[The controversy on the treatment of aortic dissection]

It is obvious that there are many controversies regarding to the treatment of aortic dissection. In this report, we discuss following points such as 1) classification, 2) thrombosed type dissection, and 3) simultaneous graft replacement of ascending and aortic arch with the reconstruction of cervical branches. From the patho-morphological status, dissection will be classified into two types, localized and extended types. From the anatomical and surgical points of view, it will be also classified as 1) ascending-arch, 2) descending-thoracoabdominal, and 3) abdominal. With the combination of these two, dissection will be classified more clearly. The thrombosed type will be incorporated into localized type. We have experienced 76 cases of this dissection, and clinical features and outcome by medical treatment only are presented. The simultaneous reconstruction of ascending aorta and aortic arch for the dissection at ascending-arch type was undertaken in total of 35 patients. The surgical results as well as follow up data are presented and the benefit of this extended procedure is presented as well.

Metal-tetracycline/H+ antiporter of Escherichia coli encoded by transposon Tn10. Roles of the aspartyl residues located in the putative transmembrane helices

Three conserved aspartyl residues located in the putative transmembrane helices in the Tn10-encoded metal-tetracycline/H+ antiporter were replaced by Asn, Lys, or Glu with oligonucleotide-directed site-specific mutagenesis. Replacement of Asp84 or Asp15 by Asn or Lys caused a severe defect in tetracycline transport activity, however, the Glu84 and Glu15 mutants retained 150 and 40% of the wild type activity, respectively, indicating the critical role of the negative charge. The increase in the activity of the Glu84 mutant was due to an increase in the affinity for the substrate. H+/tetracycline coupling was intact in these mutants, including Asn and Lys mutants. On the other hand, all of the Asp285-substitution mutants showed a severe defect in tetracycline transport activity and a complete lack of tetracycline-coupled H+ transport. However, since in vivo tests showed the tetracycline resistance for the Glu285 mutant, a negative charge in position 285 plays some role in maintaining the possible down-hill and/or low affinity efflux of accumulated tetracycline from intact cells. Similar work was done for Asp365, and here the Asn and Glu mutants showed decreased but high activity, while the Lys mutant was only marginally active (5%), indicating that a negative charge is not so demanding in position 365, possibly because it is not in the membrane.

Adenomyomatosis of the gallbladder: a clinical survey of 30 surgically treated patients

Thirty patients with adenomyomatosis of the gallbladder (AMG) were operated on between January 1983 and June 1990. They were made up 3.3% of patients who underwent cholecystectomy during the same interval. Of the 30 patients, ages ranged from 22 to 77 years (mean 52.3 years) and the male-to-female ratio was 8:7. Among the macroscopic types, 10 cases of generalized, 12 of segmental (S) and 8 of fundal (F) were noted, and the size of the affected portion in type S (0.8 +/- 0.2 cm, mean +/- SD) was significantly thinner than in other two types (p less than 0.05). Although the main symptom was abdominal pain, the majority of patients with type F had no complaints. Twenty patients (27%) were accompanied by gallstones including cholesterol stones in 60% of cases, and all six cases showing microbes in the bile had gallstones. Only six patients were diagnosed as AMG by preoperative imaging techniques. Other diagnoses comprised 15 of chronic cholecystitis and 3 of suspected gallbladder carcinoma. To identify the expanded Rokitansky-Aschoff sinuses, endoscopic retrograde cholangiography and/or ultrasonography of the abdomen were most useful. No preponderant coexistent lesion other than gallstones was noted. Levels of carcinoembryonic antigen in gallbladder bile in cases of AMG (2.5 +/- 1.5 ng/ml, mean +/- SD) were significantly lower than in gallbladder carcinoma (p less than 0.01). All the patients were easily treated with cholecystectomy, and 24 patients who have been followed up after surgery are doing well.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bone metastases in breast cancer and its risk factor--follow up study by bone scintigraphy]

Breast cancer is considered to often involve bone metastasis. Early detection and treatment of bone metastasis are essential in improving the prognosis of this disease. In 47 patients with bone metastasis confirmed with bone scintigraphy, we examined the appearance time of bone metastasis; bone metastasis was frequently observed with the progress of stage, but no association with the appearance time was found. Age was not associated with the incidence of bone metastasis but was found to be closely related to its appearance time. That is to say, patients with breast cancer below 40 years of age showed relatively early bone metastasis. Bone scintigraphy is required every 6 months at least for 3 years after the operation. In patients over 40 years of age, on the other hand, bone scintigraphy is required only once a year but has to be continued for 5 years or more, because they often show relatively late bone metastasis.

The effect of oxygen addition on the determination of cadmium and lead in blood and foods by graphite furnace atomic absorption spectrometry

It is well known that in the analysis of low temperature vaporized metal elements such as cadmium and lead, a high ashing temperature causes a loss of the target atoms at the ashing stage, while low ashing temperature causes incomplete decomposition of organic components in the sample. In order to solve these problems, the effect of oxygen addition on determination of cadmium and lead in blood and foods was studied. Oxygen was introduced into the atmosphere in the graphite furnace at the beginning of ashing stage for 20 seconds at 0.5 l/min. Relation between ashing temperature and sensitivity was examined, and the oxygen addition minimized signal depression by the sample matrix. It can be concluded that the addition of oxygen at the ashing stage not only reduces the background absorption, but also suppress the volatilization of target atoms at the ashing stage by the formation of their oxides.

Ultraviolet imaging densitometry of unstained gels for two-dimensional electrophoresis

A system suitable for ultraviolet imaging densitometry of two-dimensional electrophoretic gels that are unstained is described, together with its applications. A flying-spot densitometer linked with a personal computer was used for data acquisition, generation of mapping data, and image processing. Randomly distributed zones of proteins on two-dimensional gels were detected at 280 nm without being stained by two-dimensional scanning, and the densitometric value of each pixel (0.2 x 0.2 mm) was memorized by the computer, which generated a mapping pattern with density contours. The amount and densitometric value of cytochrome c had a linear relationship in the range of 2-200 micrograms. Zone locations of bovine liver proteins separated on two-dimensional gels were indicated on a map expressed in X-Y coordinates, and the pIs and molecular weights could be calculated from the map by use of pI and molecular weight markers on the same gel.

Reappeared pancreatic cyst after surgical treatment of cystic lesions of the pancreas

An extremely high incidence of reappearing cyst of the pancreas (24.1%; 7 out of 29 patients) was noted in the present survey. However, reappearance could have been avoided in the majority of cases with the use of thorough pre- and peri-operative assessments of the extent of cystic lesion of the pancreas. The recurrence rate after surgical treatment for pseudocysts (13.6%; 3 out of 22 patients) was similar compared with usual recurrence rate of approximately 10 percent. If the reappearing cyst is a retention cyst or a pseudocyst, a minimally aggressive procedure should initially be considered to aid its resolution. A part of this study was reported at the 51st meeting of the Japanese Society for Clinical Surgery on November 2, 1989 at Kobe, Japan.

AMP deaminase as a cell-age marker in transient erythroblastopenia of childhood and its role in the adenylate economy of erythrocytes

Erythrocytes from 11 patients with presumptive diagnoses of transient erythroblastopenia of childhood were evaluated retrospectively (six) or prospectively (five) for a possible relationship between erythrocyte adenosine 5'-monophosphate aminohydrolase, adenylic acid deaminase (AMP deaminase) activity and intracellular concentrations of adenine nucleotides. Older red blood cell (RBC) cohorts in these patients consistently exhibited significantly decreased activities of AMP deaminase (approximately 5% to 70% of normal control mean) in association with increased concentrations (up to threefold) of adenosine triphosphate (ATP) and total adenine nucleotides. We postulate that the latter is a direct consequence of the former, since diminishing AMP deaminase activity in aging cells should reduce the drain on the adenine nucleotide pool imposed by irreversible deamination of AMP to inosine 5'-monophosphate. Consistent reductions in AMP deaminase activity indicate that this enzyme should also serve as a reliable marker of mean RBC age useful in diagnostic confirmation of transient erythroblastopenia. The observed increases in ATP and total adenine nucleotides in older RBCs require a reevaluation of the traditional view that age-related losses of these compounds mediate the ultimate demise of senescent erythrocytes. Similar alterations in the balance of degradative and salvage pathways in RBC nucleotide metabolism may also underlie certain cases of so-called "high ATP syndrome."

Inhibition of adenylate kinase by P1,P5-di(adenosine 5') pentaphosphate in assays of erythrocyte enzyme activities requiring adenine nucleotides

P1,P5-di(adenosine 5')pentaphosphate (Ap5A) is an excellent inhibitor of human hemolysate adenylate kinase at concentrations near 2 microM and above. At ten times this concentration and in hemolysate enzyme assays under conditions described in this paper it appears not to alter reaction data in the case of hexokinase, phosphofructokinase, and phosphoglycerokinase. In the pyruvate kinase assay, very modest reductions in activity are noted, and kinetics with phosphoenolpyruvate, adenosine diphosphate (ADP), and uridine diphosphate (UDP) are unaltered.

Macrophage-produced oxygen radical generating activities for polymorphonuclear leukocytes

Guinea pig peritoneal macrophages were stimulated in vitro by bacterial lipopolysaccharide. After incubation, the supernatants of macrophage cultures were collected and tested for O2- production on guinea pig peritoneal polymorphonuclear leukocytes. The supernatants of macrophage cultures stimulated by lipopolysaccharide had significantly higher levels of O2- -generating activities in polymorphonuclear leukocytes, and these activities appeared in the macrophage cultures within 2 h after stimulation by lipopolysaccharide. However, the supernatants obtained from the nonstimulated cultures could not produce these activities. These activities disappeared with heating or trypsin and were not produced in macrophage cultures by incubation with cycloheximide.

[Blood flow dynamics of the portal venous system in liver cirrhosis using pulse Doppler method]

Blood flow dynamics of the portal venous system including portal vein, splenic and superior mesenteric arteries, in thirty seven cases with liver cirrhosis and 32 controls were studied by means of the pulse doppler method. Maximum blood flow velocity of the main portal vein in liver cirrhosis was 0.21 m/sec in mean, significantly lower than in controls. Blood flow volume of the portal vein in liver cirrhosis was 18.9 ml/min.kg, which was a significant increase compared with that of controls. The cases of liver cirrhosis showed an increased blood flow volume of the splenic and superior mesenteric arteries, showing an increased pre-load to the spleen. In 5 cases, liver volume measured by computed tomography was not changed despite of an increase of the main portal venous flow volume. Three of these 5 cases were of more advanced liver cirrhosis with over 40 percent of ICG value. They bend to have higher portal venous velocity than the other cases with less advanced liver cirrhosis. No correlation of the splenic arterial flow volume and the spleen volume was thought to indicate after-load to the spleen as a factor of splenic enlargement.

Pyruvate kinase Greensboro. A four-generation study of a high K0.5s (phosphoenolpyruvate) variant

The proband with lifelong hemolytic anemia has a high K0.5s phosphoenolypyruvate (PEP) erythrocyte pyruvate kinase (PK) variant substantially but incompletely normalized by the allosteric modifier fructose-1,6-diphosphate (F-1,6-P2) with conversion of sigmoidal to hyperbolic kinetics. Heterozygotes in four generations express qualitatively identical but less severely abnormal kinetics and lack overt hemolysis. Kinetic abnormalities are closely mimicked by sulfhydryl modification of normal PK. Three distinct clinical and metabolic phenotypes characterize the proband and two sisters: variant PK and hemolytic anemia, variant PK without clinical manifestations or hemolysis, and complete normality. Their mother, whose red cell PK is entirely normal except for a questionably slightly low Vmax, is postulated to express the gene products of nonidentical alleles, one encoding a product with mildly less favorable catalytic characteristics. At low PEP concentrations, the proband and heterozygotes for the PK mutant express only a very small fraction of normal PK activity despite apparent inheritance of one normal allele in the latter. Evidence suggests that disproportionately lowered PK activity may be a property of a heterotetrameric PK. Illusory abnormalities in nucleotide specificity are artifacts of diminished substrate affinity characterizing the mutant PK.

Erythrocyte pyruvate kinase (PK): the variable significance of "nucleotide specificity" in the characterization of mutant variants

The half-saturation constant (K0.5s) phosphoenolpyruvate (PEP) for red cell pyruvate kinase (PK) with co-factors UDP and GDP is less than one-half that with ADP with or without additions of the allosteric modifier, fructose-1, 6-dephosphate (F-1, 6-P2) to the assay. The Vmax is markedly greater with ADP than with UDP or GDP, but with (PEP) at 0.5 mM, activity with all co-factors is about equal and at lower concentrations greater with UDP and GDP. With high K0.5s (PEP) mutant enzymes, and at the usual test concentration (lmM) for PEP when nucleotide specificity is assessed, the abnormally low saturation of variant enzymes may result in higher activity with UDP and GDP than with ADP--the opposite of the "normal situation." The apparent aberration in nucleotide specificity may thus be illusory and secondary to the abnormal K0.5s (PEP) of the mutant. Example data are recorded. Variations in K0.5s (PEP) may also be introduced during enzyme preparation for assay, particularly when partial purification is employed.

Substrate specificity and pH sensitivity of deoxyribonucleotidase and pyrimidine nucleotidase activities in human hemolysates

Residual 5'-nucleotidase activities in hemolysates from nine subjects with severe hereditary deficiency of pyrimidine nucleotidase (PyrNase) were compared to those in normal and reticulocyte-rich controls. Dephosphorylation rates of 12 potential ribo- and deoxyribomononucleotide substrates were measured as a function of pH. Data confirmed the existence of at least two isozymes of 5'-nucleotidase, PyrNase, and 2'-deoxy-5'-ribonucleotide phosphohydrolase (dNase) distinguishable by differences in maximal velocities, substrate preferences and restrictions, and pH optima. PyrNase was confirmed to be active principally with pyrimidine substrates (UMP = dCMP greater than CMP much greater than dTMP greater than dUMP) at a pH optimum of 7.5 +/- 0.1. dNase activity occurred with both purine and pyrimidine substrates and was maximal with deoxy analogs (dIMP much greater than dUMP greater than dGMP greater than dTMP = dAMP much greater than dCMP) at a pH optimum of 6.2, but slight cross-reactivity occurred with some nondeoxy substrates (IMP greater than GMP greater than UMP = XMP greater than CMP). PyrNase and dNase may be complementary systems that serve physiologically to clear the cytosol of RNA and DNA degradation products during maturation of erythroid elements by conversion of nucleotide monophosphates to diffusible nucleosides.

Effects of percutaneous transluminal coronary angioplasty on segmental left ventricular function in patients with acute myocardial infarction

In order to investigate the usefulness of percutaneous transluminal coronary angioplasty (PTCA) on subsequent left ventricular (LV) function in patients with acute myocardial infarction (AMI), regional ejection fraction (REF) was calculated from the left ventriculogram and compared in the acute and chronic phases (4 weeks after infarction) in 19 successful cases of PTCA (group A). In addition, 15 successful cases of intracoronary thrombolysis (PTCR) (group R) and 14 unsuccessful cases (group U) were also analyzed in this study. From the results, the following points were elucidated. (1) REF of group A in the chronic phase showed a significant increase compared to that in the acute phase (10 +/- 18% vs 20 +/- 19%, p less than 0.01), and this was similar to that observed in group R (9 +/- 19% vs 21 +/- 16%, p less than 0.01). (2) All cases in group A showed a significant increase in REF (p less than 0.02), if recanalization occurred within 3 hours after the onset of AMI. Some cases in the 3-6 hour recanalization group showed a decrease in REF. (3) In group A, only patients with subtotal occlusion on the initial coronary angiogram showed a significant increase in REF 4 weeks later (p less than 0.01), whereas patients with total occlusion on the initial coronary angiogram showed no significant increase in REF. (4) In group A, only patients recanalized between 3 and 6 hours showed a severe degree of prolonged contrast staining immediately after successful recanalization following PTCA. Thus, chronic phase regional wall motion was markedly improved by PTCA in those cases with residual flow. In contrast, abrupt recanalization after PTCA might causally decrease regional wall motion due to hemorrhagic infarction, if it is performed in cases with total occlusion.

Modification of erythrocyte enzyme activities by persulfides and methanethiol: possible regulatory role

Sulfhydryl modification of 22 human erythrocyte enzymes was achieved by exposing intact erythrocytes, hemolysates, and partially purified enzymes to persulfides (RSSH) generated nonenzymatically from cystine in the presence of pyridoxal phosphate and mercaptopyruvate, which donates its sulfur to suitable acceptors with the mediation of the carrier enzyme, mercaptopyruvate sulfurtransferase (EC 2.8.1.2). The inhibition pattern was qualitatively similar for persulfides and that previously reported by us for the methylthio-group donor, methyl methanethiosulfonate. Thirteen activities were inhibited, and 9 were minimally or not at all affected. Pyruvate kinase was similarly modified by all systems in terms of phosphoenolpyruvate kinetics, thermostability, and interaction with the negative effector ATP. Partial-to-complete reversal of inhibition was documented in a subset of activities inhibited by mercaptopyruvate upon 30-min incubation with 1 mM dithiothreitol. A possible physiologic role for methylthio groups and for persulfides is discussed.

Acute intravascular hemolysis in the black rhinoceros: erythrocyte enzymes and metabolic intermediates

Enzymes of aerobic and anaerobic glycolysis, glutathione cycling, and nucleotide metabolism were assayed on erythrocytes from 7 healthy rhinoceroses, 2 rhinoceroses during periods of intravascular hemolysis, and 1 rhinoceros without clinical signs of illness, which was the mother of 3 offspring with intravascular hemolytic syndrome. Measurements also were made of erythrocyte concentrations of glycolytic intermediates, adenine nucleotides, and glutathione. Although comparison of results for healthy and affected rhinoceroses did not identify an enzyme abnormality as a cause for the hemolytic syndrome, the data provided information regarding the metabolic characteristics of erythrocytes from healthy rhinoceroses.

Mechanisms of adenosine 5'-monophosphate catabolism in human erythrocytes

Uncertainties regarding the role of pyrimidine nucleotidase (PyrNase) in AMP catabolism were resolved by studies of erythrocytes from normal controls, controls with young mean cell ages, and patients with hereditary hemolytic anemia due to severe deficiency of PyrNase. Hemolysates from the latter exhibited undiminished capacity to dephosphorylate AMP over a broad range of pH, indicating that PyrNase was not directly involved. In each subject group, the rates of AMP dephosphorylation between pH 5.1 and 8.3 were indistinguishable from those of IMP, suggesting a potential role for AMP-deaminase, an erythrocyte enzyme that was stimulated by coformycin at pH 7.2. Quantitative analysis of catabolites in incubated hemolysates confirmed that AMP degradation preferentially occurred via deamination to IMP with subsequent dephosphorylation by another erythrocyte nucleotidase isozyme, deoxyribonucleotidase. Both AMP-deaminase and deoxyribonucleotidase have acidic pH optima with minimal activities at physiologic pH, suggesting that this pathway of AMP catabolism could accelerate depletion of the adenine nucleotide pool and thereby mediate the demise of senescent erythrocytes sequestered in the spleen.

Adenine ribo- and deoxyribonucleotide metabolism in human erythrocytes, B- and T-lymphocyte cell lines, and monocyte-macrophages

Ordinarily packaged in DNA, adenine deoxyribonucleotides are preferentially concentrated in erythrocyte and lymphocyte cytosol in adenosine deaminase (adenosine aminohydrolase, EC 3.5.4.4) deficiency. A spectrum of cytosol enzyme activities are defined in terms of reaction velocities, K0.5s, and nucleotide partition after incubation with ribo- and deoxyribonucleotides. AMP and dAMP were dephosphorylated, but only AMP was deaminated in vitro. Although nucleotidase activity is much stronger in lymphocytes, AMP deaminase was the dominant degradative reaction in all erythrocyte and lymphocyte lysates under the conditions specified. For most cytosolic enzymes, ribonucleotides were preferred cofactors, implying that dADP and dATP often may be bystanders at metabolic events. The adenylate kinase-mediated partition of approximately equimolar ribo- and deoxyribonucleotide substrates yielded a very large preponderance of AMP in the monophosphate compartment, the monophosphates alone being directly vulnerable to degradative loss. The adenylate kinase(s) of lymphocytes differed strikingly from those of erythrocytes in reaction velocities with nucleotide cofactors, K0.5s, and in susceptibility to substrate inhibition.