Surgical treatment of diaphragmatic eventration in adults

Surgical intervention of diaphragmatic eventration is urgent and life-saving in infants but is rarely in adults. In the past 22 years, Seven adults with diaphragmatic eventration were encountered at the Division of thoracic surgery, Dept. of surgery, VGH, Taipei. The age on diagnosis ranged from 32 to 65 years with mean of 44 years old. Male and left diaphragm were more frequently affected (6 men, 1 woman; 6 left, 1 right). All of them received operation of plication. In spite of good immediate postoperative return of the diaphragms to normal position with clinical improvement found in all patients, 5 dyspneic patients were found to have gradual diaphragmatic rise or relapse of respiratory symptoms after repair. Diaphragmatic eventration could cause compression of lung by abdominal organs and reinforcement of diaphragm through plication might increase the diaphragm strength and diminish the clinical symptoms. Yet according to our series, we recommend surgical intervention is only for existence of distress stemmed from it and unresponsive to medical therapy.

Alteration of intracellular DNA and RNA patterns by liver arginase studied with flow cytometry

Previous study of lymphocyte proliferation in the presence of liver arginase has indicated that arginine-depletion in the culture medium plays an important role in inhibiting cell proliferation. The inhibitory effect of both liver arginase and arginine-free condition on DNA, RNA and protein syntheses in PHA-stimulated lymphocytes were studied in cultures by measuring the incorporation of labeled precursors. Simultaneously, their influence on DNA and RNA contents in cells stained by acridine orange was investigated by automated flow cytometry. With 3 micrograms/ml arginase, the syntheses of DNA, RNA and protein were markedly inhibited after 72 h of culture. The degrees of inhibition were close to that induced in an arginine-free condition. The DNA and RNA contents of the individual cell, either cultured with 3 micrograms/ml arginase or in arginine-free medium, were arrested in G0/G1 phase. The results of cell arrest in G0/G1 phase were similar whether the cells were cultured for 24, 48 or 72 h.

Serum sialyl stage-specific embryonic antigen levels in adenocarcinoma of the lung

The serum levels of sialyl stage-specific embryonic antigen (SSEA-1) in 67 patients with adenocarcinoma of the lung were studied to assess their values for diagnosis. A solid-phase immunoradiometric sandwich assay with an FH6 monoclonal antibody was used. Another 49 healthy adults, 52 patients with benign pulmonary diseases, and 142 lung cancer cases with cell types other than adenocarcinoma were evaluated for comparison. The mean (+/- S.D.) levels (U/mL) for adenocarcinoma of the lung, lung cancer other than adenocarcinoma, benign pulmonary diseases and normal subjects were 182.9 +/- 309.7, 53.5 +/- 22.6, 38.9 +/- 17.1 and 30.5 +/- 6.5, respectively. The mean serum sialyl SSEA-1 level was significantly higher in adenocarcinoma of the lung, compared with lung cancer other than adenocarcinoma (p < 0.001), benign pulmonary diseases (p < 0.001), or normal subjects (p < 0.001). For late stage (Stages III and IV, n = 58) adenocarcinoma of the lung, the mean (+/- S.D.) serum sialyl SSEA-1 level (204.3 +/- 327.6 U/mL) was significantly higher than that of earlier stage (Stages I and II, n = 9) adenocarcinoma of the lung (39.9 +/- 19.3), p < 0.001. There was no statistical difference among the mean serum levels of various histologic types of lung cancer other than adenocarcinoma (p > 0.05). In the lower range of values, considerable overlap existed between adenocarcinoma of the lung and lung cancer other than adenocarcinoma. However, very high sialyl SSEA-1 levels (> 140 U/mL) were only encountered in late stage adenocarcinoma of the lung (22/58).(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant thymoma

Sixty-one patients underwent operations for malignant thymomas between 1961 and 1989. Twenty-three patients had associated myasthenia gravis (MG), an incidence of 37.7%. Upon being admitted to the hospital, the patients' most common symptoms included chest pain, MG, cough, and dyspnea. Only 7 of 61 (11.5%) patients had no symptom. Tumor staging of 58 patients with invasive thymomas was performed according to Masaoka classification. The patients were classified as follows: Stage II disease, 5; Stage III, 41; Stage IVa, 8; and Stage IVb, 4. In addition, thymic carcinoma was present in three patients. The series had a resection rate of 55.7%. The incidence of operative complications was 16.3%. Only one patient died of myocardial infarction; the incidence of operative mortality was 1.6%. The patients with MG had a higher rate of resection (69.6%) and a higher incidence of complete thymectomy (14 of 23 patients; 60.9%). Mixed lymphoepithelial tumors and epithelial cell predominant tumors were the most frequent histologic patterns (45.9% and 34.4%, respectively). Fifty-two patients had postoperative radiation therapy, and 10 patients had chemotherapy. The overall cumulative survival rates in the series were 59% and 34% at 5 and 10 years, respectively. The results demonstrated that the factors affecting the prognosis may include resectability, postoperative irradiation or chemotherapy, MG, and tumor staging. The influence of histologic variation on survival rates could not be clearly defined in the series. Surgical resection, particularly complete thymectomy, followed by irradiation is the primary option of therapeutic management for malignant thymoma.

Gastric substitution for resectable carcinoma of the esophagus: an analysis of 368 cases

Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Gelatinase and proteoglycanase activity during the periovulatory period in the rat

Gelatinase and proteoglycanase are metalloproteinases that govern extracellular matrix remodeling. In the present study, immature rats were primed with eCG (20 IU) and hCG (10 IU). Ovarian gelatinase and proteoglycanase activity were determined at the time of hCG administration (0 h) as well as 4, 8, and 12 h later. Gelatinase and proteoglycanase were extracted by homogenization in Triton and by heating (i.e., heat extraction). An aliquot of the heat extract was reduced and alkylated to destroy metalloproteinase inhibitors. Heat extracts not reduced and alkylated showed low levels of gelatinase and proteoglycanase activity that did not change at the different time points. However, with reduction and alkylation, gelatinolysis increased approximately 4-fold (p less than 0.05) at 4 h, 8 h, and 12 h after hCG priming. Proteoglycanase activity increased approximately 2-fold (p less than 0.05) between 0 and 8 h and declined at 12 h after hCG. The ovarian gelatinolytic activity was due to a metalloproteinase as demonstrated by the inhibition of enzyme activity by phenanthroline and EDTA (97.1 +/- 0.7% and 97.4 +/- 0.6% inhibition respectively). Proteoglycanase activity was not inhibited by phenanthroline (11.5 +/- 3.5%), suggesting that the enzyme activity was not specifically a metal-dependent enzyme. Gelatin gel zymography of the ovarian extracts demonstrated four predominant and distinct gelatin-degrading enzymes of 78, 72, 66, and 62 kDa, similar to the size of gelatinase. The present findings demonstrate a periovulatory increase in ovarian gelatinolytic and proteglycanase activity that may play a pivotal role in connective tissue remodeling associated with ovulation.

Xanthogranulomatous pyelonephritis: experience in 36 cases

A retrospective study of 36 patients with xanthogranulomatous pyelonephritis who underwent nephrectomy at our hospital was performed. The disease occurred most frequently in middle-aged women with a history of recurrent urinary tract disorder. There were 2 cases of focal xanthogranulomatous pyelonephritis, 2 associated with emphysematous pyelonephritis, 2 that manifested as fistula formation between the colon or skin, and 1 with deep sinus formation into the hip joint that presented as septic arthritis. Flank pain and fever were the most frequent complaints. Escherichia coli (67%) and Proteus mirabilis (26%) were the most common organisms isolated from the voided urine, kidney and blood stream. Cephalothin plus gentamicin or tobramycin were the drugs of choice before surgical intervention.

[The detection of an early glomerular filtration rate change of spinal cord injury patients by renal scan]

A Technetium-99m DTPA computer-assisted renal scan and CCR studies were performed on 35 spinal cord injured patients who had been hospitalized in the rehabilitation ward of Kaohsiung Medical College Hospital for less than 6 months during the period of August 1988 to March 1990. For each patient, the glomerular filtration rate (GFR), the effective renal plasma flow (ERPF), and the filtration fraction (FF) were obtained by a renal scan. CCR was measured by conventional procedure and was corrected with body length, body weight and body surface. Least square fit linear regression analysis revealed the best correlation between GFR and CCR. Based on GFR values the renal function was classified into four grades from normal to severe damage and the change of renal function was analyzed using four corresponding factors. The results showed that the ratio of GFR impairment in early spinal injury is 48.6% (mostly mild impairment). There are not significant differences between levels of lesion, severity of injury or successfulness of bladder training by Fisher's exact test. Renal function deteriorated proportionally with age and most of those patients having the worst renal function belonged to an old age group. Thus age is also one of the major factors in renal function impairment. Single kidney function impairment was noted in two patients whose total GFR or CCR were in the normal range, which implied the characteristic of early detection of renal dysfunction by renal scan.

Inhibition of lymphocyte proliferation by liver arginase

The activities of thymidine kinase and uridine kinase (enzymes for pyrimidine salvage pathway) in phytohemagglutinin (PHA)--prestimulated lymphocytes were inhibited by arginase in a similar pattern to the inhibition on thymidine incorporation. Further study revealed that arginase did not directly affect the activities of these enzymes in the cell-free system. Thymidine kinase and uridine kinase activities of PHA-prestimulated lymphocytes were inhibited by arginase making their activities as low as that cultured in arginine-free RPMI-1640 medium. These results suggest that arginine-depletion in the culture medium is the primary mode of action of arginase on the inhibition of mitogen-stimulated lymphocyte proliferation.

Heart rate--QT relationships during baroreceptor stimulation with diminished autonomic influence on the ventricles. Ventricular autonomic tone and QT interval

The shortening of the QT interval of the electrocardiogram coincident with acceleration of heart rate and vice versa has been accepted for many years as evidence that the action potential duration and hence QT are necessarily dependent on heart rate. Exceptions to this rule have been attributed to the intervention of counteracting autonomic effects. In order to test this assumption, 26 conscious dogs divided into three groups were tested during baroreceptor stimulation by a bolus injection of phenylephrine. Seventeen dogs had been used in earlier studies in which they had undergone an experimental anterior myocardial infarction with apparent full recovery. A group of those dogs underwent beta-adrenergic blockade by intravenous atenolol 30 min prior to the baroreceptor activation. To test the intactness of the baroreceptor responses in the previously infarcted dogs, a third group of nine dogs that had had no prior myocardial infarction was included. All dogs were adapted to the laboratory environment and were not sedated during experiments. Simultaneous recordings of RR, QT interval, and phasic arterial pressure were made in all dogs before and during baroreceptor stimulation. In the normal group, and the previously infarcted group that received no atenolol, baroreceptor stimulation elicited a small (8/msec), but significant prolongation of the QT associated with a nearly 50% reduction in heart rate. The QT interval of the atenolol-treated dogs, although significantly more prolonged before stimulation, remained unchanged during the reflex. The data indicate that withdrawal of ventricular sympathetic tone may prolong the QT interval, thereby confirming the role of sympathetic innervation in the control of QT.(ABSTRACT TRUNCATED AT 250 WORDS)

Cystic duct occlusion by microwave tissue coagulator in rabbits

In this preliminary study a flexible bipolar microwave electrode, 1.8 mm in diameter, was designed to occlude the cystic duct in 18 rabbits. Thermal model tests were performed to evaluate the effect of the antenna and to master the coagulating condition. Through surgical cholecystostomy, the antenna was inserted into the proximal cystic duct for various coagulation treatments. Cholecystography showed that the cystic duct was occluded minutes to hours after coagulation. Histologically, the microwave technique induced a chronic inflammation and fibrosis which eventually obliterated the coagulated cystic duct permanently. In group A (30 mA for 20 s) the cystic duct epithelium regeneration occurred and surrounding liver damage was limited, while in groups B (50 mA for 10 s) and C (70 mA for 6 s) no epithelium regeneration was observed and injury to the liver was mild to moderate. It was found that microwaves generated at 50 mA for 10 s to occlude the rabbit's cystic duct are effective and less injurious.

Heart rate-Qt interval relationship during postural change and exercise. A possible connection to cardiac contractility

The QT interval of the electrocardiogram, although often coordinated in an inverse relationship to heart rate, appears from the existing evidence to be regulated by mechanisms separate from those that govern heart rate. The purpose of this inquiry was to explore further the relationship of the two and to test other factors that may contribute to the regulation of QT. Heart rate and QT duration were measured in healthy human subjects during postural change and exercise. The data showed that, while coordinated in an inverse relationship under some circumstances, under others heart rate and QT were discordant, leading to the inference that there is no fixed linkage between the two. Previous work by the authors and other published studies have suggested that ventricular contractility may have more predictable association with QT shortening than do increases in heart rate. Observations of force of ventricular contraction (HI and IJ velocity) as reflected in ballisto-cardiographic tracings were made using each of 12 human subjects as the authors' own control. The data revealed a highly significant correlation between the velocity measures and QT duration (p less than 0.01) but not heart rate. These findings led to the conclusion that there is clearly not a fixed relationship between heart rate and QT interval and to the hypothesis that QT may more closely reflect the degree of cardiac contractility.

Plasma levels of atrial natriuretic peptide during labour and in puerperium

Atrial natriuretic peptide (ANP), a new cardiac hormone, has potent natriuretic, diuretic and vaso-relaxant properties in animals and humans. Plasma ANP levels increased in response to volume expansion, atrial distension or postural change. The present investigation was designed to examine the effect of labour on plasma ANP in normotensive pregnant women. The results show that plasma ANP in pregnant women (n = 9) increased significantly in active phase of first stage of labour from 19.5 +/- 4.6 pg/ml to 74.5 +/- 15.1 pg/ml. The magnitude of the increase in ANP levels in active phase varied among the patients. During and after delivery, plasma ANP decreased in all instances towards control level. The cause for the increase in plasma ANP levels in the active phase remains to be determined.

Characterization of murine liver-derived inhibitory protein

Murine liver-derived inhibitory protein (LIP) capable of inhibiting human lymphocyte proliferation was highly purified from liver extract. Its molecular weight determined by gel filtration and SDS-PAGE was 105,000 and 38,400 respectively. LIP moved electrophoretically at the gamma-globulin region. Its activity in inhibiting lymphocyte proliferation was temperature-stable up to 60 degrees C, and pH-stable between 4 and 11. It was not cytotoxic to lymphocytes as shown in 51Cr-release experiments. The purified LIP possessed arginase activity.

Content of glucocorticoid receptor and arginase in gastric cancer and normal gastric mucosal tissues

The content of glucocorticoid receptor (GR) and arginase in human gastric cancer and the corresponding normal gastric mucosal tissues was determined. Among the 25 patients studied, the GR content in gastric cancer tissues was 33.2 +/- 10.2 fmol/mg protein versus 7.6 +/- 3.4 fmol/mg protein in gastric mucosal tissues. This difference is statistically significant (P less than 0.005). Of the 25 paired samples, 19 cancer tissues contained GR, whereas only seven of the normal mucosal tissues had GR. The level of arginase in gastric cancer tissues in 19 patients was assayed, it was 26.6 +/- 4.2 ng/mg protein which is also significantly higher than that in normal gastric mucosal tissues (13.5 +/- 1.8 ng/mg protein) (P less than 0.005). Since glucocorticoids and arginase are potent immune suppressive agents, the increased level of GR and arginase in gastric cancer tissue suggest that these glucocorticoid-related factors in gastric cancer tissue may play a partial role in regulating cellular immunity.

Reconstruction of the esophagus with the left colon

This report reviews our experience with 96 patients with benign or malignant stricture of the esophagus who underwent interposition of the left colon with or without esophageal resection from July 1982 to June 1987. There were 67 male and 29 female patients ranging in age from 8 to 80 years. Thirty-seven patients had fibrotic stricture secondary to corrosive injury of the esophagus, 42 had cancer of the esophagus, and 17 had cancer of the gastric cardia. The incidence of postoperative complications and surgical mortality, respectively, was 16.2% and 2.7% for patients with corrosive stricture of the esophagus, 35.7% and 11.9% for patients with cancer of the esophagus, and 35.2% and 5.8% for patients with cancer of the gastric cardia. Reconstruction resulted in good function in 75.6% of the patients with corrosive stricture of the esophagus, 66.6% of the patients with cancer of the esophagus, and 70.5% of patients with cancer of the gastric cardia. The morbidity and mortality were higher in the group with malignant esophageal strictures because of advanced age, poor general condition of the patient, and extent of the surgical procedure needed. Cervical anastomotic leakage was the most frequently encountered complication (13.5%), and all the poor-function results were caused by this complication. In our experience, reconstruction of the esophagus with left colon is a satisfactory method that can be accomplished with acceptable morbidity and mortality. The left colon is a durable and functional substitute.

Double lung transplant in primate

Experimental en-bloc double lung transplantation was first reported by Dark et al. to broaden the indications for heart-lung and single lung transplantations. They used puppies as an acute model: however primates are optimal in expecting improving survival. In this study we used Taiwan cynomolgus monkeys for 20 enbloc double lung transplants. The animals weighing 2.4-8.0 kgs. were divided into two groups: one with surface cooling and profound hypothermia and the other one with bypass using heart lung machine. For surface cooling group the average ischemic time was 58.5 minutes, and the result was disappointing: The best survivor sustained only 8 hours after transplant, and 5 died on table. In the group with bypass, the perioperative course was rather smooth. The animals could restore their respiratory function after transplant. Postoperative bleeding was the major course of complication. All the animals died within one day. During operation, evidence of tuberculosis and filariasis were observed. While some problems have to be solved before a clinical trial starts, clinical en-bloc double lung transplant is technically feasible.

The mechanisms of the inhibitory effects of liver extract on lymphocyte proliferation. III. The effects of arginase on DNA polymerase activities

The incorporation of labeled precursors into DNA, RNA and protein in phytohaemagglutinin (PHA)-prestimulated human lymphocytes was maximally inhibited by liver extract (LEx) or arginase at 24 h. The activities of DNA polymerase alpha, beta and gamma were less inhibitable by these agents than was [3H]thymidine incorporation. The inhibition of DNA, RNA and protein syntheses by either LEx or arginase is probably due to arginine depletion by arginase activity, since their syntheses were similarly inhibited when cultured in an arginine-free medium in the absence of arginase. These results indicate that arginase nonspecifically inhibits the activities of DNA polymerase. The inhibition is probably due to arginine depletion.

Manipulating the QT interval of the ECG by cognitive effort

Abnormal prolongation of the QT interval of the ECG has been reported to indicate a hazard of sudden arrhythmic death. Therefore, with the aid of biofeedback from a newly devised instrument capable of measuring and recording the QT interval of the ECG in real time, ten healthy subjects, aided by biofeedback, attempted to shorten and also to lengthen QT. Although the changes achieved were relatively small, the ten subjects as a group were successful in both shortening and lengthening QT at the 0.01 level of significance. The degree of success varied, however, from person to person and from time to time in the same individual. If the findings reported here can be applied more generally to patients at risk for sudden death, and if biofeedback effects can be made to persist without reinforcement, it or other cognitive techniques may prove clinically useful for shortening QT.

Responses of the QT interval of the electrocardiogram during emotional stress

The relationship of emotional stress to the duration of the QT interval of the electrocardiogram (which contains the period of repolarization of the myocardium) was explored because QT prolongation has been shown under some circumstances to carry a risk of potentially fatal cardiac arrhythmia. A thoroughly studied case of repeated serious and ultimately fatal arrhythmia which occurred in a setting of overwhelming family and personal stress and which was preceded by marked prolongation of the QT interval prompted an experimental study of the behavior of the QT interval during stressful interviews. The subjects were 17 men and women ranging in age from 26 to 74. The experimental sessions included: 1) a period of inactivity with the subject sitting alone, 2) a period of "neutral" discussion, 3) a period of dwelling on a presumed stressful topic, followed by 4) a period of reassurance. Heart rate, respiration, arterial pressure, and the electrocardiogram were recorded throughout the four intervals together with a real time tracing of the QT interval of the electrocardiogram made by a computerized instrument recently devised by one of us (J.E.). Most of the subjects reacted to the stressful discussion with anger and resentment that was associated with shortening of QT. Two of them, however, who reacted with dejection and a feeling of being overwhelmed, displayed lengthening of QT. The QT changes were generally not linked to changes in heart rate.

Primary mediastinal seminoma

Primary mediastinal seminoma is a rare neoplastic disease. Only 133 cases have been reported in the literature. Five patients with primary mediastinal seminoma had been treated at VGH from 1974 to 1986. All of them received exploratory thoracotomy but only two of them were resectable. Postoperative radiation therapy was given regardless of resection. One had additional chemotherapy due to nodal involvement. All five patients showed complete resolution and were alive and free of disease for an average follow-up period of 42.6 months (range, 5-82 months). So we conclude that mediastinal seminoma is a rare neoplastic disease and can be treated primarily by surgery. Irradiation can also induce complete remission and long term survival in those with unresectable tumors.

Down regulation of myelopoiesis by mediators inhibiting the production of macrophage-derived granulomonopoietic enhancing activity (GM-EA)

Monocyte-derived lipid-containing macrophages (MDLMs) constitutively synthesize a granulomonopoietic enhancing activity (GM-EA) that potentiates the function of granulocyte-macrophage colony-stimulating activity (GM-CSA). In the study reported, we show that GM-EA is distinct from interleukin-1 (IL-1) in biochemical and functional properties and that its production is negatively regulated by several mediators. Thus, MDLM cultures pretreated with interferon-gamma (IFN-gamma, 3 to 900 U/mL), prostaglandin E2 (PGE2, 10(-13) to 10(-8) mol/L), or lactoferrin (LF, 10(-13) to 10(-8) mol/L) invariably produced less GM-EA than untreated controls. The relative potency of inhibition was in the order of IFN-gamma greater than or equal to PGE2 greater than LF. The extent of the inhibitory effects was proportional to dosage and the duration of treatment and could be observed following only a brief exposure (two hours) of the MDLMS to physiologic doses of the mediators. Under optimal conditions, IFN-gamma (300 U/mL for 24 to 48 hours) and PGE2 (10(-9) mol/L for 24 to 48 hours) could totally abrogate the ability of the MDLMs to produce GM-EA. However, the drug-inhibited MDLMs could be reactivated to produce GM-EA by treatment with zymosan (60 micrograms/mL). These results demonstrate that a mechanism for the control of myelopoiesis by mediators such as IFN-gamma, PGE2, and LF may involve the inhibition of GM-EA production. Furthermore, this negative feedback control is reversible and can be overridden when a proper stimulatory signal is given.

Purification of murine liver-derived inhibitory protein

Murine liver-derived inhibitory protein (LIP) capable of inhibiting human lymphocyte proliferation was separated from liver extract. The steps of purification included ammonium sulfate precipitation, DEAE-cellulose and hydroxylapatite ion exchange chromatographies, and gel filtration. The purified LIP appeared to be highly homogeneous, as verified by polyacrylamide gel electrophoresis (PAGE) and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). There was arginase activity in the LIP Preparation.

The mechanisms of inhibitory effects of liver extract on lymphocyte proliferation: II. Inhibition of DNA, RNA, and protein synthesis and their relationship to the effects of metabolic inhibitors

The inhibitory effects of liver extract (LEx) on DNA, RNA, and protein synthesis in phytohaemagglutinin (PHA)-stimulated lymphocytes were studied by measuring the incorporation of labelled precursors. DNA, RNA, and protein synthesis were all inhibited by LEx in a dose-related manner. The inhibitory effect of LEx on protein synthesis was additive to the inhibitory effect of puromycin. The inhibitory effect of LEx on DNA synthesis was antagonistic to the inhibitory effect of mitomycin C. In the case of actinomycin D for RNA synthesis, its interactions with LEx were variable, but not additive. LEx may act as an inhibitor of protein synthesis through the mechanism of arginine-depletion.

The outcome of thymectomy in nonthymomatous myasthenia gravis

From October 1979 to December 1984, 77 patients with nonthymomatous myasthenia gravis underwent thymectomy and 74 patients were available for careful follow-up study in this review. Among these 74 patients, 18 were male and 56, female. Their ages ranged from 13 to 68 years with an average age of 30.2 years. Men tend to be affected at a later age than women (an average age of 38.0 versus 26.1 years). Duration of the disease was from one to 30 years, with an average of 4.2 years. A sternal-splitting incision was performed for all patients. Thymectomy was made by removal of all anterior mediastinal fat between the pleuropericardial reflection and phrenic nerve bilaterally. Seventy of the 74 patients benefited from thymectomy. Of these, 34 patients had remission and 36 patients had substantial improvement; three patients did not improve after thymectomy but did not increase in severity of symptoms or medication requirement. There was no postoperative death. Myasthenic crisis developed in four patients and five patients had pulmonary complications. These nine patients were among the 21 patients who did not receive either plasmapheresis preoperatively or a high dose of steroids perioperatively. Early thymectomy is recommended for patients with nonthymomatous myasthenia gravis. We also recommend that patients undergoing thymectomy should be treated either with plasmapheresis preoperatively or with high doses of steroid perioperatively.

Esophageal manometric studies in patients with myasthenia gravis

Dysphagia is often present early, with varying degrees of involvement, in patients with myasthenia gravis. Twenty-five patients with a clinical status of myasthenia gravis were graded according to a modified Osserman classification and the esophageal manometric results were reported according to their clinical status. The results were also compared with those in 20 normal control subjects. Twenty-four patients (96%) had abnormal motility. The only patient who was in class I had a normal tracing. There was no significant difference in function of the lower esophageal sphincter, but a significant decrease in mean amplitude (15.1 +/- 6.1 versus 29.7 +/- 4.7 mm Hg) and a prolongation in mean duration of the peristaltic wave (7.4 +/- 2.8 versus 4.5 +/- 0.2 seconds) was noted in the upper esophagus. The cricopharyngeal sphincter pressure also showed a significant decrease (23.4 +/- 9.5 versus 43.1 +/- 3.1 mm Hg), but relaxation and coordination were good. The mean amplitudes, mean duration of peristaltic waves, and cricopharyngeal pressures between the myasthenic and control populations were statistically significant, with a p value of 0.001. Besides this, frequent spontaneous contractions, simultaneous contractions, and biphasic repetitive contractions typical of peristaltic dysfunction were also found in myasthenic patients. Motor dysfunction of the esophagus as assessed by manometric study correlates well with Osserman's modified clinical classification.

Ultrasonic guided percutaneous transhepatic bile drainage for cholangitis due to intrahepatic stones

Acute cholangitis due to intrahepatic stones is frequently associated with biliary sepsis. Emergency surgery for these high-risk patients is usually associated with a high mortality. Therefore, we recommend nonoperative methods for the management of this acute disease. Percutaneous transhepatic cholangiography and drainage (PTCD) combined with antibiotic and fluid treatment was used successfully in the management of 41 patients with acute pyogenic cholangitis due to intrahepatic stones. The general condition of these patients improved after treatment with PTCD. Repeated cholangiography should be performed so that the entire biliary tree and lesions can be viewed. Elective surgery (21 patients) or removal of the stone through the sinus tract via PTCD (14 patients) was performed when the patients' general condition improved following emergency PTCD. Therefore, we recommend PTCD over emergency surgery in the treatment of acute septic intrahepatic stones.

The effects of arginase on neoplasm. I. The role of arginase in the immunosuppressive effects of extract from gastric cancer

Arginase, a potent immune inhibitor, is studied in gastric cancer for its possible role in immunosuppression. Aqueous extracts (n = 12) from gastric cancer tissue inhibited PHA-induced lymphocyte proliferation more than those from normal gastric mucosal tissues (p less than 0.05). The inhibition was not due to cytotoxic effect of the extracts. Gastric arginase was isolated from gastric extracts by an affinity column conjugated with an anti-arginase antibody. The arginase from both normal and cancer gastric tissues strongly inhibited lymphocyte proliferation. By using enzyme-immunoassay, the arginase contents in cancer tissues were determined and showed 3 times as much as that in normal gastric mucosal tissues (n = 14) (p less than 0.005). The increased arginase content in cancer tissue was further confirmed by immunohistochemistry study. Arginase exists abundantly amounts in the cytoplasm of cancer cells, much more than that of normal cells (n = 30). It is conceivable that the depressed cellular immunity in gastric cancer patients might be partly due to the abundant amount of arginase in cancer cells.

Liquid chromatographic determination of amprolium in poultry feed and premixes using postcolumn chemistry with fluorometric detection

Two extraction and liquid chromatographic procedures are presented which separate amprolium from compounds in poultry feed or premixes that could interfere with its fluorometric determination. The procedures are based on earlier work on the determination of thiamine in food samples. Amprolium is extracted from feed with a hexane-aqueous sulfosalicylic acid mix, separated on a C18 column, and detected fluorometrically after postcolumn derivatization. For premixes, water extraction is used. Values for the amprolium content of poultry feed obtained with these procedures are in good agreement with those obtained with AOAC official methods. It is suggested that these methods with suitable modifications may be of use for routine analysis of amprolium in feeds. The overall methods are rapid and appear to give reasonable results.

Monoclonal antibodies against human esophageal carcinoma cell lines

Two monoclonal antibodies, designated 4C4 and 4G1, were produced by immunization of BALB/c mice with a human esophageal carcinoma cell line, CE69T/VGH, followed by fusion of the spleen cells from an immunized mouse with myeloma cells NS-1. 4C4 showed strong binding activity to three human esophageal carcinoma cell lines and one human hepatoma cell line, but not to any other cell lines tested. 4G1 reacted with three human esophageal carcinoma cell lines and four other cell lines. By peroxidase-antiperoxidase staining, 4C4 and 4G1 detected antigens of the epithelial cells on 10 pairs of esophageal carcinoma and normal esophageal specimens. 4G1 recognized a CE69T/VGH antigen with a molecular weight of 180K. Since 4G1 also reacted with purified carcinoembryonic antigen (CEA) and immunoprecipitated 125I-CEA, 4G1 seems to be an antibody recognizing CEA produced by CE69T/VGH cells. Since 4C4 also bound to the epithelial cells of normal uterine, vaginal, breast and liver tissues, it seems to recognize an epithelial antigen, and can be used to characterize the antigen in the specialization or differentiation of epithelial cells.

Modulation of lymphocyte proliferation by murine liver extract

Murine liver extract (LEx) purified by ammonium sulfate (45-70% saturation) possesses a strong inhibitory effect on human lymphocyte proliferation. We have shown that the inhibitory effect of LEx is not via a cytotoxic effect and that it is proportional to the length of incubation with LEx. Mitogen-prestimulated lymphocytes are more resistant to LEx inhibition than cells not prestimulated. B cells stimulated by PWM are more susceptible to LEx-induced inhibition than PHA- or Con A-stimulated T cells. In Con A cultures, there may be a population of cells more resistant to LEx inhibition. This population is not yet identified. The degree of reversibility of LEx inhibition was different in cells prestimulated by different mitogens. The inhibitory activity of LEx decreased in the presence of an increasing number of cells in the culture.

The mechanisms of inhibitory effects of liver extract on lymphocyte proliferation. I. The extracellular mechanism of the inhibition

Liver aqueous extract (LEx) can powerfully inhibit phytohaemagglutinin (PHA)-induced lymphocyte proliferation. The extracellular mechanism of inhibition by LEx was studied. There are three possibilities. (1) The possibility of extracellular inactivation of PHA by LEx was excluded by incubating cells with PHA first, followed by washing, and then incubating cells with LEx. The result was that LEx was still able to inhibit cell proliferation completely. (2) The possibility of competition for cell surface PHA receptors by LEx was excluded by the above experiments plus the use of N-acetyl-D-galactosamine to remove surface-bound PHA. Following this treatment, LEx was still able to inhibit cell proliferation completely. (3) The possibility of arginase-induced arginine depletion resulting in lymphocyte suppression was supported by the following experiments. Cells were incubated in media in which arginine was depleted either by reacting with LEx, and the media were afterwards bound with anti-arginase antibody, or by amino acid constituted media without arginine. The degrees of proliferation inhibition were similar in both treatments. These results indicate the important role of arginine-depletion by LEx, and may account for the LEx-induced lymphocyte inhibition.

Obstructive uropathy caused by bilateral synchronous ureteral carcinoma: report of a case

We report on a 67-year-old man with bilateral, synchronous, ureteral transitional cell carcinoma. He presented with bilateral flank pain accompanied by nausea, vomiting and oliguria. Bilateral hydronephrosis with upper ureteral filling defects was found on antegrade pyelogram. After urinary diversion with bilateral percutaneous antegrade drainages for 6 days, serum creatinine fell from 10.1 to 4.7 mg/dl. Exploration revealed bilateral upper ureteral tumors. Right nephroureterectomy and left ureterectomy with left nephrostomy were done.

Serum concentration of pancreatic polypeptide in normal subjects and in peptic ulcer patients

The present study evaluates the serum concentration of pancreatic polypeptide (PP) in normal male and female subjects of different ages (ranging from 20 to 69) and also in patients with peptic ulcers. The PP level rose with age and was higher in the male subjects (from the age of 30). Serum levels of the peptide in patients with gastric or duodenal ulcers were not significantly different from the normal subjects (age and sex matched with the diseased groups).

Growth of Japanese encephalitis virus in Culex tritaeniorhynchus cell cultures

Ovarian cells from the mosquito Culex tritaeniorhynchus established in continuous tissue cultures have been found to support the growth of Japanese encephalitis virus with titers reaching as high as 10(7.36) MICLD50 per 0.03 ml. Virus-cell cultures were serially subcultured 60 times over 300 days and the virulence of the virus was determined after each passage. A gradual loss in virus titer was observed, with titers always higher in the medium than in the cells. Cytopathogenic effects were not observed in the infected cell cultures, either in primary or subsequent passages. However, the cell growth rate suggested that the cells may have been metabolically or mechanically damaged. The chromosome complement of the cells remained unchanged. Direct-fluorescent antibody studies during early and late passages revealed a loss in virus infectivity from chronically infected cells which may have been due to a gradual decrease in virus replication as the passages increased. The infectivity of virus particles, however, returned to previous levels after passage into fresh cell cultures. The loss of virus particles during serial passage may be correlated with the condition of the cells.