Evaluation of structural change in diffuse liver disease with frequency domain analysis of ultrasound

To evaluate structural changes in diffuse liver disease, frequency domain analysis was applied to ultrasonic signals from the liver. We assumed that liver tissue is a collection of semiregularly arrayed small scatterers of ultrasound. We applied cepstral analysis to the ultrasonic waveforms and evaluated the periodicity of scalloping of the power spectrum caused by an interference effect among liver scatterers of a given spacing. Patients with liver conditions involving nonspecific change (n = 6), chronic hepatitis (n = 11), cirrhosis (n = 7) or fatty liver (n = 6) were examined. One hundred ultrasonic signals were obtained noninvasively with a 3.5-MHz transducer, and the space among scatterers was calculated for each signal using cepstrum analysis. Two statistical parameters, mode and kurtosis, were determined from the distribution of the space among scatterers for each patient; these parameters were compared with the histological findings in the liver. Space among scatterers kurtosis decreased with progress of liver fibrosis, and space among scatterers mode increased in cirrhosis. Neither space among scatterers kurtosis nor space among scatterers mode was affected by pathological fat in the liver. These results suggest that we can evaluate fibrotic changes in diffuse liver disease and that we can also noninvasively discriminate diffuse fibrotic liver disease from fatty liver.

[Evaluation of home blood pressure measurement by a correlation study between home blood pressure and ambulatory blood pressure]

To evaluate the self-measurement of blood pressure at home, a comparative study was performed among home (Home BP), ambulatory (24-hour BP) and office blood pressure in essential hypertensive patients. In all patients, Home BP was self measured by themselves twice a day for a month. 24-hour BP was measured once during the period of self-Home BP measurement. Office BP was measured twice a month. The average of Office BP (147/92 mmHg) and Home BP (145/89 mmHg) were higher than the average of 24 hour BP (131/82 mg). For systolic BP, about two weeks self-measurement of BP at home just after waking elicited a very high correlation between home and average 24-hour BP (r = 0.82), whereas for diastolic BP the r value was moderate (r = 0.61). In patients (n = 22) treated with antihypertensives, furthermore, the correlation coefficient between home and 24-hour BP for systolic BP reached 0.89, which is higher than in all patients (n = 28). The average value of BP measured just after waking at home elicited a higher correlation with the average value of 24-hour BP compared with that measured before going to bed. The results suggest that in essential hypertensive patients who are treated with antihypertensives, to measure BP just after waking for about two weeks at home could help clinicians to evaluate and predict the value of average 24-hour BP.

Pathological findings in dicephalus dipus dibrachius: implications for mechanisms in two pairs of lateral conjoined twins

The anatomical and pathological features of two pairs of dicephalic conjoined twins (case 1 and 2) are described. Both twins showed duplicitas lateralis representing diprosopus dipus dibrachius. There were two complete heads on two necks, one thorax, one abdomen and externally normal two arms and two legs. Case 1 showed dicephalus with anencephaly, two vertebral columns and two spinal cords, which converged from the thoracic region distally. The esophagus, stomachs and partial small intestines were duplicated, which fused at yolk sac (with Meckel's diverticulum). The heart was incompletely fused. The lungs and trachea were doubled. Two spinal cords were fused from the thoracic region caudally and showed myelomeningocele and Arnold-Chiari malformation in case 2. Two larynxes and two thracheas connected with the incompletely fused three lobes of lungs. The conjoined lungs were hypoplastic. The heart was single, showing ventral septal defect, transposition of great arteries, two cuspid aortic valves and preductal aortic coarctation. The duplicated esophagi were conjoined in Y-shape and single stomach, duodenum, intestine and colon were found. There were pairs of kidneys, adrenal glands and ureters and single female genitalia in both cases. These findings indicate that the craniocaudal paleoaxes were separated in the cranial region and converted or fused under the thoracic region like a Y-shape. Further development defects and deformations might be important factors to form malformations in these case.

Dendritic cells in esophageal cancer and lymph node tissues

The density of infiltrating S-100 protein-positive dendritic cells (DCs) on histological sections and that of CD1- and L-M2 positive DCs on cryostat sections of esophageal dysplastic and cancerous lesions were examined. There was no significant correlation between the number of S-100 protein-positive DCs and the degree of dysplasia, tumor of S-100 protein-positive DCs and the degree of dysplasia, tumor differentiation, depth of invasion or lymph node metastasis of esophageal cancer, but the numbers of these cells in patients after preoperative radiotherapy were significantly lower than those in patients without radiotherapy. Immunohistochemical staining of cryostat sections with anti-CD1 antibody and L-M2 revealed that poorly differentiated squamous cell carcinoma (SCC) contained significantly more DCs than well differentiated SCC. Analysis of the numbers of Langerhans cells (LCs) and interdigitating cells (IDCs) revealed that well differentiated SCC contained 32.8% LCs and 67.2% IDCs, moderately differentiated SCC contained 37.0% LCs and 63.0% IDCs, and poorly differentiated SCC contained 2.1% LCs and 97.9% IDCs, the overall proportions being 24.2% for LCs and 75.8% for IDCs. Morphometrical analysis of regional primary lymph nodes revealed that the degree of paracortical hyperplasia with cancer metastasis was significantly higher than that without cancer metastasis, and that the degree of sinus hyperplasia with cancer metastasis was significantly lower than that without. Furthermore, lymph nodes with cancer metastasis contained significantly more S-100 protein-positive IDCs than those without.(ABSTRACT TRUNCATED AT 250 WORDS)

Dendritic cells in various human thyroid diseases

The aim of this study is to determine the presence of S-100 protein-positive and CD1-positive dendritic cells (DCs) in tissues with various human thyroid diseases. Infiltrating DCs were frequently observed in papillary carcinoma and Hashimoto's disease, and these DCs were composed primarily of IDCs. The number of DCs was closely correlated with the expression of thyrocytes for S-100 protein and Ia-antigen. These findings suggest that DCs may play an important role in the immunologic defence mechanisms against papillary carcinomas and in the progression and self perpetuation of autoimmunity.

Modulation of noradrenaline release via activation of presynaptic beta-adrenoceptors in rabbits with adriamycin-induced cardiomyopathy

We investigated the role of beta-adrenoceptors at postganglionic sympathetic nerve endings in noradrenaline release in rabbits with cardiomyopathic congestive heart failure produced by adriamycin (1 mg/kg, I.V., twice a week for 8 weeks). Plasma noradrenaline levels were measured before, 30 min after, and 60 min after the start of continuous intravenous administration of adrenaline (0.06 micrograms/kg/min) in adriamycin-treated and vehicle-treated rabbits in anesthetized condition and pithed condition with electrically stimulated sympathetic outflow (3 Hz, 1 ms square wave pulse, 90 V). In both the anesthetized and pithed conditions, adrenaline increased plasma noradrenaline levels in vehicle-treated rabbits. However, in the adriamycin-treated rabbits, adrenaline had no effect on the plasma noradrenaline level. Pretreatment with propranolol (0.2 mg/kg, bolus I.V. + 0.1 mg/kg/hr, continuous infusion) almost completely abolished the rise in plasma noradrenaline associated with adrenaline infusion in vehicle-treated rabbits. These results suggest that in rabbits with adriamycin-induced cardiomyopathy, the noradrenaline release from the sympathetic nerve endings via the activation of presynaptic beta-adrenoceptors is reduced. This might be due to down-regulation of presynaptic beta-adrenoceptors caused by the elevated plasma noradrenaline due to cardiac failure. However, other possibilities such as reduced affinity or impaired signal transduction cannot be excluded.

[Definitive repair for double inlet ventricle and common atrio-ventricular valve]

From 1982 through 1990, 13 patients with double inlet ventricle and common atrio-ventricular valve underwent definitive cardiac surgery. Nine patients simultaneously had anomalous systemic venous connection and 4 had anomalous pulmonary venous connection. One patient with double inlet left ventricle underwent a successful partition of ventricle and atrio-ventricular valve. All other 12 patients underwent a Fontan operation, which utilized different techniques to deal with various forms of anomalous systemic and pulmonary venous connection. Four patients with common atrioventricular valve regurgitation underwent a Fontan operation combined with a concomitant circular annuloplasty of atrio-ventricular valve. In all 4 patients, the degree of regurgitation decreased postoperatively. There was one operative death (mortality 7.7%). Most of patients with double inlet ventricle and common atrio-ventricular valve now are considered to be suitable not for partition but for the Fontan operation. Because of the complexity of anatomic variables, however, the repair of anomalous systemic or pulmonary venous connections in conjunction with the Fontan operation requires an individualised plan in each patient to provide unobstructed systemic and pulmonary venous pathways. We think that a circular annuloplasty could effectively decrease the degree of atrio-ventricular valve regurgitation in most cases.

Presence of the entire coding region of GP IV mRNA in Nak(a)-negative platelets

It has been reported that Nak(a)-negative platelets lack GP IV. To examine the GP IV genetic defects in Nak(a)-negative platelets, we studied four unrelated Nak(a)-negative subjects by amplifying their GP IV cDNA, which were synthesized from platelet mRNA using the reverse transcriptase/polymerase chain reaction (RT/PCR). We detected the entire coding region of GP IV mRNA in the platelets of all four subjects. Restriction enzyme analysis of the amplified GP IV cDNA showed fully predictable cutting sites. These results suggest that no gross deletion or insertion had occurred in the GP IV mRNA of Nak(a)-negative platelets.

Angular webbing associated with Stevens-Johnson syndrome

Angular webbing as a result of erythema multiforme affecting the lips of an 11-year-old child is reported. The adhesions had to be excised because they obstructed mouth opening.

Interleukin-2 enhances the viability of primary cultured rat neocortical neurons

We determined the neurotrophic activity of interleukin-2 (IL-2) on primary cultured neocortical neurons from embryonic rat brain. IL-2 clearly enhanced the viability of cultured neurons in a dose-dependent manner. The neurotrophic effect of IL-2 was completely neutralized by IL-2 antibody. Furthermore, expression of IL-2 receptor mRNA was more pronounced in neurons than in other cultured cells such as astroglia and microglia. These results strongly suggest that IL-2 plays certain roles in the central nervous system as a neurotrophic factor.

[A case report of pulmonary valve blood cyst]

A six-year-old boy with pulmonary stenosis was hospitalized in order to examine the cause of pulmonary stenosis. The right-ventriculography showed a large shadow defect in the right ventricular outflow tract. But the echocardiography showed the cystic tumor, which was covered with thin wall and had echo-free space in it, in the right ventricular outflow tract. We made a diagnosis of pulmonary blood cyst. After cardiopulmonary bypass was established, the main pulmonary artery was incised longitudinally. There were two blood cysts at the left pulmonary cusp which were 1.5 x 1.5 cm and 0.7 x 0.5 cm in size. The cysts were resected and the pulmonary cusp was plicated. Histologically, the wall of the cysts was consisted thick valvular tissues. No pulmonary valve pressure gradient was detected with the echocardiography following the operation.

[Measurement of cardiac output by Doppler echocardiography: clinical validation in pediatric patients after open heart surgery]

We compared the cardiac output obtained by pulsed Doppler echocardiography (COPW) with simultaneous thermodilution measurements (COTD) in 13 children for 33 times after open heart surgery. Good correlation (r = 0.84, slope = 1.15) of cardiac output was obtained when direct measurements of aortic diameter during operation were used in the calculations. Cardiac output was overestimated (r = 0.89, slope = 1.42) when 2 DE measurements of aortic diameter were used. Nineteen measurements of 8 VSD patients revealed good correlation (r = 0.89, slope 0.85) using direct measurement of aortic diameter, whereas 14 measurements of TOF patients showed somewhat overestimation of cardiac output (r = 0.90, slope = 1.31). In serial determinations, percent change change in COPW well correlated with COTD (r = 0.75, slope = 1.08). We conclude that accurate cardiac output can be obtained by pulsed Doppler echocardiography after pediatric cardiac surgery by measuring aortic diameter directly in operation room. Accuracy in percent change in cardiac output proved that COPW is useful especially in hemodynamically unstable patients after pediatric cardiac surgery.

Surface-enhanced Raman spectroscopic detection of CO2-(3), SO2-(3), and nucleic acid bases using polyvinyl alcohol film doped with Ag fine particles

Surface-enhanced Raman scattering (SERS)-active polyvinyl alcohol films doped with Ag particles have been prepared by a counterdiffusion method. SERS spectra of CO2-(3), SO2-(3), and DNA bases have been observed by using the films. The films containing aggregated Ag particles are useful to observe SERS spectra of adsorbates. DNA bases (cytosine, uracil, thymine, guanine, and adenine) can be detected at a level of 10(-8)-10(-9) M by this method.

[Surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis]

Between 1986 and 1990, fourteen patients with univentricular atrioventricular connection and subaortic stenosis underwent surgical treatment. The patients consisted of 7 cases of double inlet left ventricle, 4 with double inlet right ventricle, 3 with tricuspid atresia. The palliative operation was performed in 6 infants ranging in age from 17 days to 6 months. Four patients with mild subaortic stenosis underwent pulmonary artery banding, in two patients this was combined with repair of coarctation of the aorta. Two patients with severe subaortic stenosis underwent the Norwood operation. There were no operative deaths. One of two patients who underwent the Fontan operation 2 years after the Norwood operation died later. The definitive operation was performed in 8 children ranging in age from 4 to 11 years. Five of these 8 patients had previous pulmonary artery banding. Five children with double inlet left ventricle underwent septation combined with enlargement of bulboventricular foramen. Postoperatively all remained in sinus rhythm and had no pressure gradient between Aorta and left ventricle. A Fontan operation combined with a Damus operation was performed in 2 children, 1 of double inlet right ventricle and 1 of tricuspid atresia. In both cases, postoperative angiogram showed no pulmonary incompetence. One patient underwent enlargement of bulboventricular foramen after a Fontan operation. All survived later. Young infants and neonates with severe subaortic stenosis can survive by the Norwood operation. Infants with mild subaortic stenosis, although can survive by pulmonary artery banding, should be closely followed for the development of subaortic stenosis. For relief of subaortic stenosis, enlargement of bulboventricular foramen may be effective in septation.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of bilateral aldosterone-producing adrenal adenomas]

A 43-year-old female was admitted to our hospital for high blood pressure control. She showed hypokalemia with increased urinary potassium excretion, high plasma aldosterone concentration (33.9ng/dl, normal range; 2-12ng/dl) and reduced plasma renin activity (trace, normal range; 0.83-5ng/ml/hr). Bilateral adrenal tumors were revealed by abdominal computed tomography, and left adrenalectomy and right partial adrenalectomy were performed. Cytochromes p-450 and other enzymes involved in aldosterone synthesis were found predominantly in the tumor portions but not in the zona glomerulosa of the attached adrenals, which histopathologically showed paradoxical hyperplasia. This was a rare case of bilateral aldosterone-producing adrenal adenomas, which we could differentiate from idiopathic hyperaldosteronism by employing immunohistochemical analysis of steroidogenic enzymes.

Clinical features of autosomal dominant retinitis pigmentosa with rhodopsin gene codon 17 mutation and retinal neovascularization in a Japanese patient

A 49-year-old Japanese man had autosomal dominant retinitis pigmentosa with a point mutation in codon 17 of the rhodopsin gene, resulting in a threonine-to-methionine change, and retinal neovascularization in both eyes. Pigmentary degeneration mainly in the inferior area of the fundus, and severe loss in the upper portion of the visual field were observed. Moderately preserved rod and cone functions were demonstrated by electroretinograms. These findings differed from those of Japanese and white patients with autosomal dominant retinitis pigmentosa with a codon 347 mutation and were almost the same as those of white patients with the codon 17 mutation. Our study indicates that phenotypic similarities exist among patients with the same mutation, but of different racial backgrounds. The neovascularization in the right eye diminished over a two-year period in conjunction with the progression of retinal degeneration.

Sulphation requirement for GlyCAM-1, an endothelial ligand for L-selectin

L-selectin participates in the initial attachment of leukocytes to the vascular endothelium. On lymphocytes, it mediates binding to high endothelial venules of lymph nodes. As a selectin it functions as a calcium-dependent lectin recognizing carbohydrate-bearing ligands on endothelial cells. Two lymph node ligands for L-selectin have been identified as sulphated glycoproteins of M(r) approximately 50K and approximately 90K, called Sgp50 and Sgp90 (ref. 10). The recently cloned Sgp50 (ref. 12), now designated GlyCAM-1, is a high endothelial venule-associated, mucin-like glycoprotein containing predominantly O-linked carbohydrate chains. Sialylation of GlyCAM-1 is necessary for its ligand activity and a role for fucosylation is suspected. We have used chlorate as a metabolic inhibitor of sulphation, and report here that GlyCAM-1 has an additional requirement for sulphate.

Enhanced production of platelet-activating factor in stimulated rat leukocytes caused by the blockade of lysophospholipid acylation

We have previously reported that triacsin C, an acyl-CoA synthetase inhibitor, enhanced the production of platelet-activating factor (PAF) in calcium ionophore-activated rat polymorphonuclear leukocytes (PMNs). In this report, we further demonstrated that the production of PAF by PMNs in response to opsonized zymosan was significantly enhanced by pretreatment with triacsin C and also by the pretreatment with merthiolate, which was reported to be an inhibitor of acyl-CoA/lysolecithin acyltransferase. Pretreatment with triacsin C or merthiolate also enhanced the lyso-PAF content in the stimulated PMNs. Addition of lyso-PAF in the incubation mixture of PMNs in the presence of opsonized zymosan augmented the production of PAF. The enhancement of PAF production by lyso-PAF has been reported by several authors, and the importance of lyso-PAF in the remodeling pathway of PAF synthesis has been generally recognized. Therefore, from the above findings, it is assumed that blockades of the reacylation of lyso-phospholipids, by inhibitors such as triacsin C and merthiolate, might lead to accumulation of lyso-PAF and might result in the enhancement of PAF production when the remodeling pathway is active.

[The effects of intrarenal infusion of recombinant human erythropoietin on renal hemodynamics and renal function in anesthesized rabbits]

To determine whether recombinant human erythropoietin (rHuEPO) has direct effect on mean arterial pressure or renal function, rHuEPO was infused intrarenally at a rate of 100 U min-1 for 30 min in anesthetized rabbits without renal failure. Intrarenal infusion of rHuEPO resulted in no change in mean arterial pressure, renal blood flow, or renal vascular resistance as compared with vehicle control. rHuEPO also produced no significant change in glomerular filtration rate, filtration fraction, or arterial hematocrit. However, urine volume, urinary excretion of sodium and potassium, and fractional sodium excretion were significantly reduced by intrarenal infusion of rHuEPO. These observations demonstrate that rHuEPO has no direct effects on mean arterial pressure or renal hemodynamics, whereas rHuEPO stimulates net tubular sodium reabsorption possibly by direct tubular action, and reduces urine volume and urinary excretion of sodium and potassium in anesthetized rabbits without renal failure.

Nucleotide sequence of the Serratia marcescens threonine operon and analysis of the threonine operon mutations which alter feedback inhibition of both aspartokinase I and homoserine dehydrogenase I

The nucleotide sequence of the Serratia marcescens threonine operon (thrA1A2BC) was determined. Three long open reading frames were identified; these open reading frames code for aspartokinase I (AKI)-homoserine dehydrogenase I (HDI), homoserine kinase, and threonine synthase, in that order. The predicted amino acid sequences of these enzymes were similar to the amino acid sequences of the corresponding enzymes in Escherichia coli. The AKI-HDI protein is apparently a tetramer composed of monomer polypeptides that are 819 amino acids long. A deletion analysis revealed that the central and C-terminal region was responsible for threonine-resistant HDI activity, a monomeric fragment extending from the N terminus to residue 306 was responsible for threonine-resistant AKI activity, and an N-terminal portion containing 468 residues was responsible for threonine-sensitive AKI activity. The thrA(1)1A(2)1 and thrA(1)5A(2)5 mutations of threonine-excreting strains HNr21 and TLr156, which result in the loss of threonine-mediated feedback inhibition of both AKI activity and HDI activity, cause single amino acid substitutions (Gly to Asp at position 330 and Ser to Phe at position 352, respectively) in the central region of the AKI-HDI protein. The thrA1+A(2)2 mutation of strain HNr59, which results in a threonine-sensitive AKI and a threonine-resistant HDI, also causes a single amino acid substitution (Ala to Thr at position 479).

[Surgical treatment of double orifice mitral valve in atrioventricular septal defect]

Ten patients with double orifice mitral valve and atrioventricular septal defect (AVSD) were examined. There were four cases with incomplete type, three with intermediate type and three with complete type AVSD. All patients with incomplete type AVSD were doing well after the mitral cleft repair, Leaving the accessory orifice untouched. Various valve repair procedures and prosthetic valve replacement were performed in the patients with intermediate and complete types of AVSD with left-sided atrioventricular valve regurgitation. There were three operative deaths, which included one patient with the intermediate type and two with the complete type. All of them were one-month old babies and were operated on emergency. Their general operative findings were hypoplasia of the common atrioventricular valve leaflets, abnormal attachment of the chorda tendineae and papillary muscle dysplasia. These findings increased the difficulty of the valve plasty to control mitral regurgitation.

A case of secondary aldosteronism similar to Bartter's syndrome with no abnormality in renal chloride reabsorption

We had a 20-year-old male patient of secondary aldosteronism similar to Bartter's syndrome, which had proved to be evident after the remission of nephrotic syndrome. In the patient, hypokalemic alkalosis and hyperreninemic hyperaldosteronemia were observed, although the blood pressure was normal. Hyperplasia of juxtaglomerular cells was observed and no abnormalities indicating either glomerulonephritis or renal artery stenosis were found; the pressor response to intravenously infused angiotensin (ang) II was markedly decreased; urinary prostaglandin (PG) E2, kallikrein and kinin excretion were elevated. The inhibition of PG synthesis with indomethacin decreased renal PG production and partially corrected both hypokalemia and pressor responsiveness to ang II. Thus, this case is considered to be a case of Bartter's syndrome. Contrary to the previously reported observations, the effective fractional chloride reabsorption rate in the renal distal tubules was normal (> 80%) and not changed by PG inhibition. Plasma atrial natriuretic peptide level was normal. An interaction between renin-angiotensin and PG systems appears to play a prior role in this case. To explain the pathophysiology, we have hypothesized an abnormal function of ang II receptor signal transduction which excessively stimulates PLA2, resulting in overproduction of PG synthesis in tissues.

[Biventricular repair with a modified Glenn shunt for the hypoplastic right ventricle]

Between 1982 and 1990, 14 patients with small right ventricle underwent biventricular repair with a modified Glenn shunt. The patients consisted of 8 cases of pulmonary atresia and intact ventricular septum, 2 with pulmonary stenosis and intact ventricular septum, 3 with tetralogy of Fallot, 1 with pulmonary atresia and straddling tricuspid valve. Nine patients had one or more prior preliminary palliative procedures. Repairs consisted of a modified Glenn shunt and closure of the intracardiac and extracardiac shunt, with right ventricular outflow reconstruction in 13, and pulmonary valvotomy in 1. In nine patients superior vena cava was not ligated. There was one operative death (7%). Preoperative RVEDV ranged from 19 to 70% of normal with a mean of 36.1% of normal. Preoperative pulmonary resistance ranged from 1.6 to 5.3 unit with a mean of 2.8 unit. Preoperative PA index ranged from 102 to 444 mm2/m2 with a mean of 234.3 mm2/m2. No patients died later. Follow-up 2 to 9 year after operation showed that 9 patients were in the New York Heart Association class I and 4 were in class II. Our experience shows that this procedure can be safely done for patients, who have hypoplastic right ventricle smaller than 40% of normal and are not candidate for Fontan procedure because of high pulmonary vascular resistance and inadequate size of pulmonary artery. In this procedure a modified Glenn shunt without ligation of SVC may effectively reduce the volume overload on the right ventricle.