A quantitative assay using basement membrane extracts to study tumor angiogenesis in vivo

We describe a quantitative assay for assessing tumor angiogenesis in vivo using basement membrane extracts (Matrigel). Nude mice were injected s.c. with liquid Matrigel mixed with HT1080 human fibrosarcoma cells. Since Matrigel rapidly forms a solid gel at body temperature, the gel containing tumor cells can be removed immediately and then processed for histological studies. Tumor angiogenesis was monitored quantitatively by measuring both the number and the total area of neovessels present in the gels using an image analyzer, which could be achieved approximately 72 hr later. Furthermore, HT1080 cell-conditioned medium, which may contain various tumor-derived factors, promoted the basement membrane degradation, migration, proliferation and tube formation of endothelial cells in vitro, as did Matrigel, although to a lesser extent. In addition, Northern blot analysis demonstrated that the amount of vascular endothelial growth factor (VEGF) mRNA in HT1080 cells was much higher than that in human fibroblasts or NIH3T3 cells. Our results suggest that angiogenesis observed in our assay may be due to the synergic effects of tumor angiogenic factors such as VEGF, and Matrigel. The advantages of our assay are: 1) it is possible to assess early angiogenesis quantitatively; and 2) this assay may be applicable for screening anti-angiogenic therapeutic agents to be used against human neoplasms.

Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining

BACKGROUND

Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers.

METHODS

A cohort of 629 male alcoholics (54 +/- 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes.

RESULTS

Iodine-unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty-six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine-unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively).

CONCLUSION

Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.

HLA-DR antigen expression in colorectal carcinomas: influence of expression by IFN-gamma in situ and its association with tumour progression

The authors attempted to investigate the host's immune response against colorectal carcinoma through the expression of HLA-DR antigen on carcinoma cells (Ca) on normal epithelia immediately adjacent to carcinoma (AN) in relation to tumour progression. The expression of HLA-DR antigen on Ca and on normal epithelia, both on AN and those 5-10 cm removed from the carcinoma (RN), were examined immunohistochemically. mRNAs of cytokines, IFN-gamma and TNF-alpha, were detected by reverse transcription-polymerase chain reaction (RT-PCR) in both carcinoma and remote normal tissues. The expression of HLA-DR antigen on AN was significantly increased compared with RN. Patients with tumours showing HLA-DR staining both in Ca and AN were in less advanced Dukes' stages (Dukes' A or B) compared with those without the stain. Furthermore, the expression of HLA-DR antigen in normal mucosa coincided significantly with the existence of IFN-gamma mRNA. Detection in carcinoma tissues of IFN-gamma mRNA that leads to the induction of HLA-DR antigen on AN could be an indicator of a host's immune response to carcinoma. These in vivo observations might be clinically applicable to the prediction of patients' immune responsiveness to carcinomas.

Outcome of anterior decompression and stabilization for thoracolumbar unstable burst fractures in the absence of neurologic deficits

STUDY DESIGN

This study investigated the outcome of anterior decompression and stabilization for "unstable" burst fractures without initial neurologic deficits in the thoracolumbar spine.

OBJECTIVE

To determine the pain and work status of the patients, who underwent the anterior decompression and stabilization, to evaluate the relationship between residual back pain and the degree of kyphosis, and to analyze the advantages and disadvantages of surgery for burst fractures without initial neurologic deficits in the thoracolumbar spine.

SUMMARY OF BACKGROUND DATA

A retrospective review was conducted on 45 patients with unstable burst fractures in the thoracolumbar spine treated by anterior decompression and stabilization in our institutions from 1982 to 1993. Nineteen patients were available for this study. Ten patients were men and 9 were women. Their age at surgery ranged from 15 to 76 years (average, 46 years). The duration of follow-up ranged from 24 to 84 months (average follow-up, 54 months).

METHODS

All clinical charts and radiologic data of these patients were reviewed by the first author. Their pain, work, and employment statuses were assessed by the scales proposed by Denis in 1984.

RESULTS

Nine patients were rated P1, 7 were rated P2, 2 were rated P3, 1 was rated P5, 11 were rated W1, 3 were W2, 1 was W3, and 4 were rated W5. Even the physical laborers' return to work averaged 5 months after surgery (range, 3-12 months). The postoperative kyphotic angle ranged from -6 degrees to 45 degrees (average, 11 degrees), and it remained -5 degrees to 45 degrees (average, 12 degrees) at final follow-up. There was no statistical correlation between the kyphotic angle and the pain scale.

CONCLUSIONS

Anterior decompression and stabilization for unstable burst fracture without initial neurologic deficits in the thoracolumbar spine has some advantages in the view of anatomical reduction and rigid stability that allows patients an early rehabilitation, return to work, and gainful employment.

Correlation between cytokine levels of amniotic fluid and histological chorioamnionitis in preterm delivery

The aim of this study was to investigate the correlation between the cytokine levels in the amniotic fluid (AF) and the histological stage of chorioamnionitis (CAM) in premature labor. AF of 6 cases (7 samples of AF were obtained as one was a twin pregnancy) in whom CAM was diagnosed histologically, and 12 cases without CAM were included in this study. Amniotic fluid was obtained within 24 hours prior to delivery. Cytokine levels (IL-2, -4, -6, TNF-alpha, IFN-gamma) in AF were measured by an ELISA method. Levels of IL-2 and -6 in the CAM-positive group (mean +/-S.E., 52.9 +/- 83.9 pg/ml, and 20,537.9 +/- 8853.7 pg/ml, respectively) were higher than those in the CAM-negative group (i.e. undetectable, and 65.6 +/- 27.5, respectively) with a statistical significance of p < 0.05, p < 0.001, respectively. There was a positive linear relationship between IL-6 levels of AF and the placental histological inflammatory stages of Blanc in the CAM-positive group. From these results it would appear that the IL-6 level in AF is the most sensitive test in the detection of extraamniotic infection or intraamniotic infection in preterm labor with intact membranes and also indicates the severity infection.

Anatomic study of the bronchial arteries with special reference to their preservation during the radical dissection of the upper mediastinum lymph nodes

BACKGROUND

The anatomy of the bronchial arteries was studied, with special reference to their preservation during the radical dissection of the upper mediastinum lymph nodes.

METHODS

The bronchial arteries of 71 cadavers were studied macroscopically by use of the surgical field of right thoracotomy. The small branches difficult to identify macroscopically were described by x-ray imaging with digital subtraction angiography. Their anatomic relationship to the adjacent organs was observed microscopically.

RESULTS

The bronchial arteries arising from the intercostal arteries (the intercostobronchial arteries) were observed in 66 of 71 cases. By use of the surgical field of right thoracotomy the intercostobronchial arteries were easily found and preserved. All cadavers also had other bronchial arteries arising from the aorta. These were difficult to preserve because of the depth of the surgical field and the location of their course in the dissected area. Bronchial arteries had established connection with each other via the vascular network in the tracheal proper sheath. India ink injected into the intercostobronchial arteries was observed in the tracheal proper sheath and the submucosa of the trachea.

CONCLUSIONS

Saving the blood supply to the trachea is possible with careful preservation of the intercostobronchial arteries and the tracheal proper sheath during radical dissection of the upper mediastinum.

Molecular and crystal structures of two 1,6-anhydro-beta-maltotriose derivatives

Crystal structures of two 1,6-anhydro-beta-maltotriose derivatives, 1,6-anhydro-beta-maltotriose nonaacetate and 6"-bromo-6"-deoxy-1,6-anhydro-beta-maltotriose octaacetate, have been determined. Both structures are isomorphous and belong to the orthorhombic system, space group of P2(1)2(1)2(1), with cell dimensions of a = 15.659(3) A, b = 20.587(6) A, c = 13.023(2) A and a = 15.402(7) A, b = 19.737(8) A, c = 13.481(5) A, respectively. Each molecule has three alpha-(1-->4)-linked glucose units, and two of them have a typical 4C1 chair conformation, while the glucose unit with the 1,6-anhydro bridge has a 1C4 chair-envelope intermediate conformation. In spite of introducing the 1,6-anhydro bridge and acetyl groups, the conformations of the glycosidic linkages in these molecules are almost the same as those of other alpha-(1-->4)-linked oligosaccharides. Crystal structures are stabilized by hydrophobic interactions and by a weak intermolecular hydrogen bond of C-H. . .O.

Central nervous system disease in a child with primary Sjögren syndrome

A 9-year-old girl had hemiparesis, and a diagnosis of primary Sjögren syndrome was made. The neurologic dysfunction was multifocal, involving both the brain and spinal cord, and was recurrent; the findings mimicked multiple sclerosis. Corticosteroid treatment during episodes of acute neurologic dysfunction appeared to be beneficial.

Serum concentration of endogenous G-CSF in women during the menstrual cycle and pregnancy

Although granulocyte-colony stimulating factor (G-CSF) is commonly used in the field of supportive therapy for cancer treatment, the serum concentration of endogenous G-CSF in healthy women is still obscure due to the low sensitivity (30 pg mL-1) of the usual enzyme immunoassay. With the development of a highly sensitive (1.0 pg mL-1) chemiluminescent immunoassay by Kiriyama et al., we have clarified the changes of serum G-CSF levels in healthy women during the menstrual cycle and pregnancy. The G-CSF concentration showed a peak value of 27.3 +/- 2.5 pg mL-1 (mean +/- SEM) at the ovulatory phase during the menstrual cycle, which is significantly higher than in all other phases (P < 0.0001, unpaired t-test). A significantly higher value compared to the menstrual cycle, except during the ovulatory phase, was also revealed throughout pregnancy (P < 0.0001, unpaired t-test). These results suggest that G-CSF plays an important role in ovulation and the maintenance of pregnancy.

Cyanamide-associated alcoholic liver disease: a sequential histological evaluation

This is the first study that we are aware of that followed the histopathological progression of the liver disease that was caused by the combination of both chronic alcohol use and cyanamide, an antidipsotropic agent. Two sequential liver biopsy specimens were obtained on 29 alcoholics who relapsed with varying histories of cyanamide treatment. Cyanamide induced ground-glass inclusions (GGIs) in the hepatocytes. Two groups were identified, depending on whether GGIs proliferated or regressed, which was, in turn, found contingent on the duration of cyanamide treatment and the drug-free period. Group 1 included 14 cases in which GGIs either emerged only in the second biopsy specimen or else were increased in the second specimen as compared in the initial specimen. Group 2 composed of 15 cases in which GGIs were either not observed in either specimen or decreased in the second specimen as compared in the initial specimen. Acidophilic bodies were sequentially increased in five cases (36%) of group 1 and in none of group 2. The severity of portal inflammation worsened in 10 cases (71%) of group 1 but in 2 cases (13%) of group 2, although the changes in fibrotic process did not differ between two groups. These differences could not be explained on the basis of the daily ethanol consumption and the length of relapses of the two groups. Thus, when cyanamide-treated alcoholics relapsed, the combined effect of cyanamide and alcohol produced the development of acidophilic bodies and portal inflammation along with the emergence of GGIs.

[Anesthesia with transesophageal echocardiography for removal of pheochromocytoma]

A 45-year-old female was scheduled for left adrenalectomy because of a pheochromocytoma. Preoperative general condition was well controlled with alpha- and beta-blockers. Anesthesia was induced with thiamylal and vecuronium, and maintained with isoflurane (0.5-3%) and nitrous oxide in oxygen. Blood pressure was controlled with nicardipine and alpha-blocker during the manipulation of the tumor. After removal of the tumor, dopamine and norepinephrine were used. We used transesophageal echocardiography (TEE) to determine the fluid administration rate and doses of catecholamine. We could observe the wall motion and the mass of the heart, and see changes of the left ventricular enddiastolic volume, the cardiac output and the stroke volume. TEE monitoring seems to be very useful during the resection of pheochromocytoma.

Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining

BACKGROUND

Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers.

METHODS

A cohort of 629 male alcoholics (54 +/- 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes.

RESULTS

Iodine-unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty-six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine-unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively).

CONCLUSION

Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.

Effect of body position on the blood gases and ventilation volume of infants with chronic lung disease before and after feeding

The effect of body position before and after tube feeding was evaluated in six extremely immature infants who were being mechanically ventilated because of chronic lung disease. Their mean birthweight and gestational age were 722.7 g (range, 540 to 994) and 24.9 weeks (range, 23.9 to 26.0), respectively. This study was performed at a mean postnatal age of 47.5 days (range, 21 to 85 days). The prone position resulted in a significant increase in arterial oxygen saturation before and after feeding, whereas the tidal volume demonstrated an increase only before feeding. Also the prone position showed a significant decrease in heart rate before and after feeding and a tendency to decrease transcutaneous carbon dioxide tension values before feeding. There were no significant differences in minute ventilation despite increased tidal volume in the prone position, most likely due to a decrement of the spontaneous respiratory rate in the prone positioning. We conclude that the prone position may offer an advantage over the supine position in the management of extremely immature infants with chronic lung disease before and after feeding.

Two cases of monozygotic twins, in each of which one fetus was prenatally diagnosed as having a heart anomaly

In each of the 2 cases of monozygotic twins reported here, 1 of the fetuses was suspected, as a result of a prenatal ultrasonographic examination, of having congenital heart disease (CHD). One of twins (Case 1) had a hypoplastic left heart (HPLH), coarctation of the aorta (CoA), mitral stenosis (MS), and an atrial septal defect (ASD). Of the other twins (Case 2), 1 fetus had pure pulmonary atresia (PPA) and tricuspid regurgitation (TR). In Case 1, the fetus with CHD had a single umbilical artery, the other had otherwise. In Case 2, the fetus with CHD had a velamentous insertion and an accessory placenta, and the other fetus had a marginal insertion. These findings suggest that environmental factors such as blood flow, blood pressure and so on have a role in the etiology of CHD.

Clinical usefulness of the dye-injection method for diagnosing premature rupture of the membranes in equivocal cases

OBJECTIVE

In 1981, we preliminarily reported on the clinical value and safety of the intra-amniotic dye (Phenol-sulfonphthalein, PSP)-injection method for diagnosing PROM. In the current study, through examination of 64 equivocal cases in the midtrimester of pregnancy, we investigated the clinical efficacy of the PSP test.

METHODS

In the present study we examined patients with equivocal PROM in their 14th week to 33rd week of gestation, whose findings were positive according to a combination of conventional diagnostic methods. The results of the PSP test and conventional diagnostic methods were compared with the final diagnosis of PROM.

RESULTS

The conventional diagnostic methods showed an accuracy rate of 63.9%-70.5%, in contrast to the PSP test, which had a 100%-accuracy rate (p < 0.001).

CONCLUSION

Using the PSP test in combination with amnioscopy, we have established a method of differentially diagnosing PROM. We have reconfirmed the clinical efficacy of the PSP test in 64 equivocal PROM cases.

Fetal fibronectin concentration in amniotic fluid decreases with advancing gestational age

OBJECTIVE

The purpose of this study was to investigate the changes in the level of fetal fibronectin in amniotic fluid during the course of pregnancy.

METHOD

Amniotic fluid samples were obtained from 74 women whose pregnancies ranged in gestation from 14 to 38 weeks. Fetal fibronectin in amniotic fluid was examined with a sensitive immunoassay using a monoclonal antibody FDC-6 which recognizes a unique epitope (III-CS) of the molecule.

RESULTS

Fetal fibronectin levels in amniotic fluid decreased significantly during pregnancy (r = -0.79, P < 0.0001). The mean levels at less than 20 weeks of gestation were significantly higher than those at 20-29 weeks (P < 0.0001) and at 30 weeks to term (P < 0.0001).

CONCLUSION

These results must be considered when fetal fibronectin in vaginal fluid is used as an indicator of the rupture of membranes.

[Anatomical analysis of small bronchial arteries in front of the trachea by 3D-CT and digital subtraction angiography: implications for esophageal cancer surgery]

To preserve blood supply to the trachea and bronchus in the surgical procedure for esophageal cancer, anatomical characteristics of small bronchial arteries which course in front of the trachea were analysed by three-dimensional computed tomography (3D-CT) and digital subtraction angiography (DSA). In the 3D-CT study using five mediastina, three dimensional images of the bronchial arteries were reconstructed after the injection of contrast medium into the intercostobronchial arteries. Thus the detailed vascular network of the course of the small bronchial arteries in front of the trachea could be delineated. In the DSA study using seven mediastina, through this network of bronchial arteries, the branches originating from the aorta and the arteries supplying the cranial portion of the trachea could be viewed. These results indicate that the bronchial arteries are connected by a vascular network in front of the trachea. Based on these detailed findings, it is considered critical to avoid damage to the intercostobronchial artery and also the network of bronchial arteries in order to preserve blood supply to the trachea and bronchus.

Symptomatic intraventricular arachnoid cyst in an elderly man

A case of intraventricular arachnoid cyst in an elderly man is reported. A 63-year-old man developed a progressive gait disturbance over a five-year period. CT scan showed a large cyst in the left lateral ventricle which was negative to contrast enhancement. CT cisternography revealed gradual accumulation and more than 48 hours retention of contrast medium in the cyst. The patient underwent left frontal craniotomy, and the cyst wall was partially resected for histopathological examination. Although limit microscopic examination could not establish a diagnosis, arachnoid cyst was diagnosed by electron microscopic findings. Biochemical analysis did not detect any difference between cyst fluid and CSF obtained during surgery. It is suggested that a ball-valve mechanism caused progressive enlargement of the cyst and gradual development of symptoms in this elderly patient.

Intraoperative stress for surgeons and assistants

1. Less experienced surgeons and assistants exhibit more stress during microsurgery. 2. This stress cannot be reduced easily, but can be overcome with experience. 3. Experienced surgeons should be aware of this stress when they train inexperienced surgeons and assistants.

Cloning of canine osteosarcoma cells

Six clonal cells were established from a canine osteosarcoma cell line (POS) by a limiting dilution method using feeder cells. Whereas histology of mass developed in nude mice by transplantation of POS cells revealed various cell types, clonal cells were morphologically consistent in size and shape. Doubling time of clonal cells ranged from 30 +/- 1.4 to 54 +/- 1.3 hr and alkaline phosphatase activity ranged from 0.040 +/- 0.001 to 2.61 +/- 0.435 mumol/min/mg protein depending on the cell types. When transplanted into nude mice, each clonal cell type formed following four histological types; osteoblastic, chondroblastic, fibroblastic, and undifferentiated types. Since each histological feature was found simultaneously in the primary tumor, osteosarcoma tissue might be a complex of various types of cells having different characteristics. Therefore, POS clonal cells may be useful as a potential tool for the studies of differentiation, phenotypic expression, and a new therapeutic modality of osteosarcoma.

Pregnancy complicated by Ebstein's anomaly: oxygen administration to mother for chronic fetal hypoxemia. A therapeutic case report

For chronic fetal hypoxia due to maternal Ebstein's anomaly, oxygen was administered daily to the mother by mask for 105 days. At 20 weeks of gestation, umbilical venous blood gases in room air showed pH 7.42, PO2 25.7 mm Hg, PCO2 33.7 mm Hg and O2 saturation 48.7%, and changed to 7.45, 39.1 mm Hg, 25.9 mm Hg and 77.4% on 3 liters/min of oxygen inhalation by mask, respectively. The PO2 of the maternal arterial blood gases increased to 30 mm Hg on oxygen administration at 15 weeks of gestation, but at 25 weeks of gestation the PO2 increased by only about 10 mm Hg. At 30 weeks, intrauterine growth retardation was suspected. Just after the second puncture of the umbilical cord at 31 weeks and 3 days of gestation, 80 bpm fetal bradycardia occurred for several minutes without recovery and emergency cesarean section was done under the general anesthesia.

Ethylene oxide sterilization of bone grafts. Residual gas concentration and fibroblast toxicity

We examined the concentration of ethylene oxide in bone allografts after gas sterilization. Chips of the human femoral head were investigated. Residual gas concentration was determined by gas chromatography after the bone chips had been subjected to defatting and freeze-drying, followed by ethylene oxide gas sterilization. Bones were prepared in various ways in an attempt to reduce the concentration of residual ethylene oxide. The concentration was higher when gas sterilization was performed before freeze-drying than when it was done afterwards. An experiment performed with fibroblasts showed the high toxicity of residual ethylene oxide in bone chips, even when the concentration was very low. The growth of fibroblast was reduced more in medium which had been shaken with bones sterilized with ethylene oxide before freeze-drying than in medium which had been shaken with bones sterilized after freeze-drying. The higher residual ethylene oxide concentrations resulted in a decrease in fibroblastic culture activity. Our experiment showed the importance of reducing the residual ethylene oxide gas concentration. Defatting and freeze-drying result in lower residual ethylene oxide concentrations.

Inflammatory chemical mediators during conventional ventilation and during high frequency oscillatory ventilation

Inflammatory chemical mediators, platelet-activating factor (PAF), thromboxane (TX) B2, and 6-keto-prostaglandin (PG)F1 alpha, were extracted from lung lavage fluid after conventional mechanical ventilation (CMV) and high frequency oscillatory ventilation (HFOV) to clarify the relation between mode of ventilation and lung injury in surfactant-depleted rabbit lungs. Anesthetized adult rabbits were tracheostomized, and surfactant depletion was induced by repeated saline lavage. Lung lavage for measurement of mediators was performed after 4 h of CMV at an FIO2 of 1.0 and a mean airway pressure of 15 cm H2O or HFOV (15 Hz) at an FIO2 of 1.0 or 0.21 and a mean airway pressure of 15 cm H2O. The number of total cells and polymorphonuclear leukocytes (PMN) and the levels of PAF, TXB2, and 6-keto-PGF1 alpha were measured by radioimmunoassay. Total respiratory compliance (Crs) was measured by the passive flow-volume curve method. The numbers of PMN, and the levels of PAF and TXB2 in lung lavage fluid were significantly greater during CMV than during HFOV. HFOV resulted in decreased production of PAF and TXB2 in a surfactant-depleted rabbit lung. Crs was significantly less during CMV than during HFOV. These results suggest that HFOV could prevent the release of such inflammatory chemical mediators and result in less lung injury than CMV.

Vertebral pedicle diameter as determined by computed tomography: inaccuracies observed by direct measurement of cadaveric lumbar spine

The isthmic diameter of the vertebral pedicle is an important dimension affecting the stability of transpedicular screwing. The isthmic diameter of the pedicle was measured in the lumbar spines of 18 Japanese cadavers (10 male, 8 female) by axial computed tomographic (CT) scan and directly with calipers. In L1 and L2, there was no significant difference between the average value of the isthmic diameter as determined by the two methods (Student's t-test). However, in L3-5, the average value of the isthmic diameter as determined by axial CT scan was significantly greater than that given by caliper measurement. In view of the fact that caudally the longitudinal axis of the pedicle diverges towards the mid-line of the vertebral body in the coronal plane, the plane of the CT scan cannot be parallel to the real isthmic diameter of the pedicle. Therefore, it is suggested that below L2 the diameter as determined by axial CT scanning is greater than the real isthmic diameter.

Nutrient balance, metabolic response, and bone growth in VLBW infants fed fortified human milk

The effects of fortification of preterm human milk were evaluated by comparing two groups of very low birth weight infants (birth weight < or = 1300 g, gestational age < or = 30 weeks): six fed preterm human milk fortified with a commercially available protein-mineral supplement (protein 0.7 g/dl, calcium 90 mg/dl, phosphorus 45 mg/dl) and seven fed unfortified preterm human milk. Nitrogen and energy balance studies were performed at an average age of 56 postnatal days. Nitrogen retention in the fortified group (348.2 +/- 70.5 mg/kg/day) was significantly greater than that in the unfortified group (196.0 +/- 50.0 mg/kg/day) and similar to that of fetuses of comparable gestational age. Energy stored by the two groups did not differ. At age 8 weeks, the infants in the fortified group had higher serum protein, higher serum albumin, and better mineral status (higher serum calcium and phosphorus and lower alkaline phosphatase and renal tubular reabsorption of phosphate). The bone density and width of the distal third radius, as measured by X-ray microdensitometry, were greater in the fortified group than in the unfortified group 12 weeks after birth. These results suggest that the supplement corrects any nutritional inadequacies of preterm human milk for very low birth weight infants.

In vitro assay of the invasive potential of malignant bone and soft tissue tumours through basement membranes

We have used reconstituted basement membrane molecules which have formed into barriers in order to investigate the invasive potential of malignant bone and soft tissue tumour cells in vitro. A number of cell lines established from human malignant tumours demonstrated a high degree of invasiveness, although fibroblasts showed no ability to penetrate the basement membrane barrier. H-ras oncogene transfected cells into the fibroblasts were much more invasive than the parent lines. Primary cultures of malignant tumour cells demonstrated invasiveness, while those of nonmetastatic cells and fibroblasts did not. The binding of tumour cells to laminin in the basement membranes was found to induce secretion of collagenase and motility which are crucial factors for invasion. A synthetic peptide, Tyr-Ile-Gly-Ser-Arg, was able to suppress the invasiveness of HT1080 human fibrosarcoma cells, and also reduced lung colonisation in vitro. The results suggest that the in vitro assay was useful, firstly to determine the invasive potential, secondly to investigate the mechanism of invasion, and finally to development treatment against invasion and metastases.

Drug-induced endothelial injury potentiates lung colonization in a murine fibrosarcoma model

Lung colonization induced by the intravenous injection of fibrosarcoma cells into syngeneic mice was enhanced by the pretreatment of mice with cyclophosphamide (CPA), adriamycin (ADM), cis-diammine-dichloroplatinum II (DDP) and methotrexate (MTX). At equitoxic levels, CPA showed greater enhancement of the lung colonization than the other drugs treated. After a two-hour pretreatment of an endothelial monolayer culture, the adhesion of fibrosarcoma cells to endothelial cells was enhanced by all drugs, and the greatest enhancement was obtained with CPA. Data from these experiments supports the hypothesis that endothelial cell damag by anticancer drugs may facilitate metastasis of circulating tumor cells.

Postnatal reference growth curves for very low birth weight infants

To construct standard growth curves for Japanese infants of very low birth weight (VLBW) with birth weights of 500-1499 g, we reviewed longitudinal data provided by 54 neonatal intensive care units in Japan. A total of 382 surviving singleton infants, appropriate for gestational age infants, and who were free of neurological sequelae at more than 2.5 years of age, were enrolled. Growth curves, including body weight, head circumference and body length were generated for four ranges of birth weight: 500-749 g, 750-999 g, 1000-1249 g, and 1250-1499 g. When compared with previously published growth data from western countries, Japanese infants of VLBW showed greater weight loss, regained birth weight more slowly, and exhibited smaller average gains in weight, head circumference, and body length. The growth curves reported in western countries may not be useful as reference standards of early postnatal growth in Japan. The new growth curves are a more accurate reflection of current in-hospital growth trends in Japan.

Molecular and crystal structure of (2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl)-(1-->3)- [2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl-(1-->6)]- (2,4-di-O-acetyl-beta-D-glucopyranosyl)- (1-->3)-1,2,4,6-tetra-O-acetyl-beta-D-glucopyranose

Crystals of the tetrasaccharide, (2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl)-(1-->3)- [2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl-(1-->6)]- (2,4-di-O-acetyl-beta-D-glucopyranosyl)-(1-->3)- 1,2,4,6-tetra-O-acetyl-beta-D-glucopyranose, belong to the monoclinic system, space group P2(1), with a = 12.709(4), b = 27.767(9), c = 9.567(4) A, beta = 105.07(2) degrees, and Z = 2. The crystal structure was solved by the direct method and refined by the full-matrix least-squares procedure to an R-value of 0.071 for 302- observed reflections in the X-ray data. All the four D-glucopyranose residues have the usual 4C1 chair conformations. The torsional angles at two (1-->3)-beta-linkages were phi(O-5-1-O-1-C-3) = -74 degrees and psi (C-1-O-1-C-3-C-2) = -122 degrees between the nonreducing and the middle residues, and phi = -67 degrees, psi = -111 degrees between the middle and the reducing residues. The orientation about the (1-->6)-beta-linkage was found to be phi(O5-C1-O-1-C-6) = -77 degrees, theta(C1-O-1-C-6-C-5) = 160 degrees, and chi(O-1-C-6-C-5-O-5) = 63 degrees (gt conformation). The primary acetate groups at C-6 of the reducing and the (1-->6)-branched residues were in the gt conformations (O-5-C-5-C-6-O-6 = 81 degrees and 84 degrees, respectively). On the other hand, the gg conformation was observed for the primary acetate group in the nonreducing residue (O-5-C-5-C-6-O-6 = 78 degrees).

Efficacy of synchronized IMV on weaning neonates from the ventilator

This study evaluated the efficacy of a new patient-triggered ventilator that triggered the patient's inspiratory effort by detecting the change in airflow by means of a 'hot wire' anemometer. This ventilator was used in both the conventional and the synchronized intermittent mandatory ventilation (SIMV) modes in seven neonates. Values for blood gas, spontaneous breathing rate, tidal volume of spontaneous breaths and minute volume were compared in all seven neonates. The resistive work of spontaneous breathing in five neonates, obtained with synchronized intermittent mandatory ventilation was compared with the values obtained using conventional mechanical ventilation on the previous day of weaning from the ventilator. At each the inflation time studied (0.4, 0.3, 0.24 s), all mechanical breath occurred synchronously with infants' inspiratory efforts. The median trigger delay was 80 ms. Oxygenation was improved on the new system compared with the conventional system. Tidal volume of spontaneous breathing and minute volume were increased with SIMV compared with conventional mechanical ventilation, although the resistive work of spontaneous breathing was decreased with SIMV. The tidal volume of spontaneous breaths was more constant with SIMV versus conventional mechanical ventilation. Thus, the airway flow-triggered SIMV may lessen inspiratory muscle fatigue during weaning process. We conclude that the SIMV is useful in weaning neonates from the ventilator.

[Studies on cell-mediated immunity (CMI) in the glomeruli: immunization with GBM antigen from Masugi nephritis in Wistar-Kyoto rats]

The role of cell-mediated immunity in glomerular injury has been extensively studied, but the precise mechanism remains obscure. This study was undertaken to determine whether the homologous glomerular basement membrane (GBM) combined heterogeneous anti-GBM antibody would induce cell-mediated immunity. Wistar-Kyoto rats were divided into three groups; group I rats were immunized with homologous GBM antigen that was derived from Masugi nephritis and emulsified in complete Freund's adjuvant (CFA); group II rats were immunized with homologous GBM antigen that was derived from normal rats and emulsified in CFA; group III rats were immunized with CFA only. Group I rats demonstrated proteinuria on days 7 and 10 after immunization. Histologically, mesangial cell proliferation and cell infiltration were observed in the glomeruli. No changes in tubulointerstitial tissue. CD4-positive cells, CD8-positive cells and macrophages were found in the glomeruli, and mononuclear cells were found in the glomerular capillary lumen. Group II and Group III rats demonstrated no proteinuria and no histological changes. These findings indicated that the altered GBM obtained antigenicity and induced cell-mediated immunity in the glomeruli.

Separation and identification of serum gamma-glutamyl transpeptidase isoenzymes by wheat germ agglutinin affinity electrophoresis: a basic analysis and its clinical application to various liver diseases

Serum gamma-glutamyl transpeptidase (gamma-GTP) was separated into four fractions by using wheat germ agglutinin (WGA) affinity electrophoresis. By two-dimensional analysis using gel filtration combining with affinity electrophoresis with WGA, anti-alpha 1-lipoprotein antiserum or anti-beta-lipoprotein antiserum, properties of each fraction were identified as a high molecular WGA affinity fraction (HM), a relatively high molecular beta-lipoprotein binding fraction (beta-LP), an intermediate molecular alpha-lipoprotein binding fraction (alpha-LP) and a low molecular fraction (LM). Quantitative alterations in each fraction of gamma-GTP in the serum of patients with various liver diseases and gall stones (GS) were also examined. In patients with hepatocellular carcinoma (HCC), the HM fraction was more increased compared with those in patients with non-alcoholic liver cirrhosis (LC) and chronic hepatitis (CH). The rate of HM fraction was correlated with total activity of serum gamma-GTP in HCC patients. In alcoholic liver disease (ALD), no remarkable differences of the rate of each gamma-GTP fraction were shown among alcoholic LC, alcoholic hepatitis, alcoholic CH and fatty liver patients. It was, however, shown that the rate of the LM fraction decreases and the HM fraction increases gradually in accordance with an increase in serum gamma-GTP activity in ALD. These data indicate that serum gamma-GTP isoenzymes can be separated clearly into four fractions by using WGA affinity electrophoresis, the HM fraction of serum gamma-GTP is relatively increased in HCC patients, and detection of the HM fraction may be useful to diagnose HCC, although it can be increased in ALD patients with high serum gamma-GTP activity.

[Anatomical study on the right bronchial artery for operation of esophageal cancer through right thoracotomy with special reference to the intercostobronchial arteries]

In view of the operative field of esophageal cancer, anatomical findings of the right bronchial arteries were studied in specimens of 71 cadavers. Intercostobronchial arteries were absent only in 3 cadavers (4.2%; group A). As 22.6% of the cadavers had only one intercostobronchial artery supplied as the right bronchial artery (group B), it was considered to be important to preserve this artery. Cadavers both with the intercostobronchial artery and with the other right bronchial-arteries were observed in 70.4% (group C). Right bronchial arteries deriving from the aorta to course similarly to intercostobronchial arteries were present in small number (group D). Further, right bronchial arteries were classified into three types according to the deriving arteries as follows: (I) intercostobronchial arteries, (II) bronchial arteries deriving from the aorta, (III) other right bronchial arteries deriving from right subclavian artery, right inferior thyroid artery or right interthoracic artery. Considering difficulty of the approach from the operative field with right thoracotomy and the anatomical relationship with neighboring organs, it was thought that preserving the type (I) arteries is easy, the type (III) has a possibility to be preserved, and (II) is hard to be preserved. We concluded that preserving intercostobronchial arteries is important in esophageal cancer surgery approached through right thoracotomy because of small number of cadavers without these arteries and ease of preservation.

Stability of transpedicle screwing for the osteoporotic spine. An in vitro study of the mechanical stability

The influence of bone mineral density on the stability of transpedicle screwing was studied in the human cadaveric lumbar vertebrae. The pull-out force correlated with bone mineral density. The tilting moment (load needed to tilt the screw 4 degrees cranially at the screw-plate junction) and the cut-up force (load needed to tip the end plate up by the screw) correlated with bone mineral density. A correlation was also found between the maximum insertion torque of the screw and bone mineral density. The maximum insertion torque correlated with the pull-out force, the tilting moment, and the cut-up force. In the cyclic tilting test (200 cycles), the mean value of the tilting moment at the 200th cycle was 67.4 +/- 6.1%, compared with the first cycle. The results suggest that preoperative measurement of BMD is necessary for transpedicle screwing in osteoporotic cases, and that the cyclic tilting motion decrease its mechanical stability. The authors have also concluded that the maximum insertion torque could predict the mechanical stability.

[Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy under epidural anesthesia with high dose fentanyl]

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by asymmetric hypertrophy of the intraventricular septum, causing intermittent obstruction of the left ventricular outflow tract. General principles of management for HOCM include maintenance of adequate preload and afterload, and avoidance of tachycardia and increased myocardial contractility. A 57 year old male for subtotal gastrectomy and gastrojejunostomy received epidural anesthesia with epidural high dose fentanyl (0.5 mg) and 0.5% isoflurane with N2O and oxygen. Blood pressure and heart rate decreased mildly but were stable during the operation and during the recovery period from anesthesia without any complaints of pain. The results suggest that epidural high dose fentanyl anesthesia is a good method for patients with HOCM.

[Anatomic study of the bronchial arteries for operation of esophageal cancer]

In view of the operative field of esophageal cancer, anatomic findings of the bronchial arteries were studied in specimens of 38 cadavers. The number of right and left bronchial arteries were 68 and 61, respectively. The most common branching type was two right and two left arteries, occurring in 36.8% (14/38). Next common type was two right and one left arteries (34.2%). Each specimen had one right intercostobronchial artery and it was considered easy to preserve blood supply to right bronchial artery when cleansing of mediastinal lymphatic chain is performed. But the other 30 right bronchial arteries originating from the aorta coursed, to the area of inferior tracheobronchial lymph nodes, and thus there will be possibility of injury. All of the left bronchial arteries derived from the aorta. The course of 5 left bronchial arteries ran to the area of inferior tracheobronchial lymph nodes, and the one of 41 arteries passed to the area of left tracheobronchial lymph nodes. Therefore, there will be strong possibility of injury to these left bronchial arteries. But the other 19 left bronchial arteries didn't course to any area of lymph nodes, and the arteries can possibly be preserved.

Stannum (IV) chloride stimulates vanadium (IV) catalyzed oxidation of NADH

Stannum has been found to be an essential ultratrace element, however, the biological functions of stannum remain to be clarified. We found that stannum (IV) chloride stimulates vanadium (IV) catalyzed free radical chain oxidation of NADH. Stannum (IV) chloride, per se, did not catalyze the NADH oxidation. Superoxide, H2O2, and OH. are known to be the key species in vanadium catalyzed NADH oxidation. The inhibition of the vanadium (IV) catalyzed NADH oxidation in the presence of stannum (IV) chloride by catalase, superoxide dismutase (SOD), and hydroxyl radical scavengers indicated that the stannum (IV) chloride stimulated NADH oxidation consisted of almost the same reaction steps as that in the absence of stannum (IV) chloride. The results of inhibition studies on the NADH oxidation with SOD and catalase suggested that the reaction mixture containing stannum (IV) chloride contained a greater amount of H2O2 and a lower amount of O2- than that containing only vanadium (IV). Hydrogen peroxide is the precursor of OH. in the free radical chain reaction. The stimulation of NADH oxidation by stannum (IV) chloride is due to the stimulation of H atom abstraction by OH.. Stannum (IV) chloride might stimulate the generation of OH. by producing H2O2.

Ventriculitis in infants: diagnosis by color Doppler flow imaging

A color Doppler flow imaging technique was used to study the dynamics of cerebrospinal fluid (CSF) in infants with meningitis. Eight infants with bacterial meningitis (6) or aseptic meningitis (2) were studied with color Doppler imaging of CSF flow for a total of 18 times. In 2 infants with bacterial meningitis, Doppler sonograms of CSF flow were obtained in the aqueduct during the acute stage. The CSF flow demonstrated a to-and-fro motion which was synchronized with cardiac pulsations and respiration. The detection of CSF flow on color Doppler flow imaging in the aqueduct may indicate the existence of ventriculitis. Color Doppler flow imaging is useful for the evaluation of CSF flow dynamics in infants.

Effect of mexiletine on elimination and metabolic conversion of theophylline and its major metabolites in rats

In an attempt to clarify the possible mechanism of the interaction between theophylline (TP) and mexiletine (ME), the elimination kinetics and in vitro metabolism of TP and its metabolites were investigated in rats. The plasma elimination of TP, 1,3-dimethyluric acid (1,3-DMU) and 1-methyluric acid (1-MU) was significantly delayed by the intravenous (i.v.) administration of ME. The oral administration of ME also decreased the elimination rate of TP to the same extent as the i.v. dosing. The in vitro metabolic experiment showed that ME significantly inhibited the metabolic conversion of TP to 1,3-DMU and, 1,3-DMU to 1-MU, and slightly inhibited the conversion of TP to 3-methylxanthine, these processes being mediated by microsomal enzymes, with no inhibition of xanthine oxidase. Our results indicated that ME could inhibit the metabolic conversion of TP and its metabolite in rat, as reported in man.

A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure

A multicenter randomised trial was conducted in nine neonatal centers in Japan to re-evaluate the safety and the efficacy of high frequency oscillatory ventilation using the piston type oscillator (Hummingbird) in the treatment of respiratory failure in preterm infants weighing between 750 and 2000 g at birth. A total of 92 infants were enrolled in the study. Forty-six infants were allocated to high frequency oscillatory ventilation and 46 infants to conventional mechanical ventilation. There were no differences in sex, birth weight, gestation and Apgar score between groups. The study was begun 2.0 +/- 1.6 h (mean +/- S.D.) after birth in the high frequency oscillation group and 1.7 +/- 1.5 h after birth in the conventional mechanical ventilation group. The absence of intraventricular hemorrhage was confirmed by echography in all cases before beginning ventilation. Mortality was similar in high frequency oscillatory ventilation and conventional mechanical ventilation (0 and 2%). The incidence of intraventricular hemorrhage was also similar in the high frequency and conventional mechanical ventilation groups (15 and 13% overall; 4 and 2% in grades III and IV, respectively). Nine percent of the infants in high frequency oscillatory ventilation and 13% in conventional mechanical ventilation developed bronchopulmonary dysplasia, but the difference was not significant. The frequency of air leaks was also equal in both groups. Periventricular leukomalacia was detected in 9% of infants on conventional mechanical ventilation and 2% on high frequency oscillation, but the difference was not significant. Mean airway pressure was significantly higher in the high frequency oscillatory ventilation group and the infants on high frequency oscillation showed a significantly higher arterial to alveolar oxygen tension ratio after 6 h of treatment. These results suggest that high frequency oscillatory ventilation does not increase the risk of severe complications such as air leaks, intraventricular hemorrhage or periventricular leukomalacia when it is used by experienced neonatologists. Indeed high frequency oscillatory ventilation helps provide better oxygenation with higher mean airway pressure without increasing the risk of bronchopulmonary dysplasia and severe complications such as air leaks and intraventricular hemorrhage.

Immunological abnormalities in HIV-free haemophiliacs

Since some haemophiliacs manifest profound immunodeficiency with no evidence of human immunodeficiency virus type 1 (HIV) infection, we measured the circulating immune complex (CIC) level in sera obtained from haemophiliacs and addressed the question of whether viral infection is associated directly or indirectly with enhanced CIC production. While more than 90% of HIV-positive individuals had a high level of CIC, around 60% of seronegative ones also showed CIC levels comparable to those of seropositive patients. These sera activated fresh complement in vitro. The patients infected with either HIV or Hepatitis C virus (HCV) or both showed higher frequency and concentration of serum CIC than those free of either pathogens. It is worth noting, however, that 64% of patients with no evidence of infection with HIV or HCV produced significant amounts of CIC. Among the infectious viruses examined, parvovirus is considered as one of the pathogens associated with CIC synthesis, since all the haemophiliacs including the HIV-free patients who had been supplied with heated coagulation factors for several years from birth carried antibodies to parvovirus B19. Strikingly, 60% of the children in this category were positive for CIC, suggesting the possible contribution of parvovirus infection to CIC formation.