Intrathoracic fibrin glue for postoperative pleuropulmonary fistula

Twenty cases of persistent pleuropulmonary fistula after a thoracic surgical procedure were successfully treated with fibrin glue injection into the thoracic cavity through a drainage tube. A new technique, the overlying method, which is a modification of the conventional technique of fibrin glue injection, was devised. Each patient received one to four injections (mean number, 1.6). This method resulted in closure of the pleuropulmonary fistula in all but 1 patient. Minor complications included pain in 1 patient and fever in 3 patients. A control study involving 24 patients with pleuropulmonary fistula was performed. Autoblood, OK-432, and tetracycline were used instead of fibrin glue. The fistula resolved in 12 patients. Complications after injection included pain in 15 patients, fever in 10, and occlusion of the chest tube in 4. With our new method, patients rarely exhibited pain and fever, and occlusion of the chest tube did not occur.

[Malignant fibrous histiocytoma of the urinary bladder: a case report]

A case of malignant fibrous histiocytoma (MFH) of the urinary bladder was presented. A 59-year-old man visited our hospital with a chief complaint of gross hematuria with clots. Intravenous urography revealed a filling defect on the left side of the bladder. CT scan demonstrated that the tumor invaded the bladder wall deeply. The histology of the biopsy specimens obtained by TUR was suspected to be transitional cell carcinoma. Bleeding from the bladder was so severe that a lot of units of blood transfusion were required in order to compensate for anemia before total cystectomy was performed. The tumor was hemispheric, moderately demarcated, measuring 5.5 cm x 4.0 cm x 5.5 cm, and located at the posterior wall. The histological diagnosis was malignant fibrous histiocytoma, inflammatory type, with venous invasion of tumor cells. Postoperatively, the patient received 5 courses of combination chemotherapy of adriamycin (100 mg/body, day 1) and dacarbazine (400 mg/body, day 1-5). He is alive with no evidence of local and metastatic disease 24 months after operation, in spite of the poor prognosis predicted from the histological findings. MFH of the urinary bladder is very rare. We also made a brief review of prior reports on this disease.

[A bulky mass non-Hodgkin's lymphoma with dysuria in the rectovesical space]

A case of non-Hodgkin's lymphoma is reported. A 71-year-old man presented with complaint of dysuria and urinary frequency. Rectal examination and CT scan revealed a bulky mass in the rectovesical space. Transperineal needle biopsy of the tumor revealed non-Hodgkin's lymphoma, large cell type, diffuse. The patient received combination chemotherapy of adriamycin, cyclophosphamide, vincristine, prednisolone and pepleomycin. After two days the tumor was marvelously reduced in size, and partial response (PR) by CT was achieved after two months. PR was sustained for two months with cyclophosphamide, vincristine and prednisolone. However, the tumor progressed gradually, and he died five months after the first treatment and two additional courses of chemotherapy. Autopsy showed a 1,700 g bulky mass in the rectovesical space. The mass was covered with peritoneum and had a fistula from rectum to central necrosis of the tumor. Nine cases of the non-Hodgkin's lymphoma with complaint of dysuria have been reported in Japan before our case, which seemed to arise from the submucosal tissue of anterior rectal wall, prostate or lymphatic tissue of rectovesical space.

Hydrophobic residues 382-386 of antithrombin III, Ala-Ala-Ala-Ser-Thr, serve as the epitope for an antibody which facilitates hydrolysis of the inhibitor by thrombin

In the presence of a monoclonal antibody raised against the human thrombin-antithrombin III complex, the reaction between thrombin and antithrombin III proceeded to form preferentially a two-chain form of the inhibitor rather than to follow the major pathway of stable acyl complex formation. We thus propose the term "switching antibody" for an antibody that switches the enzyme-inhibitor reaction (Asakura, S., Matsuda, M., Yoshida, N., Terukina, S., and Kihara, H. (1989) J. Biol. Chem. 264, 13736-13739). By analyzing a CNBr fragment of the thrombin-antithrombin III complex that reacts with the antibody we localized the epitope for the antibody to a strongly hydrophobic residue 382-386 peptide segment, Ala-Ala-Ala-Ser-Thr, of the inhibitor, which is also contiguous with a hydrophobic amino acid Ala at its carboxyl terminus. This particular region should be cryptic in nascent antithrombin III, but could have been exposed to provide the reactive site for the antibody at an early stage of the reaction. Thereby a conformational change may have been induced at or near the reactive site of the complex, facilitating hydrolysis of the inhibitor by the enzyme. Interestingly, this hydrophobic region is highly conserved among members of the serpin family.

Total reconstitution of Salmonella flagellar filaments from hook and purified flagellin and hook-associated proteins in vitro

Salmonella flagellar filaments comprise the following distinct parts connected in series: a curved hook composed of a single kind of subunit (hook protein); two short segments made up of hook-associated proteins (HAP1 and HAP3); a long helical filament composed of flagellin; and a cap composed of HAP2. In this study, a procedure was developed to isolate HAPs from the culture medium of a short-flagella mutant. We demonstrate that hook-filament complex can be formed in vitro by sequential addition of HAP1, HAP3 and flagellin to hook fragments.

Fibrinogen Sapporo: dysfibrinogenemia characterized by the replacement of A alpha arginine-16 by histidine resulting in the delayed release of fibrinopeptide A by thrombin

Congenital dysfibrinogenemia was found in a 60-year-old asymptomatic female and her daughter. Purified fibrinogen derived from the propositus, apparently a heterozygote for the abnormality, characteristically showed delayed but complete release of fibrinopeptide A upon digestion with thrombin but its defective release by Ancrod, a snake venom enzyme, from half of her fibrinogen molecules. This congenital dysfibrinogenemia with an A alpha arginine (Arg) to histidine (His) substitution was tentatively designated as fibrinogen Sapporo. Although this type of abnormal fibrinogen had been identified among Caucasians, no such cases have so far been reported in Japan.

A monoclonal antibody that triggers deacylation of an intermediate thrombin-antithrombin III complex

Upon incubation of antithrombin III with thrombin in the presence of a monoclonal antibody recognizing an epitope exposed on the heavy chain part of thrombin-cleaved two-chain antithrombin III, antithrombin III was preferentially cleaved by the enzyme as a substrate, rather than covalently complexed with the enzyme to form an equimolar, stable acyl complex. Once the stable acyl complex was formed between the enzyme and antithrombin III, however, no further liberation of two-chain antithrombin III was observed. Kinetic studies showed that heparin does not affect this reaction, although generation of thrombin-cleaved two-chain antithrombin III is apparently accelerated in accordance with the rate constant for heparin-enhanced thrombin-antithrombin III complex formation. Here we propose the term "switching antibody" for an antibody that triggers deacylation of an intermediate enzyme-inhibitor complex by switching the enzyme-inhibitor reaction from the major pathway of stable acyl complex formation to an alternative pathway of cleavage of the inhibitor as a substrate.

Synacrosomal formation after cell fusion of round spermatids of Xenopus laevis

Cell fusion was induced by hypotonic medium in pairs of spermatids which were derived from single secondary spermatocytes. In a pair of fused spermatids, a single acrosome (synacrosome) eventually formed whenever the cell fusion was induced during the course of acrosomal formation. Direct observation of the process of synacrosomal formation was made on pairs of fused spermatids which had completed acrosomal formation. Two patterns occurred, namely, fusion of two acrosomes or enlargement of one with diminution of the other. The total volume of the two acrosomes before synacrosomal formation almost equaled the volume of the coalesced synacrosomes in fused spermatids. Neither colchicine nor cytochalasin B prevented synacrosomal formation in spermatids which were fused after each had completed acrosomal formation. These results indicate that neither microtubules nor microfilaments seem to play a role in the formation of a synacrosome in pairs of fused spermatids. However, cycloheximide did inhibit acrosomal formation when present during the early stage of acrosome differentiation in pairs of spermatids which had been fused just after second meiotic division. This fact indicates that acrosomal formation is mediated by some protein(s) which are synthesized during the initial period of acrosomal formation.

The role of endogenous dopamine in congestive heart failure

Although the effects of epinephrine and norepinephrine in congestive heart failure have been extensively studied, and exogenous dopamine, another of the catecholamines, has been widely used for the treatment of congestive heart failure, little attention has been paid to the physiological significance of endogenous dopamine in this condition. The present study was therefore designed to assess the physiological significance of endogenous dopamine in congestive heart failure. Nineteen patients with congestive heart failure caused by such conditions as acute myocardial infarction, valvular disease and dilated cardiomyopathy were examined before and after treatment with diuretics, digitalis and vasodilators. Electrolyte, creatinine and catecholamine concentrations in plasma and urine were analyzed. Urinary dopamine levels were increased in 13 out of 19 cases before treatment and returned to the normal range after treatment, falling from 2448 +/- 950.7 to 528.8 +/- 56.3 micrograms/day (normal level, less than 700 micrograms/day). Urinary dopamine excretion was markedly elevated within 24 hours after the onset of symptoms of heart failure, such as chest pain, palpitations and dyspnea. The relationship between urinary dopamine excretion and time after the onset of symptoms showed a strong statistical correlation (r = 0.55, p less than 0.001). Urinary dopamine excretion was also well correlated with plasma dopamine concentration, urinary norepinephrine excretion and venous pressure. From these results, it is concluded that endogenous dopamine seems to play an important role during the acute phase of congestive heart failure.

Calcium-triggered movement of regulated actin in vitro. A fluorescence microscopy study

We previously reported setting up an in vitro system for the observation of actin filament sliding along myosin filaments. The system involved a minute amount of fluorescently labelled F-actin, and its movement was monitored by fluorescence microscopy. Here, we report observations of the Ca2+-dependent movement of F-actin complex with tropomyosin plus troponin (regulated actin) added to the movement system in place of pure F-actin. In a wide range of pCa (-log10[Ca2+]) between 3 and 5.5 at 30 degrees C, regulated actin filaments moved rapidly, and the average velocity depended little on the Ca2+ concentration (about 7.5 microns/s). However, when the Ca2+ concentration was decreased to pCa = 5.8 or lower, the filaments suddenly stopped moving. In striking contrast to these observations, unregulated actin moved rapidly within the whole pCa range examined, the average velocity (about 7.5 microns/s) being essentially Ca2+-independent. These observations indicate that (1) tropomyosin-troponin actually gave Ca2+-sensitivity to F-actin, and (2) the movement system was regulated by Ca2+ in an on-off fashion within a narrow range of Ca2+ concentration. In a pCa range between 5.8 and 6.0, regulated actin filaments did not exhibit thermal motion; instead, they had fixed positions in the specimen, possibly because they remained associated with myosin filaments in the background, without sliding past each other. Although regulated actin moved fast in the presence of 1 mM-CaCl2 (pCa = 3) at 30 degrees C, it became entirely non-motile as the temperature was decreased to 25 degrees C or lower. Such a sharp movement/temperature relation was never found for unregulated actin. We assayed regulated actin-activated myosin ATPase in the same conditions as used for microscopy, and found that the ATPase activity depended both on pCa and on the temperature considerably less than the movement of regulated actin. The results suggest that the sliding velocity in the in vitro system would not be proportional to the rate of actin-activated ATPase.

Improved technique of tubeless cutaneous ureterostomy and results of permanent urinary diversion

An improved technique of tubeless cutaneous ureterostomy through a single stoma was devised by modifing the traditional cutaneous ureterostomy. Using this method, urinary diversions were performed on 12 cases with malignancies: 6 had radical cystectomy and the other 6 had pelvic exenteration. Normal bilateral ureters were observed in 11 cases in preoperative intravenous pyelography. Stomal stenosis was found in 1 case (8.3%) requiring operative stomal revision. Generally satisfactory results were obtained. This method could lower the incidence of complications. A long-term follow-up is needed, but 2 cases who have survived for more than 4 years since the operation have shown excellent results. It was thought that it would be difficult to perform tubeless cutaneous ureterostomy on normal-sized ureters, but our clinical results indicate that this method may be able to provide permanent urinary diversion.

Clinical observations on fertile males with varicocele

During the clinical observation of 32 fertile cases with varicocele interesting findings were made. Normal semen, a sperm density above 40 million/ml and a motile sperm rate of over 60% were observed in 46.9% of the cases. Furthermore, a sperm density of more than 40 million/ml was found in 75% and a motile sperm rate of more than 50% was detected in 81.3%, indicating normal or adequate spermogram data. A difference in right-left testicular size was recognized in 35.5% (11 cases). Only 2 of the cases had oligospermia and 9 cases had normospermia. Two cases had low testosterone values and low motile sperm rates were also detected. Secondary infertility occurred in 33.3%. In 25% of the cases, scrotal scintigraphy revealed an accumulation of high radioactivity indicating venous blood pooling over the affected site in the early phase of dynamic images. In the other cases, different venous flow characteristics were detected visually.

[Two cases of urethral leiomyoma]

Two cases of urethral leiomyoma are reported. Two Japanese women 39 and 28 years old presented with the complaint of a painless mass protruding from the anterior wall of urethra to urethral meatus. The mass was firm with associated condyloma acuminatum on its surface and was easily removed by surgical excision. Sixty-four cases of urethral leiomyoma have been reported in Japan before the present cases. The majority of them were in females. The peak of incidence was in the 30th to 40th decade, suggesting the relationship of urethral leiomyoma to female sex hormones. No malignant development has been described. Judging from these findings, it appears possible to differentiate leiomyoma of urethra from caruncle, urethral prolapse or urethral carcinoma by careful inspection and palpation of a mobile firm mass under epithelium.

Formation of flagella during interphase in secondary spermatocytes from Xenopus laevis in vitro

In cell culture, single motile flagella, 1 micron in length, were observed to grow from secondary spermatocytes of Xenopus laevis within 2-3 hours after telophase I, at 22 degrees C. About 90% of the secondary spermatocytes formed flagella as observed by phase-contrast microscopy. The flagella grew up to 2-6 microns in length during interphase II, which lasted about 18 hours. The presence of the "9 + 2" microtubular structure of the flagellar axonemes of secondary spermatocytes was confirmed by electron microscopy. When chromosomal condensation began (prophase II), the flagella were resorbed into the cells and, after the second meiotic division, a flagellum was formed again by each of the round spermatids. Thus, there appears to be a close relationship between the meiotic division cycle and the formation of flagella. The possible contribution of Sertoli cells to the formation of flagella in secondary spermatocytes was examined by reducing the number of Sertoli cells to less than ten per culture. Under these conditions, flagella formed in secondary spermatocytes with very high efficiency. It is very likely that secondary spermatocytes form flagella in vivo, since the secondary spermatocytes were observed to have flagella immediately after dissociation of the testes.

Preparation and characterization of monoclonal antibodies against the human thrombin-antithrombin III complex

Monoclonal antibodies were raised against human thrombin-antithrombin III complex by a hybridoma technique. Among them, five monoclonal antibodies, designated as JITAT-4, -14, -16, -17 and -19, were found to react with thrombin-antithrombin III, but not with its nascent components, alpha-thrombin or antithrombin III. Their respective immunoglobulin classes are IgG1 for JITAT-16 and -19, and IgG2a for JITAT-4, -14 and -17. Besides the thrombin-antithrombin III complex, they all bound to the Factor Xa-antithrombin III complex and the active-site-cleaved two-chain antithrombin III as well. Moreover, the reactivity of these two antibodies to the neoantigens was not affected by heparin, suggesting that their epitopes are independent of heparin-induced conformational changes of antithrombin III. Two of them, JITAT-16 and -17, were categorized as high-affinity antibodies to thrombin-antithrombin III complex, the dissociation constants being 6.7 nM and 4.8 nM, respectively. However, they do not share antigenic determinants. These monoclonal antibodies may allow us to explore more precisely the reaction between antithrombin III and thrombin or its related enzymes.

Induction of a novel Ca2+-dependent protease in preneoplastic and neoplastic liver tissues during rat liver carcinogenesis

The activity of a novel Ca2+-dependent protease in preneoplastic and neoplastic tissues of male Fisher 344 rat liver was examined during experimental liver carcinogenesis. This protease activity is significantly high in hyperplastic nodules and hepatocellular carcinomas which were induced by the method of Solt and Farber. Taken together with our previous report on the promoter-specific induction of this protease, the results suggest the possible importance of this protease in the promotion stage of liver carcinogenesis.

[A case of inverted papilloma of the ureter with malignant findings]

A 70-year-old female with inverted papilloma of the ureter is presented. She was hospitalized because of asymptomatic macrohematuria. Excretory urography and retrograde pyelography demonstrated a filling defect with smooth contour at the mid-portion of the right ureter. Abdominal computer tomographic (CT) scan showed mass lesion (CT number 41) at the same portion as the filling defect. She was diagnosed as having an ureteral tumor and right nephroureterectomy was performed. The gross specimen contained a 24 X 12 mm, polypoid, pedunculated and smooth-surfaced tumor. Pathological diagnosis was inverted papilloma. However, microscopic examination revealed a malignant finding corresponding to transitional cell carcinoma grade 1. From the Japanese and foreign literature, 25 cases of ureteral inverted papilloma were collected and are reviewed. Clinical and pathological features are discussed.

The effect of reduced alcohol consumption on blood pressure: a randomised, controlled, single blind study

A randomised, controlled, single blind trial was conducted in office workers with mild hypertension (systolic blood pressure (SBP) 140 to 180 mmHg, diastolic blood pressure (DBP) 90 to 110 mmHg) to determine the effect of decreasing alcohol consumption. After a baseline examination, 50 male volunteers aged 30 to 59 were randomised to two groups. Group A were told to abstain from or reduce alcohol consumption for two weeks, while group B were instructed to maintain their usual alcohol consumption. Complete records were obtained on 49 subjects. The daily alcohol consumption of groups A and B at baseline was similar, i.e. 71.9 ml and 72.5 ml of ethanol, respectively, and changed to 16.1 ml and 62.9 ml, respectively, during the experiment. After two weeks, group A were asked to resume their normal consumption whilst group B were asked to reduce or abstain (phase II). However in view of a treatment period interaction, statistical analysis was confined to phase I. During phase I, group A, whose alcohol consumption had reduced, showed decreases of 5.8 and 7.1 mmHg in SBP during the the first and second weeks, respectively. In group B, these decreases were only 0.6 and 1.9 mmHg, respectively. The difference between the falls in SBP in groups A and B was significant (P = 0.005) as judged by analysis of variance. The DBP also decreased, but there was no significant difference between the decreases in the two groups. Changes in gamma-glutamyl-transpeptidase, a biochemical marker of alcohol consumption, from the initial values to the end of phase I were significantly different in groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

Localization and stoichiometry of hook-associated proteins within Salmonella typhimurium flagella

The localization of hook-associated proteins (HAP1, HAP2, and HAP3) in Salmonella typhimurium flagella was studied by using specific antibodies together with a second antibody conjugated with colloidal gold. HAP1 and HAP3 were localized at the hook-filament junction, as has been suggested previously. HAP2, however, was localized at the filament tip. This finding supports the idea that HAP2 acts to induce polymerization of endogenous flagellin at the filament tip, and HAP1 and HAP3 are junction proteins to connect hook with filament. Analysis of the protein composition of short flagella from a mutant indicated that a single flagellum contains about 10 to 20 HAP1, 10 to 20 HAP2, and 10 to 40 HAP3 molecules.