Usefulness of extracorporeal membrane oxygenation for treatment of fulminant myocarditis and circulatory collapse

Prognosis for fulminant myocarditis with cardiogenic shock refractory to conventional therapy is poor. This report describes mechanical circulatory support with extracorporeal membrane oxygenation as an effective alternative for treating fulminant myocarditis with circulatory collapse.

Prognosis of patients with resection of stage IV gastric cancer

We retrospectively analyzed 116 patients who underwent resection of stage IV gastric cancer to investigate the prognostic factors responsible for long-term survival. Statistically significant clinicopathological differences between patients surviving 3 years or more (n = 9) and those surviving less than 3 years (n = 107) were observed in regard to macroscopic type, curability of surgery, lymph node metastasis and blood vessel invasion. These four variables also had a statistically significant influence on survival by univariate analysis. Multivariate analysis revealed that no residual tumor (R0) surgery was a significantly beneficial factor for long-term survival. However, no patients with the diffusely infiltrative type of tumor survived for more than 2 years even if they underwent R0 surgery. Patients without the diffusely infiltrative type who underwent R0 surgery had better survival rates: a 27.3% and 13.6%, 3 and 5 year survival rate, respectively. In conclusion, R0 surgery contributes to long-term survival even in stage IV gastric cancer, and some patients with the not diffusely infiltrative type, in particular, may receive a survival benefit by R0 surgery.

Resection of both hepatic and pulmonary metastases in patients with colorectal carcinoma

BACKGROUND

More than 40% of patients who undergo curative resection of advanced colorectal carcinoma can be expected to have recurrence of the disease. The most frequent sites of recurrence are the liver (33% of patients) and lung (22%). Interest has therefore focused on treating hepatic or pulmonary metastases, or both, to improve the outcomes of these patients. Although surgical resection has become an increasingly accepted treatment for resectable localized hepatic or localized pulmonary metastases from colorectal carcinoma, the value of aggressive surgery for the removal of both hepatic and pulmonary metastases from patients with primary colorectal carcinoma remains to be clarified.

METHODS

Data on 30 patients who had undergone resection of both hepatic and pulmonary metastases from colorectal carcinoma were included in the study.

RESULTS

Independent, significant prognostic features were found to be the time that hepatic or pulmonary metastases occurred and the distribution of pulmonary metastases. Median survival times were 30 months (range, 7-108 months) after resection of both hepatic and pulmonary metastases and 48.5 months (range, 11-149 months) after excision of the primary colorectal tumor. Actuarial 1-, 3-, and 5-year survival after resection of both hepatic and pulmonary metastases was 86.7%, 49.3%, and 43.8%, respectively. No perioperative mortality occurred. There were three cases of minor morbidity, which the authors considered acceptable.

CONCLUSIONS

Resection of both hepatic and pulmonary metastases from colorectal carcinoma may help to prolong the survival of a small group of patients with these metastases.

Resection of both hepatic and pulmonary metastases in patients with colorectal carcinoma

BACKGROUND

More than 40% of patients who undergo curative resection of advanced colorectal carcinoma can be expected to have recurrence of the disease. The most frequent sites of recurrence are the liver (33% of patients) and lung (22%). Interest has therefore focused on treating hepatic or pulmonary metastases, or both, to improve the outcomes of these patients. Although surgical resection has become an increasingly accepted treatment for resectable localized hepatic or localized pulmonary metastases from colorectal carcinoma, the value of aggressive surgery for the removal of both hepatic and pulmonary metastases from patients with primary colorectal carcinoma remains to be clarified.

METHODS

Data on 30 patients who had undergone resection of both hepatic and pulmonary metastases from colorectal carcinoma were included in the study.

RESULTS

Independent, significant prognostic features were found to be the time that hepatic or pulmonary metastases occurred and the distribution of pulmonary metastases. Median survival times were 30 months (range, 7-108 months) after resection of both hepatic and pulmonary metastases and 48.5 months (range, 11-149 months) after excision of the primary colorectal tumor. Actuarial 1-, 3-, and 5-year survival after resection of both hepatic and pulmonary metastases was 86.7%, 49.3%, and 43.8%, respectively. No perioperative mortality occurred. There were three cases of minor morbidity, which the authors considered acceptable.

CONCLUSIONS

Resection of both hepatic and pulmonary metastases from colorectal carcinoma may help to prolong the survival of a small group of patients with these metastases.

Conflict among individual mitochondrial proteins in resolving the phylogeny of eutherian orders

The phylogenetic relationship among primates, ferungulates (artiodactyls + cetaceans + perissodactyls + carnivores), and rodents was examined using proteins encoded by the H strand of mtDNA, with marsupials and monotremes as the outgroup. Trees estimated from individual proteins were compared in detail with the tree estimated from all 12 proteins (either concatenated or summing up log-likelihood scores for each gene). Although the overall evidence strongly suggests ((primates, ferungulates), rodents), the ND1 data clearly support another tree, ((primates, rodents), ferungulates). To clarify whether this contradiction is due to (1) a stochastic (sampling) error; (2) minor model-based errors (e.g., ignoring site rate variability), or (3) convergent and parallel evolution (specifically between either primates and rodents or ferungulates and the outgroup), the ND1 genes from many additional species of primates, rodents, other eutherian orders, and the outgroup (marsupials + monotremes) were sequenced. The phylogenetic analyses were extensive and aimed to eliminate the following artifacts as possible causes of the aberrant result: base composition biases, unequal site substitution rates, or the cumulative effects of both. Neither more sophisticated evolutionary analyses nor the addition of species changed the previous conclusion. That is, the statistical support for grouping rodents and primates to the exclusion of all other taxa fluctuates upward or downward in quite a tight range centered near 95% confidence. These results and a site-by-site examination of the sequences clearly suggest that convergent or parallel evolution has occurred in ND1 between primates and rodents and/or between ferungulates and the outgroup. While the primate/rodent grouping is strange, ND1 also throws some interesting light on the relationships of some eutherian orders, marsupials, and montremes. In these parts of the tree, ND1 shows no apparent tendency for unexplained convergences.

[Concomitant cardiac and pulmonary operation, the profits of not using cardio-pulmonary bypass]

We performed off pump CABG (coronary artery bypass grafting) and right upper lobectomy with R2a lymph nodes dissection on the patient suffered from both lung cancer in the right S1 and stenotic lesion in the left anterior descending artery. Because the coronary lesion was long-segmented one, it was not suitable for percutaneous transluminal coronary angioplasty. To perform absolutely curative operation for the lung cancer, CABG was undergone simultaneously under off pump condition. It is generally feared that the cardiovascular surgery under CPB may have adverse effect for the patient with malignant lesion. Off pump CABG is expected to avoid such disadvantage of CPB, and thought to be suitable method for such a patient as we present above.

Vascular endothelial growth factor in angiosarcoma

Angiosarcoma(AS) is a malignant tumour of the endothelium of lymphatic or blood vessels. Vascular endothelial growth factor (VEGF), a specific mitogen of endothelial cells, is considered essential for the growth of many tumours including AS. We have recently treated several patients with AS; in two of them, using a newly developed enzyme-linked immunosorbent assay (ELISA) for VEGF, we sequentially measured serum VEGF concentrations. While serial serum VEGF levels reflected tumour burden, the various VEGF concentrations were within the normal range we reported previously. Furthermore, the VEGF concentrations were not remarkably elevated in AS tumour tissue compared with benign vascular lesions and hypervascular tumours.

Pharmacological profile of T-0201, a highly potent and orally active endothelin receptor antagonist

The authors studied the pharmacological properties of N-(6-(2-(5-bromopyrimidin-4-yl)-4-(2-hydroxy-1, 1-dimethylethyl)benzensulfonamide sodium salt sesquihydrate (T-0201), a new nonpeptide endothelin (ET) receptor antagonist, in vitro and in vivo. In binding studies, T-0201 competitively antagonized the specific binding of [125I]-ET-1 to human cloned ETA receptors (the Ki value was 0.015 +/- 0.004 nM). T-0201 weakly inhibited [125I]-ET-1-binding to human cloned ETB receptors; the Ki value was 41 +/- 21 nM. T-0201 shifted the concentration-response curve of ET-1-induced contraction of the isolated rat aorta (ETA receptors) to the right (pA2 = 9.0 +/- 0.2). In the isolated rat trachea, a selective ETB agonist sarafotoxin S6c-induced contraction was inhibited by T-0201 (pA2 = 6.8 +/- 0.3). T-0201 also caused the inhibition of ET-1-induced contraction of the isolated rabbit pulmonary artery (pA2 = 5.7 +/- 0.3). In anesthetized rats, T-0201 (0.01-1 mg/kg) inhibited the pressor response to exogenous big ET-1 (1 nmol/kg i.v.), after both i.v. and p.o. administration, in a dose-dependent manner. The significant inhibitory effect of orally administered T-0201 on big ET-1-induced pressor response lasted for 4 hr at 0.1 mg/kg and for 8 hr at 1 mg/kg. Thus the present study demonstrates that T-0201 is a highly potent, long-lasting, orally active and selective ETA receptor antagonist.

[Postoperative follow-up of acute aortic dissection and the result of second operations]

Between January 1990 and March 1998, surgical treatment was performed in 75 patients with acute aortic dissection at Omiya Medical Center. Seventy-three patients (97%) of them were classified type A aortic dissection. Thirteen of them died due to hemorrhage (5 cases), cardiac failure (3 cases), visceral ischemia (3 cases) and others (2 cases) after the operation. Hospital mortality rate was 17.3%. Sixty-two survivors were followed up to 8 years. During the follow up period, five patients died due to pneumonia, gastric cancer, cardiac failure, brain hemorrhage and unknown event. Five-year survival rate including hospital death was 77% evaluated by Kaplan-Meier method. Second operations for the enlargement of residual false lumen with the entry were performed in 4 patients (6.5%) of 62 survivors. Second operations were also performed in other 6 patients referred to us from other hospitals because of the enlargement of false lumen. Nine of them survived (90%) and returned to their daily life.

Cloning of hamster preproendothelin-1 cDNA and its expression in the heart

To elucidate the pathophysiologic roles of endothelin-1 (ET-1) in the heart, we first cloned and sequenced a part of hamster preproET-1 cDNA from the heart of the CHF146 hamsters. The amino acid sequence has 89% homology to that of rat preproET-1 in the cloned part. The deduced hamster 21-residue mature ET-1 is identical to human, rat, canine, and mouse ET-1. In the next step we investigated the expression of preproET-1 mRNA in the failing heart of CHF146 hamsters. For this purpose, we used 46-week-old CHF146 hamsters and age-matched control healthy hamsters. Left ventricular (LV) + dP/dtmax was significantly lower in CHF146 hamsters than in control hamsters. LV end-diastolic pressure was significantly higher in CHF146 hamsters than in control hamsters, as was central venous pressure. These results suggested that the CHF146 hamsters developed congestive heart failure. The expression of preproET-1 mRNA was greatly enhanced in the LV of the CHF146 hamsters. Because it has been reported that ET-1 induces cardiac hypertrophy and injury to cardiac myocytes in addition to its potent positive inotropic and chronotropic actions, the present findings suggest that endogenous ET-1 plays pathophysiologic roles in the failing heart of CHF146 hamsters.

A combination of preductal aortic coarctation and type B dissection: report of a case

We present herein the case of a 39-year-old man found to have significant coarctation of the preductal aorta combined with a type B dissection, associated with Marfan's syndrome. This extremely rare pathological combination could be defined preoperatively only by a three-dimensional computed tomography scan. By means of selective cerebral perfusion, the coarctation was resected, and the total aortic arch was replaced with a Dacron graft.

Alpha1-adrenoceptor subtypes and two receptor systems in vascular tissues

The subtypes of alpha1-adrenoceptor are coexpressed in many tissues. We examined the relationship between coexpressed alpha1-adrenoceptor subtypes and their functions in blood vessels. Rat and rabbit aortas coexpressed three subtypes (alpha1A, alpha1B, alpha1D) and four subtypes (alpha1A, alpha1B, alpha1D, alpha1L), respectively. In rat aorta however, noradrenaline-induced contraction was mediated predominantly through the alpha1D subtype, and oxymetazoline produced alpha1B-mediated contraction. In rabbit aorta, concentration-response curves for noradrenaline were composed of two components (alpha1B and alpha1L-mediated), while oxymetazoline produced alpha1L-mediated contraction. Therefore, the inhibitory actions of some antagonists varied markedly among tissues and agonists. These results demonstrate diversity of the two receptor systems and suggest that the heterogeneity of physiological responses reflects the differences in functional subtypes among tissues and in their sensitivities to agonists and antagonists.

Pharmacologic profile of TA-606, a novel angiotensin II-receptor antagonist in the rat

This study was carried out to characterize a novel angiotensin II-receptor antagonist, TA-606, (3-pentyloxy) carbonyloxymethyl-5-acetyl-2-n-propyl-3-[2'(1H-tetrazole-5-yl) biphenyl-4-yl]methyl-4,5,6,7-tetrahydro imidazo [4,5-c] pyridine-4-carboxylate hydrochloride, which is a newly synthesized prodrug of 606A. In anesthetized rats, 606A inhibited angiotensin II-induced pressor response with a median inhibitory concentration (IC50) of 6 microg/kg, i.v., and was 8 times more potent than EXP3174, an active metabolite of losartan. Bioavailability of TA-606 was 11 times higher than that of 606A in Sprague-Dawley rats, with consistent hypotensive potencies in spontaneously hypertensive rats (SHRs). In conscious renal hypertensive rats (RHRs) and conscious SHRs, TA-606 lowered the blood pressure without any effects on the heart rate, and its effective dose for 30 mm Hg (ED30) values were 0.14 and 0.21 mg/kg, p.o., respectively. The effect of TA-606 lasted > 10 h in both models. Moreover, the effect of TA-606 was approximately 30 and 10 times more potent than those of losartan in RHRs and SHRs, respectively. TA-606 did not affect the blood pressure in deoxycorticosterone acetate (DOCA)-salt hypertensive rats. TA-606 given for 12 weeks attenuated the development of hypertension in stroke-prone SHRs. These results indicate that TA-606 is a potent angiotensin II-receptor antagonist with antihypertensive efficacy. Thus TA-606 is suggested to be a possible useful agent in the treatment of hypertension.

Antithrombotic action of TA-993, a new 1,5-benzothiazepine derivative, in a canine model of femoral arterial thrombosis

TA-993 is a novel 1,5-benzothiazepine derivative of l-cis configuration, having a potent antiplatelet action and an increasing action on femoral blood flow. We evaluated the antithrombotic effect of TA-993 in a canine model of femoral arterial thrombosis. Thrombus was induced by both application of direct anodal current to the femoral artery and partial occlusion of the artery. The partial occlusion by placing an adjustable occluder on the artery and the current application were carried out 40 and 60 min after the intraduodenal administration of drugs, respectively. In control dogs, complete sustained occlusion of the femoral artery due to thrombus occurred 55.4 +/- 9.2 min after the onset of current application. TA-993 (3 and 10 mg/kg) dose-dependently prolonged the time for occlusion. Aspirin (30 mg/kg) also prolonged it. TA-993, 10 mg/kg, significantly inhibited whole-blood aggregation 60 min after the administration with a weaker potency than that of aspirin (30 mg/kg), whereas 3 mg/kg of TA-993 did not. The inhibitory effect of TA-993 (10 mg/kg) on platelet aggregation was maintained for >7 h. Moreover, TA-993 (10 mg/kg) increased femoral blood flow in spite of the partially occluded condition. These results indicate that TA-993 has an antithrombotic effect on femoral arterial thrombosis and suggest that an increasing action on femoral blood flow of TA-993 is more relevant than its antiplatelet action to the antithrombotic effect in this model.

[Detection of apolipoproteins E5 and E7 by a widely used commercial ApoE IFE kit--evidence provided by genotyping]

The purpose of this study is to examine a possibility to detect apolipoprotein (apo) E5 and E7 isoproteins with a commercial kit widely used (Phenotyping Apo E IFE System, Jokoh Co. LTD., Tokyo) and to clarify the frequency of the rare alleles in Central Japan. A total of 1,445 subjects living in Central Japan (1,030 hemodialysis patients and 415 apparently healthy individuals) was phenotyped for apo E isoproteins with the kit using isoelectric focusing with immunoblotting. In 23 subjects, unique apo E4 isoproteins, which migrate more basically than apo E4 isoprotein, were found. These unique isoproteins were proved to be apo E5 or E7 isoproteins by PCR with restriction fragment length polymorphism and with amplification refractory mutation systems, respectively. No significant differences in the frequencies of apo E5 or apo E7 alleles were observed between healthy individuals and hemodialysis patients (0.011 vs. 0.018, NS). The frequencies of apo E5 and E7 alleles were 0.001 and 0.005, respectively, in healthy individuals, and 0.003 and 0.005, respectively, in hemodialysis patients. These data in Central Japan were consistent with those in Western Japan (Matsunaga, et al, Clin Genet, 1995). These results indicate that the commercial kit is applicable to detect the rare alleles, apo E5 and E7 alleles and that the frequencies of the rare alleles in Central Japan are similar to those in Western Japan.

[Two surgical cases of right parasternal minimal incision for aortic valve replacement]

Although median sternotomy has been used as a good approach to all cardiac valves and coronary arteries, advantages of the minimal invasive cardiac operation have been reported recently. We employed the right parasternal minial incision, reported by Cosgrove et al. for two cases of aortic valve replacement. In the first case, we were able to get a good operation field and easily implanted a mechanical prosthesis. In contrast, we had some difficulties with the second case where in addition to the third and fourth cartilages, a second cartilage resection was necessary because the aortic root lay at a cephalic level. Moreover, the operation field was restricted because we left several rib cartilages to preserve the right internal thoracic artery. The cannula had to be inserted via the right atrium as we failed to insert it in the right femoral vein, and the aortic root deviated more medially than usual. From these experiences, it is important to check the position of aortic root, and if the cannula cannot be inserted in the femoral vein, cannulation via the right atrium can ve utilized in the minimal invasive cardiac operation.

Cardiovascular effect of a new 1,5-benzothiazepine derivative TA-993 in anesthetized dogs

TA-993 is a new 1,5-benzothiazepine derivative having l-cis configuration and shows a potent antiplatelet aggregating action. We studied its cardiovascular effect in anesthetized dogs by using diltiazem as a reference compound. TA-993 (> or = 10 microg/kg, i.v.) significantly increased blood flows of common carotid, brachial, and femoral arteries. The peak of its effect was observed approximately 60 min after the administration, and the peak level was maintained until > or = 300 min after the administration. TA-993 (100 microg/kg, i.v.) slightly increased cardiac output in the same manner. However, TA-993 did not cause any persistent effects on arterial pressure, LVdP/dtmax, or vertebral, coronary, superior mesenteric, and renal blood flows. TA-993 caused concentration-dependent vasorelaxation in the isolated canine femoral artery contracted with 40 mM K+, but its potency was approximately 1/20 that of diltiazem. The increasing action of TA-993 on femoral blood flow was completely inhibited by pretreatment with hexamethonium in anesthetized dogs. These results indicate that TA-993 has a selective increasing action on common carotid, brachial, and femoral blood flows and suggest that the action is mediated by the autonomic nervous system.

[Intraoperative assessment of the ascending aorta by echogram during the CABG operation for the prevention of cerebral infarction]

While coronary artery bypass grafting operations (CABG), we started to use the echogram to evaluate the ascending aorta intraoperatively from December 1993. During a period from January, 1990, to June, 1995, 379 patients were treated with CABG. Intraoperative echogram was used in 127 cases (group I) and 252 cases unused (group II). The sites of the aorta for evaluation were following: site of cannulation, aortic clamping, and proximal anastomosis respectively. Depending on the echographical findings the operative procedures were changed as required. The incidence of postoperative cerebral embolism in group I was 0.8% (one patient) and in group II, 2.4% (6 patients). Although no significant difference was found in the cohort, rate of incidence in the group II was high. There were 4 cases who had significant atheromatous lesions clearly evaluated by echogram, which were not detected by palpation. We conclude that the intraoperative assessment of the ascending aorta by echogram is beneficial in prevention of cerebral infarction.

Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy

BACKGROUND

The left ventricular end-systolic volume index (LVESVI) helps to predict postoperative left ventricular function in patients with ischemic cardiomyopathy.

METHODS

We retrospectively assessed the ability of preoperative variables to predict death and the development of postoperative congestive heart failure in 41 patients with a preoperative ejection fraction of less than 0.30.

RESULTS

A preoperative LVESVI of greater than 100 mL/m2 was identified as an independent predictor of death by Cox's proportional hazards model. Diabetes and a preoperative LVESVI of greater than 100 mL/m2 were independent predictive risk factors for the development of postoperative congestive heart failure. Postoperative congestive heart failure developed in 2 of the 23 patients (8.7%) who had a preoperative LVESVI of less than 100 mL/m2 and in 10 of the 16 patients (62.5%) who had a preoperative LVESVI of greater than 100 mL/m2. The actuarial survival rate during follow-up in patients who had a preoperative LVESVI of less than 100 mL/m2 was significantly greater than that in patients who had a preoperative LVESVI of greater than 100 mL/m2. The actuarial rate of freedom from congestive heart failure during the follow-up period also was greater in patients who had a preoperative LVESVI of less than 100 mL/m2.

CONCLUSIONS

Our results suggest that the preoperative LVESVI predicts the development of postoperative congestive heart failure and the actuarial survival rate in patients with ischemic cardiomyopathy.

Cystic dilatation of ventriculus terminalis in adults: MRI

We report the MRI findings in two patients with cystic dilatation of the ventriculus terminalis. The latter is usually a tiny ependyma-lined cavity of the conus medullaris. In both cases the markedly dilated ventriculus terminalis was seen as a rounded cavity with regular margins, the content of which gave the same signal as cerebrospinal fluid with all MR pulse sequences. No contrast enhancement was seen.

[HLA antigens are associated in seronegativity to cytomegalovirus(CMV)]

Cytomegalovirus(CMV) is ubiquitous in the world, but the rate of CMV antibody positivity (seropositivity) in adults varies geographically. In Japan, CMV seropositivity in adults in 90% and we perceived seronegative adults tend to remain seronegative in 10 years follow up study. We have performed HLA typing 125 seronegative healthy donors of 28 years and up (28-57, Ave.35), and the results were compared with those of healthy donors in same area and whole Japan (data from 10th HLA workshop). Incidence of HLA-A33 and HLA-Cw4 were significantly higher in seronegatives than control groups. This report suggests possible involvement of HLA type in CMV negativity.

Malignant schwannoma-derived cells support human skin mast cell survival in vitro

We have recently observed mast cell infiltration in malignant schwannoma (MS) arising in the patient with von Recklinghausen's disease. To determine the cell to cell interactions between human skin mast cell (HSMC) and MS cell, we investigated the HSMC survival and the morphological changes when cultured with MS-derived cells isolated from the patient. Partially purified HSMCs obtained from normal adult skin and cutaneous neurofibroma by enzymatic digestion were cocultured with MS-derived cells on the coverslips. The number of HSMCs stained with crystal violet were directly counted by light microscope. HSMCs cocultured with MS-derived cell feeder layer revealed significantly increased HSMC survival compared to that with normal human skin fibroblast layer at 1 and 2 weeks. Conditioned medium of cultured MS-derived cell did not influence HSMC survival. In the morphology HSMCs cultured with MS-derived cells demonstrated spindle form in close contact with the adjacent MS-derived cells, suggesting cell to cell interactions. We failed to detect stem cell factor (SCF) mRNA in cultured MS-derived cell by RT-PCR. These results suggest that MS-derived cell is capable of supporting HSMC survival in vitro. Some factor(s) other than SCF, which is associated with direct contact between HSMCs and MS-derived cells, might relate to these observations.

Acutely severe myocarditis successfully treated by percutaneous cardiopulmonary support applied by a newly developed heparin-binding oxygenator and circuits

The feasibility of using the heparin-bound percutaneous cardiopulmonary support system (PCPS) for prolonged extracorporeal circulation in patients with acute severe myocarditis is demonstrated. The case histories of 2 patients with cardiogenic shock caused by acute myocarditis are presented; both were successfully treated with long-term PCPS using a newly developed heparin-binding oxygenator and circuits without changing the oxygenator. The courses of both patients remain uneventful more than 12 months after discharge. We also discuss the clinical aspects of using heparin-bound PCPS in patients with acute severe myocarditis.

A new high-molecular-weight glycophorin C variant with a duplication of exon 2 in the glycophorin C gene

Glycophorin C (GPC) and glycophorin D (GPD) are closely related sialoglycoproteins in the human red blood cell (RBC) membrane. Both are thought to be encoded by the GPC gene (GYPC). We report here the new GPC variant, MAT, with a high-molecular-weight form of GPC and GPD. The murine monoclonal antibody to GPC (CBC-96), which had specificity for the N-terminal region of GPC, gave a stronger reactivity with the MAT RBCs than did normal RBCs in direct agglutination tests. Immunoblotting of the MAT RBC membranes with anti-GPC antibodies showed the apparent molecular weight of GPC.MAT and GPD.MAT was 5000 greater than that of their normal counterparts. cDNA was synthesized from total RNA obtained from three unrelated, heterozygous MAT blood donors and analysed by the polymerase chain reaction with primers that spanned sequences encoded by GYPC. Two fragments were generated: one was 510 bp, the other was 453 bp and corresponded to the normal GPC. Sequencing of the mutant 510-bp fragment showed an insert of 57 nucleotides that corresponds to the entire sequence of exon 2 in GYPC. These results show that MAT is the result of a duplication of exon 2 in GYPC, which probably encodes the two high-molecular weight forms GPC.MAT and GPD.MAT. The MAT mutation is found with a frequency of 0.02% in the Japanese population.

Quantification and distribution of alpha 1-adrenoceptor subtype mRNAs in human vas deferens: comparison with those of epididymal and pelvic portions

1. This study was intended to quantify the amounts of the alpha 1-adrenoceptor subtype mRNAs in human vas deferens, and demonstrate the receptor subtype responsible for the vas contraction. 2. The RNase protection assay showed that the mean total amount of alpha 1a mRNA was 7.4 +/- 2.2 pg/5 micrograms of poly (A)+ RNA (97.0% of the total alpha 1 mRNA) in the epididymal portion (E-vas) and 4.9 +/- 0.8 pg/5 micrograms of poly (A)+ RNA (96.3% of the total) in the pelvic portion (P-vas). The E-vas showed a tendency to have a greater alpha 1a mRNA abundance than the P-vas (P = 0.11). The alpha 1b and alpha 1d mRNAs were absent or of extremely low abundance. 3. By an in situ hybridization, the alpha 1a and alpha 1d mRNAs were recognized in the smooth muscle cells of the E-vas and the P-vas, and the distribution pattern the same in both tissue. The alpha 1b mRNA positive site was scarcely detectable in both vas portions. 4. In a functional study, l-phenylephrine produced concentration-dependent contraction in the E-vas (Emax = 2.24 +/- 0.70 g; pD2 = 5.32 +/- 0.09) and the P-vas (Emax = 2.46 +/- 0.46 g; pD2 = 5.07 +/- 0.12). KMD-3213, a novel alpha 1A-adrenoceptor-selective antagonist, caused parallel rightward shifts of the concentration-response curves for l-phenylephrine. Apparent pKB values were 9.90 +/- 0.16 for the E-vas and 9.71 +/- 0.17 for the P-vas. There was no significant difference in Emax, pD2 or pKB estimates between the two portions. 5. We have found that alpha 1a mRNA is predominant in the human vas deferens, and confirmed that contraction of this organ is mediated by the alpha 1A-adrenoceptor.

Protective effect of T-686, an inhibitor of plasminogen activator inhibitor-1 production, against the lethal effect of lipopolysaccharide in mice

We have examined the effects of an inhibitor of plasminogen activator inhibitor-1 (PAI-1) production, (3E,4E)-3-benzylidene-4-(3,4,5-trimethoxy-benzylidene)pyrrol idine-2,5-dione (T-686), on lipopolysaccharide (LPS)-induced death in mice. Oral administration of T-686 (10 and 100 mg/kg/day) for 8 days prior to the LPS injection (35 mg/kg, i.v.) protected mice from the lethal effect of LPS in a dose-dependent fashion. Moreover, treatment with 100 mg/kg T-686 attenuated the increase in plasma PAI-1 activity and the decrease in AT-III activity induced by LPS. We conclude that T-686 can reduce the mortality of mice induced by LPS, which seems to be partially correlated with both hypercoagulation and hypofibrinolysis.

An estimation of craniofacial growth in the untreated Class III female with anterior crossbite

The literature has little to say regarding the normal growth and development of untreated individuals with Class III malocclusion or anterior crossbite. In part, this paucity of information is because of the relatively low prevalence of these characteristics in European-American populations and the need, recognized by the lay public and health professionals, for treatment of these conditions. Given the absence of true longitudinal data, this study attempts to estimate the growth of the untreated individual with Class III malocclusion and anterior crossbite by evaluating large samples of untreated subjects at distinct developmental stages. Initially the morphologic characteristics of 2074 Japanese female patients who had anterior crossbite were evaluated cephalometrically before treatment. On the basis of the cephalometric analysis, all subjects who did not have a Class III molar relationship were excluded from further analysis, leaving a sample of 1376. The subjects then were classified into seven groups (120-256 subjects per group) according to Hellman's stages of dental development. Descriptive statistics for 28 measurements were calculated. The results of this study imply that the maxilla in Japanese females maintains a retruded relationship to the cranial base and does not become less retrusive with time. In contrast, the mandible is protrusive even in the late deciduous dentition and becomes more protrusive with time, making the discrepancy between the upper and lower jaws progressively more severe. Dental compensations in both arches become increasingly evident as development progresses, and the underlying skeletal and dentoalveolar imbalances also are reflected in the soft tissue profile.

Second primary carcinoma in the residual cervical esophagus after thoracic esophagectomy: report of five cases

BACKGROUND AND OBJECTIVES

Development of second primary carcinomas after thoracic esophagectomy has become of much concern, because recently the prognosis of thoracic esophageal carcinoma after esophagectomy with extended lymph node dissection has been improving. We report our experience of diagnosing and treatment second primary carcinomas arising in the remaining esophagus after thoracic esophagectomy.

METHODS

Among 253 patients who underwent esophagectomy for thoracic esophageal carcinoma more than 2 years previously, second primary esophageal carcinomas developed in five (2.0%), and these five patients were examined.

RESULTS

All second primary carcinomas were found by endoscopy, and were diagnosed as superficial carcinoma (Tis or T1) of the residual cervical esophagus. One patient underwent laser irradiation, another endoscopic mucosal resection, two had surgical mucosectomy, and one segmental resection of the esophagus. After the second treatment, three patients were disease free for 37-38 months, one died of recurrent disease of the first carcinoma 36 months later, and one died of distant metastases of the second carcinoma 8 months later. There have been no local recurrences after treatments for the second primaries.

CONCLUSIONS

A variety of low-trauma treatments were employed for the second carcinomas because they were found at an early stage. Endoscopic follow-up is proposed to detect second lesions at an early stage.

Uprighting the mandibular molars stimulates mandibular growth during treatment of class II malocclusion

We hypothesized that uprighting of the mandibular molars creates a counter-clockwise rotation of the mandible and stimulates mandibular forward growth during the treatment of a Class II malocclusion. This investigation used 33 longitudinal lateral cephalometric radiographs of Class II, Division 1 female patients. All cases were treated with non-extraction. Treatment was started in early adolescence with .018 slot edgewise Alexander appliances. High-pull head-gear and Class II elastics were used. Seventeen cases that showed more than 5 degrees of uprighting of the mandibular first molars were selected as the uprighted group. Cases that showed less than 5 degrees of uprighting of the mandibular first molars were selected as the non-uprighted group. There was a significant correlation coefficient between the uprighted degree of the mandibular first molars and the degree of clockwise rotation of the mandibular plane to FH.

[An emergent surgical case of acute massive pulmonary embolism supported by antithrombotic percutaneous cardiopulmonary support system]

We present an emergent surgical case of massive pulmonary embolism. A 57-year-old male patient was refereed to our medical center for progressive dyspnea. He was intubated because of severe hypoxia. Pulmonary arteriography revealed massive pulmonary embolism. In the catheter laboratory he fell in shock and the heart was arrested, antithrombotic percutaneous cardiopulmonary support (PCPS) was introduced immediately. Emergent thrombectomy was carried out consequently under moderate hypothermic complete cardiopulmonary bypass. Up to 30 x 20 x 10 mm in size fresh clots were removed. Antithrombotic PCPS and IABP were maintained for 168 hours postoperatively. There were no hemorrhagic complication during the support because low dose heparin was administered continuously to keep ACT around 150 sec. He discharged from the hospital two months later and alive in good health. In conclusion, antithrombotic PCPS is very useful to care massive pulmonary embolism with thrombectomy.

KMD-3213, a novel alpha1A-adrenoceptor antagonist, potently inhibits the functional alpha1-adrenoceptor in human prostate

KMD-3213, (-)-(R)-1-(3-hydroxypropyl)-5-[2-[[2-[2-(2,2,2-trifluoroethoxy)phe noxy]ethyl]amino]propyl]indoline-7-carboxamide, is a novel and selective alpha1A-adrenoceptor antagonist. The potency of this drug to antagonize functional alpha1-adrenoceptor-mediated contraction in human prostatic smooth muscle was evaluated and compared with that of other alpha1-adrenoceptor antagonists. KMD-3213 inhibited noradrenaline-induced contractions with an apparent pK(B) value of 9.45 +/- 0.039, indicating a potency similar to that of tamsulosin. The affinity of prazosin for prostatic alpha1-adrenoceptors is given as potency for the alpha1L-adrenoceptor with an estimated pA2 value of 8.84 +/- 0.044. The data obtained in this study suggest that KMD-3213, an alpha1A-adrenoceptor-selective antagonist, has strong affinity for the alpha1L-adrenoceptor in the human prostate.

Synthesis biological evaluation of alkyl, alkoxy, alkylthio, or amino-substituted 2,3-dihydro-1,5-benzothiazepin-4(5H)-ones

2,3-Dihydro-1,5-benzothiazepin-4(5H)-ones substituted with an alkyl, alkoxy, alkylthio, hydroxy, or amino group on the fused benzene ring of the 1,5-benzothiazepine skeleton were synthesized and their vasodilating, antihypertensive, and platelet aggregation-inhibitory activities were investigated. (-)-cis-3-Acetoxy-5-[2-(di-methylamino) ethyl]-2,3-dihydro-8-methyl-2-(4-methylphenyl)-1,5-benzothiazepin- 4(5H)-one ((-)-13e) was selected for further studies as a potent inhibitor of platelet aggregation.

Sclerosing sweat duct carcinoma in the peri-anal skin: a case report

We report a case of sclerosing sweat duct carcinoma, a rare tumor, occurring in the peri-anal skin, a rare position. The patient, a 41-year-old Japanese woman, was admitted to our hospital with recurrence of sclerosing sweat duct carcinoma in the peri-anal skin, which had been initially resected at a local hospital. She underwent abdomino-perineal resection. No lymph node metastases or distant metastases were found. Although we allowed a 2-cm resection margin around the tumor, microscopy showed that the tumor had extended to within 2 mm of this margin at several sites, indicating that sclerosing sweat duct carcinoma is locally aggressive. An ample resection margin should therefore be taken at initial surgery for this type of tumor. Moreover, surgical excision that is wider and deeper than primary excision is required when this tumor recurs.

A new strategy for management of retroperitoneal tumors with supradiaphragmatic vena caval thrombi

A new surgical technique to treat retroperitoneal tumors with supradiaphragmatic vena caval invasion is described. In this technique, hepatic warm ischemia can be avoided with reversed hepatic outflow through the portal vein and neither hypothermic circulatory arrest nor cardiopulmonary bypass is necessary using centrifugal blood pump-driven bypass.

Characterization of dnaA gene expression in Mycoplasma capricolum

Expression of the dnaA gene in Mycoplasma capricolum was studied. The transcriptional start site was located 10 bp upstream from the putative translational initiation codon. Immunoblotting analysis revealed that DnaA protein was expressed at the levels significantly larger than those in Escherichia coli, and was localized mainly in the membrane. The transcriptional level of dnaA gene was reduced by inhibition of DNA synthesis with methyl methanesulfonate or mitomycin C, while the level of DnaA protein did not change. Reduction of protein synthesis did not significantly affect the total amount of DnaA protein, suggesting that the rates of synthesis and degradation of the protein are slow. These observations showed that the expression pattern of dnaA gene in M. capricolum is different from those of walled bacteria in some aspects.

A spontaneous testicular teratoma in an ICR mouse

A spontaneous teratoma was detected in the left testis of a 7-wk-old male ICR (Crj:CD-1) mouse. The tumor was composed of a variety of well-differentiated tissue elements from all 3 germ layers including neuronal tissue and stratified epithelium as ectoderm-derived tissues, bone, cartilage, striated muscle, and adipose tissue as mesodermal tissues, and respiratory columnar epithelium as endoderm-originated tissue. No tumor metastasis was detected. It may be of congenital origin as in strain 129 mice. To the best of our knowledge, this is the first report concerning spontaneous testicular teratoma in a strain ICR mouse.

Structural determination of monosialyl trisaccharides obtained from caprine colostrum

Acidic oligosaccharides were separated by dialysis, ion-exchange, preparative paper and gel chromatography from caprine colostrum. Four sialyl trisaccharides were characterized by 1H-NMR spectrometry as follows: alpha-N-acetylneuraminyl-(2,6)-beta-D-galactopyranosyl-(1,4)-2-N-acetami do-2 -deoxy-D-glucopyranose (Neu5Ac alpha 2-6Gal beta 1-4GlcNAc), alpha-N-acetylneuraminyl-(2,3)-beta-D-galactopyranosyl-(1,4)-D-glucopyra nose (Neu5Ac alpha 2-3Gal beta-1-4Glc), alpha-N-acetylneuraminyl-(2,6)-beta-D-galactopyranosyl-(1,4)-D-glucopyra nose (Neu5Ac alpha 2-6Gal beta 1-4Glc) and alpha-N-glycolylneuraminyl-(2,6)-beta-D-galactopyranosyl-(1,4)-D -glucopyranose (Neu5Gc alpha 2-6Gal beta 1-4Glc).

Changes in contrast enhancement of hepatocellular carcinoma and liver: effect of temporary occlusion of a hepatic vein evaluated with spiral CT

PURPOSE

To assess the hemodynamics of the liver and of hepatocellular carcinomas (HCCs) with hepatic vein occlusion.

MATERIALS AND METHODS

Selected hepatic veins were temporarily occluded with a balloon catheter in 21 patients with 28 nontreated nodular HCCs. Computed tomographic (CT) arteriography was performed without and with temporary occlusion of a hepatic vein that drained the blood from segmental liver parenchyma containing tumor by using a unified spiral CT and angiography system. The degree of enhancement and change in appearance of the HCC in each condition were compared.

RESULTS

All HCCs were well-enhanced, almost round masses at CT arteriography. At CT arteriography with hepatic vein occlusion, however, HCCs were changed as follows: (a) the absolute attenuation of the HCC was decreased in 27 (96%) of 28 tumors compared with that at CT arteriography without hepatic vein occlusion, while attenuation of the surrounding liver parenchyma was increased; (b) the size of the highly enhanced area in HCC became smaller in 17 (61%) tumors (of these, two disappeared); and (c) the shape was changed in 12 (43%) tumors.

CONCLUSION

Hepatic vein occlusion resulted in reciprocal hemodynamic changes in the liver parenchyma relative to HCCs: Enhancement of the liver increases and that of HCCs decreases.

Identification of 2'-fucosyllactose in milk of the crabeater seal (Lobodon carcinophagus)

1. An oligosaccharide was isolated from extracts of crabeater seal milk by preparative paper chromatography. 2. The saccharide was identified as Fuc alpha 1-2Ga1 beta 1-4G1c by 1H-NMR spectroscopy. 3. This work represents the first identification of an oligosaccharide, other than lactose, in the milk of a pinniped.

The pharmacologic profile of 606A, a novel angiotensin II receptor antagonist

The pharmacologic profile of a novel angiotensin I (AT1) receptor antagonist 606A was studied in various in vitro and in vivo preparations. The 606A showed a high affinity at AT1 receptors [inhibition constant (Ki), 12.8 +/- 0.4 nM] in rabbit adrenal cortical membrane and a low affinity to AT2 receptors (Ki, > 1 mM) in bovine cerebellar membrane, indicating potent and selective AT1 properties. In the guinea pig aorta, 606A reduced the maximal angiotensin II-induced contraction (pD'2, 9.06 +/- 0.04), whereas EXP3174 showed suppression of the maximum response and a shift to the right of the concentration-response curve at lower and higher concentrations, respectively (conventionally calculated pd'2, 8.61 +/- 0.23). The 606A had no effects on KC1-, norepinephrine-, serotonin-, and endothelin-1-induced contractions or any agonist activities. In anesthetized dogs, 606A inhibited the angiotensin II-induced pressor response 35 times more potently than losartan. In renal hypertensive rats and spontaneously hypertensive rats (SHRs), 606A decreased systolic blood pressure 10 and 3 times more potently than losartan, respectively, without any chronotropic effects. By repeated administration of 606A to SHRs for 2 weeks, an augmentation of the hypotensive effect was observed No rebound phenomena occurred after discontinuation. These results indicate the 606A is a potent AT1-selective insurmountable angiotensin II receptor antagonist having more potent angiotensin II receptor antagonistic and hypotensive effects than losartan in in vivo models. 606A is suggested to be a useful agent for the treatment of patients with hypertension.

Cloning, functional expression and tissue distribution of rabbit alpha1a-adrenoceptor

A cDNA clone, which has an open reading frame of 1398 nucleotides encoding a 466-amino-acid peptide, has been isolated from rabbit liver cDNA library. Compared with the peptide sequence, it shows high homology to alpha1a adrenoceptors of human, bovine and rat. We expressed this clone in COS-7 and investigated the pharmacological properties, revealing similarity to those of human alpha1a adrenoceptors. Competitive RT/PCR has detected the mRNA in variety of rabbit tissues, especially abundantly in liver, vas deferens, brain, and aorta, but not in heart.

Immunocytochemical characterization of malignant schwannoma-derived cells in culture

We recently demonstrated that cultured malignant schwannoma (MS)-derived cells can support human skin mast cell (HSMC) survival in vitro. Cultured HSMCs were spindleshaped in close contract with MS-derived cells, suggesting cell to cell interaction. To elucidate the mechanism of the enhanced HSMC survival in coculture with MS-derived cells and the cellular interactions between HSMC and MS-derived cells, we examined the immunocytochemical characteristics of MS-derived cells using immunofluorescence. Morphologically, cultured MS-derived cells were polygonal with abundant cytoplasm and resembled perineurial cells. The cultured cells immunoreacted positively with vimentin, fibronectin, laminin and collagen IV, but negatively with anti-S100 protein, anti-neuron specific enolase, and anti-neurofilament (68 kd, 145 kd, 200 kd) antibodies. MS-derived cells were distinct from Schwann cells in their lack of S100 protein and also distinguishable from endoneurial fibroblasts that produce fibronectin, but never expressed laminin or collagen IV. MS-derived cells thus possess the characteristics of perineurial cells in their general morphology and their immunocytochemical properties. Immunoreactivity for substance P (SP) and neurokinin A (NKA) was found in the cytoplasm of these cells, particularly around the nuclei. Vasoactive intestinal peptide, somatostatin, and calcitonin gene related peptide were negative. From these findings, we characterized the MS-derived cell's in vitro properties and concluded that it is similar to a perineurial cell. The extracellular matrix protein, laminin, and fibronectin expressed in the MS-derived cell might contribute to HSMC survival and morphology through cell to matrix adhesion. Neuropeptides such as SP and NKA, expressed in the MS-derived cell, might play some role in enhanced HSMC survival in vitro.

Protective effect of l-cis-diltiazem on hypercontracture of rat myocytes induced by veratridine

The protective effect of l-cis-diltiazem, the stereoisomer of d-cis-diltiazem, was studied against the veratridine-induced hypercontracture of rat myocytes. Veratridine increased both [Na+]i and [Ca2+]i, but did not cause hypercontracture in the absence of extracellular Ca2+. Both l-cis-diltiazem (0.1-10 microM) and d-cis-diltiazem (10-30 microM) inhibited the hypercontracture and the increase in [Ca2+]i in a concentration-dependent manner. However, l-cis-diltiazem did not exert a negative inotropic effect in K+ (20 mM)-depolarized rat papillary muscles even at a dose of 10 microM. As seen in the case of tetrodotoxin, l-cis-diltiazem and d-cis-diltiazem also suppressed the increase in [Na+]i. The results show that l-cis-diltiazem prevents the veratridine-induced hypercontracture of myocytes by suppression of the [Ca2+]i increase. The attenuation of the [Ca2+]i increase by l-cis-diltiazem was not dependent on inhibition of Ca2+ channels, but was partly due to inhibition of excessive Na+ entry via veratridine-modified Na+ channels.

Effect of KMD-3213, an alpha 1a-adrenoceptor-selective antagonist, on the contractions of rabbit prostate and rabbit and rat aorta

KMD-3213, (-)-(R)-1-(3-hydroxypropyl)-5-[2-[[2-[2-(2,2,2-trifluoroethoxy) phenoxy]ethyl]amino]propyl]indoline-7-carboxamide, a newly synthesized alpha 1-adrenoceptor antagonist, has been shown to have potent action toward, and to be selective for human cloned and native alpha 1-adrenoceptors. In the present study, we characterized the inhibitory effect of KMD-3213 on the phenylephrine (alpha 1-adrenoceptor-selective agonist)-induced contraction of rabbit prostate, rabbit thoracic aorta and rat thoracic aorta to functionally confirm the tissue selectivity of KMD-3213. The mean pA2 value for KMD-3213 for the inhibition of the rabbit prostatic contraction was 10.05, whereas the values for the rabbit and rat aortic contractions were 9.36 and 8.13, respectively. The order of mean pA2 values for the inhibition of the rabbit prostatic contraction was KMD-3213 > or = tamsulosin >> prazosin, whereas that for the rabbit and rat aortic contractions was tamsulosin > KMD-3213 > prazosin and tamsulosin > or = prazosin >> KMD-3213, respectively. KMD-3213 produced a sigmoidal inhibition curve for single-dose phenylephrine-induced contractions of rabbit prostate, whereas it produced a non-sigmoidal curve for that of rabbit aorta. KMD-3213 had no effect on isoproterenol-induced chronotropic action in guinea-pig atria, and 5-hydroxytryptamine-, histamine- and acetylcholine-mediated contractions of rabbit aorta. These results indicate that the potency of the inhibitory activity of KMD-3213 depends on the tissue subtype expression and that KMD-3213 preferentially antagonizes prostatic contraction.