3%, than did those with a greater degree of metastases (p < 0.01). Other factors including the disease-free interval, size of metastases, type of pulmonary resection, and stage of primary cancer had no apparent influence on post-thoracotomy survival. Furthermore, the presence of controlled hepatic metastases had no adverse effect on survival and did not seem to contraindicate pulmonary resection. The lung and primary colorectal region were the major sites of recurrence. Therefore, the primary colorectal site should be explored thoroughly and the number of metastases should be carefully considered when pulmonary resection is considered for metastatic colorectal cancer.

Reduction of regional contractile function by preconditioning ischemia does not play a permissive role in the infarct size-limitation by the preconditioning

Although previous studies have shown that preconditioning cannot be explained by concurrent myocardial stunning alone, it remains unclear whether reduction of contractile function by preconditioning ischemia is required for its cardioprotective effect. The present study examined whether preconditioning occurs in the absence of regional contractile dysfunction. In the first series of experiments, rabbits received two cycles of 2-min coronary occlusion separated by 5-min reperfusion, with or without dobutamine infusion (10 micrograms/kg/min, i.v.) commencing before the onset of ischemia. Regional thickening fraction measured by epicardial Doppler sensor was 72.8 +/- 4.7% of baseline (mean +/- SEM) in the untreated group and 102.9 +/- 3.1% in the dobutamine group at the end of the second cycle of ischemia/reperfusion. In the second series of the study, four groups of rabbits underwent 30-min coronary occlusion and reperfusion. The control group was untreated, and the PC group was preconditioned with two cycles of 2-min ischemia/5-min reperfusion before the 30-min ischemia. The PC-DOB group received both preconditioning and dobutamine infusion (10 micrograms/kg/min, i.v.), which was started 5 min before the preconditioning and continued for 19 min. The DOB group was given dobutamine infusion like the PC-DOB group, but was not preconditioned. After 72-h reperfusion, infarct size and area at risk were determined by histology and fluorescent particles, respectively. Infarct sizes in the PC and PC-DOB groups (25.0 +/- 3.4% and 22.7 +/- 3.3% of area at risk, respectively) were significantly smaller than that in the control group (48.2 +/- 2.6%). In the DOB groups, infarct size (43.5 +/- 4.0%) was similar to the control value. Infusion of dobutamine at a dose sufficient to abolish the contractile dysfunction which would have been induced by ischemic preconditioning did not attenuate the infarct size-limiting effect of preconditioning. Thus, it is unlikely that reduction of contractile function plays a permissive role in the appearance of the cardioprotective effect of preconditioning.

Hypoglycemic activity of polygonati rhizoma in normal and diabetic mice

The hypoglycemic effect of different dose of Polygonati Rhizoma, i.e., "Ousei", was investigated in both normal and streptozotocin-induced diabetic mice. The methanol extract of Polygonati Rhizoma (OM) (800 mg/kg) reduced the blood glucose of normal mice from 202 +/- 7 to 144 +/- 13 mg/100 ml 4 h after intraperitoneal administration (p < 0.01), and also lowered significantly the blood glucose of streptozotocin-induced diabetic mice from 589 +/- 34 to 396 +/- 15 mg/100 ml under similar conditions (p < 0.001). However, the hypoglycemic effects were not accompanied by any alteration in the serum insulin in these mice. OM also suppressed epinephrine-induced hyperglycemia in mice. These results support, therefore, the use of Polygonati Rhizoma in patients with diabetes and confirm its role as a traditional medicine. In addition, one of the active components of OM was identified as a spirostanol glycoside (PO-2).

Tendon insertions onto allografts pretreated with heat and/or bone surface demineralization

Tendon insertions onto allogeneic bone grafts were studied histologically and biomechanically in 132 rats. Before grafting, allogeneic bone was treated at different temperatures or partially demineralized or both. Mesenchymal cell and fibrous tissue invasion were easily recognized in non-heat-treated allograft groups and in groups with allografts incubated at 70 degrees; invasion was not observed in autoclaved (130 degrees) allograft groups. New bone formations were found between the tendon and the surface-demineralized allografts in the non-heat-treated and 70 degrees-treated bone groups but not in the autoclaved group. Allografts pretreated with heat demonstrated graft-insertion tensile strengths lower than in non-heat-treated and 70 degrees-treated allografts. Surface-demineralization enhanced graft-insertion tensile strengths in the non-heat-treated and 70 degrees-treated groups, whereas the tensile strength of attachments in noninductive, autoclaved allografts was not enhanced.

Latent menstrual cycle in pre-menarcheal monozygotic twins

The distribution of menarcheal interval-length between cotwins in 67 pairs of female identical twins in Tokyo was found to cluster at fairly constant intervals. When delayed in one twin, the menarche occurred in the second twin at intervals of approximately 28 days after that of the earlier twin. This finding suggests the existence of a latent lunar or menstrual cycle in pre-menarcheal girls, evidence for which was detected by recording the menarcheal intervals between MZ cotwins in days.

A missense mutation in the cholesteryl ester transfer protein gene with possible dominant effects on plasma high density lipoproteins

Plasma HDL are a negative risk factor for atherosclerosis. Cholesteryl ester transfer protein (CETP; 476 amino acids) transfers cholesteryl ester from HDL to other lipoproteins. Subjects with homozygous CETP deficiency caused by a gene splicing defect have markedly elevated HDL; however, heterozygotes have only mild increases in HDL. We describe two probands with a CETP missense mutation (442 D:G). Although heterozygous, they have threefold increases in HDL concentration and markedly decreased plasma CETP mass and activity, suggesting that the mutation has dominant effects on CETP and HDL in vivo. Cellular expression of mutant cDNA results in secretion of only 30% of wild type CETP activity. Moreover, coexpression of wild type and mutant cDNAs leads to inhibition of wild type secretion and activity. The dominant effects of the CETP missense mutation during cellular expression probably explains why the probands have markedly increased HDL in the heterozygous state, and suggests that the active molecular species of CETP may be multimeric.

MR imaging of musculoskeletal sarcomas: the clinical significance of peritumoral low signal intensity lines in planning surgical margins

The authors studied 33 musculoskeletal sarcomas, comparing preoperative MRIs with postoperative pathological evaluations based on JOA criteria. Fifty-one sites were investigated to determine the clinical significance of a low signal intensity line (LSL) on the outer margin of the tumor image. LSLs at different sites were counted as individual cases, since they sometimes showed different characteristics at different sites. An LSL showing a consistent width and no change on either of two time-weighted images (T1-W or T2-W) was evaluated as a strong LSL, and was thought to represent a barrier preventing tumor penetration. In cases showing a strong LSL, resection beyond the line can provide a safety margin, even if defind as a marginal procedure according to the JOA criteria. In cases showing only a faint LSL, a high rate of tumor cell presence was observed external to the line; in such cases the surgical plan must be focused on the attainment of a curative margin.

An analysis of sit-to-stand movements

We analyzed the movements involved in rising from a knee-high chair in 12 healthy men weighing within +/- 10% of standard body weight. A regular series of transition points was observed in the angles of the hip, knee, and ankle joints throughout the sit-to-stand movement, which was classified into six stages. As the duration of sit-to-stand movements increased, the duration of Stage 2 decreased, whereas Stage 3 grew longer. The durations of stages 4 and 5 remained constant. We also calculated the minimum unilateral hip and knee extension torque per weight in kilograms required for natural sit-to-stand movements, or N-Stand (1.7-2.3 seconds), and found that minimum hip extension torque was 0.7Nm and minimum knee extension torque was 0.9Nm. The minimum hip and knee extension torque required for N-Stand corresponds to a mean 27% and 30%, respectively, of the actual maximum hip and knee extension torque.

[Multi-center cooperative phase II study of combined infusion of PJ-203 (degradable starch microspheres) into hepatic artery in metastatic liver cancer]

In the present multi-center cooperative phase II study, in which 16 institutions participated, PJ-203 and mitomycin C were concomitantly infused into the hepatic artery of patients with metastatic liver cancer and the tumor response and safety of the combined therapy were examined. Of 81 patients treated with PJ-203, 52 patients were complete cases in which bidimensionally measurable lesions could be assessed for anticancer effect in accordance with the Direct Evaluation Criteria of Chemotherapy. The number of treatments given to the complete cases until the assessment of therapeutic effect ranged from 1 to 11 times, with the mean of 3.1 times. The overall response rate was 48.1% (25/52). The response rate for each primary lesion was 68.8% (11/16) for stomach cancer, 40.7% (11/27) for colorectal cancer and 33.3% (3/9) for other types of cancer including the gallbladder. The 25 patients with CR or PR, a 50% decrease in tumor size was confirmed after the treatment ranged from 1 to 5 times, with the treatment periods of 2 to 3 weeks. Adverse reactions were found in 56 (69.1%) out of 81 patients assessed for safety. Relatively frequent symptoms were pain in 49.4% (40/81), nausea and vomiting in 33.3% (27/81), fever in 30.9% (25/81) and anorexia in 6.2% (5/81). Principal abnormal laboratory values included a transient elevation of GOT (26.3%), GPT (22.5%), LDH (12.7%) and Al-p (8.8%). Blockade of blood flow could be observed by angiography when the amount of PJ-203 infused was in the range from 180 to 900 mg as degradable starch microspheres. The blood flow blockade could be observed most frequently at the amount of 600 mg (37.7%). The period attaining over 50% of tumor response in 25 complete cases was 42 days as a median. After the treatment was initiated in 81 patients, 50% survival duration and one-year survival rate averaged 277 days and 35.7%, respectively. The corresponding figures for each primary cancer were 419 days and 51.0% for patients with liver cancer metastasized from colorectal cancer, against 239 days and 11.8% for those with liver cancer metastasized from stomach cancer.

[Reconstruction of the pulmonary outflow tract without prosthetic conduit for correction of tetralogy of Fallot with pulmonary atresia]

We reconstructed right ventricular outflow tract without prosthetic conduit for 2 year 11 month and 59 day old Tetralogy of Fallot with pulmonary atresia patients. Left appendage anastomosed between pulmonary trunk and right ventricle was utilized as the posterior wall of the tract. Pericardial patch covered the tract the beneficial methods for patients with Tetralogy of Fallot with pulmonary atresia to avoid late postoperative deleterious complications of prosthetic conduit.