Antithrombotic effects of the novel inhibitor of thrombin-induced offtelet aggregation and thrombus formation, 3-[2-[1,1':2',1"]-terphenyl-4'-yl)ethyl]phenoxyacetic acid

The new compound 3-[2-([1,1':2,1"]-terphenyl-4'yl)ethyl]phenoxyacetic acid (F1070) was synthesized and its effects on platelet aggregation induced by thrombin, thrombin receptor agonist peptide (TRAP), ADP and collagen were evaluated in humans, guinea pigs and rats, and were compared with the effects of he thrombin antagonists argipidine and (D)Phe-Pro-Arg-CH2Cl (FPR). F1070 inhibited the platelet aggregation induced by these agonists and was highly selective in its inhibition of thrombin. F1070 inhibited fibrin formation induced by thrombin, but far less effectively than argipidine. In a guinea pig model of extracorporeal circulation thrombosis, F1070 (10 mg/kg p.o.) significantly inhibited the development of a thrombus. F1070 is thus a key compound that should facilitate the development of new orally active antithrombotic drugs that are specific for thrombin.

A new approach to the development of anti-ischemic drugs. Substances that counteract the deleterious effect of lysophosphatidylcholine on the heart

Lysophosphatidylcholine (LPC) is an amphiphilic metabolite that can be produced from membrane-phospholipids by activation of phospholipase A2 (PLA2), and it accumulates in the heart during ischemia and reperfusion. It is known that LPC is an arrhythmogenic substance. Recent studies have revealed that LPC produces mechanical and metabolic derangements in perfused working rat hearts, and Ca(2+)-overload in isolated cardiac myocytes. Thus, LPC possesses an ischemia-like effect on the heart. LPC accumulated in the myocardium activates phospholipase A2, establishing a vicious circle; i.e. LPC itself has an ability to produce another LPC. Therefore, a drug that has an anti-LPC effect would protect or improve ischemia/reperfusion damage. This article will review the effect of LPC in relation to ischemia, and consider a possibility of developing new anti-ischemic drugs on the basis of the anti-LPC action.

Acute posterolateral rotatory subluxation of the elbow joint. A case report

The elbow joint has become increasingly recognized as a very important joint for all sports activities. Players in some sports cannot compete at all with an unstable elbow due to ligament injuries. Thus, professional sports players and heavy laborers, as in our case, should find the excellent results of primary ligament repair preferable. This technique is less invasive than secondary ligament reconstruction and can result primarily in an accurate, stable elbow with full range of motion for mobilizing the joint and muscles at an early stage.

Lysophosphatidylcholine induces Ca2+-independent cellular injury attenuated by d-propranolol in rat cardiomyocytes

In isolated rat cardiomyocytes, exogenous lysophosphatidylcholine (LPC) (15 microM) increased the intracellular Ca2+ concentration (Ca2+]i) from 72 +/- 5 to 3042 +/- 431 nM accompanied by cell injury as indicated by the hypercontracture of the cells and the increase in creatine phosphokinase (CPK) release. In order to understand whether the cell injury induced by LPC was a consequence of the elevation of [Ca2+]i, the effect of LPC was examined in the Ca2+-free solution containing EGTA. Under the Ca2+ -free conditions, LPC did not increase [Ca2+]i, whereas it still inflicted injury on the cells in terms of cell-shape change and CPK release to the same degree as that under the Ca2+-present condition. Addition of ryanodine (10 microM) failed to prevent the changes in cell-shape and CPK release induced by LPC under both Ca2+-free and Ca2+-present conditions. Preincubation of the myocytes with d-propranolol (50 microM) inhibited the LPC-induced changes in cell-shape and CPK release under both Ca2+ -free and Ca2+ -present conditions (p < 0.05). Our study provides clear evidence that the cellular injury induced by LPC could be independent of the increase in [Ca2+]i, and the Ca2+-independent cellular injury induced by LPC could be attenuated by d-propranolol, although the mechanism remains unknown.

Vascular reconstruction in limb salvage operations for soft tissue tumors of the extremities

Eight patients with vascular threatening soft tissue tumors underwent wide excision of the tumors followed by vascular reconstruction. Superficial femoral vessels were resected in 6 patients and popliteal vessels in 2 patients. Arterial reconstruction was performed with a synthetic graft in 4 and a reversed saphenous vein graft in 4. Venous reconstruction was performed with a synthetic graft in 5 and a saphenous vein graft in 2. Adjuvant multimodality treatment was used in 6 patients. After an average of 30 months, the revascularized vessels were found to be patent in 5 patients with arterial reconstruction and in 1 patient with venous reconstruction. Six patients maintained functional extremities. Two other patients had to have amputations, 1 because of a deep infection that involved the grafts and the other because of an acute occlusion of the reconstructed artery. Edema of the leg, which was treated successfully with an elastic support and elevation of the leg, has been observed in all patients after operation. No local recurrence has been observed with an average followup period of 42.5 months. Pulmonary metastasis developed in 2 patients, and 1 of them underwent a pulmonary metastasectomy. Limb salvage in vascular threatening soft tissue tumors using vascular reconstruction techniques is useful and preferable in some patients.

Dilazep and its derivative, K-7259, attenuate mechanical derangement induced by palmitoyl-L-carnitine in the isolated, perfused rat heart

The effect of dilazep, a potentiator of the adenosine-mediated effects, on the palmitoyl-L-carnitine (PALCAR)-induced mechanical derangement was studied in the isolated rat heart and compared with that of K-7259, a dilazep derivative having less potentiating action on the adenosine-mediated effects. The heart was perfused aerobically by the Langendorff's technique at a constant flow and driven electrically. PALCAR (5 microM) decreased the left ventricular developed pressure and increased the left ventricular end diastolic pressure in the heart (i.e., mechanical dysfunction). These mechanical alterations induced by PALCAR were attenuated by dilazep (1 microM) and K-7259 (1 microM). In contrast, adenosine (10 or 100 microM) did not attenuate the PALCAR-induced mechanical derangement. On the other hand, neither dilazep nor K-7259 modified the mechanical function of the normal (PALCAR-untreated) heart. These results suggest that dilazep and K-7259 attenuate the PALCAR-induced mechanical derangement and that the protective action of both drugs is not due to potentiation of adenosine-mediated effects.

[A new approach to the understanding of the mechanism of ischemia/reperfusion damage in the heart and the effects of anti-ischemic drugs]

The classical understanding of the mechanism of anti-anginal or anti-ischemic drugs is an increase in blood supply to the heart and/or a decrease in oxygen consumption of the heart, maintaining energy balance in the heart between supply and demand and hence maintaining the tissue levels of high-energy phosphates. This scheme is reasonable. During reperfusion following ischemia, however, there is more serious damage to the heart, although the tissue levels of high-energy phosphates increase. This is probably because toxic substances are generated in the heart during ischemia/reperfusion. We propose that both lysophosphatidylcholine and palmitoyl-L-carnitine that accumulate in the myocardium during ischemia/reperfusion are candidates for the toxic substances that accelerate ischemia/reperfusion damage to the heart. Therefore, drugs that have anti-lysophosphatidylcholine and/or anti-palmitoyl-L-carnitine effects are promising for the treatment of ischemic heart diseases. We found that K-7259, a novel derivative of dilazep having a minimal effect on the normal heart, is a drug that attenuates the deleterious effects of both lysophosphatidylcholine and palmitoyl-L-carnitine on the heart, and therefore attenuates the ischemia/reperfusion damage.

Pathomechanism of pain-related behavior produced by allografts of intervertebral disc in the rat

STUDY DESIGN

This study was designed to evaluate whether allografts of intervertebral disc materials produce hyperalgesia in the rat and whether an immune response, pH, or chemicals correlate with the induced hyperalgesia.

OBJECTIVE

To elucidate the pathomechanisms of radicular pain secondary to lumbar disc herniation.

SUMMARY OF BACKGROUND DATA

It has been reported that a low pH, an autoimmune reaction, or chemical radiculitis is likely responsible for radicular pain associated with lumbar disc herniation. In animal studies, it has been shown that hyperalgesia (an increased sensitivity to painful stimuli) involves activation of phospholipase A2 and nitric oxide synthase.

METHODS

Fat, nucleus pulposus, and anulus fibrosus were allografted into the epidural space at L6 in the rat. Withdrawal response thresholds to mechanical stimuli and withdrawal response latencies to thermal stimuli on the tail and pH in the applied tissues were measured after surgery. Interleukin-1, phospholipase A2, and nitric oxide synthase were examined in the applied tissues using immunohistochemistry, nicotineamide adenine dinucleotide phosphate-diaphorase histochemistry, and in situ hybridization.

RESULTS

Allografted fat did not produce hyperalgesia. Allografts of nucleus pulposus and nucleus pulposus plus anulus fibrosis showed evidence of mechanical and thermal hyperalgesia, respectively. There were no observed changes in pH over time. Although interleukin-1 was demonstrated in all applied tissues, phospholipase A2 was only observed around the applied nucleus A2 was only observed around the applied nucleus pulposus and nucleus pulposus plus anulus fibrosus. Nitric oxide synthase was only markedly increased around the applied tissues.

CONCLUSION

The nucleus pulposus and anulus fibrosus produce different forms of hyperalgesia (mechanical vs. thermal) associated with different and distinct immunohistochemical changes. It is possible that radicular pain of a lumbar disc herniation results from chemicals, such as phospholipase A2 and nitric oxide.

NON-TRAUMATIC PARALYSIS OF THE POSTERIOR INTEROSSEOUS NERVE

We treated 31 patients with non-traumatic paralysis of the posterior interosseous nerve over 15 years. There were 10 men and 21 women of mean age 40.3 years (17 to 71). Six were managed conservatively, and 25 by operation.

In 14 patients entrapment occurred at the supinator, including three who had double compression at both the entrance and exit from the muscle. In four it was caused by a ganglion, in one by a lipoma, in one by a dislocated radial head and in two by a marked constriction in the nerve of unknown cause. The remaining three patients were retrospectively diagnosed as having neuralgic amyotrophy, the only observable change at operation being slight oedema of the nerve.

Paralysis recovered in 24 out of the 25 patients at between 2 to 18 months (mean 5.6) after operation, and the one failure was treated later by tendon transfer.

Non-traumatic paralysis of the posterior interosseous nerve

We treated 31 patients with non-traumatic paralysis of the posterior interosseous nerve over 15 years. There were 10 men and 21 women of mean age 40.3 years (17 to 71). Six were managed conservatively, and 25 by operation. In 14 patients entrapment occurred at the supinator, including three who had double compression at both the entrance and exit from the muscle. In four it was caused by a ganglion, in one by a lipoma, in one by a dislocated radial head and in two by a marked constriction in the nerve of unknown cause. The remaining three patients were retrospectively diagnosed as having neuralgic amyotrophy, the only observable change at operation being slight oedema of the nerve. Paralysis recovered in 24 out of the 25 patients at between 2 to 18 months (mean 5.6) after operation, and the one failure was treated later by tendon transfer.

Capillary architecture in the skeletal muscles in the rat hind limb

We observed differences in the capillary architecture of the skeletal muscles that have different fiber metabolism. The soleus, the vastus intermedius and the tibialis anterior muscles of adult Wistar rats were prepared using two different techniques. Samples for adenosine triphosphatase (ATPase) staining were prepared following Dubovitz's method, and the distributions of fiber type, Types 1, 2A and 2B, were analyzed. Then, corrosion casts of capillary architecture of these muscles prepared following Murakami's method were observed with a scanning electron microscope (SEM) and compared with the fiber distribution. The fiber type composition of the soleus muscle showed Type 1 (slow-twitch) dominance and that of the vastus intermedius and the tibialis anterior muscle showed Type 2 (fast-twitch) dominance. The capillaries of the soleus muscle were tortuous, and this was thought to be advantageous for blood supply. In contrast, the capillaries of the vastus intermedius and tibialis anterior muscles had a relatively parallel pattern. Additionally, two different patterns of capillary architecture that appeared to correspond to certain metabolic characteristic of different muscle fiber types were preserved with corrosion casting. In conclusion, comparative studies on capillary architecture of the skeletal muscles are useful for analyses of its function.

The Galeazzi-equivalent lesion in children revisited

A fracture at the medial end of the distal third of the radius with an epiphyseal separation of the distal ulna in a 16-year-old boy is described. This injury, known as the Galeazzi-equivalent lesion in children, is characterized by complete distal ulnar epiphyseal separation without rupture of the distal ligamentous stabilizing system between the radius and ulna, which includes the triangular fibrocartilage complex, interosseous ligaments and periosteal tube of the ulnar. The Galeazzi fracture-dislocation and the Galeazzi-equivalent lesion appear to be completely dissimilar in their pathological anatomy. We suggest calling the latter a "pseudo-Galeazzi injury".

SHOULDER PAIN IN LONG-TERM HAEMODIALYSIS PATIENTS

We reviewed 166 adult patients on long-term haemodialysis, dividing them into three groups according to the presence and type of shoulder pain. The 24 patients in group A, with spontaneous pain related to a supine posture, had been under haemodialysis for significantly longer than the others, and had a much higher incidence of carpal tunnel syndrome.

Open or arthroscopic resection of the coracoacromial ligament in 21 shoulders relieved pain during haemodialysis and night pain, and histological examination showed amyloid deposits and inflammatory-cell infiltration in the subacromial bursa in almost all cases, and in the tenosynovium of the bicipital groove in some.

We conclude that one type of shoulder pain experienced by patients on long-term haemodialysis is caused by the subacromial impingement of amyloid deposits. This should be distinguished from other types of shoulder pain, because it can be relieved by resection of the coracoacromial ligament.

In vitro antiplatelet activity of the carbinol analogue of ketoprofen, 3-(1-methyl-2-hydroxyethyl)-benzophenone

3-(1-Methyl-2-hydroxyethyl)-benzophenone (F025) is a close structural analogue of ketoprofen, in which the carboxylic acid of ketoprofen is reduced to a carbinol moiety. The in vitro effects of F025 on platelet aggregation, cyclooxygenase and hypotonic NaCl-induced erythrocyte hemolysis were examined in comparison with those of ketoprofen. Although the inhibitory activity of F025 on collagen, arachidonic acid and ADP-induced platelet aggregation was between 2 and 20 times that of ketoprofen in healthy volunteers, guinea pigs, rabbits and rats, F025 had only one-tenth of the inhibitory action of ketoprofen on sheep seminal vesicle cyclooxygenase F025, but not ketoprofen, inhibited hypotonic NaCl-induced erythrocyte hemolysis in guinea pigs. The substantial antiplatelet activity of F025 may be due to membrane stabilization as well as to cyclooxygenase inhibition.

Shoulder pain in long-term haemodialysis patients. A clinical study of 166 patients

We reviewed 166 adult patients on long-term haemodialysis, dividing them into three groups according to the presence and type of shoulder pain. The 24 patients in group A, with spontaneous pain related to a supine posture, had been under haemodialysis for significantly longer than the others, and had a much higher incidence of carpal tunnel syndrome. Open or arthroscopic resection of the coracoacromial ligament in 21 shoulders relieved pain during haemodialysis and night pain, and histological examination showed amyloid deposits and inflammatory-cell infiltration in the subacromial bursa in almost all cases, and in the tenosynovium of the bicipital groove in some. We conclude that one type of shoulder pain experienced by patients on long-term haemodialysis is caused by the subacromial impingement of amyloid deposits. This should be distinguished from other types of shoulder pain, because it can be relieved by resection of the coracoacromial ligament.

Effects of beta-adrenoceptor antagonists on Ca(2+)-overload induced by lysophosphatidylcholine in rat isolated cardiomyocytes

1. The effects of beta-adrenoceptor antagonists including (-)- and (+)-propranolol, (-)- and (+)-penbutolol, timolol, pindolol, atenolol, acebutolol and practolol on the Ca(2+)-overload induced by lysophosphatidylcholine (LPC) were examined in isolated cardiomyocytes of the rat. 2. Fura-2 was used for measurement of the intracellular calcium concentration ([Ca2+]i). LPC (15 microM) produced a rapid increase in [Ca2+]i from 72 +/- 5 to 3042 +/- 431 nM which coincided with a decrease in the percentage of rod-shaped cells from 69 +/- 2 to 5 +/- 2%. 3. Preincubation with (-)-propranolol (20 microM), (+)-propranolol (50 microM), or (-)- or (+)-penbutolol (20 microM), the lipophilicity of which is higher than other beta-adrenoceptor antagonists, significantly inhibited both the increase in [Ca2+]i and the cell-shape change induced by 15 microM LPC. The inhibitory effects of the four drugs on the LPC-induced increase in [Ca2+]i and cell-shape change were concentration-dependent. The IC50S of (-)-propranolol, (+)-propranolol, (-)- and (+)-penbutolol for the increase in [Ca2+]i were 1.28, 10.50, 0.67 and 0.76 microM, respectively. 4. Pretreatment with pindolol, timolol, acebutolol, practolol, atenolol or lignocaine did not inhibit the increase in [Ca2+]i and the morphological change induced by LPC. 5. LPC markedly increased the release of creatine phosphokinase from 9 +/- 1 to 45 +/- 2% which could be significantly reduced by (-)- or (+)-propranolol but not by acebutolol or timolol. 6. The protective effects of (-)- and (+)-propranolol, (-)- and (+)-penbutolol against the Ca(2+)-overload induced by LPC were not associated with the beta-adrenoceptor antagonistic action, but probably with an unknown action which is related to the preservation of membrane integrity. Further studies are necessary to clarify the exact mechanisms of the protective action of these beta-adrenoceptor antagonists against the Ca(2+)-overload induced by LPC.

Ulnar buttress arthroplasty for reconstruction after resection of the distal ulna for giant cell tumour

A giant cell tumour of the distal end of the ulna was treated by en bloc resection. The resected distal end of the ulna was replaced by an iliac bone graft, preserving the triangular fibrocartilage complex. The wrist was pain-free and had a full range of motion 6 months postoperatively.

Eosinophilic pustular folliculitis effectively treated with recombinant interferon-gamma: suppression of mRNA expression of interleukin 5 in peripheral blood mononuclear cells

Eosinophilic pustular folliculitis (EPF) is characterized clinically by pruritic grouped follicular papules and pustules on the trunk, limbs, and face, and, histologically, by follicular infiltration with eosinophils. The blood eosinophil count is elevated in most patients. Oral minocycline, nonsteroidal anti-inflammatory drugs, diaminodiphenylsulphone, and corticosteroids may induce remission. We report two Japanese men with EPF who responded poorly to the usual therapy. Intravenous injections of recombinant interferon-gamma (rIFN-gamma), 5 x 10(5) to 2 x 10(6) Japan Reference Unit (JRU) (1 JRU roughly corresponds to 4 NIH units) daily for 7 days, cleared the skin lesions and returned the peripheral eosinophil counts to normal in both patients. However, the lesions recurred 2-3 days after rIFN-gamma was stopped. Both patients have received intravenous rIFN-gamma once or twice a week for nearly 1 year without systemic side-effects. Reverse transcriptase-polymerase chain reaction revealed a decreased expression of interleukin 5 (IL-5) mRNA in peripheral mononuclear cells after the rIFN-gamma therapy. rIFN-gamma may become the treatment of choice in recalcitrant EPF, although further studies are needed. It may work by interfering with the immunological function of type 2 T-helper cells, including IL-5 production responsible for the growth and differentiation of eosinophils.

K-7259, a novel dilazep derivative, and d-propranolol attenuate H2O2-induced cell damage

We studied the effects of dilazep, K-7259 (a novel derivative of dilazep) and d-propranolol on the change in cell shape and accumulation of nonesterified fatty acids (NEFA) induced by hydrogen peroxide (H2O2) in isolated rat cardiac myocytes. Myocytes were incubated in a Krebs-Ringer bicarbonate buffer containing 2 mM diethyltriamine pentaacetic acid (DETAPAC) and 2mM FeSO4 for 10 min, and then treated with 2mM H2O2 for 50 min. Before the treatment with H2O2, the percentage of the number of rod-shaped cells to that of total cells was 66 +/- 2%, and decreased to 35 +/- 3%, 25 +/- 4% and 14 +/- 2%, after 30, 40 and 50 min of the H2O2 treatment, respectively. The levels of NEFA (lauric, myristic, palmitoleic, arachidonic, linoleic, palmitic, oleic and stearic acids) increased after the treatment with H2O2. In the absence of FeSO4 and DETAPAC, however, H2O2 did not have these effects, and therefore all the experiments with drugs were performed in the presence of Fe2SO4 and DETAPAC. K-7259 (30 microM) and d-propranolol (50 microM) attenuated both the changes in cell shape and accumulation of NEFA induced by H2O2, whereas dilazep (30 or 50 microM) did not. N-(2-mercaptopropionyl)glycine (2 mM), an .OH scavenger, inhibited the H2O2-induced changes completely. These results suggest that K-7259 and d-propranolol attenuate the H2O2-induced changes in cell shape and accumulation of NEFA, probably because of their .OH-scavenging effect.

Histologic and scanning electron microscopic study of the glenoid labrum

Three-dimensional fibrillar architecture of the glenoid labrum and its attachment to the glenoid rim were studied in 15 cadaveric shoulders to understand the pathophysiologic condition of various shoulder diseases. The true anatomic labrum was a narrow band located at the junction of the glenoid rim and fibrous capsule and varied considerably in size and shape. A triple-layered collagen structure of the labrum was observed by scanning electron microscopy. The thin superficial layer (articular surface) was a reticulated fibrillar network. The second layer was stratified. These two layers seem to act as a bumper against impact on the humeral head. The third, main layer of the labrum consisted of bundles of the fine fibrils densely arranged almost parallel to each other and oblique to the glenoid rim. This layer appears to act as a cushion to stabilize the shoulder joint.

Histopathology of Kienböck's disease. Correlation with magnetic resonance and other imaging techniques

Histopathological studies of extracted whole lunate bones obtained from 10 patients with Stage 3 Kienböck's disease at surgery for tendon-ball replacement were correlated with magnetic resonance imaging (MRI), computed tomography (CT) and tomography images made prior to surgery. A reforming zone, or a reactive interface between the reactive new bone and granulation tissue formation, and new vascularization were observed surrounding the bone necrosis area showing empty lacunae, fatty necrosis, and disappearance of osteoid. Findings of CT, tomography and microradiography of slices of extracted lunate bone confirmed that fractures of the articular cartilage and the subchondral bone occurred secondarily by overloading, and showed the extent of the collapsed area of the lunate. MRI showed complete loss of signal intensity in T1 images of the lesion of the lunate in advanced Stage 3 Kienböck's disease. MRI is at present unable to distinguish bone necrosis, the histological reactive interface or surrounding hyperaemia in detail. However, the low-intensity arc, or the reactive interface present on MRI in early Stage 3, sometimes correlates with the histological findings of osteoid and granulation zones.

Dorsally displaced epiphyseal fracture of the phalangeal base

A dorsally displaced epiphyseal fracture of the middle phalanx (Salter-Harris Type I) is described. The epiphyseal fragments were attached to the central slip of the extensor tendon and collateral ligaments. The articular surface of the PIP joint was intact and smooth. The epiphysis was reduced and fixed without cutting the central slip or the collateral ligaments 8 months after injury. This kind of fracture can occur in the PIP and DIP joints, and presents special diagnostic difficulties. Open reduction is evidently necessary to correct the displacement.

Malignant hemangioendothelioma

BACKGROUND

The administration of interleukin-2 (IL-2) has recently been reported to be favorable for treating malignant hemangioendothelioma (MHE).

METHODS

Two patients with MHE responded well to intralesional injections of recombinant IL-2 (rIL-2) without major side effects. The purpose of this study was to characterize cells infiltrating the regressing tumor following rIL-2 treatment. Immunohistochemical studies were performed on biopsy specimens taken from rIL-2-injected lesional skin.

RESULTS

It was shown that CD8+ lymphocytes and CD56+ natural killer (NK) cells infiltrated at the rIL-2-injection sites, suggesting that these cells contributed to the tumor regression. In addition, MHE cells bore intercellular adhesion molecule-1 (ICAM-1) whose expression was augmented by rIL-2 injections.

CONCLUSIONS

These findings suggested, that rIL-2 not only induces lymphokine-activated killer (LAK) cells and NK cells, but also facilitates these cytotoxic cells to adhere to MHE cells by enhancing ICAM-1 expression of tumor cells.

Delayed posterior interosseous nerve palsy

A rare case of delayed posterior interosseous nerve palsy that developed 39 years after an unreduced anterior dislocation of the radial head is reported. The posterior interosseous nerve was compressed and narrowed at the arcade of Frohse. Radial head resection and release of the arcade was done. The paralysis continued to recover 6 weeks after operation. The nerve, at the arcade of Frohse, was susceptible to compression by the dislocated radial head, especially in the supinated position. Repeated supination and pronation movement over time may have led to developmental changes that caused the delayed nerve palsy.

A histological study of the cardiac muscle of the human superior and inferior venae cavae

Human superior and inferior venae cavae at the orifices to hearts obtained from two cadavers were histologically examined with regard to the distribution of cardiac muscle fibers in their walls. The superior vena cava contained cardiac muscle fibers together with smooth muscle fibers. The cardiac muscle fibers were distributed uninterruptedly from the atrium to the root of the azygos vein, covering a length of 45 mm. Cardiac myocytes were present outside the smooth muscle and coursed in bundles longitudinally, obliquely, or circularly. Cardiac myocytes occupied one to two thirds of the wall thickness, but decreased in amount toward the periphery. The inferior vena cava also contained both cardiac and smooth muscle fibers. The cardiac muscle fibers extended continuously, covering a distance of 18 mm from the atrium to a level just under the diaphragm. Their fibers were bundled, running circularly or obliquely, and being more abundant in the anterior wall than in the posterior. From these findings, the venae cavae close to the atrium are histologically regarded as an extension of the atrium. The venae cavae close to the atrium probably contract together with the atrium and work as a functional valve that contributes to the pumping mechanism of the heart.

Intraneural ganglion of the posterior interosseous nerve with lateral elbow pain

We report an intraneural ganglion of the posterior interosseous nerve causing lateral elbow pain. The cystic lesion was identified by magnetic resonance imaging, and surgical exploration using the microscope permitted complete extirpation of the cyst without damage to nerve tissue. The patient experienced complete relief from pain, with full preservation of function.

Dilazep inhibits binding of batrachotoxin to sodium channels in canine sarcolemmal vesicles

We studied the effect of dilazep on the binding of [3H]- batrachotoxinin A 20 alpha-benzoate ([3H]BTXB), which binds to and stabilizes the activated state of the Na+ channel, and compared it with that of lidocaine in canine cardiac sarcolemmal vesicles. Dilazep inhibited the specific [3H]BTXB binding in a dose-dependent manner with an IC50 value of 0.37 microM, while lidocaine inhibited it with an IC50 value of 92 microM. Scatchard analysis of [3H]BTXB binding demonstrated that both dilazep and lidocaine reduced the amax without a marked effect on the K(D). The inhibition of [3H]BTXB induced by dilazep was reversible. Both dilazep (4 microM) and lidocaine (100 microM) increased the dissociation rate constant of [3H]BTXB only in concentrations which are about a 10-fold greater than their IC50, indicating the low affinity of both drugs for the [3H]BTXB-bound Na+ channel. However, dilazep (0.5 microM) and lidocaine (100 microM) decreased significantly the association rate constant of the [3H]BTXB binding at concentrations near their IC50, indicating that the affinity of both drugs for the [3H]BTXB-unbound Na+ channel is relatively high. These results suggest that, in canine cardiac membrane vesicles, the effect of dilazep in inhibiting the binding of [3H]BTXB and stabilizing the Na+ channel is similar to that of lidocaine, but the potency of dilazep is greater than that of lidocaine.

Rotationplasty for patients with osteosarcoma around the knee joint

The results of rotationplasty for patients with osteosarcoma around the knee joint are presented. After an average observation period of 13.3 months, there has been no local recurrence or metastasis. The ankle joints (the new knee joints) of the patients were able to support their body weight with an average range of motion of 75 degrees. All patients could walk well without crutches and without risk of the giving way phenomenon. The average rate of the functional evaluation according to the re-modified system by Enneking was 84.5% (range, 80.0-86.7%). No patient had psychological trouble in accepting the shortened and rotated extremity. The results show that rotationplasty is a useful reconstructive method for the treatment of osteosarcoma around the knee joint.

Photodynamic DNA-breaking activity of serum from patients with various photosensitivity dermatoses

Various drugs and chemicals break the DNA strand under ultraviolet irradiation. This study aimed to clarify the DNA-breaking activity (DBA) of serum from 39 patients with various photosensitivity disorders and that from eight normal subjects. A mixture of serum and circular plasmid DNA was exposed to longwave ultraviolet radiation, and the photoinduced cleavage of plasmid DNA was examined by electrophoretic analysis. DBA was found in serum from patients with erythropoietic protoporphyria (2 of 2), drug-induced photosensitivity (3 of 5), chronic actinic dermatitis (1 of 12) and hydroa vacciniforme (1 of 1). DBA was not found in serum from patients with porphyria cutanea tarda, collagen diseases with photosensitivity, papulovesicular light eruption or pellagra. The inhibition profile of DBA by active oxygen scavengers was different between afloqualone- and tetracycline-induced photosensitivity and chronic actinic dermatitis. The present method was useful for the detection of serum phototoxicity and the investigation of the pathomechanisms of photosensitivity.

Ewing's sarcoma of the hand: magnetic resonance images and treatment

Two cases of Ewing's sarcoma of the hand were treated by preoperative chemotherapy and radiation therapy to decrease tumor volume. Magnetic resonance images were useful in showing the soft tissue mass and in estimating the effect of the chemotherapy. The results of surgery were satisfactory with this treatment regimen.

A study on dilazep: II. Dilazep attenuates lysophosphatidylcholine-induced mechanical and metabolic derangements in the isolated, working rat heart

The effects of dilazep, d-propranolol and lidocaine on the mechanical and metabolic changes induced by lysophosphatidylcholine (LPC) were studied in isolated, perfused working rat heart. After a stabilization period, the heart was perfused for 5 min with LPC (10 microM) alone, LPC plus dilazep (5, 10 or 20 microM), LPC plus d-propranolol (30 or 50 microM) or LPC plus lidocaine (30 or 100 microM) and then perfused with normal Krebs-Henseleit bicarbonate (KHB) buffer for a further 20 min. Perfusion with LPC for 5 min followed by KHB for 20 min irreversibly decreased cardiac mechanical function, decreased the tissue levels of adenosine triphosphate and creatine phosphate significantly, and increased the tissue levels of lactate and free fatty acids including arachidonic acid. Dilazep or d-propranolol significantly attenuated the mechanical and metabolic changes induced by LPC, but lidocaine did not. These results indicate that the exogenous LPC causes ischemia-like changes, suggesting that LPC is one of the important factors in producing ischemia-reperfusion derangements in terms of mechanical and metabolic functions, and that both dilazep and d-propranolol can prevent the LPC-induced myocardial damage.

A study on dilazep: I. Mechanism of anti-ischemic action of dilazep is not coronary vasodilation but decreased cardiac mechanical function in the isolated, working rat heart

In the isolated, perfused working rat heart, ischemia (15 min) decreased the mechanical function and the tissue levels of adenosine triphosphate and creatine phosphate and increased the levels of lactate and free fatty acids. Reperfusion (20 min) did not restore the mechanical function, but restored incompletely the levels of metabolites, with the exception of free fatty acids, which increased further during reperfusion. Dilazep was given 5 min before starting ischemia until the end of ischemia. Dilazep at 5 or 10 microM decreased the cardiac mechanical function, but did not affect coronary flow in the pre-ischemic heart. Dilazep at 5 or 10 microM accelerated the recovery of mechanical function and coronary flow during reperfusion, and it attenuated metabolic changes induced by ischemia and reperfusion. Dilazep at 1 microM neither decreased the pre-ischemic mechanical function nor restored the mechanical function during reperfusion, although it attenuated the accumulation of free fatty acids during reperfusion. These results suggest that dilazep attenuates both ischemia- and reperfusion-induced myocardial damage and that the anti-ischemic action of dilazep is not due to coronary vasodilation but probably due to an energy-sparing effect and other effects that remain to be studied.

Finite element analysis of pathogenesis of osteoarthritis in the first carpometacarpal joint

Stress distribution in the first carpometacarpal joint was analyzed in 49 cadaveric hands using the finite element method to clarify the pathogenesis of osteoarthritis in the joint. The results of the finite element method analysis were compared with those of the contact pressure distribution in the first carpometacarpal joint of cadaveric specimens using pressure-sensitive film, and with the simple roentgenographical and microradiographical manifestations of spur formation, and with histological findings of osteoarthritis to verify the accuracy of the models of computer simulation models. The comparison of these results showed that osteoarthritic changes of the first carpometacarpal joint were found in areas where stress was concentrated during movement of the joint. The saddle shape of this joint is essentially well-designed for the dispersion of normal stress, however minimal displacement due to instability could easily induce osteoarthritis. Furthermore the shallow trapezial configuration may contribute to the high incidence of osteoarthritis changes. The finite element method helped clarify the relationship between stress patterns and osteoarthritis response.

Effects of antiischemic drugs on veratridine-induced hypercontracture in rat cardiac myocytes

The effects of different groups of substances (beta-adrenoceptor antagonists, Ca2+ channel blockers and vasodilators) which are known to have antiischemic properties were studied on veratridine-induced hypercontracture. Veratridine increases Na+ influx by slowing the inactivation process of the Na+ channel, thereby inducing a continuously increased Na+ entry in depolarized cells. Veratridine (6.3 x 10(-6) M) produced a change in cell shape from rod-shape to round, resulting from hypercontracture of cells. Before treatment with veratridine the proportion of rod-shaped cells was 70% and fell to 0% 5 min after the treatment with veratridine. dl-Propranolol, d-propranolol, l-penbutolol, d-penbutolol, nisoldipine, and dilazep all inhibited veratridine-induced hypercontracture dose dependently. In contrast, acebutolol, atenolol, timolol, nifedipine, diltiazem, and nitroglycerin did not inhibit the rounding of cells. Concomitantly with the rounding of cells, the [Ca2+]i was increased by veratridine. dl-Propranolol, d-propranolol and dilazep prevented the increase of [Ca2+]i induced by veratridine, whereas timolol and nitroglycerin did not. These results show that dl-propranolol, d-propranolol, l-penbutolol, d-penbutolol, nisoldipine, and dilazep possess Na+ channel blocking actions on the veratridine-modified Na+ channel, thereby preventing excessive Na+ influx and secondary Ca2+ overload.

Malunited Colles' fracture. Analysis of stress distribution

To try to explain disability in the wrist after malunited Colles' fractures, an experiment was designed to evaluate pressure distribution through the wrist joint with varying degrees of angulation of the distal radius. The results of computer simulation analysis of stress concentration using finite element methods were compared with those of pressure distribution studies on the radial articular surface of cadaveric radii in various positions using pressure-sensitive film. Stress existed in volar regions of the radio-lunate joint under normal pressure in the neutral position, but shifted to dorsal regions of the joint, and was concentrated when dorsal angulation reached 30 degrees. We believe that concentrated loads result in pain and may lead to early degenerative joint disease. Early additional reduction of a displaced fragment or a post-fusion osteotomy should be considered when dorsal angulation exceeds 30 degrees in malunited distal radial fractures to decrease abnormal loading across the wrist joint.

Increased number of dendritic epidermal T cells associated with induced anagen phase of hair cycles

With the use of immunofluorescent staining we investigated the number and the morphologic and phenotypic changes of murine dendritic epidermal T cells (DETC) at various phases of the hair cycle that were synchronized by depilation. The epidermis on day 1 after depilation contained a small number of DETC, round DETC populated at perifollicular space on day 7, and then a large number of DETC with conspicuous dendrites were found mainly at interfollicular space on day 10. This suggests that the in situ proliferation of DETC may be correlated at least partly to the hair cycle, and that hair follicles, which are major skin appendages, may be involved in cutaneous immunity.

Cubital tunnel syndrome in a patient in long-term haemodialysis

The onset mechanism of cubital tunnel syndrome and carpal tunnel syndrome may be similar in haemodialysis patients. Carpal tunnel syndrome is well recognized as a consequence of dialysis-associated amyloidosis. This case report documents the development of cubital tunnel syndrome in a patient on haemodialysis treatment for 10 years. Proliferating granulation tissue at the elbow had entrapped and displaced the ulnar nerve. This was corrected surgically, and the patient experienced immediate relief of the numbness and the "tingling", but the muscular atrophy had not improved after 8 months.

Computer simulation analysis of fracture dislocation of the proximal interphalangeal joint using the finite element method

Stress is a proximal interphalangeal (PIP) joint model was analyzed by the two-dimensional and three-dimensional finite element methods (FEM) to study the onset mechanisms of the middle phalangeal base fracture. The structural shapes were obtained from sagittally sectioned specimens of the PIP joint for making FEM models. In those models, four different material properties were given corresponding to cortical bone, subchondral bone, cancellous bone and cartilage. Loading conditions were determined by estimating the amount and position of axial pressure added to the middle phalanx. A general finite element program (MARC) was used for computer simulation analysis. The results of the fracture experiments compared with the clinical manifestation of the fractures justify the applicability of the computer simulation models using FEM analysis. The stress distribution changed as the angle of the PIP joint changed. Concentrated stress was found on the volar side of the middle phalangeal base in the hyperextension position, and was found on the dorsal side in the flexion position. In the neutral position, the stress was found on both sides. Axial stress on the middle phalanx causes three different types of fractures (volar, dorsal and both) depending upon the angle of the PIP joint. These results demonstrate that the type of PIP joint fracture dislocation depends on the angle of the joint at the time of injury. The finite element method is one of the most useful methods for analyzing the onset mechanism of fractures.

Cystic radio-lucency of carpal bones in haemodialysis patients. An early indicator of the onset of carpal tunnel syndrome

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radiolucency of carpal bones in 35% of the hands. Radiographs were classified into three groups: Group A--cyst growing, Group B--cyst not growing, and Group C--cyst absent. The prevalence of carpal tunnel syndrome was 100% (27/27) in Group A, 5.6% (1/18) in Group B, and 6.5% (6/93) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.