Indications and problems of coronary artery bypass grafting without cardiopulmonary bypass

As an alternative method of myocardial protection and to obviate the inherent risks of cardiopulmonary bypass (CPB), we have been performing coronary artery bypass grafting (CABG) without CPB in carefully selected patients. Since the first such operation was successfully performed in January 1995 on a patient with angina pectoris and lung cancer, four other patients have subsequently undergone this technique. This series of 5 patients, being 1 man and 4 women ranging in age from 68 to 80 years, is presented in this report. The reasons for the selection of this procedure were concomitant diseases including lung cancer, a calcified aorta, and myocardial infarction. The mean time of ischemia for each anastomosis was 15.3 +/- 5.3 min, and the maximum cardiac muscle creatine phosphokinase (CPK-MB) was less than 14 unit/l postoperatively. None of the patients required ventilatory support for longer than 24 h postoperatively, and oral intake was started within 24 h after extubation in all patients. Postoperative angiography confirmed graft patency and none of the patients developed any ischemic symptoms. All the patients were discharged between 1 and 2 months postoperatively. Thus, the off-pump technique is useful when concomitant diseases are present and will become an alternative method of treatment for coronary artery disease in selected patients.

Trial of electrolyzed strong acid aqueous solution lavage in the treatment of peritonitis and intraperitoneal abscess

Electrolyzed strong acid aqueous solution is acidic water that contains active oxygen and active chlorine and possesses a redox potential. We performed peritoneal and abscess lavages with an electrolyzed strong acid aqueous solution to treat 7 patients with peritonitis and intraperitoneal abscesses, who were seen in our department between December 1994 and April 1995. The underlying disease was duodenal ulcer perforation in 4 of these 7 patients and gastric ulcer perforation, acute enteritis, and intraperitoneal perforation of pyometrium in 1 patient each. Irrigation was performed twice a day. Microbiological studies of the paracentesis fluid were negative in 3 cases, and the irrigation period was 2-4 days. Anaerobic bacteria were isolated in 3 of the 4 positive cases (Bacteroides in 2, Prevotella in 1), and a fungus (Candida) was isolated in the remaining patient. The period of irrigation in these patients ranged from 9 to 12 days, but conversion to a microorganism negative state was observed in 3-7 days.

[The prion diseases]

Prions (proteinaceous infectious particles) are responsible to subacute spongiform encephalopathies (SSE) in man and animals. Recent outbreak of bovine SSE (BSE), or mad cow disease in UK provoked concerns on its possible human hazards. A statement of the British Government in March 1996 upset the world, which was based on 10 cases of "new variant" form of Creutzfeldt-Jakob disease (CJD). Prion diseases in animals are often epizootic and may be spread to different species through various routes including ingestion of contaminated meats. It is possible that mad cow disease causes a CJD-like malady in man through a dietary route. human SSE include; 1) Classical CJD, which represents over 95% of the cases with SSE, dispersely sporadic in occurrence in 1 per million a year, with monotonously rising incidence rates with age, of which the origin of the prion is totally unknown. 2) Gerstmann-Sträussler-Scheinker's disease which is inherited dominantly due to various genetic variants of the prion. 3) Transmitted cases of CJD occurring due to the prion introduced through contaminated objects either directly to the brain or its coverings, or indirectly to the brain through peripheral organs. 4) Kuru occurring among the Fore people in Papua New Guinea, probably due to the prion spread by a dietary route in cannibalism. New variant CJD (vCJD) now totals 14 cases all observed in UK and is different from all of four, is encountered in a dispersely sporadic manner, is far younger at onset than classical cases, showing kuru-plaques. Prions from vCJD have physical-chemical properties similar to those from BSE. Countermeasures in Japan against human hazards of BSE include, 1) agent controls by means of quarantine, and 2) host controls. So far no vCJD-like case is observed in Japan. An emergent surveillance for CJD was introduced by the Ministry of Health and Welfare in July 1996. It obtained a total of 2,637 answers from 4,027 departments of neurology, psychiatry, etc throughout the country and identified 766 cases including 51 familial cases, but no case with vCJD.

Osmoregulation of plasma vasopressin in three cases with adrenal insufficiency of diverse etiologies

Neurohypophyseal function was studied by hypertonic saline infusion with plasma vasopressin measurement in 3 patients with adrenal insufficiency before and after cortisol replacement. Although each patient had different causes of adrenal insufficiency, all showed impaired water excretion before replacement. The first patient with isolated adrenocorticotropin deficiency had marked hyponatremia and inappropriate vasopressin secretion which was normalized after replacement, indicating vasopressin hypersecretion during hypoadrenocorticism. The second patient had combined anterior and posterior pituitary deficiency due to postpartum hypopituitarism and showed completely absent vasopressin secretion, with her polyuria being masked before cortisol replacement, suggesting a vasopressin-independent intrarenal mechanism of antidiuresis. The third patient with panhypopituitarism due to a pituitary tumor also had preexisting diabetes insipidus with defective vasopressin secretion. In this case, however, plasma vasopressin was found to be elevated when adrenal insufficiency and hyponatremia subsequently developed. Together, these results indicate that vasopressin hypersecretion does occur during adrenal insufficiency, but that the accompanying urinary diluting defect may be attributable either to vasopressin-dependent or to vasopressin-independent mechanisms.

The effects of 20 days bed rest on serum lipids and lipoprotein concentrations in healthy young subjects

The effects of 20 days bed rest (BR) on serum lipids and lipoprotein concentrations were investigated in 23 healthy young subjects (13 males and 10 females, aged 19 to 25 yr.). After 20 days BR, VO2max was reduced in both genders, but body composition did not change. The ratio of glucose area to insulin area during an oral glucose tolerance test decreased gradually throughout BR, which suggested a decrease in insulin sensitivity. Estimated changes in plasma volume from the beginning of BR were largest at day 3 of BR (-9.1% in females and -3.4% in males) and seemed to return the initial level at the end of BR in both genders. The increase in serum triglycerides and the decrease in high density lipoprotein (HDL) cholesterol, and apolipoprotein AI were observed in both genders during BR. In a smaller study of 4 males and 5 females, 20 days BR was associated with a decrease in HDL, cholesterol, a decrease in apolipoprotein AI and apolipoprotein AII, decrease in a plasma postheparin lipoprotein lipase activity and an increase in very low density lipoprotein triglyceride. Overall, the data suggested that the decrease in lipoprotein lipase activity and insulin sensitivity may contribute to the impairment in HDL metabolism.

Invasive thymoma with endobronchial polypoid growth

A rare case of invasive thymoma with endobronchial polypoid growth is presented. A 68-year-old woman presented with coughing and sputum. The chest X-ray and computed tomography (CT) findings demonstrated a large mass with a calcified lesion in the left hilar region. A bronchoscopic examination showed a polypoid tumor in the left B3b bronchus. The tumor was surgically resected and revealed a unique polypoid endobronchial extension. This tumor was pathologically diagnosed to be invasive thymoma.

High frequency of p53 protein expression in thymic carcinoma but not in thymoma

Thymic epithelial tumours are broadly classified into thymomas and thymic carcinomas. Although both tumours occasionally show invasive growth, they exhibit different clinical and biological findings. The oncogene and anti-oncogene in thymic epithelial tumours have not been evaluated fully. We investigated the expression of p53 protein by immunohistochemical analysis using the anti-p53 polyclonal antibody (CM-1) in 17 thymomas and 19 thymic carcinomas. We also examined p53 gene (exon 5-8) mutation in 18 thymic carcinomas by using polymerase chain reaction-single-strand conformation polymorphism methods and direct sequencing. Of the thymoma cases, only one invasive thymoma showed focal nuclear staining. Fourteen of the 19 thymic carcinomas (74%) showed nuclear staining. Point mutations of the p53 gene were recognized in only 2 of the 18 thymic carcinomas (11%). One was the mutation C to T transition in the first letter of codon 222 in exon 6, which results in the amino acid substitution from proline to serine. Another was a silent mutation. p53 protein accumulation is highly frequent in thymic carcinomas but not in thymomas, and gene mutation is uncommon in thymic carcinomas.

The cessation of fluoridated water administration and the fluoride distribution profiles in rat molar cementum

The aim of this work was to obtain further information about the origin of fluoride profiles in cementum. Fluoride was administered to rats at varying doses (0.50, 100 ppm F in drinking water) and for different durations (4, 13 and 25 weeks). Fluoride distribution across the full thickness of molar cementum in rats was measured by means of an abrasive micro-sampling technique. The average fluoride concentrations in cementum increased significantly with increasing dose and duration of fluoride administration. The relative reduction of the average fluoride concentrations after cessation of fluoride administration was 94.2-36.5% at 50 ppm F and 62.2-49.2% at 100 ppm F in the outer layers (1-60 microns) and 91.5-24.1% at 50 ppm F and 74.1-7.6% at 100 ppm F in the middle (61-120 microns) layers of the cementum, respectively. The reduction rates were more closely related to the time intervals following cessation rather than fluoride concentrations in drinking water or specificity within the cementum. Two factors which may influence this are new cementum formation after withdrawal of fluoride and some fluoride release from cementum surfaces when the fluoride supply stopped. It was concluded that the cessation of fluoride administration reduced the fluoride concentration on the outer layers of cementum differing from bone where reduction occurs across the entire thickness.

Comparative studies of CAM 123-6 and carcinoembryonic antigen for the serological detection of pulmonary adenocarcinoma

Carcinoembryonic antigen (CEA) has been clinically used as a serum marker for lung cancer, especially for pulmonary adenocarcinoma. Since we had developed a tumor marker against pulmonary adenocarcinoma, CAM 123-6 belonging to KL-6 MUC 1 mucin, we compared its clinical value with that of CEA, in combination with squamous cell carcinoma-related antigen (SCC) and neuron-specific enolase (NSE). The subjects were 30 patients with adenocarcinoma, 23 with squamous cell carcinoma, 16 with small cell carcinoma, and 20 with benign lung disease. For discriminating lung cancer from benign lung disease, the combination of CAM 123-6, SCC, and NSE showed 64% diagnostic accuracy, and the combination of CEA, SCC, and NSE 65%. In differentiating pulmonary adenocarcinoma from other lung cancer, the diagnostic accuracy of CAM 123-6 was 81% and that of CEA was 74%, although there was no significant difference between them. These observations indicate that the diagnostic accuracy of CAM 123-6 is similar to that of CEA. Neither marker is sufficiently specific to differentiate pulmonary adenocarcinoma from other forms of lung cancer.

Tomographic distribution of acetylated histone H4 in plant chromosomes, nuclei and nucleoli

Root tip cells of broad bean (Vicia faba L. cv. 'Wase soramame') and barley (Hordeum vulgare L. cv. 'Minorimugi') were immunostained with antibodies specific for acetylated histone H4. With an antiserum that recognizes histone H4 acetylated at lysine-5, the nucleolar organizing region (NOR) in mitotic chromosomes was strongly labeled in both species. The broad bean had two signals in the metaphase and telophase chromosome complements and four signals in the prophase and anaphase chromosome complements, while the barley had four signals in the metaphase and telophase chromosome complements and eight signals in the prophase and anaphase complements. Five different patterns of signals were observed at interphase: in type I only nucleoli were wholly stained; in type II perinucleolar knob-like signals and/or fiber-like signals emanated from the nucleus; in type III aggregate signals appeared in the nucleolus; in type IV many small dot-like signals were distributed throughout the nucleus, except nucleoli; and in type V string-like or some granule-like signals appeared in the nucleoli. Type II was very similar to previous results by in situ hybridization with sense rDNA probes. Type III was similar to the patterns of DNA synthesis recognized as chromatin domains by anti-BrdU antibodies. Type V was very similar to the results of in situ hybridization with pTa71, rDNA probes and the appearance of the dense fibrillar components of the nucleolus.

Analysis of (-)-epigallocatechin gallate in human serum obtained after ingesting green tea

A method for analyzing the EGCg concentration in human serum was developed by using high-performance liquid chromatography with electrochemical detection. EGCg was detected in human serum after the ingestion of 5 g of green tea powder (matsu-cha) dissolved in 200 ml of hot water. The concentration of EGCg in the serum reached the highest level about 2 h after ingesting the green tea, and then decreased.

Near-death asthmatic reaction induced by disodium cromoglycate

A near-death asthmatic reaction was induced by disodium cromoglycate (DSCG) as evidenced by positive skin and inhalation provocation tests. The patient's history revealed an episode of exacerbation by inhalation of DSCG. In spite of such an experience, he inhaled DSCG for relief of asthmatic attack, resulting in near-death exacerbation. This patient emphasizes the need to re-recognize that DSCG is not a reliever and the DSCG could cause fatal asthma.

[Surgical treatment of aortic stenosis with polycythemia vera: a case report]

We report a case of 67-year-old woman with severe aortic stenosis complicated by polycythemia vera (PV). She has been treated for PV with busulfan over the past three years. On admission, she had increase in white blood cell, red blood cell and platelet count. The pressure gradient between left ventricle and aorta was 170 mmHg. Aortic valve was bicuspid and replaced with a 21 mm Carpentier-Edwards pericardial xenoprosthesis. Ascending aorta with a diameter 6.0 cm was replaced simultaneously with a 30 mm Dacron graft (Hemashield). Post-CPB course was uneventful except for a tendency to the prolongation of activated clotting time. She was discharged from the hospital in good condition.

Can Paneth cell metaplasia in cecum indicate the presence of colorectal epithelial neoplasia?

The main purpose of the present study was to investigate the relationship between the incidence of Paneth cells in cecal mucosa and the incidence of colorectal epithelial neoplasias. Using endoscopic biopsy specimens, obtained from cecum of 375 subjects in cases of total colonoscopy, we examined the incidence of Paneth cells in the cecal mucosa. In the present study, Paneth cells were present in the human cecal mucosa (47.7%, 179/375 subjects) regardless of age. Paneth cells were found more frequently in the subjects with colorectal epithelial neoplasia (57.3%, 90/157 subjects) than in the subjects without colorectal epithelial neoplasia (40.8%, 89/218 subjects) (p<0.01, chi(2) test). Our results suggest that the incidence of Paneth cells in cecal mucosa indicate some changes in the environment with tumorigenesis of the colorectal region according to the function of Paneth cells, proposed by other investigators.

[A case of coronary artery bypass grafting using patch mounted graft technique for aortitis syndrome with left coronary ostial stenosis]

Coronary artery bypass grafting (CABG) was performed on a 36-year-old female for treatment of aortitis syndrome with left coronary ostial stenosis. The left anterior descending artery was anastomosed with the left internal thoracic artery. The circumflex artery was anastomosed with the saphenous vein. In the proximal anastomosis, the ascending aorta was sutured with a gelatin sealed knitted Dacron graft patch and anastomosed with the saphenous vein to prevent late occlusion due to intimal proliferation. Graft angiography 40 days and one year after the operation showed good patency of both grafts. Patch mounted graft technique seemed to be suitable for CABG in aortitis patients with the high incidence of late occlusion.

ST reelevation at reperfusion is associated with the occurrence of late potentials in patients with acute anterior infarction

The relationship between ST reelevation at reperfusion and the occurrence of late potentials (LPS) in 35 patients with a first anterior infarction who had single vessel disease was investigated. All patients underwent a successful primary angioplasty and had a patent infarct related artery confirmed angiographically 4 weeks later. Patients were classified into groups based on changes in the ST level at reperfusion: patients with ST reelevation (group A, n = 22) and patients without ST reelevation (group B, n = 13). Signal-averaged ECG was performed 4 weeks after primary angioplasty to detect LPS. Cineventriculography was performed to measure left ventricular ejection fraction (LVEF) and evaluate regional wall motion of the infarct area (SD/chords). LPS were present in eight of the 22 group A patients (36%) and in none of the 13 group B patients (P < 0.05). Left ventricular function was impaired in patients in group A compared with patients in group B (LVEF: 5 1 +/- 12 vs 63 +/- 10, P < 0.01; SD/chords: -2.7 +/- 0.9 vs -1.9 +/- 1.1, P < 0.05). These data suggest that ST reelevation and myocardial damage at reperfusion are associated with the occurrence of LPS in patients with successfully recanalized infarct related arteries after acute anterior infarction.

Inhibitory effect of a novel orally active GP IIb/IIIa inhibitor, SC-54684A on intimal thickening in the guinea pig femoral artery

The inhibitory effect of a novel orally active platelet membrane glycoprotein receptor complex IIb/IIIa (GP IIb/IIIa) inhibitor, SC-54684A is studied on intimal thickening in the guinea pig femoral artery. A segment of the femoral artery was occluded by a platelet-rich thrombus induced by photochemical reaction between systemically administered Rose Bengal and transluminal green light which causes endothelial injury followed by platelet adhesion and aggregation at the site of photochemical reaction. Three weeks after successful thrombolysis by tissue-type plasminogen activator, intimal thickening occurred at the irradiated site. SC-54684A (30 mg/kg), administered 2 h before photochemical reaction, significantly (P < 0.05) prolonged the time to occlusion of the femoral artery; in this respect aspirin (100 mg/kg) was ineffective. A combination of SC-54684A and recombinant tissue-type plasminogen activator (rt-PA) increased the frequency of reopening and significantly (P < 0.05) prolonged the duration of reflow compared with rt-PA alone. Further, SC-54684A administered orally twice a day for 3 weeks significantly (P < 0.05) inhibited intimal thickening but aspirin, administered orally once a day for 3 weeks, was ineffective. Scanning electron microscopy revealed extensive platelet adhesion and aggregation on the denuded vessel walls in the untreated group 24 h after successful thrombolysis. In separate experiments, SC-54684A markedly inhibited platelet aggregation ex-vivo. Inhibition of platelet adhesion and aggregation at the site of endothelial injury by SC-54684A (via GPIIb/IIIa inhibition) may account for its inhibitory effect on intimal thickening.

Von Hippel-Lindau tumour suppressor gene. Localization of expression by in situ hybridization

Inactivation of the von Hippel-Lindau (VHL) tumour suppressor gene is responsible not only for VHL disease, but also for sporadic renal cell carcinoma and cerebellar haemangioblastoma. The distribution of VHL gene expression in the mouse embryo was recently studied by in situ hybridization, along with human VHL in 14-week-old fetal kidney: there was widely distributed expression in the former and expression in the tubules and blastema in the latter. Adult human tissue and other fetal organs were not examined. The present paper describes an in situ hybridization study to assess the function of the VHL gene in adult human tissues and in tissues of human fetus at 28 weeks of gestation. The expression of the VHL gene was limited to the adult and fetal brain and kidney, and the adult prostate. Nerve cells in adult and fetal brain were positive, including the cerebellar Purkinje cells. In adult and fetal kidney, the proximal tubular epithelium, the putative origin of the common type of renal cell carcinoma, showed intense signal, whereas the distal nephron, glomeruli, and nephrogenic blastema showed no significant signal. The prostate showed significant signal in the basal epithelium. The adrenal, pancreas, and epidydimis showed no significant signal, in spite of the frequent occurrence at these sites of neoplastic or hamartomatous lesions in VHL disease.

Quinazoline derivatives suppress nitric oxide production by macrophages through inhibition of NOS II gene expression

We have found three novel quinazolidine derivatives which inhibit the formation of nitrite dose-dependently in a murine macrophage cell line, RAW264.7. The decreased nitrite formation was due not to the inhibition of nitric oxide synthase activity but to suppression of NOS II mRNA and protein expression. In rat vascular smooth muscle cells (VSMC), however, these compounds rather enhanced NOS II mRNA. These compounds also prevented LPS-stimulated heme oxygenase-1 (HO-1) and cyclooxygenase-2 (COX-2) gene expression in RAW264.7 cells, but again not in VSMC. The three quinazolidine derivatives specifically inhibit gene expression of NOS II, HO-1 and COX-2 only in macrophage cells, indicating that they are selective inhibitors of inducible gene expression in macrophages.

[Two cases of total arch replacement after coronary artery bypass surgery with internal mammary artery graft]

We report two successful cases of total arch replacement after coronary artery bypass surgery (CABG) using internal mammary artery graft (ITA). Case 1 had a true aneurysm of the distal aortic arch occurring 7 years after CABG using left ITA, and case 2 had a dissecting aneurysm of DeBakey II occurring 10 months after CABG using right ITA. This patient was also complicated by a preexisting true aneurysm of the proximal descending aorta. Both cases were managed by repeat midsternal incision, selective cerebral perfusion (SCP) and retrograde cardioplegia. In both cases, functioning ITAs were dissected out easily without injury, and an operative filed for total arch replacement was well obtained under the cardioplegia and brain protection mentioned above.

Human cytomegalovirus latent gene expression in granulocyte-macrophage progenitors in culture and in seropositive individuals

Following infection with cytomegalovirus, human granulocyte-macrophage progenitors carry the viral genome but fail to support productive replication. Viral transcripts arise from a region encompassing the major regulatory gene locus; however, their structure differs significantly from productive phase transcripts. One class, sense transcripts, is encoded in the same direction as productive phase transcripts but uses two novel start sites in the ie1/ie2 promoter/enhancer region. These transcripts have the potential to encode a novel 94 aa protein. The other class, antisense transcript, is unspliced and complimentary to ie1 exons 2-4, and has the potential to encode novel 154 and 152 aa proteins. Consistent with a role in latency, these transcripts are present in bone marrow aspirates from naturally infected, healthy seropositive donors but are not present in seronegative controls. Sense latent transcripts are present in a majority of seropositive individuals. Consistent with the expression of latent transcripts, antibody to the 94 aa and 152 aa proteins is detectable in the serum of seropositive individuals. Thus, latent infection by cytomegalovirus is accompanied by the presence of latency-associated transcripts and expression of immunogenic proteins. Overall, these results suggest that bone marrow-derived myeloid progenitors are an important natural site of viral latency.

Malignant lymphoma of the gastric stump developing 25 years after a distal gastrectomy for benign gastric disease: report of a case

We report herein the case of a 57-year-old man in whom malignant lymphoma originating in the gastric remnant was confirmed 25 years after a subtotal gastrectomy with Billroth II reconstruction had been performed for gastric ptosis. Gastroscopy revealed an ulcerated tumor on the fornix, and histologic examination of the endoscopic biopsy specimens demonstrated malignant lymphoma. Thus, total gastrectomy with splenectomy, pancreatectomy, and resection of the previously anastomosed jejunal stoma were performed. Histologic examination of the stomach remnant confirmed a diagnosis of B-cell lymphoma of the large-cell type. Although we were unable to study the surgical specimen from the initial operation, the possible relationship between pseudolymphoma and malignant lymphoma has been presented in the literature, which is reviewed following this case report.